5 Easy things to make your clinic shine more brightly

Hello all of you beautiful tungsten atoms! After meeting so many of you this weekend, I know that you all bask in the diversity of your patient base. You look around at your treatment room and grin at the variety of economic, racial, age, professional, and etc., etc. profiles of your patients. It sure takes a full spectrum to make a bright light! I’m writing here to bring you another slice of the rainbow. You can do these five easy things to make your clinic even more GLBT friendly: 

1. Post a non-discrimination statement on your website and hang it in your office.
2. Make your health history forms friendly.
3. Remove gender from your bathrooms.
4. Get to know your local GLBT community.
5. Learn some more.

Following is more detail on how and why to do each of these. This material was developed for the CANference 2011, and was delivered in a breakout session on Sunday. All of the following is also in the handouts:

1. What: Post a non-discrimination statement on your website and hang it in your office.

How: Here’s a sample from the AMA:
“This office appreciates the diversity of human beings and does not discriminate based on race, age, religion, ability, marital status, sexual orientation, sex, or gender identity.” Get bonus points for adding “height, weight, national origin, language, education, HIV status” to the list.

You can also hang a “Safe Zone” poster in your window. You don’t need a fancy one – you can find an example online and hand-make one – just include a pink triangle and the words “Safe Zone.”

Why: The GLBT community, and Trans people in particular, often experience medical facilities and medical personnel as hostile, disrespectful and/or derisive. As a means of self-protection, many of these people will “screen” your clinic to see if there’s any clue that you might be open and responsive to their needs. This screening may be a visit to your website, and e-mail, a phone call, a walk-by, or any number of creative ways to find out who you are and what you stand for.

2. What: Make your health history forms friendly.

How: Use one all-inclusive form rather than separate M/F forms. Don’t label the sections “male” and “female” when asking about prostate, menses, etc. Group the questions for your convenience, and label them as “fill out if applicable”
Leave a blank for “relationship status”.
Don’t ask “gender,” which is not about biology, ask “sex” and leave a blank for people to fill in rather than simply M/F options.
If you are talking to a patient and are not sure what pronoun to use, just ask.

Why: Transgender people may need to enter medically relevant information in both the “male” and “female” sections of their health history. One unified form lets these folks know that they are welcome and expected. Also – a friendly form is more likely to elicit more honest answers. For example, a trans-man who has to choose between gendered forms will likely choose the male paperwork, leaving no opportunity for the two of you to discuss menstrual issues. Likewise, a trans woman will most comfortably choose the women’s intake, leaving you no natural opportunity to talk about prostate health. Trans people may identify as simply M or F, or as MtF, FtM, genderqueer, or any number of variants.

3. What: Remove gender from your bathrooms.

How: If you have more than one, and they are single-stall, label each of them as all-gender bathrooms. If your facility has multi-stall bathrooms, be sure there is at least one single-stall bathroom and that it is labeled as all-gender. This will also be helpful for parents attending differently-gendered children, and caregivers attending differently-gendered persons with disabilities.

Why: “Some people often feel uncomfortable when using segregated restrooms. Female/male sex-segregated bathrooms are not accessible spaces that everyone can use. Many people are subject to harassment, intimidation, legal charges, and violence on an every day basis.
Transgender, genderqueer, and/or gender non-conforming people are particularly affected by bathroom segregation because of the visible gender differences that may not correlate with cultural gender norms. Even in cities, towns, and college campuses that are generally considered “liberal” places where it is “easier” to be gender non-conforming, many people are still harassed in both women’s and men’s rooms.”

Transgender Law Center, “Peeing in Peace: A Resource Guide for Transgender Activists and Allies” https://www.transgenderlawcenter.org/pdf/PIP%20Resource%20Guide.pdf

4. What: Get to know your local GLBT community

How: Find your local GLBT Community Center:

Connect with your local PFLAG Chapter: Parents, Families, and Friends of Lesbians and Gays:

Consider setting up a booth at your annual gay pride event, or using some of your marketing dollars to sponsor events through the GLBT center.

Why: Many GLBT centers maintain a resource referral list, whether formal or informal. It is common practice for GLBT folks to use these lists to find friendly practitioners for services from healthcare to babysitting to tax prep help.

5. What: Learn some more

How: If You Want to Learn More about Transgender Issues, and You Have:

5 Minutes:
Read: “Top 10 Things Transgender Persons Should Discuss with their Healthcare Provider” A publication of the Gay and Lesbian Medical Association, attached and at https://www.glma.org/_data/n_0001/resources/live/Top%20Ten%20Trans.pdf

20 Minutes:
Watch this YouTube Video on Transgender Basics. It is informative without being at all dry or didactic. It is very well produced and clear, and I found the people interviewed to be witty and admirable: https://www.gaycenter.org/transgenderbasics

90 Minutes:
Watch this 2001 documentary: Southern Comfort, available by mail from Netflix. It is about Robert Eads, a Transgender man who was denied medical care by over 20 doctors, and eventually succumbed to ovarian cancer. This is a nice personal profile documentary – it doesn’t drag the viewer through the tortuous medical path Robert had to tread, but rather paints a compelling and warm portrait of Robert and about half a dozen of his friends and family as they live out their lives as gender-variant people in the American deep South.

If You Want to Learn More, and You Like to Read Fiction:
Middlesex, by Jeffrey Eugenides – 2007
Stone Butch Blues, by Leslie Feinberg – 1993

If You Want to Learn More, and You Like to Read Non-Fiction:
Gender Outlaw: On Men, Women, and the Rest of Us, by Kate Bornstein – 1995
Gender Outlaws: The Next Generation, by Kate Bornstein and S. Bear Bergman – 2010

Why: Most GLBT folks would love to walk into a clinic knowing that they don’t need to educate you about the basics of their identity, their relationships, or, for Trans people, the unique health issues related to their hormone levels or surgeries. Don’t expect them to educate you, though some may be willing. It is a classic marker of privilege to demand that those who are not similarly privileged educate us about their struggles.

But, I don’t see many of these people… Where are they? Trans folks often avoid health care offices whenever possible. They avoid going to the dentist, they forego regular health checkups and screenings, and even if they do come in, they may not reveal their trans status if at all possible – because it has not been safe or comfortable.

Based on our best guess at total population percentage, here’s how many trans folks you can/will see if you are successful in breaking down the barriers to healthcare:
Pxs per week   Pxs per year   Trans Folks/year   One every
30                  1,500             10                       5 weeks
50                  2,500             16                       3 weeks
80                  4,000             26                       2 weeks
100                5,000             33                       1.5 weeks
200              10,000             65                        Week or less
400              20,000           130                        2-3 days

In summary,

Point #1:     GLBT folks are still subject to serious discrimination. Trans folks in particular have been subject to extreme prejudice. Besides daily discrimination in employment, housing, credit, civil rights, and access to basic public accommodations, they suffer a murder rate that is 17 times the national average.

Point #2:
    We will have the opportunity to help these people.

Point #3:     We will lose that opportunity if we are not prepared. They will screen us, and only come in if we “pass” the screening.

Point #4:     We have an ethical responsibility, and therefore an amazing opportunity, to reach out and compensate for a social injustice.

Shine on, people!

Author: MichelleRivers

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  1. Michelle, you are amazing!

    Michelle, you are amazing! This is a fantastic resource. Your patients are so lucky to have you in their community.


    xox Demetra 

  2. .

    This breakout was definitely one of the best ones I was able to attend. SO helpful personally and full of great information for the clinc. Thank you. First project since getting home is getting TCA Awesomified. I la la love michelle, shiny eyed she is.

  3. This is great!

    Thank you Michelle.  I was going to call/email with some questions since I did not get to attend your class.  You have answered almost all of them with this helpful post.  We changed all of our paperwork in our first year to include/take out most of what you address.  The exception is the sex/gender question…..or in our case fill in the blank. Our paperwork looks like this.

    Gender___________   People can put what they wish or put nothing at all.  In the case of trans or genderqueer folks my thinking is that this gives them a chance to tell us how they identify.  It also gives us a sense of pronoun preference if that is not otherwise clear.  Is there something I’m missing?  Let me know your thoughts as I value your input and opinion. When I heard you mention the non-discremination statement that was a big “Duh” moment for me.  We know we’re friendly but that doesn’t mean anyone else does!


  4. thanks

    Thanks, Demetra. I’m always available for brainstorming specific issues that might come up in anyone’s clinic. I am hoping that this will be the first of a series addressing underserved populations and how we can be even more accessible. I know I’d love to be in the audience and hear people talk about breaking down a number of other barriers.

    – Michelle Faucher, Chico Community Acupuncture

  5. duh moments

    Hi Whitney,

    Yeah, the non-discrimination statement was nig big duh moment for me, too, as I was prepping for this talk. We’ve got a brand new website about to launch as soon as I come up for air, and it will have one (finally).

    I think your fill-in-the-blank does the job nicely. Feel free to contact me if you want to throw more ideas around. I still need to come in for the full OAP experience – that’s happily on my to-do list! 

    – Michelle Faucher, Chico Community Acupuncture

  6. This was the most valuable breakout for me, too!

    Somehow the short description of the class didn’t adequately describe the huge shifts in attitude and insight generated by Michelle’s presentation.  Great job, Michelle!

  7. sex vs gender

    Hi Lumiel,

    Thanks for the kind words about the breakout session.

    The most important thing is to have a fill-in-the-blank.

    In my handouts, I have recommended asking patients to identify their sex, and leaving a blank. That’s because a person’s sex relates to their physical body parts and hormonal makeup, which is relevant medical information. Knowing how a person identifies in terms of gender is important for deciding what pronouns you might want to use to refer to them in order to convey your respect. Gender is a word we most often use to talk about a phenomenon that is socially and culturally determined. That being said, I didn’t suggest that Whitney change the forms at OAP from inquiring about gender, because it was clear from the post that the information was being used by OAP staff to choose pronouns, which is where understanding a patient’s gender identity is helpful.

    In the detailed medical history part of the intake, most of us will ask about menstrual history, prostate health, etc., and will therefore be able to get the information we need about a patient’s sex through those questions about reproductive health.

    Again, the important part is the blank.

    – Michelle Faucher, Chico Community Acupuncture

  8. Thanks for posting this

    Thanks for posting this here!  I’ll just be another voice adding to the chorus of appreciation for leading that session.  Really good stuff.

  9. This is an excellent post

    This is an excellent post for doctors who want to have a successful clinic. I agree that understanding your target patients will give you a bright idea on how you could retain existing patients and possibly get new patients. By the way, I came across a useful post on how to fix patient retention. Would you mind if I post the link here?


  10. Since some of the above links are old & not functional, I thought I’d put the new links to the material here:

    The link to the handouts didn’t work but I don’t know how to access those.

    Peeing in Peace: https://transgenderlawcenter.org/issues/public-accomodations/peeing-in-peace

    Top 10 Things Transgender Persons Should Discuss with their Healthcare Provider: https://www.lgbt.ucla.edu/documents/TopTenTrans.pdf

    Transgender Basics: https://gaycenter.org/wellness/gender-identity#transgender-basics

    Hope that helps y’all out!!