(Tones Drop) ….
(Dispatch) – Medic 1 respond to an 18-year-old male with severe abdominal pain.
My partner and I go en route, and being the medic, I am thinking about all the possibilities of what could be going on with the patient. We get on scene and find an 18-year-old transgender male with severe left sided abdominal pain. What do we do in this situation? How do we handle medical questions tactfully? We want to be as sensitive and inclusive as possible without obstructing our ability to care for our patient properly and promptly.
The LGBTQIA+ community is part of our society. For a study, I examined multiple accounts of transgender, transitioning, and/or gender non-conforming (GNC) people in the community that utilize the local healthcare system. These people were asked what the healthcare system could do to make them feel more comfortable. The answers were almost uniform in nature and highlighted a bigger problem in healthcare. The healthcare system overall does not tend cater to anything outside of the biological normative. The same lines of questions have been on the healthcare forms for decades. They face significant obstacles in acquiring culturally knowledgeable healthcare regardless of proposals by specialized groups and the establishment of antidiscrimination laws.
This study investigates interaction and technical impediments to GNC and transgender healthcare and recommends pragmatic measures to help improve inequalities and unfair treatment. Some ways healthcare can improve to better assist: proper staff guidance, primary patient contact, office atmosphere, registration/record methods, privacy, cognizance and acquiescence of antidiscrimination laws, and outreach programs. Taking the feelings and needs of the patient and making those come first can improve healthcare and overall quality of life. This also has an impact on the billing system and those outside of the LGBTQIA+ communities. By initiating a feedback loop during initial patient contact, the healthcare system can continuously improve to better the interaction and become culturally capable and truly inclusive.
It is essential to comprehend the difference in the definition of “gender” and “sex.” Even though frequently these two are mistakenly used to mean the same thing, they have different medical and psychological meanings. “Gender” symbolizes identity and individuality, whereas “sex” symbolizes the external physical attributes. The transgender person identifies as a separate gender than that of which they were born (aka cisgender), which is different from their sex.
As a paramedic, I theorized that since we take care of transgender and GNC patients, there had to be a better way to assist practitioners in working with the LGBTQIA+ community including education and there had to be a way to assist the LGBTQIA+ community to feel safer and more respected in healthcare. I have had the pleasure of knowing many gender non-conforming patients (GNC). I try to instill empathy with all my patients, not just those from the LGBTQIA+ community.
Related: Trans Safe Employee Space
Out of the twelve patients I have reached out to for this article, all twelve patients have unanimously agreed that the biggest disappointment in healthcare is being misgendered (not being called their pronouns) as well as being called by their deadname (the name given to them at birth). They believe that if healthcare can fix those two things, that would be a huge win for the community, and they would feel respected, as any patient should.
According to the 2015 U.S. Transgender Survey, one-third of transgender people stated they had undesirable interactions with health workers in the previous year, mainly because of being misgendered, being called the wrong name, health workers refusing to affirm their gender identity and being forced to enlighten cynical or ill-knowledgeable health workers. This survey substantiates what my transgender patients have told me about their dealings with the healthcare community.1
The patient in the scenario was treated for a ruptured ectopic pregnancy and needed surgical intervention that was unavailable at the closest facility. Had EMS not known to ask for the patient’s assigned sex at birth, pronouns, and legal name, the outcome may have been devastating. It is examples like this that should prompt the need for an unbiased and uniform way to ask all patients what pronouns they use and their preferred name. If the healthcare system makes it a habit to ask everyone these questions, then it will become second nature.
Some healthcare already does this for nicknames by adding it beside the first name in quotes, for example: Rebecca “Becky” Lynn Smith. This is harmless for a nickname; however, for a transgender person, this could be devastating to see Amanda “Frank” on the first line. Legal names have a place in medicine and in billing, and that place is in the electronic patient care report (ePCR) and not in the interview process. The chosen name belongs in the interview portion of healthcare, known to those taking-over care for continuity and transgender knowledge.
Considering the feelings and needs of the patient and making those come first can improve healthcare and overall quality of life. This also has an impact on the billing system and those outside of the LGBTQIA+ communities. By initiating an open feedback loop during initial patient contact, the healthcare system can continuously improve to better the interaction and become culturally capable and truly inclusive. It is the practitioner’s job to “first, do no harm,” and that includes emotionally scaring our patients. There are medical concerns to calls such as the one discussed, to include the use of hormone replacement and the lack there of. There are many psychological, anatomical, physiological and pathophysiological implications associated with caring for transitioning/transitioned patients.
I propose the electronic care report (ePCR) needs to have a section that says legal name and one that says preferred name or chosen name as well as a section for pronouns. Ask those two things on every patient to make asking second nature. Introduce yourself and ask them: “What would you like me to call you?” Then let the transgender patient know that for billing purposes and medical records, you must ask them their legal name.
- James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive Summary of the Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. https://www.ustranssurvey.org/reports.