Experiences of Transgender and Nonbinary Patients in an Academic Family Medicine Clinic.

Abstract

Background: Transgender and nonbinary (TGNB) patients face significant health disparities and negative experiences in health care spaces. With our family medicine residency clinic caring for an increasing number of TGNB patients, we sought to better understand the unique experiences and needs of this population.

Methods: We utilized a mixed methods approach, recruiting participants via our online patient portal and inviting them to complete a 36-item online survey and/or participate in one of four 90-minute focus groups exploring their interactions with a variety of care team members, perspectives on our physical clinic space, ideas for improvement, and other areas. We analyzed survey data using descriptive statistics and performed open coding on survey free-text responses and interview transcripts to identify salient themes.

Results: 90 TGNB patients completed the survey, and 20 participated in the focus groups. Participants described a variety of positive interpersonal and noninterpersonal experiences including being gendered correctly, clinicians being knowledgeable and responsive to feedback, and seeing visible markers of LGBTQ+ inclusivity. Negative experiences included misgendering and deadnaming, being asked unnecessary questions, and being outed as TGNB without their consent.

Conclusions: Participants' positive and negative health care experiences, along with their specific recommendations for interpersonal and system-level change, will help guide ongoing efforts to improve the care of TGNB patients at our clinic. Future needs assessments and ongoing conversations with our TGNB patients are needed to further explore this study's emerging themes, with particular attention to the impact of age, race/ethnicity, primary language, and other intersecting identities on TGNB patient experiences.