Open communication facilitates dignity and respect in care of gender-diverse patients

According to a 2020 report from the Center for American Progress, 15 percent of LGBTQ Americans reported that they postponed or avoided medical treatment due to discrimination, including nearly 30 percent of transgender respondents. Providers’ knowledge and understanding of appropriate terminology, language, and expression are necessary to ensure respectful, safe, and inclusive communication with LGBTQIA+ and gender-diverse patients.

The best way to identify a patient’s gender is to ask and mirror the language they use to describe themselves, said Lina Rosengren-Hovee, MD, MPH, MS, in the Saturday session Dignity and Respect: How to Welcome and Care for Gender Diverse Patients in Your Practice. She also noted terminology to avoid, such as “trans man” or “trans woman,” phrases that make an unnecessary distinction in gender. If providers ask questions related to a person’s gender or sexual orientation, they should take the time to explain why the question is relevant to the examination they’re performing.

“Being compassionate and open-minded improves your patient-doctor relationship and tells the patient you care about their overall health and well-being,” explained Dr. Rosengren-Hovee, Assistant Professor of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill.

The session is available for on-demand viewing for registered ACR Convergence participants through October 31, 2023, on the virtual meeting website.

According to Dr. Rosengren-Hovee, providers need to be aware of the trauma and vulnerabilities that many LGBTQIA+ individuals have experienced during healthcare interactions in order to create a supportive clinical environment.

While discussing sexual activity with a patient, she recommended using language that is neutral, straightforward, and specific. When examining a patient’s body, providers should ask permission first and explain throughout the examination why they’re checking different areas.

“Be willing to learn, be willing to engage, be willing to apologize for mistakes, and be willing to enjoy working with this really wonderful, fun population,” Dr. Rosengren-Hovee said.

Nathan Levitt, FNP-BC, MSN, RN, BSN, MA, Director of LGBTQ and Gender Justice Learning, Yale School of Nursing, discussed how rheumatology providers can enhance their clinical skills when treating transgender and non-binary (TGNB) patients. During his time in primary care, Levitt recalled interacting with many TGNB patients who said they had never sought care before.

“Transgender and gender non-binary patients might have more chronic health issues, not related to being trans, but related to the discrimination they face when they try to come in for care,” Levitt said.

When a person is transitioning, it can mean that they are starting hormone therapy, having gender-affirmation surgery, or have decided to go by a different pronoun or name. Providers need to ask these patients relevant questions about their transition in a supportive and inclusive way to gain a full picture of the patient’s health, such as what their transition means to them, whether they’re taking hormones, or if they underwent gender-affirming surgery, Levitt said.

“You might not be managing these surgeries, but you still want to know about what these surgeries are and be able to refer your patients that need them,” he explained.

He urged attendees to integrate TGNB care into their practices by discussing inclusive strategies within their institutions, identifying potential systemic barriers to these practices, and clearly defining the levels of support necessary for implementation.