🏳️‍🌈 Consulting Transgender Patients in PLAB 2: Cultural Competence Without Assumptions

Ann Augustin
Jun 24
4 min read

Updated: Jun 26

In the PLAB 2 exam—and in NHS practice—you may meet patients who are transgender. But what should you do if they come in with a common complaint like a urinary tract infection, headache, or joint pain?

👉 Do not jump into a gender identity assessment right away.

Treat them, first and foremost, as you would any other patient—with curiosity, compassion, and clinical focus.

🧭 Start with the Main Concern—Not the Identity

Let’s say a patient presents with UTI symptoms and their records indicate they are transgender. Many international medical graduates feel unsure whether to immediately explore the patient’s gender history.

🎯 Here’s the golden rule:

Only explore transgender-specific aspects if they are clinically relevant to the presenting complaint.

For example:

UTI in a transgender woman who has had genital surgery? Yes, this might be relevant. Or UTI if they are holding their urine for long because they can't find a suitable restroom? Yes, this might be relevant.
Headache in a transgender man? No need to explore gender history unless related to hormone use or stress factors.

Your ability to maintain the patient’s dignity without making assumptions is a key element of cultural competence—and a tested domain in PLAB 2.

🌍 Helping IMGs Build Cultural Competence

Many IMGs may come from healthcare systems where transgender health is not commonly taught. The UK’s NHS, however, expects doctors to:

Use inclusive, non-judgmental language
Avoid assumptions about gender or pronouns
Be respectful of diverse gender identities
Handle sensitive topics with empathy and confidentiality

👂 A culturally competent consultation helps patients feel safe, respected, and heard—no matter what background they come from.

💬 Before you ask, “Are you biologically male or female?”, ask yourself:

“Is this relevant to solving the patient’s current concern?”

Only delve into transgender-specific topics if needed for diagnosis, treatment, safeguarding, or emotional support.

🧾 Transgender Assessment Template for PLAB 2 (Use When Relevant)

Use this structured framework when the patient presents with gender-related concerns or when relevant to the presenting problem (e.g. sexual health, mental health, hormone side effects, safeguarding):

🧬 1. Background History (Transgender-Specific)

Assigned sex at birth“Were you assigned male or female at birth?”
Current gender identity“How do you currently identify your gender?”
Dysphoria“Do you feel discomfort in your current gender?”“How long have you felt this way?”
Transition-related actions“Have you taken any steps to live in your preferred gender?”
- e.g. "Have you changed your name, clothes, or the way you present yourself?"“Have you spoken to anyone or done research on what options are available?”

💊 2. Gender-Affirming Medical History

Healthcare engagement“Have you seen any doctors about your gender?”“Have you been referred to a gender dysphoria clinic?”
Hormone or surgical treatment“Have you started any medications like hormone therapy?”“Have you undergone any procedures or surgeries?”“If yes, where and when?”

❤️ 3. Sexual Relationships and Orientation

Activity“Are you sexually active?”“Have you been sexually active before?”
Orientation“Do you tend to have relationships with men, women, or both?”

🧠 Remember: Sexual orientation ≠ gender identity.

🏠 4. Support System and Disclosure

Living situation“Who do you live with?”“Do you feel supported at home?”
Parental awareness“Have you told your family about your gender identity?”“How did they respond?”
Friend support“Have you shared this with any friends?”“Do you feel supported by them?”
Community groups“Have you been to any support groups, like the LGBT Foundation?”“How did you find the experience?”

⚠️ 5. Mental Health and Psychosocial Risk

Stigma and discrimination“Have you ever faced bullying or discrimination because of your identity?”“Has anyone made you feel unsafe or uncomfortable?”
Emotional wellbeing“Do you ever feel low, anxious, or isolated?”“Have these feelings affected your daily life?”
Coping and resilience“What helps you cope when you’re feeling stressed?”“Do you have someone to talk to about these things?”

✅ Quick Checklist: Cultural Competence in PLAB 2

✔ Do	✘ Don’t
Ask about preferred name and pronouns	Use “Mr./Ms.” or pronouns without asking
Focus on the presenting complaint	Launch into gender history without context
Be respectful and validating	Laugh, look surprised, or act awkward
Include social support questions	Avoid psychosocial history
Use patient-centered phrases	Use outdated or clinical-only terms

💬 Sample Language to Use

“Thank you for being open. I’m here to support you with what matters most to you today.”
“Can I ask what pronouns you use so I address you respectfully?”
“Is your current treatment affecting how you feel physically or emotionally?”
“Would you like me to arrange a referral to a gender specialist, if that would help?”

📘 Conclusion: Respect First, Relevance Always

The heart of a good PLAB 2 consultation is safe, respectful, person-centered care. Whether a patient is cisgender or transgender, your approach should reflect clinical need, not assumptions.

Remember:

“You don’t need to know everything about transgender care. You just need to listen with empathy and treat each person with dignity.”

By practicing with this mindset, you’ll not only succeed in your PLAB 2 exam—but become a better doctor for every patient you meet.

📚 References: