Trevor, a 25-year-old male, arrives at the local health clinic to get a physical
ID: 241403 • Letter: T
Question
Trevor, a 25-year-old male, arrives at the local health clinic to get a physical for work. He notices the forms ask for his current gender identity and his sex at birth. He is surprised but glad to see that the clinic might actually be trans-affirming. A woman family nurse practitioner (FNP) enters, greets him pleasantly, and asks, “What brings you in today?” Trevor reports that he has not seen a physician in over six years. The FNP notices his paperwork and says, “Well, welcome to being a woman.” Trevor is horrified. He thought that this clinic would be different, especially with the forms he filled out earlier. Trevor tells the FNP, "Didn’t you see how I identify? I’m not a woman; I’m a man!” The FNP tries to gather herself and says, “I am so sorry, I did not see that. This is new to me, and I am slowly learning how to treat our patients who identify as transgender. Let’s try this again.” Trevor accepts her apology and proceeds to tell the physician that he has not seen a doctor for many years because of treatment like what just happened. He mentions he needs a physical for his new job. The FNP tells Trevor to let her know if she says something not correct regarding his body parts, offers him a gown (in case he is shy about his body), and begins conducting the physical exam and ordering required tests, explaining each step in the process to him as she does it. Trevor is feeling more comfortable with the FNP and begins to share more about his medical history.
question to be answered
Discuss the assumptions the FNP placed on Trevor prior to looking at the forms he filled out.
Discuss how the FNP in this case provided good patient care. How can her care be improved?
Explanation / Answer
Create a Supportive Environment
To a transgender patient, how they identify is more important than their sexual equipment.
If all else fails, “you” and “your” work great.
On that subject, ask the patient the name s/he prefers. A patient’s legal name may be Michael, but she prefers Debra.
But verbal language is not the only kind of communication.
Does the healthcare space offer symbols of inclusivity? A rainbow flag or poster about World AIDS Day can go a long way.
Ensure that forms cater to transgender individuals. There should be a section for preferred name, sexual orientation, gender identity, and “partner” information.
Rework assessment questions with hetero-preferential word choices. Even LGBTQ members on your team can set the stage for open interaction.
Setting the Pace for Self-Disclosure: Let the Transgender Patient Lead
The transgender patient may be slow to reveal much about themselves. Negative experiences can do that to a person.
Cultivate patience. Over time, the individual will feel assured that the environment is safe for self-disclosure.
Gender Transitions Happen Slowly
Transgender identity is a process. Individuals may fall at different points along the transition spectrum.
A transgender man is a person assigned female at birth but who identifies as male. A transgender male patient may have taken hormones and/or had breast reduction surgery, but may or may not have female genitalia.
A transgender woman is a person assigned male at birth but who identifies as female. A transgender woman may have a female voice and breasts, and also the male genitalia that genetics gave her.
Don’t assume she will use a bedpan. Instead, ask “Is there anything else you need for your physical comfort?”
Put Yourself In His High Heels
Transgender individuals often avoid or postpone preventive screenings.
Many can’t endure the thought of a repeat of a past experience. And, some fear the looks when others assess that they are walking into the “wrong” type of clinic.
A transgender male may be stressed by having to sit in a mammography waiting room with women.
He has a right to be there, though. His residual female breast tissue warrants a mammogram.
Likewise, a transgender woman still has a prostate needing an annual check.
Nonetheless, quality care includes good information to help patients protect their health and life through early screening and detection.
Get familiar with recommended screenings for transgender men and women. Be ready with the correct information and protocol.
Don’t act surprised or flustered. This heightens tension and can shut down any chances you had at having an open discussion.
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