By: K. Abel Knochel, PhD, University of Minnesota Duluth, Duluth, Minnesota, and Dylan Flunker, MPP, Rainbow Health Initiative, Minneapolis, Minnesota
Melissa is a white, 63-year-old academic. She began identifying to others as female six years ago, although she has self-identified as female throughout her life. Melissa is in the process of transitioning and receives care through Smiley’s Family Medicine Clinic. She discussed her experiences in an interview with the Minnesota Transgender Aging Project (MTAP) in September 2016. MTAP is exploring the care that older transgender adults experience and expect in the Twin Cities Metro and Northland regions of Minnesota. The interview is excerpted below, with Melissa’s permission.
In her interview, Melissa emphasized the difference it makes for a patient to have their legal name accord with their gender by describing two minor experiences with misnaming and misgendering at Smiley’s, both of which occurred before her medical records used her preferred name.
Experience 1: [S]omebody was looking at my chart, and no one had written [my preferred name] on the top of it, which is what they typically do, and so called out my old name … I just sat there … I didn’t even say, “That’s not my name.” … So they gave up and went in and talked to somebody else and then came back out and just said my name. I got up and went, “Eh.”
Experience 2: I was going through some issues of dizziness and fainting that had to do with adjustment of meds related to hormone therapy and my high blood pressure …. It was a Friday late in the afternoon, they were about to close, so [they] said, “Better get in here because we won’t be open until Monday.” …. [T]he nurse that was involved was new to me. He … misgendered me, … but [it] wasn’t malicious, and I corrected him.
These types of experiences underscore the call from Hinrichs et al to ensure that medical staff throughout the clinic are trained to provide competent care to transgender patients.
Despite these experiences, Melissa described an overwhelmingly positive experience with receiving care through Smiley’s. She spoke of the ways the clinic staff has responded to her gender identity, honored her humanity, and partnered with her on medical care.
Smiley’s has been fabulous …. [W]hen you ask for an appointment you have to say why …. I said, “I need someone who’s knowledgeable about—or comfortable about—dealing with midlife or later trans women.” My medical insurance still had my birth name and … so I wrote in my preferred name. Within a few hours, I got a call saying, “May I please speak to [preferred name]?”
[T]he first day I got [to the clinic] … there [were] two people at the desk … I thought, “Oh. How are they going to feel about this?” I [went] up to the first one who was free and… she said, “Could you give me your name and show me your insurance card?” I said, “Well, they won’t be the same because I’m a transgender person.” She said, “Oh, thank you so much for telling me.” She was so … professional about it … pleasant about it … no big deal about it.
The very first day …. I was really prepped to make my case for hormone therapy, because I’d had this resistance, with [a previous doctor] saying no and [previous physician assistants] feeling at sea a little bit …. [My doctor] said something welcoming, and I said, “I guess I’m going to have to persuade—” She stopped me and put her hand on my knee … and said, “You don’t have to persuade me of anything.” I just started weeping …. [She] asked me right away, “Do you need a letter for surgery?” She’d actually read my little note [in the chart] and the whole clinic has clearly been trained. … [M]y current doctor … clearly feels I’m part of my own care team in way that I haven’t experienced …. That is to say … I have a huge role in the decision-making process.
… [T]he overall atmosphere is so positive. I feel that I’m a human being there. I’m not a freak, and that’s huge …. My experience makes me hopeful that I’ll be treated well [by medical providers in the future].
The care demonstrated in these interactions is consistent with the characteristics of trans-competent care that Hinrichs et al identified in their study.