Actionable advocacy in support of gender-diverse patients

You wake up in an emergency department confused and disoriented. There are no familiar faces around you. It feels like you have been hit by a truck. Maybe you have been. You touch a hand to your face and realize there is an oxygen mask pressed to it. You stop short. The hospital wristband has a name on it that is not yours. It is a name you legally changed years ago and have not used in even longer. How could this have been dredged up from any recent or relevant records? Does anyone on this medical team know anything about your health?

Medical records are rife with inaccuracies about patients who identify as 2SLGBTQIA+ and about patients who are trans and gender-diverse (TGD) in particular. When I started providing primary care to 2SLGBTQIA+ folks and their families, it is not an exaggeration to say that every chart I reviewed contained the potential for harm. My patients had been misgendered and dead named, and organs and sexualities had been erroneously assigned to them. Partners were assumed to be friends and relatives. Parents were misgendered or presumed to play heteronormative roles. Not only is there potential for medical errors when appropriate demographic information is not collected, but for patients receiving these records it can cause psychological distress and shatter their trust in providers, in the health care system, and in the quality of care being received. Even after names and gender markers on licences and health care platforms have been legally changed, I have witnessed dead names being pulled out of oblivion, devastating patients when they least expect it and in their most vulnerable moments.

These issues are not isolated to my city. In a study conducted in Boston, Mass, Burns et al reviewed the charts of TGD patients undergoing oncology treatment.¹ They found 41% of charts had mixed pronoun usage and 24% used only those pronouns corresponding to patients’ sex assigned at birth rather than their documented gender identity. Based on a sample of gender-diverse adults across North America, Alpert et al reported common themes in electronic medical records, including that using the wrong name, pronoun, or gender marker for patients is common and erodes trust and causes trauma for patients.²

My advocacy proposal is simple: Actively correct inaccuracies in patients’ records. Send back any piece of documentation with dead names, misgendering, or incorrect pronouns when you receive it with a simple note providing the correct demographic information and requesting that the sender correct their records. While success is not guaranteed, patients will see the advocacy rather than their provider being complicit in overt, systemic, or unconscious transphobia through inaction.

By advocating for these changes in patients’ records, family physicians contribute to creating a safe medical home where TGD individuals feel accepted, appreciated, and understood, while also setting a precedent for compassionate care throughout the medical community. Small actions can strongly affect the provision of equitable and affirming health care for all.

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