National University of Health Sciences (NUHS) alum Sami Ebner, DC, ND recently delivered a presentation to the NUHS community designed to help future health care professionals learn more about creating their practices to provide more affirming spaces and understanding, inclusive terminology.
When it comes to seeking even basic health care, one of the greatest concerns among the LGBTQIA+ community is fear.
“Many are scared to go to specialists or other providers for fear of mistreatment or discrimination, as well as having to educate their providers. It makes me put a lot of emphasis on trying to find safe referrals and preparing patients to advocate for themselves,” said Dr. Ebner.
“I always encourage taking a friend or family member if they need extra support.”
The statistics reported in the 2015 U.S. Transgender Survey Report are eye-opening:
- 33% of respondents who had seen a health care provider in the past year reported having at least one negative experience related to being transgender, such as verbal harassment, refusal of treatment, or having to teach the health care provider about transgender people to receive appropriate care.
- 23% did not see a doctor when they needed to because of fear of being mistreated as a transgender person.
- 40% of respondents have attempted suicide at some point in their lives, compared to 4.6% in the U.S. population. 48% of respondents seriously thought about killing themselves in the past year, compared to 4% of the U.S. population, and 82% have had serious thoughts about killing themselves at some point in their lives.
Additionally, transgender and gender diverse (TGD) individuals experience high levels of trauma, bias and discrimination in their day-to-day lives:
- 78% report being harassed in school
- 57% report being rejected by their families
- 65% report experiencing discrimination when taking transportation, shopping, dining and accessing health care.
Because of discrimination, TGD individuals are significantly more likely to be homeless, unemployed and receive a lower income than others in our society. (1)
Creating a safe space is key.
“Like most marginalized groups,” said Dr. Ebner, “LGBTQIA+ folks look for little signs signaling a space is safe or not.”
“Training medical staff on how to use pronouns, sometimes avoiding pronouns and not using titles like ma’am, sir, miss, etc. are important to create an inclusive space,” they said.
So will marking single occupancy bathrooms “all genders”, protecting patient confidentiality (aka HIPPA), always using the correct name and pronouns of patients-even when they are not present, and not joking or gossiping about transgender patients, Dr. Ebner added.
When it comes to electronic health records (EHR) and charting, they said, make sure the name the patient uses is what you see at the top of their chart, so you don’t mix it up if they still have their “dead name” as their legal name. Using someone’s former name, or “dead name” means calling or referring to them by the name they no longer use. The former name is usually their birth name, from before their transition.
For some patients, even visually seeing dead names and incorrect pronouns can be triggering. Practitioners need to figure out how to put pronouns by their name in the chart and be sure to chart names and pronouns appropriately when making SOAP* notes, said Dr. Ebner. (2)
Instrumental in accomplishing this is ensuring that patient intake forms are mindful and reflect gender identity. For example, offering designations Female/Male/NB/GQ/Intersex/FTM/MTF/Other, and offering space for patients to indicate their pronouns, such as she/her/hers, he/him/his and they/them/theirs.
While 1.14% of the U.S. population identifies as transgender, this is equivalent to approximately three million adults. (3)
“We are just people trying to live our lives and take care of ourselves. We deserve just as much respect and care as the next person; sometimes even more gentle care due to trauma from society’s inequalities, biases and harm toward us. The best thing you can do as a practitioner is truly listen to your patients, trust they know what they need, and help them advocate for it,” Dr. Ebner said.
For more information on understanding transgender health care issues, please see the list of helpful resources below, and NUHS blog, “Transgender Health Care: How to Meet Their Needs.”
Sources:
- Source: National LGTBQIA+ Health Education Center
- *SOAP stands for Subjective, Objective, Assessment and Plan; SOAP notes help clinicians assess, diagnose and treat patients, communicate with other health professionals and create patient-specific plans.
- Source: USAFacts calculations using Census Bureau data
Helpful Resources:
National Center for Transgender Equality
Trans Student Educational Resources
National LGTBQIA+ Health Education Center
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