Improving the patient experience is a priority for many of us in healthcare today. It’s not just that everyone deserves compassionate care. We also know that good patient experiences lead to more engagement and better outcomes, but due to our fractured and inefficient healthcare system, the patient experience is often still difficult.
When patients come to a clinic, they are already prone to worry. About their health, of course, and how much they will have to pay for the necessary procedures. They are often confused by complex documents, byzantine invoicing or opaque pricing. So while a trip to the doctor or hospital should be as smooth and stress-free as possible, it often isn’t.
This is especially true for those of us who don’t fit neatly into traditional categories, including members of the LGBTQ+ community. Transgender patients also face conscious and unconscious bias, a lack of awareness of their medical needs, and even outright hostility. We can do better. From training clinicians and administrators to providing better technology, we need to improve medical care for transgender patients.
Continuing to improve the patient experience
Hearing about the health care experiences of LGBTQ+ people shines a light on what needs to change. When Jack, our colleague Betsy’s son, was growing up as a girl, there were signs he identified with traditionally masculine characteristics. Betsy told us she “had some undercurrents and innuendo” about Jack’s gender identification, but he didn’t come out until college. After all, Jack had had to deal with the emotional and physical challenges of being born female but identifying as male for most of his life.
Finding a provider you are comfortable with can be difficult for all of us. This is often even more the case for LGBTQ+ patients, who may face prejudice or disdain. And for transgender patients, something as simple as the box one checks for gender at the doctor’s office can be confusing and uncomfortable.
Recently, when Jack went to see a new doctor near his new home in Madison, Wisconsin, the patient’s questionnaire only included two choices for gender identification: male or female. As a transgender man, whose birth certificate still identifies him as female, Jack ticked “female.” This immediately created awkwardness and confusion for both patient and provider, and impeded the provision of proper care. Even providers that strive to be inclusive can be stymied by outdated systems.
Leverage technology to eliminate bias
Electronic medical records (EMRs) are often rigid and medical questionnaires often still have a binary bias. The challenge is compounded for miners. If a patient is covered by his parents’ insurance and his parents do not know that he identifies with a different sex, it complicates things threefold because the doctor is not authorized to tell the parents about it. There are times when the patient prefers one name, but there is a different name in the EMR and for billing. All of this adds a layer of complication and confusion.
Often the doctor may know a patient’s history, but nurses or administrators may know that without better systems and training, there is always the risk that a single weak link in the chain of care could ruin the whole patient experience.
We see some providers taking steps to improve their care for LGBTQ+ patients by signing up for special training. Some healthcare systems are also investing in updating the EMR and other software to better reflect the diversity of their patient population. Hopefully more providers and individual practitioners will follow.
Working backwards; Moving forward
Amazon has developed the innovation framework called “working inside out”. According to Ian McAllister, director of Amazon Day and former director of Amazon Smile, the process begins with trying “to work backwards from the customer, rather than starting with a product idea and trying to attract customers. above”.
In applying this framework to LGBTQ+ healthcare, we need to be compassionate in our approach and start with the patient’s perspective when developing healthcare technologies. We love all systems that evolve, but we must be especially mindful of making those systems human and responsive to the needs of each patient. In this case, it means building capacities that recognize, honor and serve non-binary experience. Sometimes it’s as simple as providing the appropriate gender identification fields in our software. Other times, it uses social determinants of health data to better engage patients and give clinicians greater visibility into specific health risks and treatment options.
We consider it an integral part of our respective roles to help provide more equitable, effective, and compassionate care for LGBTQ+ patients. Through better awareness, training and technology, we can improve the healthcare experience for transgender patients.
Laura Anderson is Senior Vice President and Product Manager of RCM Technology Product Management at Change Healthcare, and has over 25 years of experience in healthcare informatics. Angela Nicholas, MD, is chief medical officer of Einstein Montgomery Medical Center.