When we collect information from our patients, we ask, often unthinkingly, for quite a lot of it. Some of it has obvious value to our consultations: how long has it been there, and where does it itch? Some of it has additional use in research, and in auditing our practice. Today, we’re going to take a look at how we ask for some of these basic demographics and what it says about our perception of society, and of our patients’ lives, when we do.
In the UK, we classify infants at birth by many characteristics, and sex is one of those. This is obvious to anyone who has tried to pick a gift, or a card, to congratulate new parents: we, as a society as a whole, treat sex as a dichotomy of male or female. This is referred to as the gender binary. If this were a fundamental truth, it makes collecting information regarding sex to be as simple as checking a box for either, and in turn, stored in a binary form digitally; however, the truth is more complex. Many countries allow for the legal recognition of a third gender, and this is a state welcomed by people who do not identify with either, or with aspects of both. This may due to an intersex condition diagnosed at birth, or a subjective lack of affiliation with either sex despite sexual organs and characteristics of one sex. One can argue that the reasons are academic, as it is the end state of requiring an option outside of the gender binary that matters.
For many people, the definition of the word “gender” is roughly interchangeable with “sex”, and both terms are taken to mean the reproductive organs existing within a person and associated secondary sexual characteristics; however, some people and organisations define gender as being the abstract social roles based on sex, and diverging the definition of “sex” to be the definition stated above, pertaining to sexual organs and characteristics. In this post, we’ll be using the latter.
One organisation which collects vast amounts of personal data: Facebook, has come into focus as it demonstrates how to handle information outside of the gender binary in an attempt to sensitively reflect the real life experiences of users; however, as a recent paper reviewing Facebook’s handling of this information shows, the way that Facebook deals with the information regarding sex is not new, but over time has been changed by user pressure. When Facebook began to collect user data on sex, it allowed options for male, female or other and subsequently used this information to provide gender based pronouns describing user activity. Over time, the use of “they” as a gender neutral pronoun created some translation difficulties and was derided as grammatically incorrect, so an attempt was made to force users to choose a pronoun on the basis of sex, and this overrode the original sex identity e.g. if you chose a female pronoun, your choice of “other” was changed to female.
Users self-organised to protest this, driving change by producing guides on amending the source code of the pages to allow reversion to the original “other” state, raising the question why this needed changed in the first place if the choice was not removed from the database itself. Over time, Facebook amended its policy and in 2014, allowed limited use of gender neutral pronouns and a greater range of non-binary identities; although the choice of a gender specific pronoun reverts the stored identity to a binary one.
The multiple options presented when signing up for Facebook with relation to sex is potentially confusing and, whilst presenting many options, remains restrictive if your choice is not offered, raising the question if there is a better way of working when requesting information. Web designer Sarah Dopp, who wrote an open letter to web designers and developers regarding this in 2010, and reminding us that the dangers of the gender binary, and the promotion of it as normal at the expense of all else, marginalises those who already feel marginalised, something that we, as healthcare professionals, should be striving to avoid.
So, the next time we sit down to ask a patient, or client, for their gender, we should take the time to reflect that whilst this may be a single question in a page of several, and perhaps just a tick in a box to us, that for them it may be a huge part of their identity that we are refusing to acknowledge through ignorance, and souring our relationship with them before we start.
For those of us who are doctors, we have benefited from the privilege of a free gender-neutral pronoun as a by-product of completion of a degree. If it’s important to us to use this title as an expression of professional identity, we could at least extend the courtesy to our patients to express, fundamentally, who they are.