What are your preferred pronouns?
Him/he, her/she or they/them? What name do you prefer to be called? What gender were you assigned at birth? What is your gender identity?
For some, these questions may be surprising and perhaps unnecessary. But for others, they are a sign of compassion, respect and a desire to learn and understand.
It’s a topic that has seen a lot of news coverage over the last few years. A ban on transgender people serving in the United States military. The first-ever transgender contestant competes for the Miss Universe title. Debates about which public bathroom a transgender person should be allowed to use.
As transgender people simply try to live their lives openly and honestly, conversations are happening more frequently as many try to understand the issues faced by this community. Medicine is no exception, as concerns about accessible, timely and compassionate health care for transgender individuals are voiced more and more.
Dr. Michael Marshall, a psychiatrist based in Edmonton, is considered a specialist in providing health care to transgender Albertans. He’s been instrumental in helping the College understand how we can support our members in asking their LGBTQ2S+ patients the right questions.
“It is often said I am one of five psychiatrists who do this work,” shares Dr. Marshall. “But that’s not actually, wholly correct. Any psychiatrist can do this work. Any physician who has engaged in that training and education can do this work.”
This type of education has been lacking until recently. In medical school, there hasn’t always been a lot of time spent on social issues (including LGBTQ2S+ issues) and how they impact a physician’s role. As a result, many physicians graduate without confidence in their abilities to treat the gender-diverse population. According to Dr. Marshall, what many practitioners don’t realize is that transgender persons have the exact same health concerns and require the same kind of care as any other patient.
Without understanding, physicians might worry about causing offence and therefore, gender-diverse persons often find it difficult to find practitioners who are not afraid to misstep. Because of this, the experience for people who are sexual minorities or gender-diverse in Alberta has been inconsistent. “My work with the LGBTQ community has mostly come about because I’m not afraid to say I’m sorry, I don’t know this, let me find out. Or, what would you like me to call you, what are your pronouns? Questions we sometimes don’t ask in medicine,” says Dr. Marshall.
Talking is the first step
Recognizing this gap in education, the College sought Dr. Marshall’s expertise and clinical experience for a CPSA round-table discussion about gaps in the delivery of diagnostic and lab services to LGBTQ2S+ Albertans. The majority of all clinical decisions are made as a result of a diagnostic test. To actually make an impact on the medical care received in the LGBTQ2S+ community, we needed to initiate work in this important area.
More than 20 participants from the College, Alberta Health Services and a variety of community agencies and health professions participated and spoke about how to change existing processes to ensure gender diverse patients receive appropriate procedures and safe and respectful care in these facilities.
“These conversations are hugely important on a number of different levels,” shares Dr. Marshall. “As the transgender population is smaller than the rest of the population, sometimes it’s easy to forget the experiences of persons who walk the earth differently. Simple things like lab investigations that may be unaffirming, or reports back that may be difficult to reconcile in terms of sex marker versus experienced gender, these things are an important first step for physicians to spend some time on—just one of the many steps that should be happening in parallel.”
These developments and new opportunities for education are a good start, but there is more to do. The College continues to engage in and drive these conversations to better understand how we as the medical regulator can help. Ideally, the gender-diverse community in Alberta needs a dedicated service—a cohesive system of well-trained, educated providers who work together, so that practitioners who treat the gender diverse community are not doing good work in isolation. We’re continuing to advocate for that.
“It is our responsibility to offer good care as physicians,” says Dr. Marshall. “And in order to do that, we sometimes have to learn things that we didn’t expect to have to learn about. There is knowledge available, to allow us to provide good care to the transgender population, that we should all avail ourselves to.
It will save a person’s life.”