Caring for Transgender Patients: First Do No Harm

shutterstock_84259324~by Jennifer Hanrahan, D.O.

Two weeks ago, I took care of a transgender person in the hospital. She had been in the hospital a few weeks, and was just transferred to my service. The residents who cared for her didn’t know how to address her, and the entire chart referred to her as “he,” even though she identified herself as a woman. She was anxious about not being seen as a woman, not about being transgender. She had accepted herself as a woman, but the surrounding world was not yet comfortable with this idea. She told me that she didn’t want other people to be uncomfortable, so she was not dressing as a woman in the hospital. However, this was causing her great distress.

We are getting better. We are becoming more aware, but we are not yet there.

Why does it matter that we figure out our own biases and challenge our own prejudices in this area? Individuals who are transgender are at higher risk for depression and suicide (1), substance abuse (2), and negative health outcomes, including HIV infection. Transgender individuals who are victims of discrimination may be more likely to engage in high risk behaviors, and face significant barriers to healthcare. One of my patients described having been the victim of violence during adolescence because she is transgender MTF. When she comes to the hospital, she is always worried that she will be called by a male name. This is a problem because she identifies as a woman and looks like a woman. Every time someone calls her by a male name, she worries that she will once again be the victim of violence. She deals with this by mostly staying at home and avoiding contact with others. Coming for clinic visits is a big deal for her. She has to get past her anxiety, and build up courage every time she leaves the house. Coming to clinic means putting herself at risk for another emotional trauma. The healthcare system should not be traumatizing those we are here to help. I was ashamed when I realized what had been going on, and my failure to fully grasp the impact on my patients’ lives.

It is hard enough being human in a culture that places such high value on beauty and youth, without having been born into a body that is not concordant with one’s gender identity. We as humans and physicians have an obligation to care for people with empathy and respect, and to recognize where we can be better, where we may be propagating harm, and to stop this from happening.

I’m wondering what others have done to improve healthcare for transgender individuals. Do you have a clear way of identifying the preferred name in the medical record even if it is not legally changed? What challenges have you dealt with?



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Jennifer HanrahanJennifer Hanrahan, D.O. is an infectious disease physician at MetroHealth Medical Center and is medical director of infection prevention at MetroHealth Medical Center. She has served as co-medical director of the Cleveland Department of Public Health, and has extensive experience teaching residents, fellows and medical students. Her areas of expertise include influenza, hospital-acquired infections, legionella, HIV/AIDS, and hospital preparedness for infectious diseases.