PART 2 – Systems and Procedures
Traditionally, medical systems and procedures have not considered the needs of trans clients. Some simple changes to existing protocols can make services more accessible and trans-friendly.
Procedures in the waiting room
Many clinics require clients to show care cards or service cards. This can put trans clients in a difficult situation, given that almost half of trans clients have government issued ID that does not correspond to their lived gender.
Trans and gender diverse clients frequently report being misgendered and/or having their former name used in clinical settings. This is not only upsetting, it also carries the potential for the client’s trans status to be revealed in a public space. Contrary to common misconceptions, it is not usually possible to know if someone is trans by looking at them, so these instances of misgendering or using incorrect names could create a situation where the client is outed as trans.
By being outed in a public space, trans people run the risk of encountering prejudice, discrimination, and violence.
Some tips for reducing the possibility of misgendering clients include:
- Do not make assumptions about a person’s gender or body parts based on their voice, appearance, or legal identification. When in doubt, ask (quietly and respectfully).
- With each new client, ask what name the client would prefer to be called, and make sure all forms include space for their chosen name if different from name on care card.
- Use non-gendered language with all clients. Call clients by first name rather than using a gendered honorific such as Mr. or Ms.
- Take care to always use the client’s chosen names when calling them in for an appointment. Consider using a number system rather than a name system to call clients, which would increase privacy for all clients.
- Have all staff take trans 101 and gender diversity awareness training, including reception clerks, intake workers, nurses, doctors, and operations managers. The first contact a person has in your clinic can make or break the clinic experience. The resources listed below in the Education and Training section are a good starting place.
Procedures in the exam room
It is not necessary to use gendered language when talking about sexual health, but this practice is still common.
Clinicians should practice getting comfortable using non-gendered language when talking about sexual health and be aware that naming genitals can be triggering to trans people with gender dysphoria. It is preferable to say genitals instead of vagina or penis. If it’s necessary to be specific about body parts, remove gendered associations from those parts. For example, instead of saying “female genitalia”, name the relevant parts: “People with cervixes can benefit from pap tests.”
For more ideas on using non-gendered language in sexual health, see the essay Purportedly Gendered Body Parts by Dean Spade, founder of the Sylvia Rivera Law Project.
Forms and databases
If you have sex or gender data fields on your forms, consider why this information is there. Sex and gender information does not reliably tell us what type of body and genitals a person has, or how a person identifies.
If you are required to keep gendered forms, it’s recommended that “transgender” is not used as a third gender option, since that requires to people to choose between male, female or transgender. Since the majority of trans people identify as male or female, being asked to select “transgender” rather than male or female leaves out the client’s chosen gender identity. To avoid this, use a separate tickbox or category if it’s necessary to know if your client is trans.
Also, be aware that some gender diverse people may not identify as either male or female. As an alternative to M/F markers, consider a write-in gender space if necessary, or just a preferred pronoun write-in space.
If your billing or clinical software requires the client’s legal name, try to ensure that there is also a chosen name option. This could include adding an extra field in the database, or simply adding a second label to the client’s physical chart.
Examples of trans-friendly intake protocols and forms:
Gender neutral body map
Education and training
All staff that interact with clients, including those who create systems for them, should have a basic understanding of trans and gender diverse identities. Consider providing office-wide training for doctors, nurses, reception clerks, intake workers, operational managers, and technical systems managers. The more people who understand the needs of gender diverse clients, the more possibilities for creating institutional change.
Resources for education and training
- Vancouver Coastal Health: The Trans Health Information Program offers educational opportunities for clinicians, and also has excellent online resources.
- Qmunity: BC’s queer resource centre offers customizable workshops and presentations.
- Trans PULSE Project: A community-based research project investigating the impact of social exclusion and discrimination on the health of trans people.
- FORGE: A website for professionals that includes a trans 101 webinar and FAQ sheet on working with trans people.
Next up is the final installment of this series: Part 3 – Accessible Spaces
- Bauer G, for the Trans PULSE Project. Trans Ontarians’ Sex Designations on Federal and Provincial Identity Documents: A Report Prepared for the Canadian Human Rights Commission. 15 November, 2012.