November 13, 2022
2 minute read
Levitt C. Session 12S114: Improving clinical skills with transgender/non-binary patients in the rheumatology setting. Presented at: ACR Convergence 2022; November 11-14, 2022; Philadelphia (hybrid meeting).
Levitt does not report any relevant financial information.
PHILADELPHIA – Doing an “anatomical inventory” during visits can help create a more supportive environment for transgender and non-binary patients to discuss their gender identity and the need for organ-specific care, a presenter said here. .
“The TGNB community – which stands for transgender and gender non-binary – needs social services and experiences a lot of discrimination,” Nathan Levitt, FNP-BC, MSN, RN, BSNdirector of LGBTQ learning and gender justice at the Yale School of Nursing, attendees at ACR Convergence 2022 told.
“Even if you are the most sensitive and knowledgeable clinician, before this patient came to your door, they were discriminated againstmaybe outside your health center or hospital, maybe when they arrive at reception and their identification does not match their appearance, maybe by other patients in the ward expectation, especially if they’re there for anything gender-related,” he said.
Levitt noted that many people in the community will avoid primary care for fear of the discrimination they might face. However, by avoiding primary care services, patients also perpetuate health disparities that disproportionately affect the TGNB community.
“What you might find is that transgender and gender non-binary patients have more chronic health issues — not related to being trans, but related to the discrimination they face when trying to come in for basic care,” Levitt said.
He recommended that clinicians do an “anatomical inventory” with their patients to document the presence or absence of certain organs that will help guide patient-centered preventive health screenings. Regardless of gender identity, anatomy inventories are essential because clinicians “need to know what body parts people have in order to care for them.”
“As a man who identifies as transgender, I’ll use myself as a case example to explain why it’s so important to ask about your patient’s anatomy,” Levitt said. “If I show up at your office, most of you may have no idea that I have been assigned female organs. You can never offer a pregnancy test if I go into surgery. You maybe don’t know how to interpret my labs that come across as male defining labs if you don’t know the anatomy I have.
The EHR has also expanded to accommodate more inclusive documentation for TGNB patients, including legal gender, pronouns, correct name, marital status and emergency contacts – as well as a “complementary package in the Epic electronic health record,” which includes a list of what organs are present for individual patients, he said.
“If you think of someone who has had a hysterectomy, you’re not going to think about it in the same way as someone who hasn’t when considering pregnancy risks — the same goes for trans populations,” Levitt said. “They have different body parts; you want to know what they are so you can take care of them.
He added: “I want you all to think about this in your daily care: how can we incorporate this? What are the current strategies within your institution? What are the systems that make this difficult? What are the possible fixes? What can you do in your role and what support would you need? I give you homework to take back to your places of work and think about how to incorporate this.