Transgender woman files complaint, alleges doctor asked irrelevant questions during a health exam

A transgender woman says "inappropriate" questioning by doctors at recent appointments is emblematic of discrimination transgender people frequently face in the health care system. 

Reann Legge said a mandatory assessment earlier this year for insurance purposes quickly spiralled into discomfort. She wasn't there to talk about her gender or her genitals, but said the doctor led the conversation there.  

"People — when they go to a health professional for say a headache — do not expect to go into the doctor's office and have the doctor ask what their genitals look like," said Legge, 30.

Legge was involved in a traumatic vehicle collision when she was 12 years old. She spent weeks in a coma and then years at medical appointments and rehabilitation programs. 

She still lives with health complications like an acquired brain injury, partial left side paralysis and back problems.

Saskatchewan Government Insurance required her to see multiple medical professionals so they could determine coverage for rehabilitation programming.

Legge left most of the appointments uncomfortable this year. She said she was asked questions that were "innocent, but inappropriate." 

For example, Legge said a chiropractor asked her how long it took to walk like a woman and a physiotherapist asked how long she had known she was a woman.

Legge said she wasn't surprised because she and other transgender people experience unwarranted questions often. 

She was most concerned by what went on at a visit to a general practitioner. 

"I was there for some things unrelated to me being trans, but this doctor took it upon themself to ask about my genitals and other surgeries that I have had."

Legge said the doctor mentioned the absence of a scar from a tracheal shave — a procedure to lessen the adam's apple. 

"Trying to laugh stuff off, I told him I have to leave this second chin before I need to worry about a tracheal shave."

Legge said the doctor then asked if she had breast implants or bra inserts, before asking if she had gender reassignment surgery.

The term is outdated, she said, adding genital reconstruction surgery is more appropriate.

"Emotionally, it is quite draining. Every time I am asked: 'So,what do your genitals look like?' I feel as it invalidates me as a person," she said. 

"I'd like to see medical professionals realize that trans people have the same rights as cis people."

Legge made a complaint against the Saskatchewan Health Authority to the Saskatchewan Human Rights Commission (SHRC), alleging discrimination on the basis of sex and gender orientation. The SHRC didn't accept the complaint.

"The material submitted is insufficient to conclude that the questions themselves are not relevant to the assessment of your health," according to a document provided to CBC by Legge. She said she feels belittled by the decision.   ​

College disciplined different doctor last year

She was advised by the SHRC to report it to the College of Physicians and Surgeons, which she did.

The college confirmed it is handling a complaint from a transgender person alleging inappropriate conduct by a physician.

It has previously disciplined one doctor, Dr. Mary Anderson, for unprofessional conduct related to a transgender patient. Anderson told the patient that "being transgender is an abomination" and "perverse."

The college concluded that Anderson had made statements that were insensitive and unrelated to the reasons for which the patient requested medical services. 

In 2016, Anderson was reprimanded and required to pay a fine of $2,500, cover costs of the investigation and complete an education program related to diversity training on sexual orientation and gender identity.

Bryan Salte, Associate Registrar for the college, said an investigation into allegedly inappropriate comments would examine why the doctor asked the question and the impact on the patient.

"In a perfect world, with perfect communication, the physician would say, 'Here's the reason I'm going to ask this rather personal question.' But we're not perfect," Salte said.

"Is this something that rises to the level of being unprofessional conduct because it is intrusive, harmed the patient, created problems? Is this something that the physician was asking, thinking it was relevant, even though it wasn't?"

Doctors shouldn't indulge curiosity: psychiatrist

"There are doctors who I think don't realize how uncomfortable it might be for trans patients to talk about their genitalia, just to indulge a doctor's curiosity," said Dr. Sara Dungavell, who is a Saskatoon-based psychiatrist. 

She said there is already an existing problem in the transgender community with people choosing not to seek primary healthcare, "because they're afraid that when they go to the physicians they'll experience discrimination."

She said this results in increased rates of preventable illnesses. Doctors need to be sensitive, particularly when dealing with marginalized populations, she said.

"A part of the doctors job is to ask the questions in a way where the patient understands why we are asking them, where it's not experienced as traumatizing," Dungavell said.

She said health care professionals need more education on trans health issues.

"We don't really have any historical education on dealing with people who are trans," said Dungavell.