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 a psychiatrist and founder and clinic director, Brooklyn Minds. This article originally appeared in The Capsule Blog.

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

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

  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • How to overcome telemedicine’s biggest obstacles

    Harvey Castro, MD, MBA
  • The patient who became my soulmate

    Anonymous
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions
    • Contract Diagnostics is the only firm 100 percent dedicated to physician contract reviews

      Contract Diagnostics | Sponsored
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds

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

  • Pregnant, Black? Here's Your Drug Test
  • Progestin-Only Birth Control Linked to Small Increase in Breast Cancer Risk
  • Fatty Acid Tube Feeding May Backfire for Preemie Breathing Disorder
  • Case Reports Detail Vision Loss Linked to Recalled Artificial Tears
  • Admin Trumps Med Students: Anti-Abortion Group Allowed on Campus

Meeting Coverage

  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Second-Line Sacituzumab Govitecan Promising in Platinum-Ineligible UC
  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions
    • Contract Diagnostics is the only firm 100 percent dedicated to physician contract reviews

      Contract Diagnostics | Sponsored
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • 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...