By James Shea

In 2017, Madison Watkins sat in a patient’s room at VCU Health and waited for her primary care physician (PCP). Anxiety coursed through her body. She planned to talk with her PCP about transitioning from male to female and needed his recommendations on a path forward.

“I had been seeing my PCP for years, since like 2011,” Watkins said. “I was absolutely scared when I got to the place where I wanted to disclose to him.”

Her PCP came into the room, and she informed him about her decision. He was supportive and connected her with someone at VCU Health who provided transgender care.

“There is a lot of anxiety as a transgendered person going to a doctor’s office,” Watkins said. “I have been discriminated against in a doctor’s office. There are so many times that I have avoided going to see a doctor or avoided going to an emergency room, because I was afraid of how I would be treated. It’s a fact. I delayed a lot of my health care for a long time.”

To support Watkins and others who are transgender or non-binary, VCU Health implemented a pronoun pin initiative in 2022. Doctors, nurses and staff wear a pin with their preferred pronoun. The pins come in four variations — she/her/hers; he/him/his; they/them/theirs and with the phrase “Ask me about my pronouns.” About a year after the initiative started, more than 9,000 pins have been distributed to the 14,000 VCU Health team members.

The effort was started after Marcelle Davis, DSL, MBA, VCU Health’s vice president of diversity, equity and inclusion, spoke with a medical student about pronoun pins at the hospital. The health system did not offer these pins at the time, but Davis and others saw pronoun pins as a way to enhance diversity, equity and inclusion at the health system.

“This is important because using correct pronouns is a basic way to show respect for an individual’s gender identity and since we cannot determine a person’s gender by outward appearance, the pronoun pins share this information and can make individuals feel safe and included,” Davis said. “By identifying oneself and including pronouns in a visible place, patients and team members will feel more comfortable. This allows for a more welcoming environment across our health system.”

The initiative fits into the larger DEI goals within VCU Health, Davis says. In January of 2022, VCU Health launched a 4-part DEI strategy — education and communication, DEI governance, recruitment of diverse team members and advancement, retention and engagement of diverse team members.

“The pronoun pin initiative is a key part of the education and communication effort because of its connection to creating a safe, respectful and equitable environment for all team members and patients,” Davis said.

Besides being a patient, Watkins is also a VCU Health team member and has been heavily involved in the pronoun pin effort. If her PCP had been wearing a pronoun pin the day she disclosed her desire to seek transgender care, Watkins says it would have alleviated a lot of her anxiety – making her feel more comfortable about the conversation.

“If he had been wearing a pronoun pin, it would have had a huge impact,” Watkins said.

VCU Health’s pronoun pins come in four variations — she/her/hers; he/him/his; they/them/theirs and with the phrase “Ask me about my pronouns.” (VCU Enterprise Marketing and Communications)

Challenge of getting care

The transgender community often has a complex relationship with the medical field. To undertake transition, they must engage in the medical field. At the same time, there is a lot of trepidation about visiting a doctor.

Like herself, Watkins has heard from friends who have experienced discrimination within health care. She has a friend who suffers from a variety of medical complications but refuses to visit a hospital.

“[My friend] will not go to an emergency room, even when doctors tell her to go, because she has been treated so poorly in other cases,” Watkins said. “The pronoun pins help break that wall down.”

According to a recent National Institutes of Health study, 42% of transgender respondents reported delaying medical care due to discrimination. Watkins says this has only become more pronounced as health care for the transgender community, especially among children, has become more political.

“If I see a new doctor and see a pronoun pin, it says to me that I am safe there,” Watkins said. “If I don’t see that, I don’t know.”

To increase the number of people with pronoun pins, VCU Health is making them available to new team members. Every new team member must undergo a health screening, and that office makes the pins widely available.“

We thought it would be a great idea so that not only would people know that employee health was a safe space, but VCU Health was a safe space,” said Valerie Scott, a VCU Health patient access representative who works closely with Watkins. “It was a place that would affirm their identity and pronoun.”

Scott wears a pin and is often asked questions about it when people come for appointments. As well, she lets someone know about the pins if the person has they/them as a pronoun on team member paperwork. She wants team members to realize that VCU Health is a welcoming and understanding place.

The demand for the pronoun pins has been high since the program was put in place last year.

“We can’t keep them in stock,” Scott said. “The new hires love them. The current team members love them. I think it’s a cool thing for them to have. They really appreciate it.”

Watkins is encouraged by the work VCU Health is doing to make the health system a welcoming place for transgender and non-binary people. For her, the journey to transition has been a long and winding road, and she wants to make it a more pleasant experience for others.“

Just because you don’t agree with someone’s life, doesn’t mean you can’t give them dignity and respect,” Watkins said. “The pronoun pins, in my opinion, show that I am going to treat you as a human being. I don’t need to know someone’s political views. I just need to know when I walk into the doctor’s office or go into the emergency room that someone is going to treat me with the same level of respect and care that they would any patient who comes in.”