In June, President Joe Biden signed an executive order asking the federal Departments of Health and Education to expand access to gender-affirming medical care. While it’s great to see the evolution of Biden and Harris’ personal and policy positions on LGBTQIA+ issues, many LGBTQIA+ people remain skeptical of government protections around LGBTQIA+ health care.
The surge of anti-LGBTQIA+ legislation like Florida Senate Bill of 1834 and House Bill 1557known colloquially as “Don’t Say Gay” bill, highlights how many spaces are still unsafe for LGBTQIA+ people, and how much work we need to do to not only legally protect their rights, but also to challenge and reduce anti-LGBTQIA+ values. It is imperative that practitioners, educators, and legislators understand the extent of the trauma this group of people has experienced at the hands of systems and individuals that, in theory, exist to protect people. Only by acknowledging this can LGBTQIA+ people begin to heal and build back trust in these systems.
Community members often feel they have to educate their practitioners and medical professionals, which can be exhausting and discouraging. This may seem like the default practitioners assumptions of heterosexuality with patients or a provider making inaccurate assumptions about a patient’s sexual behavior and basing their diagnosis and treatment plan on that. Heteronormative language and anti-LGBTQIA+ practices are woven into our current health care system, and it will take active efforts to unlearn these practices. Below are some key practices that can significantly improve the experience of LGBTQIA+ people in healthcare settings.
1. Eliminate unnecessary generic language
LGBTQIA+ people already have disproportionately low access to health services– and the health care options they have are often not equipped to meet their needs. A crucial part of providing access to comprehensive health care is ensuring that transgender and nonconforming patients see themselves presented in the materials, language and services that health services provide. For example, if the language on a clinic’s website or advertising is strongly gendered and refers to services for “men” and “women,” this is an indication that the facility may not be a welcoming place for a non-binary or gender non-conforming person. If gender services make assumptions about patients’ body parts, this is a clear indication that transgender and gender-expansive people have not been taken into consideration. Minimizing generic language as much as possible and training staff to avoid making assumptions about patients’ bodies and needs is the surest way to minimize harm.
2. Ask for the necessary information in a clear way
It is always best practice to remove gender-related language when not necessary, but when information is required from a patient, often related to body parts, sex, or gender, it may be helpful to request additional information about the patient. For example, if you require the patient’s gender to be determined at birth, request the patient’s gender as well gender identity it shows that you understand the difference in these issues and want to respect your patients.
On the other hand, if you only ask for “gender” or “gender,” patients may again be confused as to what information is being asked of them, causing confusion later in appointments, pharmacies, or labs. In addition, it is important that practitioners treat patients using the correct reference ranges for their bodies. If clinicians do not ask for this information in a clear way, it can lead to patients receiving inaccurate treatment, which is of concern from both a legal and health perspective. Making this information available to staff will also minimize assumptions about a patient’s gender identity or body parts they possess. Making these questions a routine part of the onboarding process will help guide and set expectations for any staff who are new to the language or conversations.
3. Introduce yourself with pronouns and ask what name the patients use
For the same reason, providers and practitioners should be in the habit introducing themselves with their pronouns as well as asking patients theirs. Some people only do this when they introduce themselves to people they assume are queer based on their appearance, but queer people don’t look a certain way, and it’s best to avoid making assumptions about someone’s identity based on how they look. are introduced.
Normalizing these questions and processes is extremely important if a patient is going through a healthcare process that affects multiple businesses. For example, a doctor may ask a patient for the name they call themselves as well as their legal name (sometimes called a dead name). Many people go by a name other than their legal name, so adopting the practice of asking patients what name they use is a way to be inclusive. If a doctor has adopted this practice but has not communicated properly with a laboratory or pharmacy, the patient may not know what name to say in order to obtain the necessary tests or medications. This can lead to a painful and invalid patient experience with another touch point in the medical system.
4. Testing at home
At-home testing allows LGBTQIA+ people to take responsibility for their own well-being and needs, making healthcare more accessible than ever. This model offers individualized and comprehensive care for individuals with a variety of needs: they may live in rural areas, may not have the time or means to travel to in-person appointments, or may need the safety and comfort of choosing a space to take their appointments. This model also reduces potential harm in spaces such as public transport and the pharmacy, as patients can bypass steps that have historically been barriers to care.
As telehealth becomes more popular, it is even more important to center LGBTQIA+ people when building inclusive and gender-affirming businesses. Learning from enterprises that provide gender-affirming health services is a great place to start, as they have likely been intentional about the language they use to promote their services and interact with their patients.
No one reaches a point of sexual competence; language is constantly evolving and we are all learning together how to use new language and what language we find affirming and validating. Look at organizations led by LGBTQIA+ people and resources made by LGBTQIA+ people to engage in continuous learning, instead of learning coming from patients. While taking the time to routinely read gender-affirming best practices and facilitate staff trainings can be time-consuming, it is time well spent investing in the LGBTQIA+ community. All these efforts will be noticed – and may even be life-saving.
Photo: sasirin pamai, Getty Images