Unmet Expectations in Health Care Settings: Experiences of Transgender and Gender Diverse Adults in the Central Great Plains

Abstract

Transgender and gender diverse (TGD) individuals face a long-term, multifaceted process if they choose to begin a gender affirmation journey. Decisions to go on hormone therapy and/or have a surgical procedure necessitate the TGD individual to set up an appointment with a health care provider. However, when TGD patients interact with health care practitioners, problems can arise. This article documents and categorizes the types of unmet expectations that are common in the TGD patient–health care provider social dynamic in the Central Great Plains of the United States. Utilizing a community-based participatory research model, qualitative in-depth interviews were conducted with 27 TGD individuals about their health care experiences. From this, the researchers identified four main themes of unmet expectations: probing, gatekeeping, stigmatizing stance, and misgendering/deadnaming. Steps that can be taken by both the health care provider and the TGD individual to have a more successful encounter are discussed.

Health and Health Care of Sexual and Gender Minorities

“…Health care encounters are also populated by stories of SGMs being treated like specimens (Meyer et al 2020) and extensive gatekeeping (Shuster 2016). When these situations happen, individuals report feeling caught off guard, embarrassed, or harassed (Meyer et al 2020) and less likely to use preventive care (Willging et al 2019).…”

“…Furthermore, SGMs have also reported that they are met with paternalism and suspicion because of bias held by providers (Baker and Beagan 2014; Meyer et al 2020; Shuster 2019). For example, Shuster (2019) documented how providers of trans medicine say they used informed consent in their work with trans patients, but how they described their practices had little resemblance to an informed consent model.…”

“…Health care encounters are also populated by stories of SGMs being treated like specimens (Meyer et al 2020) and extensive gatekeeping (Shuster 2016). When these situations happen, individuals report feeling caught off guard, embarrassed, or harassed (Meyer et al 2020) and less likely to use preventive care (Willging et al 2019). Patients have also reported that providers may be unwilling to listen to, admit their lack of knowledge of, and seek out relevant information for their needs; this can happen even among providers who self-claim as experts in SGM health (Baker and Beagan 2014).…”

Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making

“…This conceptual model is intended to educate students and professionals and may be useful as part of medical education curricula and health care protocols, especially for girls and young women experiencing CSE who present in emergency and reproductive health care settings. By reshaping the power structure and offering more control for youth seeking services, this model may serve as an initial and critical shift toward addressing pervasive unmet expectations and health care discrimination among diverse groups (Kattari & Hasche, 2016;Meyer et al, 2020). In addition, greater collaboration across sectors and disciplines, as well as partnering with survivors and survivor serving programs can ensure girls and young women affected by CSE are connected to services that meet their complex needs holistically, especially medical needs.…”

Developing Suicide Safety Protocols for Qualitative Research as a Universal Equity Practice

“…Qualitative research offers an important opportunity to elucidate the health and social experiences of populations and communities that are historically oppressed and repressed including but not limited to children, older adults, individuals experiencing homelessness, people who use illicit substances, those experiencing intimate partner violence, racial and ethnic minorities, those living with chronic or mental illness, and sexual and gender minority populations (Butler et al, 2019), and those living in rural areas, who may lack access to resources and for whom these experiences may be exacerbated (Cristancho et al, 2008;Meyer et al, 2019;Pendse & Nugent, 2017). Systemic racism and structural inequities are well-recognized barriers to equitable inclusion of these populations that are historically underrepresented in biomedical research.…”