Language Matters: How to Improve Patient/Provider Communication
–Michelle Levy, Stand with Trans Volunteer

Interactions between transgender people and healthcare providers can be fraught with anxiety.  From misgendering to miscommunication, it is important to understand the dynamics and take charge of your experience within the healthcare setting. As a trans person or a parent or friend accompanying a trans person, you should be aware of the level of healthcare provider knowledge of trans issues, and possible miscommunication due to both lack of knowledge and underlying cisnormativity and heteronormativity. Whether you are in a healthcare setting for a broken arm, or something related to trans medical care, make sure that your health care provider understands your concerns and that you fully understand each other’s terminology. If you anticipate cisnormativity, heteronormativity, and inexperience with trans language, you will have a better chance of clearing up misunderstandings by asking questions and anticipating misconceptions and clarifying what you mean when you answer questions. 

Here is an illustrative story. Transgender people often choose to have gender affirming surgeries.  As more doctors perform these surgeries, including physicians who have not necessarily had previous experience in transgender care, it is extremely important that we are able to effectively communicate with them. Language matters, and we shouldn’t assume that care providers have enough knowledge to ask questions that get them the information that they need. 

An ob/gyn surgeon who specializes in hysterectomies reached out to the trans community, realizing that trans men were being underserved.  His patient base had previously been exclusively cis women.  Because of that, he had trouble phrasing his questions to get the information he needed when dealing with his new transgender patients.  As patients or guardians, we need to be mindful of how information is communicated.  Normally, a pap smear is done before hysterectomies, unless certain conditions are met.  As pap smears can be dysphoria inducing or traumatic for trans men, unnecessary testing should be avoided.  Sexual history is relevant as to whether a pap smear is required.

The issue was that the surgeon’s sexual history questions did not work when questioning his transgender patients. “Have you ever had sex” seems like a simple, straight-forward question to ask. However, what he meant was heterosexual relations between cis men and cis women. A trans man who had a history of having sex with cis women or trans men would not need a pap smear but would answer “yes” to “have you ever had sex.” Even “have you ever had sex with a man” would not necessarily give the physician the correct information if the patient answered “yes” but his experience was with other trans men. And of course, what does one mean by “having sex”?  The heteronormative concept of sexual activity focuses on penetrative intercourse, which is what the surgeon needed to know about. This type of assumption could lead to miscommunication between doctor and patient, and an unnecessary and potentially distressing vaginal medical procedure. The best way to get the specific information required would have been to ask something like, “have you ever had sexual intercourse with a cis man” or “have you ever had penis-in-vagina sex.” Both of those questions are clear, precise, and are inclusive of trans men (and gay/bi women as well). 

Both patient and doctor in the scenario above both thought that they were communicating effectively with each other, but there was a disconnect. In medical situations, it is extremely important that accurate information is obtained. Don’t be embarrassed to advocate for yourself/the patient. Ask questions to get to the assumptions behind questions. Have your doctor explain why they need to know certain things, because the reasons may expose a misunderstanding. Sometimes providing more information that asked for can expose the miscommunication. So, if asked “have you ever had sex” and the patient responded, “Yes, with trans men,” the assumptions would be tested.  Because many transgender people seek medical treatment, it is important to remember that language matters, and that patients need to clarify questions, to make sure that all information needed is given. 

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