My name is Susan Mari. I’m a fourth-year EM-bound medical student in a large Midwestern city, and my pronouns are she/her. My name holds a lot of privilege. Although I often nag my parents about being the only Susan under the age of 55, the traditionally female name assigned to me at birth does align with my gender identity. When strangers assume my pronouns based on my outward appearance, they’re usually right.
Not everyone has this privilege.
A few weeks into an internal medicine rotation at my local county hospital, I was on call with my team when a new patient was admitted from the ED for abdominal pain. Her symptoms sounded pretty classic for cholecystitis (great for medical student teaching purposes), so my senior resident assigned me to the case. I bounded upstairs to meet the patient and complete an overly thorough history and physical, as only a third-year medical student does. My patient good-naturedly endured all of my questions, pokes, and prods, but she was clearly anxious and uncomfortable. Half an hour later, I glanced back over my notes on my way out the door, satisfied that I knew everything there was to know about my patient - except how to pronounce her name.
“Hey, how do you pronounce your last name?” I asked. She clarified.
“And what do you like to be called?” I ask most patients this to avoid the whole John vs. Mr. Smith debacle.
I saw the first hint of a smile as she gave me a nickname and then a chosen name to use in place of her legal one.
Catching on, I asked, “What pronouns do you use?”
“They, them,” they beamed, anxiety dissipating. “Thank you. You’re the first person to ask me that.”
Counting the multiple staff members, nurses, techs, interns, residents, and attending physicians, I must have been at least the 10th person to interview this patient - but the first to ask their name and pronouns. That unfortunately didn’t surprise me. Not everyone has had the basic training on gender-affirming care that my medical school provides. Medical students also generally have more free time to sit and get to know our patients. Everything that happened next, however, did surprise me.
I went straight to my supervising intern to let her know our patient’s preferred name and pronouns and asked if we could add the information to the EMR so other members of the care team could see it as well. She said she didn’t understand my question. That was foreboding, but I chalked it up to cultural differences and moved on. A quick search through the demographics tab on the system’s EMR didn’t show a field for pronouns, so I sent the same question to the whole team in our secure chat. I explained that it would be nice for them to have their preferred name and pronouns in the EMR so they wouldn’t have to repeatedly explain it to everyone they met.
One resident let me know that wasn’t a possibility with the software the hospital uses. Another resident responded, “But isn’t her full name (---)? That’s all we need to know,” with a crying laughing emoji. I didn’t know where she saw the humor in this situation, but I certainly wasn’t laughing and didn’t think my patient would be, either. I looked helplessly down at my phone, an icy wave of dread washing over me as I realized just how difficult the next few days were going to be for my patient.
The next morning, I emphasized my patient’s name and pronouns in front of the whole team throughout my oral presentation. Thankfully, I didn’t witness anyone on the team use the wrong pronouns (or any pronouns at all) in front of them, but they all continued to do so in private. Every time I gave my team updates on my patient, my they/them was met with she/her, and no one could seem to remember who I was talking about when I used their chosen name. After a handful of reminders, I’m ashamed to say I started letting it slide. I couldn’t figure out where the disconnect was, and it was an awkward situation to be in as a student.
I was in the room multiple times when nursing staff misgendered my patient, and the way they visibly shrunk whenever it happened broke my heart. With their permission, I informed the nurses of the right pronouns. It didn’t stick. We even wrote their name and pronouns in big, bubble letters on the room’s whiteboard; that didn’t help either. At one point, I apologized that no one was respecting their pronouns.
“It’s OK,” they said. “I’m used to it.”
“It’s not OK,” I said simply.
I didn’t understand how I could be the only person on this patient’s care team who thought such a fundamental piece of caring for them mattered. How can we expect patients to trust us to diagnose them, treat them, even operate on them when we don’t get their names right? The short answer is that we can’t. We need to do better.
I invite my colleagues in all corners of the medical field to join me in advocating for our transgender and nonbinary patients through clear and decisive action. First, I believe every hospital needs a dedicated field in their EMR to acknowledge a patient’s preferred name and pronouns. Not only would this have facilitated easier communication between the different care teams (IM, GI, general surgery, etc.), but it also would have been a clear reminder for every RN, resident, tech, student, and attending who pulled up the chart before walking into the patient’s room. Simply put, the burden of having to inform and remind every single staff member of a patient’s name and pronouns should not fall on the patient themselves.
Second, we must address the culture of ignorance and indifference surrounding gender identity and expression among healthcare providers through advocacy and education. While we all come from different backgrounds and experiences, the expectation of a basic level of competency in caring for some of our most vulnerable patients is long overdue. I trust that the vast majority of us want to do right by our patients. If we can start bridging the gap with practical training, we can empower providers to feel more comfortable using the language, advocating for their patients, and speaking up when pronouns aren’t respected. It’s time we hold ourselves and our colleagues accountable, ask the uncomfortable questions, and put in the work individually to create structural change.
This kind of change won’t come easily, and it won’t happen overnight. Even as we graduate entire classes of medical students who have received training in gender-affirming care, there are still many generations of physicians in practice today who haven’t had as much experience caring for openly transgender and nonbinary patients. As a recovering perfectionist, I understand the fear and hesitancy involved in trying something new, but just like any skill, asking for pronouns and using them fluently takes dedication and practice. It’s okay to start small: add your pronouns to your Twitter bio, order a pronoun pin for your lanyard, or ask your next patient what they like to be called. The more visibility we bring to pronouns, the more second-nature they’ll become. As clinicians, we need to leave personal opinions and egos at the door and get comfortable being uncomfortable. Trying and making mistakes along the way is still more respectful to our patients than not trying at all.
There has never been a more critical time for the healthcare community to stand up for our trans and nonbinary patients. Using a person’s chosen name and pronouns isn’t difficult. It isn’t radical. It’s human decency. I hope you’ll join me in creating a future where members of the trans and nonbinary community can come to see hospitals not as places of ignorance and trauma, but as havens of acceptance filled with their fiercest allies.