After a recent language lecture, a student wrote:
Hi Kate, I’m a student in a pretty old-fashioned area, and I often see patients who aren’t familiar with gender diversity or LGBTQ+ identities. I want to provide inclusive care, but I’m not sure how to bring that up without making anyone uncomfortable. Any advice?
-Respectful in Rural Practice
Thanks for asking, Respectful! You’re naming something many students—and seasoned providers—struggle with.
In the lecture, we talk about introducing ourselves with our pronouns as one way to signal that it’s safe for patients to share theirs. That simple act can help build rapport and guide a more accurate, personalized care plan.
Of course, not all patients—or providers—are comfortable with this. If you want to show you’re a safe and respectful provider for people of any gender identity, but don’t want to ask outright, try saying, “How would you like me to refer to you during the visit?” This phrasing gives space for those who want to share more while feeling neutral to others.
Helping anyone feel safe in your presence—while also protecting your own comfort—is a balancing act. Each provider has to decide what feels right based on their comfort level, the setting, and their patients’ likely reactions. There’s no way to guarantee you’ll never offend anyone or that every patient will feel fully supported. Your responsibility is to practice in ways you can ethically and professionally defend.
When someone reacts negatively to a question about pronouns, remember that discomfort often reflects their own history—maybe a loved one’s identity or unspoken feelings about self-expression or belonging. It’s rarely about you personally. Staying calm and kind helps the moment pass.
In smaller or more traditional communities, there are just as many transgender and queer people as in bigger cities (proportionally)—but they often have less information, fewer role models, and fewer sources of support. It’s also important to remember that you can’t always tell someone’s gender identity or sexual orientation by looking at them. A person who is transgender may present in a way that aligns with their sex assigned at birth, especially in communities where being open about identity can carry risk. That doesn’t make their identity any less real.
The few safe, affirming interactions they do have carry extra weight, so your warmth and respect—even in a short visit—can make a real difference.
You don’t have to be the only source of that support. Small, visible actions can help signal allyship, such as:
- Wearing a small inclusive Pride or “safe space” sticker or pin (if you feel comfortable and safe doing so).
- Attending or helping with a regional Pride event or community health fair.
- Staying up to date on inclusive health practices and terminology, so if someone does open up, you can meet them with confidence and understanding.
If anyone questions why you asked about a name or pronouns, you can simply say, “I ask everyone because identity can affect a person’s health, comfort, and how we communicate. It helps me give the best care possible.” That’s completely within your professional scope.
Ultimately, how and when you bring up these topics depends on your judgment and what feels sustainable for you. Supporting patients includes supporting yourself, too.
Thanks for what you do,
~ Kate