Transgender Health

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Snelgrove et al. BMC Health Services Research 2012, 12:110 http://www.biomedcentral.com/1472-6963/12/110

RESEARCH ARTICLE

Open Access

“Completely out-at-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for transgender patients John W Snelgrove*, Amanda M Jasudavisius, Bradley W Rowe, Evan M Head and Greta R Bauer Abstract

Background: Members of the transgender community have identified healthcare access barriers, yet a corresponding inquiry into healthcare provider perspectives has lagged. Our aim was to examine physician perceptions of barriers to healthcare provision for transgender patients. Methods: This was a qualitative study with physician participants from Ontario, Canada. Semi-structured interviews were used to capture a progression of ideas related to barriers faced by physicians when caring for trans patients. Qualitative data were then transcribed verbatim and analysed with an emergent grounded theory approach. Results: A total of thirteen (13) physician participants were interviewed. Analysis revealed healthcare barriers that grouped into five themes: Accessing resources, medical knowledge deficits, ethics of transition-related medical care, diagnosing vs. pathologising trans patients, and health system determinants. A centralising theme of “not knowing where to go or who to talk to” was also identified. Conclusions: The findings of this study show that physicians perceive barriers to the care of trans patients, and that these barriers are multifactorial. Access barriers impede physicians when referring patients to specialists or searching for reliable treatment information. Clinical management of trans patients is complicated by a lack of knowledge, and by ethical considerations regarding treatments—which can be unfamiliar or challenging to physicians. The disciplinary division of responsibilities within medicine further complicates care; few practitioners identify trans healthcare as an interest area, and there is a tendency to overemphasise trans status in mental health evaluations. Failure to recognise and accommodate trans patients within sex-segregated healthcare systems leads to deficient health policy. The findings of this study suggest potential solutions to trans healthcare barriers at the informational level—with increased awareness of clinical guidelines and by including trans health issues in medical education—and at the institutional level, with support for both trans-focused and trans-friendly primary care models.

Background Transgender and transsexual (trans) people continue to experience discrimination, even in societies with advanced human rights protections. The social marginalisation of trans people is the focus of a growing body of scholarly work that draws attention to discrimination in employment, education, income, and housing [1-3]. Research shows that transphobia—the experience of discrimination based on * Correspondence: jsnelgrove2011@meds.uwo.ca Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada

having a gender identity or expression that varies from the sex assigned at birth—also constitutes an access barrier to medical care, both in general primary care [4-6], and in specialised areas such as mental health [7], substance abuse treatment [8], and HIV [9,10]. Barriers to access are multifactorial, and although contributing issues include frank discrimination such as verbal abuse, other more subtle processes create environments that are ill adapted to the needs of trans patients. Lack of knowledgeable healthcare providers and medical information regarding trans healthcare are cited as restrictions for trans patients seeking

© 2012 Snelgrove et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,...
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