Medical Abuse
Selecting for Better Medical Care
When to Complain, or Not

Why a Trans Person May Suffer Abuse in Silence
Reasons Some People Don’t Want to be Kind to Trans People
Tips for Hospitals, Doctors, and Nurses
It May Not be Your Fault
The Cure

Medical abuse hurts, even when you don’t see it.

I’ve been at this since 1981, am an old former social worker / psychotherapist. I’ve seen a lot in various hospitals with different doctors and nurses, and with many trans patients.

An awareness of medical abuse issues can be helpful to both trans patients and staff in improving medical care for us all.

Medical Abuse

Most people don’t want to deal with trans people; a few don’t mind. This holds through people and groups in general, conservative or liberal, regardless of education or profession…and that includes doctors and nurses, as well.

I’ve known toward myself and others a long list of medial abuse concerns, which I automatically recognize, and which interferes with my ability to find compassionate, quality medical care. I’m not talking about issues that relate to transition; I’m talking about medical issues that any person may develop: heart issues, cancers, diabetes, gastrointestinal diseases, vision or hearing, musculoskeletal diseases, neurological diseases, aging, etc.

Medical abuse against trans people is real, and I’m not psychic so I ask evaluative questions in conversation with doctors, nurses or hospital administrators. It can easily be seen what matters to them and how, what they will engage with and what they avoid as offensive. If responses are problematic, and if I press, problematic staff will likely maneuver to avoid by falsely assuring me they already have assured me, or that they have assured me by other means, or segue to an otherwise good reputation—but they will still tend to avoid actually engaging in or speaking core T issues.

That is a tell, a red flag, and it is from this group that problems such as these below are more likely:

  • an unwillingness to find underlying medical concerns for proper diagnoses,
  • improper or harsh medical treatment, both verbally and physically,
  • medication given improperly, late, or not at all,
  • an unwillingness to come to the hospital room, coming late, or not at all,
  • false reasons given for genital examinations,
  • sneaking inappropriate peeks at T genitalia when the patient is or is thought to be asleep,
  • asking if it is okay to look at T genitalia as if the T is there as an example, the T fearing refusal may incur abuse, and
  • disrespecting the trans person, even vilifying if there is a complaint about any of the above, and unlawful unwillingness to copy the chart later if requested.
Selecting for Better Medical Care

I believe it is better to avoid doctors and nurses who do not like dealing with trans people or our issues and to speak up if there’s a problem. I believe treatment and health are better served if I can find good doctors and nurses who don’t mind or are even respectful of diversity.

Selecting for good medical care may seem obvious to me, but not everyone agrees:

I’ve known hospitals to assert—in denial, in fear of liability, or in the hopes people are unaware—that everyone there gets the same, great treatment, so there is no choice to make from problematic to better care, and the effort to do so is crazy, insulting or both. Do patients and staff really need to grapple like this while the patient is ill?

I’ve known some trans patients to fear retribution if they complain, unsure how to do it, needing the treatment.

I’ve known some trans patients who seemed disposed to ignoring unkind and abusive behavior as part of wanting to believe (1) staff does not dislike them, or (2) that the trans patient is “passing” under close medical scrutiny.

And I had a trans person tell me that we should not complain when we experience abuse as we need hospitals and staff to want our business, and we catch more flies with honey.

Insecurity and fear are common and understandable among trans people for reasons of prejudice, rejection, discrimination, and hate crimes. Hospitals should become more aware of this, where trans people are in a particularly vulnerable position.

When to Complain, or Not

I think that if unkind or abusive behavior is suffered in silence, it can enable the problem, and medical staff can get the impression what they are doing is okay, or okay to get away with, which may affect later treatment or the care of other patients.

Some things do rate a compliment or a complaint. Defeatist attitudes many of us may harbor are a product of society’s general ill treatment of us—but where there are prejudiced people who abuse, there are also other treatment professionals who truly do struggle to help, to please, which I think are valued all the more. We cannot discern one from another by their accent, area of the country, religion, etc. Just as we ask them not to stereotype and demean us, so must we offer the same to them.

Each person will need to make up their own mind about how to evaluate, assert, ask for help, and what is best to do within the context of any given situation. No one else can make that decision.

Why a Trans Patient may Suffer Abuse in Silence

Some trans people, particularly if newer, find themselves wanting to believe they “pass,” that they look so good in new role that other people can’t tell—stealth—that they think they were born the other cisnatal. If so, the patient may believe that whatever happens cannot be abuse per being trans, believing the nurse / doctor doesn’t know.

As well, the trans patient may be purposefully cooperative to encourage cooperation from staff or prevent conflict or further abuse. This can be due to insecurity or a feeling of relative helplessness, and certainly being in a hospital can be that way.

Some trans patients may put up with some activities without even realizing it’s medical or even sexual abuse. How could that happen? ONE EXAMPLE: In my case, over the first 20 years in transition (my SRS was 1981), I was in various physicals given Pap smears, told they were necessary. I was focused on other things in life at the time (housing dicrimination, employment discrimination, paying rent (alone in college through transition), gossip among fellow students / employees, family distancing…) and I did not think to look into it. Then another MD told me those tests were not needed, why (I never had a cervix), and that the doctors seemed to him to have been invasive for their own curiosity. That would explain why I rarely got the “results” unless I made an effort to ask. Since it’s my genitalia, it has always felt like sexual abuse, medical malpractice.

Some trans patients will try to survive the abuse, take notes, and then approach the hospital later in quite a negative way. STAFF: Don’t set this up by being unkind in the first place.

Reasons Some People Don’t Want to be Kind to Trans People

When things like these below affect the quality of medical care, inappropriate moral judgments are made about which patients deserve kindness or good medical care:

Some people don’t want to be kind to trans people fearing if they were, they might inadvertently give the impression of validating a way of living they feel is sinful, hurtful to society, or even ill. This may sound minor, but it’s actually a very common reason and very damaging to relationships, including treatment staff / patient relationships.

Some people interpret statements or actions by trans people as wrong, somehow offensive, or even hostile—when, if the same thing were said or done by a preferred group, it may have been welcome.

Some people want to hurt the trans patient to make the point that they shouldn’t be there.

Some people may displace anger felt toward another trans person who they feel has been offensive or done them wrong in the past.

Tips for Hospitals, Doctors, and Nurses

Hospitals, doctors, nurses: Admit the problem, if only to yourselves.

Where most staff in any given setting may be neutral or even positive, it only takes one to ruin the experience and seriously hurt a patient. A general policy of egalitarian, quality treatment may sound nice on paper, but a few may abuse a trans patient, anyway, and then not own up to it. These will likely come from the large group who do not want to deal with trans patients, but who are unwilling to curb their disgust when others are not looking, and are the problem.

You may feel that openly admitting abuse is a liability problem or an admission of poor professionalism, but there are things you can do on the front end to put the patient at ease and help prevent these issues from arising:

  • Be willing to accept people as they identify, even if it’s not popularly known: man, woman, transsexual, queer, neither sex… The patient may take that as validation, but that’s his/her private issue. Don’t argue and say, “But I don’t know what [this or that] really is.” You are not validating; you are accepting someone as they identify. Rather, you’re not validating PTs religion; you’re just accepting that it’s hers;
  • Do not take things you learned off TV, continuing education courses, or from your cousin who is trans…and transfer that perspective to other trans people. The source may be gender biased or not know of or appreciate variations. In life, we have quite varied ideas about what is gender, sex, groupings, traits… In my case, if you ask me what pronouns to use for me, you will upset me as that disrespects transsexualism. Transgenderism is about moving on a gender continuum to where you feel more comfortable; they want the pronoun question. Transsexualism is about needing to be the other binary—to me. Some people identify as “transsexual,” though, if they just have a sex identity of the other sex regardless of physical changes or not, so…back to the first item in this list.
  • Be willing to discuss treatment issues the patient raises, specifically.
  • Ask before intruding and only intrude where it’s actually medically indicated.
  • Give the patient proper due in searching for diagnoses, attending the room, delivering medication and proper treatment and charting.
  • Be specific in leadership practices of acceptance and engagement with trans patient issues, choices, genitalia and body modifications. Patients cannot keep their sex-and-gender non-binarism from treatment staff—think gowns, scans, catheters, physiology—and acceptance of specifics which will become obvious must come down from above. With staff, don’t avoid details with generalities and say you care, because avoiding them says you don’t think they’re okay to mention. Speak things and make them okay; they’re going to deal with them in time.

Sorry for the kid gloves, but I didn’t make the problem. All of this grows out of varied people needing to live in a society that hates variety.

Doing things like these do not in any way indicate any deficit or fear of liability.

Instead, they’re compassion in action, a demonstration of kindness attached to nothing other than your character, concern for the patient, and an interest in better treatment outcome. And I don’t mean say you’ll do it, and—there—it looks good on paper; I mean actually do it, even staff who won’t but won’t admit it.

Sadly, many hospitals, doctors and nurses will not do these things I ask. They may say they do, but then not. When so, I think the problem is like I’ve said before: Most people just don’t like T issues, don’t like the phenomena.

That is prejudice.

It May not be Your Fault

Even if the hospital / staff do everything right, are not prejudiced, are compassionate…there can still be conflict with some trans people.

The popular ideology today is the transgender umbrella, make it all about gender, don’t mention sex… This is gender supremacy, and it’s based on denial of sex issues. It’s based in social hatred of T sex issues; that’s why transgenders demand the denial, then deny the denial…fearing rejection. (Sex supremacy is just as bad the other way around.)

The patient may bring that into the hospital with her. An example of a source of conflict is if an MtF transgender comes in saying she identifies as “female,” yet she has male genitalia. “I’m female; this is just what I have.” And then some staff indicates disagreement. This may be exacerbated if the patient demands you agree.

As well, a trans patient may have been severely abused at some time, as most have, or attacked, raped, suffered too much hate…

How things are handled depend a lot on how people seem, inflect, respond…so I’m not second guessing you,

JUST A NOTE: I don’t want this to be misconstrued if you don’t see what you did wrong, because you may have done something wrong and not know it…but it is also possible that you didn’t really cause the problem, that you did nothing wrong.

Just take into account the things I’ve shared and do them honestly, compassionately, professionally. Most problems should be prevented as well as they can, and understand these dynamics among staff.

When the trans “gender” social movement is based on sex denial, conflict is built in, physical sex issues cannot be hidden in a hospital, and most trans patients are abused in life in general, conflict is going to happen.

The Cure

The cure needs to be that society quits hating all kinds of trans people.

FWIW, I am not usually allowed to explain these things to medial staff, as they don’t want to hear about it or discuss it—another bad sign.