Susan Boisvert, BSN, MHSA, CPHRM, is a Senior Risk Specialist at Coverys, a leading provider of medical professional liability insurance. She recalls that clients started asking her about caring for transgender patients more than 10 years ago. She began to study and understand the issues involved. Later, her own child came out as transgender while he was in college. At that point, Boisvert resolved to learn everything she could and has since become well known as a resource and educator for transgender patient care. Recently she described strategies providers can use to improve patient safety for this population.
Betsy Lehman Center: Do transgender patients face specific safety risks in health care? What is unique about this population that may increase the risk of medical error?
Sue Boisvert: The unique feature of the transgender population is that it is invisible, which is the single most important risk transgender patients face in health care and almost every other aspect of their lives. We do not record gender identity in census data or medical records. We can’t do retrospective studies, so there is very little evidence-based guidance for transgender patients. For example, we don’t know the long-term effects of gender reassignment procedures or hormone replacement therapies. Treatment of transgender children may include using medication to delay puberty, but we don’t know the long-term effects of the drugs, which generally have not been used on children. Transgender care is not informed by long-term, evidenced-base medicine; that’s about as unique a patient safety risk as you can get. In addition, transgender patients often feel misunderstood and stigmatized, which hampers communication and can lead to errors.
Betsy Lehman Center: Could you suggest a few things primary care providers can do to reduce the risk of harm to transgender patients?
Sue Boisvert: First, they really need to check their biases; most primary care physicians are exceptionally good at that with other populations. They may not be as familiar with transgender patients as with, say, gay or lesbian patients, but the way that bias can distract from patient-centered care is the same.
It’s also important for the clinic or physician’s office to be a welcoming space for transgender patients, which includes ensuring that all staff members are trained and supportive. Providers can offer gender-neutral bathroom access and information in waiting rooms about transgender care. They can also signal acceptance by using graphics such as rainbows and the Human Rights Campaign’s logo.