For Teachers & Professionals

Improve the health care environments for patients with nonbinary/ nonconforming gender identities

Patients who identify as part of sexual or gender minority groups can experience challenges or discrimination when seeking health care. Persons that identify as part of sexual and gender minority groups are part of every race, ethnicity, religion, age, and socioeconomic group and the number of people who feel free to express themselves is growing. Patient-centred care has grown attention in the last years; in order to do that clinicians should develop an understanding of the terminology used in these minority populations and learn how to approach these patients with understanding and compassion. 

Often, the health care system has used the mere binary distinction of ‘male’ and ‘female’ with no acknowledgement of non-binary gender identities. Doctors need to develop an awareness of and sensitivity to patient needs, adopt the right terminology use and adapt the environments to be more warm and welcoming.

What are some steps to take in order to do that?

1. Asking about pronouns

Patients must be asked what pronoun they prefer and the pronoun must be used consistently in all charting and communications. Patients are also asked what name/prefix (eg, Mr./Ms.) they wish to be called. Doctors should not make assumptions regarding a patient based on presentation or appearance. As an example, a patient may mix the typical binary characteristics in a single presentation (wear a beard and a skirt), or express different typically binary presentations at different times. No assumption should be made, the patient should be addressed by their name until a pronoun (he, she, they) is communicated by the patient or a specific question is asked.

2. Specific health-related issues

Patient intake forms are inclusive for all genders and include health-related questions specific to LGBT issues. When gender dysphoria (the lived experience of feeling an incongruence with one’s gender assignment) is present in a patient, doctors should be aware of the healthcare needs of the patient, including the benefits and risks of treatment options for gender dysphoria. The treatment approach should match the patient's specific needs, particularly being attentive to the patient’s goals for gender expression. Doctors should help facilitate access to appropriate care by forming interdisciplinary relationships with other healthcare providers that specialize in transgender health.

3. Environment

Waiting rooms and exam rooms should have visual cues that welcome all genders. A welcoming environment starts with the waiting room, where patients initially develop their first impressions. Displaying posters of a variety of genders, such as same-sex couples, and offering informational brochures for LGBT support groups or information that addresses LGBT health issues can signal to an individual who identifies as part of a minority group that they are in a safe space.

The health care facility should have non-gendered restroom/toilet facilities available.

4. Knowledge

Providers and staff have training in patients' sexual orientation and gender identity issues. Provider-patient encounters provide a safe and reassuring environment and opportunities for patients to discuss their gender-related health issues, thus they should be aware of specific health issues or health risks related to all genders including non-binary ones. Specific to health care, standards of care and educational materials are available from the World Professional Association for Transgender Health and the National LGBT Health Education Center (https://www.wpath.org/publications/soc).

Knowledge of the commonly used vocabulary may benefit the clinician in establishing more successful doctor-patient relationships.  Information about creating a welcoming environment for individuals who identify as part of a sexual or gender minority may aid in the development of more inclusive practice. 

REFERENCES

Lady, S. D.; Burnham, K. D. (2019). Sexual Orientation and Gender Identity in Patients: How to Navigate Terminology in Patient Care. Journal of Chiropractic Humanities, 26(), 53–59. doi:10.1016/j.echu.2019.08.005