This article is a follow-up to my review of a study called, “Treating Acne in Transgender Persons Receiving Testosterone: A Practical Guide,” by Radi et al. (2022). In that study, the authors reported dermatology providers have been under utilized in the efforts to improve access to inclusive, quality and culturally competent care for transgender men and women. They put out a call to action for more dermatology providers to prescribe isotretinoin to treat testosterone-induced acne. In this article, I’ve created a downloadable checklist to help you provide inclusive and culturally competent care. You’ll also find the “Twelve Tips for Inclusive Practice in Healthcare” developed by Marjadi et al. (2023).
Inclusivity
An inclusive practice model starts by defining a clear set of objectives so everyone knows their roles and expectations. It also defines the parameters for how to make people feel welcomed, supported, respected, heard, and valued. I would argue that inclusion requires someone to be willing to be self-aware, self-reflective, and open to critique. The more successful someone is at putting these steps into practice, the more likely they will be able to be comfortable with being vulnerable, a necessity to understanding internal biases which can be barriers to inclusivity.
Marjadi et al. (2023) created the twelve-steps to address the lack of inclusivity guides in the literature. During the creative process, the research team identified the five emerging themes below that are key to advancing an inclusive practice model. The steps in the checklist, form a quick guide that can be used by clinicians, frontline employees, leaders, and health professional students.
1. Diversity
2. Equity
3. Inclusion
4. Intersectionality
5. Strength-based approach
The Checklist
The first step to take is ensuring you have an inclusive and welcoming practice. Delivering inclusive care begins with your reputation in the community and in dermatology at large as people are likely to receive referrals to your practice from colleagues, friends, acquaintances and through social media. I’ve created a downloadable checklist to help everyone in your practice from those who answer the phone to providers with prescriptive authority.
How to build an inclusive dermatology practice
Additionally, Marjadi et al. wrote the “Twelve Tips for Inclusive Practice in Healthcare” to help you build an inclusive practice model:
1. Ask questions. Avoid assumptions.
2. Promote best-practice terminology. Encourage the use of neutral, non-judgmental terms that focus on health and health behaviors. Use medical terminology to describe how someone is living/managing a condition (wheelchair user; a person with autism) rather than suffering from it or being labeled as the condition (wheelchair bound; autistic). Avoid terms that place blame.
3. Use inclusive language and avoid othering people. Inclusive language terms:
- You all
- Folks
- Friends
- Mirror the language the patient uses, as appropriate
4. Devote time to learning about intersectionality as it relates to power, privilege and oppression. Google webinars and local events; these are easy to find in this era.
5. Design a clinical space that is accessible to people with various physical, sensory and cognitive needs.
6. Practice patient-centered communication by asking patient preferences for things like names, pronouns, body part terms, personal space, and touch. Also, consider asking and documenting preferences related to language, culture, race, ethnicity, religion, and gender identity. This information can be collected prior to the appointment or by trained support staff.
7. Start with a blank canvas when developing your perception of patients. Stereotypes and generalizations can rob us of truly getting to know patients for who they are, not where they are from, demographics, socioeconomics, and other social determinant of health components like education.
8. Promote diversity and inclusion in research. Address barriers to recruiting and retaining LGBTQIA+, rural, and other under-represented communities. Make sure your inclusion criteria include the likelihood these communities will be well represented. Providing transportation, offering remote participation, and ensuring access to interpreters are potential options.
9. Patient-centered healthcare delivery. Survey current and potential patients to find out what delivery care changes you could make to build a more inclusive practice. Some considerations are offering services outside of normal business hours. Adopt policies that standardize cultural competence training, holistic and integrative healthcare interventions, and consider flexible payment options.
10. Advocate for more equitable and inclusive care in the community, amongst colleagues, and in your advertising and marketing campaigns. Find out the needs of patients and leverage your role to accommodate them as much as it's possible. Keep it simple, your role may be addressing gaps in knowledge when it comes to understanding advocacy, equity, and inclusion.
11. Commit to lifelong learning to becoming more inclusive to more diversity. This journey includes making time for self-reflection and listening to people’s lived experiences to influence quality improvement and personal growth.
12. Adopt inclusivity into your practice model. An inclusive practice model is an environment where patients and staff feel welcomed, supported, and represented at every level of corporate strategy. It includes a sustainable methodology that can evolve with the growth of the business, encourages feedback, utilizes data analytics, and fosters personal development.
Inclusive Language for History Taking
Refer to the study by Radi et al., Table 1, for a list of example history questions to ask. Some example questions include:
How would you describe your gender identity?
Please tell me which organs you have or had removed?
What body parts do you use?
Do you have sex with people who can produce sperm?
30 Article Challenge
This blog post is part of a series I posted on Instagram where I read and review articles related to dermatology and discussed the implications for dermatology nurse practitioners. The archived posts can be found on my Instagram page in the highlights labeled:
I’ll continue to update the highlights as I review more articles. If you have any references on providing inclusive and culturally competent care for transgender persons, please message me, I would love to continue the conversation.
References
Marjadi, B., Flavel, J., Baker, K., Morns, M., Triantafyllou, M., Strauss, P., Wolff, B, Procter, A., Mengesha, Z., Walsberger, S., Qiao, X., & Gardiner, P.(2023). Twelve tips for inclusive practice in healthcare settings. International Journal of Environmental Research and Public Health, 20, 4657. https://doi.org/10.3390/ijerph20054657
Radi, R., Gold, S., Acosta, J., Barron, J., & Yeung, H. (2022). Treating acne in transgender persons receiving testosterone: A practical guide. American Journal of ClinicalDermatology, 23, 219-229. https://doi.org/10.1007/s40257-021-00665-w
Kimberly Madison, DNP, AGPCNP-BC
Kimberly Madison is a new dermatology nurse practitioner with a passion for writing, entrepreneurship, financial literacy, and mentorship. I created this blog to share my journey as I become a dermatology nurse practitioner and entrepreneur. Most importantly, I’m looking forward to helping nurse practitioners and aspiring students to better understand the business of dermatology and their role to improving access to care, providing culturally competent care, and advancing education.
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