Creating Affirming Spaces for Transgender Patients
Partnership, Quality, Compassion
I am concerned, no alarmed, no troubled, or maybe its all three.
As I am writing this The American Civil Liberties Union (ACLU) is tracking 413 anti-LGBTQ+ bills in 40 states across the United States. Of those 40 states, 24 have bills limiting or eliminating the access of gender affirming care for minors. In some bills, accessing this care can be a criminal offensive of child abuse for the parents or guardians. Additionally, some of the bills limit the way a person can identify in healthcare, reverting to a binary gender definition: male or female. (ACLU,2023) In addition to these bills, “anti-cabaret” or “anti-drag” bills have been introduced and are proceeding through the legislature of 11 states.
You may be wondering why a person associated with healthcare is writing about anti-LGBTQ+ legislation. The answer is simple. Efforts like these directly impact the healthcare of all transgender individuals residing in areas that actively have legislation in place or pending. These laws and the accompanying rhetoric have created a narrative of transgendered persons being a threat, deviant, and other pejorative terms. This narrative has put the health and safety of our transgender patients at risk.
According to the Center for American Progress survey Protecting and Advancing Healthcare for Transgender Adult Communities (2021):
– 47% of respondents and 68% of respondents of color experienced discrimination in healthcare the previous year.
– 32% of respondents and 46% of respondents of color experienced a provider intentionally misgendering them.
– 18% of respondents and 28% of respondents of color experienced refusal of care form providers due to perceived or actual gender identity
– 22% of respondents and 28% respondents of color experienced delaying or not accessing healthcare due to previous discrimination.
– 40% of respondents and 54% of respondents of color avoid or postpone regular healthcare because of previous discrimination or fear of discrimination.
Additionally, according to the Trevor Project 2022 National Survey on LGBTQ Youth Mental Health, 45% of LGBTQ+ youth considered suicide and 1 in every 5 transgender youth considered suicide. Given the current legislative climate, we can only expect these estimates, from both surveys, to rise.
We simply cannot assert that access to healthcare is a human right and turn a blind eye to the healthcare experiences and needs of the transgender community. What can we as healthcare professionals do to evoke change? The answer lies in inclusion and the creation of affirming spaces where people can safely access the care they need and know they will be treated with dignity, respect and empathy. To do this, we must look at the three key areas that define any person-centered approach: Partnership, Compassion, and Quality.
Partnership
Each healthcare organization is a part of a community. Invariably, in that community, there are transgender persons living and thriving. But are they accessing the healthcare they need? Have we created an environment where they feel safe and respected? Have we fostered relationships of mutual trust?
A first step is to identify community-based LGBTQ+ organizations that can become partners in co-designing a safe space for transgender individuals to receive care. Developing common goals, anticipated outcomes, and organizational responsibilities are the hallmark of successful community-based programs. The most important aspect of partnership is to listen and understand others’ experiences without judgement or blame. We can engage partners in understanding how to create affirming spaces through language, signage, bed assignments and accommodations for privacy needs. Strong partnerships in the community will communicate that, as a healthcare organization, you are working towards creating a safe and welcoming space for care.
Compassion
Compassion starts with empathic curiosity. This entails inviting the person to share their experience with us as we listen and seek to understand without judgement and stigma. This enables us to see and acknowledge the person and for the person to feel seen and acknowledged.
The care experience is comprised of many different touchpoints. Creating affirming spaces for transgender patients requires us to be mindful of the interactions that occur, and the messages conveyed during all of these touchpoints. Forms, medical records, registration processes and name bands should be inclusive so that we can capture and use a person’s preferred name and pronouns. Improving privacy standards, defining the use of touch and permission to touch, and use of pronouns of choice in conversation and documentation all contribute to an affirming, safe healthcare environment.
Quality
When accessing care, one thing that is universally prioritized amongst all patients is quality and safety. Quality care includes positive outcomes, safe environments, privacy, and inclusion. Yet to create a truly inclusive and high-quality healthcare experience, we must do more than posting signs, using inclusive paperwork, and following the protocol for terminology.
We, as healthcare providers, have to understand and acknowledge our own bias, misunderstanding, and prejudices. Quality care hinges on patient engagement. Bias, whether implicit or explicit, blocks connection and engagement, which ultimately undermines quality and healthcare outcomes – especially when individuals don’t feel safe to seek care.
When a transgender person seeks care, they have already performed mental gymnastics, often asking themselves: Am I sick enough to go and deal with what I have experienced before? These mental exercises also include the intersectionality of color, gender expression and identity, and mental health bias. These are all contributing factors to an individual’s decision-making process around seeking care. Quality for all starts with the acknowledgement of the individual, who they are, and what they are bringing with them from past experiences and, in some cases, past trauma.
This path is not an easy one for anybody, but as providers and healthcare professionals, it is one we must walk. As a basic human right, healthcare should be available for all to access so that we can all receive the care we need to thrive and achieve well-being. The laws mentioned before are eliminating or significantly limiting a transgender individual and transgender youth from accessing gender-affirming care. Many in the transgender community have already stated how fearful they are to go to certain states and areas that have anti-trans laws in place. This isn’t a political issue. It is a human issue. It is an issue not unlike female reproductive rights, fetal and maternal demise in Black women and newborns, mental health stigma, and a litany of other care limiting concerns.
Advocacy and allyship has not always been a comfortable space for healthcare organizations, especially on social issues. But perhaps now, as we face more and more challenges to the right to access healthcare, is the time for all of us – especially those of us committed to the values of person-centered care — to stand up and create safe, caring spaces for transgender individuals. Because asserting that healthcare is a human right is in vain if we don’t take also take action to ensure that that care is affirming, dignified, compassionate and respectful – for all.
Connect with me today to learn more and partner to humanize the healthcare experience for everyone, everywhere, every time.
