Ask, don’t assume: Things to avoid

“When I was hospitalised in the ward, I don’t know if it was meant to be like, respectful or what, but they kept overly using gendered terms. And in the ward, I was too scared to tell them that I was trans because I was essentially trapped.”

from Trans Inclusive Healthcare? Trans people’s experiences accessing healthcare in the UK (2024)

When we make assumptions about people, it has the potential to be harmful. In a hospital, staff might make assumptions about a patient’s gender or their body based on their voice, their name, the gender marker on their medical record, or on their appearance. In the case of trans people, these assumptions are frequently incorrect. Many of these assumptions may also commonly impact intersex people and people who don’t conform to gender stereotypes too.

Often your assumptions might cause you to misgender a patient. That is, referring to them using the incorrect pronouns or gendered language. For trans people, the experience of being misgendered can trigger feelings of dysphoria and be extremely distressing. Some assumptions, of course, may have significant clinical implications which extend beyond the experience of dysphoria.

Here are some common assumptions that people make and alternative ideas which will  help you avoid making them.

This patient is a man, he’ll need a urine bottle.I don’t know if this person will be able to use a urine bottle, I’ll offer a choice of urine bottle or bed pan.
This person is dressed in a feminine way, so I’ll refer to them as ‘this lady’.I’ll refer to the person by their name, or ‘this person’ if I don’t know what they’re called.
This person has a deep voice, but I’m trying to phone a woman. It must be her partner, I’ll ask if their wife is available to speak.I don’t know who I’m talking to, so I’ll ask to speak to the person I’m trying to call by referring to the patient by name.
I don’t need to ask this man if he could be pregnant.I don’t know if this man is trans or not and it’s important to know if someone is pregnant for this procedure. I’ll ask him whether there’s a chance he could be pregnant and explain that it’s something that we ask all our patients before this particular procedure.
This person has ticked ‘Mx’ for a title, but they look like a woman to me. I’ll correct it to Ms.I’ll trust that the patient checked over the paperwork before giving it back to me.
My patient hasn’t arrived yet, the only person in the waiting room is a woman and I’m meant to be seeing someone about a suspected issue with their prostate.I’ll call the patient’s name, it’s possible that the woman in the waiting room is trans.
This patient is non-binary, I’d better find out if they’ve had transition-related surgery.Either: This condition could not be impacted by my patient having had transition related surgery, I don’t need to ask them about it.   Or: This condition could be impacted by my patient having had transition related surgery. I’ll ask them about it, but explain why I’m asking.

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