A little knowledge goes a long way

By Dr Irene Dolan, GP and Health Pathways WA GP Clinical Editor, WA Primary Health Alliance

My interest in trans, gender diverse, and nonbinary (TGDNB) health began in 2008 when, as a medical student, I was privileged to attend the International AIDS Conference in Mexico City. There, I talked with trans woman who spoke of the stigma that many TGDNB people face when accessing healthcare and the impacts that misgendering can have.  

TGDNB health was not something we were taught as medical students, but her story stuck with me and was the genesis of my most rewarding work to date. 

On graduating from medical school, I specialised in general practice and still did not learn about TGDNB health in my studies. So, when I took on a role as a GP at a sexual health clinic and was told I might see TGDNB patients, I asked the clinic manager for some help.  

He introduced me to the then chair of TransFolk of WA, a peer support service for TGDNB people and their loved ones in Western Australia, who very generously taught me the basics of respectful and appropriate language, the use of pronouns and chosen name.  

These early learnings gave me the confidence to see TGDNB patients at the practice I was working at. I soon discovered that piecing together referral pathways, models of care and the clinical knowledge required was challenging. 

At the same time, I was fortunate to be working as a GP Clinical Editor within Health Pathways WA at WA Primary Health Alliance. I took the opportunity to plant the seed about developing a WA-specific transgender health and gender diversity HealthPathway. 

Given the organisation’s commitment to diversity and inclusion and the deficit in information for health professionals on TGDNB health, I got the green light to proceed. 

I have been extremely fortunate to work with such a knowledgeable and engaged group of subject matter experts on the pathway’s development. This included representatives of the TGDNB community and clinical specialists from Royal Perth Hospital and Perth Children’s Hospital Gender Diversity Services who work with TGDNB people of all ages. GPs with experience in TGDNB health have also been involved in the pathway development. 

Their depth of knowledge and insights into the subject matter helped to create a pathway which addresses the complexities faced by TGDNB individuals when accessing health care and some of the challenges faced by GPs face when trying to help their patients access gender affirming care.

It steps GPs through the assessment, management and referral pathways to specialised services for TGDNB people of all ages, offers guidance on creating welcoming clinical environments, and provides patient information and information on support organisations for TGDNB patients and their families. The pathway also includes links to useful resources and a section on professional support.  

The final pathway was informed by consultation undertaken by the WA Department of Health and is a fitting example of collaboration across the depth and breadth of the health system. 

My approach in developing the pathway and forthcoming education series has been shaped by my professional experience. I share these to show a small amount of knowledge can go a long way and to demonstrate the importance of lived experience. 

I cannot recall another 30-minute conversation I had during medical school or GP training which has influenced my work to the same extent as that conversation in Mexico City.  

I hope this work will help to bridge a gap as, equipped with knowledge and confidence, GPs can make an enormous difference to the health of TGDNB people. 

Health professionals can access the Transgender Health and Gender Diversity HealthPathway and associated Transgender Specialised Assessment request page, or request access.