Communication = Connection
“Communication leads to community, that is, to
understanding, intimacy and mutual valuing.”
— Rollo May
A visit to a healthcare facility can make people nervous for any number of reasons. Some people may be uncomfortable revealing sensitive information to health care professionals who need it to provide certain services. Others find it difficult to talk about health concerns. Creating an environment in which these conversations are more comfortable for the patient is an important goal for all health care staff.
Communication is an exchange of information, but connection is an exchange of our humanity. In order to connect better with our LGBTQ+ patients, we will explore three main areas to improve communication as we aim to build a comfortable and inclusive environment.
Communication Basics
Using the right words helps to establish a trusting relationship and reduces barriers to care. All staff should avoid making any assumptions about gender identity and sexual orientation, just as they should avoid assuming racial identity, age, and other characteristics.
This can be done by using the terms that people use to describe themselves and their partners. For example, if someone calls himself “gay,” do not use the term “homosexual.” If a woman refers to her “wife,” then say “your wife” when referring to her; do not say “your friend.” Our primary focus has to be on making our patients comfortable (1).
It is not always possible to avoid making errors, and simple apologies can go a long way. If you do slip, you can say something like: “I apologize for using the wrong pronoun/name/terms. I didn't mean to disrespect you” (1).
Patient Intake Forms
The way you treat gender, sexuality and relationships on patient intake forms is extremely important (2). The easier it is for LGBTQ+ patients to complete the forms with answers that truly reflect who they are, the better they will feel and the more likely they will be to provide complete and accurate information.
Collecting data on sexual orientation and gender identity should happen routinely. Staff should respectfully clarify when a patient’s name or gender identity does not match their insurance or medical records (3).
Intake forms that allow people to easily share information about their sexual orientation and gender identity will facilitate effective and respectful communication between your patients and members of your staff (2, 3).
Electronic Medical Records (EMRs)
Accurate representation of their gender identity within health records continues to be a challenge for TGDNB peoples as the health care community struggles to use inclusive terminology in medicine (4).
It has been over 25 years since the Canadian McInerney v. MacDonald (1992) case established that patients have the right to access information contained in their health records, and in the United States, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule enfranchised those same rights (5,6). With ongoing health care advances, medical documentation has dramatically changed from hand-written notes to online documentation. These electronic medical records (EMRs) serve to digitally immortalize patients’ health histories and health care.
To further overcome TGNB populations' experience of health inequities, additional training efforts to help longitudinally integrate gender-neutral and non-exclusionary transgender language into EMRs is an absolute must to move forward as a society (7). Why EMRs are important are because studies demonstrate that individuals who were able to choose their name in any context had experienced 71% fewer symptoms of severe depression, a 34% decrease in reported thoughts of suicide, and a 65% decrease in suicidal attempts (8).
Effectively serving LGBTQ+ patients require us to understand the cultural context of their lives, and to modify our policies, procedures, behaviour, and language to be inclusive, non-judgmental, and helpful at all times. By taking these steps, health care staff can help ensure that LGBTQ+ patients receive the level of care that everyone deserves.
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References:
Providing Inclusive Services and Care for LGBTQ Patients: A Guide for Health Care Staff. National LGBT Health Education Center: A Program of the FENWAY Institute. 2017. Accessed June 2, 2020 <https://www.lgbthealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People.pdf>Making Your Clinic Welcoming to LGBTQ Patients. UNM Family Medicine Residency Collaborative Workplace. 2017. Accessed June 2, 2020 <http://unmfm.pbworks.com/w/file/fetch/110464234/Making%20Your%20Clinic%20Welcoming%20to%20LGBTQ%20Patients.pdf>
Focus on Forms and Policy: Creating an Inclusive Environment for LGBT Patients. National LGBT Health Education Center: A Program of the FENWAY Institute. 2017. Accessed June 2, 2020 <https://www.lgbthealtheducation.org/wp-content/uploads/2017/08/Forms-and-Policy-Brief.pdf>
Lane R. Developing inclusive primary care for trans, gender-diverse and nonbinary people. CMAJ. 2019;191:E61–E62 [PMC free article] [PubMed] [Google Scholar]
Health Information Privacy Division. Individuals' Right Under HIPAA to Access Their Health Information | HHS.Gov. Washington, DC,: 2016 [Google Scholar]
Canada. Supreme Court. McInerney v. MacDonald. Dom Law Rep. 1992;93:415–431 [PubMed] [Google Scholar]
Dubin SN, Nolan IT, Streed CG Jr., et al. Transgender health care: improving medical students' and residents' training and awareness. Adv Med Educ Pract. 2018;9:377–391 [PMC free article] [PubMed] [Google Scholar]
Ahmad T, Lafreniere A, Grynspan D. Incorporating Transition-Affirming Language into Anatomical Pathology Reporting for Gender Affirmation Surgery. Transgend Health. 2019;4(1):335‐338. Published 2019 Nov 21. doi:10.1089/trgh.2019.0026
Russell, Stephen T. et al. Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth, Journal of Adolescent Health, 2018;63(4):503 –505, DOI: https://doi.org/10.1016/j.jadohealth.2018.02.003