Barahona 1
Patricia Barahona
Ms. Myrtetus
English 1A
13 April 2015
We All Have Medical Care Rights
Despite advances in medicine and theories on the best way to care for patients,
there remains a lack of information and research into the needs of LBGT needs, particularly
transgender individuals. Health care providers are not “culturally competent in and
knowledgeable in LGBT health” (Lim, Brown, and Justin Kim). Instead, transgender patients
face discrimination, harassment, and rejection. This results in transgender individuals receiving
culturally incompetent care or, in some cases, avoiding medical treatment all together. Many
health institutions do not currently have policies in place that protect transgender patient rights.
Thus, not having policies in place that address the unequal medical care provided to underserved
transgendered patients, is a current problem in today’s hospital settings.
According to the American College of Obstetricians and Gynecologist, the word
Transgender is a term used broadly for people who’s “gender identity differs from their assigned
sex at birth” (ACOG). Gender dysphoria is a medical diagnosis for “patients who have
discomfort or distress caused by a discrepancy between their biological gender and gender
identity” (Emmanuel and Wilczynski). Transgender people come in “all shapes, sizes, ages,
races, sexual orientation, socio-economic levels, and educational backgrounds” (USCF). While
discrimination in health care institutions also affects transgender children, we will only refer to
adult transgender patients for the purpose of this research paper. The terminology that will be
used is Transgender.
Barahona 2
Although there is limited data to support claims, through anecdotal evidence, it is known
that transgender patients “have particular health disparities as compared to the overall
population” (AMCA). The challenges patients face are finding adequate medical care that
provides equal care to their health needs. Many times, patients feel judged, misunderstood, and
are rejected by health care professionals because of their gender identity. A survey conducted by
the National Center for Transgender Equality and the National Gay and Lesbian Task Force,
found that nineteen percent of participants “reported being denied care because of their
transgender status” (Zunner), and “twenty-nine percent cancel or do not show up for scheduled
appointments because of the discrimination they feel from staff” (Wichinski). Because of the
ongoing problem in the health care system, transgender patients decline to seek medical
treatment. Past experiences have isolated these patients and forced them to deal with health
issues without the guidance of a health care professional. This is a direct result from lack of
information, knowledge, and lack of policies in place to address best practice for transgender
patients. By not having established policies in place, that protect transgender patients, has made
it difficult to hold those who are discriminant towards them, accountable for their actions.
There are speculations as to why some health care providers are reluctant to provide care
for transgender patients. It is implied that some lack knowledge in trans–health and “often the
problem stems from health professionals being scared of practicing beyond their competency or
beyond the scope of their licensure” (Hansel). Because of the limited data availability, more
research is needed to prove this allegation.
*Chantel is a Registered nurse at a hospital in Los Angeles, California. Chantel is a
transgender woman (Chantel requested to use her alias for this research paper). Chantel is one of
many transgender patients who has had the misfortune of having horrible experiences during her
Barahona 3
many hospital stays. Chantel described how humiliated and misunderstood she felt by her nurses
and physicians. Basic human necessities were neglected by staff. Something simple like
requesting towels for a bath were not provided, being assisted to have a bath was not provided;
being addressed as Mr. instead of Miss was always an issue. Chantel endured this because as she
states:
“I was sick and needed to be admitted. Had my illness not been so severe, I
would have walked out and filed a complaint. I chose not to take that route
because I was afraid of the repercussions I could face while being in the hospital.
I just stayed in my room and tried not to call too much in hopes that that would
help my case and the staff would at least think of me as one of the good patients
who doesn’t bother all the time.”
Chantel also mentions that during her hospital stays, she was very young and knew that
transgender individuals were discriminated by many and felt ashamed for being herself. She
states
“If there had been federal laws in place that protected transgender people during
my youth, hospitals would have had policies already in place that protected those
rights under federal law. Maybe I wouldn’t have had to endure the humiliation I
did. Maybe I could have fought for my legal rights, demanded respect and
demanded to receive the same care that cis-gender patients receive. Now that I am
older and work in the health care field, I know better.”
This is the testimony of one person, who first handedly faced discrimination in the medical field
in the early 2000’s. Chantel says she wants to bring awareness to her facility in the importance of
Barahona 4
having policies in place for transgender patients, so that they feel protected within the facility
and know that their rights will be respected.
The best way to begin closing the gap on unequal medical care for transgender patients is
by training future physicians and hospital staff on how to effectively provide the best care. By
training staff to increase their knowledge and sensitivity toward transgender patients, it will help
“facilitate a positive experience for the patient” (ACOG). Future health care professionals will be
more open minded and comfortable with providing care to all patients whether they are cisgender or transgender and all in between. Having an all patient–centered care in place, many of
our transgender patients would feel more comfortable seeking medical care. With a simple
acknowledgment of who they are and how to properly address them with the proper pronoun
they prefer, many would not put their health and overall well-being at risk to the dire point of
death. The website commonhealth.org has an article aimed toward physicians and nursing staff
on how to effectively provide and communicate with transgender patients. Doctors should not be
afraid to ask their trans-patients questions on how they would like to be addressed. By using
these resources, health professionals will be able to further promote a safe, accepting, and
welcoming environment.
From a nursing perspective, a nurse’s responsibility is to provide “culturally appropriate,
sensitive care” (ACOG) and advocate for their patients over all well-being during their hospital
stay. Patients should know that nurses are there to look after their best interest. They are put in a
position in which they are “vulnerable because of their health care needs and ust trust that their
clinicians- who have the knowledge and skill to meet those needs- will hold their best interests as
the primary concern” (Zunnar). Nurses can help transgender patients feel comfortable with the
care they are being provided, by simply acknowledging they are human beings and using the
Barahona 5
name and pronoun they choose to be addressed by. Nurses should provide a “safe and
trustworthy environment” (Wichinski) for patients and “reassure patients about confidentiality”
(Wichinski) by respecting patient privacy, respecting their gender identity, providing the best
care that cis-gender patients receive, Nurses will make a difference in a patients stay at the
hospital tolerable, maybe even pleasant. This can be achieved by having policies in place that
will help protect the patient’s rights.
Possible solutions have been brought up by multiple organizations to help ensure that
transgender patient’s rights are validated and not violated would be to encourage hospitals to
create institutional policies that outline equal patient rights for all, guidelines for staff who come
into direct contact with the patient, training sessions for all staff, online module training, annual
in-services, etc. Hospital administration should consider revising documentation forms to reflect
“transgender option” (AMSA) when asking for gender of the patient, or “leave a black space”
(AMSA) where the patient may specify their gender. By making small changes to paper work, it
signals that this change “is a sign of acceptance” (ACOG). Installing gender neutral restrooms
(unisex) throughout the facilities will “go a long way toward alleviating stress and eliminate[e]
barriers to health care” (UCSF). Simple changes will go a long way to make transgender patients
feel welcome and safe at health institutions.
The Center of Excellence for Transgender Health at the University of California, San
Francisco, has created a resource called the Primary Care for Protocol for Transgender Patient
Care, where they provide guidelines on how to provide the best possible care to transgender
patients. The Transgender Law Center has created a pamphlet where ten tips are outlined to help
improve services for transgender patients, which health institutions can adopt and apply to their
individual facilities. The Lambda Legal organization has published a handbook: Creating Equal
Barahona 6
Access to Quality Health Care for Transgender Patients: Transgender Affirming Hospital
Policies, which provides information to hospitals on how create or adopt and modify policies to
better fit individual health institutions. The Joint Commission has also published a handbook:
Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered
Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide, in
which it is evidence based and the focus is on the LGBT community. It covers health care
leadership; provision of care, treatment, and services; the workforce; data collection and use; and
patient, family, and community engagement. It also suggests that health care officials develop or
adopt non-discriminant policies, ensure equal visitation, incorporate a broad definition of family
into policies; have disciplinary process in place for disrespectful, intimidating, discriminatory
behavior to patients and or staff. “The Joint Commission stated, in the United States ‘federal
statuses prohibit discrimination on the basis of race, color, national origin, age, disability, and
sex in virtually all hospitals nationwide.’” (Lim, Brown, and Justin Kim) With these changes in
place, everyone would be held accountable for their actions, the hospital would be ensuring all
patients are receiving the best care their staff can provide, and where it provides information on
how health organizations can incorporate guidelines, policies, and create a welcoming
environment for transgender patients.
Malcolm Gladwelll states in his book Outliers, “The Rosetans were healthy because of
where they were from, because of the world they had created for themselves in their tiny little
town in the hills” (pg 9). We can be that little town that makes a difference in our community.
By embracing everyone who is part of that community, we show we care about the well-being of
everyone. Small changes make an immense difference in someone’s life. By simply making
those small changes, society can lessen the hardships transgender individuals face. The
Barahona 7
healthcare system can also make a difference by including in their facilities policies that protect
transgender patients, changes in their documentation to reflect gender options, staff training that
cater to transgender patients, education for physicians and nurses to broaden their knowledge,
creating a welcoming atmosphere to patients of all gender. By making these small changes, our
transgender individuals will feel accepted and seek medical care, lessoning the chance of health
risks that may be prevented, for a healthy life among the community.
Barahona 8
Work Cited
“Center of Excellence for Transgender Health.” Primary Care Protocol for Transgender Patient
Care: Transgender Patients.Web. 29 Mar. 2015.
“CREATING EQUAL ACCESS TO QUALITY HEALTH CARE FOR TRANSGENDER
PATIENTS.” Lambda Legal. Web. 1 Apr. 2015.
<http://www.lambdalegal.org/sites/default/files/publications/downloads/fs_transgenderaffirming-hospital-policies.pdf>.
Gladwell, Malcolm. Outliers: The Story of Success. New York: Little, Brown, 2008. Print.
Hansel, Jeff. “Discrimination in Health Care Industry Common for Transgender People.”
(September 2014): n. page. EBSCOhost. Web. 29 Mar. 2015.
Jointcommision.org. Web. 16 Apr. 2015.
<http://www.jointcommission.org/assets/1/18/LGBTFieldGuide_WEB_LINKED_VER.p
df>.
Lim, Fidelindo A., Donald V. Brown, Jr., and Sun Min Justin Kim. "Addressing Health Care
Disparities in the Lesbian, Gay, Bisexual, and Transgender Population: A Review Best
Practice." American Journal of Nursing 114.6 (June 2014): 24-34. Ovid. Web. 29 Mar.
2015.
“Transgender Health Resources.” Transgender Health Care. American Medical Student
Association. Web. 29 Mar. 2015.
Barahona 9
Wichinski, Keith A. “Providing Culturally Proficient Care for Transgender Patients.” Nursing 45
(February 2015): 58-63. Ovid. Web. Mar.-Apr. 2015.
Wilczynski, Cory, and Mary Ann Emmanuel. “Treating a Transgender Patient: Overview of the
Guidelines.” Postgraduate Medicine 126 (November 2014): n. page. CINHAL. Web. 29
Mar. 2015.
Zunner, Brian P., and Pamela J. Grace. “The Ethical Nursing Care of Transgender Patients.”
American Journal of Nursing 112.12 (December 2012): 61-64. Ovid. Web. 29 Mar. 2015.
“10 Tips for Working with Transgender Patients | Transgender Law Center.” Transgender Law
Center. Web. 29 Mar. 2015.
“12 Tips For Nurses And Doctors Treating Transgender Patients.” CommonHealth RSS. Web.
29 Mar. 2015.