As an emergency physician, I’m always engaging in a fast-tempo, often awkward, all too stressful dance with strangers. Lately, though, I’ve noticed a particular gap in my own medical education and training, as well as in that of my colleagues, that’s further tripping up our steps: how to provide optimal health care for transgender patients.

The gap is amplified in the emergency room, where even under the best of circumstances the interaction we have with patients is typically rushed and never entirely comfortable — and where I’m usually meeting a patient for the first time and don’t have the patient’s medical history at my fingertips. Because transgender people are less likely to have health insurance and are four times more likely to live in poverty compared to the general population, the emergency room serves as a particularly important safety net for these patients.

Sometimes the patient is registered as the wrong gender immediately from triage, resulting in a strained communication from the get-go. Other times, a staff member lets out a surprised gasp as a patient undresses for a physical exam. Then there are the moments when providers call a patient a “he/she” or “they” on rounds. Private rooms are also hard to come by in busy, overcrowded emergency rooms, and patients may be inappropriately clustered by gender.

None of this, for the most part, is out of malice. Instead it’s because of our own ignorance — and stems from our lack of education and training on providing sensitive and evidence-based care for transgender patients.