Louisville Medicine Volume 65, Issue 8 - Page 7

From the PRESIDENT Robert A. Zaring, MD, MMM GLMS President | rob.zaring@glms.org PHYSICIANS AND TRANSGENDER PATIENTS: A New Working Relationship I hope everyone had the most enjoyable holiday season, and I wish everyone the happiest new year. The new year will no doubt bring many challenges and innovations to the field of medicine and the Louisville medical community. In my past articles, I have mentioned different technologies that I thought would shape the field of medicine in the future. However, not all innovations are technologically based. Sometimes, innovations are simply a new way of looking at a previous issue. This month, we celebrate the birth of Dr. Martin Luther King Jr. and his way of fighting for equal rights which forever changed our country. This is an example of exceptional ideas and brave implementation to tackle problems that had marred the moral fabric of our country for years. It is also how one person, or one idea can catapult the zeitgeist of a generation down a new path. Today, we still fight inequalities. The old ones still exist and others have grown in visibility in the public forum. Through the last several years, we have seen the battles over allowing marriage between same sex couples and even arguments regarding who can use what bathroom tear apart states like our own and North Carolina. Gender identity issues have taken center stage and names like Caitlyn Jenner and Jazz Jennings of Being Jazz: My Life as a (Transgender) Teen have stirred public discourse. Other popular television shows such as Orange is the New Black have featured transgender individuals in prominent roles, and just this past election cycle Danica Roem, a transgender woman, was elected to the Virginia State House of Delegates. These individuals and shows have challenged traditional views of what it means to be a man or a woman. With something so personal and intimate as how you view your own gender, it should not be any surprise that health care would also be affected with this rise in gender identity awareness. The American Medical Association, at several of its latest meetings, has had resolutions and discussions on how to handle classifying an individual’s gender in the medical chart. Furthermore, there has been more discussion and mindfulness about the unique health problems that transgender individuals face. Vanderbilt University’s website lists some of these key health problems that are particular to transgender individuals or are more frequently seen in this patient population. These problems include the following: access to health care, the effects of hormone usage, cancer, injectable silicone, substance abuse, depression and anxiety, sexually transmitted diseases, alcohol, tobacco and heart disease. On that list, one of the most disturbing to me is access to health care. The reason I find this so disturbing is that the lack of access to health care has primarily been due to negative experiences these individuals have had with the medical community. Regardless of how one views the political debate, there can really be no argument that these individuals deserve the dignity and respect other patients receive. The patient-physician relationship is a sacred connection that requires the physician to hold the patient’s information private but also to treat the patient with compassion. It is only through that relationship that a patient can feel free to disclose what ails them, so the physician can treat them appropriately. Disclosing such personal information as your health history with someone is already intimidating enough, much more so if the recipient has a judging demeanor. It is also important to remember that this relationship must be maintained throughout the medical team staff, including those in the front office scheduling appointments. I believe that a big part of the negative experiences which transgender individuals may have faced in the past within the medical community have come as we have just not known how to handle these issues. Therefore, education is the key. Getting back to the importance of innovation, I certainly believe that U of L deserves a lot of credit for its initiative in tackling this issue. The university has led the way, and now offers a LGBT Health Certificate for health care students and professionals. The certificate provides training for successful interaction with LGBT patients. This program is self- directed and online or may be completed in-person. Furthermore, the University of Louisville School of Medicine is now serving as a pilot for medical schools across the country by incorporating LGBT training into the curriculum. The training will help medical students understand and treat the unique issues faced by the LGBT community. The Greek philosopher Heraclitus is credited with the famous quote, “There is nothing permanent except change.” This statement has had many different permutations throughout the years but is still often used, because it is so true. The way gender identity is viewed is changing in the public forum and the medical community must adapt to those changes so that we can offer the best care to our patients. Thankfully, programs like those sponsored by the University of Louisville exist to guide us through these transforming times. Dr. Zaring is an anatomic and clinical patholo- gist with Louisville Pathology Associates and practices at Jewish Hospital. JANUARY 2018 5