Overall, Chris Hayhurst wrote a very respectful piece on transgender healthcare. It’s clear that he did his due diligence in researching the issues that transgender people face when they seek out medical care.
However, Hayhurst’s overarching problem within his article is how he describes transgender people’s “biological” sex. He says Keelin Godsey, whom he repeatedly references in his article, was “born and remains legally female but identifies as male.” This contradicts itself. Godsey identifies as male - therefore, he was born male. Godsey being “legally female” is the author’s own description and is, in itself, transphobic. For this article, Hayhurst did amazing research on the medical issues that transgender people face but he seems to have done very little research into the social aspect of transgender people. Had he done so, he would not have referred to Godsey as female in any way. Godsey’s legal gender identity (and, indeed, his sexual organs) has no bearing on this article. Simply referring to Godsey as a transgender male would have been more than sufficient.
This ties directly to my next problem with Hayhurst’s article. In his “creating a friendly practice” subheading, he discusses “properly worded intake forms.” Hayhurst is correct that the current practice of having the patient check the tickbox for either male or female sends a message to the transgender community. However, one of his sources, Daniela Mead, says the same thing about her transgender patients as Hayhurst did when introducing Keelin Godsey. Mead uses an example of a female patient who is biologically male. The questions she would add to intake forms are similar - she would include “what was your gender assigned at birth”” and “what is your current gender identity?” - which many transgender people will find transphobic. Hayhurst follows this stating that Godsey agrees with Mead’s ideas but the quote Hayhurst uses doesn’t show this. Godsey says that “intake forms should give the patient the opportunity to tell you everything you need to know.” Godsey doesn’t mention anything about “gender assigned at birth” or “current gender identity.” Many transgender people balk at discussing any of this but most recognize the necessity of being 100% honest and upfront with doctors. Godsey’s idea - which I agree with more than Mead - would give the patient the space to explain their identity as necessary.
To be fair, a lot of these overarching problems are not the fault of Hayhurst or Mead. In the entire medical community, there is an entire lack of understanding of transgender identity. A transgender man is not biologically female. He is a man, full stop. the medical community needs to improve its understanding. A vagina is just a vagina. It is not female anatomy, nor does it prove that someone is biologically female. Intersex people prove that there isn't just penis or vagina, so why does the medical community insist on making these changes?
About the Author: Hannah Althof graduated from Arizona State University in 2013 with a bachelors degree in English Literature and minors in Psychology & LGBT Studies. She is an LGBTQ activist always looking to increase her knowledge of how the world intersects with the LGBTQ community with the outlook towards improving related social needs issues. She also serves as the editor and creative consultant of this blog.
Read the assenting opinion here.
Great post! In the interest of building a better practice, what are your suggestions for better wording on intake forms? It is helpful to determine both the person's identity and preferred pronoun for daily interactions, as well as their health risk factors related to genetic makeup (osteoporosis, heart disease, side effects of hormone therapy, etc). How should a well-meaning therapist open up that conversation?
ReplyDeleteHello and thank you for responding to our post! Hannah is currently on vacation and will answer your question when she returns. I will be sure to personally remind her.
DeleteHi! Thank you for your response. Like Heidi said, I've been on vacation so I appreciate your patience in waiting for my reply.
ReplyDeleteI want to preface this by saying I am not a physical therapist. I haven't studied physical therapy. I haven't received any education in physical therapy. I am going to talk about this as if a magic wand could be waved and all these changes could happen perfectly and immediately.
Ideally, gender on intakes would be a fill in the blank ie "gender: _____" giving the patient the opportunity to list their own personal gender identity. I know that reproductive organs can effect health problems and how those problems would be treated but I would be extremely offended if a medical intake asked me what my reproductive organs were, and I imagine it would be much worse for a transgender person. I think this question should be discussed in private, during consultation, rather than on a piece of paper.
Hayhurst mentions in his article that many transgender folks already avoid medical care so I think by the time a transgender person has made the decision to see a physical therapist, or any medical doctor, they would have also made the decision to "come out" about their gender identity and history. I think this should always come from the patient. In regards to a therapist opening up this line of communication, I don't think a doctor should ever ask a patient if they are transgender. Even knowing that a PT could provide more effective treatment if they knew their client was transgender, I still absolutely believe that this information should come from the patient voluntarily.
I hope I answered your questions!
I agree with Hannah. As a physical therapist, I admit that it can really change my diagnosis pattern approach if I know that an individual may be transitioning and hormones are in play which could manifest as musculoskeletal issues (such as ligamentous instability), however we can't MAKE our patients tell us anything. Sure we might chase rabbits until we get this last piece of information, but how is this any different than the patient who all of a sudden remembers that they have been taking a ridiculous amount of NSAIDS everyday for the past year? We can't MAKE our patients tell us anything. That is part of patient autonomy. I believe that trust is the foundation for any physician/patient relationship. Asking direct questions such as "what organs do you have?" is rude and aggressive. Rewording the question to something such as
ReplyDelete"Since you have mentioned that you are transitioning/have transitioned/are on hormonal therapy/etc, there are extra factors to consider in my diagnosis and evaluation. I am not asking to be rude, but merely to make sure that I am understanding your full health profile to make sure I am giving you the correct care and the right answers to your questions. Would you mind telling me where are you in your current transition plan and what i coming in the next few weeks/months so I can make sure to coordinate your PT care with any medical care you may be undergoing?"
I have used the above spiel a few times and it sets the tone for an open and honest line of non-threatening communication. I get my answers and my patient gets the care that they deserve.