Transgender Awareness & Acceptability: From a regulator and MRT perspective - PowerPoint Presentation

Transgender Awareness & Acceptability: From a regulator and MRT perspective 1

Acknowledgements Many slides compliments of Sidsel Pedersen , MRT(R), Bachelor of Radiography and Virginia Sanders, MRT(R), MSc., which are featured in their award winning presentation “It’s the Parts that Matter”Traditionally, MRTs have used a binary sex model known as male / female to determine appropriate radiation protection practices. This binary model is now obsolete. Now, a gender continuum has been identified that contains approximately 31 different categories of gender variance. Gender variances that are presented within this continuum may include sex to gender congruency and sex to gender incongruencies. Therefore, it is imperative for us as MRTs to be aware of the diversity within the gender continuum as we are the ones delivering ionizing radiation to the public. Additionally, we must ascertain the placement of the patients reproductive organs in order to adhere to best practice guidelines of radiation protection. Questionnaires and communication must be adapted to ensure that MRTs are protecting the public appropriately, while remaining professional and respectful of people’s diversity.

© 2017, National Geographic, http://www.nationalgeographic.com/magazine/2017/01/ In USA (2017) 1.4 million people identify as transgender

4 As a regulator, we have undergone an in-depth analysis of all documentation with a lens to gender identity and expression. As a result, we identified many areas in our documents that needed a gender neutrality update but did not impact content. We have completed these ‘housekeeping’ edits on our outward facing documents like the Standards of Practice, Code of Ethics, website and information collection tools.On our hard and soft copy forms key changes include removing ‘prefix’, providing a new gender option X, added the clarifying word ‘legal’ to first and last name, and are starting to collect ‘practice name’. In the next few weeks, we will update our public register to reflect these changes.We have also updated our communication templates/letters and policies. Council has been provided a revised set of governance policies that have been updated with gender neutral language.We have planned training for staff and ongoing opportunities for discussion to further our understanding of gender neutrality and ensure appropriate corporate culture

5 Honorable Sarah Hoffman, Minister of Health AB As a Regulator, we are faced with a unique challenge when wanting to make gender neutral wording changes. What should be a simple process is not that simple….. For example: The ACMDTT Code of Ethics carries legal authority and must be approved by Alberta Health. The current ACMDTT Code of Ethics does not contain the wording “gender and identity” under the Diversity clause. We have written to the government asking for the change to be made, but have not heard back…..

6 Take a look at your policies with a gender neutral lens Review your online registration process and forms to ensure gender inclusiveness Review pronouns: He/She is not only, consider they/zeAs an Association or a College what you can do:

7 Check Gender Markers on All Registration Forms are Updated

8 The Gender Spectrum is a sliding scale based on: GENDER EXPRESSION: outward gender presentation or behavior ( Clothing, hairstyle)GENDER IDENTITY: how we think about ourselves (sense of being man, woman, or a gender that is both, fluid, or neither)BIOLOGICAL SEX: the reproductive organs we are born with, male, female, intersex

http://itspronouncedmetrosexual.com/2012/01/the-genderbread-person/

Stages of Transitioning Social Transition: when a person begins to live as their desired gender 2. Hormone Therapy: Cross-sex hormones can be prescribed by family physician and in some cases psychiatrists. Patients may also be on hormone blockers to prevent biological traits from surfacing3. Legal Transition: identification documents and legal name change occurs. Must live 1 year as desired gender first.4. Gender Confirming/affirming Surgery

Trends towards gender neutral identification As of August 31, 2017 Canadians can choose gender unspecified “X” on their passports. In June 2016 the Ontario government started issuing Ontario photo health cards without indicating the cardholder’s sex In early 2017 the Ontario government began offering the option “X” on a driver’s license for those that do not identify as male or femaleIn 2018 Alberta government began offering the option “X” on a driver’s license for those that do not identify as male or female

12 32% of transgender patients stated they were either verbally harassed , denied benefits of service, asked to leave, or assaulted when their ID did not match their presentation Transgender people are at a higher risk for depression and anxiety when their ID doesn’t match their expressed gender Having ID concordant with lived gender reduces exposure to violence as well as depression

13 TEDTALKS (Producer). (2017, June). How to talk (and listen) to transgender people. [Video podcast].

Dedication and Long Waits for Surgery In Alberta it can take can take up to seven years from a person seeing their family physician to obtaining a surgical referral for gender affirming surgery In British Columbia and Ontario the process is more accessible as many family doctors undertake the role and start patients on hormone therapy treatmentIn Red Deer, AB alone the plastic surgeon on staff performs at least 2 gender reassignment surgeries a week/ over 104 per year

Code of Ethics CAMRT Respecting patient dignity and rights Treating all individuals with respect and dignity, providing care regardless of race, national or ethnic origin, colour, gender, sexual orientation, religious or political affiliation, age, type of illness, mental or physical abilityACMDTT Diversity A regulated member provides patient care and service with respect for human rights, regardless of, but not limited to, race, ethnicity, religion, language, sexual orientation, age and socioeconomic status, mental or physical abilitiesProviding a safe environment (CAMRT)Ensuring a safe environment and taking steps to minimize the exposure to potential risks (e.g., radiation exposure, strong magnetic fields, risk of infection)

Gonadal Shielding Health Canada Safety Code 35 states: Appropriate use of specific area gonad shielding is strongly advised when: the gonads lie within, or are in close proximity to, the X-ray beam; the patient is of reproductive age; andclinical objectives will not be compromisedACMDTT Standards of PracticeUtilize shielding in accordance with radiation protection principles without compromising the examCAMRT Best practice guidelines:Because risk increases with dose, there should always be an effort to perform procedures with a dose that is as low as reasonably achievable (ALARA)

Shielding Evan Time Magazine September 12, 2016 vol. 188

Time Magazine September 12, 2016 volume 188

19 TEDTALKS (Producer). (2014, March). Why I must come out. [Video podcast].

Adults and Mistreatment Due to living as their desired gender: 34% had been verbally threatened or harassed 20% had been physically or sexually assaulted 57% avoided public washrooms due to safety fears 40% of Transgender people have attempted suicide - 9 times higher than the rest of the population

Medical Marginalization Due to living as their desired gender: 49% of older youth reported missing needed physical healthcare 25% had been belittled or ridiculed by an emergency care provider for being Transgendered 21% did not see a doctor when they needed to because of fear of being mistreated 40% of those who have a family physician experienced discriminatory behavior from their doctor

How can MRTs help? The Gender Diverse community needs our support to feel safe Use their ‘name in use’ and pronoun by asking them Explain why more personal questions are needed Don’t make it weird We are trained to build a rapport with patients in a short period of time. We deal with patients with cultural sensitivities, learning disabilities, and language barriers to name a few. Providing care to a transgender patient is no different

23 Online Course Featured on OAMRS Website

Positive Feedback “It feels good when people use it, even if it is the only name they know. It feels like a signifier of respect . It is a signifier of respect. Although it seems very simple, having someone treat me as who I say I am (regardless of my drivers license or birth certificate) tells me that I will be safe enough accessing their services and support. This is particularly true when accessing medical and counselling services” - Kyle Taylor-Shaughnessy“She (an x-ray tech) asked carefully about my internal organ complement, with no assumption, inclusive language and very respectful. I’ve found that x-ray techs have consistently set the bar really high for how respectful a medical professional can be to me regarding or because of my transness. Don’t know why, not gonna question” - Patient feedback from TESA (Trans Equality Society of Alberta)

Create a safe space Introduce yourself using your preferred name and pronoun Ask patient what their name in use and pronoun they wish to use If you make a mistake: apologize, correct it, and move on Don’t make it weird“If you make a mistake you are not transphobic you are just figuring it out”–Lee Airton, Ph.D., University of Toronto

Thank you 26