Incorporating gender inclusive language into your patient practice

If practitioners aren’t using gender inclusive language in their practice, it may be preventing some patients from feeling comfortable enough to share their health problems, according to Efrat LaMandre, ND.

LaMandre is the founder of EG Health, a primary care practice that specializes in integrative and functional health and provides LGBTQ+ affirming care in Staten Island, New York. She said, to provide quality healthcare to LGBTQ+ patients as well as those belonging to other minority communities, inclusive, welcoming language needs to be a priority in all healthcare settings, including integrative practices.

LGBTQIA+ is an acronym that stands for lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender, according to the dictionary by Merriam-Webster. According to a 2022 Gallup poll, those who self-identify as lesbian, gay, bisexual, transgender, or something other than heterosexual make up 7.1 percent of the United States population, and that’s up from 5.5 percent in 2020. So, said LaMandre, LGBTQ+ individuals make up a significant percentage of patient populations making it all the more important to embed inclusivity into a practice’s culture and workflow.

The language practitioners use, specifically surrounding gender, can have a significant impact on patients, explained Anjali Ferguson, PhD, a clinical psychologist who specializes in culturally responsive care in Richmond, Virginia.

“While some of these nuances in language may not be relevant to you individually, they can really harm and impact the individual you are working with,” said Ferguson. “If your patient or client does not feel like their identity is being valued or seen then they are likely not going to feel completely comfortable in your care.”

Ferguson defined gender inclusive language as “communication written or spoken that does not discriminate against any particular gender identity, including a range of things such as use of correct pronouns as well as avoiding use of terms that may be harmful or exclusive for some groups.”

Gender inclusive language involves rephrasing terminology to be representative of not just male and female patients, but also those who identify as non-binary or something else. Switching to inclusive language is as simple as saying “Hi folks” while addressing a room of individuals rather than “Hi guys,’” said Ferguson. As for more clinical phrases, instead of saying “biologically male/female” Ferguson suggested providers use the term, “sex assigned at birth.” In addition, practitioners can try referring to a patient with they/them pronouns until they ask the patient their preferred identification, Ferguson suggested.  

For LGBTQ communities, there’s an increased risk of maladaptive medical care, Ferguson said. These communities are often misdiagnosed and mistreated in clinical settings, Ferguson explained, failing to address physical and mental health needs, impacting quality of life, and life expectancy.

“LGBTQ communities have significantly high rates of suicidality and attempts which are often related to belonging and struggles with identity formation and lack of gender-affirming care,” said Ferguson. “Being more gender inclusive and affirming has shown to reduce suicidality significantly. Gender inclusive language and support are inherently lifesaving for these populations.”

According to a 2017 study published in the Journal of Homosexuality, there are several health disparities between the LGBTQ population and groups of cisgender, heterosexual individuals, including increased risk for sexual transmitted infections (STIs) like HIV/AIDS in the LGB community, higher rates of depression, anxiety disorders, as well as suicidal thoughts and actions. The study analyzed patient responses about experiences surrounding disclosure of their sexual identity and/or gender identity with healthcare providers.

Results from the study showed the most common reasons that patients did not disclose their LGBTQ identity included providers not asking about it, internalized stigma, and the belief that LGBTQ identity was not prevalent to their healthcare. In addition, the study found that when individuals did reveal their identity to their providers, reactions varied from discrimination, disbelief, affirmation, and respect.

To LaMandre, making the effort to provide LGBTQ+ patients with a safe setting where they feel accepted is the most important aspect of creating an inclusive practice. Making a mistake and stumbling on some phrases or pronouns is inevitable, she said, but that shouldn’t scare someone away from using gender inclusive language.

“For some providers it’s so overwhelming that they'd rather not try,” said LaMandre. “For people in the community, if you say, ‘hey, I just want to let you know I'm really going to try to use your pronoun. I might mess this up, but my heart is in the right place,’ is all people want to hear. That you're trying.”

Inclusivity in action: where to start

Creating an inclusive environment is a multilayered undertaking, LaMandre explained, but using inclusive language is essential to the process. According to LaMandre this starts with training for not only practitioners but all staff members including front desk associates. In addition, providing space for patients to check off a range of gender identities rather than just “male” or “female” on paperwork is crucial, said LaMandre.

To incorporate gender inclusive language into a healthcare setting, Ferguson suggested three starting initiatives:

1. Conduct a review of current forms and assessments to ensure that all language is appropriate.
2. Consider redeveloping intake information and how medical information is stored in charts.
3. Trainings and practice.

Like LaMandre, Ferguson stressed that mistakes surrounding this language are normal.

“There is a likelihood that you may mess up or 'get it wrong' in the process,” she said, “That’s okay as long as you remain flexible to learning and growing because the landscape is ever evolving.”

For most large healthcare settings, training on inclusivity in general, which includes diversity and gender inclusivity, is mandatory. However, this isn’t the case for small private practices. For private practices and many integrative healthcare settings, whoever is managing the culture of the clinic controls whether their staff receives inclusivity training, and it’s not always on the forefront of people’s minds, said LaMandre.

Training modules are widely available and very helpful for these private practices, said LaMandre. However, she added, while trainings are a good start, inclusivity isn’t just a concept, it’s something that needs to be integrated into practices in meaningful, concrete ways.  

In addition to language, inclusive signage can be very impactful for LGBTQ patients. Something as small as an equal sign on the wall or inclusive bathroom signage signals to many LGBTQ patients that they’re in a safe space, she said.

“It could be something as small as having rainbow flag somewhere that just lets people know ‘hey, we thought of this and this is a safe place for you,’” said LaMandre. “It’s important to make it a point to have symbols in your waiting room, your door, and on your website. If the community looks for that, it lets them know they're in the right place.”

To Ferguson, what using gender inclusive language boils down to is treating patients with respect.

“In order to improve treatment adherence and rapport in healthcare settings we have to humanize the experience and that starts with respecting and validating all individuals,” Ferguson said.