Addressing Needs of Transgender Patients: The Role of Family Physicians

Asa E. Radix, MD, PhD, MPH

Disclosures

J Am Board Fam Med. 2020;33(2):314-321. 

In This Article

Creating a Transgender-affirming and Welcoming Environment

Transgender individuals often avoid seeking medical care due to concerns about mistreatment in health settings.[7] Family physicians have an opportunity to improve transgender patients' health care experiences by creating a welcoming environment. The 2 key principles of care are 1) respect for peoples' identities and experiences, and 2) avoiding assumptions concerning gender and gender conformity in clinical interactions.

All staff members need to be trained in how to provide care that is welcoming and respectful. The first encounter in a new medical setting can be extremely uncomfortable for a transgender person when incorrect assumptions are made about their gender. Many transgender people use chosen names that differ from their legal name or may use pronouns that differ from the gender on legal documentation. It is often at the front desk in a clinic that a perceived mismatch between a patient's gender expression and their legal name or gender marker is recognized; how the front desk staff address this discrepancy sets the tone for the patient's experience at the clinic. One example of how front desk staff can address patients when these situations arise includes "do you use a name that is different from the one on this insurance/ID card?" Another recommended practice is to gather information at the time of registration about all patients that includes their gender identity, sex assigned at birth, and pronoun usage.[9,10] When pronouns are not known, staff can use the pronoun, "they." Another tip is to avoid gendered language such as "sir" and "ma'am" until you are certain of a patient's pronoun use. If a mistake is made, for example, using the wrong name or pronoun, an acknowledgment of the error and apology is the best course of action.

The National Academy of Medicine (formerly called the Institute of Medicine), Joint Commission, and other entities advise collecting information on sexual orientation and gender identity from all patients.[11,12] The recommended way to collect information on gender identity is to use a 2-step question[10] that asks patients for both their gender identity as well as their sex assigned at birth, as some people whose gender identity is not congruent with their assigned sex at birth do not identify as transgender (Table 1). These questions have been found to be understood and acceptable to transgender individuals as well as to the majority of heterosexual, cisgender patients.[13] Sexual and gender minority patients may prefer to disclose their gender identity in writing, for example by completing registration forms.[14] Knowledge of a person's sex assignment at birth is important for health care providers to deliver appropriate medical care, in particular for sexual and reproductive health and cancer screenings.

Creating a welcoming environment for transgender patients also includes attention to office features such as restrooms. If these cannot be single occupancy or all gender then offices can instead have a clearly posted policy that directs patients to use the restroom that matches their gender identity. Adding images of transgender people to educational materials and displaying posters or pictures of transgender people will also demonstrate that the health facility seeks to be inclusive of gender diversity.[16,17] Examples of free posters and educational materials can be found on the US Centers for Disease Control and Prevention's (CDC) Act Against AIDS initiative Web site.[18] Additional items that have been suggested by community members are that clinicians improve their knowledge about transgender-specific issues such as hormone therapy and use culturally relevant language when discussing identity and obtaining a sexual history.[19]

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