When working with patients, use and encourage the usage of names and pronouns of their choice. Prioritizing anatomy and assigned birth sex over the patient’s expressed wishes can create an experience that is hostile, dehumanizing and anxiety provoking.
When there is uncertainty in pronouns, consider offering your pronouns when you introduce yourself, then ask your patient how they want to be addressed and which pronouns they prefer.
If you make an error, promptly offer a brief and sincere apology—but don’t overdo it. Excessive apologies can be awkward for the recipient, and they may feel pressured to comfort you, which is not their responsibility. Follow up by thanking them for their patience and then introduce yourself using your preferred pronouns if you haven’t already.
Default to gender-neutral and stated preference We may not be able to understand the experience of each of our patients, but we do have the choice and responsibility to be respectful in our interactions. Consider using gender neutral pronouns (they/them/theirs) rather than guessing and causing a needless misstep.
For example, try not to presume that a married patient is partnered to someone of the opposite sex. Instead, they may be with someone from across the gender spectrum. In such instances, use “spouse” rather than “husband” or “wife.”
Consider their care network Many LGBTQ+ patients are estranged from their birth families and utilize chosen family and others who are unrelated as their main support system in times of crisis. Ensure these essential care providers are welcomed into appropriate spaces during visits.
Step 3: Assess systems, policies and practices As leaders, we need to craft policies that are nuanced in their approach and gender-neutral in language when appropriate. Consider whether the verbiage or practices hew towards cis- gender, heteronormative standards that may exclude a significant amount of the population we serve. Perhaps create a workgroup from various areas of your
organization to develop ideas and transfer them into actionable strategies. Welcoming policy changes could be as simple as having staff include their pronouns on ID badges, regardless of gender identity, to signal that your institution possesses an awareness and sensitivity to such matters and wants to get it right. Including pronouns in institutional email signatures is another way to signal this—and has already become common practice in many companies and facilities.
After policies have been implemented, make certain the institution evaluates outcomes. Even policies that are utterly neutral in their language and approach may unintentionally lead to disparate outcomes. Expect that policy revisions will be required over time.
Institute safety policies Safety and high-quality outcomes are bedrock principles of IR, and part of that is mitigating the risks of radiation in early-stage pregnancies. Regardless of a person’s gender expression, if a patient has the functional anatomy to conceive, pregnancy may be possible. It may be awkward to inquire if a male- presenting patient may be pregnant. However, if there is any doubt regarding a patient’s reproductive status for procedures requiring radiation, an inquiry must be made. Develop a departmental process and strategy to inquire about the possibility of pregnancy rooted in safety and respect. For instance, politely engage the patient by inquiring, “For your safety and wellbeing I have to ask, is there any chance that you’re pregnant today?”
Update paperwork In signage, brochures, discharge instructions and forms, utilize gender- neutral language when practical. Steer away from needlessly gendered language for cancer screening and focus on the body parts that need to be screened.
Glossary
Gender neutral: Denoting a word or expression that cannot be taken to refer to one gender only.
Heteronormative: Denoting or relating to a world view that promotes heterosexuality as the normal or preferred sexual orientation.
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Intake forms are an excellent place to focus attention. Consider updating forms that provide options for patients to choose to designate their gender identity, birth sex, sexual orientation, chosen name and preferred pronouns. The One Colorado and Callen-Lorde forms9,10
offer examples of how to implement an inclusive approach.
Include and educate staff Organizations won’t be impactful if they focus all their energies in crafting policies. Involving employees from across the organization to devise solutions and assess their impact is the best way to build a broad coalition. An enduring leadership commitment focused on implementation and dedicated to change over time is what will win.
Consider including antidiscrimination language that directly includes LGBTQ+ individuals in standard contracts between the institution and employees as well as contractors. Additionally, rather than waiting for a harmful incident to happen, proactively provide specific education to staff regarding the nuances of interacting with and assisting LGBTQ+ patients and colleagues.
Step 4: Consider public image Many patients will assess a healthcare institution by their website and advertising. These outward-facing displays are often the best way for patients to determine whether they will be welcomed and whether the institution can fit their needs.
Thus, crafting a platform that displays a variety of patients’ families is essential. Specifically including sexual orientation and gender identity in the nondiscrimination statement is another important signifier of an inclusive space. Ensure the website search box has content for “LGBT,” “gay,” “lesbian” and “transgender” inquiry, and consider using a small rainbow flag icon
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