By Kara Chaudhary, MD
In celebration of Pride Month, ABIM is elevating the voices of physicians who belong to the LGBTQ+ community. Dr. Chaudhary (she/they), is a board certified primary care physician with Avenues Internal Medicine.
He—two letters and such a small word, but still one that has the power to cause a lot of hurt.
Coming out as transgender is never easy—especially if you do it like I did and come out halfway through residency. Suddenly simple interactions turn into a mental back-and-forth over whether I’ll be working with someone long enough that it’s worthwhile to spend the emotional energy coming out to them. Everyone responds differently when you tell them. Some are good natured but confused. Others are supportive and adapt easily. But some people, it doesn’t even feel safe to come out to. I knew an attending who misgendered a trans patient repeatedly to her and her partner’s face despite correction and who immediately suggested we transition her to comfort care and stop treatment. That’s an extreme example, but there are plenty of other smaller things that someone can do to make it feel unsafe to come out to them. Dealing with other physicians who act like that made it hard for me to be my true self in residency. And people aren’t always as directly hostile. It was very common when I initially came out and was using they/them pronouns that others would just not use them because they “didn’t know how to” or because “it’s too hard to remember”.
This happened even after I moved on to fellowship where nobody knew me prior to transitioning. I had issues with administrative staff refusing to change the name on my badge despite that being the policy and going out of their way to call me sir and use my deadname. When dealing with the attendings I worked with, I got the same excuses and almost malignant repeated misgendering, despite trying to correct them. I was told, “It takes time to adjust,” and “You have to correct me more,” which seemed to fall flat for people who never knew me before I transitioned and had nothing to adjust to. One thing that people didn’t seem to be conscious of is that telling me to just correct them puts a lot on me. Is it reasonable to expect me to interrupt a conversation with a patient or a multidisciplinary meeting in front of the whole department to tell them they used the wrong pronouns? That takes a lot of energy that I didn’t have and would draw even more attention to the fact that I’m trans when I just want to exist as me. And given this was being done by people in authority, people who had been gendering me correctly would follow their lead and start misgendering me because they assumed my attendings were correct and that they’d been mistaken.
Besides the daily personal microaggressions, the trajectory of my career changed due to people’s response to me being trans. Once, I met with a program director regarding a fellowship position I was interested in; as soon as I mentioned that I was trans (when it was early on and not obvious) I was told that I wouldn’t be getting an interview at their program. At the places I did interview, I was at best met with, “What you do outside of the hospital doesn’t matter,” (which may have stemmed from a lack of understanding of gender versus sexuality) and, at worst, directly transphobic jokes. When I decided not to pursue fellowship and was looking for jobs, I met a department head who lead with, “So they tell me you’re a transsexual.” I wasn’t able to get a job that I wanted because the Catholic physician in charge of the hiring process felt that “Primary care for transgender patients isn’t real primary care,” after I indicated that I wanted to make LGBTQ care a part of my practice. The issues I ran into didn’t stop, even after I found a position, and are still something I’m dealing with.
These are just my experiences as one transgender physician, and others that I know have had experiences that are just as bad, if not worse. As a whole, medicine needs to do a better job of supporting those that fall outside of the cisgender-heterosexual norm. If we can start calling someone by a new name after they get married, there’s no excuse for having trouble adapting to someone who is switching their name/pronouns with their transition. It might take some effort initially, but as physicians we have a responsibility to be compassionate and empathetic to our patients—we have to extend that to our colleagues as well. Make an effort to educate yourself rather than expecting people to do it for you, and realize how a simple change—like adding one letter to he and making it she—can have a profound impact on someone’s wellbeing.
There are also other realms where it’s important to show your support if you consider yourself an ally. Over the last few years, the rights of LGBTQ Americans have become a target. To date, 19 states have banned standard of care treatments for trans youth, and several of these states have made it a felony to follow society guidelines and provide care that improves survival. Following this, several states have now banned or severely restricted access to care for trans adults as well. This doesn’t include the other numerous legislative attacks—e.g., now, if I have a layover in a Florida airport and have to use the restroom, I would face criminal charges for using the restroom that matches my gender. As physicians, we need to stand up for what is best for our patients and work against the infringements blocking standard of care treatments which are known to decrease mortality. If we start allowing the legislatures to ban life-saving treatments just because someone belongs to a minority, where do we draw the line?
Have you ever considered:
- Asking each of your colleagues and trainees what their pronouns are?
- That it is difficult for others to “just correct” you if you use a wrong name or pronouns, especially if you are in a role of authority?
- Correcting your colleagues when they misgender a patient or colleague? Being an ally is more important than you can imagine.
- That learning a transitioning colleague’s first name and pronouns shouldn’t be any harder than adjusting to the name change of a colleague who got married or divorced?
- That some of your colleagues might face criminal charges for using the restroom matching their gender?