A child anxiously steps through the doors of Children’s Hospital of Philadelphia (CHOP). “What name will they call me?” she wonders and fears the worst.
The tone of today’s appointment will be set before the child even sees the doctor. It will come in the fleeting moment when a Hospital staff member calls the child’s name aloud to be escorted to a private room. If the child’s male birth name is called out, the child — who self-identifies as a girl — will be crushed.
"That's devastating," says Linda A. Hawkins, PhD, MSEd, LPC, Co-director of the Gender and Sexuality Development Clinic, which supports transgender and gender non-binary youth. "The sadness you feel when a kid is close to tears because they were called back to their appointment with the wrong name."
Respecting a patient’s dignity
At CHOP, we never want children to feel unwelcome and afraid. Instead, Hawkins adds, “We want to make the lives of children and their families better.”
One way to do this is by calling children by the name and pronouns they most identify with — which don’t always match the patient's legal name.
“We want to respect their dignity by giving staff a standardized way to know a patient's preferred name," says Stephon N. Proctor, PhD, ABPP, a Psychologist who works in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP.
Both Hawkins and Proctor knew from feedback and research that having the wrong name used when a child first walks into a clinic sets the appointment off on the wrong foot. So, they set their eye on solutions.
Changing the system
Their first step was writing a note in the family section of EPIC, the Hospital’s electronic health record, and then emailing all of the caregivers who would be seeing the family. But this plan fell short when it came to sharing the information between shifts. The information didn’t always make it to the next provider in time.
Hawkins and Proctor then focused a more coordinated system: implementing the preferred name as a new field in EPIC. In other words, it’s a new piece of critical information being collected and stored in the child’s medical record. So now, the preferred name is "visible to all of the care providers, or as many as humanly possible," Hawkins adds.
Under the new system, when a new or existing patient arrives at CHOP, registration staff members ask the patient, parent or guardian whether the patient has a preferred name. If a preferred name is given, the scheduler adds it to the child’s chart.
The change "was 100 percent welcome," Hawkins says, adding that many employees saw the need as much as parents.
The change spans across CHOP Primary Care, Specialty Care, and Urgent Care practices as well. In one recent example, a family who had just moved to the area, met with Hawkins in the Gender and Sexuality Development Clinic, where the child’s proper name and pronoun were entered into their medical record. When the family attended another CHOP facility, the child’s correct name was used.
"He nearly cried, he was so happy to be able to be himself,” Hawkins says. “Our staff all used the right name and the family couldn’t have been happier."