1. Affirming LGBT People through Effective Communication
Welcome to the learning module: Effective Communication with LGBT People: Case Scenarios. In this module, you will learn ways to provide affirming and inclusive health care for lesbian, gay, bisexual, and transgender, or LGBT, patients through basic communication principles. To learn more about LGBT people and their health care needs, see our other Learning Modules on
Learning Module for All Staff

2. Terms and Definitions
This module begins with some basic concepts and definitions. These will help serve as the basis for the rest of the module.

3. Sexual Orientation and Gender Identity
All people have a sexual orientation and a gender identity
How people identify can change
Terminology varies
Gender identity and sexual orientation are separate concepts
Everybody has a sexual orientation and a gender identity. The words people use to describe their sexual orientation and gender identity varies between people and across cultures . Keep in mind that sexual orientation and gender identity are not the same thing, although they are often confused. The next slides will explain them further.

4. Sexual Orientation
Sexual orientation is how a person characterizes their physical and emotional attraction to others. It has 3 dimensions:
Identity
Do you consider yourself gay, lesbian, bisexual, straight, queer, something else?
Attraction
What gender(s) are you attracted to?
Behavior
What gender(s) do you have sex with?
Sexual orientation is how a person characterizes their sexual and emotional attraction to others. It can be helpful to think of sexual orientation as consisting of three parts or dimensions – 1) behavior, 2) attraction, and 3) identity. It is important to realize that some people have same-sex partners (behavior) but do not think of themselves as lesbian, gay, or bisexual (identity). Others are attracted to people of the same sex (attraction) but are not sexually active with members of the same sex (behavior).
A person’s sexual identity, behavior, and attraction can change over time. While sexual orientation is not a choice, a person’s stage of development, cultural environment, etc. can shape their own awareness and self- acceptance of their sexuality.

5. Gender Identity
Gender identity is a person's internal sense of being a man/male, woman/female, both, neither, or another gender.

6. Transgender
Transgender people have a gender identity that is different than their birth sex
Transgender woman, trans woman, male to female (MTF)
Transgender man, trans man, female to male (FTM)
Trans masculine; trans feminine
Genderqueer; gender fluid
Cisgender is a term for people who are not transgender
Transgender people have a gender identity that is not the same as the sex they were given at birth. The word transgender includes many different kinds of people. Transgender people use a variety of terms to describe themselves, including some that are not listed here. A transgender woman is someone who was assigned male at birth and whose gender identity is female (sometimes referred to as male to female). A transgender man is someone who was assigned female at birth and whose gender identity is male (sometimes referred to as female to male). Genderqueer or gender fluid are people have a non-binary gender identity. That is, they do not identify as either male or female, and may see themselves as a combination of the two, or some other gender.
Cisgender describes people who are not transgender.

7. LGBT Glossary
To download a glossary that defines other LGBT terms, click here or go to:

8. Effective Communication

9. Communication: The Whole Team
Many LGBT people have difficulty finding health care where they feel included and accepted. On the next slides, you will learn basic communication principles and strategies that will help you and your colleagues create welcoming environments for all.

10. Avoiding Assumptions
A key principle of effective communication is to avoid making assumptions:
Don’t assume you know a person’s gender identity or sexual orientation based on how they look or sound
Don’t assume you know how a person wants to describe themselves or their partners
Don’t assume all of your patients are heterosexual and cisgender (not transgender)

11. Avoiding Assumptions
To avoid making assumptions about gender identity or sexual orientation with new patients, use gender-neutral terms and avoid using pronouns. For example:
Instead of: “How may I help you, sir?”
Say: “How may I help you?”
Instead of: “She is here for her appointment.”
Say: “The patient is here in the waiting room.”
Instead of: “What are your mother and fathers’ names?”
Say: “What are your parent(s) or guardian(s)’ names?”
Instead of: “Do you have a wife?”
Say: “Are you in a relationship?” or “Do you have a partner?”
When you encounter a new patient, try to steer clear of words that assume a certain gender identity or sexual orientation. For example, avoid using pronouns (e.g., he and she) or words like sir, ma’am, Mrs., Ms., or Mr. This will help you from accidentally insulting the patient. The scripts on this slide provide examples of how to do this. You may need to practice these scripts with friends, family, and colleagues, before it comes naturally.

12. Using Names and Pronouns
Another key principle is to use patients’ preferred names and pronouns
Transgender people often change their name to affirm their gender identity
This name is sometimes different than what is on their insurance or identity documents
Transgender people also want others to use pronouns that affirm their gender identity

13. Using Names and Pronouns
Registration forms should have a space for patients to enter their preferred name and pronouns
This information should also be included in medical records
A patient’s pronouns and preferred name should be used consistently by all staff

14. Using Names and Pronouns
Subjective
Objective
Possessive
She
Her
Hers He
Him
His
They
Them
Theirs Ze
Zim
Zirs
Sie/Zie
Hir
Hirs
Some people may use words or pronouns that are unfamiliar. Pronouns such as "zie" or "they" are sometimes used by people who do not want to identify with the gender binary of he/she.
The button on this slide is one used by Fenway Health staff members. Other buttons have “he/him/his”, “she/her/hers”, and “Ask me.”
Adapted from

15. Using Names and Pronouns
If you are unsure about a patient’s preferred name or their pronouns:
“I would like be respectful—what name and pronouns would you like me to use?”
If a patient’s name doesn’t match insurance or medical records:
“Could your chart/insurance be under a different name?”
“What is the name on your insurance?”
If you accidentally use the wrong term or pronoun:
“I’m sorry. I didn’t mean to be disrespectful.”

16. Keeping Up with Terminology
Avoid these Outdated Terms
Consider these Terms Instead
Homosexual
Gay, lesbian, bisexual, or LGBT
Transvestite; Transgendered
Transgender
Sexual preference; Lifestyle choice
Sexual orientation
The terms on the left are now considered by most to be outdated and less affirming (or offensive) to many.

17. What about Queer?
An increasing number of people, especially youth, identify themselves as queer
Queer means having a sexual orientation that is something other than heterosexual
Although queer has traditionally been an insult, many use this term with pride
However, the term queer is not embraced or used by all members of the LGBT community

18. Using Identity Terms
It is important to listen to, understand, and mirror the terms that patients use to describe themselves
Keep in mind that some people do not like to use any terms to describe their sexual orientation or gender identity

19. Communication “Don’ts”
Don’t laugh or gossip about a patient’s appearance or behavior
Don’t use stereotypes or ask questions that are not necessary for care. Examples of “don’ts”:
“You’re so pretty! I cannot believe you are a lesbian.”
“Are you sure you’re bisexual? Maybe you just haven’t made up your mind yet.”
“I see you checked ‘gay’ on your registration form. How’s the club scene these days?”
“Wow. You look just like a real woman!”
It is easy to fall into stereotypes or ask unnecessary questions when trying to engage your patients and build rapport. Before asking a question, ask yourself: “What do I need to know? How can I ask this in a sensitive way?”

20. Accountability
Creating an environment of accountability and respect requires everyone to work together
Don’t be afraid to politely correct your colleagues if they make a mistake or make insensitive comments
“Those kinds of comments are hurtful to others and do not create a respectful work environment.”
“My understanding is that this patient prefers to be called ‘Jane’, not ‘John’.”

21. Learning through Case Scenarios
The following slides will go through some “real world” cases that highlight common mistakes in communication with LGBT people. Each case asks questions about what went wrong in the scenario, how the mistake could have been prevented, and/or how to apologize or change a system to improve communication. Before clicking on the answers, think about how you would answer the question yourself, based on what you have learned so far.

22. Case Scenario: Janice and Tonya

23. Janice and Tonya
Two women, Janice and Tonya, arrive with a baby for a 6 month check up and immunizations
A medical assistant introduces herself to Janice and says, “Oh, did you bring your sister? How nice!”
Tonya and Janice both frown. Tonya says with exasperation, “Actually, I’m her wife and this is our baby.”
Why are Tonya and Janice upset?
What could the medical assistant have said instead?
How could the medical assistant apologize?
Q: Why are Tonya and Janice upset?
A: The medical assistant made an assumption that Tonya and Janice are sisters rather than spouses, and that only Janice is the mother of the baby. This made Tonya and Janice feel unwelcome and “invisible” as a family. Tonya’s exasperation is a sign that this is not the first time someone has made this assumption.
Q: What could the medical assistant have said instead?
A: Instead, the medical assistant could have introduced herself to both Tonya and Janice without saying anything about their relationship. This would allow Tonya and Janice the opportunity to introduce themselves however they choose (e.g., “Hi, I’m Janice, this is my wife Tonya and our baby Sam.”) The medical assistant can also ask an open-ended question in order to learn more, such as “Hello, I’m [first name]. Who do we have here today?” During the visit, she can be careful to direct her conversation to both Janice and Tonya. If it was an older child who came in for a visit rather than a baby, the medical assistant might direct her introduction to the child; for example, “Hello [child’s name]. Nice to meet you. Who did you bring with you today?”
Q: How could the medical assistant apologize?
A: She could say, “I am so sorry for my mistake. I didn’t mean to offend either of you or disrespect your relationship.” Apologizing for a mistake and moving past it are important. It is not always possible to avoid mistakes, and simple apologies can go a long way.

24. Case Scenario: Marcus

25. Marcus
In talking about his history, Marcus tells Amy, his nurse practitioner, that he has had 2 male sexual partners this year, as well as female partners in prior years.
Amy encourages Marcus to have an HIV test by saying, “I recommend all my gay patients get tested at least once a year.”
After Amy says this, Marcus appears upset.
Why is Marcus upset?
What could Amy have said instead?
Q: Why is Marcus upset?
A: Even though we know Marcus’s sexual history, we only know about his behavior and not how he identifies his sexual orientation. Amy assumed that Marcus identifies as gay. However, even though Marcus currently has sex with men, he may consider himself bisexual or straight, or he may use some other term to describe his sexual identity (such as queer or same-gender loving). He may choose to not label his sexual orientation at all. Some people also change the terms they use to describe their sexual orientation over time; for instance, in the previous year, Marcus may have called himself straight, and now may think of himself as bisexual. Remember that sexual orientation has three dimensions: behavior, identity, and attraction. These three dimensions do not always align.
Q: What could Amy have said instead?
A: It was appropriate for Amy to encourage Marcus to have an HIV test. However, she should not have used the word “gay” unless she heard Marcus use it to describe himself. Avoiding assumptions and mirroring the terms that patients use to describe themselves helps improve the provider-patient relationship. Amy could have said instead: “Based on your sexual history, I am going to order an HIV test for you, and I recommend that you be tested at least once a year.” (NOTE: The CDC recommends that men who have sex with men be tested annually for HIV and other STDs, and be tested more frequently if they are engaging in risky behaviors.)

26. Case Scenario: Ethan

27. Ethan
Gladys, the medical assistant, is asked to prepare a patient for a preventative screening. Gladys glances at the chart and notes that the name on the chart is “Emily Turner.” When Gladys enters the examination room where the patient is waiting, she sees a man leaning against the exam table. He says, “Hi, I’m Ethan.”
How can Gladys politely determine if she is in the correct room and if the patient is here for a Pap smear?
What is the best to covey transgender patients’ preferred names to all staff involved in their care?
Q: How can Gladys politely determine if she is in the correct room and if the patient is here for a Pap smear?
A: Gladys will want to affirm the patient’s identity by saying “Hello Ethan, I’m Gladys.” She can then say something like, “I’m sorry, but the chart I was given has a different name. I might be in the wrong room or have the wrong chart. Is it possible that your chart is listed under a different name?” At this point, Ethan might explain that Emily is the name on his medical chart, but that he prefers to be called Ethan. Gladys may be able to make a note in the chart explaining this. At this point, she can also ask Ethan what pronouns he uses, and mark those down as well.
Q: What is the best to covey transgender patients’ preferred names to all staff involved in their care?
A: It is recommended that health care organizations have a system that allows patients to input their preferred name, gender, and pronouns into registration forms and other relevant documents. This allows staff to see the patients’ preferences, and to use them consistently. Creating such a system is helpful for non-transgender patients, too since some patients may prefer to use nicknames or middle names, etc.
Most transgender men retain a cervix and require Pap smears at the same frequency as women. Transgender men may require greater sensitivity from their providers when receiving pelvic exams and screening. Some may have uncomfortable feelings about their female anatomy and may need reassurance.

28. Gloria

29. Gloria
Gloria was seeing her primary care provider for her annual wellness checkup. When taking a history of her sexual health, Gloria and her provider discuss that Gloria identifies as bisexual, and is currently in a monogamous relationship with another woman.
The provider then started talking to Gloria about pregnancy prevention. Gloria said that it wasn’t necessary and that she wasn’t interested, but the provider insisted.
The provider said Gloria should take the birth control prescription because “bisexuals sometimes go back to men because they are confused and cannot make up their minds.”
What should the provider have said instead?
How could Gloria’s provider talk to her about birth control while being respectful?
I have heard some people describe themselves as pansexual. Is that the same as bisexual?
Q: What should the provider have said instead?
A: Gloria’s provider assumed that her bisexual identity meant she was confused, or that she might engage in sexual behaviors with men even though she has stated she is in a monogamous relationship with a woman. Instead of focusing on stereotypes, the provider should be focusing on Gloria’s sexual history and behaviors in order to provide recommendations for health care. Gloria’s monogamous relationship should be respected, regardless of how she identifies.
Q: How could Gloria’s provider talk to her about birth control while being respectful?
A: Some patients who have exclusively same-sex partners may feel they are not welcome or understood by their providers if they are asked about pregnancy prevention. If her provider wants to discuss that decision with her, it should be a productive, patient-centered conversation, instead of making comments about Gloria’s bisexual identity. The provider could have started with general questions, and then left the door open for Gloria to follow up if she wanted more information at a later time:
Do you have any plans or desires to have children? Are you concerned about getting pregnant? Do you want information on birth control?
Please let me know if, at any time, your decision about this changes.
Q: I have heard some people describe themselves as pansexual. Is that the same as bisexual?
A: Pansexual is when people are attracted to all genders, or attracted to people regardless of their gender. Sometimes people chose the term pansexual to describe themselves because it feels more inclusive of those individuals outside the gender binary. Others choose to define bisexual as being attracted to their own gender and to other genders to make the term more inclusive. While some may use these terms interchangeably, others do not. It is important to use the terms that the patient uses when describing themselves. If a patient uses a word you are unfamiliar with, politely ask them to describe it to you and what it means to them.

30. Case Scenario: Luis

31. Luis
Luis, a teenage boy, completes an intake form and hands it to Mary, the receptionist. Mary says to Luis “excuse me, but you need to fill out your mother’s and father’s names. Can you tell them to me?” Luis looks away and, in a low voice, says, “I have two dads. Their names are Carlos Montoya and David Sandoval.”
Before she can catch herself, Mary becomes flustered and blurts out, “Oh! You don’t have a mother?” Mary’s exclamation arouses attention in the waiting area.
Luis’s face turns red and he starts heading out the door.
What did Mary do to create an uncomfortable situation for Luis?
What could she have said instead to prevent this situation?
What are the implications for his health care?
Q: What did Mary do to create an uncomfortable situation for Luis?
A: Mary was trying to be helpful. However, she made a mistake in assuming that Luis had a mother and a father; her second mistake was showing surprise when she learned he had two fathers.
Q: What could she have said instead to prevent this situation?
A: To avoid this situation, it would have been better if she asked about his parents in gender neutral terms. Even if the forms are not in neural language, Mary could have altered the language from “mother/father” to “your parents” when she was reading the forms aloud for Luis. Also, she needed to be prepared for the answer.
Q: What are the implications for his health care?
A: Since Luis left because he was uncomfortable, it might be a while before he attempts to engage in care again. This lost time can be very impactful for patients, depending on their individual health needs. This illustrates the importance of all interactions, especially those in the waiting area.

32. Case Scenario: Kyle

33. Kyle
Kyle is working at the registration desk. A new patient arrives at the clinic. The patient is wearing a dress and heels, and has long hair. Despite the patient’s appearance, the identification documents (e.g., insurance card, driver’s license) say “George Brogan.”
How should Kyle greet the patient at the front desk?
How can Kyle find out what name and pronoun the patient prefers to use?
When the clinician is ready to the patient, how should Kyle call the patient into the exam room?
How should Kyle let the clinician know about the patient’s preferred name and pronoun?
Kyle should use gender neutral language and avoid pronouns when first greeting the patient (e.g., How may I help you today?).
Ideally, all patients are asked for their preferred name and pronouns on the registration form. However, in Kyle’s case, this is not the current practice. Therefore, Kyle can ask: “I would like to be respectful. What name and pronouns would you like us to use?” Kyle can continue to try to avoid pronouns and use gender neutral terms until he is able to ask this question.
Kyle should use the patient’s preferred name. Ms. Brogan is appropriate if he has learned that the patient uses female pronouns. The organization can adopt a policy of saying “Last name: Brogan” if they have not learned the preferred name or pronouns.
If possible, Kyle should tell the clinician about the patient’s name and pronouns privately, in advance. Entering this information into a standard location in the electronic health record (EHR) would also facilitate use of the preferred name and pronouns.

34. Case Scenario: Rima

35. Rima
Rima is the head nurse on a medical unit of a teaching hospital. One of the patients on the unit identifies as a transgender woman, but has a masculine appearance.
While working on a computer near the patient’s room, Rima overhears an attending physician say to a resident, “I just don’t understand, is it a he or a she?” In response, the resident shrugs her shoulders and they continue doing rounds.
What is a more culturally-appropriate way for the attending to inquire about this patient’s gender identity and pronouns?
What are the possible consequences of this conversation taking place in a public or shared space?
Should Rima talk to the attending that made the comment? What could Rima say?
Q: What is a more culturally-appropriate way for the attending to inquire about this patient’s gender identity and pronouns?
Rather than refer to the patient as “it,” the attending should instead have said to his colleague, “I would like to be respectful of this patient, but I’m not sure what pronouns to use. Do you know?” Ideally, gender identity, sex assigned at birth, sex listed on insurance, pronouns, and preferred name are captured during intake and shared with all members of the care team, thereby reducing these kinds of mistakes and confusion. Providers and other health care staff should remember first and foremost that it is never appropriate to refer to a person as “it.”
What are the possible consequences of this conversation taking place in a public or shared space?
This scenario highlights how easily comments can be overheard. If Rima heard the comment, it is entirely possible that the patient being talked about heard it, and perhaps other patients as well. This can lead to patients and staff feeling that the health care environment is not inclusive or welcoming.
Should Rima talk to the attending that made the comment? What could Rima say?
It is important to create an environment of accountability among staff. Right after Alison overhears the comment, she could approach the attending and say, “Excuse me, doctor? Do you have a second?” Alison could then have a private one-on-one conversation with the attending. An example of what to say is “I overheard you asking about [patient’s name]. I know it can be confusing, but this patient identifies as a woman and uses the pronouns she and her. Referring to the patient as “it” is disrespectful.” Rima could then recognize that these situations are complex, and recommend training for the entire staff working on the unit

36. Case Scenario: Mandy

37. Mandy
Mandy is in for her annual wellness visit, and her provider’s office has just implemented collection of sexual orientation and gender identity data as part of a patient’s electronic health record. Mandy has been coming to this practice for a while, but had never before disclosed her lesbian identity.
When the nurse takes her to an exam room and goes over her intake forms, he says, “So when did you know you were a lesbian?”
Is this an appropriate question to ask Mandy?
How is collecting sexual orientation and gender identity data in the EMR helpful for providers and for patients?
Health care providers should only ask questions that are necessary for care. Discussions about sexual orientation may be an important part of care for some patients, but asking patients these questions in order to satisfy one’s curiosity is not appropriate. Instead, people who care for LGBT people are encouraged to read quality materials and take continuing education courses to learn more about the experiences of LGBT people. In Mandy’s case, her primary care provider may want to talk with her about health care issues specific to the needs of a lesbian woman. The provider will also want to talk with Mandy in an open and affirming manner about her relationships, sexual health, and children or plans for children.
Collecting data on sexual orientation and gender identity, as well as having patient conversations, help clinicians provide more targeted, relevant care to the patient. It also helps the health care organization understand more about the patients it serves. Data on sexual orientation and gender identity can be used like any other demographic data—e.g., to track progress on health outcomes, to evaluate quality, and to compare patient satisfaction scores.

38. Case Scenario: Chris

39. Chris
A new patient, Chris, completes the registration paperwork and hands it to Mike at the front desk.
Mike is looking over the forms and notices that Chris has skipped the gender question. Mike asks Chris to complete the skipped question.
Chris says, “But I don’t identify with the options (male or female) and left it blank on purpose.”
How can Mike proceed with this patient’s registration?
How can Mike work with this patient to be respectful?
What are ways in which this scenario could be avoided?
Some people express their gender in ways that do not conform to traditional male and female categories. In this case, Chris has a non-binary gender identity; that is, Chris does not identify with being male or female. At this point, Mike can politely apologize that the form only gives male and female options for gender and ask if there is another term that best reflects the patient’s gender. Mike can note the patient’s identity in the chart. To move forward with registration, it is possible that Mike will need to ask Chris for the gender listed with their insurance company. Mike should explain that the clinic will use the patient’s preferred name, gender identity, and pronouns, but that for billing to go smoothly, it is important for the clinic to have the information that is listed with the insurance company.
Mike may be able to talk to Chris’s clinician, so that there can be a follow up conversation in a more private setting. The clinician can then work with Chris to find a way for the medical file to be reflective of their gender identity, as well as Chris’s preferences for name and pronouns.
Ideally, the clinic would alter the registration and medical record forms. Instead of just asking one question with only male or female as answers, it is recommended that forms ask two questions: one about current gender identity, and another about assigned sex at birth. The gender identity question has multiple responses, allowing patients to find themselves reflected in the forms. The assigned sex at birth question captures information that might be needed for billing, but also provide helpful information to providers, such as which screening exams are most appropriate for patients.

40. Case Scenario: Herb

41. Herb
Stella, a case manager, is meeting a new patient, an older gentleman named Herb. Stella asks Herb who will be his Emergency Contact. Herb remains silent for a bit, appearing to be unsure of who he would want to list. He eventually gives a name, and Stella asks what Herb’s relationship is to this contact. Herb says, “Well, I guess you could say that he is my friend.”
Stella is surprised that he would choose a friend and asks Herb if he has any family he could include instead.
Herb is upset as he sits through the rest of the registration process.
Why might Herb be upset?
Why might Herb have named a friend instead of family?
What could be done to prevent this situation?
Stella’s comment implies that biological or marital family ties are most relevant when it comes to listing an emergency contact. It is important to remember that LGBT people (especially older adults) may not have biological families they keep in touch with, and may consider friends or other bonds as their closest family. He also may not be accustomed to describing his friend as his partner or even husband.
Some LGBT people may not be comfortable being “out” to their providers or in a health care setting. Herb’s friend may be a close friend or his boyfriend, husband, or partner. Other people consider relationships outside of biological family to be the most important to them.
Stella should have been ready to hear any relationship that Herb chose to list. The form that Stella is using to record this information should also be inclusive of the various kinds of relationships that are important to people.

42. Case Scenario: Jacob’s Patient

43. Jacob
A patient of Jacob’s is dressed femininely and uses female pronouns and a female name. Jacob uses the patient’s preferred name and pronouns throughout the appointment.
At the next appointment, the same patient is dressed in a more masculine manner and requests that Jacob use a male name and male pronouns. Subsequent visits follow a similar pattern.
How does Jacob work with this patient to be respectful?
How does Jacob help his colleagues do the same?
This is a challenging situation, and its ok for Jacob to be confused, make mistakes, and apologize. Jacob can explain to the patient that he wants to be respectful and will continue to try to get it right. Examples of ways to apologize: “I’m sorry. I didn’t mean to be disrespectful. Let me try again” or “I’m sorry. I didn’t mean to disrespect you. I’m still learning. Feel free to correct me any time I say the wrong thing.”
There may be a setting in which is appropriate for Jacob to brief his colleagues about this patient. There might also be systems in place, such as the EMR, to record this patient’s current preferences along with a note that the patient’s preferences vary. It is important to ask patient’s their preferences at every appointment, so that the encounter can run smoothly.

44. Case Scenario: Malika

45. Malika
While in the waiting room, Malika watches as three other patients--all of whom arrived after she did--get called to an exam room. She is already upset because the security guard addressed her as ‘Sir’ when she entered the building, an experience that is not uncommon but always annoys her.
After an hour of waiting, Malika finally loses her patience, and storms up to the front desk. She demands to know what is going on and accuses the clinic of discriminating against her for looking the way she does.
What may have contributed to Malika’s feelings of discrimination and disrespect?
How should the front desk staff respond to Malika’s accusation of discrimination?
What could have been done differently to prevent Malika from getting upset?
Malika likely has experienced a great deal of stigma in her life, leading to expectations of discrimination and rejection. She may have had prior negative experiences in health care related to her masculine gender expression, as she did with the security guard that day. For these reasons, she may be quick to expect mistreatment by the clinic staff. In addition, the front desk staff failed to let Malika know that her provider was running late, and that the patients who went ahead of her were there to see other providers.
It is best to respond with an authentic apology. Assure Malika that she is always welcome at this clinic and that you do not discriminate. If Malika is not satisfied with the apology, she should be directed in how to make a formal complaint.
This situation could have been prevented first by training all staff, including security guards, about how to communicate best with patients, including not using gender terms like “sir.” In addition, the front desk staff should have been aware of the long wait time, and should have told Malika and other affected patients about the reasons for the delay.

46. Conclusion Thank you for taking this learning module!
This module provided a basic introduction to LGBT health and effective communication. For more training and resources on this topic, please explore the website of the National LGBT Health Education Center:

47.  lgbthealtheducation@fenwayhealth.org 8 www.lgbthealtheducation.org   8
&