Medicine Aims to Improve Care for Trans Patients
WHY YOU SHOULD CARE
Because when a vulnerable community is misunderstood by those they turn to for help, it’s a recipe for disaster.
By Zara Stone
Throughout her 11 years as a psychotherapist, Kristie Overstreet has heard a refrain time and time again from transgender patients. They aren’t getting the medical care they need as they find doctors dismissive or ignorant of their conditions. “I hear horror stories of clients being told, ‘We don’t treat people like you,’” she says.
This is more than upsetting — it’s downright dangerous, as transgender people have a higher prevalence of health issues and suicide than the rest of the population, according to the National Center for Transgender Equality. Overstreet’s solution: teaching medical professionals best practices when working with trans patients. In September, she launched the Transgender Health Care Dignity Model Training & Certification Program, with a curriculum covering health care, trans terminology and personal bias.
It’s important to bring awareness to what barriers patients deal with.
Kristie Overstreet, psychotherapist
Overstreet joins a growing number of providers seeking to give better treatment to the 1.4 million Americans identifying as transgender. A report in the Journal of Nursing Education found that the average doctor and nurse get two to five hours, tops, of LGBT-related training — hence the dire need for more education. The knock-on effect: 30 percent of trans people avoid or delay visiting doctors for the very real fear of discrimination. Some providers are stepping up. In Florida, you can undertake a 40-hour course by the International Transgender Certification Association that teaches standards of practice and regulation, and in Canada, there’s TransEd, a trans-specific training module for health care students that launched in the fall of 2016. Clinics are evolving too. In summer 2017, the University of Minnesota opened a transgender health clinic for students, staff and faculty — no risk of having the wrong pronoun used here — and in upstate New York, Bassett Healthcare Network opened a gender wellness center and has hosted transgender sensitivity training days for doctors in their network.
“The key things are making intake paperwork and forms inclusive,” Overstreet says. “It’s important to bring awareness to what barriers patients deal with, and, knowing most patients are nervous and scared, [saying], ’I’m here to help you, what do you need,’ [is important].”
Her training costs $275 while in beta mode, and all modules are approved and tested by Overstreet’s trans consultants and clients. Recognizing that she approaches this from a cisgender perspective, she says their input is vital. She believes that trans-lebrities such as Caitlyn Jenner and Laverne Cox have helped people double down. “With more visibility, people feel safer to come out and demand competent providers,” she says. “Insurance says you cannot discriminate on gender identity, so let’s give them more training.”
In Florida, Dr. Carol Clark, founder of the International Transgender Certification Association, says she gets approached by a wide variety of companies, including staffers from the South Carolina Department of Corrections and a cancer treatment center. “There are people in the [prison systems] that say we want to know how to treat [transgender inmates] in a humane and considerate way,” she says. She’s held a handful of these six-day trainings so far, priced at $2,495 a head. Class sizes range from 10 to 20 people. Her work is geared toward therapists, educating them on both the basics and the more complex nuances of the struggles trans patients have. “There’s a lot of misinformation out there,” Clark says. “Therapists need to educate themselves and be knowledgeable on standards of care.” For example, a trans teenager has different problems than a trans senior. To help, Clark hosts panels that include seniors, teens and parents, among others, so the class can ask them questions.
But it’s not all bright and shiny. For every step forward, it can feel like two steps backs for trans rights as well. Around 19 percent of trans patients get denied treatment by doctors, and 28 percent experience harassment in their doctor’s office; President Trump tweeting that he’s going to ban transgender folk from military work adds to that conflict. His reasoning? “The tremendous medical costs and disruption that the transgender in the military would entail.”
“People are scared,” says Clark. “It’s very geographically contextual. In Miami it’s not a big deal, but for someone in Kansas or North Carolina, it’s problematic. Some people are scared they’ll never be accepted — and they’re right.”
Then there’s the fact that the people who need trans training are the ones who’ll benefit from it least; it’s the unwilling who really need to be educated. To reach these people, Overstreet approaches places where her clients report having had “bad” experiences. They’re often unreceptive. “They haven’t been rude and ugly. They just say. ‘I can’t focus on it right now,’ as if it’s an option,” she says. “That’s what’s scary. These people are coming into urgent care and they deserve a provider who is competent to treat them.”
But the growth of transgender training companies shows that people are listening, even if it’s not everyone — yet. In 2016, the Department of Health and Human Services mandated that Medicaid must cover transition-related care, and 14 states plus the District of Columbia have announced they fully support this. To quote Caitlyn Jenner, “Trans people deserve something vital. They deserve your respect. And from that respect comes a more compassionate community, a more empathetic society and a better world for all of us.”