Takeaway
To build trust and help patients feel safe, use their preferred name and pronoun. Doing so consistently ensures that every patient feels recognized and respected.
Lifelong learning in clinical excellence | March 25, 2026 | 3 min read
By Nettie Reynolds, MDiv, interfaith chaplain
Six months ago, in a plastic surgery waiting room, I held my son’s hand. He’s 28, an entomologist, a young adult who’d taken years to arrive at this decision with care and clarity. He was about to undergo top surgery.
In the pre-op room, in the too-big gown and hospital socks, I felt both of my roles at once. I’m his mother, and I’m also a chaplain who’s spent years in clinical spaces where moments like this carry weight. Not this surgery specifically, but this kind of threshold, the moment before something irreversible, when who you are is no longer negotiable.
“I’d like to borrow that flannel shirt when you’re done with it,” I whispered.
He rolled his eyes. “Mom.”
We both laughed, but underneath that moment was something I recognized from my work. There’s a particular kind of vulnerability in being seen clearly, and an equal risk in not being seen at all.
The power of a name
A decade ago, when I started working as a chaplain, I was trained to listen, to assess, and to respond. I wasn’t trained to ask about pronouns, and I didn’t yet understand how much weight something as simple as a name could carry in a clinical encounter. What I did understand, even then, was how quickly a room could shift depending on how a person was addressed.
When care falls short
I’ve been in rooms when patients weren’t met with care—the first question wasn’t about what they needed, but about explaining themselves. When a name on a chart was used even after a patient asked otherwise, pronouns were assumed or ignored, and the focus drifted away from the reason they came for care. You can feel it when that happens. The room changes. The patient pulls back, even if only slightly, and trust begins to thin in ways that are rarely documented but deeply felt.
Sitting there with my son, I was aware of how much this moment would depend on the people who walked into that room after I left. How they would speak to him, what name they would use, whether they would ask or assume, and whether they would treat him as a patient in need of care or as a question to be solved.
Lessons from entomology
My son is an entomologist. He studies organisms that don’t always conform to binary categories, including insects that can develop with both male and female characteristics in a single body. He studies insects that change form, hold multiple traits, and become something different over time. When he talks about them, he describes what’s there and lets them be what they are.
Restraint instead of interpretation
Not everything requires interpretation. Some things require restraint. For trans patients, the clinical encounter is shaped by whether they’re recognized or questioned, whether their identity is respected or treated as provisional. This shapes everything that follows, including communication, trust, safety, and care itself.
The many touchpoints of care
What’s easy to forget is how many people a patient encounters in a single visit. Registration staff, nurses, medical assistants, physicians, technicians, transport, billing, follow-up care. Each interaction carries the same opportunity to either reinforce trust or erode it. It’s not one moment that defines the experience, but the accumulation of many.
Clinicians work in teams, and teams shape culture. We notice how each other speaks to patients. We hear the names that are used, assumptions that are made, and questions that are asked. There are sometimes moments where we can redirect, clarify, or model something differently. This is a way of helping each other get it right.
Presence as practice
What I’ve come to understand over time is that presence isn’t passive. It’s a practice. It shows up in how we address someone, whether we ask or assume, and how closely we stay aligned with why the patient is here in the first place.
Three things I’ve learned that can help improve our care of patients:
1. Call patients by their preferred name, not their dead name.
2. Ask patients for their preferred pronouns.
3. Keep questions relevant to medical treatment.
Small acts of recognition and restraint—the names and pronouns we use, and the focus of our questions—compound across a visit. By modeling respectful care, we help preserve trust, safety, and dignity for every patient.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.