Ensuring high quality health care for transgender patients

A PHS 795 student draws our attention to the issue of providing high quality, accessible and respectful care to transgender patients. They write:

The article “Living as a Man, Fighting Breast Cancer: How Transpeople Face Care Gaps” reminds us how the healthcare system can deter transpeople from seeking care.

Often, trans men avoid annual screens such as pap smears because of the fear of a humiliating office visit or the chance of talking to a provider who fails to recognize their trans identity. The article also states that many transmen don’t know that they are at risk for breast cancer after having top surgery.

Hruschka points out how that culture itself can be a reason for disparities and poor health outcomes. Many of our cultural norms are centered on gender roles.   The medical community often reinforces the notion that gender is fixed, essential, and biologically derived.  I ask myself how can we begin to provide more inclusive, quality care, and an overall safe space to trans people.

 4 Living as a Man, Fighting Breast Cancer: How Trans People Face Care Gaps

www.nytimes.com

Though awareness of the nation’s transgender population has grown, medical networks are still scrambling to catch up with that group’s highly specialized needs.

Healthcare.gov has some useful information for transgender persons seeking to purchase healthcare coverage on the affordable care act exchanges https://www.healthcare.gov/transgender-health-care/ . The Human Rights Campaign also has a good summary of information available on patient services and support for transgender persons: http://www.hrc.org/resources/transgender-patient-services-support-resources-for-providers-and-hospital-a

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6 thoughts on “Ensuring high quality health care for transgender patients

  1. I thought this article was great. Unfortunately, this is an issue that not everyone, including myself, thinks about everyday so this was a great reminder for myself and for others.

    The comment in the article that Mr. Oberman’s visits with doctors were usually fine, but other healthcare workers have given him problems. First of all, this shows the need for more education/training for workers in a healthcare setting, regardless of if they are providing care or not. There should be a no-tolerance policy for anyone who cannot be respectful of each and every patient. Secondly, this shows a strong need for standard workflows and care models. Regardless of the clinic, any patient should have the same experience, regardless of their sexual identity or orientation.

    Healthcare systems need to make it easier and more accessible for patients to make complaints if they experience anything that makes them feel unwelcome or uncomfortable. Mr. Oberman said he didn’t report his unpleasant experience(s) because he was already dealing with treating his cancer. We need to make it so that the reason they are in the clinic does not prevent them for reporting bad experiences.

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  2. Excellent article! I appreciated that it indicated that even how you structure your waiting room can deter transgender patients from receiving the care they need. Visiting a breast cancer surgeon or gynecologist can “out” a transgender patient, which is a highly personal decision, and naturally many people don’t want to potentially elicit scorn or controversy when they are dealing with a serious health issue. I’ve realized that even though the DSM IV classified gender dysphoria as a medical issue to provide a medical indication for sexual reassignment surgery for only the patients that desire it, it has in effect medicalized being transgender and created confusion- I have heard people say that being transgender is a mental disorder and that everyone that is transgender wants SRS, which isn’t the case at all. I am curious after reading this article how physicians counsel their patients about hormone replacement therapy, and how to have a conversation about weighing identity and mental and social well being versus potential long term health risks. This article touches on how physician assumptions can affect the health of transgender patients beyond the process of sexual reassignment directly, and I think more of this needs to be done.

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  3. I also thought this was a very good article and a very important topic in the public health field. I agree that situations like this and other situations involving minority populations accessing medical care would greatly benefit from a standardized work flow. It would mean that providers would be less likely to skip steps or questions they would ask of the majority group, but not ask someone from a minority group based on the assumptions they make about the patient. It also demonstrates a need for improved education among medical professionals at all levels. Just because doctors are starting to make changes it does not mean that the rest of the staff at clinics and hospitals are getting the message. I feel that continuing education on this and similar topics could be incorporated into a standardized work flow.

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  4. I agree with the other students on many of these thoughts. As a no- trans individual, and being a straight woman, I also do not have these thoughts everyday or often ever. I think that there needs to be better training or protocols set into place specifically within the heath care field. What is surprising to me is that more healthcare workers are not educated in this field, however, because gender reassignment surgery / trans affiliation (non surgery) is something that has become more common in the recent years, it is understandable as to why these workers might lack knowledge. However, this does not excuse for rude or uncanny remarks of patients. I think that all healthcare workers should undergo training specifically for transgender individuals so ensure that these individuals feel more comfortable and safe going to the doctor. We saw this in previous decades with gay men, and how many were not honest with their doctors about their sexual orientation because they were worried about how healthcare workers would perceive them. I think that there could be more detailed patient forms that could ask the patient what their current sex is and if it is their biological sex, etc. This way when the patient is seeing the nurse, PA or physician, they will all be aware and can help the patient with their particular needs. This will still not help or de stigmatize the way that people think, but it is a way to start. I really enjoyed this article because it is something that I have seen more and more recently in pop culture but have not heard about how it can relate to public health. I liked how the article said that some transgender men still have their ovaries and breasts and vice versa for transgender males. Overall, this topic is very interesting and I hope that there will be a change in the education in regards to healthcare workers for transgender individuals.

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  5. I enjoyed the article, and it did well talking about how incredibly complex the issue is for everyone involved. I’ve read before about trans individuals not wanting to identify their biological sex at medical appointments because it makes them uncomfortable – partly not wanting to risk transphobia from the doctors, and partly wanting to put their old assigned identity behind them completely. There’s also the sheer number of medical personnel one deals with upon a cancer diagnosis; if you have to see 20 different professionals (ranging from receptionists to surgeons), it’s unlikely you’ll be lucky enough to have all of them be trained.

    I was reminded of a case of a cisgender man who got breast cancer and struggled with getting his insurace to pay for it, because it was only covered for women by that company. It makes me wonder if this ever becomes an issue as well – if transgender people have their official sex changed on their information at their insurance company, does this put another barrier to accessing healthcare related to their primary and secondary sexual characteristics?

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  6. In agreement with most of those who commented, this is a very important, and unfortunately under-represented, issue that needs to be addressed as a mainstream topic. While there is still significant progress to be made, one thing I think the medical profession is doing well to begin addressing this issue is the requirements that are now being asked of medical students and those entering the medical field. There has been a shift by many medical schools from a focus on a science heavy background to the desire and requirement of applicants to have a more well-rounded background, including more prerequisites from the social sciences field. Many schools- including UW- are requiring prerequisite courses such as psychology, as well as promoting dual degrees such as MD/MPH, which require coursework focused on addressing SES disparities. I believe this is a great start to promoting education that will hopefully help our incoming health professionals address issues related to gender identify and promote better access to healthcare for individuals across the spectrum.

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