Recently Gina Ruesch, D.P.M.’01, treated a patient for toenail fungus. Afterward, the patient rated the appointment as the best clinical experience she’d ever have. While that’s music to the ears of any health care provider, Dr. Ruesch was troubled by it, because she knew the patient, a transgender individual, had had extensive clinical experiences.
“The patient had been to countless doctors, but it was the podiatric physician who treated her fungal toenails who gave her her best clinical experience?” she posed during a Zoom grand rounds for foot and ankle surgical staff physicians and residents at HealthPartners/Regions Hospital in St. Paul, MN. “I was happy for me, but I felt very sad for the patient.”
That inspired the topic of the grand rounds session – how to interact respectfully with nonbinary patients, individuals whose gender identity falls outside the traditional binary paradigm of male/female or who reject the concept of gender. Joining the interactive session were Sarah Parrott, D.O.’02, FAAFP, chair of DMU’s family and internal medicine department and a clinician in the DMU Family Medicine Clinic, and Mandy Hale, D.O.’23, a DMU student who identifies as nonbinary. Dr. Ruesch invited Dr. Parrott to participate in the session, knowing about her care for lesbian, gay, bisexual, transgender and queer (LGBQTQ) patients; Dr. Parrott in turn invited Mandy to join the group to share information and perspectives.
“When Dr. Ruesch and were talking about this presentation, I said I’m very comfortable talking with LGBQ patients, and I’m becoming more comfortable as I take care of transgender patients. But I’m a cisgender female, and working with nonbinary patients is new to me,” Dr. Parrott shared with the group. A cisgender person, sometimes informally abbreviated as “cis,” is a person whose gender identity matches their sex assigned at birth.
Increasingly, nonbinary individuals are making known the pronouns they want to be addressed as. Using pronouns preferred by all patients, the grand rounds participants agreed, is part of providing compassionate, respectful care. That’s why Mandy welcomed the opportunity to participate in the session. As a nonbinary person, Mandy uses the pronouns “they” and “them.”
“I’m so excited you reached out and wanted to have this conversation,” they told the group. “I’m glad you’re taking the initiative because you want to learn more and give nonbinary patients the best experience possible.”
Drawing on resources from the Fenway Institute and one of its programs, the National LGBTQIA+ Health Education Center, Dr. Parrott and Mandy shared this list, which is not comprehensive, of some terms relating to gender:
- Agender: describes a person who identifies as having no gender
- Bigender: describes a person whose gender identity is a combination of two genders
- Gender fluid: describes a person whose gender identity is not fixed
- Gender nonconforming: describes a person whose gender expression differs from societal norms for girls/women and boys/men
- Genderqueer: describes a person whose gender identity falls outside the traditional binary gender paradigm of either girl/woman or boy/man
- Nonbinary: describes a person whose gender identity falls outside the traditional binary gender paradigm of either girl/woman or boy/man or who rejects the concept of gender
- Pangender: describes a person whose gender identity comprises more than one gender
- Transfeminine: describes a person assigned male sex at birth who identifies with femininity to a greater extent than with masculinity
- Transmasculine: describes a person assigned female sex at birth who identifies with masculinity to a greater extent than with femininity
- Two spirit: describes a person who embodies both a masculine and a feminine spirit; this is a culture-specific term used among Native American and American Indian people
“The best way to figure out the label a person uses is to ask with respectful curiosity,” Mandy said. That strategy also applies well when determining which pronouns to use. If the preference is documented in notes on the patient from prior appointments, a care provider may want to confirm the choice with the patient. Another option: to ask patients to indicate their preferences on the practice’s intake form.
“The best care is nonjudgmental care that shows the person they deserve my respect,” Mandy said. “It does take time to get used to these new pronouns. Like riding a bicycle, it takes practice. Be open and honest with patients. There are bound to be slip-ups; apologize and move forward. By showing you want to learn from the patient, you show that you are trying your best and that you will do the best you can for each patient.”
As for Dr. Ruesch’s transgender patient who was so pleased with her care, the next time she came to the clinic, Dr. Ruesch thanked her. “This session was all because of my interaction with her and her interaction with me. She started the conversation,” she said. “Our nurses want a session like this, because they do patient intake. It’s much-needed training.”
