Carolanne Wartman, PharmD, BCPS, BCPP (she/her)
Clinical Assistant Professor of Pharmacy Practice
The University of Mississippi School of Pharmacy
Jackson, MS
Dr. Wartman (she/her) graduated from Purdue University with her PharmD in 2020. She completed a PGY-1 Pharmacy Practice residency at the University of Michigan and a PGY-2 Psychiatric Pharmacy residency at Eskenazi Health/Purdue University. During her PGY-2, she provided outpatient services on her rotation in Eskenazi Health’s Gender Health Program and published research on the role of a psychiatric pharmacist in this space. She continued this work in her new role by serving as the psychiatric pharmacist at the University of Mississippi Medical Center’s Trustworthy, Evidence-based, Affirming and Multidisciplinary Care (TEAM) Clinic, through the Center for Gender and Sexual Minority Health, before it was disassembled. Despite losing this clinical practice, she continues to advocate for sexual and gender minorities by serving on AAPP’s diversity, equity, and inclusion (DEI) Committee and as the DEI Community Co-Leader, in addition to continuing scholarly efforts in this space.
How do I ask patients about sexual orientation and gender identity (SOGI) information, without causing offense?
Never make assumptions. When addressing someone, refrain from using gendered titles (e.g. Mr./Ms., sir/ma’am) until you know how they would like to be addressed. When introducing yourself to any patient, irrespective of their sexual or gender identity, it is considered best practice to first share your own name and pronouns and provide the space for others to share theirs, if comfortable. This approach establishes a foundation for clear communication and expectations and can passively identify that person as a safe person to discuss SOGI-related matters. For instance, you could say, “Hello, I am Dr. Wartman and my pronouns are she/her. How would you like me to address you?” The term “preferred pronouns” is no longer favored as it implies a hierarchy of pronouns. It is more inclusive to keep the introduction open, allowing individuals to share as much or as little information as they are comfortable with. Some people may prefer not to use any pronouns at all.
Many electronic medical records now include a specific location for SOGI information in the heath record. Collection of SOGI data should be a routine practice to ensure the health care team is referring to patients with the most up-to-date demographic information. Sexual and gender identity is fluid and may change over time, emphasizing the need for regular inquiry to maintain rapport and trust with patients. One practical approach is to have patients update their personal information, including SOGI details, at registration for each interaction, similar to how insurance and other health-related information is updated. Utilizing written documentation as opposed to directly, verbally asking may make the patient feel more comfortable to disclose this information.
Remembering that we are all human is crucial, and making mistakes is inevitable as we continue to learn and grow. If you do make a mistake when addressing someone, a simple apology, correction, and moving on is sufficient. It may be tempting to press on about how bad you may feel, but prolonged apologies can inadvertently place the burden of comfort on the patient. A concise apology and correction go a long way.
How can I create an inclusive environment for sexual and gender minorities (SGM)?
Patients who identify as SGM (e.g. people who identify as bisexual, transgender, Two Spirit, asexual) often report negative experiences with health care professionals and difficulty accessing care when needed.1,2 As a result, they may avoid seeking care altogether or approach health care settings with apprehension. The initial impression patients receive upon entering a health care facility significantly influences their overall experience. Small gestures like displaying pride flags or LGBTQIA+-friendly signage and having pronouns visible on badges may help patients feel more at ease at your location. During interactions, respecting an individual’s gender identity by addressing them as they wish to be called is one of the simplest and most effective ways to show respect. In general, it is advisable to adopt neutral and inclusive language in communication, such as using “chest” instead of “breast” and “you all” in lieu of “you guys.”
Numerous organizations and resources are available to provide guidance and improve patient access. For example, the Human Rights Campaign has developed the Healthcare Equality Index (HEI), which evaluates health care facilities nationally based on their policies and practices for LGBTQ+ patients, visitors, and employees.3 On an individual level, health care providers can join national provider registries that help patients find providers who are allies of SGM, such as OutCare’s provider directory and the LGBTQ+ Healthcare Directory.4-5 These actions can have a broad impact and assist patients in locating quality care. Personally, I have received inquiries from patients in other states seeking assistance in finding an ally in their area.
The key takeaway is to treat all patients with dignity and respect regardless of their defining characteristics. We are all human and deserving of empathy, compassion, and high-quality care.
How do I advocate for SGM?
The most effective way to advocate for SGM is first to stop and listen. We cannot effectively advocate for a population without first hearing their voices. Stay informed by attending continuing education events, participating in diversity, equity, and inclusion initiatives, and seeking guidance from experts in this field. We are all continuously learning in this evolving landscape, and I would be amiss to say that I have gotten to where I am without guidance from others working in this field. Many professional organizations offer resources, guides, and continuing education credits on caring for SGM, such as the American Pharmacists Association and the American Society of Health-System Pharmacists.6-7 The need for self-directed learning and advocacy cannot be overstated.
Stay informed about legislature at both the state and national levels. Unfortunately, politics can have a significant impact in this realm and may jeopardize the safety and mental health of SGM. Continuously speak out against legislation that could restrict access to quality care for all people. As pharmacists, we have taken an oath to hold ourselves accountable and advocate for change to enhance patient care. Lead by example in your practice and set a standard for others to follow and emulate. If you notice a colleague misgendering someone, kindly correct them and move forward. Show grace to one another as we continue to learn and grow.
