CASE STUDY: My patient just told me they are trans. What do I say?

Communicating with transgender patients

Transgender patients experience significant barriers to accessing health care.
As with many marginalized communities, physicians as a profession have contributed to the trauma inflicted on transgender people. We need to acknowledge this history is woven into our white coats and act accordingly with our trans patients
Despite a DSM-V diagnosis, trans patients are not mentally ill. They do not have higher rates of schizophrenia or bipolar order, but do experience higher levels of socially-mediated illness like depression and anxiety due to external societal pressures caused by the gender binary.

Based on his book Transforming Practice and almost 15 years of research and clinical experience, Dr. Greatheart recommends

Facilitate care even if you can’t provide it yourself; don’t become another barrier. Provide the care you can within your scope and training, refer to a provider you trust or have screened, and be an ally to you patient.
Recognize that trust is earned, and even our commitment to continuing medical education in trans care does not entitle us to our patients’ trust. Demonstrating empathy and cultural competency is vital.
Screen for depression and anxiety using using your usual clinical tool, as well as Transgender-related social trauma using Dr. Greatheart’s tool.