Transgender Persons Face Challenges When Seeking Clinical Care, Including Decisions About What Information to Disclose and Risk of Substandard Care
Researchers conducted a qualitative study to investigate transgender people’s experiences with sharing health information in clinical encounters. They held seven qualitative focus groups with 30 transgender adults living in North America. Four themes emerged: 1) Transgender people often perceive clinicians’ questions as voyeuristic, stigmatizing, or self-protective; 2) Patients describe being pathologized, denied, given substandard care, or harmed when clinicians learned they are transgender; 3) Transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; and 4) Improving the safety of transgender people is difficult in the context of contemporary medical systems. The authors conclude that transgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and system changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings.
What We Know: Many transgender people experience mistreatment in health care encounters, which can include harassment, assault, and denial of care. Understanding the experiences of transgender people when their gender identities are known to clinicians and the reasons transgender people may share, modify, or withhold information, could yield important clinical insights.
What This Study Adds: The authors present short-term and long-term steps toward reducing ontological oppression and its health consequences. These include family medicine clinicians 1) ensuring their questions are medically relevant and explaining their medical relevance to patients, 2) avoiding putting information in patients’ EHR that may be used to stigmatize them, 3) advocating for patients who are stigmatized by other clinicians, and 4) shifting medical culture by ensuring formal curriculum, guidelines, and patient-facing forms and documents be inclusive of transgender people.
Transgender People’s Experiences Sharing Information With Clinicians: A Focus Group–Based Qualitative Study
Ash B. Alpert, MD, MFA, et al
Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut; Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
Pre-embargo article link (Link expires at 5 p.m. EDT Sept. 25, 2023)
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The Annals of Family Medicine