Most providers reading this already know something is wrong. You've seen the headlines — care bans, FBI probes into pediatric hospitals, an anonymously authored HHS report endorsing conversion therapy by another name. You know the political environment is hostile to your trans and gender-diverse patients. You probably know it's hostile to you, too, if you're providing affirming care.

What's less clear is what to do about it.

Not in the abstract. In the concrete. In the day-to-day reality of running a practice, managing an intake process, navigating institutional culture, talking to a journalist, or pushing back when your employer's public commitment to inclusion doesn't match the experience your patients are actually having. The conviction is there. The toolkit often isn't.

Fae Johnstone has spent over a decade working in that gap — the space between knowing better and doing better. Johnstone is the executive director and co-founder of Queer Momentum, a national 2SLGBTQIA+ advocacy organization in Canada, and a former DEI consultant who worked directly with health and social service organizations on inclusion through Wisdom2Action consulting. She's also a trans woman who has been on the receiving end of international hate campaigns for her public visibility, and who has testified before Canadian Parliament on the rise of anti-LGBTQ+ hate.

"Cultural competency isn't about memorizing a tip sheet," Johnstone told me. When the work becomes about categorizing every identity into a neat box, "we risk losing sight of people's shared humanity, of the nuances that all of us bring to every facet of our lives." What actually closes the gap, she argues, is a model built on "compassion, care, and humility at the core, meeting people where they're at."

That might sound simple. It isn't — not because providers lack compassion, but because the systems they work within aren't often designed to support it. Johnstone describes the gap between organizational statements of inclusion and the on-the-ground experience of trans people accessing care as a cart-and-horse problem. Public commitments matter — they signal values, shift culture, open internal dialogue. But they lose that value very quickly with follow-through.

She's not dismissing the flags and the statements. She's saying they're the beginning, not the destination. "I'm not a fan of window dressing," she said. "It's less about having a pride flag on every window or in every doorway. It's more making sure that our folks get good care when they show up in our spaces." That means doing the structural work: the training, the community partnerships, the policy changes. "If you're only doing one but I'm not seeing the other, that's where I have cause for concern."

The good news is that the foundation is already there. "We don't need you to be perfect," Johnstone said. "We need you to do your best to meet clients where they're at. These are core values already spoken about in our health and social service systems." Getting to know a patient — really know them, the same way providers are trained to with every patient — matters more than memorizing a list of key terms. "We're not just one story," Johnstone said. "We are a lovely mosaic of different things. And we have a lot in common with just about anybody else."

And here's the part that should matter to every provider reading this, regardless of patient population: this work doesn't only serve queer and trans people. "Homophobia and transphobia also lead to worse health outcomes for straight people," Johnstone points out. "By tackling health inequity facing queer and trans people, we actually build better systems that better serve people of all kinds." Fixing the system for the most underserved fixes it for everyone.

That's the premise of this column.

Rx Resist is a new monthly feature at Well Beings News built on one idea: that providers who want to do better deserve more than good intentions and hope. Each season, this column will rotate through a core area of tactical education — media literacy, provider activism, systems literacy, and collective care.

We'll start on Trans Day of Visibility, March 31, with media literacy: how to evaluate the coverage shaping public perception of your work, how to talk to journalists, and how to recognize when misinformation is being laundered through legitimate-looking sources. Future seasons will tackle how to advocate within and beyond your institution, how to read and push back on policy, and how to sustain yourself and your colleagues through the long fight for queer trans rights.

Anti-trans policy-makers and lobbyists have decided that they know better than physicians do, as Johnstone puts it. They're counting on providers being too scared, too busy, or too unsupported to push back. This column is here to make sure that's not true.

If you want to be sure you have access to all the future installments, get 20% off your upgrade to a Professional Membership today!