In recent years, healthcare centers have starting understanding the importance
of incorporating sexual orientation and gender identity (or SOGI)
in their medical records.
Traditionaly, one's assigned sex at birth is the biological sex
which depend on their sex chromosomes.
If they have a Y chromosome, their biological sex is male.
If they have two X chromosomes,
their biological sex is female.
However, things aren't that simple.
For example, a person could have a Y chromosome
but their missing specific genes,
that encode for specific male characteristics
So, even having chromosome only male,
they appear as what we stereotypicaly describe as female.
So, you're thinking biological sex can be linked back to genes, right?
Well, things get even more complicated than that.
Some genes get expressed at high levels
and others at low levels.
So, a person may have genes that express a high level of testosterone,
and little or no estrogene or progesterone.
Or vice versa.
Finally, hormones like testosterone, estrogene or progesterone bind to receptors.
And some people may have lots of receptors that can easily bind to hormones
While others may have very few receptors.
In many cases, these peoples are intersex individuals
whose body do not fit into the standard definition of male or female.
The bottom line is that biology is messy
and like most things, biological sex exists on a spectrum.
Now, separate from the biological constructed sex
is gender identity and gender expression.
Gender identity is a person's own sense of their gender
and gender expression is how they present themselves to the world.
Many people identify as either men, or women.
But there are also various types of non-binary gender
or gender identity that lie outside of the man-woman dichotomy.
For example, someone could identify as multiple genders
such as natives or indigenous two-spirits too.
Furthermore, some well identify with a gender that's neither male or woman.
While others may have a more fluid gender identity.
Some individuals identify themselves as transgender,
when their gender identity is discordant from their sex assigned at birth.
Meanwhile there are people who don't feel any of these labels describe them
or don't like the idea of identifying with a specific gender at all.
Neither biological sex nor gender identity determines the person's sexual orientation.
This concerns with gender or genders an individual
is sexually and/or romantically attracted to.
An individual can be heterosexual
which mean they are attracted to a different gender.
Or they are attracted to the same gender, and the prefered term is gay, not homosexual.
An individual can also be bisexual, meaning attracted to two or more genders,
or pansexual, meaning that they are attracted to any gender.
Some people identify as asexual,
or they may not experience sexual attraction to anyone.
Finally, terminology continues to change and evolve.
And words that people use to describe their sexual orientation
is ever changing and evolving as well.
Now, depending on their gender identity,
any person can chose the pronouns that suit them the best.
Commonly used pronouns include he / him / his,
or she / her / hers.
Often a person can chose the pronous they / them / theirs,
which are more gender neutral.
And you can use these pronouns when talking about someone whose gender you don't know.
For instance, you might say:
"this patient's name is Sam, they have diabetes and they're here for a follow-up on their new medication".
Not only that is considered as grammatically correct
but pronouns like "they" have been used to refer to singular personal pronouns
for hundreds of years, even by famous authors like Shakespear and Jane Austin.
When someone changes their gender expression
they may chose to go by a new firstname
and may even regard their previous firstname as a "deadname".
Alright, now, many individuals have to face a daily struggle of being referred to by the wrong pronoun.
This is known as being "misgendered".
Imagine a following scenario.
A transgender young woman named Esther is in a waiting room,
and a clinician yells across the room
"Mr. Albert Kim, please follow me".
Being referred to by the wrong gender, or deadname, or both,
can cause a deep sense of shame, loss of self esteem,
and leads to harassment and discrimination from others,
even from healthcare staff!
This is especially true if that information is declared publicly.
That young women might not want to come back to the clinic and might even feel unsafe,
now the others are aware that she is transgender.
In fact, based on the 2011 National Transgender Discrimination Survey,
28% of transgender patients postponed medical care due to discrimination
19% are refused medical care altogether,
and 28% experienced verbal harassment by medical professionals.
That's why, in a healthcare setting, it's essential to collect SOGI data,
or a person's assigned sex at birth, gender identity, and their pronouns,
without making assumptions based on their name, appearance or behavior.
Also make sure that these are documented in electronic health records,
or EHR, for other healthcare workers.
Now, gathering SOGI data and referring to a person as they wish
can take an additionally thirty seconds or so,
but this is time well spent.
Simply saying "I want to address you the way you want to be addressed. Can you tell me your name and pronouns?"
can make them, and their families, more comfortable,
and trust that they're getting the best care possible.
It's important to note that SOGI information can change over time,
so it shouldn't be considered fixed.
If you accidentally refer to a patient using their wrong pronoun or their deadname,
it's important to apologize,
correct the mistake,
and go on using the right pronoun, and their chosen name.
Okay, now in a healthcare setting,
sometimes administrators ask for a patient's assigned sex at birth
for insurance or billing purposes,
and that is often confirmed with an identity document such as a driver license.
Administrators can also ask for their gender identity and pronouns.
However, sexual orientation is considered private, or sensitive information,
and can only be asked by the clinician responsible for the patient,
and only, if it's relevant to the patient's care.
Alright, here's a quick recap'!
Healthcare systems collect and report sexual orientation and gender identity data, or SOGI data,
from their patients.
Sexual orientation refers to whom you are sexually and/or romantically attracted.
While gender identity is about how you identify yourself,
and sex is about biology.
It's also important to ask someone which pronoun to use when referring to them.
Collect these data is essential to show respect to patients and their families,
but also to understand the differences individuals with a particular sex or gender identity can have.