Allied Health Focus: Medical/insurance coding and clinical practice scenarios

Exercises for Practicing Use of Chosen Names and Pronouns

Here are unique, affirming, and practical activities designed to help helping professionals and educatorscomfortably and respectfully ask clients or students about their pronouns. These activities center relational trust, trauma-informed practice, and gender identity justice.

Goal: Normalize and affirm pronoun sharing in a way that reduces harm, supports agency, and builds safety.

 1. “Pronoun Ecosystem” Mapping

Audience: High school teachers, social workers, counselors, allied health professionals
Purpose: Explore where and how pronouns show up in daily work and how power influences disclosure.

Steps:

• Ask participants to map their “professional ecosystem” (e.g., intake forms, staff meetings, classroom rosters).

• Highlight where pronouns are collected (or not) and how.

• Discuss:

  • Where might a client/student feel pressure to disclose?

  • Where can we create optional, low-stakes opportunities instead?

• Redesign one part of the system to be more affirming.

Why it works: Promotes systems-level reflection and supports redesigning institutional habits.

2. “Mirror and Window” Script Practice

Audience: Medical assistants, EMTs, teachers, massage therapists
Purpose: Build comfort and fluency in asking about pronouns without making it awkward or performative.

Steps:

• Provide 3–5 sample scripts (e.g., “Hi, I’m Jordan, and I use they/them pronouns. What pronouns feel right for you today?”).

• Participants practice in pairs, switching roles.

• Discuss which scripts felt most natural and why.

• Invite participants to write a version in their own voice.

Why it works: Encourages authentic, affirming language and avoids robotic phrasing.

3. “Pronoun Pause” Intake Activity

Audience: Therapists, nurses, case managers, front-desk staff
Purpose: Rethink how intake processes ask about identity details.

Steps:

• Show participants a traditional intake form (with “Gender: ___” or “M/F” boxes).

• Invite them to critique it from a gender-justice lens.

• Guide them to draft a “Pronoun Pause” insert, such as:

  “You’re welcome to share your name and pronouns, but only if you want to. We’ll do our best to use what you share.”

• Add optional fields: “Pronouns you use: ___ (optional),” and “How should we refer to you in front of others?”

Why it works: Centers consent and reduces pressure to disclose in unsafe contexts.

4. “Pronouns in Practice” Roleplay Scenarios

Audience: All helping professionals
Purpose: Respond to real-world misgendering moments with confidence and care.

Steps:

• Roleplay brief scenarios like:

  • A colleague misgenders a client.

  • A client misgenders another client.

  • A client says, “I don’t care about pronouns.”

• Debrief using reflective prompts:

  • “What did you notice about your comfort level?”

  • “What could be said to redirect with care?”

  • “What repair would feel affirming?”

Why it works: Builds muscle memory for in-the-moment intervention and models harm reduction.

5. “Postcard to My Future Self”

Audience: Teachers, therapists, nursing students, DEI facilitators
Purpose: Sustain reflective practice and commitment.

Steps:

• Ask participants to write a postcard to their future self:

  • What do you want to remember about asking for pronouns?

  • What discomfort or joy came up today?

  • What’s one promise you’ll make to affirm others more fully?

• Collect and mail them back in 3–6 months.

Why it works: Moves the work from performative allyship to lasting accountability.

6. “Name Me as I Am” Activity

Audience: Teachers, health professionals, intake staff, social workers
Purpose: Build fluency and care in asking about chosen names — without making assumptions or causing harm.

Steps:

1. Warm-Up Reflection (Silent Writing)
   Prompt participants:

   • “What assumptions do you make when you see a name on a form?”

   • “How do you feel when someone calls you the wrong name, nickname, or title?”

   • “Why might someone not want to use the name on their ID or file?”

2. Script Rewrite
   Provide a typical phrasing:

   “What’s your name?” or “What’s your legal name?”

   Then invite participants to revise it to be more affirming. Examples:

   • “What name would you like us to use when we talk with you?”

   • “Is there a name that feels right for us to call you here?”

   • “What name feels most like you today?”

3. Pair Practice + Debrief

   • In pairs, roleplay introducing themselves and asking about both name and pronouns.

   • Debrief: What wording felt warm? Where did it feel awkward? Why?

4. Form Language Redesign (Optional Extension)
   Have participants revise a sample intake or roster form with inclusive language:

   • “Name you’d like us to use: __________”

   • “Legal name (only if required): __________”

   • “Is it safe to use this name when calling in the waiting room/classroom?” (Y/N)

Scenarios and Medical and Health Insurance Coding

When working with medical and health coding procedures for transgender individuals, it’s important to ensure that codes and documentation are inclusive and accurately reflect the care provided. Below are some sample activities that can be useful for training or working with healthcare professionals in coding procedures for trans patients:

1. Scenario-Based Role Play for Accurate Medical Coding

Objective: To help coders practice identifying and coding gender-affirming procedures and other relevant services in real-world scenarios.

• Activity Setup:

  • Create diverse patient case scenarios involving transgender individuals. For example, a transgender man undergoing chest masculinization surgery, a transgender woman receiving hormone therapy, or a non-binary individual seeking routine health check-ups.

• Task:

  • Participants will receive a patient’s medical history and encounter details, and then work in small groups to identify the appropriate medical codes. They must ensure that gender-affirming procedures are accurately documented.

• Learning Outcome:

  • Coders will practice using ICD-10, CPT, and HCPCS codes related to gender-affirming care, including hormone therapy, surgery, and mental health services.

  • Understand how to appropriately code for trans-inclusive care (e.g., gender dysphoria diagnosis, gender-affirming surgery).

2. Mapping Gender-Affirming Care to Appropriate Codes

Objective: To reinforce the importance of accurate medical coding for gender-affirming care and reduce errors in billing and insurance claims.

• Activity Setup:

  • Provide a list of common procedures and treatments used in transgender healthcare, such as hormone replacement therapy (HRT), voice therapy, or genital reconstruction surgery.

• Task:

  • Participants will match each procedure to the appropriate ICD-10 diagnosis code and CPT procedure code. Additionally, they will consider modifiers to distinguish between services provided to cisgender versus transgender patients when applicable.

• Learning Outcome:

  • Coders will gain familiarity with the codes for common gender-affirming treatments and understand how to differentiate these codes from other medical procedures.

  • Emphasis will be placed on gender-affirming surgeries like mastectomy or genital reconstruction, which often need specific coding considerations.

3. Understanding ICD-10 Codes for Gender Dysphoria

Objective: To ensure coders are knowledgeable about the specific ICD-10 codes for gender dysphoria and related diagnoses.

• Activity Setup:

  • Provide a brief overview of the ICD-10 codes related to gender dysphoria (e.g., F64.0, F64.2, etc.) and explain when these codes should be used in medical documentation.

• Task:

  • Participants will work through case studies in which gender dysphoria is a primary diagnosis, ensuring the appropriate ICD-10 codes are selected. The cases should include varied gender identities and health scenarios (e.g., a trans person seeking mental health support or a transgender person receiving hormone therapy).

• Learning Outcome:

  • Coders will learn how to properly document gender dysphoria, identify when a specific code should be used (e.g., F64.0 for transgender identity), and how to differentiate between gender dysphoria and other psychological conditions.

  • Emphasis on gender-affirming care and the patient’s gender identity will be reinforced throughout the exercise.

4. Simulated Insurance Claims Review

Objective: To develop the ability to navigate and troubleshoot gender-affirming care claims through insurance.

• Activity Setup:

  • Provide simulated insurance claims with varying levels of complexity, including gender-affirming surgeries, hormone treatments, and related mental health care.

• Task:

  • Participants will review the insurance claims to identify if any billing issues arise, such as denied claims for transgender-related services or incorrect code usage. They will also practice finding solutions, such as using the correct modifiers or re-submitting claims with additional documentation.

• Learning Outcome:

  • Coders and billing specialists will learn how to address common issues faced when processing insurance claims for transgender individuals.

  • They will understand how to ensure that gender-affirming care is not denied based on misunderstandings or errors in medical coding.

5. Workshop on Gender-Inclusive Documentation Practices

Objective: To emphasize the importance of inclusive and accurate documentation practices when working with transgender patients.

• Activity Setup:

  • Present a detailed case study of a transgender patient seeking various types of care (e.g., hormone therapy, mental health support, and gender-affirming surgeries).

  • Discuss common pitfalls in documenting transgender care, including using incorrect gender pronouns, omitting gender history, or inaccurately coding gender-affirming procedures.

• Task:

  • Participants will review and correct mock patient records, ensuring that gender-affirming care is properly documented. This includes ensuring the correct use of preferred names and pronouns, gender identity, and medical history.

• Learning Outcome:

  • This workshop will help participants develop a deeper understanding of how to document transgender care in a way that is respectful, accurate, and in line with medical coding standards.

  • Emphasis will be on proper terminology, the impact of documentation on insurance reimbursement, and improving patient care through clear and accurate records.

6. Understanding Transgender-Specific Modifiers in Coding

Objective: To clarify how to use modifiers in medical codes when documenting transgender-specific services.

• Activity Setup:

  • Provide information on the use of modifiers in CPT and ICD-10 codes, including how they apply to gender-affirming surgeries and treatments.

• Task:

  • Participants will practice using specific modifiers for transgender health procedures (e.g., modifier 22 for increased procedural complexity, modifier 50 for bilateral procedures). They will analyze patient scenarios and apply the correct modifier where needed.

• Learning Outcome:

  • Coders will learn how to apply specific modifiers to transgender health services, ensuring that the procedures are accurately represented and billed.

  • The activity will cover common procedures such as mastectomies, breast implants, and other surgeries that may require special billing considerations.

7. Cross-Cultural Sensitivity in Coding for LGBTQIA+ Patients

Objective: To promote awareness of cultural sensitivity when working with transgender patients, ensuring that coding practices do not contribute to stigmatization.

• Activity Setup:

  • Lead a discussion or provide materials on the importance of cultural sensitivity in transgender healthcare, emphasizing the need for appropriate documentation.

• Task:

  • Participants will review a set of coding scenarios involving transgender patients, focusing on how to approach cultural issues and navigate potential challenges in a compassionate manner.

• Learning Outcome:

  • Coders will understand the impact of cultural competence in documentation and coding for LGBTQIA+ patients, ensuring that practices reflect respect for the diverse experiences of transgender people.

8. Coding Practice with Mock Insurance Forms

Objective: To ensure accurate coding practices are followed and understand how errors can impact reimbursement and patient access to care.

• Activity Setup:

  • Provide participants with sample insurance forms, patient history, and treatment details that include gender-affirming surgeries and hormone treatments.

• Task:

  • Coders will work in teams to correctly complete the insurance forms, ensuring that gender-affirming treatments are accurately reflected.

• Learning Outcome:

  • This activity ensures that coders understand the complexities of insurance claims for transgender care and the critical role coding plays in securing patient access to services.

These activities are designed to enhance the knowledge and skills needed for coding gender-affirming care while ensuring that transgender individuals receive respectful, accurate, and inclusive medical documentation.

Scenarios about Dental Care

1. “Deadnaming at the Front Desk”

Context: A trans man checks in for a cleaning, and the receptionist loudly calls out his birth name from the chart.
Challenge: The patient becomes visibly upset and leaves.
Prompt: How should dental staff approach names and gender respectfully from intake to exam?

2. “Assumptions About Appearance”

Context: A nonbinary patient wears heavy makeup and facial piercings. The hygienist says, “That’s quite a look—you must like the attention.”
Challenge: The patient feels judged and disengages.
Prompt: What assumptions should dental professionals avoid, and how do bias and commentary affect care?

3. “Who’s the Parent?”

Context: A child is accompanied by two dads. The dental assistant repeatedly asks, “So which one is the real father?”
Challenge: The parents express discomfort and consider switching providers.
Prompt: How can dental teams communicate respectfully with LGBTQIA+ families?

4. “Pride Flag Pushback”

Context: A staff member puts up a small Pride flag in their operatory. A patient complains and demands removal.
Challenge: The office manager hesitates to take a stance.
Prompt: What role do visible signs of support play in patient comfort, and how should dental offices respond?

5. “Sexual Health Questions Done Wrong”

Context: A pansexual patient discloses dry mouth related to HIV meds. The dentist replies, “Well, maybe be more careful about who you sleep with.”
Challenge: The patient is offended and distrusts the provider.
Prompt: How should dental care professionals address sensitive health disclosures without judgment?

6. “Medical History Forms and Binary Boxes”

Context: A patient asks how to complete the gender section of the form. The only options are “male” and “female.”
Challenge: They feel unseen before the appointment begins.
Prompt: How can dental offices create more inclusive paperwork and documentation?

7. “Gendered Small Talk”

Context: During a procedure, the dentist jokes, “Bet your boyfriend doesn’t floss either,” to a queer woman.
Challenge: The patient doesn’t correct the dentist but chooses not to return.
Prompt: How can dental professionals engage in inclusive, affirming communication during care?

8. “Training Gaps and Trans Patients”

Context: A dental student is unsure how hormone therapy might affect oral health in a trans woman and avoids asking or looking it up.
Challenge: The patient senses discomfort and mistrusts the student.
Prompt: How should dental care providers close gaps in their clinical knowledge to support LGBTQIA+ patients?

9. “LGBTQ Elders and Isolation”

Context: An elderly lesbian in assisted living comes to the clinic and refers to her late partner. A student says, “Oh, I didn’t know you were… one of those.”
Challenge: The patient becomes silent and avoids further conversation.
Prompt: How can dental professionals practice affirming care with LGBTQIA+ elders who may have faced decades of discrimination?

10. “Fear of Disclosure”

Context: A closeted bisexual patient declines to disclose medication info, fearing how the staff might react.
Challenge: This leads to a potentially dangerous drug interaction.
Prompt: How can dental professionals create environments where LGBTQIA+ patients feel safe disclosing vital health information?

Scenarios about EMSI

1. “Name vs. Identity”

Context: A nonbinary patient is found unconscious and identified by their legal ID, which lists a name and gender that do not match how they present.
Challenge: EMTs continue using the legal name with hospital staff despite a wristband with the correct name.
Prompt: How can first responders respectfully handle identity when legal records conflict with expressed identity?

 2. “Field Triage and Pronouns”

Context: A conscious trans man requests male pronouns and name use. A trainee laughs and says, “Got it, ma’am.”
Challenge: The patient becomes visibly distressed.
Prompt: What are the professional and ethical responsibilities when a colleague disrespects a patient’s identity?

 3. “Outing in Public”

Context: A lesbian patient discloses that her partner is also a woman, and a responder repeats it loudly at the scene.
Challenge: Bystanders react, and the patient becomes anxious.
Prompt: How can EMS providers ensure confidentiality and discretion in chaotic or public environments?

 4. “Medical History and Bias”

Context: A gay man reports chest pain. The EMT asks about drug use and HIV status before checking vitals.
Challenge: The patient says, “Are you assuming something about me?”
Prompt: How can EMS providers collect essential medical history without reinforcing stereotypes?

5. “Touch and Trauma”

Context: A bisexual woman involved in a car crash becomes tense when touched during assessment. She later shares she has a history of sexual trauma.
Challenge: The EMT was unaware and did not ask for consent to touch the torso.
Prompt: How can EMS providers integrate trauma-informed care in emergent scenarios where time is limited?

6. “Chosen Family at the Scene”

Context: A trans teen is injured at a park. Their queer best friend (not a legal guardian) insists on accompanying them in the ambulance.
Challenge: The EMS crew debates policy.
Prompt: How can first responders honor chosen family and emotional safety while observing legal and ethical guidelines?

7. “Gender-Affirming Devices”

Context: A trans woman wearing a breast form and tucking undergarments is unconscious. A responder hesitates, unsure how to remove clothing for care.
Challenge: The team delays response and communicates uncomfortably.
Prompt: How can EMS students be trained to recognize and respectfully manage gender-affirming devices during triage?

8. “Radio Misgendering”

Context: While updating dispatch and ER staff, a paramedic refers to a nonbinary patient as “female en route.”
Challenge: The patient corrects them but is ignored.
Prompt: What protocols can be developed to support identity accuracy in time-sensitive communications?

9. “Hesitation in Rural Response”

Context: In a rural area, a visibly queer teen is in distress. A responder mutters, “We don’t get those types out here much.”
Challenge: Other team members are unsure how to respond.
Prompt: What is the role of peers in addressing discriminatory comments in EMS settings?

10. “Mental Health and Identity”

Context: A pansexual college student calls EMS for a panic attack after being outed on campus.
Challenge: The provider dismissively says, “It’s just anxiety—you’ll be fine.”
Prompt: How can EMS providers recognize the intersection of mental health crisis and identity-based trauma?

Scenarios in Nursing

1. “A Room With a Viewpoint”

Context: A transgender man admitted for surgery is roomed with female patients despite his request for privacy.
Challenge: Other staff say, “It’s just easier this way.”
Prompt: How should nurses advocate for gender-affirming accommodations within institutional constraints?

2. “Hesitation at Intake”

Context: A nonbinary patient hesitates when asked to list a legal name and gender on the intake form.
Challenge: The nurse insists on the legal ID only.
Prompt: How can nurses collect necessary info while showing respect for name and identity?

3. “Family at the Bedside”

Context: A lesbian patient’s partner is told, “Only family members are allowed in the room.”
Challenge: The nurse says, “Sorry, those are the rules.”
Prompt: What are the patient’s rights, and how can nurses protect chosen family access?

4. “Just Curious”

Context: A nurse casually asks a gay patient, “How did you two meet?” while laughing and calling the partner “your friend.”
Challenge: The patient becomes quiet and guarded.
Prompt: How do personal assumptions or microaggressions affect therapeutic communication?

5. “Mental Health Disclosure”

Context: A bisexual patient discloses past suicide attempts related to family rejection. The nurse responds, “Well, at least things are better now, right?”
Challenge: The patient shuts down emotionally.
Prompt: How should nurses respond to trauma disclosures with empathy and appropriate follow-up?

6. “Electronic Health Records”

Context: The EMR system auto-populates gendered language and a deadname.
Challenge: Staff continue using incorrect pronouns.
Prompt: How can nurses advocate for inclusive documentation and respectful communication?

7. “STI Assumptions”

Context: A pansexual patient is in for a routine STI screening. The nurse asks, “Why? Do you think you were with someone risky?”
Challenge: The patient feels judged and refuses further testing.
Prompt: How can nurses ensure inclusive, non-stigmatizing sexual health care?

8. “Pride Pins and Patient Reactions”

Context: A nurse wears a rainbow badge. One patient complains to management, saying it’s “inappropriate.”
Challenge: The hospital considers restricting visible symbols of support.
Prompt: What is the role of visible affirmations in patient trust and safety?

9. “Gender-Affirming Hormones and Pain Management”

Context: A trans woman is in for pain management post-surgery. The nurse expresses concern that her hormones “might interfere with anesthesia.”
Challenge: The patient feels her care is being delayed due to bias.
Prompt: What must nurses understand about gender-affirming medications and treatment planning?

10. “Long-Term Care and Isolation”

Context: An elderly gay man in a rehab facility is repeatedly misgendered and referred to as “that bachelor.”
Challenge: He isolates and refuses meals.
Prompt: How can nurses address ageism and heteronormativity in long-term care settings?

Scenarios about Massage Therapy

1. “Pronouns Dismissed”

Context: A nonbinary client indicates their pronouns as “they/them” on the intake form. During the session, the student therapist repeatedly uses “she.”
Challenge: The client becomes quiet and does not rebook.
Prompt: How do correct pronouns foster safety and professionalism in bodywork?

2. “Chest Binding and Physical Tension”

Context: A transmasculine client arrives with shoulder pain and discloses that they bind their chest daily. The student reacts with surprise and says, “That can’t be good for you.”
Challenge: The client feels judged and refuses to remove the binder during the session.
Prompt: How should therapists respond neutrally and supportively when LGBTQIA+ clients share identity-related physical habits?

3. “History of Sexual Trauma”

Context: A queer woman discloses a history of sexual assault. During the massage, the student works too close to the inner thigh without checking in.
Challenge: The client freezes and later reports the session felt violating.
Prompt: How should therapists adapt bodywork to honor trauma-sensitive boundaries?

4. “Intake Form Language”

Context: A gay male client points out that the intake form asks for “husband/wife” rather than “partner/spouse.”
Challenge: The student responds, “It’s just a standard form—don’t take it personally.”
Prompt: How does inclusive language on paperwork shape client trust from the beginning?

5. “Touch Aversion from Dysphoria”

Context: A nonbinary client requests only arms and legs be massaged due to intense chest and torso dysphoria.
Challenge: The student says, “You’ll feel better if we just do the full session.”
Prompt: How can massage therapists honor client-defined touch boundaries without projecting their own assumptions?

6. “Misgendered by Staff”

Context: A trans woman hears a receptionist whispering and laughing with another staff member about her voice.
Challenge: She enters the session already anxious and tense.
Prompt: How should massage therapists advocate within a workplace for a safe, inclusive environment?

7. “Client Anxiety in Undressing”

Context: A bisexual teen survivor of assault is nervous about undressing, even partially. The student says, “It’s fine—we’ve seen it all before.”
Challenge: The client does not proceed with the session.
Prompt: How can therapists create safety around modesty, consent, and exposure for LGBTQIA+ clients with body trauma?

8. “Pride Pin on a Practitioner”

Context: A visibly queer client sees a Pride flag pin on the therapist’s lanyard and smiles, saying, “That makes me feel safer.”
Challenge: Another client later complains the pin is “political.”
Prompt: How should practitioners and clinics navigate affirming visibility while maintaining professional ethics?

9. “Body Hair and Body Shame”

Context: A trans woman receiving massage apologizes for body hair and says, “I’m still working on laser.”
Challenge: The student therapist replies, “No worries, I didn’t even notice.”
Prompt: How can therapists affirm body diversity without dismissing the client’s expressed vulnerability?

10. “Touch and Religious Trauma”

Context: A queer client from a conservative religious background shares that massage brings up guilt and shame from childhood teachings about the body.
Challenge: The student doesn’t know how to respond and changes the subject.
Prompt: How can massage therapists hold space for complex emotional responses during bodywork?

Scenarios about Medical Assisting

1. “Gender Marker Mismatch”

Context: A trans patient’s ID shows “M,” but they present as a woman and use a feminine name.
Challenge: The MA calls out their birth name and misgenders them in the waiting room.
Prompt: How can medical assistants uphold confidentiality and use affirming names/pronouns, even when legal records differ?

2. “Intake Forms and Erasure”

Context: A nonbinary patient asks why the new patient form only allows “male” or “female” and has no space for pronouns.
Challenge: The MA responds, “That’s just how the system is.”
Prompt: How can MAs advocate for inclusive forms and intake procedures, even when using outdated systems?

3. “Partner Assumptions”

Context: A lesbian patient mentions her wife. The MA says, “Oh, you mean your friend?”
Challenge: The patient becomes uncomfortable and withdraws.
Prompt: What assumptions about relationships should MAs avoid, and how can they use language that reflects what the patient shares?

4. “Sensitive Exam Preparation”

Context: A transmasculine patient arrives for a pap smear and appears visibly anxious.
Challenge: The MA avoids eye contact and rushes through the pre-exam checklist.
Prompt: How can medical assistants support patients during potentially triggering procedures?

5. “Commenting on Appearance”

Context: A gender-nonconforming teen arrives in makeup and a skirt. The MA says, “Wow, bold look for a guy!”
Challenge: The patient feels mocked and does not return.
Prompt: What is the impact of commenting on LGBTQIA+ patients’ appearances, even if it’s intended as friendly?

6. “HIPAA and Outing”

Context: A bisexual woman is out to her doctor but not to her family. Her mother calls asking about her medication.
Challenge: The MA gives a vague summary, mentioning it may relate to “women’s health and relationship stress.”
Prompt: How can medical assistants safeguard patient confidentiality, especially around LGBTQIA+ identities?

7. “Microaggressions in Scheduling”

Context: A trans patient requests a follow-up with a doctor they trust. The scheduler rolls their eyes and says, “Why does it always have to be complicated with you people?”
Challenge: The patient overhears this.
Prompt: How should MAs respond to bias from coworkers, and how can they advocate for affirming care?

8. “Insurance and Deadnaming”

Context: A trans woman’s legal name is still listed on her insurance. The billing assistant insists, “I have to use your legal name, sorry.”
Challenge: The patient says, “I want to leave.”
Prompt: How can MAs balance documentation requirements with affirming, respectful communication?

9. “Body Trauma Disclosure”

Context: A queer man discloses past sexual trauma and asks to skip weight and vitals due to dysphoria.
Challenge: The MA insists, “We can’t skip that—it’s standard.”
Prompt: How can MAs approach care protocols flexibly and trauma-sensitively, especially for LGBTQIA+ patients?

10. “Student Confusion on Pronouns”

Context: A student MA is unsure what “they/them” means and asks a patient, “But are you a boy or a girl?”
Challenge: The patient looks stunned.
Prompt: How should students learn to respectfully ask and use pronouns, and what are the professional consequences of not doing so?

Scenarios about Respiratory Care

 1. “Gender Marker and Equipment Fit”

Context: A trans woman is being fitted for a CPAP mask. Her legal gender marker is male, but she presents and identifies as female.
Challenge: The respiratory care student hesitates and uses “sir” repeatedly.
Prompt: How can students ensure respectful, affirming care regardless of documentation or appearance?

2. “Intake Form Misgendering”

Context: A nonbinary patient is asked to fill out a respiratory intake form that only includes “male/female.”
Challenge: The student shrugs and says, “Just pick one.”
Prompt: How can respiratory care providers advocate for inclusive data collection without compromising clinical detail?

3. “Bias in Family Involvement”

Context: A gay man hospitalized with COPD asks his partner to help make treatment decisions. The student says, “Is he your brother?”
Challenge: The patient corrects them and grows visibly frustrated.
Prompt: How can respiratory therapists recognize and respect chosen family in patient care?

4. “Chest Trauma and Gender Identity”

Context: A transmasculine patient with asthma presents with chest tightness. The student asks if the patient binds their chest.
Challenge: The student reacts uncomfortably and avoids eye contact after the patient says yes.
Prompt: How should providers approach gender-affirming practices like binding with clinical curiosity and respect?

5. “Confidentiality Breach”

Context: A respiratory therapist tells a colleague, “That patient used to be a woman.”
Challenge: The patient overhears the comment.
Prompt: What are the ethical and professional standards around confidentiality and gender identity?

6. “Touch Consent and Trauma History”

Context: A queer client with a history of sexual trauma is asked to remove their gown for a chest wall assessment. They hesitate and look nervous.
Challenge: The student says, “We have to do this. Just breathe through it.”
Prompt: How should respiratory care students practice trauma-informed physical assessments?

7. “Pronouns Ignored”

Context: A patient uses they/them pronouns, which are listed on their chart. The respiratory therapist continues to say “he” throughout the visit.
Challenge: The patient stops engaging and limits communication.
Prompt: How do pronouns affect rapport and care outcomes in respiratory treatment?

8. “Assumptions in Health History”

Context: A bisexual woman presents with shortness of breath. The student asks, “Do you smoke, drink, or use drugs? Your lifestyle could be a factor.”
Challenge: The tone feels accusatory and biased.
Prompt: How can students gather accurate health histories without making assumptions about LGBTQIA+ patients?

9. “Hospital Environment Hostility”

Context: A nonbinary teen recovering from pneumonia hears staff in the hallway joking about “preferred pronouns.”
Challenge: The student therapist is unsure whether to say something.
Prompt: What is the responsibility of respiratory care professionals when encountering microaggressions by colleagues?