Transgender Health

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

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Conclusions This exploratory study provides a novel inquiry into physician-side barriers to healthcare provision for trans patients. Barriers previously identified by the trans community were found to limit care provision by physicians as well, including the inaccessibility of resources and appropriate referrals, inadequate medical knowledge and training, the limitations of GID diagnosis, and the low availability of trans healthcare services. This study presents additional insight to physician-side barriers involving the ethics of providing transition-related medical care. The findings contribute to an emerging debate regarding models of trans healthcare organisation, and how these may address some of the barriers faced by trans people and their physicians within the healthcare system. While the findings of this study elucidate some of the barriers faced by physicians, more research is needed to fully understand healthcare provision barriers, and to develop solutions that are acceptable to both the medical and trans communities. Additional file Additional file 1: Participant interview schedule. Abbreviations CME: Continuing Medical Education; DSM: Diagnostic and Statistical Manual of Mental Disorders—refers to DSM-IV TR unless otherwise specified.; GID: gender identity disorder; HIV: human immunodeficiency virus; LGBT: lesbian, gay, bisexual or transgender; SRS: sex reassignment surgeries, which may include hysterectomy, oophorectomy, phalloplasty, metoidioplasty, mastectomy and chest reconstruction, orchiectomy, and vaginoplasty. Competing interests The authors declare that they have no competing interests. Acknowledgements We wish to acknowledge the thirteen physician participants involved with this study. 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