Patients & Providers: Binders of Our Own

Allie is an Occupational Therapy student at USC, and grew up in a family of health care providers. It wasn’t until she started Skyping every week with Charlie through the student-patient partnership program Stanford Medicine X Ed that her eyes were opened to the intricacies and realities of trans health. She is now determined to educate her classmates with what she continues to learn about the trans community, and has a newfound interest in binders – of all kinds.

Binders of Our Own

by Allie Schmiesing


I opened up my browser to the Google Hangouts homepage and sat staring at it for a few moments filled with nervous anticipation. I was meeting Charlie for what would technically be the second time. A few months previously I had been responsible for chauffeuring him across the Stanford campus in a golf cart where he was giving a talk at a medical conference. I liked him immediately and I somehow doubted our 10-minute golf cart ride would have made an impression, so I was anxious to make a good impression on him during our call. Unfortunately, my goal was complicated by the fact that Charlie was the first transgender person I had ever (knowingly) met.

Growing up in the Bay Area during the 1990s and 2000s, I am friends with and even related to members of the L, G, and B portion of the LGBTQIA+ community. But I had never met anyone who identified themselves to me as transgender, non-binary, intersex, or asexual. Needless to say, I was worried I would put my foot in my mouth or say something stupid and unintentionally insulting.

Over the next couple of months, I spent hours each week Skyping with Charlie and creating a shared journal with him, culminating in a panel discussion at Stanford Med X Ed. And yes, I did put my foot in my mouth more than once. A particularly memorable moment was the time Charlie spent 5 minutes talking to me about chest binders only to realize that I thought he was talking about academic, 3-ring binders the entire time. We laughed it off in the moment, and my faux pas turned into a running joke.

While I loved and appreciated Charlie’s patience with me, it weighed on my conscience that he had to spend so much time educating me. I imagined if this had been a more typical health care provider meets transgender patient relationship, the frustration my gaffs and knowledge gaps would create. No longer would it be comical that I didn’t understand what a binder was or the unique health implications it might have for a patient.

As health care providers and caregivers, it is our responsibility to understand our clients needs and respect their unique concerns. Just as I would never enter into a patient encounter without knowing their diagnosis, I should never meet with a trans-masculine patient who is on low dose testosterone without understanding the implications of hormone therapy on my practice. Unfortunately, I – and many of my peers both in Occupational Therapy and other health care fields – do not receive the necessary academic preparation to feel confident in our ability to address trans patients’ concerns. The majority of us don’t even know enough to ask the right questions and conduct our own research.

The handful of times transgender health concerns made their way into my lessons, it was as a statistic, not as a topic for discussion or inquiry. A recent study by Stanford Medicine found that the average medical student only spends 5 hours learning about the needs of the LGBTQIA+ community. If you estimate that health care students will spend approximately 6,000 hours in the classroom, 5 hours is only 0.0625% of their time. As Charlie often said, that is not even enough time to address the L, let alone the GBTQI or A. I wholeheartedly agree. We do a disservice not only to our patients, but to ourselves when we willfully ignore the unique health concerns of 10 million American adults.

I was blessed to have Charlie by my side, to get to know him as I did, to feel comfortable asking him questions, and to call him a friend today. The majority of health care students will not have anything remotely close to this opportunity, yet we will need to provide competent, equitable care to all. I believe all health care students should have access to binders – 3-ring, academic binders we create ourselves full of information about LGBTQIA+ health concerns and the role we will take in combatting the current institutional injustices within our health care and health education systems.  

About Allie

Allie Schmiesing is an occupational therapy masters student at the University of Southern California. She works as a research assistant at the Neuroplasticity and Neurorehabilitation Lab and is a 2017-2018 Albert Schweitzer Fellow. She looks forward to deepening her involvement in the LGBTQAI+ community as a clinician and advocate for incorporating transgender health education into the occupational therapy curriculum.

Tell us in the comments!

This series relies on your voices to participate – it is an opportunity for patients and providers to learn from each other.

How can we educate health care students on trans health?

2 thoughts on “Patients & Providers: Binders of Our Own

  1. Medical education needs to involve a greater array of trans community voices, not just the limited medical texts in existence. Those of us willing to talk about our experience should be utilized to improve provider knowledge.

    1. I agree! Even the “trans friendly” providers I’ve seen ask me nonbinary 101 stuff, because they’ve just never been exposed to non-traditional narratives.
      On the other hand, they should understand that trans people who make themselves available are different from their patients, who should not be used as their teachable moment, as Dr Acquaviva phrased so well in the last post.

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