As medical education and research shift to address the health of lesbian, gay, bisexual and transgender (LGBT) issues, it’s important to make sure your practice does the same. Understanding the concerns of patients with varying gender identities can help minimize health disparities. Learn how to make your practice transgender-friendly with advice from an expert.
While LGBT patients have increased risks for depression, suicide attempts, and substance disorders, transgender individuals are also “more likely to postpone medical care because of lack of insurance and encounters with discrimination,” according to a recent article in JAMA.
This disparity is not surprising considering the bias a transgender patient may encounter during an initial patient visit, said Jamie Feldman, MD, PhD, an associate professor at the University of Minnesota Department of Family Medicine and Community Health. She has served as the chair of the World Professional Association for Transgender Health's Transgender Medicine and Research Committee since 2001.
“Being transgender is something people are stigmatized for all the time, so patients may be afraid that you’re not going to treat or touch them, or you’ll kick them out of your office when you find out,” Dr. Feldman said. “Because of this, as the physician, you have to take the initiative and ask the right questions.”
So how can you better care for transgender patients? “The first thing transgender patients will want to know is if you know anything about them. Some may quiz you or wait to see if you ‘get it’ and understand their perspective,” Dr. Feldman said. She recommends starting by educating yourself.
Dr. Feldman suggests gender-specific questions physicians can ask themselves to establish a more open practice environment:
- Do my practice intake forms reflect diverse gender identities? Collecting information about gender identity during patient registration can help you identify LGBT patients who may need special care and lets them know they are welcomed at your practice. View sample questions to add to your intake forms here.
- Does my practice have gender-fluid facilities? Do you have pink pastels plastered all over the women’s bathroom or blue gowns designated strictly for male patients? If so, consider updating facility resources like restrooms and gowns to reflect a neutral gender standard.
- Is my staff aware of LGBT guidelines and how to treat transgender patients respectfully? In 2014, the Association of American Medical Colleges (AAMC) released guidelines on training physicians to treat LGBT patients, which includes 30 competencies the AAMC recommends physicians learn. Make sure your staff is up-to-date on this information.
Once you’ve made adjustments to your practice, some questions physicians can ask transgender patients during their actual visits are:
- How would you like me to address you? What’s your name and preferred pronoun? When greeting a new patient, abandon any assumptions you may have about gender. Instead, ask patients how they’d like to be identified, what name they preferred to be called, and what preferred pronoun they’d like you to use. Transgender patients may prefer to be identified as “he,” “she” or neither. It’s important to ask this early in your patient’s visit as it “demonstrates that you’re an open-minded physician and you understand that just because a person is born as one sex, it doesn’t mean they can’t identify with another,” Dr. Feldman said.
- Are you taking cross-gender hormones? If your patients are taking hormones, you’ll want to learn how the hormones were procured to make sure they’re following a healthy dosage. Some key follow up questions to ask: Are you getting the hormones through a physician or your own resources? How many are you taking and have they done what you want them to do? Are you experiencing any complications? If your patient is in need of hormones, you have to determine your level of comfort prescribing them.
- Have you had any gender-related surgeries? Ask this while taking a general inventory of body parts your patient may or may not have, Dr. Feldman said, noting that the presence of sexual organs varies based on each transgender patient’s journey. Gauge your patient’s level of comfort as they discuss this with you. “If you don’t understand how transgender patients interact with their bodies, you won’t be able to provide the best care possible for them,” she said.
- When was your last pelvic and/or breast exam? Asking preventative care questions can help you gain a better sense of transgender patients’ health and the referrals they need. This is especially important since exams tend to be a sensitive issue for transgender people who often fear discrimination and unnecessary probing during medical visits, Dr. Feldman said. With this in mind, if your transgender patient simply needs a routine exam and you don’t think it’s medically urgent, try to schedule it after you’ve established more comfort with your new patient.
Each of these questions aims to help you better partner with transgender patients, so you can provide the quality care they deserve. Partnering with LGBT patients is a key priority for the AMA’s LGBT Advisory Committee, which provides a forum within the AMA to address the needs of LGBT physicians, medical students, and patients.
For more on transgender care, visit the AMA’s resource page on making an LGBT-friendly practice and University of California San Francisco (UCSF) Center of Excellence for Transgender Health. Also review the Fenway Institute’s comprehensive guide on LGBT health and free publications on transgender patient care.
