​Among transgender and gender-nonconforming individuals, "there is a demand for competent healthcare," said Kristin Keglovitz Baker, PA-C, AAHIVS, chief operating officer and associate medical director, Howard Brown Health Center. She spoke on April 28, 2017, at the spring conference of the Wisconsin Society for Healthcare Risk Management. Unfortunately, these individuals continue to experience trauma in their personal and work lives and in their pursuit of healthcare, said Keglovitz Baker. According to the National Transgender Discrimination Survey, 19% of respondents said they had been denied medical care because of their transgender or gender-nonconforming status. In other situations, patients might come in with a virus and find that their visit suddenly veers into a conversation about their transgender status. Because of this trauma, many patients postpone or avoid seeking care. However, as the transgender community has become more empowered, these patients' expectations have shifted. "Their expectation is that we're going to do basic things," like using the appropriate pronouns, said Keglovitz Baker. "We need to set this as our level of expectation." For example, many intake or registration forms do not contain appropriate options for transgender or gender-nonconforming patients. "Even if we don't mean to, we don't come off as inviting." Keglovitz Baker discussed the care of patients at her organization, a lesbian, gay, bisexual, and transgender organization that delivers healthcare and social services to 16,000 people annually. Some effects of body modification, such as hormone therapy or procedures, are permanent or semipermanent, highlighting the importance of discussing patients' goals, managing patient expectations, and obtaining informed consent. At any organization, "one of the things I've seen that works the best is ongoing cultural change," said Keglovitz Baker; once-a-year training is ineffective because it does not get into the organization's culture. Further, the evidence clearly shows that health outcomes are linked to feelings of being accepted or rejected. When gender-nonconforming patients come to healthcare providers for care, "how you react to them is going to have a huge impact on them," said Keglovitz Baker.