Researchers at the UCLA William’s Institute conducted a study revealing that an estimated .6%, or 1.4 million, adult Americans identify as transgender. While practices are becoming more LGBT-friendly, there’s still a transgender gap in healthcare. Whether you agree or disagree with the concept of identifying with the gender that does not correspond with birth sex, it’s a relevant topic in today’s society. Working with transgender patients was not part of the curriculum when many of today’s older physicians were training and in medical school.
Transgender patients have also faced discrimination in health care settings. In 2015, the hashtag #transhealthfail started trending on Twitter and still continues today. Transgender patients use this hashtag to share their negative experiences with the system. It’s important that physicians, in particular veteran physicians, take the time to understand how to treat and care for transgender patients.
The Transgender Gap in Healthcare
The Learning Gap
Between May 2009 and March 2010, researchers surveyed over 100 medical schools in the United States and Canada. The results suggested that on average, less than 5 hours are devoted to LGBT health overall. Some schools also reported zero hours of training for treating LGBT patients.
Slowly but surely, the education system is changing to fill this transgender gap in healthcare. In November 2014, the Association of American Medical Colleges released its first medical education guidelines for LGBT health. The University of Louisville School of Medicine also integrated a new model of physician training, called the “eQuality Project.” This program is not an additional training module, but instead, it is integrated throughout the entire curriculum.
Dr. Amy Holthouser is the associate dean for medical education at Louisville. She explained that many schools do make the effort to educate students on LGBT health, but focus only on STDs and HIV. This can further stigmatize these patients, so Dr. Holthouser wanted to be sure that students are educated to provide all aspects of care.
Ignorance in Treatment
While there are certainly instances of blatant discrimination in healthcare settings, there are also events that are caused just by pure ignorance. The transgender gap in healthcare continues into the doctor’s office and in emergency medical situations. Since over 70% of the transgender population has experienced discrimination in medical facilities, many avoid seeking healthcare or disclosing their transgender status to a physician.
So if your patient doesn’t tell you, how are you supposed to know? Well, that’s the tough part. Unless there are medical records that indicate transitioning, hormonal supplements, or any other sign, you really don’t know. This issue is especially prevalent in the emergency room.
Transgender people are less likely to have health insurance and are more likely to live in poverty, so the emergency room is where they go for medical assistance. Fast, awkward, and stressful interactions are pretty normal here, but one physician began to notice the transgender gap in healthcare through interactions in the ER. Sometimes, the patient’s medical history isn’t readily available at the first interaction. Other times, the patient is registered as the wrong gender, to begin with. And if the ER is busy, it’s unlikely that you’ll get a private room and likely that the transgender patient will be wrongly clustered by gender. These situations usually don’t arise from the intention to discriminate but from ignorance, unawareness, and inexperience.
Closing the Gap
Training and education on treating transgender patients are not mandatory, but schools are starting to see the importance. Dr. Holthouser predicts that schools will catch up once specific questions pertaining to LGBT health are featured on board exams. Young medical students may have the chance to participate in this curriculum before practicing, but what about older generations? There are many tips and resources to help provide better care to transgender patients.
- Learning Modules from the National LGBT Health Education Center
- Online resources at the University of California-San Francisco
- The World Professional Association for Transgender Health
- Speak to transgender patients as you would any other patient
- Remember to use the correct name and pronoun that corresponds with gender identity
- Ask politely for clarification and that you are trying to be respectful (“How would you like to be addressed?”)
- Don’t make assumptions
- Ensure confidentiality