Transgender and Gender Nonconforming in Emergency Departments: A Qualitative Report of Patient Experiences

Abstract

Background: Individuals who have a transgender or gender nonconforming (TGGNC) experience belong to a marginalized segment of the U.S. population, and healthcare can be difficult for them to navigate. Although emergency departments (EDs) traditionally serve as healthcare “safety nets” for vulnerable populations, quantitative studies outside the United States have found that TGGNC-experienced persons tend to avoid EDs and/or have negative experiences. This qualitative study primarily describes the ED experiences of people with a TGGNC history; furthermore, the study explores reasons why this population avoids U.S. EDs and their recommendations for improvements to ED care.Methods: This qualitative study used data about TGGNC-historied persons' experiences in U.S. EDs from retrospective, anonymous, written surveys (paper or web based). National data collection took place from June 2012 through December 2014. Participant responses (n=240) were examined using thematic analysis.Results: Using a framework that recognized positive and negative responses, the themes of Self-Efficacy and Power Inequity surfaced. These themes exposed the tension between patients with TGGNC experiences and clinicians who were perceived to lack training in this area, resulting in negative patient experiences. When practitioners had specific training about this population, participants reported positive care experiences.Conclusions: This study indicates that many TGGNC-historied persons who use U.S. EDs have negative experiences, largely due to lack of provider sensitivity toward and training about this patient population. Data from this investigation suggest that training of U.S. ED providers and institutional support would help improve care for this marginalized group.

Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey

“…Despite these limitations, our results mirror the social disparities seen in other studies and are consistent with the Minority Stress Model. 6,7,9,18,[28][29][30] Despite having higher levels of education compared to the general population, 13% of our sample reported being unemployed and 42% reported an annual income less than $24,000. These are comparable to the 2015 US Transgender Survey where 16% of respondents were unemployed and 55% reported annual incomes less than $24,000.…”

“…This aligns with other studies that have found that increased support, provider knowledge about transgender issues, and access to transition-related care improve mental health. 7,30,32 Provider training may be one component of a multi-pronged strategy for improving the health of transgender patients. The Veterans Affairs conducted a multi-site provider training that demonstrated the feasibility of implementing training programs, increased provider self-confidence, and intent to treat more transgender patients.…”

“…In the 2015 US Transgender Survey, 31% reported that none of their healthcare providers knew they were transgender. [6][7][8] The lack of inclusion at both the population and healthcare system levels systematically erases transgender individuals from the health care discourse.…”

Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey

“…Training for all clinicians and patient-facing health professionals, including emergency departments and administration and clerical staff, are very much required, and professional societies need to place TGD health as a training priority [10,14,17]. Moreover, more investment in training programs nationally is very much needed, as well as the implementation of trans cultural awareness amongst various health professional degrees and accreditations.…”

Toward Structural Competency in Emergency Medical Education

“…Health policy, material deprivation, inequality, and stigma are implicated in poor health outcomes among emergency department (ED) patients . Researchers have emphasized the role of the social determinants of health, structural racism, gender discrimination, homophobia, and transphobia on the health of ED patients. These topics continue to gain interest and attention as their ties to medical education, clinical care, and population health are elucidated and emphasized.…”