Open Dialogue as a Best Practice in Transgender Health Care
Due to a multitude of factors including discrimination and bias, individuals who identify as transgender experience higher rates of mental health issues than the general U.S. population. A 2013 article published in the Journal of Consulting and Clinical Psychology found that about 50% of individuals identifying as transgender presented with clinically significant depressive symptoms. Further, the results of a 2016 survey conducted among transgender individuals by the National Center for Transgender Equality found that about 40% of transgender individuals had attempted suicide at least once in their lifetime (compared about 5% of the U.S. population). While a report published by the Williams Institute in May of this year reported that increased visibility of transgender individuals has been shown to reduce transphobia, there is no evidence, to date, showing that increased visibility has led to better health outcomes for transgender individuals.
Specific reasons for the higher rates of mental health issues in transgender individuals include higher rates of everyday discrimination in all environments (e.g. in public, at work, in medical settings, etc.), higher visibility of perceived gender nonconformity, and unstable job or housing status among others. It is particularly important for mental health professionals to understand that transgender individuals have a long and documented history of discrimination within healthcare settings. Further, conscious or subconscious bias can permeate all levels of a healthcare setting from the physician or therapist to the receptionists to the billing staff and everywhere in between. In order to combat this discrimination and better serve transgender patients, the National LGBT Health Education Center released their Best Practices for Front-line Health Care Staff in 2016 and, in it, are tips to becoming a more inclusive healthcare environment.
The most important lesson gleaned from Best Practices is that the entire office staff should be involved in making a healthcare setting more inclusive. This includes the front office, therapists and physicians, case managers, medical records, and billing team. Further, the entire office team should strive for open and honest dialogue with all patients. Unless a patient has already expressed their preferred pronouns, office staff should avoid gendered pronouns. For example, staff might greet patients with “Good afternoon,” instead of “Good afternoon, sir.”
A mistake in labelling or language may make a patient upset, however, the staff member should avoid personalizing the patients anger or dismay. Instead the staff member should apologize to the patient, even if what they said wasn’t intended to be offensive. A sincere apology can help to reestablish dialogue between patient and staff.
Finally, Best Practices helped to define the role of clinicians in caring for transgender patients. Physicians, counselors, and therapists should foster the exploration of a patient’s gender identity discovery. They should also assist the patient in learning about medical and non-medical approaches to gender affirmation. Clinicians should evaluate their patients current mental state as well as their capacity to make informed medical decisions and make appropriate referrals to other forms of care. Lastly, clinicians should constantly reevaluate their own internal biases and predispositions in order to provide the best care for all patients.
A recent study by Safer and colleagues found that two of the biggest barriers to transgender individuals accessing care were unfriendly office environments and a lack of knowledge in healthcare providers. Transgender patient care is not routinely taught in medical school curricula and, as such, few physicians have the appropriate levels of knowledge to care for transgender patients. Additionally, the majority of research regarding access to transgender individuals’ access to care is obtained from self-reported data collected from transgender individuals. Safer could only find two published articles that collected data from medical students and residents and, in both studies, participants reported less comfort in providing care to transgender patients than providing the same care to cisgender patients. While there is no standard curriculum for transgender cultural competency training, several resources can be found online. Presentations and resources from the Indian Health Service (IHS), the Center of Excellence for Transgender Health, and the National LGBT Cancer Network are linked below.
By taking the small step of educating staff members and promoting open and constructive dialogue at all levels of a healthcare office setting, health professionals can better ensure that transgender individuals are receiving appropriate care.