Discrimination in Trans Healthcare and the Call for Further Provider Education

By | January 26, 2017
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Adequacy of healthcare for transgender patients has recently come to light, particularly with the increased discussion of trans persons in the media. Trans individuals identify their gender differently from their assigned sex at birth. Trans healthcare is an emerging field of research, and this increased focus continues to uncover the lack of knowledge amongst providers about trans health needs.

A recent article by Jaffee, Shires, and Stroumsa, published in Medical Care in November 2016, addresses the impact of discrimination and lack of knowledge amongst providers on delays in accessing needed healthcare for trans patients. Jaffee and colleagues state the most significant finding from their study is that trans patients who must teach their providers about trans health needs are four times more likely to delay needed care than trans patients with knowledgeable providers. The authors note that delays in needed medical care are expensive to the US healthcare system due to overutilization of emergency departments, and delays in care also increase morbidity and mortality for trans patients.

A poignant theme addressed by Jaffee and colleagues is the lack of knowledge amongst providers regarding trans care and the impact this has on delayed access to needed healthcare. Thus, providers and office staff are encouraged to further their education and cultural humility regarding trans health needs.

Various resources and online training modules exist to assist with this furthered education. The National LGBT Health Education Center, a program of The Fenway Institute, recently launched an online series of six training videos for providers about trans-specific health needs. The training series is entitled, Optimizing Transgender Health: A Core Course for Health Care Providers. Additionally, the Center of Excellence for Transgender Health at the University of California, San Francisco (UCSF) offers lectures, online trainings, and easy access to guidelines for trans healthcare. Madeline B. Deutsch, Director of Clinical Services of UCSF Center of Excellence for Transgender Health, recently published Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People, 2nd edition. The World Professional Association for Transgender Health (WPATH) has also recently published Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, which is based on the best scientific evidence to date and expert opinion.

Furthermore, much improved education about trans health needs ought to be included in medical school and residency training. The Association of American Medical Colleges (AAMC) published a 2014 guidebook entitled, Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators, which presents a competency-based medical education framework for addressing the health inequities experienced by LGBT and gender-nonconforming persons, as well as persons born with disorders of sex development.

Finally, a simple way to show respect for trans patients is to use their preferred name and pronouns at each encounter. Based on my professional and personal experiences with trans persons, the correct use of preferred pronouns shows respect for patients and also provides comfort, which has the opportunity to make all the difference in a trans patient’s decision to pursue needed healthcare.

Rebekah Rollston

Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston’s professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.
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About Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston’s professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.