‘Anatomy inventory’ fosters more inclusive care for transgender, non-binary patients
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PHILADELPHIA — Taking an “anatomy inventory” during visits can help cultivate a more supportive environment for transgender and non-binary patients to discuss their gender identity and the need for organ-specific care, a presenter here said.
“The TGNB — which stands for transgender and gender non-binary — community are in need of social services and experience a lot of discrimination,” Nathan Levitt, FNP-BC, MSN, RN, BSN, director of LGBTQ and Gender Justice Learning at the Yale School of Nursing, told attendees at ACR Convergence 2022.
“Even if you are the most sensitive and informed clinician, before that patient ever gets to your door they have experienced discrimination, maybe outside your health center or hospital, perhaps when they get to the front desk and their identification doesn't match the way they look, maybe by other patients in the waiting room, especially if they are there for anything that is gendered,” he said.
Levitt noted that many people in the community will avoid primary care for fear of the discrimination that they might face. However, in eschewing primary care services, patients are also perpetuating the health disparities that disproportionately affect the TGNB community.
“What you might find is that transgender and gender non-binary patients have more chronic health issues — not related to being trans, but related to the discrimination they face when they try to come in for basic care,” Levitt said.
He recommended that clinicians take an “anatomy inventory” with their patients to document the presence or absence of certain organs that will help guide patient-centered, preventive health screenings. Regardless of gender identity, anatomy inventories are critical because clinicians “need to know what body parts people have in order to take care of them.”
“As a transgender-identified man, I’m going to use myself as a case example about why it’s so important to ask about your patient’s anatomy,” Levitt said. “If I show up to your office, most of you may not have any idea that I was assigned female organs. You may not ever offer a pregnancy test if I’m going into surgery. You may not know how to interpret my labs that come out as male-defining labs if you don’t know the anatomy that I have.”
EHR has also expanded to accommodate more inclusive documentation for TGNB patients, including legal sex, pronouns, correct name, marital status and emergency contacts — as well as an “add-on package in the Epic electronic health record,” which includes a list of what organs are present for individual patients, he said.
“If you think of someone who has had a hysterectomy, you are not going to think about them in the same way as someone who hasn't when you are considering pregnancy risks — the same goes for trans populations,” Levitt said. “They have different body parts; you want to know what they are so you can take care of them.”
He added: “I want you all to think about this in your daily care: How can we integrate this? What are the current strategies within your institution? What are some systems that make this challenging? What are some possible fixes? What can you do in your role and what support would you need? I'm giving you homework to take back to your workplaces and to think about how to integrate this.”
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Levitt C. Session 12S114: Enhancing clinical skills with transgender/non-binary patients in the rheumatology setting. Presented at: ACR Convergence 2022; Nov. 11-14, 2022; Philadelphia (hybrid meeting).
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