Most people aren’t asked about their genitals when seeking treatment for a sore throat. But that was the experience of a transgender person, who shared on Twitter using the hashtag #transhealthfail.
“So you’ve had all the Surgeries [sic]?,” the Twitter user recounted the doctor asking. “I’m here because I have the flu,” the person responded.
Interactions like this are common for transgender patients seeking medical care, said Jess Guerriero, MSW, and Amy Penkin, LCSW, of Oregon Health and Science University’s Transgender Health Program. The two discussed how to provide compassionate healthcare for transgender clients on Nov. 7 at the Linfield-Good Samaritan School of Nursing (LGSSN).
The two were invited to present at LGSSN by Paul Smith, assistant professor of nursing, and Aster Wolfe ’17 as part of a Faculty Student Collaborative Research Grant. Smith and Wolfe are using a measurement scale to evaluate belief and attitudes of nursing students regarding transgender individuals before and after a planned educational intervention.
An estimated 0.6 percent of adults, about 1.4 million people, identify as transgender in the United States. Oregon has an estimated 19,750 transgender adults living in the state, and the population is expected to increase.
“So if you haven’t already cared for clients who identify as transgender,” Guerriero told Linfield students, “if you’re staying in Oregon, you will.”
Nationally, the transgender community reports high levels of negative health care experiences. Some 23 percent of transgender people, according to a recent survey, have postponed necessary medical care when sick or injured, and 33 percent have delayed or not sought preventative care because of experiences of health care discrimination.
Worst of all, 73 percent of surveyed transgender people believe they’ll be treated differently than cisgender (those whose gender identity matches the gender they were assigned at birth) people when seeking healthcare. The “Trans Broken Arm Syndrome” describes the tendency by healthcare providers who assume that all medical issues are a result of a person identifying as transgender, from mental health problems to chronic conditions to even, yes, broken arms.
The most important thing to keep in mind when providing care for transgender clients, the presenters emphasized, is respect.
“Get to know the person you’re talking to,” said Penkin.
Guerriero and Penkin advised asking what the client’s preferred pronouns are, and then using them in all conversations and correspondence. They paid particular attention to using the client’s preferred name and pronouns in reminder calls, patient correspondence and chart notes.
Don’t, they warned, use the phrase “What’s your pronoun preference?” That suggests that correct pronouns are optional. Instead, ask “What pronouns do you use?”
Penkin and Guerriero also counselled using “transgender” as an adjective as opposed to a noun, such as “a transgender person” or “transgender client,” not “is a transgender.”
They emphasized that nurses should keep the focus on what’s relevant. Asking about surgery or hormone therapy, questions about living as a transgender person or querying about transgender status if it’s not related to the situation at hand is intrusive and unsuitable.
“Asking questions …if the motivation for the question is only your curiosity and is unrelated to care,” Guerriero warned, “is inappropriate and can create an unsafe and unwelcoming environment.”
For clinical care, Guerriero and Penkin suggested documenting affirming language in a client’s record, such as: “Jasper is a 67-year-old assigned female at birth who identifies as a trans man and uses he/him or they/them pronouns.” They also emphasized making sure the patient is part of the conversation about what gets documented and how.
They advise that transgender clients might also need additional considerations for physical care. Penkin and Guerriero said that transgender patients may find some elements of a physical exam traumatic. They suggested explaining all the steps in the physical exam or contact, and ensuring the client’s readiness before moving forward.
Additionally, transgender clients may wear clothing such as binders or breast forms to aid their gender expressions. Guerriero and Penkin said nurses should have a discussion with the client during the exam if these items need to be removed for care, and to allow extra time after an exam to put them back on.
Ultimately, Penkin and Guerriero encouraged nursing students to become allies with patients—by being aware of personal biases, advocating for change, becoming knowledgeable and educating others.