Beyond the Sum of Their Parts: Overcoming Disparities in Care

Background

Health disparities and inequalities are widespread throughout the medical community and can impede our patients’ access to care, quality of care, and health outcomes. And for the transgender community, these disparities can lead to fatal consequences.

In a brave patient’s story, these disparities led to a decade of pain and suffering. Tristian Bilash, a transgender man, struggled with a challenging menstruation cycle from a young age. And while Bilash’s gender dysphoria outweighed any concern he had with his inconsistent cycle, when seeking care, his clinicians only focused on ensuring that he continued to stay on his cycle.

After years of misdiagnosed symptoms, Bilash was diagnosed with stage IIIC ovarian cancer at age 30 and received both a bilateral oophorectomy and a total hysterectomy. And while that seven-hour treatment was successful and eradicated him of the female reproductive organs challenging his gender identity, Bilash still wonders whether his mental and physical health would’ve been in a better place had he been treated beyond ensuring that his cycle was regular.

Patient Impact

Bilash is just one of many patients that have been treated without considering their gender identity of the patient. This is just one of many barriers that continue to hinder our efforts to improve care for the LGBTQ+ community, including lack of written and/or spoken inclusive language, inability to obtain health insurance, and implicit bias.

When clinicians make assumptions about their patients’ assigned or chosen identities, their LGBTQ+ patients suffer the consequences, including missed diagnoses, delayed treatment, or worse, a disease state that advances beyond the point of treatment.

On top of that, implicit bias within the healthcare community has led to significant variances in diagnosis and treatment. Studies show that minority groups of oncology patients have seen worse outcomes than their counterparts.

Breaking Down the Barriers

Research suggests that these implicit biases extend beyond healthcare providers, and many patients themselves carry their own biases in deciding who to seek care from. Beyond the patient-provider relationship, implicit bias has also impacted our healthcare systems. Its importance is further explored in Healthy People 2030 as a Social Determinant of Health

As we work to close these gaps in health disparities, it’s important that we look beyond the parts that make up our patients. Instead, we need to ask our patients about the meaning they give to their own bodies by learning more about their assigned or chosen identities, parts, and all. While improving awareness of unconscious/implicit bias is one of the most important things we can do to overcome these obstacles to care, taking a patient-centered interdisciplinary team approach to care can improve clinical accuracy, significantly reducing treatment disparities and improving patient outcomes.

Lessons learned from our transgendered patients reinforce the need to look beyond fixing the parts of our patients and to take a more holistic look to optimize outcomes and provide the best care we can.

References: 
Bilash, Tristan, and Lauren M Walker. 2022. “Spare Parts: Navigating Ovarian Cancer as a Transgender Man.” Journal of Clinical Oncology, January. https://doi.org/10.1200/JCO.21.01249.

Centola, Damon, Douglas Guilbeault, Urmimala Sarkar, Elaine Khoong, and Jingwen Zhang. 2021. “The Reduction of Race and Gender Bias in Clinical Treatment Recommendations Using Clinician Peer Networks in an Experimental Setting.” Nature Communications 2021 12:1 12 (1): 1–10. https://doi.org/10.1038/s41467-021-26905-5.

Fiscella, Kevin, Ronald M. Epstein, Jennifer J. Griggs, Mary M. Marshall, and Cleveland G. Shields. 2021. “Is Physician Implicit Bias Associated with Differences in Care by Patient Race for Metastatic Cancer-Related Pain?” PLOS ONE 16 (10): e0257794. https://doi.org/10.1371/JOURNAL.PONE.0257794.

Fitzgerald, Chloë, and Samia Hurst. 2017. “Implicit Bias in Healthcare Professionals: A Systematic Review.” BMC Medical Ethics 18 (1). https://doi.org/10.1186/S12910-017-0179-8.

“Healthy People 2030 | Health.Gov.” 2022. Office of Disease Prevention and Health Promotion. 2022. https://health.gov/healthypeople.

Walker, Lauren M. 2022. “Sexual Recovery Interventions Following Prostate Cancer Treatment.” Nature Reviews Urology 2022, March, 1–2. https://doi.org/10.1038/s41585-022-00582-5.