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May 2015, Vol 3, No 5 - From the Trenches
Marc Drummond, PsyD, MBA

Healthcare Providers and the Transgender Community

The clinical challenge published in the April issue of Inside Patient Care: Pharmacy & Clinics was an interesting case study. Gender identity has been receiving a lot of media coverage recently; a great deal of the coverage surrounds legal issues specific to gender-neutral amenities for transgender people.

At the state level, legislation is being proposed to limit access to gender-segregated amenities (eg, public restrooms). Discrimination issues are driven by fear and lack of understanding. Although we often discuss issues surrounding how transgender people are treated in the general public, we neglect to discuss how this patient population can be made to feel marginalized in the medical field. Mutual trust and respect are the core of a successful therapeutic relationship.

A federal court recently ruled that discrimination against patients on the basis of their gender identity is now prohibited.1 Protections against discrimination within Title VII of the Civil Rights Act of 1964—which apply to the healthcare field—will also include gender identification, and impacts all healthcare providers that accept Medicare or Medicaid funding.2

The Affordable Care Act has provided transgender patients with greater access to health insurance; many of these individuals may have been denied services in the past because of preexisting health conditions. However, greater access to health insurance does not translate to greater access to healthcare. The transgender population is often met with resistance, possibly because many people may have misconceptions about this community.

Although the antidiscrimination provisions have been made clear, an insurance company’s responsibility and scope of coverage is still unclear. Procedures and/or medications may be denied because they are seen as cosmetic, regardless of medical documentation to the contrary.

Education surrounding transgender issues has been a footnote in most medical training programs. A majority of providers who specialize in the care of this population are located in major medical centers in larger cities. Because the transgender community now has greater access to healthcare, it will create a vacuum in which there will be a dearth of medical professionals who are able to competently care for their specialized needs.

We as healthcare providers have a responsibility to educate ourselves and our staff about the transgender population. Ethically, it is incumbent for us to increase our understanding of this patient population and their unique medical needs so that we can effectively treat them. We must advocate and ensure that all of our patients are treated with the highest level of respect.

(See "Reply to the Letter to the Editor: Healthcare Providers and the Transgender Community.")




References

  1. District Court, Minnesota 2015. Rumble v Fairview Health Services. Case No. 14-cv-2037 (SRN/FLN). http://scholar.google.com/scholar_case?case=13873135761293950230&hl=en&as_sdt=2006. Accessed April 28, 2015.
  2. US Equal Employment Opportunity Commission. Title VII of the Civil Rights Act of 1964. www.eeoc.gov/laws/statutes/titlevii.cfm. Accessed April 28, 2015.
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