Keaton has the perspective of a transgender patient, and is in the process of learning the perspective of a provider as they near the end of their education to become a Physician Assistant. Having rotated through clinics across Arizona, they reflect on their time training in a gynecology office, the time constraints providers face, and the challenges that identities pose in the workplace.

Both Sides of the Coin

by Keaton Marsh

As both a transgender patient and a medical provider, I’ve had the unique opportunity of seeing both sides of the coin. I have had opportunities to educate my classmates as well as other medical providers, and I have experienced the judgment that comes from being a patient at an office that has not been educated about transgender health care.

I came out as non-binary to my classmates two weeks into the start of my Physician Assistant program. I had come out to friends, family, and coworkers several years prior, but I felt that it was necessary to let my classmates – people with whom I would be in a classroom for up to ten hours a day –  know this about me. My coming out was received fairly. The staff at my school was very supportive, and my classmates had many questions, most from an educational standpoint. There were a few classmates who never spoke to me again, but thankfully they were the minority. I kept myself open to questions from classmates, hoping to help them grow as culturally competent providers.

Now, graduating in a little less than a month, I have more insight into what I expect from a medical provider. When I graduate, I will be a Physician Assistant, a nationally certified and state licensed mid-level provider who practices medicine as part of a team, with doctors and other medical professionals. I spent the last year traveling to clinics all across Arizona, from the smallest rural town to the city of Phoenix, spending my time as a student clinician in order to complete my academic requirements. I was at a total of eight different clinics, and I was able to share my story of being non-binary and transgender.

One of the clinics I rotated through actually worked with transgender patients on a regular basis. It was a gynecology office where one of the providers credited herself with working well with transgender patients, and she met not only the women’s health needs of her patients, but also acted as a primary care provider. She initiated hormone replacement therapy for her patients, and she made sure that her staff was well-educated about the health care needs in the trans community. Her patients all appeared very comfortable receiving care at the office.

As a provider, I related very well with the transgender patients. However, as someone who is non-binary, I felt as though the office tried to make me choose a binary gender to represent myself. Prior rotations had let me introduce myself to the patients prior to speaking with them, which allowed the patients to see me and to decide for themselves which gender they see me as. The women’s health clinic had several patients who only wanted to see a female provider. Rotating through this clinic made me realize that it would be difficult to work in such an environment, unless I wanted to share my life story with every patient, which isn’t something that time permits.

One of the biggest things I learned during this time was that most providers are not well educated about how to take care of their transgender patients. However, while that may not come as a surprise to most, my experience showed me that it’s not because health care providers are unwilling to learn. In fact, it was quite the opposite. Every health care provider I worked with was eager to hear about the ways I felt that they could improve the care given in their offices. I think many of the providers were just afraid to ask for help or didn’t know where they could receive training.

During my clinical year, I worked with a social work student to develop a presentation for medical providers. It was a basic outline about specific health needs in the transgender community, as well as small changes that could be made in order to improve care. The biggest changes I proposed were inclusive intake forms for patients and gender nonspecific restrooms. The presentation was well received by more than a hundred people, medical providers and their staff at Bayless Healthcare in Phoenix, AZ. Bayless Healthcare provides primary care and mental health services to its patients.

As a transgender patient, I have experienced firsthand the issues with health care, sometimes facing harsh judgment because of my transition. However, as a transgender medical provider, I feel as though I have been able to make an impact on the other providers throughout my education. With plans to graduate soon and to begin my career, I hope to utilize my knowledge and my personal experience to provide others with competent, nonjudgmental care.

About Keaton

Keaton Marsh is a 31 year old non-binary Physician Assistant student who lives in Phoenix, Arizona. They moved to Arizona almost ten years ago from New Jersey, and they have been working in the medical field ever since, first as a nurse in urology, and soon as a Physician Assistant in the same field. You can follow Keaton on LinkedIn or Facebook.