Advice For the Medical Professional
It is a well established
fact that the medical and psych communities get little to no training in
Transgender Healthcare. If any is received it is usually from text
books that are out of step with the current body of knowledge.
Often the material contained is blatantly false having been gathered
from discredited pseudo research that somehow manages to maintain its
grip on the publishers of these books. This is a very poor track
record before you as a medical professional begin to treat any
transgender patient.
There is good news
however and that is this. You have found a good starting point for
your quest for information right here. It is by no means complete
in all detail but it does several things for you and subsequently your
client.
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It establishes
insight into the issues we face as human beings.
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It presents basic
pointers toward current in-depth medical research.
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It helps you
communicate with your transgender patient.
Ready then? Good.
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Communication. The first and
absolute foremost thing you must do is establish good communication
with your patient. Your patient has probably been through a
half dozen doctors already and met with everything from the doctor's
revulsion to transgender to an "I dont know anything about it so I
am hesitant to treat you." At least this is an honest
statement.
Empathy. Be empathetic to your
patient. Try to understand what they have endured and what
they are experiencing. Ask direct questions but choose your
words carefully. If you want to know their sexual orientation
then be up front and let them know you are concerned about STD's.
Dont ask roundabout questions and never ask questions that have
nothing to do with your clients gender issues. If s/he
masturbates ten times an hour is has nothing to do with gender
issues. You want to know if they are using protection; ask it
that way.
Confidentiality. Assure your
patient of the confidentiality of your relationship then be prepared
to live up to that. If you cannot maintain that for any reason
then divulge it to your patient up front. Your patient NEEDS
to be able to trust you and his or her coming out to you is
unsettling at best to painful.
Listen. Be prepared to listen and
take notes. Never think you have all the answers because the
likelihood that your patient knows more about transgender healthcare
than you do, is very high. We have the luxury and network to do
research you dont. Believe me when I say, we do research this;
we research it to death sometimes. So be open to being
educated by your patient. Then contact other professionals
through Rainbow Health
Ontario (RHO) who have a wealth of information and resources at
their fingertips that will assist you.
Honesty. Be honest with your
patient at all times. Treat him or her as a person not as a
patient or illness. Ask them what name you want them to use. Be sure
to use the proper pronouns. A small note on the cover or tab
of the patient file will help you remember. If you dont have
an answer to a question promise your patient you will get the answer
and let them know; then follow through.
Respect. This is always a tough
one for many doctors. Never treat your patient as someone
inferior to you. Yes you spent many years learning your
business but that transgendered auto mechanic in front of you did
the same and will continue to do so every year until retirement.
Would you want him/her to treat you with disrespect when your car
needs service? It is a simple thing to do and goes a very long
way to making your treatment effective and collaborative. You
need to understand this is a journey for your client and you are a
part of that journey. You can do it best by ensuring your
patient that s/he is a part of the planning, not the subject of the
planning.
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Get Educated! Learn about the
physiology and neurology behind transgender. It will explain a
lot about your patient's state of mind. Your patient is not
mentally ill; not by any definition unless you accept discredited
work. Your patient is suffering anxiety and depression over
gender identity issues. This is often called Gender Dysphoria
and can range from mild to debilitating.
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Network. If you are going to be an
active part of your patient's healthcare it might be worth your
while to join WPATH. You can network with other physicians and
professionals involved in the research and treatment of transgender.
They have a tremendous amount of information available to you.
It is not expensive. Find out who the psychiatrists and
endocrinologists are in your area that work with the transgender
population. Get to know them. They can be a tremendous
support system for you.
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Social. Learn about your patient's
social and support system. It will have a major influence on
their thinking and state of mind. Be constantly aware for any
signs of self mutilation or suicidal ideations. If housing or
employment are problems, be proactive in helping them get the
assistance they need. Your patient wants dignity and wants to
live a life like anyone else. You are a part of that process
of reestablishing that life.
As much as I hate to say
this, hide your copy of the DSM. It is of no value to you.
Learn the Harry Benjamin Standards of Care published by WPATH.
Keep in mind it is a guideline for you and each patient is
different with different needs. Be flexible to adapt to those
needs where you can.
Understand that you are a
part of a medical team and you may be the linking pin of that team.
It is healthcare management across a wide spectrum that could include
social workers, psychiatrists, psychologists, endocrinologists,
gynecologists, surgeons, to name a few. You need to know who is
involved and what your role actually is. If you are a GP your role
could very well be that link pin. Communicate with them.
Nursing Role:
Your role although lesser
in the treatment protocols can be just as influential as your
employer's. You are usually the first and perhaps the last contact
the patient will have during a visit. You need to make sure s/he
is comfortable both physically and mentally. If it means chatting
for a couple of minutes then do it. A nervous patient will not
give good BP results no matter how professional you are.
Compliment the patient
where appropriate. Pay attention to names and pronouns and find
out what is acceptable and under what circumstances. For instance
a phone call to asking for Sue to book an appointment when a spouse
answers is not a good idea. Always talk directly with the patient
and never leave messages for others to hear or pass on.
Learn about transgender
and be prepared to act as an advocate where it is necessary.
For the Mental Health
Professional
Treat the person.
You cannot treat transgender so treat the person and start working with
them toward becoming a better person free of anxiety and
depression. Start helping them tear down barriers.
Cognitive and Behavioural
Treatment protocols are contraindicated by the APA for so called
"treatment" of transgender issues. If you are not able to use a
Humanist/Existentialist approach, the do not take on the patient.
You will be doing them harm, as well as your own reputation.
If asked for, or you
believe necessary for your patient's growth, involve the client's
support system and family. They will need your help in dealing
with the changes that could occur. They may be a part of the
problem and may need to hear that from a 3rd party; you. Their
feedback could very well influence your approaches.
Of course, as was pointed
out earlier, call them by name and use the correct pronouns. Give
your client dignity.
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