In the United States, an estimated 0.6 percent of adults, or 1.4 million individuals, identify as transgender, according to a study published in 2016 by researchers at the Williams Institute at UCLA School of Law.* The study provides the first state-level estimates of the percentage of adults who identify as transgender, ranging from 0.3 percent in North Dakota to 0.8 percent in Hawaii. (For Pennsylvania, the estimate is 0.44 percent, or 43,800 people.) Young adults are more likely than older adults to identify as transgender. Among adults ages 18 to 24, 0.7 percent identify as transgender. Moreover, according to a 2017 report from the Williams Institute, 0.7 percent of U.S. youths between the ages of 13 and 17 say they are transgender.
Transgender and Gender Non-binary Patients
It is well known that transgender and gender non-binary individuals (people who identify as neither men nor women) face health disparities, including increased risk of HIV infection and delayed cancer diagnosis. These disparities can stem from a lack of access to quality care, but they are also related to a reluctance to seek care when it is available. If a patient's sex assigned at birth and gender identity differ, if the patient's appearance — or insurance card — doesn't match someone else's expectations, the encounter is stressful from the outset.
To enhance the ability of Drexel Medicine staff to create an environment that is inclusive, welcoming and respectful, the Population Health Management group organized a special Staff Grand Rounds, "Welcoming Transgender and Gender Non-binary Patients." The training was facilitated by Jesse Krohn, associate director of education and prevention in the Drexel University Office of Equality and Diversity, and Alex Daniels-Iannucci, executive director, Student Life.
In order to promote culturally competent care, the session focused on a basic understanding of sex versus gender; the differences between gender identity, gender expression, and sexual orientation; learning about the transgender and gender non-binary communities; the experience of transgender and gender non-binary patients and other members of the Drexel community; and best practices. Best practices include being aware of one's own biases and behaviors, using gender-inclusive language, and addressing each patient in a way that is courteous and respectful of them.
Allscripts EHR gender dialogue box
You can't be expected to know the patient's preferences in advance, Krohn says, but you can avoid making assumptions. Instead, she advises, ask questions and be sure to listen to the answers with an open mind. Call the patient by name, rather than use the gender-based honorifics Mr., Ms., and so on. Ask what pronouns the patient uses. The pronouns they, them and their may be preferred by gender non-binary folks (used with the plural verb: they are, not they is).
The language, particularly pertaining to individuals who are transgender and gender non-binary, changes really quickly, Krohn acknowledges. "Things that were completely appropriate and 'in the know' two years ago already start to sound hopelessly outdated." For example, gender non-binary replaced gender non-conforming.
Of course, in the 21st century, change is not real until it can be documented in electronic health records. Congruence was achieved with the latest release of Allscripts, rolled out in February, which offers optional fields for gender identity and sexual orientation in the Patient Profile Dialog.
Faculty and Staff Resources
AAMC Focus on Future Care and Current Students
2012 The Association of American Medical Colleges convenes the Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development.
2014 The AAMC Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development introduces Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators
2018 The American Medical College Application Service includes the option to specify "current gender identity" on the common medical school application. The revised form allows applicants to select their preferred set of pronouns from a dropdown menu and offers the gender non-binary Mx. in the dropdown list of honorifics.
In addition to its own programming, the University Office of Equality and Diversity offers culturally relevant training for faculty and staff upon request, tailored to the needs of the participants. Topics might include fostering an inclusive culture in the classroom, LGBTQ+ allyship, or bystander intervention, among others (drexel.edu/oed/training/overview). Online training, such as "Understanding Title IX," is offered through Career Pathway on DrexelOne.
In collaboration with Human Resources, the office has published a manual for employees about transitioning in the workplace that was "pretty warmly received," Krohn notes. Transitioning at Work: Guidelines & Resources for the Drexel Community was drafted by a committee that included the University's LGBTQA+ Colleague Resource Group. It's geared towards people at Drexel who may be considering coming out as transgender or non-binary, and what that might mean for them, what health benefits they have, how to talk to their supervisors, how to use a different name, and so on (drexel.edu/hr/resources/employee-resources/gender-transition).
The College of Medicine's Office of Diversity, Equity & Inclusion supports several student groups, including the LGBT Medical Student Group (drexel.edu/medicine/about/diversity/diversity-for-students). DUCoM students can also take advantage of the initiatives of the University-wide Student Center for Diversity & Inclusion (drexel.edu/studentlife/diversity).
*The Williams Institute, a think tank at UCLA School of Law, conducts independent research on sexual orientation and gender identity law and public policy.
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