“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.