| Language |
Use words that help establish a trusting relationship; avoid words that build barriers to care. Language and word choice is critical not only in your clinical encounter, but also in all communication with nurses, clinical assistants, front desk staff, and all other staff.
Avoid assuming a patient’s partner is opposite-sex. Ask, “Are you in a relationship?” rather than, “Do you have a boyfriend?” Use the same terms youth use to describe themselves. If a patient refers to himself as “gay”, use this instead of the term “homosexual” in your clinical encounter. Ask what pronouns a patient prefers, then use them. Transgender males, for example, may prefer that you use the terms, “he”, “him”, and “his”. Others youth may use gender-neutral terms such as “they” or “zie”.
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| Expectations |
Be aware that LGBTQ youth may have had prior adverse health care interactions and may not immediately feel comfortable disclosing sensitive information with you.
Up front, let your patient know that you are an LGBT-friendly provider. Many clinics will post materials on the walls stating that they are LGBT-friendly; often, providers will wear a rainbow pin or other affirming symbol to let youth know they welcome LGBTQ youth at their practice. At the beginning of every social history, state, “With your permission, I’d like to ask you some questions that I ask of all the youth I care for.” Always discuss confidentiality and assure it with all youth. If a patient comes with a parent, always ensure one-on-one confidential time with youth. Explain confidentiality to parents, also, so they understand that you will not disclose certain aspects of care.
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| Questions |
Understand that LGBTQ youth may have diverse and fluid identities with regard to sexual attraction, self-identified sexual orientation, gender identity, and gender expression.
Ask open-ended questions about preferred pronouns, gender identity, self-identified sexual orientation, and sexual attraction, and only when one-on-one with youth. Understand that the labels youth use do not necessarily dictate a youth’s sexual partners and associated sexual behaviors. Understanding who a patient’s partners are even despite the labels youth use can help guide clinical care.
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| Barriers |
Understand that navigating health care systems can be frustrating, and LGBTQ youth experience the same barriers to care as other youth, and more.
Some barriers to care, such as insurance problems, are common among all youth, but may be especially common for LGBTQ youth who in some cases may be estranged from their families; be prepared to offer assistance with insurance problems and where necessary, free-of-charge services
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| Charting |
Be aware that health care records and insurance plans often use the name a patient was assigned at birth, which can be problematic for transgender youth who have changed their name. The gender listed often reflects a patient’s assigned gender at birth.
Consider a special chart labeling system or identify a feature in your electronic medical record that identifies patients by their chosen name. Determine whether your medical record system can include fields not only for “male” or “female”, but also for “transgender male” or “transgender female” as appropriate. Review the forms your clinic mails to patients or administers in the waiting room. Often, these contain binary male/female fields, but should include other options as well.
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| Handling Mistakes |
Know that even experienced practitioners sometimes make mistakes with names and pronouns. Be prepared to correct them when they occur.
Confront head-on your own mistakes or those of your colleagues’ when they occur. To a transgender female called her assigned male birth name by a clinic staff member, say, “I apologize that we used the wrong name for you. We strive to be respectful of all our patients and we did not mean to disrespect you.” Hold all staff accountable for creating a welcoming environment, starting at the front desk and proceeding to every clinic staff worker. Work to improve the quality of your organization’s care by making an LGBTQ youth-friendly environment a priority and discuss it openly and frequently with staff.
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