Patient-centered for whom? Cis-/neuro- normativity in ‘patient-centered’ trans healthcare

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 12. Sexual and Gender Minority Health

Abstract

Patient-centered care is touted as integral for quality healthcare. However, scholarship has shown that this ideal is often implemented inequitably along the lines of race, socioeconomic status, and disability status. Autistic people in particular struggle in healthcare interactions due to patient-, provider-, and system-level factors. This is particularly important in the provision of gender-affirming care (GAC) for transgender people, as complex conversations about an individual’s gender identity and inner life are significant parts of the assessment and ongoing care processes. This paper examines the uneven consequences of patient-centered care and (mis)communication in GAC practices. What happens when there are disjunctures between what providers think they are doing and the impact of their practices on patients? I analyze interviews with 10 providers of GAC, participant observation of a transgender health conference, and interviews with 23 autistic trans people. I argue that practices that are viewed as “patient-centered” are not received as such by all groups of people. The analysis suggests that providers construct their practice as patient-centered and trans-positive through 1) privileging open-ended questions about patients’ “gender goals” and “gender journeys”, 2) emphasizing capacity assessment as a protective process, and 3) emphasizing their relationship-building efforts. However, insights from interviews with autistic trans people suggest that these practices are often felt as confusing, challenging, paternalistic, and invalidating. This suggests that the current standards for patient-centered care make normative assumptions about patient cognition and communication, which may lead to negative healthcare experiences, poorer provider-patient relationships, and in the case of autistic trans people, delays and denials of GAC. I contribute to scholarship on health care delivery, medical sociology, and transgender studies by illuminating the normative assumptions behind patient-centered care standards and elaborating on the mismatch between providers’ intent in their GAC practices and the impact of those practices on trans people.

Author

• Nic Rios, Barnard College