Research question | Themes | Subthemes | Meaning units |
---|---|---|---|
(1) Attained and utilized information | 1. Knowledge Acquisition: Formal and Informal Pathways to Competency | Formal pathways to competency | Healthcare school/residency exposure Organizational training |
Informal pathways to competency | Mentor Self-taught Patient | ||
(2) Perceived barriers and facilitators and (3) Understood gaps in their professional training | 2. Perceived Challenges and Barriers: “I didn’t know what I was doing” | “People don’t know how to treat”: Knowledge gaps in providing care | General knowledge gaps Scientific knowledge gaps Specific knowledge gaps Knowledge gaps that harm Knowledge gaps based on caseload |
“She was not comfortable”: Establishing a patient-clinician relationship | Reciprocal distrust Meeting patient expectations | ||
(2) Perceived barriers and facilitators | 3. Power to Deny: Prescriptive Authority and Gatekeeping | Gatekeeping: The stigma, discomfort and underlying denial of hormone therapy | Conditional access to hormone therapy Discomfort providing care Collegial and organizational pressure Fear of malpractice Fear of hormone permanency Fear of hormone side effects Fear of referrals |
Exceptions to the gatekeeping rule | Continuation of hormone therapy Initiation of hormone therapy Recognition of power of prescribing | ||
(2) Perceived barriers and facilitators | 4. Stigma: “This is really strange, and I can’t really understand it” | Negative stereotypes: “They’re really homosexuals that are afraid to admit it” | “Risky sexual behaviors” Homophobia Difficult patients |
Physical appearance: “It’s this obsession” | Physical appearance preoccupation Passing prejudice | ||
“This is really strange, and I can’t really understand it” | Discomfort Disbelief Discrimination | ||
“Go all the way” | Goal of invisibility | ||
(2) Perceived barriers and facilitators | 5. Reflections: Strategies for Success, Rewards, and Personal Motivations | Becoming proficient: Strategies for success | Patient-centered care Time/practice Clinical environment Confronting fears and biases Mentorship from within |
Why I provide care | Rewards and benefits Doing my job “Tikkun olam” |