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For many LGBTQ people, even a routine doctor visit can be a ‘degrading experience’

Katharine Prescott holds a photo of her late son, Kyler Prescott, in the memorial garden she created in his memory at her home in Vista, Calif., a San Diego suburb, on Sept. 21, 2016. (Maria J. Avila/National Center for Lesbian Rights)

For any parent, teacher or health-care provider — actually, for anyone with a beating heart— the suicide of 14-year-old Kyler Prescott is a wrenching story. In April 2015 the San Diego teenager was depressed from being repeatedly harassed and bullied about his gender identity. His mom, Katharine Prescott, took him to Rady Children’s Hospital-San Diego for help with his self-inflicted wounds and suicidal thoughts. Although she introduced Kyler as a transgender boy (both his legal name and official gender had been changed) the hospital staff continued to address him as a girl, adding to Kyler’s distress.

Katharine Prescott describes her son as being "in despair" in a lawsuit filed last week and said that she expected the hospital to keep him for the full 72-hour observation period typical for those at risk of self-harm. Instead, Kyler was released after 24 hours. A month later, he took his own life. Although it was only May, Kyler was the third transgender teen to die by suicide in 2015 in the San Diego area alone.

What happened to the Prescotts is tragic, and it should alarm anyone seeking health care. The problem may be greatest for LGBTQ people, but it affects anyone who is outside the norm in any way. And as Kyler's story shows, sometimes the words we use are literally a matter of life and death.

"To treat me, you need to know who I am," says Liz Margolies, founder and executive director of the National LGBT Cancer Network. I have firsthand experience with doctors not knowing fully who I am: At my local hospital, the patient information form I filled out years ago — and which still is being used — lists only "single," "married," and "divorced" as options for marital status. There's no option for "partnered," "widowed," or "separated," all of which give health-care professionals much-needed information about an individual's support system (or lack thereof). That's not exclusively an LGBTQ issue, since it affects people in many different life situations, but a more expansive list of choices would provide a conversation-starter about orientation and identity.

“Intake forms are a powerful and early indicator of the welcome LGBT [people] can expect in a health-care setting,” Margolies says. At most facilities, the form allows for only “male” and “female” when it comes to gender, which completely erases anyone who identifies as transgender or intersex.

And that's just the waiting room. According to a study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, 37 percent of transgender Americans have experienced discrimination in a hospital or doctor's office. Meanwhile, a staggering 80 percent of first-year medical students expressed some form of bias against lesbians and gays, the National Institutes of Health reported in 2015.

Part of the problem, no doubt, is that medical schools devote so little time to LGBTQ-related health issues. According to a JAMA study of 132 medical schools, the median time dedicated to LGBTQ health in an entire doctor's education totaled a mere five hours. With so little training, how can providers do right by LGBTQ patients?

This is in large part why Margolies works so diligently to take down the barriers that prevent LGBTQ people from getting the care they need, especially considering our higher rates of depression, substance abuse, and HIV infection. Last year Margolies's organization created a powerful instructional video for health-care providers called "Vanessa Goes to the Doctor," which contrasts positive and negative approaches to welcoming transgender patients.

"Training makes all the difference in the world," says James Parker Sheffield, a transgender man and a director at Atlanta's Health Initiative, an LGBTQ wellness organization. When I asked him about Kyler Prescott's suicide, Sheffield told me how crucial it is "that medical professionals use current and considerate language. If they don't, it could destroy the relationship." And what about the hospital's staffers referring to Kyler as a girl? Sheffield says: "When you're misgendering someone, you're essentially telling them that they don't exist. It's a degrading experience. . . . To use the right pronouns and language is common courtesy." It's also about respect and recognition.

So how do we protect future Kylers and real-life Vanessas? "Medical schools have to make it a priority," Sheffield says. But today's LGBTQ patients need quality care now, not in 10 or 20 years. And they need it everywhere, not just in a few large urban centers where LGBTQ awareness runs high. For now, LGBTQ people mostly rely on word of mouth to find inclusive practices, and find the courage to write in their truth on forms that would erase their identities and relationships.

Two other sources for those seeking LGBTQ-friendly doctor recommendations are local gay and lesbian centers and the Human Rights Campaign's health-care tool, which evaluates more than 2,000 medical facilities nationwide.

Last week, Katharine Prescott filed a lawsuit against Rady Children’s Hospital-San Deigo, alleging discrimination in how her son was treated. The court’s ruling will make a statement about transgender patients, but this is a prescription for all health-care professionals: Talk the talk with all of your patients, because you don’t know anyone until you ask them who they are. Just ask ­Kyler’s mom.

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