By Kristina Gern Johnson, MD, Family Medicine & Sara Groff Stephens, PHD, Teen & Young Adult Health
Why is this work important for us (UVA Health)?
Kristina: Creating a safe space starts with using language that supports our patients and our workforce.
What we know is that the more diverse the team, the higher functioning that team is. But it’s more than diversity. You can’t round up people with different backgrounds and expect them to be high functioning. The members of the team need to feel included. People “cover” at work, meaning they hide things about themselves because they fear they may not be accepted. This could mean an African American woman not wearing her natural hair, an LGB employee not telling team members about their relationship, or a transgender employee not outwardly expressing their gender. Another example is that there are people with uteruses who don’t identify as women. We need to work together to make our language more inclusive. Phrases that support this work include chestfeeding instead of breastfeeding, lactating person instead of breastfeeding mom, and parental leave instead of maternity leave.
Sara: This work is important for all areas where we interact with other human beings. I cannot think of an organization or a situation where it is not important to be respectful and inclusive of others.
Why is it important, specifically to you?
Kristina: I am core faculty for the UVA Family Medicine Residency Program, where I am in charge of a 3-year longitudinal residency curriculum on health equity. For the Department of Family Medicine, I am the chair of the Diversity and Inclusion Committee and see patients in both the Adult Gender Health Clinic in Crozet and the Primary Care Center. For the School of Medicine, I am the Diversity Consortium’s liaison to the Curriculum Committee and am part of a team working on an anti-racism curriculum for first-year medical students. So overall, I’m interested in providing patient-centered care and making systemic changes to reduce health disparities–which includes recruiting and supporting a diverse workforce.
Personally, I have a lot of friends, family members, colleagues, and patients that identify as LGBTQ and I’ve witnessed and learned about the horrible things they’ve experienced. No one should have to go through these things, in life, and especially not in health care where they are at their most vulnerable. It’s exhausting for patients when they are misgendered repeatedly. When they call their health insurance and are transferred numerous times, and each time they have to explain, “No, my name is different than what you have in the system” or “Please stop using she, I go by he”. Then, they come to visit a doctor and experience this over and over again… there has to be a better way.
Sara: I’m a social worker and it is a primary mission of the social work profession to help meet the basic human needs of all people, with particular attention to the needs and empowerment of vulnerable and oppressed people. Working on creating an environment at UVA that is inclusive and representative of all people very much aligns with my personal and professional values and I’m proud that UVA is working on making these changes.
What do you want team members to know?
Kristina: I’ve had healthcare professionals tell me that they’re exasperated by these efforts and the pressure to be “politically correct.” My answer is that it’s way past political correctness at this point. This is trauma. Patients are misgendered, refused care, and feel unsafe. And this is happening in our Medical Center. When we signal to someone that this is a safe space, it’s not about “not offending someone.” It makes the difference between a patient accessing care versus not, or being retraumatized versus affirmed. I challenge all of us to evaluate whose comfort we are prioritizing.
I’ve also heard care providers say they’ve never cared for someone that is transgender. My answer to that is, “You’ve never cared for someone who you knew was transgender. I guarantee you have cared for someone who is transgender.” A lot of us get hung up on the language. We worry how to come right out and ask a patient. Here’s what I practiced: every single time I introduce myself to someone new, I say, “Hi, I’m Dr. Johnson. I use she, her, hers. What do you go by?” That’s my script and I use it every time. My pronouns are in my email and on my name display in Zoom meetings. This greeting communicates that I am a safe person to talk to. It gives my patients the opportunity to tell me their preferred name and pronouns.
Sara: I want team members to know that being inclusive of all people matters. Being inclusive helps people to feel welcome and cared for. It can dictate whether patients feel safe enough to be honest with their providers. It can be a deciding factor for whether they will trust their providers and their recommendations.
Alternatively, not being inclusive can be very damaging and harmful. People may avoid seeking healthcare for fear of having to navigate providers and team members that may make incorrect assumptions. They may also fear judgement by a healthcare system that does not openly affirm their gender identity or sexuality.
Start paying attention to the language that you use with patients and in your personal life. Are the forms that you use inclusive of all individuals and family types? Do you make assumptions when you work with people about their gender, sexuality, preferred pronouns, family make-up, etc.?
What can leaders do to help?
Kristina: Hire more diverse leaders. But it’s not just “if you build it, they will come” – we also must support people when they get here. If leaders are making decisions on renaming service lines and someone in the group identifies as LGBTQ, they might be more likely to speak up and say, “We might not want to use the term ‘women’. Here’s why…” Recruitment and support set the stage moving forward. UCFS is doing fantastic work with their policies, which are written in gender inclusive language.
Sara: Leaders can provide language and tools to help team members be successful. For example, have gender and sexuality inclusive lists in the electronic health record. Train team members to ask open-ended questions and to not make assumptions. Team members can educate themselves on inclusive language and practices (there are many awesome resources available!). Maintain a nonjudgmental attitude when interacting with people that are different than you or have a different family make-up than what you are accustomed to. Ask questions that are relevant to their care and avoid asking unnecessary questions because you are curious.
There are also nonverbal ways to be inclusive. Represent different family structures, genders, ethnicities, and abilities in your materials and artwork or decor. Representation matters!
How can we learn more?
Watch the video “Vanessa Goes to the Doctor” (this perfectly illustrates creating a safe space from the patient perspective): https://www.youtube.com/watch?v=S3eDKf3PFRo
Online webinars and learning modules covering many topics: https://www.lgbtqiahealtheducation.org
An excellent guide for healthcare workers: https://www.lgbtqiahealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People.pdf
A Toolkit for Collecting Data on Sexual Orientation and Gender Identity in Clinical Settings: https://doaskdotell.org
Filed Under: Features