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Welcoming Transgender Patients

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Project Health

on 8 August 2016

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Transcript of Welcoming Transgender Patients

What kind of medical services do trans* people need?
Sexual Orientation is
what's in your heart
Learning Objectives
It is not the patient's responsibility to educate us.

It is our responsibility to educate ourselves.

It is our responsibility to educate others.

Educate yourself

Expecting discrimination in a medical setting is

Expect that people may be sensitive, even overly sensitive

Try not to get defensive. Do not to correct them,
just apologize

Seek to re-empower patients by allowing them to make choices about their care whenever possible
Responding to Patient Sensitivity

Sincerely acknowledge mistake.
“Whoops! I apologize for using the wrong pronoun/name."

State your intentions. Briefly,
"I did not mean to disrespect you.”

Move on and leave it alone.
"I promise to get it right next time, thanks for your patience with me while I'm learning.
Ok, are you ready to head back to the exam room?"
Apologizing for Mistakes
Calling a patient from the waiting room
Accidents Can Happen
Not everyone wants surgery

Not everyone who wants surgery can get it
not safe for people with certain conditions
insurance is inconsistent
long, difficult process to access

Gender Identity is legitimate whether or not patient has pelvic surgery
Don't Judge Gender by Surgery

Changing documents is complicated and takes time

Patient may not be "out" to family members or employer

Insurance may not cover treatment if gender does not match anatomy

Cross-check by date of birth and address
What if the records don't match?
If you don't know, ask
Be warm and extra polite

Some people use gender-neutral pronouns like "Zie", "Hir" or "They"

No one goes by "It". RUDE!
Preferred Name
Validate Current Gender Identity
Transgender Patients

“Cis” = on the same side

Sex Assigned at Birth
+ Gender Identity
Transgender Terms
Patients may be sensitive

Patients may be tried of educating providers

If you're just curious, it's not your business.

Would you ask a cisgender person that same question?

Curb Your Curiosity
When babies are born, a sex is assigned based on observable genital structures. Most cultures use a binary system to categorize sex – male or female only, no “both” or “none of the above” options available.

For most people, that sex assigned at birth (male or female) and the gender identity most comfortable to them as they develop (boy or girl) are aligned.

Congratulations! It’s a…BABY!

Refer to the patient as the gender they are moving toward, NOT where they started

Don't say “When you were a girl…,”
Say “Before you transitioned...”

Kate Bishop, MSSA (MSW)
STAR TRACK Adolescent Health Program
University of Maryland School of Medicine

Transgender Patients

Why don’t you make your voice lower?

Which bathroom do you use?

Do you plan to have children? How will you conceive and birth them?

Do your sex partners generally enjoy the shape of your body?

Do you always dress like a guy?

Is your family disappointed in who you are?

Do you plan to have surgery
on your reproductive organs?

Great to meet you!
(Excuse me, I’m just curious…)

Can I see a picture of you from before, when you were less comfortable in your body?

What’s your real name?
No, no, I mean your REAL name.

What do your genitals look like?
Are you happy with your penis the way it is?

Become familiar with basic terms, concepts and social dispairities about gender-variant patients.
Get some tips about working with transgender patients in a way that is both warm and appropriate.
Gain confidence that you'll avoid "saying the wrong thing", but learn how to recover from a mistake.
A birth name is a very sensitive piece of PHI (Protected Health Information)

Ask everyone “What name would you like us to use?”

The patient's "preferred name" IS their "real name".
Respect Pronouns
"Outing" means revealing that someone is transgender

Not your information to reveal
Gender Variant
Gender Identity
Preferred Pronouns
Birth defect
"used to be a boy"
You people
Specialty health care for chronic conditions
Hormone Therapy
puberty blockers
cross-sex hormones
Gender Affirmation Surgery
Facial feminization
Tracheal shave

"Top surgery": Mastectomy or Breast Augmentation

"Bottom surgery": Hysterectomy, Vaginoplasty or Phallopasty
“Trans” = across or beyond

Sex Assigned at Birth
+ Gender Identity
How many people are transgender?
Sex is what's between your legs
Gender is what's between your ears
April 2011 study from the Williams Institute
Sexual Orientation
Transition-related care:

I want to be respectful --
can you tell me what pronouns you use?
Do you go by he, she, they, or something else?
What name would you like us to use?
If I ask everyone, some patients will be confused.
Explain why you are asking.

Signals transgender patients this is a safe place.

Great chance to educate.

We have a lot of transgender patients in this practice. Sometimes the right pronoun is not obvious, so we ask everyone to make sure all patients can feel comfortable here.
Could your chart be under a different name?
Can be hard to guess gender by the sound of someone's voice

Transgender patients may be sensitive about voice

Parent calling may not reveal child is transgender

Avoid "Sir" and "M'am"
Accidents Can Happen
Avoid "Mr." or "Ms."

Use last name or initials

Go up to the patient

Answering phone calls
Are you sure you're in the right place?
Accidents Can Happen
Patient presents as a man, but is scheduled for a pap smear

Patient is transgender, but here on the "wrong" day

Patient or family does not want to tell desk staff they are transgender
Overly friendly staff
Accidents Can Happen
Stay professional while trying to make the patient comfortable

Making gender jokes is risky

Don't try to prove you are trans-affirming, just be trans-affirming
National Transgender Discrimination Survey, 2011
of respondents reported being
verbally harassed
in a medical setting
reported being
physically attacked
in a doctor’s office

delayed care when sick or injured due to discrimination
Findings of a Study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force
By Jaime M. Grant, Ph.D., Lisa A. Mottet, J.D., and Justin Tanis, D.Min. With Jody L. Herman, Ph.D., Jack Harrison, and Mara Keisling
The Family Acceptance Project www.familyproject.sfsu.edu/
Intersex Society of North America www.isna.org
PFLAG – Parents, Family & Friends of Lesbians and Gays www.pflag.org
NGLTF - National Gay and Lesbian Task Force www.ngltf.org
National Center for Transgender Equality www.transequality.org
The Gender Book

Fenway Institute

The Center of Excellence in Transgender Health

Sex Assigned at Birth
Gender Identity
Accidents Can Happen
Kate Bishop
Transgender Discrimination
Accidents Can Happen
Avoid Outing Anyone
Full transcript