Population Care

Caring for transgender patients: Experts offer guidance

Timothy M. Smith , Contributing News Writer

Transgender patients often face obstacles to timely, supportive, culturally competent medical care, and some even avoid seeking care due to stigma in the health care system. The AMA Journal of Ethics, @JournalofEthics, recently hosted a tweet chat, “Ethical Care for Transgender Patients: Lessons for Healthcare Professionals,” with two experts who discussed what physicians can do in clinical settings to provide good care and help ensure health equity for transgender people.

Rachel Levine, MD, @PhysGenLevine, is the liaison for the lesbian, gay, bisexual and transgender (LGBT) community for the Office of Diversity at the Penn State College of Medicine, where she has established an LGBT faculty and staff affinity group and is the facilitator for the LGBT student group. Dr. Levine is also the Physician General of Pennsylvania. She taught at the Penn State College of Medicine on topics in adolescent medicine, eating disorders and transgender medicine.

Ryan Sallans, MA, @ryansallans, is a public speaker, diversity trainer, consultant, publisher and author specializing in health care, campus inclusion and workplace issues surrounding the lesbian, gay, bisexual, transgender and queer/questioning, intersex and asexual community.

Following is a sampling of questions and answers from the tweet chat, along with takeaways and resources to help physicians, their clinician colleagues and office staff improve health care experiences and health outcomes among transgender patients.

Ryan, in your recent article for AMA Journal of Ethics, you offer 10 lessons for treating transgender patients. What experiences inspired these lessons?

Takeaway: Negative experiences in the health care system can make transgender people reluctant to seek care or share information about their gender identities and health histories.


Dr. Levine, what lessons or advice would you add about how clinicians can provide respectful and inclusive care to transgender patients?

Takeaway: Be aware of your assumptions about transgender patients and work to check them at the exam room door.


Dr. Levine tweeted several additional recommendations:

  • “Avoid assumptions. Don’t assume all patients use traditional label.”
  • “Avoid assumptions. Don’t assume sexual orientation based on appearance.”
  • “Avoid assumptions. Don’t assume sexual behavior based on gender identity.”
  • “Ensure ALL staff are culturally competent, from RN to front desk.”
  • “Respect confidentiality of patients.”

Ryan, what do you think are the most important factors in creating a culture of respect for transgender patients?

Takeaway: Medical practices need policies in place to ensure transgender patients feel respected and understood at every phase of their visits, from reception to discharge.


What are the most important social and cultural determinants clinicians should know about transgender patients?

Takeaway: Transgender people face widespread harassment and discrimination. Health care settings need to be safe and supportive environments.


If you could add 10 hours about transgender issues to every health professions school’s curriculum, what content would you add?

Takeaway: Many aspects of transgender identity are not widely understood, and some physicians are not aware of health disparities among transgender populations.


If you missed the tweet chat, visit the Storify for this #AHealthierNation chat for a chronological recap of all participants’ tweets.

Learn more about what the Code says

The November issue of the AMA Journal of Ethics features opinions from the revised AMA Code of Medical Ethics related to discrimination and disparities in health care. The Code of Medical Ethics recently underwent a comprehensive modernization, resulting in greater relevance, clarity and consistency.