Displaying Empathy through Gender-Inclusive Language

Bryce Ringwald, MD
Posted on November 20, 2023

Note: The opinions expressed in this blog post are the author’s and are not intended to represent official policy of the AAFP or the editorial staff of AFP.

Have you ever had your name mispronounced? Then you can appreciate, at least a little, the frustration nonbinary patients face when they are mislabeled by an identity they do not embrace. Misgendering is a problem that, to correct, requires a cultural shift toward gender neutrality. The discussion around nonbinary people is a newer phenomenon in the United States, but it has existed throughout history within multiple cultures. In Hindu society, nonbinary people—notably the Hijra, which are a major third-gender sect in South Asia—have played prominent roles for centuries,¹ including serving as prominent spiritual leaders. The practice of having a third gender was also common in Native American culture, which had and continues to believe in select two-spirit individuals who possess both masculine and feminine qualities.² Similar to the Hijra, these individuals were revered as shaman, healers, and leaders in their tribes.

The use of gender-neutral language has positive effects on making LGBTQIA+ people feel welcome, included, and respected in the health care setting.³ These inclusive practices have been shown to produce significant health benefits, such as continuity of care, adherence to screenings based on organs rather than gender, and reduced stress and depression.⁴ Collectively, gender-neutral language and inclusivity for all patients provides better whole-person care.

Recently, efforts have been made to neutralize gender-specific language in electronic medical records, intake forms, and personally by physicians, but a dire need for this language is still necessary. These efforts remain under constant threat of being labeled as “woke” or “grooming”; in the United States, the governor of Arkansas banned the use of gender-inclusive language in official government documents, citing parental rights.⁵ Similarly, Florida passed a law limiting teachers' ability to express their preferred pronouns to their class.⁶ And, yet, the Council of Science Editors⁷ and the United States Preventive Services Task Force⁸ are among the professional societies advocating for these changes that neutralize gender-specific language.

Misgendering is a microaggression, and, although the intent may be small, the repeated trauma is extremely impactful. The use of gender-inclusive language does not harm those who identify with a specific gender but is harmful for those who do not. Nonbinary patients deserve to be treated with the same respect provided to any other patient. By using gender-inclusive language, physicians show empathy to ALL patients, regardless of gender identity.  Family physicians can be part of the solution by focusing on using gender-inclusive language throughout their clinical and scholarly practices (Table 1).