A Trans Tale of Two Hospital Systems

How You Approach Care Tells Whether You Care

Once upon a time, there were two hospital systems. I know—I worked for one and now the other, the two biggest in my state. I deal directly with customers—patients coming in or calling for appointments. The tone I set matters everything. Folks coming in/calling are in pain, struck down with illness, and daunted at navigating the crow's nest that is healthcare in America today. Really, either side of the phone/desk, we're all just people doing what we can to get/deliver care.

A front-desk person can make a tremendous difference in a patient's care … provided that the system and caregivers behind us walk the talk of their mission statements.

I try to humanize the encounter by putting myself in the shoes of patients, while I keep in mind my own experiences with healthcare. A front-desk person who helps patients through the ins and outs of dealing with the clinic/practice/lab/hospital can make a tremendous difference in a patient's care … provided that the system and caregivers behind us walk the talk of their mission statements.


Courtesy of the National Center for Trans Equality.

Directives

One day, at my old hospital system, I received an all-points-bulletin from the Training Department directing front-desk personnel on how to ask about patients' gender. Our orders were to ask patients for their "birth sex" when registering or checking them in. Mind you, nowhere in that hospital system's registration system are there alternative field responses other than "M" or "F," nor are there fields differentiating gender assigned at birth from gender identity.

it was never about training personnel in how to care for patients—rather, it was about complying in a way that covers the system's bohiney Message to the front-desk people who shape patient encounters?

In short, it's the worst of binary times at this hospital system for trans and nonbinary folks,


I Tried

I sent the following to the Training Department:


Hello! As a trans person, I can tell you that the best way to ask for “birth sex” from a patient is to say “What was your gender assigned at birth on your original birth certificate?”

Asking for a person’s “sex at birth” can trigger or further gender dysphoria in a trans person. We’re care providers; let’s please do everything possible to accentuate care versus inadvertently causing pain.

If you have further questions, I’m a professional educator and speaker who advises health organizations and medical schools on affirming ways to deliver care for trans and nonbinary folks! I’d love to help you with this effort!


Comply, Comply, Comply

The response I received was


I just wanted to follow up on your email and let you know that we did take this to the System Compliance team and they approved this scripting and education. I wanted you to know where it came from just so you didn’t think we went with what anyone just threw out there 😊

So, it was never about training personnel in how to care for patients—rather, it was about complying in a way that covers the system's bohiney. The message to the front-desk people who shape patient encounters? "It's not about the care or the dignity of the persons we care for but about whether we don't get sued in the process."

"It's not about the care or the dignity of the persons we care for but about whether we don't get sued in the process."

Be the Change You Want to See—Until the Change You See is Elsewhere

I tried to change that organization during my time there, but you can guess how far I got. I've since learned not to beat my head against walls but to throw my pearls before something other than swine. That and I'm privileged enough to navigate the job market and land a better gig, which I did via the second hospital system in our fairy tale.


This system gave me good vibes, better pay, better benefits, a closer-to-home work situation. I'm no saint here but wanting to better my situation. The second hospital system came through on those good vibes. As a huge part of its new-hire training, it fully explained what shouldn't be "nuances" to anybody delivering care to trans and nonbinary folks, defining the:

  • difference between "gender assigned at birth" and "gender identity"

  • difference between sexual identity and gender identity

  • medical need for knowing both and a compassionate, affirming way to ask for both

You empower better care by creating a welcoming environment for that care and equipping staff to confidently lay out the welcome mat.

It was an education in enbie/trans issues that I wish everyone could get. Translation: "We want to care for all persons by affirming their humanity." What a novel idea! You actually empower better care by creating a welcoming environment for that care and equipping staff to confidently lay out the welcome mat.


Exampling by DOING It

I wrote a story last year about a nurse who vilified me and trans persons on social media only to be surprised by having to encounter me in the course of treating my wife a few days later.


Guess what hospital system they worked for?


Some things you should learn in kindergarten—like, you make the world harder for yourself and others by perpetuating a big lie versus owning up to the truth and living it.


Still, many organizations have the agility of the Titanic when it comes to pivoting. They run by a power-for-me approach that's lawyer- and compliance-heavy. They don't do it because they want to be evil but because they don't know—and refuse to be educated about—any other way of being. "Our way makes money."


Let me add that this same excretory hospital system gave its CEO a $20-million bonus, all while viciously clinging to its "non-profit" status.

Be the change you want to see. Also, put the vote of your presence with organizations who are doing the change right now.

The second hospital system may have warts that I'm yet to learn. But I'm there. And it welcomes me to welcome folks of all stripes to authentic care within the confines of a very problematic American, insurance-driven healthcare hegemony.


Be the change you want to see. Also, put the vote of your presence with organizations who are doing the change right now.


(For more information on trans-compassionate health care, go to the National Center for Transgender Equality's Health Care Action Center page.)

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