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ACEP Now: Vol 33 – No 03 – March 2014

Wesly Heney, a transgender person, cites discrimination from health care professionals as a reason that he avoids visiting the doctor.

Ask the Patient

Providers who have not treated transgender patients may be uncomfortable about the encounter due to lack of training and/or reliance on social stereotypes. Delivering competent care for transgender patients begins with how patients are addressed, notes Dr. Bauer. “It’s important for physicians to be aware that when trans patients do come in, they may have had negative experiences and that doctors [and allied health professionals] should treat them with respect. For trans people that means making sure you use the name and pronoun that they use in their daily lives,” she says. Providers should avoid making assumptions about people’s gender based on their appearance or behavior. For example, a male-to-female transgender individual could be in the ED due to a car accident. If that person is dressed as a female but has not yet fully transitioned from male, the physician may be unsure about how the person self-identifies. In such a case, the physician need only ask for clarification: “How do you identify yourself, and how do you want me to refer to you while we are working together
here?”

“We can become desensitized in the ED. We’ve seen so much that everything becomes ‘open season.’ Sometimes it’s important to remember to keep personal boundaries.”
—Madeline B. Deutsch, MD

“If the preferred name and pronoun are not used, that immediately begins to color the patient’s experience,” notes Dr. Deutsch. A simple question such as the one above, says Heney, can open the door to establishing the trust that is necessary for the health care encounter. “The number-one message I often tell people is to ask permission to ask questions,” he says. “If you tell me, ‘I’ve not encountered this before, so I need to ask some clarifying questions to give you the best care I can,’ I will be a lot more open.” This rule of thumb works in any ED situation, notes Dr. Deutsch, who draws a parallel with the Russian patients she encounters in the San Francisco ED where she practices. “Walking in and totally mispronouncing their last name is not the way to do it,” she says. “After hello, I ask, ‘Can I ask you how to correctly pronounce your name?’”

Focus on the Care

Accurately capturing the percentage of people who identify as lesbian, gay, bisexual, or transgender (LGBT) is challenging due to the very factors that act as barriers to health care: negative experiences, poverty, and lack of social support services. An amalgamation of several health and epidemiological surveys in the past decade by The Williams Institute at the University of California, Los Angeles, estimates that 3.5 percent of the US population identifies as LGB people and 0.3 percent identify as transgender. There are, the institute estimates, approximately 9 million LGBT Americans.