Q&A: How PCPs can improve care for their transgender patients
Key takeaways:
- Transgender patients report being asked questions that seem irrelevant, stigmatizing or voyeuristic.
- Many also described experiences getting worse when clinicians found out they were transgender.
In medical settings, transgender patients often must decide between facing the risks associated with transphobia and those associated with clinicians not having all possibly relevant information, according to an expert.
“Transgender people experience mistreatment in health care encounters that can include harassment, assault and denial of care,” Ash B. Alpert, MD, MFA, lead study author and an instructor of medicine at the Yale School of Medicine division of hematology, and colleagues wrote in Annals of Family Medicine. “The specific experiences of transgender people when clinicians learn they are transgender and the impact of these experiences on patients’ information sharing remain largely unexplored.”
Alpert and colleagues conducted a qualitative study to evaluate the experiences 30 transgender adults in North America had when sharing their health information in clinical encounters.
Healio spoke with Alpert to learn more about the study, what primary care physicians should know about transgender patients’ experiences in health care and more.
Healio: Why did you decide to research this subject? Will you discuss the importance of equitable care?
Alpert: We were interested in this topic for a number of reasons. There is a national push to collect sexual orientation and gender identity data in order to better understand the health of lesbian, gay, bisexual, transgender, queer and other nonheterosexual, noncisgender people. Given other research of mine, I was concerned that providing gender identity information may not always be safe for transgender people. We were in the midst of a separate study regarding the experiences of transgender people reviewing their medical records, and one participant directly asked me and a coinvestigator if she had to tell doctors that she was on estrogen. Many participants in our study described negative experiences when clinicians learned they were transgender. Participants also talked about the questions they had about what information to share or not with clinicians. Thus, we decided to undertake this study to better understand these experiences and concerns.
Healio: What were your findings and their clinical implications? What is primary care like for transgender patients?
Alpert: We found that transgender people are often asked questions that seem voyeuristic, stigmatizing or irrelevant. We also noted that many participants described care experiences getting worse instead of better when clinicians found out they were transgender. For example, one Black trans woman in her 20s in our study noted that a clinician started using the wrong pronouns for her after he found out she was transgender. She said, "It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ And as accidental or whatever it was, it was after. Before that, it was ‘she.’"
We also noticed that transgender people are often in the difficult situation of choosing between transphobia (if they come out or mention being on hormones or having had surgeries) and suboptimal care (if they do not). For example, one white, nonbinary participant in their 30s said, “I’ve talked to a number of trans people who ... want to make [themselves] less controversial ... so that ... [they] can get what [they] need. In a lot of areas, you do know better what you need than honestly the provider. But in some cases, you may not. ... I think that’s a danger. ... You might not get the care that you need ... [or] you incur violence as a trans person for having [documentation about being transgender] on your record, truthfully.”
Healio: What is the take-home message for primary care physicians?
Alpert: Many transgender people experience harm in clinical settings across the country when their identities and experiences are known to clinicians. Transgender people are thus often put in the difficult position of choosing between the risks associated with transphobia — including misgendering, harassment, assault and subpar care — and the risks associated with clinicians not having potentially relevant medical information.
Healio: What can PCPs do to ensure their transgender patients have a better time in their clinics?
Alpert: Only ask questions that are directly relevant to the care that is being provided, explaining how questions are relevant and how the answers will be used to improve care. Ask transgender people about other care experiences and intervene if other clinicians are stigmatizing transgender people. Lastly, we’d suggest that clinicians talk with patients about what information (including diagnoses or information about being transgender) they feel safe having in their medical records.
Healio: Is there anything else you would like to add?
Alpert: It is unjust that transgender people are put in the position of having to decide what information is relevant enough to their care to risk experiencing transphobia. It is urgent that we change this by making clinical spaces safer and by making it explicit why we are asking what we are asking.