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Transgender and Gender Nonconforming Patient Experiences at a Family Medicine Clinic

Hinrichs, Amanda DO; Link, Carrie MD; Seaquist, Lea RN; Ehlinger, Peek MD; Aldrin, Stephanie; Pratt, Rebekah PhD

doi: 10.1097/ACM.0000000000001837
Research Reports

Purpose Transgender and gender nonconforming (TGNC) patients have a wide array of often negative experiences when accessing health care, and may encounter insensitive or subcompetent care; thus, the authors conducted a qualitative study with patients at one family medicine residency clinic to assess how primary care clinics can improve care for TGNC patients.

Method In 2015, the authors held three separate focus groups at Smiley’s Family Medicine Clinic in Minneapolis, Minnesota. They invited diverse TGNC participants who have accessed TGNC-related and/or primary care at Smiley’s. The authors analyzed and coded data using a grounded theory approach with NVivo10 (QSR). The authors also administered short demographic questionnaires and analyzed the results with REDCap.

Results Twenty-three patients participated in the focus groups, and 22 completed the survey. Gender identities among the participants were diverse. Four main themes emerged: (1) shared negative experiences with health care, (2) the need for sensitive and inclusive primary care, (3) defining TGNC-sensitive care, and (4) the challenges of mainstreaming TGNC-competent care into primary care settings.

Conclusions Providing sensitive and competent primary care to TGNC patients involves allowing patients to self-identify, respecting the gender identities of every patient, and focusing on the whole person—not the trans status of the patient. Education and training on TGNC care at a clinic-wide level is needed.

Supplemental Digital Content is available in the text.

A. Hinrichs is a fellow, Hospice and Palliative Medicine, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; ORCID: http://orcid.org/0000-0001-8045-4106.

C. Link is assistant professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

L. Seaquist is research coordinator, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

P. Ehlinger was, at the time of this research, a medical student, University of Minnesota Medical School, Minneapolis, Minnesota, and is now a resident in family medicine, Alaska Family Medicine Residency, Anchorage, Alaska.

S. Aldrin is a medical student, University of Minnesota Medical School, Minneapolis, Minnesota.

R. Pratt is assistant professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

An AM Rounds blog post on this article is available at academicmedicineblog.org.

Other disclosures: None reported.

Ethical approval: This study was approved by the University of Minnesota Institutional Review Board.

Previous presentations: Select focus group results were presented at the Promoting Health Equity Conference in May 2016, Minneapolis, Minnesota, and at the U.S. Professional Association for Transgender Health Conference in February 2017, Los Angeles, California.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A466.

Correspondence should be addressed to Amanda Hinrichs, 516 Delaware St. SE, 5-255 Phillips-Wangensteen Building, Minneapolis, MN 55455, telephone: (414) 418-2642; e-mail: hinr0061@umn.edu; Twitter: @a_hinrichs.

© 2018 by the Association of American Medical Colleges