Case 1: Tim

You are a physician in an urgent care clinic and your next patient has just arrived. The nurse tells you, “This
young man fell off his skateboard and is complaining of shoulder pain.” You go into the room to start your
history and exam and see a shaggy-haired, skinny young teenager wearing a Volcom t-shirt, jeans, and a
beanie. Looking back down at the chart the nurse gave you, you see it says the name ‘Tiffany’ with gender
marked as female.
You say, “Oh, I think we pulled the wrong chart. Do you have a sister named Tiffany?”
The patient’s arms cross and face turns red. Looking at the ground the patient says, “Uh, no that’s me, but I go
by Tim.”
You are a bit perplexed but the waiting room is full and you’re feeling behind. You proceed with the gathering
the HPI for the shoulder injury. When you’re done with the history, you say, “I’ll need you to remove your shirt
so I can examine your shoulder.”
Tim is visibly anxious and asks, “Can you finish the exam with my shirt on?”

Case 2: Melanie

You are a doctor working in the ER and you’ve been given your next patient. Looking in the chart you see the
patient is a 28 year old male who presents with nausea and vomiting. You knock on the door and enter,
preparing to identify the patient and introduce yourself as you were taught in Doctoring, when you are met with
a tall, nervous, uncomfortable looking long-haired patient in feminine clothing with a coarse skinned-face,
looking almost like a face that is shaved daily. Taken aback, you skip the patient identification part, awkwardly
introduce yourself, and complete a brief history and abbreviated exam before exiting the room again.
You go find your attending to discuss the case, all the while your brain wrangling with what to say.

Discussion Questions: Break into pairs and discuss the questions

1. What was your reaction when the first patient said his name was “Tim”? When you were met with
the female-looking patient when you expected a male-looking patient?

2. How do you ask a patient about their gender when you are confused?

3. Why do you think the first patient was reluctant to take off his shirt and how might you help make
this patient more comfortable?

4. What can you do for this patient if the injury does not allow you to leave the shirt on?
5. You need to refer this patient to an orthopedist for follow up care. What pronouns would you use to
describe this patient in your note? Is it relevant to discuss the patient’s gender with the new
physician? For the second case, how do you imagine presenting the patient?

6. How can you make sure that your future practice is accessible and welcoming to all patients? Is
there anything that you can do now as a medical student?

7. What are some things that the trans* population is at higher risk for?

8. Why is it important to know a patient’s biologic sex? Why is it important to know whether a patient
is on hormones?

9. Are there system changes that can be implemented to learn a patient’s preferred name and
gender?