Experts Offer Advice to Fight Harassment Toward Gender-Affirming Clinics
Abstract
Professionals and their institutions can implement several strategies before and after potential acts of online extremism to ensure their patients and staff are safe and experience as few disruptions in care as possible.
Clinics and clinicians who provide gender-affirming care to youth have received an onslaught of threats and harassment in recent months, as treatment of transgender youth continues to be a hotly debated topic on social media and more states introduce bills that restrict gender-affirming care. In a JAMA Pediatrics viewpoint published in February, three clinicians whose institutions were the subject of harassment campaigns offered advice to support patients and clinicians in response to acts of online extremism, while always optimizing safety.
In August 2022, social media posts falsely claimed that clinicians at Boston Children’s Hospital performed hysterectomies on minors. A month later, another social media attack claimed that gender-affirming care clinicians at Vanderbilt Children’s Hospital were chemically castrating minors, among other claims. Clinicians at both institutions faced threats, harassment, bomb threats, and hate speech.
“Online extremism and the purposeful spread of misinformation for political gain undermine public trust in health care,” wrote Rishub Das, B.A., a third-year medical student at Vanderbilt University School of Medicine; Oren Ganor, M.D., M.Sc., co-director of the Center for Gender Surgery at Boston’s Children’s Hospital; and Brian Drolet, M.D., chief of the Division of Hand and Upper Extremity Surgery at Vanderbilt University Medical Center. “[T]he ways clinicians respond to harassment and hate speech regarding the care they provide have critical impacts on health outcomes, access to care, and patient and physician safety.”
In the viewpoint, Das, Ganor, and Drolet pointed out that the polarization of health care issues, like abortion and gender-affirming care, severely limit access to health care. Yet it is essential that patients are still able to access the care they need. “We have to remember our role in society, why we became doctors, and the humanity involved in medicine,” Das told Psychiatric News. “We’re taking care of human beings who are being very vulnerable in expressing their identities to us. Sometimes they haven’t even expressed those identities to their families yet.”
Das, Ganor, and Drolet described both reactive and proactive strategies that clinicians who provide gender-affirming care and their institutions can take to fight misinformation and protect both staff and patients. Reactive strategies they outlined include the following:
Make a timely institutional response to misinformation-based threats. “Issuing a clear, official statement that corrects misinformation and directs people to credible sources and evidence within the first hours of a crisis has been shown to elicit greater trust from the public,” the authors wrote.
Create clear channels through which clinicians and other staff can request the deletion of sensitive information (such as email addresses) from department websites to minimize harassment.
Connect health care workers who receive online threats to law enforcement for guidance on protecting themselves and their families.
Conduct patient appointments via telehealth if clinical spaces are at risk.
“It’s really important to make sure that information patients need isn’t removed from the websites,” Das told Psychiatric News. “There’s this mentality that we need to block all the websites so these people on social media won’t find our information. But when these attacks happen, patients need us the most. Making sure that patients continue to have access to resources should remain a priority.”
Das, Ganor, and Drolet also described numerous proactive strategies in the viewpoint article, including the following:
Gender-affirming care clinicians should feel empowered to correct misinformation and provide expert medical advice to their peers and other individuals. Further, hospitals should protect these clinicians with internal and public statements of support.
Systems should be implemented through which health care workers can report and document harassment.
Professional organizations should continue to address misinformation through evidence-based recommendations and statements, particularly because these organizations can speak on behalf of health care professionals and limit identification of individual clinicians.
Media relations teams should be prepared to aggregate and distribute reports of online harassment to law enforcement and report individual posts and users.
Das pointed out that there is already a dearth of professionals who provide care to transgender and gender diverse patients.
“The scare tactics these groups are using will further discourage clinicians from providing any kind of care to these patients,” he said. “We have to remember that respecting these patients and providing the care that is medically indicated is our duty as physicians.” ■
