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Transgender experience in the ER: "I was a freak show"

A troubling new report chronicles a transgender patient's humiliating experience in a hospital emergency room and sheds light on the many issues transgender people face when seeking health care. The report, published in the Journal of Emergency Nursing, calls on health care professionals and organizations to improve training and awareness of how to care for transgender patients.

The case study tells the story of transgender patient called Brandon James (not his real name) who visited the emergency department of a trauma center in the southeast United States.

James, described as a masculine transgender man, transitioned using hormone replacement therapy five years before his emergency room visit. But the driver's license he presented identified him as female and his electronic medical records from previous visits included female gender markers.

This prompted confusion among the staff, who began debating his gender aloud.

"They come up and she's like, 'That's a girl.' Pointing at me saying, 'No, that's really a girl.' It wasn't business-like at all," James recounted. "I was a spectacle. I was a freak show at the circus. It was definitely to draw attention to the fact that my outward appearance didn't match [my identification]."

Hear what transgender means to me

According to study author Ethan Cicero, James' experience is all too common among transgender people when seeking medical care.

"There's really an overall lack of knowledge from everyone, providers to nurses to gatekeepers or employees responsible for checking in a patient," he told CBS News.

Referring to what James went through, Cicero said, "From a safety standpoint, I don't know many people who would want to be in that position and stay in that environment, so often transgender people may leave" -- without getting the treatment they need.

But James stayed, and after several hours of waiting, a nurse who heard the story of the check-in experience from James' friend spoke with him and apologized.

"She was awesome because she was matter-of-fact," James said. "She was concerned with my care. That [being transgender] didn't matter to her. What mattered was making sure I was physically OK. That was very reassuring."

But many transgender people do not get this validation, or even get as far as receiving treatment. Cicero points to the National Center for Gender Equality's 2012 report, "Injustice at Every Turn," which found 19 percent of those surveyed had been refused medical care because of their transgender or gender non-conforming status. Furthermore, 28 percent reported postponing medical care when sick or injured due to discrimination, and 50 percent said they had to teach their medical providers about transgender care.

In the report, Cicero makes several recommendations to nurses and other health care providers to improve treatment of transgender patients:

  • Ask the person how he or she would like to be addressed. In James' case, much of the public embarrassment might have been avoided if the staff members had simply asked the patient how he would like to be addressed.
  • Keep the conversation clinical. Emergency nurses should only ask questions relevant to the patient's medical treatment during their examination.
  • Be sensitive to shared spaces. When taking transgender patients into an area of the emergency department where they might share a space with another patient, keep the gender to which they identify in mind.

James recounted his story in hopes of preventing similar mishaps in emergency departments across the country, and the Emergency Nurses Association (ENA) says it's taking the message to heart.

"This patient's story identifies new implications for emergency nursing practice when treating a transgender patient," ENA president Matthew F. Powers said in a statement. "Emergency nurses are on the front lines of treating more and more transgender patients. All patients must be treated with dignity and respect. We want nurses and their ED colleagues to understand how to give these patients the care and respect they deserve. ENA fully supports the best practices outlined in this article and supports further research around transgender emergency care."

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