Addressing transgender health care disparities

Addressing transgender health care disparities

• 1.
  WHAT EVERY PHYSICIAN NEEDSTO KNOW: ADDRESSING TRANSGENDER HEALTH CARE DISPARITIES
• 2.
  AWARENESS • In recentyears, there has been a significant increase in the awareness of transgender people and the issues they face. Not only must this population meet challenges in the workplace and in society in general, transgender individuals often struggle with accessing and receiving quality health care. • Many medical professionals may not have experience with this patient population or lack comprehensive training for treating or interacting with them.
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  GENDER FOR TRANSGENDER PATIENTS,GENDER IS NOT BINARY — FEMALE OR MALE. • Transgender individuals often identify with a particular gender orientation that does not correspond to their sex at birth. Their gender identity exists along a spectrum and it does not necessarily match their biological sex.
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  GENDER GENDER NONCONFORMITY ISNO LONGER CLASSIFIED AS A DISORDER. • Most transgender individuals do not undergo sexual reassignment surgery due to personal choice, or constraints such as cost or lack of insurance coverage.
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  NEGATIVE EXPERIENCES • Members ofthe transgender community have reported forgoing or delaying health care treatment due to negative experiences. • According to The National Transgender Discrimination Survey, 24% of respondents were denied “fair and equal treatment at a doctor’s office or hospital” with an additional 25% stating they experienced some form of disrespect or harassment.
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  NEGATIVE EXPERIENCES STIGMA, DISCRIMINATION, DISRESPECT,AND HARASSMENT... • Could be exhibited as performing rough or incomplete examinations; asking offensive questions; or using an aggressive tone of voice.
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  RISK MANAGEMENT PERSPECTIVE • Considerbecoming knowledgeable on this topic — being current on policies addressing this community facilitates a compassionate and nondiscriminatory environment. • Fluency on this topic can also protect patient-physician relationships, foster positive patient outcomes, and lower the risk of malpractice and discriminatory lawsuits. Policies and procedures can be developed and implemented to reduce disparities and concerns.
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  RISK MANAGEMENT PERSPECTIVE • Thefollowing actions are recommended to reduce liability risk and build positive patient relationships with members of the transgender community: • identify patient gender orientation at the start of the patient- provider relationship; • identify preferred pronouns; and • avoid judgement (i.e. cultural competency).
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  GENDER ORIENTATION • The Centersfor Medicare & Medicaid Services (CMS) requires EHR systems to have the capability of documenting sexual orientation data.Gender orientation may be overlooked if it is not pertinent to a particular visit, but this information should be on file. This can be done via patient intake forms, given the forms adhere to HIPAA regulations.
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  PREFERRED PRONOUNS • There aremultiple pronouns relevant to the transgender community other than “she” or “he.” For example, “ze,” “zir,” and “they” have been noted. • Improve patient intake forms by providing pronoun options such as, “she/her,” “he/him,” “they/them,” or “other” accompanied by a section to write-in a preferred designation.
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  PREFERRED PRONOUNS • Identifying preferredpronouns allows the patient’s gender identity to be validated and shows respect. When addressing the patient, if a mistake occurs, apologize, as this can have a tremendous impact on the patient-physician relationship. CLARIFYING PREFERRED PRONOUNS ENCOURAGES A POSITIVE PATIENT-PHYSICIAN RELATIONSHIP.
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  AVOID JUDGEMENT • Practicing culturalcompetency facilitates a stronger relationship between the patient and physician. This fosters increased communication — critical to patient care and minimizing medical liability risk exposure. PRACTICING CULTURAL COMPETENCY HELPS AVOID JUDGEMENT OF PATIENTS.
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  AVOID JUDGEMENT • Judgement canbe communicated subtly through tone of voice and body language. When a transgender patient feels they are in a judgement-free environment, they are less likely to delay treatment of future health care needs.
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  EDUCATION AND TRAINING • Providingculturally competent care can be difficult when there is lack of education and preparation in working with this minority patient population. On average, only five hours of classroom learning are spent on the topic of sexual minority health care during a four-year medical program. For physician assistant and nursing programs, a median of 12 hours and an average of 2.12 hours are spent respectively.
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  POLICY • A patient’sgender identity must remain confidential because it is often unclear who is aware of this information outside of the patient- physician relationship. Revealing this information, even unintentionally, could subject the patient to increased stigma and discrimination.
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  POLICY • The AffordableCare Act of 2010 prohibits discrimination on the basis of several factors, including gender, for most health care and health insurance providers.However, in January 2017 the Supreme Court ruled that physicians have the right to not treat transgender patients on grounds of religious differences.
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  ADDITIONAL READING • Addressing TransgenderHealth Care Disparities, the Reporter, 2017 4th quarter edition, https://hub.tmlt.org/reporter/the-reporter- quarter-4-2017 • Building Cultural Competency, the Reporter, 2016 3rd quarter edition, https://hub.tmlt.org/reporter/the-reporter-quarter-3-2016
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  PARTNERSHIP FOR A NEWERA OF MEDICINE ABOUT TMLT: With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. www.tmlt.org Find us on: