I am a medical student interested in LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual) competent family medicine. With that, there’s always a particular conversation I have with healthcare providers who haven’t had a lot of experience with LGBTQIA+ communities. I’m asked things like, “why does it matter if I get this person’s pronouns wrong?” and “it’s so confusing, they have these ovaries and I’m looking at their pap smear but they’re telling me they’re a man”. These are often well-intentioned, and are usually from people looking to know more and learn, but can be very difficult questions to answer as an LGBT-identifying person. So where do you start if you don’t have that experience? Why is asking a problem? How do you learn what to do if asking directly isn’t always appropriate?
As is indicated in the definition above, there are a broad spectrum of people encompassed within the label “LGBTQIA+”. The first thing to be conscious of is that identifying as such doesn’t remove other socio-economic labels that are associated with difficulty (such as “woman, person of color, poor, rural”), and each individual’s experience is going to differ wildly from another’s. However, there are some shared experiences, and, unfortunately, they’re usually negative. These negative experiences are especially common with LGBTQIA+ patients seeking healthcare, which has been repeatedly documented by facilities like Fenway Health in Boston, MA and Equitas in Columbus, OH (both of which are very vocally LGBTQIA+ friendly healthcare centers). While each identity in the LGBTQIA+ alphabet has its own difficulties with healthcare, here I want to address specifically the “T” in this case, transgender (trans) patients.
In my opinion, it’s our most basic responsibility as healthcare providers to be conscious of how we talk to patients: in this case, trans or gender minority (GM) patients. As a very broad definition, it’s generally accepted that sex is biological and gender is the social identity a person uses to interact with the world. If your gender is associated with your sex, you’re considered cisgender. If not, you’re GM. GM patients, on average, are considered incredibly high risk - not because of their identity inherently, but because of how they are treated by society. Being GM significantly increases your risk of mental illness, family rejection, homelessness, abuse of any kind, bullying in school, and decreased access to healthcare and other social services.
GM patients are aware of this pile of difficulties, and, being the incredibly adaptive folks that we are, we figure out how to survive and protect ourselves. What this usually looks like is being hyper aware of language. Language is a tool that people use to communicate intent and action before it happens. No matter who the patient is that you’re seeing, how you talk about or to them when you walk into the room shapes the encounter. If you connect with a patient they’re more likely to trust you and work with you for their healthcare. If you don’t click then it’s a little more difficult, and it’s easier to miss something in their care. When you walk into the rooms of your GM patients, if you misgender or misname them and don’t respond respectfully when corrected, you’re telling them right off the bat that they don’t know themselves as well as you know them; that they don’t have the same right to self-identity as your other patients, and you aren’t willing to respect them as they are. Why, in lieu of that, should they trust you with their health?