Journal Article

“Completely out-at-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for transgender patients

Snelgrove, John W, Bauer, Greta R, Head, Evan M, Jasudavisius, Amanda M, Rowe, Bradley W

2012

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Access to information / Adult / Analysis / Clinical practice guidelines / Delivery of Health Care - methods / Emotional abuse / Endocrine therapy / Female / Gender Identity / Grounded theory / Health Administration / Health aspects / Health care / Health care delivery / Health care industry / Health care policy / Health Informatics / Health insurance / Health Knowledge, Attitudes, Practice / Health Services for Transgender Persons - ethics / Health Services for Transgender Persons - standards / Healthcare Disparities / HIV / HIV Infections - prevention & control / HIV Infections - therapy / Hospitals / Human immunodeficiency virus / Humans / Interprofessional Relations / Interviews as Topic / Male / Medical ethics / Medical personnel / Medical policy / Medicine / Medicine & Public Health / Mental disorders / Mental health / Middle Aged / Nursing Research / Ontario / Patients / Physicians / Physicians - psychology / Primary care / Professional-Patient Relations / Professionals / Psychiatrists / Public Health / Qualitative Research / Referral and Consultation / Research Article / Sex discrimination / Sex Reassignment Surgery / Social aspects / Substance abuse treatment / Transgender people / Transgender persons / Transsexualism - diagnosis / Transsexualism - surgery / Transsexualism - therapy