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

Reasons Some People Don’t Want to be Kind to Trans People
Tips for Hospitals, Doctors, and Nurses

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.

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;
  • 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.

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.

Hospital environments place trans people in a vulnerable position—where we may be ill, drugged, unconscious, or alone—and we deserve better than harsh feeling too often felt by people and expressed in society. No hospital is an island. People—staff and patients alike—cannot leave the world entirely outside. Things interact, and the hospital is no place for staff to take advantage of a patient’s temporary disadvantage.

Remember, trans patients may well have had abusive experiences elsewhere and may need your specific reassurance.

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.