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Transgender Patients In The ED

Stuart Swadron, MD, FRCPC and Clinton Coil, MD
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15:57
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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02:50

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EM:RAP 2016 March Written Summary 858 KB - PDF

Despite any anxiety or uncertainty  we may feel when treating a transgender patient, the reason for the visit, the majority of the time, is same as for any patient who comes into the department.

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Mario P., MD -

I'm not trying to be mean or a jerk about this so please don't accuse me of being insensitive, I just want to understand things better. These patients sincerely believe they are another gender. What about patients who sincerely believe they are the Queen of England or that aliens have implanted a computer in their brain? Should we worry about offending them and be sensitive to their sincere beliefs?

Cathleen M. -

I have a question about transgender patients that your EM:RAP discussion really didn't address.
How EXACTLY would you address the topic / ask the question about what "parts" they have???
For example, I had a patient last week that identified herself as female (and we referred to her as a female) but had the appearance of a male. The triage nurse asked when her last menses was,....pt said "I don't get those".
So, in working her up for her chief complaint---lower abdominal pain---how exactly would I ask about her anatomy without being offensive to the patient?
Do I order a pelvic ultrasound to rule out ovarian torsion? A testicular scan? Do I bring a speculum into the room or just have her stand up for a hernia check???
I'm sure other physicians have had my concerns.....what are your suggestions??
Thank you, Cathleen M., D.O.

Erin S. -

Holy crap!
EM RAP just covered transgender patients!
1. It was funny, and the jokes were at the expense of people who are awful and mean, (and Canadians) not mocking gender-variant people.
2. It took for granted that transgender and transexual people are both our patients, and us/our colleagues, which lots of lectures on this topic do not.
3. It used information from the TransPulse study and it's amazing data collection methods
4. It assumed that doctors know doctoring, and didn't harp on medical trivia like what the normal hemoglobin of estrogen-based patients is, or where to find a prostate.

After I picked up my mandible, I bought all my nurses coffee and had a great shift. I am sad we still need instruction in basic manners and how not to be jerks, and happy that it is coming from such a key source in the field!

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Spring Forward Into PE Full episode audio for MD edition 236:48 min - 330 MB - M4AEM:RAP 2016 March Aussie Edition Australian 38:52 min - 53 MB - MP3EM:RAP 2016 Mars Résumé en Francais Français 52:06 min - 72 MB - MP3EM:RAP 2016 March Canadian Edition Canadian 33:43 min - 46 MB - MP3EM:RAP 2016 March German Edition Deutsche 101:18 min - 139 MB - MP3EMRAP 2016 Marzo Resumen Español Español 87:22 min - 120 MB - MP3EM:RAP 2016 March Written Summary 858 KB - PDFEM:RAP 2016 March Board Review Answers 187 KB - PDFEM:RAP 2016 March Board Review Questions 169 KB - PDFEMRAP 2016 March MP3 Files 302 MB - ZIP

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