Respecting All Patients

This is the third piece in a series on diversity. The first shares ideas on how to talk about diversity with colleagues. The second gives tips for how to hold conversations about diversity with patients who identify as minorities. This third installment talks about the need to respect the identities of our patients who are minorities. 

“When he—.”

The sentence that comes from the staff member’s mouth is already wrong. I know it’s wrong. Everyone knows it’s wrong.

Those aren’t the patient’s pronouns.

The whole room tenses. Everyone waits for someone to say something. Everyone waits for someone else to say something.

The silence stretches into cringe-worthy infinity. It’s one second and a lifetime.

The staff member who misgendered the patient keeps going right along with a slight pause. One where you know they know they made a misstep, but they’re doubling-down instead of pausing, reflecting, apologizing, and modifying their behavior.

No one corrects them.

I sure as hell am not going to speak up, even though there’s nothing I want to do more. As an African-American, gay psychiatry resident, I’ve learned my place. I’ve learned it all too well.

It’s our job as healers to speak up, but I can’t. I know I should say something. But I can’t speak. The words to gently correct the speaker are fighting to fall from my lips, but I keep them within. My lips purse to stifle the correction.

For all that I’m told I advocate for others, for all that I attempt to speak up for those who look nothing like me, for all that I hope to help remind us all of our best selves, there are many instances when I don’t speak up anymore, there are too many times when I feel as though I can’t speak anymore. I’ve been told countless times through direct words, or indirect and alarmingly direct actions, that my voice doesn’t matter.

I don’t speak and turn my attention back to my work.

But I keep thinking about how I should have said something. I continue to reflect on how, if I feel as though I can’t say something, what do patients who are in positions of vulnerability feel? Do sexual minority patients enter the hospital fearing that they’ll misgendered,deadnamed, and uncared for in the way they should be?

Why are Black patients often labeled as aggressive or disruptive? Why do they often experience discrimination in the hospital? Why are gay patients labeled as “dramatic”? Why are transgender patients subject to higher rates of discrimination by healthcare professionals? If we’re healers, why are we causing these populations the same stress that America has already inflicted upon them?

I always practice a script in my head before I work with sexual minority patients. I practice their pronouns and names. If we can practice the names of esoteric diseases, why aren’t we doing the same to respect people’s sense of self?

After and because of the incident with the speaker when I didn’t speak up, I returned to smoothly correcting others whenever someone was misgendered, even though I was terrified I’d be told that I was “difficult,” which is simply a way of putting a minority physician in their place. Clinicians have a responsibility to protect their patients.

Three years after the incident when I didn’t speak up, when I was a child and adolescent fellow, I met a patient for the first time.

“Hey, I’m Dr. Chase Anderson, but you can call me Chase. I’m going to be your psychiatrist while you’re here, let’s go talk for a bit so we can work together to figure out how to help you feel better. How do you identify and what pronouns do you use?”

They tell me with a cautious smile. I grin as I respond, “Cool. I use he, him, his, and I identify as gay. Let’s talk about how I can help you.”

Here are four things to keep in mind when talking with or about minority patients:  

1. Respect all patients.

In medicine, we learn thousands of facts. We take the time to commit the facts to memory. If we don’t do the same for facts such as a patient’s preferred pronoun when it could be part of decreasing suicide in sexual minority patients, we’re not respecting them. We need to do better, especially given the oaths we recite to take care of all patients, not simply the ones who look like us. 

2. Practice a script in your head before seeing your patient.

This ensures you correctly use the right pronoun for your patient that’s true to who they are and supports their mental health and well-being.
 

3. Help your patient feel safe.

We’re here to help heal our patient’s mind as well as their body. Given that about a quarter of respondents in 2015 U.S. Trans Survey said they had to educate their clinician about transgender people when seeking care, we need to educate ourselves. These topics need to be a part of regular discourse with colleagues and woven into all levels of medical education.
 

4. Be aware of your own implicit biases.

We all have implicit biases. Every single person has automatic thoughts that come up in every situation. It’s our responsibility to explore our personal biases and how we enact them. And it’s up to us to prevent them from them from affecting our care of patients.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.