As a student physical therapist, I witnessed some incredible examples of competent and compassionate care. The only experience that did not live up to this standard was with a patient who was transgender. I observed this patient being treated exclusively with passive modalities, likely because the treating therapist was uncomfortable dealing with her (thankfully, my instructor advocated for this patient and took over her care). This experience stuck out in my mind for years to come. The APTA Code of Ethics1 implores us to treat all patients with dignity and respect, as well as to recognize our own personal biases. Why was it so hard for this otherwise compassionate therapist to do so with this one particular patient?
The July issue of PT in Motion featured an article entitled “Managing Patients Who are Transgender”. If you have not read it, I highly suggest that you read it here. This article2 provides information for creating a welcoming space for our patients in the LGBTQ community and addressing sensitive issues that may come up during the course of treatment. According to the article, our own Section on Women’s Health is compiling resources for practitioners regarding issues of gender and sexual orientation. This is extremely important, as these topics are barely covered in PT education, if at all. The article states that 70% of patients who are transgender report some form of discrimination within the healthcare system, and 28% report postponing medical care for fear of mistreatment. As Women’s Health physical therapists, we have a unique opportunity to end this cycle and to serve as advocates for all of our patients.
Curious about the experiences of patients who are transgender, I decided to ask a dear friend of mine to share his thoughts on dealing with the healthcare system. Aryn was born physically female, and announced his transition to the male gender several years ago. He states that he hasn’t experienced any outright abuse when dealing with healthcare professionals, but has had several instances where he felt neither heard nor respected. He has a primary care physician who has years of experience with the LGBTQ community. When dealing with other providers who do not have this level of expertise, however, he describes the experience as “hell.” In particular, he states that providers have seemed fixated on questions that feel irrelevant to his medical complaints, such as whether or not he has had gender reassignment surgery and why or why not (of course, there are times when this information may be important for the practitioner, but he feels that it has been overemphasized). He also describes medical professionals looking at him like he is “a freak or crazy, and I am neither of those things.” As healthcare professionals, we need to consider what this would be like as a patient—to seek treatment for one ailment only to find your physician more (perhaps solely) interested in an unrelated aspect of your life. Would you feel like you were receiving the best possible care?
I asked Aryn if he had any advice for a new healthcare practitioner when working with patients who are transgender. He answered, “You are the doctor. It should not be my responsibility to educate you about the special needs of the transgender community. Educate yourself, and then educate your peers.” This resonated with me, as I realized that the Section on Women’s Health is one of the only voices in the PT community trying to do just that. We have a wonderful opportunity to be leaders in this area- we can educate ourselves and share resources with our peers, and we can commit ourselves to providing the highest quality, most culturally sensitive care to every single patient we see.
- Swisher LL, Hiller P, others. The revised APTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant: theory, purpose, process, and significance. Phys Ther. 2010;90(5):803-824.
- Hayhurst C. Managing Patients Who Are Transgender. http://www.apta.org/PTinMotion/2016/7/Feature/Transgender/. Accessed July 26, 2016.
About the Author:
Lisa Cheek, PT, DPT, is a 2016 graduate of Regis University. She currently serves as the Assistant Director of Membership for the SOWH SSIG. She is passionate about educating healthcare practitioners and the community about pelvic health PT. She is currently employed at N2 Physical Therapy in Denver, CO, a specialty pelvic health and oncology clinic.