This presentation brings awareness to transgender health care disparities and examines how practicing cultural competency can improve patient-physician relationships.

1. WHAT EVERY PHYSICIAN
NEEDS TO KNOW:
ADDRESSING TRANSGENDER
HEALTH CARE DISPARITIES

2. AWARENESS
• In recent years, 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.

3. 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.

4. GENDER
GENDER NONCONFORMITY IS NO 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.

5. NEGATIVE
EXPERIENCES
• Members of the 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.

6. 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.

7. RISK MANAGEMENT
PERSPECTIVE
• Consider becoming 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.

8. RISK MANAGEMENT
PERSPECTIVE
• The following 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).

9. GENDER
ORIENTATION
• The Centers for 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.

10. PREFERRED
PRONOUNS
• There are multiple 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.

11. PREFERRED
PRONOUNS
• Identifying preferred pronouns 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.

12. AVOID
JUDGEMENT
• Practicing cultural competency 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.

13. AVOID
JUDGEMENT
• Judgement can be 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.

14. EDUCATION AND
TRAINING
• Providing culturally 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.

15. POLICY
• A patient’s gender 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.

16. POLICY
• The Affordable Care 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.

17. ADDITIONAL
READING
• Addressing Transgender Health 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

18. PARTNERSHIP
FOR A NEW ERA 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
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