An estimated 1.1 million people in the United States identify as transgender. Transgender people have a gender identity that differs from their sex assigned at birth. National surveys show transgender people often don’t feel welcomed or understood in healthcare settings. And their medical needs are unique, including the multidisciplinary care necessary during the process of transitioning.
Our job is to improve health and save lives, regardless of what our patients or colleagues look like, where they come from, what they believe or who they love.
Massachusetts General Hospital has a history of caring for the lesbian, gay, bisexual and transgender (LGBT) community. The LGBT Employee Resource Group has worked with the community over the past decade and the Department of Medicine has published guidelines for the primary care of lesbian, gay and transgender patients. The Department of Psychiatry leads two federal centers for national transgender health program implementation, training, technical assistance, research and policy innovation. A hospital-wide effort is underway to create a directory of physicians with expertise in gender-affirming care.
Joan Sapir, senior vice president, highlights what’s in the works to better care for the transgender community.
What’s the plan to ensure that transgender patients find a welcoming environment at Mass General?
Our dream is to have a multidisciplinary “medical home” – an outpatient practice for adult and pediatric transgender patients. There, in one place, patients would receive primary care as well as care from a variety of specialists, including an endocrinologist for hormone therapy and surgeons trained in gender-affirming procedures. It might also involve dermatologists for those who need facial feminization or hair removal, pediatricians with training in caring for transgender children and hormonal blockade, and psychiatrists, who manage complex mental health needs and whose evaluation is needed to approve gender confirmation surgery. That’s going to take a significant investment from philanthropy for the space and staff, however.
What’s happening in the meantime?
We’re starting with small steps. The Department of Medicine has committed to opening a clinic a half day a week, which we can expand as more staff and resources are available.
We’ve also learned a lot about ways we can do better without much additional funding. We are in the process of converting public single-stall restrooms in the hospital to all-gender restrooms with affirming signs so that no one will be uncomfortable about their choice of bathroom.
We have a place in our new medical records system to note gender identity and sex assigned at birth. So, if a transgender man presents to OB/GYN, there’s a place in the record to indicate that he identifies as a man but was assigned female sex at birth.
A lot of training is needed. We want to make sure questions are asked in an appropriate way. The front desk staff, for example, need to learn how to respectfully find out every patient’s name and pronouns – he/his, she/hers or non-binary pronouns (they/them). In addition, we are reviewing all our hospital policies to make sure that they really do reflect our values.
How can philanthropy help?
As we build our ideal medical home, the faculty and staff involved have come up with some priority investments. Key will be a patient navigator program to help coordinate care, integrating the clinic into the larger Mass General community.
It goes to the heart of the hospital’s founding mission to help all our neighbors in distress.
We can also assist with insurance authorizations. Insurance now covers most procedures for transgender patients, but not all know that. The navigator can serve as a point person for all care across the hospital. We’ve had great success with the navigator model for other patients.
Why does the hospital leadership believe it important to focus on these patients?
We see it as a social justice and patient care imperative. That very much includes our president, Peter Slavin, MD, and our Board of Trustees. It goes to the heart of the hospital’s founding mission to help all our neighbors in distress. Part of our diversity and inclusion statement relates to providing the very best care to every one of our patients, regardless of gender identity, gender expression or sexual orientation.
As the statement says, “Our job is to improve health and save lives, regardless of what our patients or colleagues look like, where they come from, what they believe or who they love.”
For more information on how to support the expansion of transgender services at Mass General, please contact us.