Scenario 022: An attending repeatedly misgenders patient 

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Scenario:

The Attending, a cis woman, is talking to the MAs, CNAs and RNs about a patient in the other room. As she talks about the patient to the ED team, she misgenders the patient several times and others respond by using the patient’s correct pronouns. The attending does not seem to recognize these moments and does not change her language in subsequent conversations. 

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. Although the patient is not in the room, this incident still needs to be addressed.  Being misgendered can make a person experience feelings of invalidation and distress, as being misgendered can deeply impact their sense of identity and belonging. This matters because patient dignity and respect are fundamental to quality care. People in our community who have experienced this microaggression have expressed concerns that providers not getting their pronouns right cannot be trusted to take care of their health. Not acknowledging a patient’s identity can erode trust in the healthcare system. 
  2. While the patient is not present, there may be staff or providers in the room who may also have a gender identity that is marginalized. It can make those people feel like they do not belong. It can also erode the trust within the healthcare team and damage interpersonal relationships. 
  3. The Attending might not be aware or realize that the rest of the team is responding with the correct pronouns in order to correct her. She might not even be aware of her impact. However, repeated misgendering can lead to feelings of frustration and discomfort. Other members of the medical team may worry about her interactions with the patient, feeling compelled to advocate for respectful treatment while also navigating their relationship with a senior physician. This can create a challenging dynamic, as they may feel caught between supporting the patient and respecting authority  

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. You could interject during the meeting, saying, “Just a reminder, the patient uses [correct pronoun].” This reinforces the importance of using the correct pronouns and explains to the Attending without creating a confrontational atmosphere  
    2. You could work to create a system where all people in the room have their pronouns in view including the patient with a sticky note or white board. 
    3. After the meeting, you might approach the Attending privately, acknowledging that correcting someone in front of a group can be uncomfortable. You could say, “I noticed that you misgendered the patient earlier. I know you appreciate the importance of remembering their pronouns to provide the best care, so I want to share this with you respectfully.” 
    4. You could also advocate for creating a more inclusive environment by suggesting team training on gender identity and the importance of pronoun usage. 
    5. You may tell your supervisor or document using the bias reporting form.  Note: You may be concerned that this would potentially constitute an escalation. First we do not want to encourage the every-day use of this response as an intervention strategy, but it is important and appropriate in specific contexts, especially if other strategies have failed and the problem is continuing.  Also, it should be understood that a report to the bias reporting tool (BRT) does not automatically produce an HR or other disciplinary response.  The BRT committee explores each report as a unique instance and does not escalate to an investigation or possible discipline unless appropriate.  They aim to respond to each report restoratively, maintaining strong working relationships among those involved as much as possible.
  2. What obstacles might get in the way of you intervening? 
    1. You may worry that explicitly correcting a senior physician could lead to negative consequences for your standing in the team or even your career. 
    2. In addition, you may worry about doing this in front of other members of the team. 
    3. You might worry that your correction could be misconstrued as an overreaction, leading to more misunderstandings or awkwardness. 

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You could say, “I apologize for repeatedly misgendering the patient; I appreciate your corrections and will educate myself more on this topic.” 
  2. Engaging in training regarding the importance of respecting patient identities, demonstrating a willingness to learn and grow from the experience 
  3. You could say “I’m sorry I was dismissive of the patient’s pronouns. I will make a note on my sheet so I can practice getting it right”