Sex & Gender Perceptions and Avoidance of the ED Among Gender Minority Patients

Perceptions and Avoidance of the ED Among Gender Minority Patients

By Elaine Hsiang, MD and Alyson McGregor, MD on behalf of the SAEM ADIEM LGBTQ+ Task Force

There is a growing body of literature illustrating the health care disparities experienced by gender minority patients, including those who identify as transgender, non-binary, genderqueer, agender, and more. With the rise in proposed and enacted anti-trans legislation in the United States, it is imperative that emergency providers recognize the impact of this on the health of gender minority patients, including delays or avoidance in seeking care in the emergency department.

Avoidance of emergency care is markedly higher among gender minorities: a regional needsassessment in Colorado reported a 3.8 increased odds of lifetime emergency care avoidance by gender minorities compared to cisgender individuals. Another study in Rhode Island found that nearly half of participants reported having avoided the emergency department when they needed acute care. Qualitative data reveal avoidance is often related to fear of and negative experiences with discrimination based on gender identity, as well as the lack of provider care competency of gender minority patients. A recent scoping review of emergency care of sexual and gender minorities highlights a number of urgent opportunities for improvement, including standardized training in sexual and gender minority health, the need to systematically collect sexual orientation and gender identity data, and direct community involvement in quality improvement and research efforts in acute care settings. The SAEM ADIEM LGBTQ+ Task Force expands on many of these suggestions in a recent paper to reiterate that our emergency departments should continually work to provide a safe and inclusive environment that is free from discrimination. We can and must make emergency medicine a trans-inclusive and gender affirming specialty. ABOUT THE AUTHORS Dr. Hsiang is a third-year emergency medicine resident at the University of California, San Francisco, with an interest in LGBTQIA+ health. @egnaish Dr. McGregor is a professor of emergency medicine and serves as associate dean of faculty affairs and development at the University of South Carolina School of Medicine Greenville. @mcgregormd