Beyond the Chart

A significant body of research has demonstrated unique health disparities 1-3 and negative health care experiences among transgender people 4,5 ; however, humanizing narratives that depict their internal experiences (eg, thoughts, emotions, desires) as they navigate medical contexts remain few.We offer the following vignette to examine some of the internal experiences a transmasculine patient may have in anticipation for a cardiology appointment.Through centering the patient's inner thoughts and emotions, this narrative can serve as a teaching tool to enhance patient-actor opportunities for students and trainees, and inspire reflection among health care providers on how they can better bridge the gap between their own and their transgender patients' concerns and treatment goals.I pull into the parking lot of the hospital I had just visited 6 weeks prior.Remembering the flutter in my chest that landed me here last time, I exhale shakily.I step out of the car and walk the short path to the hospital entrance.As I approach the main door, I hear footsteps behind me-a reminder that I am not alone.I hold the door open, letting the person go in before me."Thank you, sir," the person utters in my direction, which sends the corners of my mouth upward into a smile.I enter the hospital and peer at the various signs to try to orient myself.My eyes lock on "Emergency Department (ED)," which triggers a sense of dread and that familiar flutter in my chest.Immediately adjacent I see "Cardiology," so I hasten down the corridor to the waiting room for check in.The receptionist meets my eyes and asks for my name and date of birth.She gathers some papers on a clipboard and says, "Here you go, ma'am.Please fill these forms out and the nurse will call you in shortly."My heart sinks.Here you go, ma'am, here you go, ma'am, ma'am, ma'am… echoes loudly in my mind as I walk to the waiting area.I become distracted by my own self-criticism.My voice always betrays me.I need it to get deeper already.I settle into a chair that squeaks loudly as I drop onto it, which snaps me out of my thoughts but then heightens my self-consciousness as people turn to stare at me.The unease I feel in my body makes the rigidity of the hospital's chair that much more uncomfortable.I shift nervously, keeping my eyes trained on the door that nurses keep appearing from to call patients' names.I set my pen to the form and begin to scrawl information down until I reach the prompt, "Please select your gender: female, male".I reluctantly check "female," and feel my palms sweat out of irritation.I don't fit either of these boxes.My eyes continue down the form."Reason for visit," and I feel that flutter again.It's the same feeling I had weeks ago that landed me in the ED, though this time it isn't accompanied by the stabbing pain that had made my stomach turn. TAKE-HOME MESSAGE• Integrating narratives that center a transgender patient's internal experiences into medical education helps foster empathy, trust, and shared decision-making between future providers and patients.