Over the years, modern healthcare in the U.S. has made a tremendous amount of progress, whether it be in regard to an increase in technological innovation, research data, or medical provider diversity. However, in the treatment of minority groups, such as the LGBTQ+ community, many practices still have a long way to go. Treatment disparities are especially highlighted in the case of transgender patients.
In 2018, the National Center for Transgender Equality reported the results of their National Transgender Discrimination Survey, to which almost 28,000 respondents reported alarming results: 19 percent of trans people interviewed reported being denied medical care solely because of their gender identities. In addition, 50 percent of transgender patients reported having to educate their medical provider about transgender care.
These statistics reflect a disturbing truth about healthcare today: that many providers do not possess the diversity training or knowledge necessary to provide adequate care to transgender and gender non-conforming patients.
Susan Boisvert, a senior risk specialist at Coverys–one of the nation’s leading medical professional liability insurance providers–hopes to change the lack of knowledge modern providers have surrounding LGBTQ+ and transgender patient care. She’s been interested in transgender patient care for over twelve years, speaking at both state and national professional associations in order to educate providers on the rights of transgender patients.
Last year, Boisvert spoke at the Institute for Healthcare Improvement’s annual National Forum, advising clinicians and providers on subjects such as creating welcoming care environments, working to put patients’ gender identities and sexual orientations on medical records, and educating providers on respectful LGBTQ+ care. Recently, Boisvert spoke at the “Transforming Healthcare to Be Inclusive of LGBTQ Patients” conference in Burlington MA, talking about the importance of respecting transgender patients’ rights in the ever-changing 2018 political environment as well as about her personal connection to her advocacy.
Around twelve years ago, Boisvert started to become interested in LGBTQ+ care when physician practices began calling her office asking about protocol regarding transgender and gender non-conforming patients. Later, when her son came out to her as transgender during college, Boisvert was inspired to dive into activism. “Given my knowledge of things like suicide rates among transgender people, I decided to learn as much as I could about appropriate care for transgender patients,” says Boisvert. “Then, because there seemed to be a general lack of knowledge in the healthcare and risk management community around how to provide appropriate environment for transgender people much less appropriate medical care, I started speaking.”
In 2018, Boisvert notes that some of the biggest obstacles in providing the right care for transgender patients are representation and legislation. In the CDC’s 2012 survey of the US’s top 138 medical institutions, only 15 percent of deans or chief medical officers said their workplace had lists of LGBTQ+-competent doctors.
This low statistic is a direct result of a lack of education for providers. In 2011, the Journal of the American Medical Association published an article stating that on average, medical schools had a total of only five hours of LGBTQ+-related physician education. “I think that the biggest challenge is there are not very many healthcare providers who are on the spectrum,” says Boisvert. “So healthcare professionals tend to look at LGBTQ patients through their own lens, and they don’t understand how being on the LGBTQ spectrum affects healthcare and affects relationships, and how the professional has to modify their approach when addressing LGBT patients.”
Another reason transgender patients can have difficulty in accessing care is a result of current national political sentiments. “It’s very easy to be complacent in states that do a good job of providing LGBT welcoming healthcare like Massachusetts. But there are a lot of states that aren’t anywhere near where the New England states are,” says Boisvert.
Boisvert goes on to reference the recent proposal that the Office of Civil Rights develop an Office of Conscience, which would allow healthcare professionals who have different values than their providers to deny care that goes against their personal or religious beliefs. This would allow providers to deny care to patients with a variety of minority backgrounds, including LGBTQ+ people. Although the office is not yet in place, the fact that it was proposed and has been gaining support reflects a disturbing reluctance to accommodate patient diversity in modern healthcare.
Boisvert, like many other LGBTQ+ medical advocates, knows there are solutions. She encourages providers to educate staff along every step of a patient’s visit, especially providers working jobs such as patient registration or nursing, on respectful terminology and treatment of transgender patients at the front desk. Boisvert encourages medical staff to listen to patients and use the names and pronouns they refer to themselves as, rather than those listed on often unchangeable medical records.
In addition, Boisvert advocates for single stall, gender-neutral bathrooms in order to create a welcoming and non-hostile environment for trans patients. These would especially help to accommodate nonbinary patients, who are far too often excluded from professional consideration.
Most importantly, Boisvert asks providers to educate themselves, their staff, and their coworkers as much as possible. Although formal training is undoubtedly preferred, Boisvert identifies that in cases where this isn’t possible, there are easy alternatives. “If a hospital or a physician practice wanted some LGBTQ+ people to come in so the staff could ask their questions in a safe environment, all they would have to do is contact a local college and say ‘Hey, could you send some kids from LGBT club over, we’d like to have a dialogue about how we can do a better job,” says Boisvert.
At the heart of Boisvert’s campaigning is a passion for equality, a love for both her son and the diversity of the human experience, and the acknowledgement that as far as we’ve come in accepting the LGBTQ+ community, we still have a long way to go. “One of the reasons that I tell my personal story is because it makes such a difference in the audience, and that tells me that they’re not necessarily seeing LGBT people as humans, right, they’re not thinking about the entirety of the person,” says Boisvert. “The minute they hear that I’m an LGBT mom, I can sort of see the whole audience relax, and I love that, but it shouldn’t be that way. You should be relaxed and ready to learn about everyone.”
Emily NcNeiece, a sophomore Publishing major at Emerson College, brings to MedTech a lifelong passion for the written word. As a current editor for Emerson’s Generic and Atlas magazines, and a reader for The Emerson Review, Emily loves engaging through text with the world around her. In her spare time, she enjoys cross-country running, short story writing, and watching just a bit too much TV.
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