“Why would I ask 72-year-old Mrs. Smith her pronouns?” That’s a question many practicing health-care providers already overwhelmed by long days taking care of patients may ask. This one simple act, however, can open the door to a more accepting and inclusive health-care culture for a long neglected population.
Transgender and gender diverse (TGD) individuals need care just like any other patient. Clearly, the majority of care sought by TGD individuals is not gender related. A broken elbow is a broken elbow. Patients still need that statin for treatment of hyperlipidemia, or Metformin for type II diabetes — and yes, we still recommend that yearly influenza vaccine.
Even still, transgender and gender diverse individuals also have notorious difficulty accessing care and navigating a cisgender health-care system not designed for them. A third of patients report they have had negative experiences in a health-care setting due to their gender identity. I often hear from other providers that they don’t need to worry about this since they don’t see transgender patients. But the fact is, all doctors do.
Most health-care professionals understandably don’t realize this. Population estimates of transgender and gender diverse individuals likely are underestimated due to fear of reporting, but new data is coming through regarding health-care disparities faced in this group. Thankfully, more visibility has led to more social acceptance and policy change despite the current political climate. So how do we as health-care providers change with it?
The vast majority of providers were trained to greet patients with binary titles such as “Mr.” or “Mrs.” Understandably, this idea of formal greeting stems from a culture of respect, but we must recognize that the traditional model ostracizes an entire population that does not identify along the binary genders of male or female.
When we use these terms for someone who does not identify with the sex they were assigned at birth, we explicitly mis-gender them and implicitly invalidate their true identity. It may seem small, but innocent acts like these can come across as non-acceptance and serve to exile our patients from seeking much needed care. On the other hand, the small act of asking patients their pronouns can have a profound affect for everyone identifying outside the binary.
To those unfamiliar, using correct pronouns can seem like an intimidating task. It’s the awkward rainbow elephant in the room when you meet a patient for the first time. By nature, most of us health-care providers have good intentions. So how do you go about eliciting this information without being offensive?
One idea is to start with your own. Each of us has a gender identity, and each of us uses certain pronouns. Saying, “Hello, my name is so-and-so, and my pronouns are…” sets the stage and creates an atmosphere of inclusivity and acceptance. The CDC now even has resources including gender-inclusive scripts for medical staff.
Furthermore, be genuine. Think of a patient who may be seeking care for the first time because they have worried how they might be rejected by the medical system. Invite them to tell you more and educate yourself on pronoun use. It is not up to you to judge the use of the singular “they” pronoun, which, as the dictionary makes clear, is grammatically correct.
Asking for pronouns should not be limited to a select few, but instead of all patients. Understandably, it takes practice to incorporate this into our everyday language. However, being selective about who we discuss pronouns with in our patient encounters sets the stage for implicit bias, whereas making it a routine ask of everyone invites conversation and promotes awareness. It’s possible Mrs. Smith has a non-binary family member, or has had decades of struggle over their own gender identity. On the same note, this is not an invitation to ask invasive questions that are not pertinent to the condition at hand.
Transgender and gender diverse individuals are more likely to not seek care than cis-gender patients due to fear of repercussion and ridicule in the clinical setting. Add that to the fact most of us did not receive formal education on LGBTQ+ health issues in our medical training, now resulting in huge gaps in care. Patients should be able to walk into any provider’s office for routine care and feel affirmed. It is promising to see the growing number of curriculums incorporating LGB and gender affirming care, but we must also strive to change the context in which we talk about gender and avoid implicit transphobia in our medical practice.
A good place to start? Ask Mrs. Smith their pronouns.
Ravi Iyengar, M.D., (pronouns: he/him) is a board certified Endocrinologist at Rush University Medical Center, specializing in gender affirming care. He is a Rush Public Voices Fellow through the OpEd Project.