To the Editor:
As a cisgender female, I have not personally faced the discrimination and stigma of being transgender or gender nonconforming (TGNC), but as a friend and coworker of a transgender woman, I have witnessed the prejudice TGNC people brave. I want to commend Hinrichs and colleagues1 for again raising awareness of this issue and meaningfully engaging with the TGNC community.
Studies have repeatedly shown that TGNC patients delay or avoid seeking medical care because of fear of discrimination.2 Yet the overall conclusion from the study by Hinrichs and colleagues1 seems strikingly simple and self-explanatory: “Providing sensitive and competent primary care to TGNC patients involves allowing patients to self-identify, respecting [their] gender identities … and focusing on the whole person—not the trans status of the patient.” This is echoed by another study in which TGNC participants recommended that caregivers (1) use the patient’s preferred pronoun/name and (2) not ask about gender/TGNC experience if unrelated to the visit as the top changes to improve their care.2
I find it disappointing that the health care field is still struggling with such basic essentials of caring for TGNC patients. As medical care providers, we should be doing these things with all our patients: asking their name; using their preferred appellation; not inquiring about private, unrelated issues. Why are we failing to provide this same courtesy to our TGNC patients?
The reason may be rooted in provider discomfort. While there are certainly individuals who are inherently prejudiced, I would venture that most medical professionals are not intentionally providing poor care to this population. Further educational opportunities are needed to improve provider comfort and familiarity with caring for TGNC patients. The literature has previously called for medical training in the complexities of TGNC care (e.g., hormone therapy, gender-affirming surgeries) and improving systems issues (e.g., availability of gender-neutral facilities), but Hinrichs and colleagues instead reaffirm that, for now, we are better off focusing on the basics and reinstating the Golden Rule. So let’s redirect educational efforts at what the TGNC community values most—being treated like people.
Rochelle A. Zarzar, MD
Medical education and simulation fellow, Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; [email protected]
1. Hinrichs A, Link C, Seaquist L, Ehlinger P, Aldrin S, Pratt R. Transgender and gender nonconforming patient experiences at a family medicine clinic. Acad Med. 2018;93:7681.
2. Chisolm-Straker M, Jardine L, Bennouna C, et al. Transgender and gender nonconforming in emergency departments: A qualitative report of patient experiences. Transgend Health. 2017;2(1):116.