On episode 207 of RNFM Radio, Keith flies solo, speaking at length about transgender health issues with Dr. Susan Strauss, RN, ED.D, an old friend and previous guest on the show.
This episode was recorded three days after the shocking mass shooting in Orlando at the Pulse nightclub; due to uncanny serendipity, we were already planning to speak today about issues related to the lives of transgender individuals. This is an issue of great importance and interest to Keith; he has worked with a number of transgender patients and clients over the years as a nurse, and his son currently works for Boston GLASS, a non-profit LGBTQI support organization in Boston which is a program of the Justice Research Institute.
About Dr. Susan Strauss
Susan has worked as a registered nurse in the operating room, pediatrics, medical-surgical, psychiatry, and public health. She is a seasoned health educator working with a variety of community, education, and professional groups. She has also been the director of healthcare quality improvement, director of education and development, and held other healthcare leadership roles. Susan’s involvement as a Wellness director adds to her knowledge on fitness, stress, and establishing wellness programs. One of her specialty areas is bullying and harassment in healthcare- working as an expert witness for lawsuits, training, and conducting investigations.. She researched physician abuse to RNs in the OR to determine if the abuse varied based on the gender of the nurse.
Dr. Strauss has authored over 30 books, book chapters, and articles, as well as written curriculum and training manuals. Susan has been featured on 20/20, CBS Evening News, and other television and radio programs as well as interviewed for newspaper and journal articles such as the Times of London, Lawyers Weekly, and Harvard Education Newsletter.
Susan has presented at international conferences in Botswana, Egypt, Thailand, Israel, and the U.S., and conducted sex discrimination research in Poland. She has consulted with professionals from other countries such as Israel, England, Australia, Canada and St. Maartin. In addition to her RN, Susan has a master’s degree in community health science, and holds a doctorate in organizational leadership.
The Transgender Community, Gender Identity, and More
The U.S. government states that 0.3% of American identify as transgender, but both Keith and Susan question this statistics. Transgender is defined by Susan as a person who was assigned a specific sex at birth based on their genitalia, but the transgender person sees themselves as another gender than the one which they were assigned. However, with gender being more fluid in the 21st century, we are seeing individuals who see themselves as not having a gender, or perhaps as expressing a different gender identity based on how they feel on a particular day or situation. The definition of gender is changing, and it behooves healthcare providers to understand these dynamics.
Transgender individuals have existed throughout recorded history; in some native cultures, transgender persons are sometimes referred to as “Two Spirit”. In Australia, Nepal, India, and other countries, a third gender has actually been formally identified.
During this episode, Susan also defines and discusses important terms, such as transsexual (an outdated term still used by some people), cross-dresser, trans man, trans woman, and others.
Keith and Susan also discuss sex reassignment surgery (also sometimes referred to as “sex affirmation surgery”, as well as the experiences of some transgender individuals with whom Keith is acquainted.
The Trans Experience in the Healthcare Setting
In the healthcare setting, trans patients can face subtle and overt discrimination from the moment they register at the front desk. If an individual presents as a man (facial hair, deep voice, etc) but still has female genitalia, how will that patient be treated by front line staff when he registers for an annual PAP smear? Although this person identifies as male and lives as a man in his day to day life, he has not yet undergone gender reassignment surgery (or may choose not to do so at all for his own private reasons), and he still needs gynecological care. Will he receive care based on dignity and privacy, or will he be discriminated against, mocked, or otherwise treated poorly because he does not correspond to our strict stereotypes of what a man or woman should be?
In another scenario, a man who has indeed undergone gender affirmation/reassignment surgery and lives as a woman still has a prostate gland. Will her doctor be comfortable addressing the fact that she needs an annual prostate exam and PSA blood test? Will insurance pay for such a test if the female gender is checked in the demographic section of all forms?
Speaking of forms, having only two gender identities to choose from on any given intake form in the healthcare setting can lead to problems for both the patient and providers. During the conversation, Keith raises this fact and Susan discusses potential negative outcomes for patient care.
Legal Cases Arise
Susan describes the case of Jakob Rumble, a trans man whose legal case has been deemed plausible and worthy of pursuit under the Affordable Care Act by a Minneapolis judge. A great deal of discrimination has been identified having occurred in the emergency room where Jakob was seen, and the case is likely to move forward during 2016.
In one study mentioned by Dr. Strauss, 70% of transgender individuals report having experienced harassment or discrimination in the healthcare setting.
Healthcare providers should be aware than transgender patients are protected by The Affordable Care Act (ACA), Title IX, Title VI, the Americans With Disabilities Act (ADA), some state and local laws, The Hill-Burton Act, Medicare and Medicaid regulations, Section 504 of the U.S. Rehabilitation Act, HIPAA, The Emergency Medical Treatment and Labor Act (EMTALA), and others.
A survey referenced by Dr. Strauss shows that a doctor’s knowledge of a patient’s transgender status significantly increases the likelihood of discrimination and abuse.
Some Resources For You
- The Healthcare Equality Index (HEI) is an excellent downloadable resource from The Human Rights Campaign. From their website: “The Healthcare Equality Index (HEI) is the national LGBTQ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees. The HEI 2016 evaluates a total of 2,061 healthcare facilities nationwide.”
- The Joint Commission has a set of LGBT guidelines for healthcare organizations
- The Implicit Association Exam (IAT) from Harvard University assists individuals in identifying their own implicit biases.
- National Transgender Discrimination Survey Report on Health and Health Care
- HHS Final Rule Finds Categorical Exclusions for Health Services Related to Gender Transition Are Generally Unlawful
- Animated video of sexual reassignment surgery
- Video excerpt from documentary about sexual reassignment surgery
- Graphic video of male-to-female sexual reassignment surgery
- Another graphic video of male-to-female surgery
- Health System Skimps on Trans Health Care Training
What Can You Do?
- Be curious, non-judgmental, and compassionate
- Seek information and understanding of issues faced by transgender patients; get educated
- Take responsibility that the healthcare you provide is free of transgender bias
- Understand the regulations and laws impacting patients in your state
- Review intake forms for gender discrimination that put trans individuals in an uncomfortable position
- Urge nursing schools and medical schools to provide comprehensive transgender health educational content
- Urge your organization, workplace, or facility to provide comprehensive education for staff (front line staff, housekeeping, medical assistants and support staff, nurses, doctors, surgeons, and other staff and providers)
- Examine your own biases (you can use the IAT exam mentioned above)
- Become a champion for the healthcare rights of the LGBTQI community
- Dr. Strauss says “Take an active, purposeful, intentional journey to become more inclusive, and actively apply it to your work environment.”
Find and connect with Dr. Susan Strauss:
- On Twitter
- Susan’s Facebook page regarding workplace discrimination
- Susan’s Facebook page regarding harassment and bullying in schools
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