As an educator for Regional HIV/AIDS Connection in London, Ontario, Heney knows that some providers may never have encountered transgender patients. They may be unsure about how to approach the transaction or what special concerns they should be addressing. In some acute care situations, questions about biological sex and/or hormone levels may be important for assessing risk or drug interactions. But in other cases (a broken ankle, for instance), gender identity may be irrelevant. (See “Transgender Health Issues of Special Consideration” for more on the medical needs of transgender patients in the ED.) Al Killen-Harvey, LCSW, is cofounder of The Harvey Institute, a San Diego-based training and consultation company dealing with issues of sexual health. He notes that providers should resist the impulse to ask irrelevant questions out of personal or intellectual curiosity: “No matter what we’re doing, we must ask ourselves, ‘How does what I’m doing or saying relate to the job I have at hand? Does it relate to what I need to know?’ And if it doesn’t, then it shouldn’t be part of the conversation.” Dr. Deutsch agrees and also observes that emergency physicians should not succumb to myths about trans patients. “Do not assume that a trans person with leg cramps must have blood clots due to being on a hormone regimen,” she says. “Maintain a broad differential diagnosis, remember that there may be no risk of blood clots for a trans person on hormones, and remember that the patient may be there for something unrelated to being trans.

“It’s important for physicians to be aware that when trans patients do come in, they may have had negative experiences.”
—Greta R. Bauer, PhD, MPH

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

Emergency physicians can set the example, but it is important, our sources note, for all personnel to acquire some understanding and sensitivity to gender fluidity and the ways in which gender expresses itself. “All of your good intentions may fall by the wayside if the patient has already had several negative encounters with other people in the ER system,” said Killen-Harvey. Dr. Deutsch has done research on incorporating trans-specific terminology into the electronic health record and is lead author on the recently published World Professional Association for Transgender Health EMR Working Group recommendations on electronic medical records and transgender patients.²