Best Practices for Caring for Transgender Patients: A Qualitative Study of Healthcare Providers

Background and Purpose: Transgender individuals, or those whose gender identity does not match their assigned sex at birth, report numerous barriers to finding healthcare providers who are sensitive, respectful, and knowledgeable. Although some personal and professional barriers to caring for transgender patients on the part of providers have been identified, little is known about the unique perspectives and strengths of providers who are particularly adept at caring for this patient population. Therefore, the aim of this study was to explore experiences and best practice perspectives among physicians who routinely provide sensitive care for transgender patients.

Methods: Eligible providers included those who had previously been involved with research or advocacy related to transgender health and those who were identified by transgender community members as sensitive and competent providers. Snowball recruitment was also used. Providers were invited via email to participate in a 45-minute semi-structured interview either in person or via phone (based on their preference). Non-respondents were sent up to 2 follow-up emails. Each interview was audio-recorded and transcribed. Interviewees received a $50 gift card as a thank you. Up to 30 participants will be recruited in total.

Results: Interviewees (N=9) were adult primary care providers (56%), pediatric providers (22%), and endocrinologists (22%) working in settings such as integrated health systems, community health centers, and private practices in Michigan and Ohio. Themes identified from qualitative interviews included: 1) cultural humility (making room for the patients’ expertise and apologizing for missteps), 2) using sensitive language (asking about preferred name and pronouns and not making assumptions about appropriate language), 3) understanding social context (recognizing that bias and discrimination impact transgender people in all aspects of life, including their health), 4) sensitive staff (training staff to ensure sensitivity to transgender patients in every encounter), 5) mindful referrals (only referring transgender patients to other providers or services they have been identified as transgender-friendly), 6) comprehensive process changes (modifying forms and procedures to be sensitive to transgender patients); and 7) using workarounds (designing a separate process for transgender patients to work around non-inclusive forms and procedures). While providers in community health centers were more likely to have made comprehensive process changes to ensure sensitivity to transgender patients, providers in large health systems (with less control over policies and procedures) were more likely to use workarounds. Using sensitive language and practicing cultural humility were universal.

Conclusions and Implications: Healthcare providers who especially skilled at caring for transgender patients discussed both interpersonal and structural/procedural techniques for providing sensitive and competent care for transgender patients. While interpersonal skills such as using sensitive language and demonstrating cultural humility can and should be used in any setting, the extent to which process and policy changes can easily be implemented may depend on the setting. Medical social workers can assess their workplace for sensitive policies and practices and work to improve healthcare quality for transgender patients in various ways, depending on the organization type.