How Should I Refer to Clients/Patients If I Don't Know Their Gender

“How should I refer to clients/patients if I don’t know their gender?” 

by Fátima Paredes, MA, LAC (fae/elle/they/ella/she) 

Setting intentions: 

I'm writing the following reflections based on personal and professional experiences and knowledge as a client, patient, and professional. I’m not an authority on the subject. I’m not a representative for the queer and trans community. I’ll probably miss some things, and I encourage any feedback to improve upon these reflections. My intention for sharing these reflections is to help professionals elevate the field towards a healthier environment for all, especially at a time when queer and trans folx are being actively targeted at individual and institutional levels. My reflections can be adapted to virtual settings as well; I can expand information about virtual accommodations in future reflections. 

What to say to somebody new who comes to your place of work: 

Ask queer and trans folx what our names and pronouns are! Preferred names and preferred pronouns don’t exist. We deserve to have our names and pronouns used and respected regardless of government or insurance documentation, or lack thereof. However, some folx may not be publicly out, so provide pen and paper if we seem shy or specifically ask you for something to write our name and pronouns on. Avoid honorifics such as sir or ma’am because they may not be politely received even if you think you’re being polite. Once somebody trusts you, your coworkers, and other people enough to share their names and pronouns openly, then you can use specific honorifics based on personal preference. “Məks,” “mɪks,” or “mix” work as an honorific for some nonbinary folx (i.e., mx). Either way, ask folx how they want to be addressed (i.e., sir, ma’am, miss, mx). Some agender, gender non-conforming, nonbinary, and/or trans folx prefer to be called by our first name, title and last name, and/or last name instead of by pronouns (i.e., Leslie, Dr. Doe, Smith). Accommodations help everyone, not just impacted communities! 

What to say when calling somebody back to the front desk and you don’t know their name and pronouns: 

If you didn’t personally interact with a client/patient as the first point of contact and you need to clarify or follow up on anything, then follow some of the aforementioned reflections. Call them by what they wrote on the intake and demographics forms, specific unassuming and discrete articles of clothing and apparel (i.e., red cap, brown jacket, yellow shoes), or approach them directly and ask them to come speak with you (i.e., privately, politely). Queer and trans folx can experience varying levels of dehumanization in medical and professional environments, so please approach each case individually. If there are productivity pressures at your workplace, then prioritize the human you’re intending to speak with over the line of folx behind them. If your workplace has resources for discrete buzzer tags, then you can provide them to people waiting in line or the lobby; you can activate the tag for the person you need to speak with, and the interaction can remain discrete and avoid overstimulation and/or anxious feelings. 

What to say when notifying somebody to follow you to their appointment room: 

If you haven't checked the intake form or met the client/patient prior to calling someone to follow you to their assigned room, then consider the previous reflections. If all else fails, then call out their last name or approach them directly. Ask the individual what their name and pronouns are when they come up to you. Greet them with warmth and a genuine smile. If you’re having a rough day at work, make appropriate jokes with them. Be honest and kind. 

What to say during phone calls: 

If you haven't been informed about the client’s/patient’s name and pronouns or failed to check the intake and demographic documentation, then jump right away to the security questions to vet whether they are the client/patient. This is important because some queer and trans folx aren’t out to our families, communities, workplaces, and similar first, second, and third spaces. Ask people for their phone number, e-mail, address, name on file (not legal name), and any other identifiable information from the intake and demographic forms. Don’t make the phone call experience dreadful for folx. Keep calls concise, professional, and accommodating. 

Important considerations for intake and demographic forms: 

It’s so easy to add a section to intake and demographic forms to allow folx to write their names and pronouns separate from their legal or insurance documentation. Also, allow people to write in their own gender instead of sex. You’ll have the documentation to address bioessentialist considerations such as sex and such another time. If your EHR, EMR, or any type of digital and/or analog health/medical records lack the capacity to allow for such accommodations, then it’s time for a switch/upgrade! If somebody writes something that doesn’t have a box on the forms, then take that written information seriously and add it to relevant clinical, administrative, and/or office notes. Sticky notes exist! 

Important considerations in relation to insurance filing and human connections: 

If the client/patient corrects you if you got their name and pronouns wrong, then apologize and move on! Don’t say things like, but not limited to, “well, this is how we report to the insurance,” “we must use the information matching your ID,” or “this isn’t what I was trained on.” Doubling down is a surefire way to secure a transmisia/queermisia (transphobic/queerphobic) reputation amongst the local queer, trans, and progressive communities, in addition to hemorrhaging client/patients and workers (while perpetuating medical trauma)! Handle the insurance filings behind closed doors; don’t subject clients/patients to further dehumanization, especially if they didn't come out or change their documentation (which can be lengthy, exhausting, and expensive). 

Important considerations to maintain a healthy work environment: 

New Jersey may be a state which makes legal name changes relatively accessible. However, queer and trans folx are being targeted across the country and parts of the world. Some queer and trans folx may not feel safe or may not give legitimacy to changing our names through legal means. Stop asking queer and trans folx if we thought about changing our names legally. Respect us for who we are and what our choices are! Focus more on internal trainings, accountability protocols, and general procedures/policies without putting the onus and burnout onto the shoulders of queer and trans folx. Flags, stickers, and pins can help, but what matters more is how you approach our community while humanizing us as individuals. We are not monoliths. Get out of your comfort zone and do more to make queer and trans folx feel like we can (maybe) let our guards down for at least a minute or two.