The trans physiotherapy student talks to Lucie Culkin about the benefits of diversity within the healthcare workforce
In the final year of their physiotherapy degree, Niko Brenner hasn’t yet made up their mind about a specialty or the focus of their career as a physiotherapist. But they have made up their mind to be visible.
Niko identifies as trans, and says: ‘I think visibility is hugely important’, explaining that joining the CSP’s LGBTQIA+ network and the associated Twitter feed opened up a diverse community that they hadn’t previously been part of. ‘It was a real revelation for me after I first logged on. I got more into Twitter and I found out about all these people who I could identify with. That’s just such a positive experience for me.
‘It’s one of the reasons why I want to be visible.’
Niko isn’t just talking about themselves being visible, they also want to address the lack of awareness of trans issues that they’ve experienced. Typically, Niko says, ‘misgendering is quite a frequent experience’.
‘People not using my correct pronouns or referring to me as ‘she/her’ can be quite stressful and causes me quite a lot of anxiety in some situations.’
On the three placements they’ve so far completed, Niko has tried to head off misgendering by introducing themselves in advance: ‘I usually say “look I’m trans.
I use they/them pronouns. Please let the team know about this before I start”. Because it creates quite a difficult environment when some people know and some people don’t know, it’s just a bit awkward and then some people misgender.’
It’s a bold gesture for a student to make – and Niko acknowledges that other students may not be as assertive – but that visibility is crucial.
‘I can totally see why a lot of people would not do that,’ they say. ‘Potentially placement providers might not be that understanding of your identity, they might have preconceived ideas about trans people, and you are then putting yourself in quite a vulnerable situation. But for me, the stress of being closeted and not being seen as who I am on placement is actually bigger than the risk of someone having negative ideas about me before I start the placement.’
Originally from Germany, Niko moved to the UK at the age of 16. With an interest in physiology and human anatomy, they initially explored a career as a personal trainer but felt that there were limited opportunities for career progression. ‘Physiotherapy was quite a natural step upwards from that,’ they say.
After graduating later this year, they are keen to work within the NHS, strongly believing that healthcare can influence societal change.
‘One of the main drivers for my motivation in a career in healthcare at the moment is actually social issues within healthcare, and health inequalities,’ they say.
‘I think healthcare really has the potential to be a driver for positive social change as well. That is a big motivation for me at the moment, equality and diversity within healthcare.’
Their final year studies have involved exploration of such issues, and Niko is enjoying being challenged to consider what can be changed and improved in healthcare in general as well as within the profession.
Awareness of diversity
Evidence suggests that a diverse healthcare workforce has a positive impact on patient care, and Niko supports the premise, saying: ‘Having a more diverse team brings in lots of different viewpoints and different experiences. If you have more diversity within the team, you will have more cultural competence, cultural knowledge to be able to meet local communities’ needs. You can actually draw on that knowledge within the team and learn from each other if you have a very diverse team.’
Data collected in a government survey of people from LGBTQIA+ communities indicates that UK healthcare providers are not sufficiently aware of the specific needs of trans people, which prevents some trans people from accessing the care they need. Around a fifth (18 per cent) of the trans people who responded to the survey said ‘they avoided treatment for fear of discrimination or intolerant reactions’.
Niko firmly believes that raising awareness of diversity and promoting trans healthcare are not difficult to do – particularly where patient populations are diverse. ‘Subtle changes can make a big difference,’ they say. ‘But we also need to foster a culture that recognises that diversity exists.’
They cite patient intake forms as an example: ‘Just having multiple options on intake forms where you have male, female, non-binary and some other gender options.’
Trans health learning
Along with some medical students and recent graduates, Niko is addressing the dearth of training in medical schools and healthcare education around trans healthcare awareness by developing a Future Learn course aimed at health professionals.
It is sorely needed, they say: ‘We know that trans people face huge inequalities, with regards to access to healthcare and receiving quality care. And a lot of that is just because people are not trained on it. If you have never knowingly come across a trans person in your life and then suddenly you’re treating someone it’s no surprise that maybe you’re not going to give them the best treatment that you potentially could if you had been trained.’
The four-week course will consider the sort of specific health needs a trans person might have, and explore clinical case scenarios that look at different aspects of a trans person’s health care – mental and physical. ‘It will provide people with at least some understanding of how to approach clinical contact for a trans person,’ Niko says. They expect it to be available by the autumn of this year.
When they finish their degree, Niko is ‘looking forward to band five rotations’ because they can’t yet decide where to specialise:
‘Every place I go into I’m really getting stuck into it and enjoying the speciality. For my last placement for example, I wasn’t a huge fan of MSK before the placement started and I wasn’t sure how much I was going to enjoy it. But then after five weeks I was like, “oh, this is actually really interesting, I’m really enjoying it”.
They have a strong personal support network, which includes fellow members of the CSP’s LGBTQIA+ network.
‘My partner is also trans,’ Niko says. ‘We support each other, and I have a very affirming validating friendship group where there’s no misgendering and people just refer to you the way you want to be referred to and you don’t constantly get reminded that you’re somehow different. Basically, you’re a person. And when people validate that and just see you for who you are, then it’s a lot more simple to go through the world when you don’t have to be constantly thinking about identity.’
Visibility is a clear ambition: ‘Obviously, now I’m still a student, but as I establish my career, I want to be that person for someone else who’s from a minority background, who sees someone they can identify with and actually have them feel a sense of belonging within the physio world.’
The CSP’s LGBTQIA+ network supports and empowers members with regards to LGBTQIA+ inclusion in the physiotherapy profession.
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