COMMENTARY

Do Transgender Patients Feel Welcome in Your Practice?

Jack Drescher, MD

Disclosures

October 16, 2017

Hi. This is Dr Jack Drescher for Medscape. I'm a clinical professor of psychiatry at Columbia University, a Distinguished Life Fellow of the American Psychiatric Association, and a past member of the DSM-5 workgroup on sexual and gender identity disorders. I wanted to talk a little bit about what you, as a primary care provider, might want to think about if you happen to have a transgender patient come in to your office.

One thing you want to think about is: Is that patient welcome in your office? Does your paperwork, for example, reflect the possibility of such people coming in? If your paperwork only says male and female, remember that some people identify as male or female and some people identify as other genders. You might want to see if your paperwork includes that option for people so that they do not have to [deal with this situation].

For some offices, it becomes problematic because the patient may be living as one gender but may not have had a legal name change yet. Their insurance might say John Jones, but it's Mary Jones who comes in to the office. Some offices get a little freaked out about this. It would be very helpful if people could learn how to be able to respectfully address patients with the names they are currently using, even if it isn't really their legal name, and also to be able to respect the pronouns that they prefer. If someone prefers to be referred to as she, you should not call them he or him.

This is one example that comes up sometimes when I lecture on this subject. A patient has been admitted into the hospital who was assigned male at birth and who's now living as female, but has not had surgery or has not had a legal name change. Their medical insurance and their charts say John Jones, but the patient is referring to herself as Mary Jones. What are we supposed to do when we chart this patient? The answer is, at the beginning of the chart you just note that: "The patient's legal name is John. The patient identifies as Mary. Going forth in the chart, we will refer to her as Mary and we will be using female pronouns as she wishes." There is no reason not to do that. The patient is not going to sue the doctor for malpractice for doing that. It solves the problem of staff not being able to cope with gender differences.

Most primary care providers are not going to be providing the transition services themselves. This is a very specialized area of care, although it is possible that some primary care providers may want to take on the maintenance after a patient has had transition services. For example, a patient who's been started on hormones and is stable might not need to see the specialist. They might be able to continue with a primary care physician. In general, the transition services are usually not done by people who don't have experience in this area. It would be helpful for primary care providers to know who in their area is available to provide these services.

There were a lot of gender clinics in the United States in the 1960s and '70s that shut down in 1980, but we're now seeing a reawakening of interest, both academic and clinical, in the treatment of transgender patients. Clinics are opening up around the country. Not all clinics provide all services. If you're a primary care provider who wants to help a transgender patient seeking treatment, it is useful to know where to refer the patient.

You might also think about consultation if you run into a problem. I know mental health professionals who consult with me; they often run into problems because they get confused about the use of pronouns. They get confused about how to experience the gender of the patient. It is useful to have someone who's had some experience in this area to talk with you about it.

I think those are really important areas for you to think about: respect for the patient's gender choices, thinking about expert consultation for the patient, and expert referral for the patient. This is Dr Jack Drescher for Medscape. Thank you.

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