By Stephanie Aldrin, Medical Student
According to the Institute of Medicine, transgender and gender nonconforming patients access health care less often than their cisgender counterparts. And when transgender patients do seek medical attention, it is often with more serious ailments.1 While many factors contribute to these disparities, health care providers can play a crucial role in reducing the stigma associated with seeing the doctor and in promoting safer health care environments for the trans members of our communities.
In fall 2015, the clinic I work at, Smiley’s Family Medicine Clinic, asked its patients who identify as transgender or gender nonconforming to speak candidly about their experiences accessing primary care. I remember scrambling to take notes as I listened to the patients’ stories and feeling grateful for the opportunity to have this small window into the challenges of seeking health care as a trans person.
Three major themes emerged from the patients’ experiences. First, small changes in language can positively impact the way a patient feels during and after an encounter with health care providers. Second, trans patients see their doctors for a number of reasons, and, like their cisgender counterparts, want to be seen as any other patient and not have their gender identity be the focus of the visit. Finally, positive partnerships occur when physicians come into the exam room as their authentic selves, who genuinely care about the patient in front of them.
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Richard F. Mitchell, MD, MS
“Did you discuss prostate cancer screening with your patient?”
“I did, but…”
“Well, it was strange, but as I was discussing the risks and benefits, the patient just looked at me and said, ‘This is confusing, can’t you just tell me what I should do? What would you do if it was you?’”
Has something like this happened to you while you were precepting residents? Has it happened to you when you were talking to your own patients? In this age of patient-centered care, we teach our residents to involve patients in shared decision making. How do you counsel a resident working with a patient who doesn’t want to buy into that program? How do you teach your residents to respond to the question, “If it was you, what would you do?”
You might find the answer in an invisible bag.
“There is an invisible bag right in front of you. Think ‘Santa Claus sack.’ Would you like to reach in and take something out?”
“Why would I do that?”
“It’s full of $100,000 bills.”
“Yes! Can I take two?”
“No. But there’s something else you should know. The bag also has blank pieces of paper that feel exactly like $100,000 bills.”
“That’s OK—can I put my hand in now?”
“One last bit of information before you do—it’s also full of razor blades.”
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Joseph Scherger, MD, MPH
I attended a health care forecast conference recently and learned a sobering new reality. In the near future, Americans will be getting their primary care services in many different locations.
Walmart has announced that it soon will be offering comprehensive primary care in many of its stores. Walgreens, already the largest provider of immunizations outside the government, will expand its Take Care clinics and manage four common chronic diseases: diabetes, hypertension, hyperlipidemia, and asthma. A longtime colleague and family medicine educator recently went to work for Kroger’s new clinic system, The Little Clinic. Large employers are setting up workplace clinics to provide common health services while keeping their employees on the job.
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Posted in Education, Family Medicine Stories, Public Health
Tagged education, Family Medicine, family medicine education, future of family medicine, health, health care, healthcare, medicine, Patient, primary care, Walgreens, Walmart