“And do you have a husband at home?”
“A wife, actually.”
“Oh, excuse me. And how long have you been with your mate?” the physician answered. He was unflustered and looked expectantly at the female standardized patient sitting across from him. For the remainder of the interview, when it came up again briefly, the physician referred to the patient’s wife as her mate.
In just the last few months, I’ve read a thoughtful essay contrasting biological sex and gender and a piece on the shortcomings of health care providers in caring for queer patients. Literature on discrimination (particularly sexism, racism and heterosexism) in medical school and in the medical field is easy to find. Now a growing body of academic work, anecdotes and political history has revealed that medical education is comfortably rooted in a system that presumes traditionally privileged demographics: cis-gendered, heterosexual, slim, able, neurotypical, literate, white, male, wealthy. Often, what is not labeled as default is labeled as abnormal at best, and pathological at worst.
My chief concern is not in why we prioritize social justice — for my purposes, the equitable distribution of wealth, opportunity and privilege within a society — but rather, what steps can be taken to further it, particularly as students, novices to medicine’s intensely hierarchical culture. Here, I’d like to examine the way that we use language: to include or to alienate, intentionally or from habit.
So what was problematic about the encounter above? A dictionary will tell you that “mate” and “spouse” are virtually synonymous, as are “lover” and “significant other.” The standardized patient didn’t get visibly upset. Most of us know, however, that these words carry distinct connotations, and that it takes a degree of self-assuredness to correct assumptions (perhaps more so the assumptions of someone in a position of relative power, like a health care provider). While many would view the encounter above as benign, that in itself points to the widespread acceptance of microaggression and the idea that it is the responsibility of the marginalized to educate. The patient may have answered, “No, I don’t have a husband,” and stopped there for fear of homophobia; the physician may have failed to collect pertinent information as a result of heteronormative language.
Moreover, the failure to outright recognize the patient’s marriage, particularly in light of same-sex couples’ fraught history and present, is callous. Denial of marriage as a civil right is one of many heavy oppressions that LGBT patients as a demographic are forced to bear, and which may play a role in their higher risks for several STIs, homelessness and suicide.
I’m convinced that to make progress toward alleviating health inequities, we need to actively change our language — at the bedside, in the lecture hall, in our homes. Political correctness is not the point. Critically thinking about language goes beyond doing the minimum and avoiding offense, and rather indicates genuine concern for those targeted. To be aware of language is to be aware of a fundamental measure of the status quo. Our choices of language are often unintentional, but almost always acknowledge deep-set assumptions. When someone uses sexual orientation and gender identification interchangeably in a speech or on a form, they may reveal biases or gaps in knowledge. In the words of a classmate, careless language is analogous to symptoms of disease. Careless language is a product of a larger scheme of how we differentially value others (whether it be racism or heterosexism), just as symptoms are produced by underlying pathology. Examining symptoms helps us to understand these larger problems. And within this analogy, a symptom, whether it is a high fever or the disappointment that follows hearing a slur, is itself the lived experience of the larger problem — it is the sting of feeling unwelcome, the nausea of degradation.
Think critically about language: the language that you use as well as the language that surrounds you. Is it inclusive? Is it informed?
Inclusive language is informed, stripped of assumptions, and intentionally represents diversity. An informed speaker has taken the time to learn preferred pronouns and allows the subject to self-identify. An unassuming speaker recognizes that family structures are diverse and that patients and peers come from wide varieties of cultures, financial means and educational levels, all of which impact communication and understanding. An intentional speaker incorporates all genders rather than addressing their audience with a bluntly divisive “ladies and gentlemen.” There are a variety of excellent online resources on inclusive language, including these guidelines and this set of frequently asked questions. They’re as worth reading as any set of clinical pearls.
Learning to be more inclusive with one’s own language is a constant process. Gracefully correcting oneself and accepting corrections is key to growth. So too is a persistent humility and openness; everyone should have the freedom to self-identify, without fear of judgment or stereotyping. It’s only a beginning step, but adapting our language to be more inclusive is essential to being compassionate, competent physicians. While it might be slow going, I’m optimistic that it is achievable.