Journal Article

Barriers to correct pronoun usage in healthcare settings

Cain, Roman, Holliday, Scott, Glock, Lucas, Ioerger, Michael, Makara, Jodie

2024

Overview

Background Using correct pronouns is an impactful way to establish affirming environments for transgender and nonbinary (TGNB) patients. However, physicians often report struggling with this. Objective This study set out to conduct an initial root cause analysis of factors contributing to medical students and physicians failing to use TGNB patients’ correct pronouns. Methods A 10-item Qualtrics survey was sent to medical students, residents, and physicians practicing in Central Ohio. Participants were asked to describe perceived challenges or barriers colleagues have regarding correctly using TGNB patients’ correct pronouns. A directed content analysis of participant responses was performed utilizing a fishbone diagram root cause analysis tool as a basis for conceptualizing and categorizing barriers. All coding was completed by independent reviewers utilizing a consensus reconciliation methodology. Results Of 928 survey respondents, 763 met the study inclusion criteria, of which 453 provided analyzable responses. Of these 453, attendings with five or more years of practice (32.5%) and medical students (27.4%) made up the two largest demographic categories. 1.7% of respondents identified as transgender, nonbinary, and/or genderqueer, and 64% identified as heterosexual/straight. Five core barrier categories were identified: documentation, patient care, environment, knowledge, and individuals. Sub-categories were also identified, including lack of documentation, discomfort, medical culture, lack of standardization, prejudice, and assumptions. Conclusion The study identifies important barriers to medical professionals correctly using TGNB patients’ pronouns. The root cause analysis conducted as part of this study demonstrates the necessity of multi-pronged, system-level interventions to support ensuring TGNB patients are addressed using the correct pronouns.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Attitude of Health Personnel / Barriers / Barriers to care / Basic Skills / Coding / Content analysis / Education / Electronic Mail / Environment / Feedback (Response) / Female / Gender Discrimination / Grammar, Comparative and general / Health care / Health facilities / Healthcare experiences / Heterosexuality / Humans / LGBTQ people / Male / Market surveys / Medical care / Medical colleges / Medical Education / Medical research / Medical Services / Medical students / Medicine / Medicine, Experimental / Middle Aged / Non-binary gender / Ohio / Patients / Patient–physician relationship / Physician patient relationships / Physician-Patient Relations / Physicians / Physicians - psychology / Polls & surveys / Practice / Pronoun / Pronouns / Self Efficacy / Sexual Orientation / Social aspects / Social Bias / Social Desirability / Student Surveys / Students, Medical - psychology / Surveys / Surveys and Questionnaires / Theory of Medicine/Bioethics / Transgender or nonbinary / Transgender people / Transgender Persons / Utilization