Intersectionality in Radiology

As the healthcare system becomes more in tune with the specific needs of diverse patient populations, an important step in bridging those healthcare gaps is creating safe and inclusive spaces for transgender and gender diverse patients requiring medical imaging. This is something Dr. Noah Ditkofsky, Chief of Radiology at Michael Garron Hospital is trying to move forward in radiology.

Earlier this month at the Department’s Annual Clinical Practice Improvement (CPi) Evening Event: Come, Connect, Intersect, Dr. Ditkofsky gave a presentation which discussed the need for guidelines for gender inclusion in radiology examinations and procedures.

“Considering the disparities faced by marginalized groups, healthcare providers must give additional thought to their words and actions when caring for members of those groups,” Dr. Ditkofsky says. “If you fail to do so, you risk further marginalizing these patients and creating a barrier to their seeking future care.”

Addressing gaps in transgender health care first requires an understanding of how marginalization may affect trans and gender diverse people. In a 2017 study from Am J Public Health[1], 1 in 100 high school students and 1 in 200 adults do not conform to traditional gender. Trans and gender diverse people have historically, and continue to, face disparities in health care, housing, employment, criminal justice and insurance coverage, among other social, legal and political disadvantages.

Having recognized health care gaps amongst his own patients, Dr. Ditkofsky incorporated his own set of guidelines, based on his experience, into his practice at Michael Garron Hospital, including removing pronouns, transgender status and gender identity from radiology reports and working with his staff to ensure his department is and is perceived to be a safe space in which to receive care. 

Unfortunately, Dr. Ditkofsky’s guidelines are some of the only examples available to radiologists hoping to foster a more inclusive environment. While the American College of Radiology offers some information regarding transgender breast cancer screening, there remains a wide gap in trans health care not only in resources, but in research as well. “We still don’t know if gender affirming hormone therapies should modify our other screening guidelines,” he says.

 “Effective care provision requires the patient to trust you, and this can only occur if they feel you respect them. Use of a patient’s preferred pronouns and gender identity can go a long way to establishing that trust,” says Dr. Ditkofsky, who further believes that “small changes in how we interact with marginalized patient groups can have significant downstream effects on their comfort in accessing the healthcare system.”

While physicians and clinicians continue to push forward intersectional care and research, starting with respect can be an integral part of ensuring that work continues and that patients feel comfortable seeking care in the future.