Compassionate Care for Transgender Patients
Transgender and nonbinary people have healthcare needs unique to transitioning. However, they also have many of the same healthcare needs that cisgender people have. For instance, if a trans man keeps the sexual organs he was born with, he will need the same gynecological care as a cisgender woman.
Unfortunately, many healthcare providers lack the cultural competence and empathy to provide basic healthcare to transgender people. Fear of discrimination keeps many patients from getting the preventative care they need. This results in higher rates of chronic conditions and health problems in the transgender community compared to the general population.
A recent study presented at the Endocrine Society’s annual meeting in June 2023 reported that transgender people who come to the ER for care are prone to be sicker than their cisgender peers.
W. Zeh Wellington, director of surgical services at Ann & Robert H. Lurie Children’s Hospital of Chicago, completed his dissertation on this vital topic. Titled, Development of a Clinical Practice Guideline for the Care of Transgender Patients, Wellington outlines strong CPGs for all healthcare providers to follow. In this interview with Whitman Partners, he explains how the director of surgical services can set the right tone for staff in providing quality care for all patients.
The State of Healthcare Delivery for Transgender People
Wellington chose the topic of trans health for his dissertation because of a story he heard of a transgender person that experienced discrimination while seeking healthcare. Unfortunately, this resulted in that person’s death.
“There is so much stigma and discrimination while receiving healthcare, and there is a large gap in our nursing practice,” Wellington says. “I felt that if I could help one person by doing this dissertation and providing clinical practice guidelines based on evidence-based practice, I had succeeded.”
No less than 17 states have enacted laws restricting or banning gender-affirming care for minors, and an increasing number of bills are being introduced that limit gender-affirming care for adults.
“These bills are criminalizing what doctors and psychologists say is medically necessary care,” says Wellington, who is very politically active in his current home state of Illinois. “If you work in the OR—or anywhere in healthcare—knowledge is powerful. We need to know what is going on in our state governments.”
Transgender Patients Often Put Off Preventative Care
Situations where a trans person might end up in the OR are the same as everyone else; accidents or elective surgeries. But the relationship they have with their primary care provider is critical. It can serve as a gateway to their healthcare experience. If anything keeps a trans person from regularly seeing their healthcare provider, that is where health disparities come into play. Fear and embarrassment are barriers to seeking care when, for instance, a cold that keeps hanging on could become more serious if not checked by a provider.
“We need to respect a patient’s values, preferences, and expressed needs,” Wellington says. “How can we help the patient understand their body, how it’s changing, and what still needs to get checked? They need colorectal exams and immunizations. A trans man may still need a breast exam. Having an open dialogue with their physician will help patients understand what tests and routine examinations are needed for their health.”
How a Director of Surgical Services Can Improve Practice
Although there may be financial limitations to what surgical services can do, directors can make the call on the type of leadership they can provide on their watch. Education, emotional support, and promoting inclusive policies cost nothing.
“As a leader, the dialogue starts with me,” Wellington says. “Promote a safe environment, a comfortable space, hire diverse staff, and provide training. Being a director is not just about directing. It’s also about listening. Listen to patients. Listen to families. Listen to your gut. Listen to each other. As nurses, we’re programmed to ambulate, but sometimes you need to pull back and listen.”
How providers can influence policy
Wellington advises those who want to get within earshot of their state representatives to get involved with their local branch of the American Nurses Association and the American Nurse Advocacy Institute, a year-long fellowship where nurses get involved in public policy and advocacy.
“Know who your state representatives are. Know their platforms and their agendas,” Wellington says. “Every vote counts. We are responsible for representing and advocating for all patients under our care. We as nurses have a unified voice and need to have our voices heard.”
