Reflections from the Twilight Zone: Navigating Medicine as a Nonbinary Medical Student

By Mel Ebeling on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine

Less than 1% That’s how many medical students and physicians there are in the U.S. who identify as transgender or nonbinary. What does it look like to be part of that percentage? Right now, for me, it looks like waddling through medical school with T-rex arms, plaid button-ups in the anatomy lab, pausing studying to milk my JP drains, and perhaps most exhaustingly, one too many explanations. “What’s ‘top surgery’?” “Why are you getting it?” “Do you identify as a man now?”

Before beginning this process of transitioning into the right body, the “issue” of my gender identity seemed to reside in my use of they/them pronouns. Who knew the pronoun pin on my white coat could be so controversial… and so terribly ineffective? Despite their best intentions, I soon began to feel the strain of being misgendered by peers, patients, and preceptors day after day. The pin, measuring just one inch in diameter and weighing only nine grams, quickly began to feel heavier and heavier with each disregard. I gave up on correcting.

Unfortunately, my experience as a nonbinary person — and a nonbinary person in medicine, nonetheless — is not an uncommon one. Misgendering of transgender and gender-expansive physicians in professional settings is reportedly quite common. In the general public, one Canadian report revealed that about 60% of its nonbinary respondents were misgendered daily. Intentional or not, being misgendered can negatively impact one’s health and wellbeing. Outside of misgendering, another study found that most transgender and nonbinary students and physicians have heard derogatory remarks at their workplace or training program about transgender and nonbinary individuals. Seventy-five percent of this same group of participants spent much of their time at school or work intentionally changing their speech and behavior to avoid being outed. This certainly cannot be good for one’s health either. It comes as no surprise, then, that about a quarter of transgender individuals avoid getting the health care they need out of the fear of mistreatment.

What can we do about this? As with many things, education is always a good place to start. The good news is that physician training in LGBTQ+ health has been increasing over the past decade. Specifically, emergency medicine residency programs have demonstrated a 26% increase in training from 2013 to 2020; however, the amount of training provided does not meet desire, and too many emergency medicine residents feel challenged when performing a history and physical examination on a patient who identifies as LGBT. In light of 40% of transgender individuals attempting suicide, a situation that emergency medicine physicians will likely be tasked with helping mitigate, more action and more education are necessary to promote better care for our transgender/

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nonbinary patients and treatment of our transgender/nonbinary colleagues.

Luckily, there are several ways education on LGBTQ+ health can be implemented across the spectrum of physician training. For example, if you are an attending physician wanting to increase your own knowledge on LGBTQ+ health, this could mean doing some continuing education on the topic. If you direct a residency program, this could mean using simulation to enhance your residents’ cultural competence.

If you have a title that grants you the power to revamp undergraduate medical education, maybe this means incorporating a presentation on the Genderbread Person into the curriculum.

As I sit here, recovering from genderaffirming surgery and writing this article, I wonder what it will take for us, the 1%, to be included in the AAMC’s definition of “Underrepresented in Medicine”? What will it take for our own health care needs to be better met? What will it take for us to be respected more in the training environment and workplace? Frankly, I am unsure of what it will ultimately take, but it will most certainly take more than a pronoun pin.

About The Authors

Mel Ebeling (they/them/theirs) is second year medical student at The University of Alabama at Birmingham Heersink School of Medicine and a practicing emergency medical technician/ hazmat specialist in the fire service mebeling@uab.edu

The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the goal of diversifying the physician workforce at all levels, eliminating disparities in health care and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”