A patient walks into your office. Their eyes dart across the room, searching for a sign that they are in a safe space. How can you signal to your patient that you are gender affirming?
Decor & Signs
Start by decorating your room with pride-themed items. Put a trans flag in the receptionist's pen cup holder or hang up a pride flag on the wall. Include pictures of LGBTQ+ people and families on the walls along with other people and families. Sprinkle LGBTQ+ supportive illustrations and signs throughout the room. Hang an “All Are Welcome” sign on your door.
Usually, my eyes go straight to the sign on the bathroom door(s). Is it gender neutral? Or are the bathrooms divided into “male” and “female?” For people who aren't exclusively “male” or “female,” bathrooms can be super tricky when segregated. How do you fix that? Take down the male and female signs and replace them with an all-genders-sign. This small change lets the patient know that you embrace all gender identities. Or, simply use a “restroom” sign. If you’re limited to multi-stall restrooms, include a sign that states patients should use the bathroom with which they are most comfortable.
At the Reception Desk
What is the next action your patient will take? They need to sign in. Train your receptionist to ask for their name right off the bat and include their chosen name on their registration form if it is different from their insured name. Change to the one they gave you if needed. Having your name respected is critical to feeling safe.
Next, patients typically receive a registration form. Most of the time, these forms have a checkbox for “sex.” Change the form so there is instead a label for gender and include, “Trans male, Cis male, Trans women, Cis women, Nonbinary” and a blank line for people to write a gender identity that might not be listed. Change the label“sex” and change to“sex assigned at birth.” This simple act can show the patient that you understand queer identity. Also keep in mind that they may not be able to check the gender identity box (maybe their caregiver is watching them fill the form out) or sex assigned at birth (this can be really uncomfortable for the patient).
In the Exam Room
By this time, the patient will be called back to the exam room to meet you. First impressions are important. They signal to the patient if you are a safe person to disclose their identity to. I would start with something like, “Hi, my name is Dr. Smith. My pronouns are she/her. What is your name and what are your pronouns if you are comfortable sharing?” If the patient declines to answer, respect their choice. Your request alone tells the patient that you have some understanding about the current discussion of making spaces trans-inclusive.
If the patient’s parent(s)/ guardian(s) is present, and if you’re not sure if they're trans-affirming, consider pulling the patient aside and asking for pronouns, name, and if the parent/guardian is affirming. You should also ask what name and pronouns you should use when the parent(s)/guardian(s) is around if they are not gender affirming and/or the patient is not out to the parent/guardian. This discretion prevents you from outing them. If the patient declines to answer, respect their choice.
What if you mess up and use the wrong name or misgender the patient? For me, I only wanted an acknowledgment or correction, and to move forward. Making a big deal out of a mistake always made me feel uncomfortable and forced me to comfort the other person when they should have been comforting me. If the patient corrects you, simply thank them and repeat your sentences with the correct pronouns and/or name. For example, “Oh, thanks, John. He is a Freshman in high school now?” You could add a ”Sorry,” but don’t make a fuss--“Sorry,” then repeat the sentence with correct pronouns and/or name.
If you encounter a coworker saying something transphobic or crappy, call them out! If not challenged, they are likely to repeat their actions and continue harming patients or other staff. If you are the one who is called out, treat it as a gift. I’ve started thinking this way: they don’t have to take the time to call me out, and yet they do, using their emotional energy to correct me. In my mind, that's a gift.
Diversity Among Trans Patients
Okay, so back to the exam room. Don’t make assumptions about your trans patient. Toss all your assumptions out the door. They are harmful. We (trans people) are not a singular identity. We are vast and diverse, and there’s no one way to transition or to exist as a trans person. Someone is just as trans if they opt to not medically or surgically transition as they are if they opt for full medical and surgical transition. Only ask questions about transition if they are relevant to the patient's medical treatment. You don’t need to know about their transition if they are coming in with a broken bone. These questions are unnecessarily invasive if not relevant. Even if relevant, such questions can still be super uncomfortable for the trans patient so be sensitive when asking them. If the patient doesn’t wish to disclose their transition, respect that.
When discussing body parts, ask what words the patient uses to describe their body and use those terms. Body dysphoria is a real thing and renaming body parts helps.
Now, let's say you need to perform a physical exam. Okay, so, medical transition information may be relevant--once again, though, respect the patient’s “no,” if they say no. Ask them what would make them the most comfortable, and if they permit you to do the physical, tell them what you are doing at every step.
Some Final Trans-Affirming Thoughts
First, hire trans workers when possible. When I hardly see myself reflected in the media and working environments, it feels really validating to see someone like me. It makes the place feel safer.
Second, bring in a trans-led organization to give sensitivity training. And pay them well. This is emotional labor on their part and they didn’t have to come in for you. This is a gift from them. Treat it as such. Ongoing training is necessary to keep staff fresh.
Third, please educate yourselves. Discrimination is high, especially in 2021--just look at all the laws trying to ban trans people from life saving medical care and sports. I highly recommend reading books by trans authors. I also recommend curating your social media feed so that it includes trans voices, especially trans doctors (don’t assume you know what trans people want and need--go to trans people themselves). Don’t expect trans people to educate you--that is your responsibility, not ours. Google is free! Use it! Believe us and listen to us. Queer people attempt suicide at 3 times the rate compared to their cis-het peers. Thus, listening, validation, respecting, and curating a safe space is critical.
Thank you. Further reading is attached as a hyperlink below.