In December last year our Journal of the Intensive Care Society (JICS) published an article by Luke Flower, Alice Humphreys, Kamilla Kamaruddin, Stuart Edwardson and others about the management of transgender patients in critical care. It was the first article on the subject to appear in JICS and was followed by an editorial by Luke, Alice and Stuart in February and a podcast episode released in late March.
They’d seen a knowledge gap in clinicians treating transgender patients in critical care, had noticed how interested their colleagues were in learning more, and realised they had the capacity to help fill it. So, Luke brought the group together and they set to work.
“It was seeing that appetite and seeing the knowledge gap that existed that really kind of made us think maybe this is something we can build on, something worth writing about and getting out there,” he says.
For Stuart it was also about helping his colleagues feel more confident in this aspect of their work, so they can provide better care to trans patients. “When people educate themselves they feel far less stressed or anxious and therefore actually are able to just look after people far better. So, I think it’s all about spreading knowledge and making that care better,” he says.
As both doctors and transgender women Alice and Kamilla have taken on roles advocating for themselves and other trans people, particularly when it comes to patient care. Both came out at work and had quite positive experiences, but these also confirmed gaps in our knowledge on the subject. “Everyone was very supportive and very curious” says Alice, so she’s always endeavoured to answer as many questions as she can. “The less strange it is the less scary it seems.”
For Kamilla, coming out while working as a GP highlighted the lack of guidance available. With 30 or 40 patients coming to see her each day her staff weren’t sure what to tell them. “I suddenly realised there was no guideline,” she says, “so I made up one myself.”
Their article covers many aspects of caring for trans patients, like the potential effects of gender affirming surgery on airways, and medical gender affirmation therapies like hormone therapy. During the recording of our podcast they dived a little deeper into hormone therapy and whether or not it should be continued for patients admitted to intensive care.
“If you’re admitting somebody to ITU and they’re on HRT, for the love of all things please continue it,” says Alice, considering the psychological effects stopping treatment can have on patients. Stuart agrees, particularly given the “huge burden” intensive care places on patients in terms of recovery and rehabilitation.
Overall, their message is simple; the more information we have about treating transgender patients the better care we can provide. Sometimes, this is as simple as being aware of who patients are.
“Healthcare professionals think that meeting trans patients in a healthcare setting is a rare event but there are more trans people than you think,” says Kamilla, and Alice points out this can make treatment much more difficult for patients.
“ITU is a scary and lonely place, particularly if people don’t understand you and identify you correctly,” she says.
All four authors are hopeful for the future treatment of transgender patients throughout the health service and specifically in intensive care, but there’s still a lot of progress to be made.
“We do the basics on ITU so well normally, it wouldn’t seem too much of a push for us to just be aware of these things,” says Luke, and Kamilla echoes that idea.
“We’re in a profession of caring and we clinicians should be able to provide inclusive and person-centric care to trans patients,” she says. “We just want to be treated with dignity and we just want to be treated like everyone else”.
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