Ruminations

Hello Doctor, This Is Me

"This was surprising and worrisome. For example, let's say someone comes into the ER with abdominal pain and they identify and present as male. If I assume that person is male and don't create a space for them to disclose that they have ovaries, I may not be able to provide the best medical care."
"Young people said they didn't know how to bring it up [transgender disclosure]."
"So, it can be a combination of both not having the language to start the conversation and not having a [medical] provider open the door for them."
"Young people I take care of have talked about negative experiences after disclosing their gender identity to a pediatrician or primary-care physician, so they were fearful about doing it again."
"I often also ask them to tell me if their gender is something they would like to talk about or have questions about."
"It is up to us as health care providers and health systems -- not transgender patients themselves -- to adapt and ensure healthcare environments are more welcoming for patients of all gender identities."
Dr.Gina Sequeira, Children's Hospital of Pittsburgh

"People don't always volunteer all the information one needs as a medical provider, and it's important to ask. And if you start going to topics that are more uncomfortable to ask about, such as sexuality and gender identity, it's only going to be worse."
"Here, just in December, we finally got pronouns put into the computer system so we could collect that information at registration."
Dr.Joshua Safer, executive director, Mount Sinai Center for Transgender Medicine and Surgery, New York City

The most common reasons cited by respondents in a recent survey for not revealing their gender identity were "feeling uncomfortable" and "not knowing how to bring it up." Photo by valelopardo/Pixabay

According to findings from a recent U.S. study, survey results disclosed that close to half of transgender teenagers and young adults in the United States sometimes fail to disclose their gender identity from health-care providers. This was revealed through a survey of over two hundred transgender youth, that most tended to share their gender identity with some doctors, yet 46 percent admitted they had on occasion avoided such revelations irrespective of whether they felt that to do so could be important for the treatment they would be exposed to.

Dr.Sequira who led the study noted that the patient's pain could conceivably be a result of a problem with an ovary, and if a teen presenting as male failed to disclose that physical reality, significant health detriment could ensue should the attending doctor fail to recognize the underlying presentation. So the question arose, what would cause a transgender teen or young adult to fail to apprise a doctor of their gender identity? Though the researchers failed to ask that question straight up, they left opportunity for survey participants to add comments.

It became clear that some were concerned of possible fallout resulting from disclosure. Which led Dr. Sequeira to recommend that physicians begin the session by introducing themselves with both given and surname, adding the pronoun appropriate to their personal situation, as a way of 'opening the door' to a frank disclosure on the part of the patient. There were two survey questions of particular interest to the researchers:

Have you ever chosen to tell a health-care provider outside of the gender clinic about your gender identity?
Have there been times you felt it could be important for your health-care provider to know your gender identity but you avoided telling them?

The takeaway from responses was that 78 percent of the young transgender people had informed someone not connected to the gender clinic of their gender identity, but at the same time, 46 percent had chosen to avoid disclosing their gender identity at some point. Close to half the young respondents -- 47 percent -- stated their preference, that the health-care provider be the one to initiate the discussion relating to gender as compared to 25 percent who said their preference would be to bring the issue up themselves.

These are findings that correlate to what is to be found in other areas of health care, pointed out Dr.Safer of Mount Sinai, who recommended a way for physicians to be enabled to initiate conversation; simply by including questions, such as preferred pronouns, on the registration sheet itself, relieving both patient and doctor of the initial face-to-face discomfort of revelation, should any exist.