How do you ask a new patient about sex and gender—or know which pronoun to use? Keep the conversation straightforward and respectful to put everyone at ease, says Morgan Orndorff, a transgender man who works as an administrator at a major academic medical center.
“Everyone is a little different in terms of their sensitivity level” when it comes to talking about sex and gender, says Mr. Orndorff, senior new patient intake coordinator at Johns Hopkins Medicine Division of Rheumatology in Baltimore. Mr. Orndorff told his parents that he wanted to have a sex change when he was six years old. He is now going through transition therapy. At Johns Hopkins, he builds each new patient’s chart in the hospital’s electronic health record (EHR) with information on sex at birth, gender identity and preferred pronoun.
Rheumatologists and rheumatology health professionals need to clarify sex and gender with new patients who are transgender, intersex or genderqueer (see the sidebar below, for definitions of these and other related terms), says Mr. Orndorff. He suggests starting by asking the patient’s name and preferred pronoun, followed by any important clinical questions. Rheumatologists need to know if a patient has female sex organs and could become pregnant while using a teratogenic drug, such as methotrexate, or if a patient is taking hormones for transition, which can affect bone and cardiovascular health, he says.1
Existing labels regarding gender and sex often fall short, says Mr. Orndorff.
“I don’t even like the word transgender. I feel like a straight male. Times have changed drastically,” he says. “It’s a different day and age now. I know my physicians want to give me the best care possible.”
Get to Know Each Patient
The patient intake process is a good time to explore gender and sex, says Jillian Rose, LCSW, MPH, assistant director of community engagement, diversity and research at the Hospital for Special Surgery in New York.
Intake forms should include questions about the patient’s sex at birth, gender identity, preferred pronouns and sexual orientation. “Knowing the answers to those questions allows clinicians to refer to patients with dignity and respect, and fosters trust from the beginning of the medical encounter,” says Ms. Rose. This knowledge may also help the rheumatologist ask questions about issues that may “disproportionately affect this population, such as substance abuse, mental health concerns and appropriate hormone use, that can impact care.”