This is one in a series of blogs, Start From Within, where we’re tackling some of the ‘soft skills’ elements of being a doctor, ones that you didn’t learn in medical school: healthcare inequity, the elements of professionalism as a doctor, what to do when patients have a bias, etc.
Our mission is to make learning medicine easier. But we know it’s not just how you learn medicine—the way you apply your knowledge in clinical settings is immensely important, too. This blog series is meant to help you navigate the patient situations you face daily and improve your patient care.
Creating Your Trans-Friendly Practice
Endocrinologists aren’t the only doctors seeing transgender people. A 2016 study estimated that in the U.S. 0.6% of adults, or 1.4 million individuals, identify as transgender. And 33% of trans people surveyed had at least one experience of discrimination when seeking medical treatment.
It’s important for you AND your medical staff to understand how to address the transgender community to take strides in providing equitable healthcare to transgender people.
Most Family and Internal Medicine doctors in the U.S. are absolutely willing to provide routine care to transgender patients, but often there’s a lack of exposure to transgender patients, so there’s a lack of familiarity with transgender transition care guidelines, lack of training in transgender-specific care, and an overall lack of confidence in the ‘soft skills’ surrounding caring for transgender people—suggesting that willingness is there, but competence isn’t matched.
Doctors are willing to provide care to transgender patients but can be inexperienced.
Make Your Practice A Safe Space From First Point of Contact
Your practice should be a safe place for everyone from their first point of contact. Make sure you never assume you know someone’s gender just by looking at their physical characteristics. Conforming to the gender they identify with can be incredibly important to a trans person, and when you misgender—refer to them with a pronoun or form of address that does not correctly reflect the gender with which they identify—there’s a negative impact on their self-confidence and overall mental health.
Ask what name they prefer to be called. Many trans-friendly offices have a space for the patient’s preferred name and pronoun on their new patient registrations forms. Your office can also add an additional form for this purpose if adjusting your existing forms is too cumbersome. You can also try introducing yourself to someone who has self-identified as transgender in a way that implies that your practice will be an open and safe space: “Hi, I’m Dr. Johnson. I use he/him pronouns for myself. Nice to meet you.”
Use Their Preferred Name and Pronoun
Everyone has a name they prefer to be called. Many transgender patients have a name they identify with that is different from the name that was assigned to them at birth. Use their preferred name and pronoun during every interaction.
Make sure their preferred name is listed in their EHR too. While they might like a gender-specific pronoun like he/him or she/her, some of your patients might prefer a gender-neutral pronoun, like they/them. And don’t put quotations around the preferred name!
Using The Word ‘Transgender’ in Conversation
Make sure when you use the word transgender, you’re only using it as an adjective. So, “Liz is a transgender person,” not “Liz is a transgender.”
Make Sure Your Patient Is Comfortable During Physical Exams
Transgender patients might be uncomfortable, or even frightened, in a physical exam. Make sure you move slowly and clearly explain what details while the exam is occurring. Respect the patient’s language about their own body parts.
Don’t Discuss Their Status
Make sure you and your staff respect and protect your patient’s privacy. Don’t assume that partners, employers, or family members are aware of their gender identity.
Understand Their Hormone Management Plan
An important aspect of many transgender patients’ healthcare plan is hormone management. Ask about their hormone use when it could affect another treatment. Internists and Family Medicine doctors will likely monitor hormones or continue a hormone prescription that an Endocrinologist started.
Provide Strong Primary Care for Transgender Patients
While transgender patients can have some very specific health needs, they still have the same primary care needs that non-trans patients do. Manage those the same you would for any other patient to provide the highest quality, patient-centered care possible. For management of gender dysphoria, see our Core.
It takes empathy to ensure that your patients are all treated equitably and that your practice is trans-friendly.
Do you have any tips for ensuring your practice is trans-friendly? Tweet your tips.