Xyr, Hir and They: When Using New Pronouns Feels Overwhelming

Written by Clinic Mind on .

Written By:

Laine Mohnkern, MSW, LICSW (she/they)

Pronoun Evolution

For as long as anyone has been using English, we have used pronouns found in the English language. For many people, over many years, this was done without much thought or consideration. In fact, people generally used far less consideration for pronouns than for whether there, their, or they’re is used.  Pronouns, however, are currently in the spotlight of society as their evolution is actively occurring.

This is not the first time pronouns have gone through evolution, however, as it is rare anyone uses ‘thou’ anymore, but nevertheless, a new experience of pronouns is occurring.  This occurrence is in the spotlight because of how people are identifying their genders, and how this changes in new generations.  Harvard Business Review stated that “more than 12% of U. S. millennials identify as transgender or gender nonconforming, and a majority believe that gender is a spectrum rather than a man/woman binary.” With Gen Z however, that number changes, and “25% of GenZers expect to change their gender identity at least once in their lifetime” and “59% believe forms should include options other than ‘man’ or ‘woman.’” Jae A Pucket, an assistant professor of psychology at Michigan State University reports similar research stating “24.5% of Gen Z participants identified as non-binary, whereas only 7.4% of boomers identified this way.” Identifying as a non-binary gender does not always mean using pronouns outside of he or she, but it often does. 

What Does this Mean for Medical Practitioners?

For medical practitioners, that means that we have gone from seeing around 7.4% of our patients using non-binary pronouns to potentially starting to see at least 1 in 5 of our patients using non-binary pronouns.  This is a cultural evolution creating a need for language evolution.  For many practitioners, this can be confusing or overwhelming.  The most common non-binary pronoun is the use of they as a singular pronoun.  Singular they is used in the English language and has been since the 14th century as shown by the Oxford English dictionary (and by Jane Austen and William Shakespeare); however, it has been under criticism since the mid-18th century and was only officially added as a non-binary pronoun in 2019. Also, ‘they’ is not the only non-binary pronoun out there. As early as 1972 we started to see ze and hir, but currently, there are easily 10 different non-binary pronouns, and spoken word artist Andrea Gibson is known for stating “My pronouns haven’t even been invented yet.”  Clearly, this is an active evolution, and one that has shown it’s here to stay. 

Yet it is new to so many people. This is hard for a practitioner who wants to be comfortable and competent when speaking to their patients while providing welcoming and inclusive care.  So often the learning curve can feel overwhelming.  Practitioners know we want to provide good care, but we don’t always know how.  

Malcolm Gladwell states it takes 10,000 hours to learn a new skill and Josh Kaufman says it only takes 20, but regardless to get to those hours we have to practice.  Learning any new skill will feel overwhelming in the beginning, but with practice it becomes much easier.  What can make pronouns hard is that many of us don’t practice until we are meeting with someone who already needs us to be proficient.  


Erez Lirov ClinicMind CTO – on what it means to practice


So What Can a Practitioner do to Assist Them in Making this Easier?

How about a 4 step approach: 

  1. To start off, ask each person their pronouns. That is the easiest place to start. This lets you start right off the bat knowing what your patient needs.  An easy way to ask is to also use your pronouns when introducing yourself. When you are first meeting someone for care, it is not uncommon to introduce yourself by name. As Pride In Practice suggests, a simple change can be saying “Hi, (person’s  name). My name is ____ and I use ___ pronouns. What pronouns do you use?”  Some practitioners feel odd about this introduction because they feel if they are not gender non-conformining or trans then they shouldn’t be doing this, but on the contrary, this helps to normalize the practice. Normalizing means that the responsibility isn’t solely on those who are gender-diverse, thus making the experience inclusive for all. Practitioners who have started to use this have come back stating they ended up with patients often surprised and happy and that more patients have asked for unexpected pronouns then they would have assumed. For the practitioner, this lets you know right away that you might need to practice something new. Thus leading us to…
  2. Practice, practice, practice.  Websites such as practicewithpronouns.com can help. As can making sure that you are using that person’s pronouns even when they are not in the room. This is especially true even when you are thinking about that person.  One of the many reasons we struggle is because we will think something like “she came in today really struggling” but then try to say “can you get a referral for them.”  Catching yourself, even when no one can hear, makes this so much easier. 
  3. Start to normalize the use of gender neutral language.  A great time to do this is in consultation.  Often when we are consulting we are looking to remove a lot of information to make the consultation potentially more HIPAA compliant, so why not remove gender? We often consult without using names; a great opportunity to practice is to also not use pronouns or to use they as the pronoun for all your patients. When learning something new we are going to make mistakes; that is how we learn! Many of us would prefer to make the mistake when we are not in front of the people we provide care for. This is a great opportunity for that.
  4. Have your documentation remind you, not oppose you. If you are trying to use something like “xyr” for a patient when you are talking with them but your documentation only uses she or he, that can make it so much harder.  


How Can Your Documentation Make This Easier?

Documentation that supports your practice of pronouns can be much more helpful. Typical EHR’s do not support a trans friendly workflow, they do not support pronouns or a non-legal name. This causes a clinician to have to remember to manually ‘code switch’.  However, technology exists in ClinicMind’s EHR to allow for selected pronouns to already be in a clinician’s documentation. Therefore, once a clinician has chosen the correct pronoun, ClinicMind will supplement in the clinical documentation. So the sentence you may always have in your daily note might be “Patient came in identifying anxiety was really high. She has been having trouble sleeping and states she is struggling in her life” by choosing a different pronoun such as ze/hir the sentence will automatically change to “Person came in identifying anxiety was really high. Ze has been having trouble sleeping and states ze is struggling in hir life.” Thus not only will your documentation reflect your patient’s identity, thereby increasing not only how much they feel respect in their own care, but will increase their follow through with their care and increase their ability to improve in care (as documented by that National Institute of Health). It will also help you practice the use of pronouns, so this feels less overwhelming in your day to day practice. 

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