“Completely out-at-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for transgender patients

Abstract

BackgroundMembers of the transgender community have identified healthcare access barriers, yet a corresponding inquiry into healthcare provider perspectives has lagged. Our aim was to examine physician perceptions of barriers to healthcare provision for transgender patients.MethodsThis was a qualitative study with physician participants from Ontario, Canada. Semi-structured interviews were used to capture a progression of ideas related to barriers faced by physicians when caring for trans patients. Qualitative data were then transcribed verbatim and analysed with an emergent grounded theory approach.ResultsA total of thirteen (13) physician participants were interviewed. Analysis revealed healthcare barriers that grouped into five themes: Accessing resources, medical knowledge deficits, ethics of transition-related medical care, diagnosing vs. pathologising trans patients, and health system determinants. A centralising theme of “not knowing where to go or who to talk to” was also identified.ConclusionsThe findings of this study show that physicians perceive barriers to the care of trans patients, and that these barriers are multifactorial. Access barriers impede physicians when referring patients to specialists or searching for reliable treatment information. Clinical management of trans patients is complicated by a lack of knowledge, and by ethical considerations regarding treatments—which can be unfamiliar or challenging to physicians. The disciplinary division of responsibilities within medicine further complicates care; few practitioners identify trans healthcare as an interest area, and there is a tendency to overemphasise trans status in mental health evaluations. Failure to recognise and accommodate trans patients within sex-segregated healthcare systems leads to deficient health policy. The findings of this study suggest potential solutions to trans healthcare barriers at the informational level—with increased awareness of clinical guidelines and by including trans health issues in medical education—and at the institutional level, with support for both trans-focused and trans-friendly primary care models.

Health Care Providers' Comfort With and Barriers to Care of Transgender Youth

“…Survey items inquiring about barriers to providing transgender-related care for youth were informed by a qualitative study focused on providers of transgender adults and the literature [8,9]. Clinical exposure to transgender youth was explored with items asking about the number of transgender patients for whom practitioners had provided care since completing training and whether a respondent had ever worked in a transgender clinic.…”

“…Despite these changes, there have been no empirical studies assessing providers' comfort with and barriers to providing psychologic and/or medical care for transgender youth. A qualitative study found that perceived physician barriers to providing care for transgender adults included difficulty accessing psychosocial services for their patients, deficits in transgender-specific medical knowledge, and personal ethical dilemmas with transgender-related medical care; however, there are no comparable studies on transgender youth [8]. As adolescent medicine and pediatric endocrine providers are the medical specialists most represented in multidisciplinary gender centers across the United States [3], this study aims to explore these providers' clinical experiences, confidence, and comfort with and barriers to providing care for transgender youth.…”

Predisposing, reinforcing, and enabling factors of trans-positive clinical behavior change: A summary of the literature

“…Our search did not produce any trans-positive behaviorchange interventions designed for HCPs. We found only two qualitative studies that explore physicianlevel barriers to delivering care to trans patients (Poteat, German, & Kerrigan, 2013;Snelgrove et al, 2012).…”

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

“…Professional guidelines for routine cervical cancer and STI screenings in this population are identical to those recommended for cisgender women. 21 Many FTM patients face barriers to receiving needed services due to a combination of factors, including stigma and discrimination, 22,23 lack of insurance and access to genderaffirmative health care, 24,25 patient and health care provider misperceptions pertaining to HPV and cervical cancer risk (Table 2), and apprehension about undergoing intrusive procedures such as pelvic examinations, 10 leading to decreased rates of cervical cancer screening compared to cisgender women. 26 In addition, due partially to the atrophying effect of testosterone on the cervical epithelium, cervical cytology specimens are approximately ten times as likely to be unsatisfactory among patients on the FTM spectrum as among cisgender women.…”