Transgender Interview Approach

[Beezlebub]

been reading journals lately during my breaks regarding modern medicine; feel I need improvements upon tackling the LGBTQ scenario. this is a group that needs to be explored upon in order to provide proper care and management.

What is a good approach to interviewing an individual who is transitioning from transgenderism?


What are some good questions?
What is a good intro (some people prefer to be considered a male/female, but does not correspond with their birth sex)?
Recommend any assessments?
Should screen for depression, substance use, etc?

Any advice is appreciated.

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[otterxavier]

First of all -- it's awesome that you're recognizing this as an unmet need and thinking about how to improve!

It's always a good idea to give patients an opportunity to provide their gender identity (separate from the sex that may be on their ID or insurance card) and their preferred pronouns. I think that's really best accomplished during intake, because it sets a respectful tone from the beginning and is important info for the receptionists, MAs, RNs, etc. who will all be interacting with the patient before they are interviewed by the doctor. Doctors are often in a good position to advocate for including that information on intake forms, in the EMR, etc. -- and should make sure to actually check it before they go in to see the patient.

Beyond that, a good assessment/interview for a trans patient is going to depend largely on context. You will ask different questions if you're seeing a patient who would like to start hormone therapy, vs. doing an initial primary-care visit with someone who is a few years into transition, vs. an ED visit for a trans patient with acute shortness of breath. A few strategies that I think are valuable in general are:

- If it's appropriate, let the patient set the priorities. "I noticed that you wrote on your intake form that you identify as transgender. Is that something you want to talk about today? / Is there anything that you want me to know about that so that I can give you the most respectful/appropriate medical care?"

- Focus on questions that are clinically relevant. With trans patients doctors are sometimes tempted to ask questions out of curiosity ("How old were you when you realized that you're trans?" "Are you considering genital surgery in the future?") -- if they're not relevant, that kind of probing can be alienating to the patient.

- Explain why you're asking about trans status / transition history, if the relevance may not be obvious to the patient. e.g., "I want to ask more about your hormone use, because that can increase the risk of clots that cause leg pain like you're having."

Does that start to answer your questions?

 

[Beezlebub]

First of all -- it's awesome that you're recognizing this as an unmet need and thinking about how to improve!

It's always a good idea to give patients an opportunity to provide their gender identity (separate from the sex that may be on their ID or insurance card) and their preferred pronouns. I think that's really best accomplished during intake, because it sets a respectful tone from the beginning and is important info for the receptionists, MAs, RNs, etc. who will all be interacting with the patient before they are interviewed by the doctor. Doctors are often in a good position to advocate for including that information on intake forms, in the EMR, etc. -- and should make sure to actually check it before they go in to see the patient.

Beyond that, a good assessment/interview for a trans patient is going to depend largely on context. You will ask different questions if you're seeing a patient who would like to start hormone therapy, vs. doing an initial primary-care visit with someone who is a few years into transition, vs. an ED visit for a trans patient with acute shortness of breath. A few strategies that I think are valuable in general are:

- If it's appropriate, let the patient set the priorities. "I noticed that you wrote on your intake form that you identify as transgender. Is that something you want to talk about today? / Is there anything that you want me to know about that so that I can give you the most respectful/appropriate medical care?"

- Focus on questions that are clinically relevant. With trans patients doctors are sometimes tempted to ask questions out of curiosity ("How old were you when you realized that you're trans?" "Are you considering genital surgery in the future?") -- if they're not relevant, that kind of probing can be alienating to the patient.

- Explain why you're asking about trans status / transition history, if the relevance may not be obvious to the patient. e.g., "I want to ask more about your hormone use, because that can increase the risk of clots that cause leg pain like you're having."

Does that start to answer your questions?

Appreciate your feedback. It's very helpful to me. Have you ever had an experience interviewing a trans individual, if so, could you tell me some of their concerns. If I could understand their problems and their mindset, I think that will be helpful in guiding my overall tone of the interview and localize on important issues that I can discuss w/ the patient and offer them advice/recommendations that can make their life better. Any other additional advice is helpful as well. Thanks in advance.

 

[DanielLee5]

First of all -- it's awesome that you're recognizing this as an unmet need and thinking about how to improve!

It's always a good idea to give patients an opportunity to provide their gender identity (separate from the sex that may be on their ID or insurance card) and their preferred pronouns. I think that's really best accomplished during intake, because it sets a respectful tone from the beginning and is important info for the receptionists, MAs, RNs, etc. who will all be interacting with the patient before they are interviewed by the doctor. Doctors are often in a good position to advocate for including that information on intake forms, in the EMR, etc. -- and should make sure to actually check it before they go in to see the patient.

Beyond that, a good assessment/interview for a trans patient is going to depend largely on context. You will ask different questions if you're seeing a patient who would like to start hormone therapy, vs. doing an initial primary-care visit with someone who is a few years into transition, vs. an ED visit for a trans patient with acute shortness of breath. A few strategies that I think are valuable in general are:

- If it's appropriate, let the patient set the priorities. "I noticed that you wrote on your intake form that you identify as transgender. Is that something you want to talk about today? / Is there anything that you want me to know about that so that I can give you the most respectful/appropriate medical care?"

- Focus on questions that are clinically relevant. With trans patients doctors are sometimes tempted to ask questions out of curiosity ("How old were you when you realized that you're trans?" "Are you considering genital surgery in the future?") -- if they're not relevant, that kind of probing can be alienating to the patient.
Thanks for the full and detailed reply!
- Explain why you're asking about trans status / transition history, if the relevance may not be obvious to the patient. e.g., "I want to ask more about your hormone use, because that can increase the risk of clots that cause leg pain like you're having."

Does that start to answer your questions?