When doctors ignore pronouns, patients pay the price. Here's why

The first thing I notice when the nurse enters the room is her pin: a small pink circle with "she/her" in bold lettering. She introduced herself, asked for my name and pronouns, and took my vitals.

Whether she realizes it or not, the extra ten seconds the nurse takes to ask for my pronouns signal to me that she cares about my identity and understands that not all patients adhere to the gender binary. Sadly, this type of interaction is not as common as it should be. Many providers have not received adequate training on how to treat the LGBTQ+ community. As a result, many sexual and gender minority patients experience anxiety or gender dysphoria in clinical settings.

What are the benefits of using pronoun?

Using a patient's preferred pronouns and chosen name, known as gender-affirming language, enhances the quality of healthcare experiences for gender-diverse patients. When transgender and nonbinary patients receive gender-affirming treatment, they are significantly less likely to delay healthcare in the future. Unfortunately, nearly half of transgender adults reported mistreatment or discrimination from a healthcare professional, according to a study from 2020. The same study found that at least a third of nonbinary, gender-nonconforming, and transgender patients experienced intentional misgendering or deadnaming – referring to someone with a name they no longer use – in medical settings.

Treating a patient in this manner can have lasting effects on their mental health beyond initial discomfort, such as long-term anxiety or gender dysphoria. In working to dismantle LGBTQ+ discrimination within the healthcare system, addressing these offenses and incorporating instruction on gender-affirming language in medical education can improve long-term health outcomes for the queer and trans community.

What is gender-affirming care?

In the last few decades, the medical community has gained momentum in education on gender-affirming care. The World Health Organization (WHO) defines gender-affirming care as social, psychological, behavioral, and medical interventions that support gender identity. Typical interventions range from counseling on the coming-out process to medication-based hormone therapies. Although some of these interventions may be more relevant in specific medical specialties, all healthcare providers have an opportunity to integrate gender-affirming language into their daily routines.

But many medical schools do not provide adequate or routine training on LGBTQ+ health, leaving knowledge gaps that prevent providers from effectively treating their queer patients. In fact, a study in 2011 indicated that, on average, American and Canadian medical schools only spent five hours of class time on LGBT-related topics ranging from sexual orientation to gender identity, coming out, transitioning, or safe sex practices.

Aiming to close these gaps, the American Medical Association (AMA) released a report in 2014 encouraging medical schools to offer more comprehensive training and curriculum for treating LGBTQ+ patients. The report details how existing programs can adopt LGBTQ-related content in both classroom and clinical settings, integrating the lessons into pre-existing competencies such as patient care, interpersonal skills, and knowledge for practice. In the ten years since its publication, some medical schools have made admirable progress in the development of queer and trans-informed curricula, offering certificates on LGBTQ+ health studies or creating research programs focused on transgender health.

However, most schools have not changed their curriculum due in part to the lack of requirements attached to the report. Additional factors such as insufficient knowledge among faculty, political pressures, and administrative resistance to change have obstructed progress toward universal education on LGBTQ+ health. Amid an increasingly fraught political climate, many medical schools have hesitated to incorporate inclusive curricula on gender diversity and the queer community.

How has Trump impacted LGBTQ+ healthcare?

Donald Trump's re-election has undoubtedly complicated these matters further, gradually removing medical protections for the LGBTQ+ community and pressuring public institutions not to teach queer-related topics. Medical schools must also worry about whether the use of gender-affirming practices in healthcare could inadvertently alienate a different subset of patients who may not agree with or understand gender-inclusive language. While medical institutions must take these perspectives into account when deciding how to implement LGBTQ-related curricula, they must also acknowledge the potential irreversible and detrimental effects on queer health outcomes if these topics are ignored.

Ultimately, the proven health benefits of using gender-inclusive language in medical settings outweigh the possible discomfort of those opposed.

The inclusion of a gender-affirming curriculum in medical education can serve as a stepping stone on the way towards remediating health disparities by improving the accessibility of gender-affirming care and reversing historical patterns of mistrust between LBGTQ+ patients and providers. Even seemingly minor changes, such as teaching providers to ask for a patient's pronouns, could significantly improve a transgender or nonbinary patient's health experience. Integrating gender-affirming care into the medical curriculum will help providers build trust with LGBTQ+ patients, increasing the likelihood that they return for continued care. American medical institutions must take gender-inclusive language seriously, especially when the health and lives of an already vulnerable population are at stake.

Kelly Goonan (she/her) is a first-year MPH student living in New York. She grew up in the Chicago suburbs and attended undergrad in Washington DC. She is passionate about LGBTQ+ healthcare and hopes to work on programs and policies to improve health experiences for the queer community.

Voices is dedicated to featuring a wide range of inspiring personal stories and impactful opinions from the LGBTQ+ and Allied community. Visit Advocate.com/submit to learn more about submission guidelines. We welcome your thoughts and feedback on any of our stories. Email us at voices@equalpride.com. Views expressed in Voices stories are those of the guest writers, columnists and editors, and do not directly represent the views of The Advocate or our parent company, equalpride.