Substandard medical care for trans people

Helen Ouyang is an emergency room physician at New York-Presbyterian Hospital and an assistant professor of medicine at Columbia University.

Last week she wrote an important essay for the New York Times: A Transgender Learning Gap in the Emergency Room

As an emergency physician, I’m always engaging in a fast-tempo, often awkward, all too stressful dance with strangers. Lately, though, I’ve noticed a particular gap in my own medical education and training, as well as in that of my colleagues, that’s further tripping up our steps: how to provide optimal health care for transgender patients.

The gap is amplified in the emergency room, where even under the best of circumstances the interaction we have with patients is typically rushed and never entirely comfortable — and where I’m usually meeting a patient for the first time and don’t have the patient’s medical history at my fingertips. Because transgender people are less likely to have health insurance and are four times more likely to live in poverty compared to the general population, the emergency room serves as a particularly important safety net for these patients.

Sometimes the patient is registered as the wrong gender immediately from triage, resulting in a strained communication from the get-go. Other times, a staff member lets out a surprised gasp as a patient undresses for a physical exam. Then there are the moments when providers call a patient a “he/she” or “they” on rounds. Private rooms are also hard to come by in busy, overcrowded emergency rooms, and patients may be inappropriately clustered by gender.

None of this, for the most part, is out of malice. Instead it’s because of our own ignorance — and stems from our lack of education and training on providing sensitive and evidence-based care for transgender patients.

Dr. Ouyang

A major part of the problem, of course, is that there has been a huge push to remove us from societal consideration. The most difficult obstacle to transgender equality in all facets of integration of transgender people as equal human beings deserving of equal treatment is the fyndamentalist disavowal that there is any such thing as a transgender person.

Currently, American medical schools’ curriculums are not sufficiently addressing the health needs and concerns of the lesbian, gay, bisexual and transgender community. A comprehensive survey of schools in the United States and Canada revealed that less than five hours in medical schools are devoted to L.G.B.T. health over all; some medical schools reported zero hours of training. While I did learn about providing health care for lesbian, gay and bisexual patients when I went to medical school over a decade ago, I didn’t receive any special education on the particular health needs and concerns of the estimated 1.4 million adults living in the United States who identify as transgender.

--Dr Ouyang

In one study, half of these patients had to teach their doctors about transgender health issues at some point. A Twitter hashtag #transhealthfail started trending in August of 2015, when transgender patients shared stories about their negative experiences with the health care system. Patients continue to use the hashtag today.

These holes in medical education and training can cost lives. Over 70 percent of transgender people nationwide say they have experienced serious discrimination in a health care setting. A third of transgender people postpone — or completely avoid — seeking health care because of the fear of discrimination. One in five have yet to disclose their transgender status to any medical provider.

--Dr Ouyang

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