Saturday, 23 March, 2019 by
Writing: Florence Fenner
Illustration: Abeera Devasar and Keira Johnston
CW: This article contains discussion of transphobia, mental illness and suicide ideation, as well as experiences with healthcare professionals.
When going to visit your doctor, you don’t expect to come out feeling worse than you did before. However, for trans patients in the NHS, this can sometimes be the case. We are in a situation where our doctors are woefully underinformed about their transgender patients and their needs, which puts the patients under huge stress, negatively impacting their mental and physical health.
This was made clear to me whilst undertaking a research project on transgender healthcare experiences as part of my medicine degree. We sent out a questionnaire asking trans patients to relay any interactions they had had with healthcare staff, positive or negative. The responses shocked me. They were overwhelmingly negative, and in some cases, difficult to read. Some of them talked about doctors who had no idea what a non-binary person was, or why a trans man would have unusually high testosterone, leaving the patient to have to uncomfortably explain. One particularly emotive response described a situation where a patient tried to bring up the topic of gender with their GP, who felt that there wasn’t time to discuss the issue, and ushered the patient out of her office with tears streaming down their face. This, I think, is the issue that a lot of doctors have. They think that issues surrounding gender and sexuality aren’t urgent and should be given lower priority than other more direct health issues in the short consultation time they are given .
However, what they might not realise is that providing support to trans patients can be as crucial as referring patients on a waiting list for an organ transplant the waiting list for a Gender Clinic is just as time sensitive in saving a life. Transgender people have some of the highest rates of mental health issues of any group of people. 96% of trans youth in Scotland experience some form of diagnosable mental health issue, and 63% have experienced suicidal thoughts. (1) Having a negative experience with a healthcare professional can be extremely detrimental and can trigger a worsening of mental health with potentially fatal consequences. As well as this, when doctors do not prioritise transgender patients, there can be a delay for referrals to specific services, such as Gender Clinics. Waiting lists for these services are already extremely long, so any further delays due to slow referrals can be disastrous. As well as the long waiting time impacting on the mental health of the patients, it can drive them to find alternative, and dangerous, solutions. Many people will order hormone treatments online, which when taken without proper regulation, can have risks to the life of the patient.
However, this is a problem that can be easily fixed. Far from requiring a complex medical solution, doctors simply need adequate education on transgender issues and what they can do to help their patients to avoid situations like this. It seems easy enough, yet Edinburgh Medical School, one of the leading institutions in the country, is unable to deliver this. There is only one day of LGBT education organised for pre-clinical medics, which was cancelled for my year due to the strikes. Unlike many other lectures, it was not deemed important enough to be rescheduled. Therefore, many people in the medical school are going into clinical training with no formal education on LGBT issues. As a medical student, it is incredibly frustrating to hear ignorant and misinformed views on transgender people coming from the mouths of my peers and knowing that they will soon be seeing patients without ever having these views challenged.
Many issues in medicine are so difficult to resolve that it seems ridiculous that something that can save lives so easily is being overlooked. As future doctors, we owe it to our patients to be fully educated on every person who walks through the doors of our clinics. Medical schools across the country should wake up and realise the human cost of this neglect.
(1) Lough Dennell, B.L., Anderson, G. and McDonnell, D. (2018) Life in Scotland for LGBT Young People. LGBT Youth Scotland.