Mr. Mrs. Ms. or…….?

One of our goals with Oasis Discussions is to host conversations about topics that are important for our profession to address today and tomorrow. A good starting point for such a conversation (which may be uncomfortable) is to it with a question from a Canadian dentist. Just below is a question I recently received from a colleague who takes great care to communicate empathically with all patients.

Question from a colleague in private practice (placed in context):

“At our office, we are updating/revising our health history form. At the starting point of our form, we ask patients to fill out the general stuff: name, address, phone numbers, etc. But we also ask them to circle Dr/Mr/Mrs/Ms/Miss/Master. I know, it’s a bit “old school” perhaps to be even doing so, but we do have a lot of older patients and I do refer to them as “Mrs so-and-so” it “Dr such-and-such.”

In the age of progressiveness, and gender neutrality, and inclusion…is this still appropriate? (I think yes), So, if yes, what is the prefix we provide for the gender neutral or transgender person, or person who doesn’t wish to be identified by gender? Google is suggesting “Mx” or “other”. Do you have a definitive on this? It’s a subject I don’t want to get wrong, on paper or in person…”

Initial response from Dr. Mario Brondani of the UBC Faculty of Dentistry:

I am glad to know that you are always ahead of the curve, John!

When we run the session on sexual health here, the presenters (who are experts on the subject) usually advise to:

1) if you do not know, ASK;

2) never assume gender (sex – biological) or identity (how they define their own gender) based on the way people express their gender (clothing, mannerisms, voice, etc). Gender is not binary, and it is not either/or – it can be both/and;

3) ask yourself: is it necessary to know the gender (biological) of this person? If yes, never assume ‘gender’ based solely on the way people dress, talk or look;

4) ask yourself: is it necessary to know the gender (identity) of this person? In a dental office, probably not, unless you would like to know how to properly address this person using the correct pronoun. In this case:

a) in terms of the correct pronoun, the best approach is to ask: ‘If I would like to/have to use a proper pronoun to refer to you, which would you like me to use?’ If you would like to know without asking, have a similar question in your intake form: ‘When referring to you by a pronoun, which would you like our office to use? ________’ (blank option is best);

b) avoid using the gender-bound pronouns (Mr., Ms, etc.) based solely on the way they ‘look’ or on the name that appears on the form (as patients usually fill out the forms before seeing the dentist).\

c) in terms of needing to know the bed partner (for sleeping patterns purposes), use neutral terms like partner or spouse or bed partner instead of husband or wife.

5) ask yourself: is it necessary to know the relationship status of this person? If yes, for emergency contact or in case you would like to investigate sleeping habits (bruxism, apnea). If so, have the intake form/medical history with a blank space ______ for gender instead of the usual (  ) Male, (  ) Female, (  ) Other.  

Do you, the reader, have other suggestions for how to handle this delicate communications challenge in practice?

Dear colleagues, I would love to learn how you manage delicate communications challenges in your practice and what protocols you believe hold out the greatest promise of success based on your reading of the literature and your clinical experience. Please don’t hesitate to meet me for a friendly, casual conversation at www.zoom.us/j/6136144798 (my video meeting space). I love learning the perspectives of colleagues, especially when I can share them. Sincerely, John