How emergency physicians can tailor their approach to transgender individuals and establish patient trust

Nine months ago, Wesly Heney, near collapse from viral pneumonia, was taken by ambulance to a large teaching hospital near his home in London, Ontario. Paramedics asked whether he took any medications, so Heney disclosed that as a transgender person (female-to-male, or FTM) he was taking injectable testosterone. While he was waiting in the hospital hallway on a gurney, a nurse came over to put on his patient ID bracelet. “She must have heard the paramedics’ report,” Heney surmises, “because she referred to me as ‘it.’” Later, Heney heard two nurses arguing about who would do his blood draw because “neither of them wanted to touch me.”

Experiences like these illustrate why Heney and many other trans people are often reluctant to access health care. A survey of emergency department use, avoidance, and experiences conducted by Trans PULSE, a community-based research project investigating the impact of social exclusion and discrimination on the health of trans people, was recently published in Annals of Emergency Medicine.¹ The analysis of the respondent-driven sampling survey of 433 transgender participants found that 21 percent had avoided going to the ED because they feared negative experiences. Greta R. Bauer, PhD, MPH, associate professor in the department of epidemiology and biostatistics at Schulich School of Medicine & Dentistry at Western University in London, Canada, is coprincipal investigator of Trans PULSE and was lead author on the paper. The survey documents that there are unmet needs for emergency care among transgender persons. Heney believes that the numbers in the Trans PULSE project are low and that avoidance of care is underreported. By his own account, Heney often encounters a wide range of inappropriate and biased reactions from health care providers. As a result, “nine times out of 10, I delay going to the doctor,” he says.

Emergency physician Madeline B. Deutsch, MD, clinical assistant professor in the department of family and community medicine at the University of California, San Francisco, and clinical lead at the Center of Excellence for Transgender Health, was a coauthor of the survey analysis. Despite differences in health care delivery systems between Canada and the United States, Dr. Deutsch says the take-home messages from the Ontario survey are very relevant to her US colleagues. And, Dr. Bauer points out, in a country with universal access to primary care, the finding that 21 percent of transgender people avoid going to the ED is even more significant.