effectively address the situation. Another strategy might be adding a name/identity reconciliation box or form. This strategy is particularly relevant for transgender patients in the process of transitioning from one gender identity to another. ● Clinicians can encourage openness by explaining that patient-provider discussions are confidential and that they, the clinicians, need complete and accurate information to provide optimum and appropriate medical care. ● Developing and distributing a written confidentiality statement will encourage people who identify as LGBTQ and other patients to disclose information pertinent to their health. The statement should be prominently displayed and distributed to each patient. Consider careful communication Clinicians should always ask patients how they identify and wish to be addressed. Patients may use words that are considered derogatory like “dyke” to describe themselves. Although individuals might have reclaimed the terms for themselves, they are not appropriate for use by healthcare providers. The key is to follow the patient’s lead about self- description while exploring how this self-description relates to their current and potential medical needs. For example, avoid using the term “gay” with a patient even if they have indicated a same-sex or same gender sexual partner because if the patient has not indicated a particular identity or has indicated a sexual orientation other than gay, using this term may cause alienation and mistrust that can interfere with the patient-provider relationship. Therefore, clinicians need to elicit and understand all three aspects of sexual orientation: attraction, self-described identity and behavior, as well as gender identity. Respect transgender patients by making sure all office staff are trained to use their preferred pronouns and names. Clearly indicate this information in
their medical record for easy reference for future visits. Traditional personal pronouns are based on a binary she/he framework. An inclusive approach to addressing both gender nonconforming and transgender patients is to use non-binary personal pronouns. An optimal approach is to first provide your own personal pronouns and then ask patients how they would like to be called. For transgender patients, their answers may include pronouns such as “they,” “ze” (pronounced “zee”), or “xe (also pronounced “zee”). Some clinicians may be challenged using a pronoun that they learned in English classes as a plural now as a singular noun. However, this accommodation may improve rapport with patients. Tips for clinical encounters ● Don’t make assumptions about a patient’s body or behavior based on their initial visual presentation. ● Get in the habit of assessing preferred pronouns at every visit. The most common format used is to introduce yourself and state your preference, as in “I’m Dr. Jones, and I use the pronouns she/her; how about you?” ● Understand that discussing genitals or sex may be very sensitive, stressful, or possibly traumatic for certain patients. Therefore, always ask permission before any physical contact and clearly explain all processes, tests, or examinations before they are done. For more information, visit the National LGBTQIA+ Health Education Center at www. lgbtqiahealtheducation.org. Clinical consideration: Used the wrong pronoun or name? Overheard your staff? A simple apology and dedication to do better may make the difference in your patient staying with your practice or not. “I’m sorry I used the incorrect pronoun. I did not intend to be disrespectful.” BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 1.
Case study 1 - Part 1 Instructions: Please read through the case study below and consider the questions that follow, then do the same for Part 2. Sam had been searching for a primary care provider for months. He wanted to find someone who would treat him like a person, not a freak. In the previous primary care clinic where he received care, he overheard a front desk person commenting it was a shame that such a pretty girl was going to be a male. Fortunately, that was a different place, and he was now away at graduate school in a liberal arts college with a Campus Pride Index of 4.5. Someone in the resource center recommended this office, and he had a few things he hoped to find once he arrived. Sam called to inquire and received a package of information electronically that already gave him some comfort. Instead of the questions Sam had normally seen, these forms had options for gender that included transgender and relationship questions that did not assume married or single but allowed for partnered. Questions 1. From the information in the case study, how does Sam identify? _______________________________________________________________________________________________ 2. What type of barrier to care did Sam experience in his previous primary care practice? _______________________________________________________________________________________________ Discussion continued on next page ►
Page 56
Book Code: CT24CME
Powered by FlippingBook