Pic 13: A screenshot of Danielle in a clinic with a female patient who is looking upset.
DANIELLE: The clinic I work for advertises that we welcome and are experienced treating transgender patients. One time a young woman showed up at my clinic as we were about to close, with no appointment. She had a fever and had driven over two hours to get here. I agreed to see her. She was crying and so upset she barely talked. I asked “Why did you drive all the way here with no appointment? Isn’t there a clinic closer to where you live?”
Pic 14: The screenshot updates with the patient handling Danielle a paper.
She took out a folded prescription paper, and on it a clinician had written “Go somewhere else, we don’t treat your kind here.”
Pic 15: Screen returns to Danielle on an abstract background. The description for “Fear of Discrimination” appears as “can be a barrier to accessing consistent, quality healthcare.”
DANIELLE: Access to healthcare isn’t always a problem caused by poverty, lack of insurance, transportation, or even discrimination like that experienced by this young woman. The fear of discrimination experienced by a community of people can be a barrier to accessing consistent, quality healthcare. That fear can stop some people from even trying to get the healthcare they need.
I want everyone to feel comfortable and welcome in my practice. And you never know what someone’s experience has been. So I use a set of best practices for every person in my care.
First, I make it a habit to use neutral language. That includes gender neutral language.
Pic 16: A dark gray screen appears entitled “Gender neutral Language”. The top line has red text with a big “X” that says “Avoid using Sir, Ma’am, Miss, Mr.” The bottom line has green text with a checkmark that says “Use instead full name, if known.”
For example, I used to call people sir, ma’am, or miss. It felt respectful, but often it meant guessing someone’s gender based on their appearance. A mistake isn’t a big deal to me, but I realized how frustrating it might be for someone if people mistook their gender all the time.
Pic 17: The examples update, with the red text now saying “Avoid using she, her, he, him” and the green text now saying “Use instead name or say ‘the patient’”.
When speaking with a colleague, if I’m unsure of pronouns, I can use the individual’s name, or say “the patient.”
Asking for pronouns at the beginning of a visit is recommended. It shows I care about getting it right, and I can document it on their chart.
Pic 18: The header “Ask for pronouns” appears on top with the following example and caption:
“My name is Danielle. I use she and her pronouns. What name and pronouns would you like me to use for you?”
Document preferred pronouns and name in the patient record and communicate them to other staff.
DANIELLE: When referring to someone’s body, I don’t want to assume I know their anatomy based on their gender. A woman who survived breast cancer may have had her breast tissue removed, for instance.
Pic 19: The screen updates to a chart with “Avoid using” in red text with exe’s to the left, and “Could say instead” in green text with checks to the right:
Avoid using
Could say instead
Request an Anatomy Inventory
Pic 20: Screen returns to Danielle with the caption “Ask patients to complete an Anatomy Inventory”.
DANIELLE: I ask my patients to complete an “anatomy inventory” so I can recommend the right exams and tests for their bodies.
Sometimes questions without context can put a person on the defensive, like if they came in for a broken arm and we ask about their sexual history. Give context for personal questions or unexpected parts of an exam.
Pic 21: Screen changes to a dark gray background entitled “Transitional Phrasing”. The following quotes are outlined in speech bubbles:
“To make sure I’m recommending the right exams and tests for you, can I ask a few questions about your anatomy?”
“I ask all my patients about their sexual health. Would it be ok if I ask you a few questions to collect a history?”
“Is it okay for me to touch your arm as part of my exam?”
DANIELLE: Finally, everyone makes mistakes. If someone looks uncomfortable, or tells me so, I apologize. It’s okay to admit a mistake, resolve to do better next time, and move on.
Pic 22: Screen now has the title “Apologize” with the following quote examples in speech bubbles:
“I’m sorry. What words would you prefer I use?”
“I’m sorry, I don’t have a lot of experience in that area, but I’ll learn more.”
DANIELLE: Be careful not to “over apologize.” It can derail a conversation, and make a person feel more uncomfortable.
Pic 23: Screen returns to Danielle with the captions “Over apologizing can derail the conversation and make a person feel uncomfortable.”
Pic 24: Screen transitions to a list encapsulated in a circle. Each line item is marked with a check:
Techniques to improve health outcomes:
DANIELLE: There are things I can do to improve health outcomes for those who face unique challenges. Motivational Interviewing helps me better understand each individual I care for. Using gender neutral or affirming language, transitional phrasing, and apologizing when appropriate also help everyone feel welcome.
Difficulty Options Screen:
Choose one:
Standard: Practice the techniques learned with coach feedback and guidance.
Advanced: Practice techniques with less guidance and more barriers to behavior change.