Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Pronouns matter: How we can do better in LGBTQ patient care

Carlene MacMillan, MD
Physician
July 13, 2018
360 Shares
Share
Tweet
Share

In the wake of Pride Month, I have been reflecting on how our health care system impacts the lives of individuals with identities across the gender spectrum. Sometimes, when sending a prescription to a pharmacy for any given patient, we will get a phone call that the date of birth on file with insurance does not match the date of birth we have on file. Typically, this is a clerical error that is easy to fix. What is more jarring is when a patient we know identifies as female is on file with their insurance company as being male. That one letter on a chart — M instead of F — is a stark reminder of the many daily challenges faced by those who are trying to live as their affirmed gender rather than the gender they were assigned at birth.

The World Professional Association for Transgender Health (WPATH) has made recommendations that electronic medical record systems include fields for not only assigned sex at birth and legal name, but also affirmed gender pronouns used and what name a person goes by if not their legal name. The final rules issued by the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) in October 2015 require EMR software certified for meaningful use to include fields for gender identity and sexual orientation.

However, technology can move at a glacial pace in the health care space. For individuals who identify as trans, non-binary, or other identities along the gender spectrum, the result is that many systems we use to store health care data still do not conform to the WPATH or CMS recommendations.

To address this in the group mental health practice I run in Brooklyn, we have turned to a custom electronic health record designer in part to ensure we can capture these aspects of a person’s identity. Making sure the experience of receiving mental health care is an affirmative experience for individuals of all gender identities and sexual orientations is a priority for us. However, currently, that experience stops with us. Once medical information hits insurance companies, things get a lot more complex.

For example, when we call a prescription into a pharmacy, the pharmacy is legally obligated to use on the claim whatever gender the insurance company has on file in order for coverage to be approved by the insurance company. This means that unless the patient has changed their gender with their insurance, both we and the pharmacy are forced to use birth pronouns on materials that sometimes reach the patients themselves.

Individuals can certainly contact their insurance company to change the gender on file, but if only it were that simple. Some procedures and medications are gender-specific. For example, if someone with a “M” on their chart has a pap smear ordered, the system could encounter an error that may be time-consuming to fix. Furthermore, any time a data system changes or adds fields, it can be a programming challenge with many unintended consequences.

This may not always be the case, however. While some countries recognize non-binary gender identities on official identification documents, this is very much in flux in the United States. Oregon, California and Washington, D.C. have taken steps to allow for individuals to indicate a non-binary gender identity on their documents. In New York City, legislation was introduced earlier this month to allow people to choose “X” on their birth certificates and do so on their own without a health care provider providing an affidavit. Over the next several years, I think we will see further shifts toward more inclusive and affirmative health care, but there is much work to be done.

In the meantime, no matter what our role is in the health care space — from physicians to pharmacists to hospital administrators, let’s keep in mind that helping our patients live as their authentic selves is some of the best medicine we can provide.

Carlene MacMillan is chief medical officer, Osmind, a public benefit corporation dedicated to aiding clinicians and researchers in advancing life-saving mental health treatments. In this role, she concentrates on product development, growth initiatives, and medical affairs. Dr. MacMillan is also a co-founder of Fermata Health, an interventional psychiatry practice located in Brooklyn, NYC. She can be reached on X @CarleneMac.

Image credit: Shutterstock.com

Prev

Restoring the trust in the medical profession

July 13, 2018 Kevin 14
…
Next

Doctors are conditioned to deny

July 13, 2018 Kevin 5
…

Tagged as: Primary Care

Post navigation

< Previous Post
Restoring the trust in the medical profession
Next Post >
Doctors are conditioned to deny

More by Carlene MacMillan, MD

  • Ketamine for mental health conditions: What every primary care physician needs to know

    Carlene MacMillan, MD & L. Alison McInnes, MD

Related Posts

  • More physician responsibility for patient care

    Michael R. McGuire
  • The triad of health care: patient, nurse, physician

    Michele Luckenbaugh
  • The ultimate in patient empowerment: advance care planning

    Patricia McTiernan
  • Patient care is not a spectator sport

    Jim Sholler
  • Why health care fails to deliver better value in patient care

    Kristan Langdon, DNP and Timothy Lee, MPH
  • Why health care replaced physician care

    Michael Weiss, MD

More in Physician

  • Discover the power of patience

    Diane W. Shannon, MD, MPH
  • Doctors rediscover joy in practicing medicine, on their own terms

    Kim Downey, PT
  • Physician return-to-work policies

    Deepak Gupta, MD
  • How my patients’ Zoom backgrounds made me a better doctor

    Joseph Barrera, MD
  • Understanding reproductive rights: complex considerations

    Anonymous
  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Actemra Biosimilar Approved
  • Menopause Can Negatively Affect Women's Careers
  • Sexual Activity Lowers Risk of Side Effects After Cervical Cancer Treatment
  • Preoperative Algorithm Might Halve Unnecessary Oophorectomies in Children
  • California Misinfo Law Is Dead

Meeting Coverage

  • Menopause Can Negatively Affect Women's Careers
  • Sexual Activity Lowers Risk of Side Effects After Cervical Cancer Treatment
  • Hot Flashes: Precursor to Alzheimer's Disease?
  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Discover the power of patience

      Diane W. Shannon, MD, MPH | Physician
    • Doctors rediscover joy in practicing medicine, on their own terms

      Kim Downey, PT | Physician
    • End-of-life ethics and antibiotic use [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physician return-to-work policies

      Deepak Gupta, MD | Physician
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Pronouns matter: How we can do better in LGBTQ patient care
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...