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Henry Ng, MD, MPH, an internal medicine physician and pediatrician in Cleveland who specializes in the treatment of lesbian, gay, bisexual, and transgender (LGBT) patients, walked into an exam room to meet a patient several years ago. The patient was 65 years old and presented as a man.
“Oh,” the man replied. “I’m here to transition.”
Dr. Ng immediately regretted how he had addressed the patient. In this case, his normally innocuous greeting could have been harmful. The man did not identify as a man – as “Mister” – and this could have derailed the health care encounter, Dr. Ng said. Luckily the patient corrected him.
“I made an assumption about this person based on the cues that I saw and I misperceived this person’s identity,” he said. “A patient less comfortable in their skin may have left. And a younger patient would likely have been offended if I had met and misgendered them.”
If Dr. Ng could make this kind of error, it’s clear how easy it is for clinicians with less training and experience to make clumsy assumptions about gender identity.
Even with wider societal awareness of gender identity issues, the cultural sensibilities and training among hospitalists and other clinicians required for quality care of transgender patients is still lacking, Dr. Ng said. Unfortunately, many physicians may have little interest in providing this care, or lack the skills for it, he said.
In the hospital, patients already feel vulnerable because of their medical conditions, and treating transgender inpatients may require additional layers of complexity, experts say. For instance, how should a physician address a patient? The initial encounter can have a huge impact on the clinician’s ability to earn the patient’s trust, and sets the tone for the entire hospital stay. Which bathroom should a transgender patient use? What unique family issues must clinicians be aware of? Transgender patients may be more likely to have simmering tensions with immediate and extended family, and may not want certain family members involved in medical decisions.
Physicians and nurses must be aware of these issues to create a welcoming and logistically sound environment, said Nicole Rosendale, MD, a neurohospitalist at the University of California San Francisco who has a special interest in LGBT care.
Dr. Ng noted that even the information technology clinicians rely upon may not be optimized for transgender patients. For instance, he said electronic health records may pose problems if they haven’t been adapted to include the necessary gender identity options or preferred names and pronouns.
“Most electronic health records are fairly binary-driven,” Dr. Ng said. “Our transgender patients turn that model on its head. We have had to create many additional workarounds.”
Need for more training
Hospitalists will increasingly find themselves caring for transgender patients, as more people openly claim a gender identity outside the traditional gender categories. A recent study in the United Kingdom found that 20%-25% of people under 25 did not identify as heterosexual, or considered themselves as having a personal gender identity that did not correspond with the sex assigned at birth, Dr. Ng said.
“I don’t think this is something that is a trend, I don’t think it’s a fad,” Dr. Ng said. “I don’t think it’s going to go away.”
The amount of resources available for training clinicians in caring for transgender patients is expanding, he said, and both trainees and veteran clinicians can find educational programs tailored to their needs, although they might have to seek them out. Nonetheless, Dr. Ng thinks hospitalists would be wise to pursue such training.
Unfortunately, most medical schools do not as yet offer targeted training in transgender care, or even LGBT care more broadly, said Vin Tangpricha, MD, PhD, president elect of the World Professional Association for Transgender Health (WPATH).
“The biggest gap is training in medical school and residency,” Dr. Tangpricha said. “Only one out of three medical schools have any transgender curriculum taught to students. Physicians lack knowledge on the diagnosis of gender dysphoria and the hormone regimens that are commonly used. Also, physicians don’t feel comfortable speaking to transgender patients because they lack experience working with this population.”
Training in caring for transgender patients and other segments of the LGBT patient population is available through WPATH, the Fenway Institute in Boston, and GLMA, formerly known as the Gay & Lesbian Medical Association, as well some other organizations, Dr. Tangpricha said.
Dr. Rosendale took training into her own hands. She saw gaps in the curriculum, and started LGBT training programs at New York University, where she went to medical school, and at UCSF, where she completed her neurology residency and neurohospitalist fellowship.
The curriculum, which was blended with diversity training at UCSF, involved basic concepts such as terminology, the difference between gender identity and sexual orientation, communication tips, and discussions of the health care experience from the LGBT patient perspective. Even a relatively small amount of training can go a long way, she said.
“When I work with trainees now who have heard some of the lectures and have gone through some of the training, their fluency and their comfort with the terminology, with the concepts that are used within the LGBT community, is much better than it was before,” Dr. Rosendale said.
Demonstrating the importance of training to those in charge of curriculum decisions is the most important step for anyone interested in adding instruction for transgender care at their centers, she said.
Katie Imborek, MD, cofounder of the University of Iowa LGBTQ Clinic, has worked with hospitalists on improving their care for transgender patients. She and internal medicine physician Nicole Nisly, MD, opened the clinic when a need became apparent.
Before the University of Iowa clinic opened, a transgender advocacy group hosted a forum on LGBT health care, at which patients shared stories of frustration. One patient related a story about calling a department at the university, only to be told, “We don’t take care of people like you.” In another frustrating case, a transgender man had been having vaginal bleeding and called the obstetrics department seeking help. He was repeatedly told he was calling the wrong place. During a white board exercise at the forum, one patient drew buildings representing the university health care system surrounded by barbed wire, symbolizing an off-putting atmosphere in the emergency department that was rife with misgendering of patients.
“Many providers feel like they haven’t had the appropriate training to provide medically competent care for transgender patients – including cross-sex hormones, referrals, and care coordination to ensure patients receive the mental health care, medications, and procedures needed to treat their gender dysphoria,” Dr. Imborek said.
Despite the knowledge gaps, a shift is definitely underway, she said. Dr. Tangpricha concurred, noting that the interest in WPATH’s training programs has increased dramatically.
“In the past, there was a CME program on transgender medicine every 2 years. Now we have courses every 3-4 months and we still can’t keep up with the demand. Employers and hospital systems are adopting transgender medicine as a covered benefit which has driven the need for physician education.”
Henry Ng, MD, MPH, an internal medicine physician and pediatrician in Cleveland who specializes in the treatment of lesbian, gay, bisexual, and transgender (LGBT) patients, walked into an exam room to meet a patient several years ago. The patient was 65 years old and presented as a man.
“Oh,” the man replied. “I’m here to transition.”
Dr. Ng immediately regretted how he had addressed the patient. In this case, his normally innocuous greeting could have been harmful. The man did not identify as a man – as “Mister” – and this could have derailed the health care encounter, Dr. Ng said. Luckily the patient corrected him.
“I made an assumption about this person based on the cues that I saw and I misperceived this person’s identity,” he said. “A patient less comfortable in their skin may have left. And a younger patient would likely have been offended if I had met and misgendered them.”
If Dr. Ng could make this kind of error, it’s clear how easy it is for clinicians with less training and experience to make clumsy assumptions about gender identity.
Even with wider societal awareness of gender identity issues, the cultural sensibilities and training among hospitalists and other clinicians required for quality care of transgender patients is still lacking, Dr. Ng said. Unfortunately, many physicians may have little interest in providing this care, or lack the skills for it, he said.
In the hospital, patients already feel vulnerable because of their medical conditions, and treating transgender inpatients may require additional layers of complexity, experts say. For instance, how should a physician address a patient? The initial encounter can have a huge impact on the clinician’s ability to earn the patient’s trust, and sets the tone for the entire hospital stay. Which bathroom should a transgender patient use? What unique family issues must clinicians be aware of? Transgender patients may be more likely to have simmering tensions with immediate and extended family, and may not want certain family members involved in medical decisions.
Physicians and nurses must be aware of these issues to create a welcoming and logistically sound environment, said Nicole Rosendale, MD, a neurohospitalist at the University of California San Francisco who has a special interest in LGBT care.
Dr. Ng noted that even the information technology clinicians rely upon may not be optimized for transgender patients. For instance, he said electronic health records may pose problems if they haven’t been adapted to include the necessary gender identity options or preferred names and pronouns.
“Most electronic health records are fairly binary-driven,” Dr. Ng said. “Our transgender patients turn that model on its head. We have had to create many additional workarounds.”
Need for more training
Hospitalists will increasingly find themselves caring for transgender patients, as more people openly claim a gender identity outside the traditional gender categories. A recent study in the United Kingdom found that 20%-25% of people under 25 did not identify as heterosexual, or considered themselves as having a personal gender identity that did not correspond with the sex assigned at birth, Dr. Ng said.
“I don’t think this is something that is a trend, I don’t think it’s a fad,” Dr. Ng said. “I don’t think it’s going to go away.”
The amount of resources available for training clinicians in caring for transgender patients is expanding, he said, and both trainees and veteran clinicians can find educational programs tailored to their needs, although they might have to seek them out. Nonetheless, Dr. Ng thinks hospitalists would be wise to pursue such training.
Unfortunately, most medical schools do not as yet offer targeted training in transgender care, or even LGBT care more broadly, said Vin Tangpricha, MD, PhD, president elect of the World Professional Association for Transgender Health (WPATH).
“The biggest gap is training in medical school and residency,” Dr. Tangpricha said. “Only one out of three medical schools have any transgender curriculum taught to students. Physicians lack knowledge on the diagnosis of gender dysphoria and the hormone regimens that are commonly used. Also, physicians don’t feel comfortable speaking to transgender patients because they lack experience working with this population.”
Training in caring for transgender patients and other segments of the LGBT patient population is available through WPATH, the Fenway Institute in Boston, and GLMA, formerly known as the Gay & Lesbian Medical Association, as well some other organizations, Dr. Tangpricha said.
Dr. Rosendale took training into her own hands. She saw gaps in the curriculum, and started LGBT training programs at New York University, where she went to medical school, and at UCSF, where she completed her neurology residency and neurohospitalist fellowship.
The curriculum, which was blended with diversity training at UCSF, involved basic concepts such as terminology, the difference between gender identity and sexual orientation, communication tips, and discussions of the health care experience from the LGBT patient perspective. Even a relatively small amount of training can go a long way, she said.
“When I work with trainees now who have heard some of the lectures and have gone through some of the training, their fluency and their comfort with the terminology, with the concepts that are used within the LGBT community, is much better than it was before,” Dr. Rosendale said.
Demonstrating the importance of training to those in charge of curriculum decisions is the most important step for anyone interested in adding instruction for transgender care at their centers, she said.
Katie Imborek, MD, cofounder of the University of Iowa LGBTQ Clinic, has worked with hospitalists on improving their care for transgender patients. She and internal medicine physician Nicole Nisly, MD, opened the clinic when a need became apparent.
Before the University of Iowa clinic opened, a transgender advocacy group hosted a forum on LGBT health care, at which patients shared stories of frustration. One patient related a story about calling a department at the university, only to be told, “We don’t take care of people like you.” In another frustrating case, a transgender man had been having vaginal bleeding and called the obstetrics department seeking help. He was repeatedly told he was calling the wrong place. During a white board exercise at the forum, one patient drew buildings representing the university health care system surrounded by barbed wire, symbolizing an off-putting atmosphere in the emergency department that was rife with misgendering of patients.
“Many providers feel like they haven’t had the appropriate training to provide medically competent care for transgender patients – including cross-sex hormones, referrals, and care coordination to ensure patients receive the mental health care, medications, and procedures needed to treat their gender dysphoria,” Dr. Imborek said.
Despite the knowledge gaps, a shift is definitely underway, she said. Dr. Tangpricha concurred, noting that the interest in WPATH’s training programs has increased dramatically.
“In the past, there was a CME program on transgender medicine every 2 years. Now we have courses every 3-4 months and we still can’t keep up with the demand. Employers and hospital systems are adopting transgender medicine as a covered benefit which has driven the need for physician education.”
Henry Ng, MD, MPH, an internal medicine physician and pediatrician in Cleveland who specializes in the treatment of lesbian, gay, bisexual, and transgender (LGBT) patients, walked into an exam room to meet a patient several years ago. The patient was 65 years old and presented as a man.
“Oh,” the man replied. “I’m here to transition.”
Dr. Ng immediately regretted how he had addressed the patient. In this case, his normally innocuous greeting could have been harmful. The man did not identify as a man – as “Mister” – and this could have derailed the health care encounter, Dr. Ng said. Luckily the patient corrected him.
“I made an assumption about this person based on the cues that I saw and I misperceived this person’s identity,” he said. “A patient less comfortable in their skin may have left. And a younger patient would likely have been offended if I had met and misgendered them.”
If Dr. Ng could make this kind of error, it’s clear how easy it is for clinicians with less training and experience to make clumsy assumptions about gender identity.
Even with wider societal awareness of gender identity issues, the cultural sensibilities and training among hospitalists and other clinicians required for quality care of transgender patients is still lacking, Dr. Ng said. Unfortunately, many physicians may have little interest in providing this care, or lack the skills for it, he said.
In the hospital, patients already feel vulnerable because of their medical conditions, and treating transgender inpatients may require additional layers of complexity, experts say. For instance, how should a physician address a patient? The initial encounter can have a huge impact on the clinician’s ability to earn the patient’s trust, and sets the tone for the entire hospital stay. Which bathroom should a transgender patient use? What unique family issues must clinicians be aware of? Transgender patients may be more likely to have simmering tensions with immediate and extended family, and may not want certain family members involved in medical decisions.
Physicians and nurses must be aware of these issues to create a welcoming and logistically sound environment, said Nicole Rosendale, MD, a neurohospitalist at the University of California San Francisco who has a special interest in LGBT care.
Dr. Ng noted that even the information technology clinicians rely upon may not be optimized for transgender patients. For instance, he said electronic health records may pose problems if they haven’t been adapted to include the necessary gender identity options or preferred names and pronouns.
“Most electronic health records are fairly binary-driven,” Dr. Ng said. “Our transgender patients turn that model on its head. We have had to create many additional workarounds.”
Need for more training
Hospitalists will increasingly find themselves caring for transgender patients, as more people openly claim a gender identity outside the traditional gender categories. A recent study in the United Kingdom found that 20%-25% of people under 25 did not identify as heterosexual, or considered themselves as having a personal gender identity that did not correspond with the sex assigned at birth, Dr. Ng said.
“I don’t think this is something that is a trend, I don’t think it’s a fad,” Dr. Ng said. “I don’t think it’s going to go away.”
The amount of resources available for training clinicians in caring for transgender patients is expanding, he said, and both trainees and veteran clinicians can find educational programs tailored to their needs, although they might have to seek them out. Nonetheless, Dr. Ng thinks hospitalists would be wise to pursue such training.
Unfortunately, most medical schools do not as yet offer targeted training in transgender care, or even LGBT care more broadly, said Vin Tangpricha, MD, PhD, president elect of the World Professional Association for Transgender Health (WPATH).
“The biggest gap is training in medical school and residency,” Dr. Tangpricha said. “Only one out of three medical schools have any transgender curriculum taught to students. Physicians lack knowledge on the diagnosis of gender dysphoria and the hormone regimens that are commonly used. Also, physicians don’t feel comfortable speaking to transgender patients because they lack experience working with this population.”
Training in caring for transgender patients and other segments of the LGBT patient population is available through WPATH, the Fenway Institute in Boston, and GLMA, formerly known as the Gay & Lesbian Medical Association, as well some other organizations, Dr. Tangpricha said.
Dr. Rosendale took training into her own hands. She saw gaps in the curriculum, and started LGBT training programs at New York University, where she went to medical school, and at UCSF, where she completed her neurology residency and neurohospitalist fellowship.
The curriculum, which was blended with diversity training at UCSF, involved basic concepts such as terminology, the difference between gender identity and sexual orientation, communication tips, and discussions of the health care experience from the LGBT patient perspective. Even a relatively small amount of training can go a long way, she said.
“When I work with trainees now who have heard some of the lectures and have gone through some of the training, their fluency and their comfort with the terminology, with the concepts that are used within the LGBT community, is much better than it was before,” Dr. Rosendale said.
Demonstrating the importance of training to those in charge of curriculum decisions is the most important step for anyone interested in adding instruction for transgender care at their centers, she said.
Katie Imborek, MD, cofounder of the University of Iowa LGBTQ Clinic, has worked with hospitalists on improving their care for transgender patients. She and internal medicine physician Nicole Nisly, MD, opened the clinic when a need became apparent.
Before the University of Iowa clinic opened, a transgender advocacy group hosted a forum on LGBT health care, at which patients shared stories of frustration. One patient related a story about calling a department at the university, only to be told, “We don’t take care of people like you.” In another frustrating case, a transgender man had been having vaginal bleeding and called the obstetrics department seeking help. He was repeatedly told he was calling the wrong place. During a white board exercise at the forum, one patient drew buildings representing the university health care system surrounded by barbed wire, symbolizing an off-putting atmosphere in the emergency department that was rife with misgendering of patients.
“Many providers feel like they haven’t had the appropriate training to provide medically competent care for transgender patients – including cross-sex hormones, referrals, and care coordination to ensure patients receive the mental health care, medications, and procedures needed to treat their gender dysphoria,” Dr. Imborek said.
Despite the knowledge gaps, a shift is definitely underway, she said. Dr. Tangpricha concurred, noting that the interest in WPATH’s training programs has increased dramatically.
“In the past, there was a CME program on transgender medicine every 2 years. Now we have courses every 3-4 months and we still can’t keep up with the demand. Employers and hospital systems are adopting transgender medicine as a covered benefit which has driven the need for physician education.”