Design Research — Week 01
Topic Revealed: LGBTQ + Healthcare
In this section, we are going to work on the research with NYU Langone Health. This research is about improving patient experience for transgender, nonbinary and genderqueer. When they revealed the research topic, I was so surprised because it’s a topic I am not familiar with at all. With a limited understanding of the fields, both healthcare and LGBTQ community, it is challenging for me to deal with this issue.
The Workshop about Transgenders on Class
After the reveal of the topic, a woman-to-man (WtM) transgenders came to have a workshop for us. In one of the sections, we discussed the scenario of a transgender Black woman having a medical appointment. During the discussion, I learned a lot about the situation and the feeling transgender people have while seeking medicare. They struggle with the legal name which is not suitable to represent them and feel anxious and unseen when people still call them by it.
Interview of my urologist friend
To have a better understanding of the related field, I called a friend who is a urologist, has experience with gender-affirming surgery. Although she was mainly operating the surgery not providing healthcare for transgender patients, which may have much interaction with patients, she gave me a lot of precious insight into the field. Based on her observation, the transgender patient who undertaking the surgery may encounter two situations: lacking support from family and gender dysphoria post-surgery.
Lacking support from family
Because gender-affirming surgery is not survival-related, the family of some patients might not support that. Thus their families may not accompany them while doing the surgery, so they may turn to their friends for company. However, friends without a legal relationship with the patient are not allowed in specific situations. Some of the transgender patients face huge challenging changes all alone without close support.
Gender Dysphoria Post-Surgery
Although they undergo gender-affirming treatment and surgery, it’s not able to make patients the same as a specific gender. The surgery can make the artificial sexual organs mimic the function but they can’t function like natural ones. In addition, it’s a long journey for the patients to recover from the operation and used to their new bodies after the surgery.
Barriers to Health Care for Transgender Individuals
Main Barrier:
Lack of access due to a lack of providers who are sufficiently knowledgeable on the topic.
Other barriers:
- financial barriers (insurance, income)
- Discrimination
- lack of cultural competence by health care providers
- health systems barriers (inappropriate electronic records, forms, lab references, clinic facilities)
- socioeconomic barriers (transportation, housing, mental health)
Statistics of Transgender Individuals obstacles
- Medical:
Real/perceived stigma & discrimination within biomedicine and the health care provision, in general, may impact transgender people’s desire and ability to access appropriate care - Reproduction:
Transgender women (Male to Female, MTF) are internationally recognized as a population group that carries a disproportionate burden of HIV infection. - Mental Health:
A US sample of 1093 transgender persons demonstrated a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%) - Addiction
reported current smoking (1.5x the rate of the general population), 26% reported current or former alcohol or drug use to cope with mistreatment, and 41% report having attempted suicide (26x higher than the general population)
The discrimination from society increases the perceived stigma of transgenders also influences the healthcare providers. Discrimination from healthcare providers might lead transgender people to choose not to seek healthcare when needed. Furthermore, lack of access to medically necessary care is associated with depression and suicidality. To relieve the stress from that, transgender individuals may turn to drugs or alcohol.
Moreover, external forces, such as punitive laws and lack of legal recognition, marginalize transgender people and make it increasingly difficult for them to access basic healthcare services.
Lack of Training in LGBTQ Topics
In a study of North American medical school curricula, it was found that a median of only five hours was dedicated to LGBT topics across all years of medical school training.
Actions We Could Take
For Healthcare Providers:
Early medical education and continuing medical education (CME) for healthcare providers.
Gender-Affirming:
- Social (identity/ pronouns)
- Legal (legal name and gender on ID)
- Physical (Treatment / Surgery)
- Mental (Consulting/Assessment…)
Reflection
Besides the knowledge about LGBTQ community and the obstacles they encountered, I learned a lot from the process of research from diverging more information, briefly summarizing the results, and defining the problems. I am trying to follow the double diamond design process to complete my research and remind myself don’t jump to conclusions.
Little thoughts About Pronouns
To be honest, I feel unfamiliar with stating my pronoun when introducing myself. It is because I know little about the issue that non-binary gender may encounter. However, another reason may be cultural differences, because in my language the pronoun for third-person is neutral without gender indication. Although we still have a specific pronoun to represent females, it’s fine to use the original one to represent both genders.
Reference
Barriers to Health Care for Transgender Individuals
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/
Factors Associated with Medical Doctors’ Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770086/
Benefit of Gender-Affirming Medical Treatment for Transgender Elders: Later-Life Alignment of Mind and Body
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909671/
