WhiteCoat

Addressing Transgender Patients

I read this story about how transgender patients are upset because they are addressed incorrectly when they seek medical care. Because of this, some people are demanding sensitivity training for medical personnel and are alleging that “transphobia” must be occurring.

“Transphobia”?

Sorry, but I think that the whole transgender rights thing is going a little far when transgender people are offended because medical staff need to appropriately identify them before they receive medical care.

The article states that

“We tell them, hey, if a trans person comes in with a stomach ailment or a broken ankle there’s no need to go on a tangent about what different types of surgeries they may have had.”

Yeah. Good advice. Knowing that a man has ovaries would  have no impact on my differential diagnosis of abdominal pain. None at all.
If a woman was taken for prostate surgery because medical staff didn’t want “offend” her by asking her whether or not the “MALE” designation on her ID bracelet was incorrect, you know these same people alleging “transphobia” would be demanding that all the providers’ licenses get revoked.

Don’t want to be embarrassed? Go to the hospital desk ahead of time and explain the situation or call the hospital ahead of time and discuss it with the administrator. Don’t get upset because someone is trying to properly identify you, then scream discrimination when none exists. Make it easy on us and we’ll usually try to make it easy on you.

If you act unreasonably, you’re probably going to end up offended, but it won’t be because of your current or desired gender.

32 Responses to “Addressing Transgender Patients”

  1. Mark says:

    Even Dan Savage gets called transphobic. I don’t think there is anything us mere mortals can do to ensure we don’t piss them off in one way or another.

  2. VA Hopeful says:

    Exactly. I don’t care in the slightest what gender you claim to be, but I do need to know what organs you possess.

  3. GuitargirlRN says:

    Look, there are ways to address transgender people kindly and sensitively when necessary. I encounter a lot of transgender people in the ER where I work, and most of them, like most people, are open and forthcoming about what their situation is when asked in a matter-of-fact manner.

    Look, health care professionals sometimes have to ask embarrassing questions of EVERYBODY, from the 70-year-old grandpa with chest pain (any Viagra on board? Any cocaine?) to the young man with rectal bleeding (any foreign objects up there lately?). People get offended, but then they get over it.

    • Gene says:

      When I was a medical student, I took care of a very nice transgender (pre-op) person whose chief complaint was a scrotal lesion. So many of my colleagues were too freaked out and refused to say “HER scrotum”. Never bothered me. She was a very nice person and I figured that I owed her the same respect she gave me. And I said, “her scrotum” with a straight face.

      • I think the problem stems from the fact that people can’t wrap their heads around the fact that you CAN say “her scrotum.”

        A trans-woman identifies as female. If she has a scrotum, then she has a scrotum. In this context, women can have penises and scrotums, men can have vaginas, and it’s really not that hard to use the person’s preferred pronoun.

        People are just blowing the issue up, thanks to their ignorance. Specifically, a lot of people seem to conflate “transvestite” with “transgender.” It’s not about dressing up as another gender, it’s about your brain being wired to believe that you are the wrong gender. These people are so torn up about being in the wrong body that they’re willing to remove body parts (breasts, penis and scrotum, etc) in order to rectify this. I think it’s really sad that people are still willing to ruthlessly make fun of trans people even knowing that this is the case, knowing that there’s such a huge difference between transvestite and transgender and still labeling transgender people as transvestites because it’s easier to make fun of.

        I’d really like to do a rotation in a place specializing in transgeneder health once I get into medical school. As evidenced by some of the gross comments here, it’s really hard for that population to get decent treatment by their fellow human beings, and as evidenced by the content of the post, it’s really hard for them to get respectful medical treatment. Although in the end, it’s probably not the specialty I want to pursue, just because there are other fields that appeal to me more, I’d still love to take some time to provide a maligned population with the respectful medical care that they deserve.

      • WhiteCoat says:

        Maybe for some it is an issue of “respect” or “embarrassment”.

        For medical professionals, it is a matter of proper medical care. If someone goes by the “pronoun” “SHE,” every medical text on this planet assumes that the subject of the sentence has female internal organs, an XX chromosome, and estrogen. Each of those assumptions plays a very real issue in medical decisionmaking.

        I also have an problem with when it is appropriate to begin making a determination that one is no longer belongs to their genotypic sex designation, but I’m not going to debate that issue.

        Do medical providers need to provide more compassionate care to everyone? Of course.

        Is slinging the term “transphobic” at people because they are trying to provide appropriate medical care to patients a means to foster that compassionate care? I don’t think so.

        Rather than polarizing the problem and providing inappropriate medical advice to hide ones gender-altering surgeries, the referenced article should have proposed solutions to improve the dialogue.

  4. ally says:

    I agree that it’s necessary to have all the information when treating a patient; trans patients need to know that if they withhold information about what organs they possess, what hormones are circulating in their bloodstream, etc. they can endanger themselves or limit their provider’s ability to care for them.

    That said, it’s great if you can ask questions or sort out issues in a private place if they could out the patient. You can also refer to their sex organs by gender-neutral terms (internal gonads/sex organs, external genitalia, etc) until further clarification is needed. Having sex organs of the opposite gender is a source of emotional pain for trans people so it is helpful to avoid assigning a label that they have been trying to escape their whole lives.

  5. Joe B says:

    I think you’re missing the point.

    “Many Quebec health-care workers routinely out transsexuals by arguing in public about their name and sex as indicated on the medicare card, advocates for trans people say.”

    The problem isn’t that medical staff are confused and it takes them a few moments to figure out that the person they’re talking to is trans. If that happens, just apologize and address the person as they wish to be addressed in the future. No big deal.

    The problem is when, once they figure it out, they decide to argue about it, offer their opinion, or instruct the person on what their gender is or what their first name is. If you don’t do that, then you’re not the problem.

    You are correct that the outreach worker Nora Butler-Burke is mistaken about what you need to know when somebody comes in with belly pain. Please don’t let her error distract you from the main point of the article.

    • WhiteCoat says:

      The other point is that, especially in clinics and emergency departments, we see sociopaths and people affected by mind altering substances every day. Perhaps medical staff have become calloused by patients “crying wolf”.
      This is why it is important for there to be a dialogue before there is a miscommunication rather than a blow up after the miscommunication has already been made.

  6. Tarl says:

    Sorry, but you are going to be addressed by whatever your official documentation calls you, not whatever name you might have picked for today’s use.

    In a medical setting, I lack sympathy for anyone wanting to add avenues for mistaken identity. And there are far greater things to be embarrassed about in a medical setting than your name.

    If you want to be called by a different name, you need to change your documentation. I know five transgendered people, all who did exactly that – maybe it’s harder in Canada, but it’s certainly doable.

    • Being able to change your name and legally documented gender are luxuries given to trans people who can afford it. if you click the article, you can see that the woman featured doesn’t have enough money to get a psych eval in order to change her legal gender.

      Getting your name changed costs a few hundred dollars as well, and since trans people have a hard time gaining and maintaining employment due to discrimination, they’re more likely to be poor, and as such, won’t have a few hundred dollars sitting around.

  7. Somebody says:

    The words you use to discuss this reinforce for me exactly why I find it difficult to disclose that I am trans — not just to medical people but to people in general. I’ll try to explain though I may not be able to make myself understood. I don’t think you’re stupid (in general I find you very smart and interesting to read, and this is why I read your blog) but I do think the concerns transpeople have in this area are very far removed from your own experiences.

    Firstly, I should clarify what I meant by ‘the words you use.’

    “current or desired gender” If someone identifies as this gender, is living as this gender, generally in day-to-day life is addressed as this gender… then this isn’t a ‘desired gender’ for them. Yes, there’s biology and anatomy but that has nothing to do with whether one prefers to be called sir or ma’am, or what pronouns one prefers, or any of that. If we could reliably count on other people to understand this, it would be a lot easier to mention those ovaries or lack of ovaries or penis or whatever, okay?

    But the simple fact is, we can’t rely on that at all.

    I feel that “current or desired gender” is just another aspect of the tendency other people have to think they get to decide what gender someone else ‘really’ is, and it’s right next to ‘but SHE has ovaries, so SHE is REALLY A WOMAN and we will treat HER as such.’

    I don’t know at all if this is how you personally would act. I hope not. Like I said, I like reading your blog. But it is exactly that sort of behavior that many transpeople have come to dread, not only from medical personnel.

    Now you might wonder why we’d care so much. After all, getting quality medical care is much more important than any temporary unpleasantness; if it weren’t, people would never get prostate exams or mammograms or pap smears, right? Except I think there’s a lower level of compliance associated with any procedure seen as unpleasant — how many people ought to get rectal cancer screenings that don’t? Or prostate exams?

    So if there’s already some level of anticipated unpleasantness with any medical procedure, even simple routine ones, there might be more reluctance to get even simple routine medical care. I think that unfortunately this is the case for transpeople in general; I don’t have links to the studies and supporting evidence off the top of my head, but I’m pretty sure that in general transpeople seek out medical care markedly less frequently than the national average, and this of course does lead to bad things happening.

    (Then too there are problems with insurance companies, which are difficult about paying for things like cervical/uterine/ovarian cancer screening for men… who are transmen, and do have those parts still, and do in fact need to have things done to them on occasion just like anyone else who has them. Transwomen face similar issues. You love insurance companies, right?)

    So ok, maybe we’re all just a bunch of oversensitive crybabies. After all, disclosing one’s transgender stuff isn’t a big deal other than in our heads, right? Except… that isn’t really the case either.

    Transpeople are murdered at disproportionate rates because they are trans. Even apart from the still statistically-unlikely but frightening murder rate, there’s harassment. Being discriminated against on the job due to gender identity and expression is still legal in most states — while you may not be discriminatory to a transperson, they may have no guarantees that if somehow this news gets back to their boss they won’t face trouble there.

    Many normal people will treat you differently if they know, and of course if one person who thinks it’s a big deal learns… they’re guaranteed to go tell everyone else. Now, HIPAA regulations prohibit loose lips sinking the healthcare ship but these are all just things we’re used to having to think about all the time when it comes to disclosing.

    And on top of that, many doctors are religious and may have strong religious ideas about transgender issues… or nurses might… or the rad tech might… and when you are sick and vulnerable and needing help from people, it’s not fun to play Jesus Is Sad Because You Are A Freak.

    Maybe you wouldn’t do anything like that. Maybe you and everyone you work with are all really good caring people who treat everyone with respect and try to get things right. But those other unpleasant things happen more often than you might want to believe — and you personally might never see evidence that any of it happens because…

    because, well, none of this would ever happen to you.

    Please try to imagine if it was the sort of thing you had to face. Please try to understand what makes it hard for us to be able to talk about this stuff with doctors and other medical professionals.

    Yes, maybe any well-meaning misgendering (well you have ovaries so we have to put F for Female on your wristband here, never mind you’ve been living as a man for ten years now, it’s no big deal right?) we face at a hospital or doctor’s office ought to be no big deal. But it’s a bit like getting poked in the exact same spot we’ve been poked and prodded and punched regularly all our lives. It’s a little sore there.

    • Hueydoc says:

      You sound very ” Christian Phobic”.

    • Lesbidoc says:

      Well said Somebody.

      @Hueydoc:
      I didn’t see anything Christian phobic. The comment about being religious could apply to christtans, jews, rastafarians, hindus, vegetarians…

      I see it more as a reminder that we are here to practice medicine with diligence and compassion without the need to interject our personal or private agenda when it serves no purpose in the point of care. Perhaps he should have said some doctors are prejudicial about their passions. Jesus is sad – Buddha is weeping – My wife looks great naked – and any other inappropriate comments should be zipped.

      Unfortunately, many of us have become so jaded or feel such a need to be the center of attention, that we make all kinds of jokes at others’ expense. We do it out loud in the middle of the department, where everyone can hear, nurses can laugh, colleagues slap us on the back and patients snicker – that is all but the patient you have so crudely paraded about the atmosphere of the room. Hey, bed 7 has a vacuum cleaner hose stuck you know where…

      We all realize that HIPPA APPLIES IN THEORY ONLY in the context of the typical ED. Patients separated by curtains, patients parked by the desk and other patients, visitors, and providers are privy to most sensitive details. Very few providers stop and take the patient to a private room to ask questions that the patient can answer honestly without fear of reprisal.

      I have had transgendered patients call my ED to see when I am on shift. Some want to see me personally, others are happy to see the mid-level as long as they are under my supervision. I don’t hint at what I am thinking or need to know; I ask.

      As the captain of the ship, start by setting the right example for your staff. First, think about how you will react – then ACT appropriately. Think of it as social CPR. This goes not only for the marginalized, but for everyone you meet – whether inside the ED or out.

  8. Felix Kasza says:

    Colour me confused. So if I tell everyone that I am the Emperor of China, people are supposed to address me as such and offer me peeled grapes? You don’t think the ER staff would cart me off to the rubber room and substitute Haldol for the grapes?

    It never ceases to amaze how easily offended some people are, and how they then proceed to bother one and all with the ensuing logorrhea. Sign your names, at least!

    Cheers,
    Felix Kasza.

  9. Pattie,RN says:

    Thanks for pointing out the obvious, Felix. In our current PC world, it seems that words have been stripped of any universal meaning, and “mean” whatever the speaker wants them to “mean”. Talk about a hybrid of Orwell’s Double-Speak and the Tower of Babble!

    And I WILL go to my grave believing and stating that your gender is what is evidenced by your genotype, not by what you WANT to be. Cher’s child is still female, mutilated and pumped full of exogenous hormones, but FEMALE. So sue me, but I refuse to call a spade an entrenching tool.

    • NitroRN says:

      And you would be exactly the judgemental type of caregiver that makes it difficult for transpeople to seek care. Regardless of how skilled you are at your job, I am sure that your distaste of the patient will come across as it does here.

      Who cares what a patient’s personal choices are, as long as they give you the information that you need to give them complete medical care. How can you expect them to feel comfortable discussing the most personal aspects of their lives if you radiate disgust for their “mutilated bodies pumped full of exogenous hormones”

  10. Michigan says:

    I know several transgenered people. They may be male to female, have started hormones, and are addressed as “she”, but are pre-op (saving for the surgery), and I didn’t realize the issues with official documentation (like a driver’s license) or medical insurance.

    Why can’t computer systems have more genders than “M” or “F”? Websites have “F2M” and “M2F” for transgenered people. What about people who were born with both sets of sexual parts? “H” for hermaphrodite. (Is that the term still used?)

  11. [...] White Coat talks about the practical issues of treating transgender patients. Apparently, this can be an emotional issue for those who have yet to finish the process and are in significant mental turmoil and emotional stress. [...]

  12. I Have a Reality Too says:

    While I understand that some people feel that they should have been born a different sex, I still have problems with the fact that they are asking others to state something that is in direct conflict with their reality. Surely, transgender people can understand, that, regardless of how they feel, if they were born with a penis, they are, to just about everyone, male. If a Caucasian insisted upon being called Asain, would we do it? I don’t think we need to be rude about it, but I also feel that transgendered people (especially before any surgery) have to accept a certain amount of reality, if not their own, then at least that of others, especially from medical professionals.

  13. Ianto Jones says:

    Born hermaphroditic; CAH (congenital adrenal hyperplasia). No convenient boxes for me. Living as a male, legally male, but “ambiguous genitalia”. Makes for some entertaining times in the medical environment. Also have very high voice, so makes for some entertaining times when going through telephone security validation. Sometimes get “Ma’am”‘d even though I have a full beard/moustache. Our society is very polarized about gender. Not always easy/simple answers. Not sure what I’ll do if I want to get a passport at some point (birth certificate doesn’t match social security and DMV). Fun times…

  14. Kipper says:

    WhiteCoat, I think you come to this as a person who makes a good faith effort to be respectful and feels taken aback by the implication that you are not. I don’t think you are who this article is about. I’ve heard the occasional individual make shockingly homophobic comments in the ER, the kind of things that would *not* fly in a Fortune 500 corporate office environment. I believe this is a “bad apple” problem (or “uneducated apple”, anyway), rather than a pervasive ER culture thing…but if that apple is registering or triaging a trans patient it can color the entire ER visit.

    • WhiteCoat says:

      Bad apples occur everywhere. Discussing the issue beforehand with an administrator can minimize the chances that the bad apples have an opportunity to cause problems.

  15. midwest woman says:

    Saw a documentary about a transgendered female to male who died of ovarian cancer. It showed him in.the waiting.room.with women with the same diagnosis. It was.mimd .bendimg.to.say the.least. The women were quite cold to him/her. It truly is we’re doing the best we can. No harm no foul.perhaps.

    • Gene says:

      From what I understand, there are similar problems with men and breast cancer. Breast cancer is rare but not unheard of in males, but some breast cancer support groups, fun runs, etc have excluded men with the diagnosis from their activities.

      • Ruth says:

        Its not just support groups, but financial systems. There was a case recently where a guy had to sue the government because he wasn’t eligable for monies that had been set aside to help breast cancer patients because the legal language specified “woman”.

  16. Finn says:

    Wow, some folks appear to feel really distressed (perhaps somehow threatened?) by the notion of addressing someone who has (or had) a scrotum as “her.” OBVIOUSLY medical professionals need to know what organs and meds are on board, what surgeries have been performed, etc. I don’t see how any of that prevents you from addressing a M2F patient as “Ms.” if the patient so desires. How is that any different from Patrick asking you to call him “Pat”?

  17. BoyFromCT says:

    i’m transgender and have a chronic illness. i was born with my illness and will always have it, so i’m not a stranger to doctors offices and hospitals. if i go to a new doctor’s office or if i’m hospitalized, i just explain my situation to the staff and tell them that i prefer male pronouns be used. for the most part, doctors and nurses have been very respectful to me, probably because i never made it into a “i’m special and need to be treated as such!” issue. i’ve even had people ask me if i would mind answering some questions (non-medical questions) because they’ve never met a transgender person before… and i’m more than happy to answer their questions, and i know the importance of making sure they are made aware of surgical procedures i’ve had and what hormones i’m currently taking.
    occasionally, someone will forget and say “she” or use my old name, since it is on my older records. i don’t see that as being transphobic. i see that as making a mistake. heck, even my parents will slip up and say “she” every so often. i don’t know if maybe i’m more easy-going than most people, but i don’t make a big deal about a one-time slip-up.
    the only time i ever experienced true transphobia from a medical professional was when i was in the hospital recovering from my hysterectomy. one of the nurses would refer to me as “it” and told me that what i was doing “just wasn’t natural”.

  18. Zoila says:

    I find the defensive and insensitive comments by those in my field to be quite embarrassing and shameful.

    The issue of what to call someone is an issue of respect.

    A transgendered individual asking you to call them by thier appropriate pronoun is NOT asking you to ignore thier anatomical parts. They are asking that you respect who they are as an individual.

    All of the TG individuals I know, will rapidly explain what their biological anatomy is. They KNOW what thier parts are, their risk. I imagine, like everyone, they simplly want good health care in a respectful environment.

    More importantly, why do you care if M2F wants you to use the pronoun She and her chosen name?

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