Words matter for inclusive care

Care management & redesign SDOH & health equity

If a patient’s experience is hurtful before they even enter an exam room, it won’t matter how wonderful, inclusive, and well-intentioned their doctor is. For trans and gender nonconforming (TGNC) individuals in particular, feeling welcome and seen starts with the clipboard they are given in the waiting room. Modifying language on intake and patient forms to be more gender inclusive is a simple, low-cost change that can make accessing medical care a much more inclusive and comfortable experience.

Trans and gender nonconforming individuals utilize routine and emergency medical care significantly less than their cisgender counterparts. This is especially concerning because TGNC people consistently have worse physical and mental health outcomes than cisgender people. Healthcare providers’ ethical obligation to provide appropriate care for their patients includes creating an environment of safety and inclusion.

Simple changes on a piece of paper can embed a sense of safety into a medical practice by establishing a culture of inclusivity even before patients meet the doctor. While there is a need to ask for legal names — often called “dead names” for trans patients — for billing/insurance purposes, having preferred name listed first demonstrates a provider’s commitment to person-centered care and support establishing a doctor-patient relationship founded on mutual respect by using a patient’s preferred name from the start.

For a medical practice to be truly gender inclusive, all staff must be trained and committed to using patients’ proper personal pronouns and preferred name, among other practices. There is a vast amount of evidence-based literature available that can inform the adoption of new standards of care for medical providers and clinic support staff to fully embed gender inclusivity into all aspects of care. The National LGBTQIA+ Health Education Center is a good place to begin understanding how to become a more gender inclusive medical practice. Among their many resources is their guide, Providing Inclusive Services and Care for LGBT People: A Guide for Health Care Staff, which specifically discusses ways to integrate inclusive language into medical practices.

The current language on clinic intake forms was not meant to be harmful. They are the product of our antiquated values and understanding. We now have a strong, scientific understanding that both gender and sex are far more nuanced and fluid than our historically binary understanding. This more comprehensive understanding also includes guidance and best practices for improving gender inclusivity.  It is time to update these documents to reflect this improved understanding. While it is easy to overlook the simple changes when dealing with such a complex and urgent issue, simple edits to forms can support the right to gender-affirming care and does not require traveling to Washington.

The U.S. health system is broken. Modifying paperwork does not solve the systemic disparity in health outcomes between trans and cisgender patients, nor will it restore trans people’s trust in a harmful system. However, these changes can make individuals feel safer accessing care at a practice, improve their health outcomes, and ultimately support the transition to a more inclusive system. Individual providers may not always have the power to make systemic change — though you may be surprised at what a dedicated group of providers can change when they work together — but it is possible to improve the experience of individuals through relatively small changes in language. We just need to remember that our words matter.