Well said Keyena! 

Janet Dombro, IBCLC 


> On Apr 18, 2022, at 12:34 PM, K McKenzie <[log in to unmask]> wrote:
> 
> Bird’s eye: Language is difficult to change. If we are to make advances in medicine, we must be willing to adapt, question old assumptions and discard dated practices as necessary while maintaining the relevant. 
> 
> Into the weeds: One of my goals as a clinician (practicing ND and now retired midwife) is to provide a space that is respectful, inclusive, welcoming and healing for all of my patents. What patients seek is not about me and my comfort level. They seek the means to feel better. My goals are to identify barriers to well-being and help them attain reduction or resolution of symptoms. I must remain objective and allow them to come as they are most comfortable. It can be a challenge to remain flexible and open but, in doing so, I come to know and understand a wider range of humanity. I work with and adapt my practices and language to meet the needs of members of the religious conservative, heteronormative communities I serve as well as the young urban patients who are bringing forward the need for all of us to recognize and accept the wide diversity of humans.  
> 
> In creating an inclusive intake process (forms and initial consult), I learn about my patients and what language may be important for them to feel comfortable seeking and, more importantly, continuing care. It is a simple part of the care plan and once it’s completed we move on to what ails them, all the while using proper terminology where needed. 
> 
> I cannot dissect the entirety of this article but can reply to this statement made in the conclusion: “...significant implications to desexing language when referring to inherently sexed processes and states…"
> 
> Last week I attended a day-long LGBTQI+ Health Summit offered by a Big Ten university wherein a lead geneticist spoke on this very issue when working with clients seeking genetic counselling to assess risk for themselves or their offspring. She spoke of the need for clients to understand health risks and potential follow-up care associated with chromosomal make-up…in a respectful environment. If the client seeking counsel is a man who was born with XX chromosomes, she does not hesitate to discuss the risks of XX-associated diseases that can affect him. Yes, she’ll speak of ovaries and breasts if the consult is about such organs and tissues but she does not insist on referring to the client as a woman as he sits in her office because it makes her, as the clinician, more comfortable. 
> 
> Another talk was presented by the parent of an intersex child (the term replacing the now-dated term hemaphrodite) who, with her husband authored a book on their experience raising their son. 0.5-2.0% of infants are born intersex. Slightly less common than twin births. She said if you’ve known a twin in the course of your lifetime, you’ve known intersex people. For us as LCs or health care practitioners, it means we have worked with intersex clients (both infants and nursing parents). Yet how many of us had any knowledge of our client having been born intersex? Historically gender assignment and genitalia surgery decisions have been made by parents with the “professional” counsel of surgeons. This is and will continue to change as culture grows to accept this very common bodily difference in people to allow those born intersex to make those choices themselves to identify as male, female or non-binary. 
> 
> Clinical language is not about me and my comfort level. In creating a safe, inclusive, accepting space, I have been entrusted with profound gems that allow deep healing to emerge for my patients. 
> 
> Language is fluid. It doesn’t need to be either/or. I can adapt in different environments with different demographics. But I cannot make assumptions that clients with limited education or who speak more than one language are not capable to understanding exactly what I speak of. It can take only reviewing the intake form or doing a thorough, respectful job with the intake visit to understand what your client can and cannot understand and adapt language from there. If I ask on intake what pronouns a patient uses and they look befuddled, I may revert to what I see via my acculturated assumptions. If I know my client is religious conservative, I may not ask pronouns….but that doesn’t mean that we don’t talk about why their intersex baby’s genitals appear as they do and the range of possibilities for what that might mean for the child, the decisions the parents can make now, and the decisions that child may need to make as they become adults. 
> 
> Language is indeed difficult to change  and it can make us uncomfortable but it is necessary if we are to provide inclusive care for all. Some may chose to narrow their practices only to those with the same belief systems and that is okay for them. It is not my aspiration as I remain open to cultural shifts that allow for greater inclusion of intersex, Two-Spirit, transgender, non-binary clients as well as folks who comfortably walk as men and women. 
> 
> If I insist on using gendered language where it’s not appropriate, I am overstepping my boundaries. Yes, if you’re talking about the risk of breast cancer with a trans man, you do need to speak of breasts if breast tissue remains post-operatively…but he does not need to be referred to as a woman going forward.  If I were to do so I would be overstepping my boundaries in the doctor/client relationship and potentially asserting 'power-over’ as a clinician if refer to a client as a woman because they have a uterus but identify as Two-Spirit or were born intersex and identify however they chose (male, female or non-binary) or live as a boy or man because that’s how they identify and their parents chose to not have them undergo repeated, painful surgeries to make their genitals appears female.
> 
> It is difficult to change language and binary, either/or ways thinking and speaking but consider putting a toe in the water. It gets easier with practice. I am a retired midwife and my adult daughter works in a NICU. She and I are both learning to change our language together as we talk about pregnancy, birth, lactation and parenting/guardianship. Sometimes it’s awkward but it does get easier. 
> 
> What we’ve been taught about gender, for those of us older folk on the list, has been very narrow. Research is showing a much broader diversity in anatomy, hormonal milieu, adolescent developmental change than we had ever imagined. As for me, I’ll walk into the space of learning new language that allows me to remain medically accurate while embracing diversity. 
> 
> Kindly,
> Keyena
> 
> 
> 
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