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GIVEN a magic wand and the ability to change one thing immediately to improve health outcomes for transgender and gender diverse people, Emery Wishart would boost education and training for medical practitioners, so trans individuals don’t have to rely on word of mouth to access appropriate health care.
Mr Wishart, Services Manager at Transfolk WA, told InSight+ in an exclusive MJA podcast that while professional, appropriate health care was crucial to trans people, many avoided seeing a doctor because of previous bad experiences, much of it down to a lack of education in how to engage with trans people.
“I hear a lot of stories from other trans people, binary and non-binary, of going to see a GP or going to the hospital and being called by the wrong pronouns or using an incorrect name after they’ve made clear what name they want the medical staff to use,” he said. “Or even getting invasive personal questions that are completely irrelevant to the health care that they’re needing when they present to the service.
“If there was training that encompassed a lot of the missing content, that would be amazing. It would really change the experiences that trans and gender diverse people have in health care.”
Ms Penelope Strauss, a youth mental health researcher at Telethon Kids Institute in Perth, said in the same podcast that avoidance was a clear consequence of misgendering and other inappropriate experiences in health care settings.
“When trans people access health care that is invalidating of their identity or otherwise somehow discriminatory, what happens is a lot of people later on avoid health care,” Ms Strauss told InSight+.
“What that means is screenings get missed, follow-up appointments get missed, and what we see is that some health conditions that could have been treated earlier aren’t seen until much later, which obviously leads to quite poor health outcomes for some people.
“I would love for all doctors to understand that respecting somebody’s name and pronouns is just respecting that individual. I agree that training is needed, especially for things like hormones or how to refer somebody on or going through the informed consent process for various interventions.
“However, all of this comes back to this: when a [trans or gender diverse] patient shows up, listen to them, ask them how they’d like to be referred to, what name they use, what pronouns they use, and stick to that throughout every appointment. Even if, legally, on their medical file something else is written. Respect that patient face-to-face and use the name and pronouns they use.”
Ms Strauss is co-author of a Perspective published in the MJA on misgendering and experiences of stigma within health care settings. The article calls out the structural stigma – “intentional and unintentional policies and practices that result in restricted opportunities for stigmatized people” – inherent in medical training.
“This leaves doctors ill equipped to care for trans patients,” the authors wrote.
“Many lack knowledge of trans health, do not know how to refer to trans competent providers, and may also be uncertain how to respectfully address and refer to trans individuals. This uncertainty can lead to ambivalence around providing care and patient acceptance thereof.”
Mr Wishart, who was not an author on the article, said many doctors wanted to help but had no idea where to begin treating a trans person.
“I feel like there’s a lot of missing information,” he said. “GPs can have the very best of intentions and want to be very helpful, but [have] no information about how to do that and what’s respectful and what isn’t.
“It’s a priority and should be included in medical education, definitely.”
Ms Strauss recommended that GPs and other specialists contact the Australian Professional Association for Trans Health(AusPATH) as a first port of call.
“It’s important for GPs who do want to learn more to contact community organisations, to contact professional organisations such as AusPATH, who do run training.”
Position statements on the Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents, and on the hormonal management of adult transgender and gender diverse individuals can be found on the MJA’s website.
Despite the barriers, Emery Wishart is optimistic.
“There’s more and more visibility of trans and gender diverse people in the general community, in the media, in policy, and in people becoming more aware and wanting things to change,” he said.
“People want to be doing the right thing by trans people. So yes, I’m hopeful.
“There’s a way to go and it’s a bit of a process to get there, but there are a lot of good intentions.”
Ms Strauss agreed saying:
“The primary point here is that for any health practice that does want to change, the way to do it is to be led by local stakeholders, their local transgender and gender diverse people. Then that needs to be backed by system level reform and policies that change the structures around that health practice to make sure that everybody is respected.”
Looking for information and stumbled into this article.
And wow, how very scary and shocking was the comment section. It’s surprising how some doctors are so ill-informed yet instead of looking for training to be updated with knowledge and skills they lack, proceeded on spewing hatred & misinformation online… I’m sticking to words of mouth.
Dear Anonymous we as medical doctors need to navigate with kindness, put aside our own prejudice and lack of understanding and fix our knowledge, our understanding, our forms and systems so that it is possible for transgender people to feel accepted, respected and visible. Inequity and prejudice (often imbedded) is a problem in our health services and this is one group that does have significant prejudice and barriers to seeking and receiving good healthcare and good outcomes. Transphobia has no place in our health facilities (nor in society at large). For inequity to reduce/vanish we need to view those who are trans as ‘us’ whether we ourselves are trans or cis.
For transgender individuals, we need two pieces of information: their biological sex, and the gender they prefer to be acknowledged with. If asked by the patient I am happy to refer to them and address them as the gender they prefer. But I need the biological sex information to manage medical aspects of their care (medication dose etc).
Organisations such as Pride in Health + Wellbeing also mentor organisations and individual clinicians through the cultural change needed to be inclusive of trans and gender diverse patients, as well as all sexuality and gender diverse individuals. Awareness is coming slowly and support is there if people look for it, which we have to do to ensure that TGD people aren’t compromising their health due to all three levels of stigma prevalent in Australian
Totally agree with you Andrew.
If the twentieth century demonstrated the transition of medical practice into a truly scientific discipline, then the start of the twentieth century, with its cesspit of social media and single issue ideologically blinded activists, has seen the deconstruction of those principles by pseudo-scientific populist subversion.
Please do ask all of these so called ‘social scientists’ (yes an oxymoron) and also the unbelievably dumb left-wing politicians (a Queensland speciality) who are in the process of actually legislating for this absurd outcome:
1 ) what is the accuracy and precision of psychological testing?
2) what is the positive and negative predictive value of this testing?
3) what bias is involved here?
4) what is the sensitivity and specificity of this testing?
None has been presented because none is available. The waiting period for negative outcomes with this lunacy will be decades in the presentation.
These are children who should be allowed to make these very important lifelong decisions for themselves once they reach adulthood. What is happening and being legislatively approved is nothing but institutional child abuse, It is not care.
In the not too distant future, I really don’t think historians (or the legal system for that matter) are going to treat any of these ‘social scientist’ activists and their dumb politicians kindly if this is allowed to become entrenched in law.
Another stolen generation in the making. I see another Royal Commission in the offing here asking how this was allowed to occur.
I believe that is was Mao who said (paraphrasing) that ‘there is nothing so powerful in human affairs than idea whose time has come’. Well this is an idea whose time should never come and it is time for the medical community to act in concert to stop it.
So , the GP workforce needs appropriate “education ” on childhood GD. A google search of RACGP accredited learning modules from , say, Iris Education ( a body with extensive history of providing RACGP accredited education in fields like sexual health) will reveal detailed guidance on diagnosis and management of Childhood GD, written by , not a paediatrician, not a paediatric endocrinologist, not a paediatric psychiatrist, but , tellingly ,by a clinical psychologist, I.e., a social scientist. We medical practitioners are informed/ educated by social science that biological sex is a social construct , from which point one has then to follow , understand , and accept the ideology of ” gender identity/fluidity” to be able to provide appropriate care to children asserting GD. All other management options to ” affirmation” of the child’s assertion is viewed by the protagonists as ” conversion therapy” and Qld is likely to enshrine such into state law. Who can point to any other clinical presentation which is subject to only one, government sanctioned treatment protocol, from the very point of time of diagnosis? Let’s hope enough of our medical profession, world wide, fail to be ” educated” by failing at the first hurdle by continuing to believe in the immutability of biological sex , and calling out ” gender identity/ fluidity” the social construction it is. Adults are free to plot their individual life courses, but children deserve care from those responsible for their future physical and emotional integrity.
If anonymous 2 doesn’t think they can navigate how to complete necessary medical documents for a patient who has an affirmed name that they prefer to use, and a dead name that they have not been able to change, then they are likely to be of those practitioners who is unhelpful to the trans community and likely contribute to the barriers to accessing medical services that this worthy article highlights.
Any prepubertal gender re-assignment intervention is nothing but child abuse pure and simple dressed up in psychobabble. No matter what the intentions of these well meaning people are, childhood and puberty are always difficult and confusing times for everyone. The increasing number of early gender re-assigned children and teenagers who subsequently regret their chanelling attest to that. Social acceptance of identity issues is one thing, hormonal or surgical interventions are another. Demonstrate any psychological assessment by a psychologist that can garuantee 100% certainty that that child or teenager will be totally happy with their new assigned identity for the next 70 years of their life a then I will change my opinion.
“ask them how they’d like to be referred to, what name they use, what pronouns they use, and stick to that throughout every appointment. Even if, legally, on their medical file something else is written. Respect that patient face-to-face and use the name and pronouns they use.”
So I guess there won’t be any medical certificates written or Medicare claiming in their ‘dead’ name?