Appendix H: Care to the Trans- and Gender Non-Conforming Identified Patient Video Transcription

Clerk: Josephine Ramirez. Josephine, Ramirez?

Clerk: Can I help you?

Joe: Yeah you called Josephine Ramirez, that’s me. I go by Joe, so I preferred to be called Joe.

Clerk: Really. Excuse me, I’m sorry there must be some mistake. Uh… you signed in as Joe, but I have Josephine written down in my book. I’m sure we can fix this problem. Why don’t you give me your ID and your health insurance card.

Joe: Yeah. I have all the forms.

Clerk: Oh. You downloaded them from our website?

Joe: Yeah.

Clerk: Okay. Is this your legal name? Okay. We will still be using your legal name in the medical records. Okay? Just so you know, and I’ll talk to the office administrator and see if we can’t fix this. Why don’t you just go ahead and have a seat. You can keep the other forms, I don’t need those, the nurse can go over those with you.

Joe: Okay.

Clerk: Okay?

Rick: Miss Ramirez? Miss Josephine Ramirez?

Joe: Hi, um I’m Joe Ramirez. There was a little mix-up with the paperwork, I’d like to be called Joe Ramirez.

Rick: Not a problem. I’m sorry for the mistake. If you would give me the ID I’ll take it down to the clerk to get it corrected.

Joe: I mean I don’t think that’s necessary I gave it to her already so she’s aware of the issue, it’s just that I haven’t changed my name legally yet on my license, so if you could please just call me Joe or Mr. Ramirez.

Rick: Okay Joe not a problem. Um. I’m Rick I’m tech, I’ll be taking vitals, so would you please come with me?

Joe: Sure.

Rick: Okay.

Rick: Okay have a seat Miss—sorry, Mr. Joe. Would you please take your clothes off and put this gown on and I’ll be back to take your vitals.

Joe: Um, I’d rather not. I’d rather just speak with the nurse, so…

Rick: Is there a reason why?

Joe: No, it’s just I’d really rather talk to a doctor or a nurse.

Rick: Um, it’s not going to take long, though. Plus it’ll be easier for the nurse for me to do these tasks.

Rick: Is everything okay?

Joe: Yeah, it’s fine, I’d just really rather talk to a doctor or a nurse.

Rick: I’m sorry did I do anything to offend you?

Joe: No.

Rick: Okay, um alright I’ll let a nurse know that you’re ready and they’ll be here shortly.

Joe: Okay.

*Door knocks*

Rick: Hey, Rachel.

Rachel: Yeah?

Rick: You’re patient in room two, she—I mean he doesn’t want me to take his vitals.

Rachel: Oh, really?

Rick: Uh, he wants to be called Joe but her paperwork and ID says Josephine Ramirez. Right, um he says I didn’t do anything to offend him. I just don’t know what’s going on.

Rachel: Okay, I’ll be there soon.

Rick: Alright.

Rachel: Good morning. Hi, my name is Rachel. I’m going to be the nurse here with you today in the practice. I’m just coming in to just start the assessment part and also to ask you a couple questions.

Joe: Fine, yeah.

Rachel: I noticed earlier with the interaction with our administrative aid and also with what the tech told me in regards to the vital signs I just noticed that it might’ve made you feel a certain way, so I just want to kind of ask you before doing anything else, how you’re doing and how you’re feeling.

Joe: Thanks.

Rachel: I’m so sorry for what happened earlier. I know that we have a huge learning curve we have some things we need to work on as a practice, but I can assure you we are a non-discriminating practice, and we’re here to provide high-quality patient center care. I myself have worked with the LGBT community, not as much with the transgender community but I am open and I am ready to learn new and better ways to make our practice better in serving your needs and serving any client or patient that comes into our practice to meet their needs so we can give them high-quality patient center care. If there is any point and time where you feel like I am not meeting your needs or my staff is not meeting your needs or we’re saying anything that makes you feel uncomfortable can you please just let us know so we can just address it immediately.

Joe: Sure, can I just say ouch?

Rachel: Sure, you can definitely say ouch, but I mean feel free to use any other words that you might, you know, want to say at that time. I know that it’s uncomfortable for you. Okay?

Joe: Sure.

Rachel: How would you like for me to address you?

Joe: You can call me Joe.

Rachel: Okay! Great, Joe. I’m sure you probably already understand that for documentation purposes we have to use your legal name that is indicated on your IDs, but we will definitely use your chosen name and I will let everyone know at the practice to address you as with your chosen name. Is there a particular pronoun that you would like for me to use or for us to use here in the practice

Joe: Yeah, thanks for asking. I usually go by he/him when talking about me, I actually thought it was kind of interesting that I thought your staff would kind of reflect that because your forms were really progressive online, so I was kind of surprised when the clerk didn’t get it.

Rachel: And I’m sorry again for that, we got a lot of things that we need to fix. It should not have happened and it won’t happen again. We do have a computer system that’s a bit out-dated.

Joe: What do you mean?

Rachel: It’s not programmed to meet the pathways of a transgender patient. For instance, if we have a patient or client that comes in, let’s say it’s the computer system online recognizes male and like female, so if we have a male patient that comes in, it’s gonna give me all the questions that have an physical assessment with a male patient, so for instance it’s gonna have a prostate exam, but it might not have a vaginal exam and it might not have a pap smear. So I just wanted to let you know sometimes you might see me go to my paper just to write down some notes it’s just because I want to make sure I have all the data and information that I need. But I wanted to let you know that and we’re gonna work on it to fix it so that we can make it more streamlined to meet the needs of the community.

Joe: Mm-hm.

Rachel: Okay? Alright! So, we can move forward and so what brings you here today.

Joe: Well, right now I’m covered, my insurance is through my parents, but I’m about to age out so I kind of wanted to get some stuff done before that. I came in for just a flu shot and a physical, but I’m not sure I want to go further.

Rachel: Okay.

Joe: It’s, um most of the transgender people I know in the community in this area, they go to Women Walker or a couple other doctors but it can be really hard to get in because everyone is trying to get in, and it’s just when I usually go elsewhere the burden is usually on me to educate my provider and I’m just kind of tired of being named, shamed, and blamed. So I was hopping that I could start a relationship with a provider close to me.

Rachel: Okay! And I perfectly understand, I just wanted to get some vital signs, you don’t have to take your jacket off completely, are you just able to at least expose an arm so I can take your blood pressure and just get some simple information, and then if you want to go forward with the flu vaccine then I can definitely administer but the doctor will come in here and we’ll talk to you. So how about that?

Joe: Sure.

Rachel: Okay! Alright.

Rachel: Hey Dr. Smith do you have a moment so I can talk to you about something?

Dr. Smith: Hello Ms. Rachel of course what’s the matter.

Rachel: Okay, so I’m very concerned about a new patient that and interaction between a new patient and our staff so the situation is… so the background is… my assessment is… my recommendation is…

Dr. Smith: Okay, so thank you for sharing and I’ll go in to see Joe and then another recommendation because you’re really involved with cultural sensitivity of our clinic I think you should get someone to come in to teach the whole entire staff about the transgender population as well as the LGBT population because at this clinic it is something we want to be known for to be culturally sensitive.

Rachel: And okay, I will definitely would like to get some more information for us so that we can move forward.

Dr. Smith: Great.

Rachel: Thank you very much.

Dr. Smith: Yes thank you.

Rachel: And let him know that you’re getting ready to go in there and talk to him.

Dr. Smith: Okay thank out very much.

Rachel: Yep you’re welcome.