Halfway through my medical school orientation last year, I found myself sitting around a table in a large convention hall with five of my classmates. The six of us had been placed together in our Clinical Microsystems Clerkship (CMC), a longitudinal thread in our curriculum where we would spend one day each week together over 16 months, practicing clinical skills with our faculty coach and working on a quality improvement project in our assigned clinical “microsystem.” On that first day we met, we went outside with our coach, sat in the grass, and discussed who – and how – we wanted to be as a team.
The question of how we would address one another came up quickly. “How do we feel about ‘you guys?’” one of my new teammates asked. I leaned in, interested in the response. I had been wondering the same thing. As a medical student in my 30s, I made it through and out of college squarely in the ’00s, calling everyone “you guys” without a second thought. Over the past several years, though, “you guys” as a term of address for anyone other than a group of explicitly male-identifying individuals has fallen out of favor, making way for gender-neutral terms like “y’all” and “folks.” At the beginning of medical school, “you guys” was still rolling off my tongue, but I sensed that it was becoming less appropriate. My CMC team decided we would each use whichever gender-neutral term most appealed to us. (Personally, I’ve come to favor “friends.”) This conversation was the first time in medical school I felt compelled to explicitly interrogate the language I use, and it was far from the last.
About a month later, my CMC teammates and I were introduced to our clinical microsystem: the Women’s Health Clinic (WHC), which was housed within our county’s safety net hospital and was where our faculty coach worked as an ob/gyn. The quality improvement project the clinic had assigned to us was to develop an intervention that would help raise the rate of postpartum visit attendance among the clinic’s Black patients. As we put together our project proposal over the next few weeks, our discussion turned to how we would refer to our target population. “Patients” was an easy solution, but what about in contexts where they weren’t receiving medical care? Should we refer to them as “women?” I wasn’t opposed to the word, reasoning that because the clinic referred to its clients as women, it made sense to keep our language consistent — and I voiced this opinion to the team. Privately, I also surmised that, strictly by the numbers, it was likely that the vast majority of the individuals within our target population did identify as women (although the clinic didn’t keep data on gender identity, so there was no way to be sure). As a female- and queer-identifying mother who came to medical school to pursue a career in “women’s health,” I didn’t have a problem using the blanket term. Wasn’t the fact that it probably applied to most people, I thought to myself, good enough?
Since then, however, I’ve come to believe that actually, it isn’t “good enough.” In our coursework, we have discussed the importance of person-centered language and learned never to refer to patients by their disease. Introducing myself with my pronouns has come to feel natural. I have acquired a new vocabulary, which includes terms like person experiencing homelessness instead of homeless person; substance user or person who injects drugs — which even has its own acronym, PWID — instead of addict; incarcerated individual instead of inmate.
Exactly one year after my CMC team first agreed not to address one another as “you guys,” I Zoomed into the first lecture of our ob/gyn block and listened for two hours as our instructor spoke about labor and birth without once using a gendered pronoun to refer to pregnant patients. Instead, our instructor used the all-encompassing “birthing people.” To me, an aspiring obstetrician, this capacious lexicon felt wondrous, humbling, and incredibly exciting.
Ultimately, how much does it really matter? Is the formal validation of a handful of individuals at the periphery worth these linguistic gymnastics? I would argue that it matters a lot, and that the more we draw on a clear and inclusive vocabulary, the more we allow ourselves to become comfortable with language that is both expansive and transparent, the words will stop feeling like contortions. They will start feeling normal. Much has been written (and broadcasted) about the ways in which language shapes how we think; although the degree to which this is true is debatable, the core argument remains: the words we use focus our attention on certain aspects of the world over others, and represent what is important to us. This point is particularly salient in health care. In a 2018 study, researchers from Johns Hopkins University found that when stigmatizing language was used to describe a patient in their medical record, clinicians who read those notes were more likely to view the patient negatively and were less likely to manage the patient’s pain aggressively. Beyond how we think, language shapes how we act — and how we act impacts people.
As clinicians, we are in the business of impacting people, and I think we all hope to make that impact a positive one. There are many ways we can change how we talk to and about patients that will influence our impact, and a lot of them are small. It can be as simple as stating your pronouns and asking your patient how they would like to be addressed. This practice normalizes the idea that biological sex, gender presentation, and gender identity aren’t necessarily linked. More importantly, it gives patients a blank slate to tell us who they are. It can be as quotidian as writing a medical note to document a patient visit — but writing that note as if the patient will read it. In doing so, we can hold ourselves to the highest standards of respect, and preserve the integrity of the human story contained within the EMR. In any patient encounter, selecting our words carefully to avoid making assumptions — about race, socioeconomic status, sexual orientation, gender identity — will go far toward making those spaces safer for all patients.
Last summer, my CMC microsystem, the Women’s Health Center, changed its name to the Obstetrics, Midwifery & Gynecology (OMG) clinic. The rebranding wasn’t lip service to political correctness, but rather represented a recommitment to a clear and inclusive mission. The clinic serves many people, some of whom identify as women and some of whom do not, but OMG states plainly exactly what the clinic does (in addition to being an awesome acronym).
Words often operate as small nets we use to catch bits of meaning, but when applied thoughtfully, they operate as fine tools — tools that we choose to use to build the world we want to live in. If we move away from the notion of language as one-size-fits-all, we will all be safer. Words matter because they create more space for us — and space for more of us — and that’s better for everyone.
Fiona Miller is a second-year medical student at the University of California, San Francisco and the mother of three feisty kids. She is passionate about racial health equity, reproductive justice, and harnessing the power of human stories towards healing. Fiona is a 2020–2021 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz
