Providing Sensitive and Dignified Care to Transgender Patients

Laura M. Cascella, MA, CPHRM

Research shows that people who identify as lesbian, gay, bisexual, transgender, queer or questioning, or another gender minority (LGBTQ+) are at increased risk for preventable injuries and illnesses because of health inequities.¹ Transgender people are a unique population within the LGBTQ+ community and face unique health disparities and barriers to care.

Survey data show that transgender patients are more likely than cisgender patients to have concerns that their gender identity or sexual orientation will result in judgment or affect how they are evaluated and diagnosed in medical settings. Additionally, transgender patients are more likely to report negative experiences while receiving healthcare and adverse consequences because of those interactions. These experiences may result in delays in care or avoidance of care, contributing to poorer physical and mental health outcomes for the transgender population.²

Addressing these issues will require significant efforts that cut across various domains, such as research, public health outreach, advocacy, and more. Yet even small changes can have a meaningful impact and help break down barriers to patient-centered, high-quality care. Below are various strategies that affirming healthcare providers can implement to work toward providing sensitive and dignified care for transgender patients:

• Assess how well your organization is meeting the needs of transgender patients in terms of organizational culture, policies, education and training, the built environment, registration and intake protocols, marketing and advertising, and more.
• Learn about the health issues and barriers affecting transgender patients, such as lack of access to care, stigma, economic disparities, lack of inclusion in health education and outreach, inequitable policies, and more.
• Participate in continuing education opportunities related to cultural competency, trauma-informed care, and best practices for providing care to transgender patients. Do not rely on patients to provide awareness or education. One study found that “trans adults are often burdened by the expectation that they will take on a more active role in their care than cisgender patients, including educating their healthcare providers. . .”³
• Make a purposeful effort to see each patient as a unique individual, and be aware that gender identity is only one factor that contributes to overall identity. Consider how other factors — such as race, ethnicity, education, disabilities, employment, etc. — intersect with gender identity and shape patients’ values, experiences, preferences, and needs.
• Ask transgender patients about what they perceive as barriers to their care and what works best for them in the care setting. Politely request that they provide feedback on how you and your organization can do better in the future.
• Consider including domains related to cultural competence and respectful care in patient satisfaction surveys. Review verbal and written feedback to determine strategies for further improving cultural competence and promoting patient dignity in the practice setting.
• Make sure a mechanism is in place for patients to report concerns and complaints, and develop a protocol to investigate reports of discrimination or unfair policies and practices. Make sure to use the protocol consistently when reports are made.
• Advocate for and support workforce training that raises awareness about health disparities and inequities and teaches strategies that promote health equity and cultural competence.
• Review your patient forms to assess whether they are inclusive and include elements such as:
  • A space to provide chosen name in addition to legal name
  • A space to indicate preferred pronouns
  • A space where patients can voluntarily document gender identity (separate from sex assigned at birth) and sexual orientation
  • Nongendered terms, such as “spouse/partner” rather than “husband/wife” and “parents/guardians” rather than “mother/father”
• Stay abreast of appropriate terminology and meanings in the transgender community, and try to avoid using terms that are considered archaic or offensive.
• Always use patients’ preferred names and pronouns, and make sure this information is clearly indicated in patients’ health records. If you are unsure of a patient’s preferred name or pronouns, politely ask for clarification. Give a sincere apology if you mistakenly refer to a patient using the wrong name or pronouns.
• Assure transgender patients of your commitment to privacy and confidentiality. Do not disclose patients’ gender identities or medical histories to anyone who does not explicitly need the information as part of patient care and treatment.
• Respect patient’s dignity and modesty during all physical exams. For example, ask permission before entering exam rooms, use curtains to block the view of exam rooms from hallways, leave the room while patients undress, provide gowns that fit appropriately and fasten, and properly drape patients during procedures so they don’t feel exposed.
• Ask for patients’ consent before physically touching them. Explain what you’re doing as you’re doing it, and encourage them to speak up if they are uncomfortable. Doing so can help alleviate feelings of vulnerability.
• Work with other providers and staff members in your facility to promote continued awareness of transgender health issues, to address problems or challenges, and to devise strategies that support the delivery of high-quality, equitable care.⁴

Cultural competence is a foundation of patient-centered care and a powerful tool for engaging patients as part of the healthcare team. By understanding patients’ unique backgrounds and needs — particularly patients in minority populations, such as transgender patients — providers can help put patients at ease, instill feelings of dignity, alleviate fears and anxieties, and overcome barriers to care. To learn more about this topic, see MedPro’s Risk Resources: LGBTQ+-Inclusive Care.

Endnotes

¹ Auerbach, J., & Fox, C. E. (2023, May 31). LGBTQ+ health is an essential component of public health equity efforts. Health Affairs Forefront. Retrieved from www.healthaffairs.org/content/forefront/lgbtq-health-essential-component-public-health-equity-efforts; Harvard Medical School. (2023, July 1). How health care leaders can prioritize health equity for the LGBTQIA2+ community. Retrieved from https://corporatelearning.hms.harvard.edu/blog/how-health-care-leaders-can-prioritize-health-equity-lgbtqia2-community

² Montero, A., Hamel, L., Artiga, S., & Dawson, L. (2024, April 2). LGBT adults’ experiences with discrimination and health care disparities: Findings from the KFF survey of racism, discrimination, and health. KFF Polling. Retrieved from www.kff.org/report-section/lgbt-adults-experiences-with-discrimination-and-health-care-disparities-findings/; Medina, C., Santos, T., Mahowald, L., & Gruberg, S. (2021, August 18). Protecting and advancing health care for transgender adult communities. Center for American Progress. Retrieved from www.americanprogress.org/article/protecting-advancing-health-care-transgender-adult-communities/; Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018). Improving healthcare providers’ interactions with trans patients: Recommendations to promote cultural competence. Healthcare Policy, 14(1), 11–18. doi: https://doi.org/10.12927/hcpol.2018.25552

³ Vermeir, E., Jackson, L. A., & Marshall, E. G. (2018). Barriers to primary and emergency healthcare for trans adults. Culture, Health & Sexuality, 20(2), 232–246. doi: https://doi.org/10.1080/13691058.2017.1338757

⁴ Vermeir, et al., Improving healthcare providers’ interactions with trans patients: Recommendations to promote cultural competence; Auerbach, et al., LGBTQ+ health is an essential component of public health equity efforts; Harvard Medical School, How health care leaders can prioritize health equity for the LGBTQIA2+ community; Jaffe, L. (2023, March 10). Five ways to create a gender-affirming practice. MedCentral. Retrieved from www.medcentral.com/behavioral-mental/gender/five-ways-to-create-a-gender-affirming-practice; Levesque, P. (2015, May). Culturally-sensitive care for the transgender patient. OR Nurse. Retrieved from https://nursing.ceconnection.com/ovidfiles/01271211-201505000-00005.pdf; Bass, B., & Nagy, H. (2023, November 13 [last updated]). Cultural competence in the care of LGBTQ patients. StatPearls. Retrieved from www.ncbi.nlm.nih.gov/books/NBK563176/; Coalition Ending Gender-Based Violence. (2016). Demonstrate LGBTQ access: Organizational self-assessment. Retrieved from https://endgv.org/wp-content/uploads/2016/04/Organizational-Self-Assessment.pdf

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