Diversity Matters

transgender, discrimination: Caitlyn Jenner, formerly Bruce Jenner, brought the limelight to transgender issues last year during her transition.FigureFigureFigureFigure“Whatever affects one directly, affects all indirectly.” — Martin Luther King, Jr., letter from a Birmingham Jail, AL, 1963 Transgender patients, because they are more likely to lack adequate health insurance and access to basic medical care, are also more likely to need emergency medical services, but their fear of discrimination and prior negative experiences also make them more likely to avoid seeking care. One study reported these poor experiences as high as 21 percent for all emergency department encounters for the transgender community in Ontario, Canada. (Ann Emerg Med 2014;63[6]:713.) The authors attributed bad encounters to health providers' lack of experience with transgender patients and insulting behavior. These issues place transgender patients at risk from inadequate emergency care, and merits the need for emergency departments to place heavier emphasis on improving the experience of transgender patients. Transgender individuals, those whose gender identity differs from their sex, is a subgroup of the gender nonconforming community, individuals who do not follow other people's ideas or stereotypes about their looks and behaviors based on their sex. Transgender topics have been covered more in the news and on social media in recent years, and efforts to destigmatize the transgender community have been supported by research suggesting that genetic variations, hormones, and brain structures were causes of disharmony between gender identity and phenotypic sex. (Gynecol Endocrinol 2004;19[6]:301.) This research also suggests that gender identity is not a dichotomous male or female designation, and argues that it may be a trait that lies along a spectrum. Society's use of physical characteristics to define gender identity can lead to emotional distress for those who disagree with this definition. For some individuals, this distress leads to gender dysphoria, a new DSM-V term aimed at eliminating the stigma attached to the former term, gender identity disorder. The psychiatric and medical conditions associated with the transgender community are just as important to understand as the conditions associated with other minority populations. This population also has a higher rate of suicide, potentially related to their higher rate of anxiety and depression. Unfortunately, these patients are also more likely to be victims of hate crimes, sexual/physical assault, and intimate partner violence. (Ann Emerg Med 2015;66[4]:417.) All of this information means transgender patients are more likely to need emergency medical services. Building Trust The first step toward improving the transgender patient's experience is to educate emergency physicians and staff on issues pertaining to their health. Studies have shown that a barrier to providing adequate care is physicians' lack of knowledge on specific gender nonconforming medical issues. That study from Ontario, Canada, reported that 54 percent of transgender patients had to educate their physicians on transgender issues. This void in knowledge can dismantle the patient's trust in health care. Emergency departments can remedy this by including gender nonconforming topics in their cultural competency curriculum, such as paying attention to laws surrounding single-sex bathrooms, health insurance, and spousal rights and how they may influence patient encounters. Emergency departments can also consider recruiting and hiring physicians and staff from the lesbian, gay, bisexual, transgender, and queer (LGTBQ) community to show the gender nonconforming population their commitment to diversity and inclusion. These efforts should also address prehospital care and be supported by the greater hospital administration, working toward creating a safe space to treat transgender individuals and discuss social and medical issues affecting these patients. Improving the emergency department encounter for the transgender community will not be an easy task. Some embrace the conversations and changes, but others may not fully engage in the movement due to personal beliefs. There will also be resistance because the rights of the transgender community are wrapped up in national and state legislation, which may limit the changes an emergency department can make. Regardless of the personal convictions of emergency physicians and government regulations, emergency departments must address the factors that lead to poor patient experiences among transgender patients. Ignoring the deficits in emergency health care delivery to transgender patients will only set a precedent to ignore deficits in care for other at-risk minority groups. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

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