Words Matter: Taking an Inclusive History

What things can we do to ensure we are taking an INCLUSIVE history when interviewing adolescents? 

Ask patients for preferred name and pronouns. Be a role model and demonstrate this for your patients as well.

Use open-ended questions. Avoid yes/no questions. 

  • How’s everything going at home?
  • Can you tell me a little more about that?
  • Have you ever experimented with alcohol? What about other drugs?

Explore patients’ answers with curiosity rather than just checking off boxes in the social history. 

  • Tell me why you think marijuana helps your sleep. 
  • You’ve told me a little about your thoughts and feelings. I’d like to address this more a little later. Would that be ok?

Ask permission to discuss sensitive subjects and provide reassurance when needed. 

  • I’d like to ask you a little more about yourself. Is that ok with you?
  • I ask these next questions to get to know you and see what I can do as your doctor to work with you to give you the best care. 
  • I want to reassure you that everything we talk about today will be kept confidential. Is there anything that you would like me to discuss with your parents? 

Explain the purpose of asking questions about gender identity, sexual orientation, and sexual practices. Avoid non-inclusive questions (e.g. Are your partners men, women, or both?)

  • Sometimes people feel the sex they were assigned or given at birth doesn’t coincide with the gender they feel at present. How do you feel about that? 
  • Have you been romantically, intimately, or sexually involved with anybody?
  • It helps me to know what parts are going where. This helps me identify what tests we might need, and where to get the tests from. Would you be comfortable showing me or telling me which parts are going where whenever you’re close with somebody?

Both patient and provider should explain terminology with which the other is unfamiliar. 

  • What does pansexual mean to you?

Screen for comorbidities, including substance use disorder, depression, anxiety, and suicidality. 

  • A couple of things I wanted to address from earlier in our conversation were the racing thoughts you mentioned and feeling sad. Can you talk to me a little more about those? 
  • Have the thoughts ever made you feel like you don’t want to be here anymore or want to hurt yourself? 

Make a close follow-up plan with patient’s agreement. 

  • Based on your sexual practices, I feel that we should do some testing today. How do you feel about that?

Further reading!

  • Fenway LGBTQIA+ Health Education Center
    • The National LGBTQIA+ Health Education Center aims to advance health equity for LGBTQIA+ people and the populations which may intersect with the LGBTQIA+ community; to address and eliminate health disparities for the LGBTQIA+ community; to optimize access to cost-effective health care for the LGBTQIA+ community; and to improve the length and quality of life for LGBTQIA+ people by providing training and technical assistance to health care providers and staff across the globe
  • Center of Excellence for Transgender Health
    • UCSF’s Center of Excellence for Transgender Health (Trans CoE) was founded in 2009 with a mission to increase access to comprehensive, effective, and affirming health care services for transgender and gender diverse communities. The Transgender CoE’s goal is to improve the overall health and well-being of transgender individuals by developing and implementing programs in response to community-identified needs.
  • World Professional Association for Transgender Health (WPATH)
    • WPATH is a non-profit, interdisciplinary professional and educational organization devoted to transgender health. Our professional, supporting, and student members engage in clinical and academic research to develop evidence-based medicine and strive to promote a high quality of care for transsexual, transgender, and gender-nonconforming individuals internationally.
  • The Trevor Project
    • The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people under 25.
  • Youth Pride Inc.
    • Youth Pride, Inc. is dedicated to meeting the unique needs of youth and young adults impacted by sexual orientation and gender identity/expression while working to end the homophobic and transphobic environments in which they live, work and play.

Blog post based on Med-Peds Forum talk by Erin Baroni, PGY4