As part of ISGMH’s Current Issues in LGBTQ Health lecture series, Cecilia ‘Cec’ Hardacker, Howard Brown Health’s Director of Education, presented on best practices for using gender appropriate language in clinical settings to more than 300 audience members including health practitioners, hospital administrators, and researchers. Hardacker’s lecture was hosted and cosponsored by Northwestern Medicine.
Hardacker began her lecture by defining the goals for the day: to increase familiarity, confidence, and skill in asking about and collecting sexual and gender minority (SGM) information from patients in clinical settings, to define misgendering, to list needs for collecting SGM data, and to determine ways to normalize asking SGM questions.
“I have a personal bias as someone who is a member of the LGBTQ community and an ally to the rest. But this is not something that is just for LGBTQ people – everyone in this room has a sexual orientation, everyone in this room has a gender identity.” Hardacker explained that we as healthcare professionals and providers need to understand why asking these personal and clinical questions is important, and need to normalize the process for all patients we serve.
Hardacker discussed how there’s an inherent power dynamic in clinical settings, which requires our awareness. To offset this and to build trust with patients, we need to give power and agency to patients through consent. Examples of asking for consent in patient interactions included “I will be asking you a number of very personal questions. May I have permission to do that? You may always ask for me to stop, skip, or not answer any question I ask, will this be okay with you?”
In the same vein, asking for everyone’s pronouns and giving a variety of options is crucial, especially because of the danger and consequences of misgendering. To misgender means to refer to (someone, especially a transgender person) using a word, especially a pronoun or form of address, which does not correctly reflect the gender with which they identify. Misgendering someone can signal that you are not to be trusted and that this is not a safe environment for the patient.
To avoid this, Hardacker explained that it is incredibly important to normalize asking questions about gender identity and pronouns. For example, Northwestern Medicine has a variety of options to choose from in their MyChart system, including: choose not to disclose, female, male, neither exclusively male nor female, other, prefer to discuss with my provider, trans female (male to female), trans male (female to male). Hardacker mentioned that there are additional terms that will need to be included moving forward, such as non-binary (nb), gender queer, gender fluid, agender, etc., as these terms evolve.
A great resource Hardacker shared is Practice with Pronouns, a website where you can practice with pronouns before engaging face-to-face with patients. When you make a mistake, Hardacker advised that you sincerely and simply 1. Acknowledge 2. Apologize 3. Correct 4. and Move On. Gender-neutral language is also incredibly important to implement; instead of using “ladies and gentlemen,” alternatives include “friends,” “colleagues,” “folks,” “you all,” and “y’all.” Hardacker expressed a need for more Spanish neutral alternatives, and for creativity on our part to not get pigeon-holed into binary terminology.
From a policy perspective, the stakes are very high for patients. Illinois has non-discrimination laws based on SGM identity, but more than half of states do not have non-discrimination laws. Federal law does not have a counterpart on non-discrimination, and few states explicitly protect trans people. To improve SGM health, institutions must institute their own non-discrimination statutes and standardize an approach to collecting SGM data. “We don’t capture LGBTQ information in the same way as race, ethnicity, age, etc. If you can’t name a disparity, you can’t find a disparity.”
ISGMH’s Current Issues in LGBTQ Health lecture series is generously supported by the Northwestern University Office of the Provost’s Hollister Lecture Fund and by Northwestern Medicine.