Jaymazing

Gender Uncertainty & Good Manners

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So, I'm sure we've all been in this situation to some extent at some point in our careers, and I'm curious to find out the best way to go about handling it.

Those patients who you just can't tell if they're a male or a female. How do you go about asking? Is there a polite way to do it? Maybe a subtle trick you use; perhaps in how you phrase questions? Or is it all about being blunt?

For the sake of eliminating a few of the obvious answers, lets say the patient is in their early twenties, average weight, doesn't have a wallet (and therefore no identification or paperwork), has a unisex name, is wearing bulky winter clothing, and has a voice that keeps you guessing.

The balls in your court. And yes, that was a pun, and no, I have no shame.

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If I cannot tell I ask it this way, "please don't take offense, but are you a guy or a girl" That usually does it. Either the patient gets pissed or they understand. Many pt's who its hard to tell often understand.

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"May I call you Pat or do you prefer something else?"

oh good one!

Also I ask the spelling of your full name. 'Sam - Samantha' 'Pat - Patrick'

Another is to ask if they have kids, and if so get a few details that may lead to some indicators.

I have also asked about any recent genital infections or STD's..... A lot of times - if female they will report a yeast infection within the last year.

One of the areas I cover has a population of transvestites living there, I just flat out ask the guy-looking person who is wearing a dress and a 5o'clock shadow "Do you have a penis?"

It's akward for them.... but it passes.

Other than that just wait till your at the hospital and let them sort it out lol.

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Listen to lung sounds and hope to feel a bra strap

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Hopefully with ePRF linking to the National Health Index we'll just be able to put in a few details and it'll populate all the information including sex.

Or hell you could just ask politely

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In the emergency setting, I have to ask why does it matter ? Unless they are complaining of a penile or vaginal problem, all other disease/injuries are unisex; if it is penile or vaginal, then take a look. If they are complaining of abdominal pain, then I guess it becomes a little more necessary so that you direct the patient to the right destination (ER versus OB), but our treatment in the field will not change even for that (you could always tell the nurse, "sorry I thought it was a dude/girl -- my bad"). The same question could be asked if you can not tell if someone is black or white; yes if black, maybe their pain is sickle cell related, but that does not change your treatment plan in the field (put a little oxygen on, it won't hurt). Many trannies have boobs with a penis, so a bra strap will only help if it is a "known Pat situation", but even then, how would you know, without asking (Pat could be a trannie inbetween surgeries) ? Look at the adam's apple, then measure their penis, if thats what it takes to devise a treatment plan.

Give me a situation where it matters to us.

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I have asked this question to a few people and I think I have two interesting answers, possibly worth using...

1st answer I liked was to just not ask, but bait the hospital staff to ask, cuz you know they will... haha

2nd answer from a friend of mine who is transgender states he don not know the best way to approach this situation. No help huh... Though he seemed to relay that just being polite and asking ought to be okay. Something along the lines of "no disrespect, are you male or female, I only ask to take your biology into consideration for a proper treatment plan".

- As a side note my friend seemed to indicate he has encountered persons at work in which their gender orientation is difficult to determine. He said it is easier to avoid pronouns at times, otherwise, if you are comfortable (and maybe have to deal with persons longer than he may) to just ask their preference, respectfully of course.

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In the emergency setting, I have to ask why does it matter ?

...

Give me a situation where it matters to us.

Well, there's that small issue of treating people with some basic human dignity. Even in emergency situations that's important. With that, sometimes you just need to know.

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Thanks everyone for your comments!

Except for you, Mikeymedic. I don't know why you chose to comment at all, since dismissing the question and discarding other peoples responses is neither productive nor helpful to me. You clearly operate under a completely different set of personal guidelines than I, and while I'm sure you're MUCH smarter than me (you've clearly demonstrated that), I can in fact think of situations where this is pertinent information to have, and thus am admittedly still trying to improve upon my patient interview skills when it comes to broaching the more tender topics.

Maybe where you work is different than where I work, but I can easily say that at least 80% of my calls aren't really "emergency settings" by most standards. And perhaps my tendencies to address my elders as "Sir" or "Ma'am" are outdated where you are.

But I'm supposing we live in very different worlds.

On a brighter note, I really like the bra-strap-auscultation idea, MariB, and I'm going to store that one in my toolbox for next time I need it!

Edited by Jaymazing

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