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In nursing school, you may have learned that health care provider bias can literally endanger a patient, but when an instructor explains this, a least a few classmates will probably imagine their parents scoffing. Even if you can’t imagine your parents saying “hogwash!” to healthcare bias studies, as barely 0.6% of our population is transgender or genderqueer, if you feel uncomfortable or confused about what to say and do the first time you meet a trans patient, there’s no shame in admitting it. Better yet, a trans patient has some practical advice that might help you get started on the right foot.
“Treat the person with respect and caring, and leave whatever prejudices you have at the door.”
Wynne Nowland, CEO of Bradley & Parker, Inc., a New York insurance brokerage, made business news headlines when she came out as transgender last year. As a transgender patient, Nowland has firsthand knowledge of what it is like to be a member of a small minority seeking treatment within our healthcare system, and she kindly took the time to answer questions from DailyNurse. What follows is our interview, edited for length and clarity.
DN: We want to help nurses communicate more effectively with transgender patients and better understand their needs—for example, helping them find gender-affirming care.
That said, what is the first thing that nurses should do when they meet a transgender patient? Ask what pronouns they prefer? Should they ask about gender identity and sexual orientation?
NOWLAND: People don’t really want any special treatment–we just want to be treated like everyone else.
Many times, either with the name they are using or their choice of dress, hairstyle, etc., it is clear what gender the trans person is presenting as. In those cases, you should simply use the pronouns that correspond with that gender, regardless of the fact that you may suspect the person is trans or even though the person is trans.
If they are truly presenting in an ambiguous manner, it is then perfectly OK to ask which pronouns they prefer. Unless there is something specific going on that requires inquiry on sexual orientation, I can’t see any reason for that.
Sometimes going overboard has a reverse effect… we just really want to be treated like everyone else.
DN: What can nurses do to make sure that the patient feels comfortable in their care?
NOWLAND: Aside from using the correct pronouns and just being generally respectful, I’m not sure what else is required. Sometimes going overboard has a reverse effect, and as I already mentioned, we just really want to be treated like everyone else.
Sometimes, because of medical issues, intimate topics need to be addressed and there is really no way around that. It just needs to be done with care and compassion.
DN: Is there any particular guiding principle to follow when treating a transgender patient?
NOWLAND: Treat the person with respect and care and leave whatever prejudices you have at the door. A simple formula, but one that will be effective.
DN: What are some of the biggest mistakes that nurses can make when treating or communicating with a transgender patient?
NOWLAND: Being disrespectful, judgmental, or insensitive. For some people, the temptation to let the trans person know that they know they are trans is strong and that should be avoided at all costs.
In reality, the vast majority of trans people have the same medical needs as anyone else.
DN: How can nurses help trans patients—in terms of helping them find resources for better trans care, advocating for them, or even stepping in if they see another health care provider doing something that’s not appropriate with trans patients?
NOWLAND: If a nurse sees another medical professional in some way treating a trans person in an inappropriate manner, almost anyone would appreciate the nurse taking any other professional aside and discreetly redirecting them. It’s not a great idea to have a blatant confrontation, as that can just put the trans person in an even more embarrassing position.
The same with any advocacy, while it’s appreciated, being present during a combative situation is not pleasant and is best avoided. The very phrase “trans care” is kind of nebulous. In reality, the vast majority of trans people have the same medical needs as anyone else. There are certainly some items regarding medical transition and supportive therapy that are specific to trans people. If someone is presenting in a general practice, for instance, that is not equipped to handle medical transition needs, then it certainly would be thoughtful to have referrals to those practices that can help.
DN: What do you think trans patients would most want nurses to know?
NOWLAND: A theme I have had running through my entire commentary on this topic—we just want the same care as everyone else. And sometimes we understand that specific trans care like the things I mentioned above may not be your specialty or in your practice. That’s OK. Just talk to us about it in a respectful manner and help us find those resources.
Unless there is a medical reason to know, asking what’s in somebody’s pants is just never appropriate!
DN: Is there anything else that you think our readers need to know?
NOWLAND: Sometimes people are naturally curious about trans people and some things about their lives.
Every trans person, like every other person, is different and takes this curiosity in various ways.
In my own case, I welcome respectful questions, but at the same time can see the ones that are asking for the wrong reasons from a mile away.
Finally, the one big thing most trans people feel very protective about is the status of any gender-conforming surgery. Unless there is a medical reason to know, asking what’s in somebody’s pants is just never appropriate!