PT in Motion: Appropriately Handling Sensitive Issues

From www.lgbthealthwellness.com

In the latest edition of PT in Motion, spreading from pages 16 to 22, was an article that has been a long time coming. It was titled "Managing Patients who are Transgender," and focused on many of the aspects of health care that serve as barriers to this population and what physical therapy can do to advocate for our patients. I really, really enjoyed this article and would like to offer an analysis of some of the context within the article to prove just how important this article really is to our community as a whole.

1. Navigating a Complicated Health Care System. People who are transgender face unique obstacles as well as barriers to their care. Access to care has three realms: financial, provider knowledge/available services, and pursuance of such care by the consumer (the patient). This article addresses each realm as an important aspect of physical therapy. As the article lists, individuals who are transgender can be strapped with a myriad of other health costs including hormone replacements, surgical procedures, and other medical-related expenses. Further barriers exist within an underlying general distrust of the medical community for fear of judgement or denial of services. These obstructions serve as an opportunity for the field of physical therapy to act as an advocate for our patients who are facing these issues, transgender or not. Through these enhanced interactions, we can further advocate for direct access to our patients through being a provider that is truly on the forefront of patient championing. 
2. Clinical Tips and Tricks.  The article starts with a bang by painting a great picture of the barriers that transgender individuals face, but it then picks up further momentum as the author offers solutions to these issues. So now, not only have we been educated on the issue, we also have no excuses for being able to address some of these issues. I particularly enjoyed the added push of the importance of individualized conversation regarding gender identity in order to appropriately and safely screen patients for systemic issues. A simple check box is not adequate to gain trust and promote full disclosure within the PT/patient relationship. With this, the author has made a statement that providing inappropriate care is not only an ethical issue, but also a potential malpractice issue as well. We can't ignore items of our patients' medical history because it makes us uncomfortable. Finally, we are also given a myriad of resources for additional information, further pushing the "no excuses" attitude of this article. 
3. Style and Grace. Not only does the article list all of these very important issues out and pair them with possible solutions, but it also does so with great sensitivity and objective perspective. Its states the facts, stays away from controversy that is based on emotion, and even delivers general knowledge on terminology to provide education for those who many not be familiar with this realm of the human experience. This article was composed in such a non-threatening and logical way that I personally haven't seen more of an uproar about it. But perhaps the best part about this article is the actual title itself. The way the words are ordered, this title demonstrates people-first language. The person comes before any qualifier that can be applied to them.  These people are our patients, first and foremost. Secondarily, they are defined as transgender. This is important for not only individuals who are transgender, but also patients who have chronic pain, a learning disability, or any other medical issue. This helps keep humanity and humility in the forefront of our minds as we tackle this controversial topic. 

Coming from a program in a small town in Texas, this was a hot topic among my classmates, professors, and the rest of the professional community as a whole. I knew that the moment I brought this topic up during a discussion related to pelvic floor treatments I had made a grave mistake. The class erupted into such a ruckus that not only did I not get my question answered, but people persevered on it for the next few days as well. As someone who completed their undergraduate degree in Flagstaff, Arizona, this reaction was completely foreign to me. It was shocking how the conversation was turned about from focusing on caring for the patient to a selfish rant on why being transgender is offensive to them. As members of the field of physical therapy, we need to remember this is not about us, it's about our patients (go read the APTA Code of Ethics if you don't believe me). Additionally, as a professional, if I am not able to put my personal beliefs aside for the benefit of my patients, then I have no business being in the healthcare field. Compassion extends outwards towards others, it does not inwardly project.

I have seen many narrow-minded comments and arguments both on and off-line in relation to this topic. One of the most frequent, as well as disturbing comments I have witnessed is, "It doesn't matter if they are trans, everyone should be treated the same." So if I have two patients with recent ACL repair and one is 16 and the other is 60... I should treat their rehab the same? Or if I have a patient s/p stroke, and one is 300 pounds and the other is 100 pounds, I should treat them the same? There is so much wrong with this statement that it literally makes my blood boil. As the article states (in purple bold face, I might add), patients who are transgender have certain unique needs. To ignore these needs is to deny vital and deserved services to a community of individuals who have already faced discrimination as the hands of the medical system. Let's be different. Let's show the world that we are equipped and open to serve all members of the community and that we take direct access for all populations seriously. 

For more resources, I highly suggest checking out Chris Mosier's website Transathlete. Chris is the first ever athlete, who is transgender, featured in ESPN's Body Issue.

Read the dissenting opinion article by clicking here.