Thursday, March 2, 2023

Clinicians Offer Suggestions to Combat Harassment Directed at Gender-Affirming Care Clinics

Clinics and clinicians who provide gender-affirming care to youth have received an onslaught of threats and harassment. In a viewpoint published this week in JAMA Pediatrics, three clinicians whose institutions were recently targeted by harassment campaigns offered recommendations to support patients and clinicians in response to acts of online extremism while also 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., of Vanderbilt University School of Medicine; Oren Ganor, M.D., M.Sc., of Boston’s Children Hospital; and Brian Drolet, M.D., of 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.”

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 that sensitive information (such as email addresses) be deleted from department websites to minimize harassment. But refrain from removing entire web pages or patient resources, even temporarily, so that patients continue to have access to online resources about health care options.
  • 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.

Additionally, the authors described numerous proactive strategies, 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 can play an integral role by aggregating and distributing reports of online harassment to law enforcement and reporting individual posts and users.

“Online extremism has caused substantial distress and trauma in health care professionals, patients, and their families,” the authors concluded. “If online extremism in health care is not systematically addressed, clinicians may be unwilling to provide and train in [gender-affirming care], further limiting health care access and leading to worse physical and mental health outcomes for [transgender and gender-diverse] individuals.”

For related information, see the Psychiatric News article “Gender-Affirming Clinics Subject to Onslaught of Threats, Harassment.”

(Image: iStock/Cunaplus_M.Faba)

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