Improvements to recording Sex, Gender Identity, and Pronouns.

We’ve just released a change to how a patient’s sex and gender can be recorded in Cliniko. Before we get into the details of the change, we should cover the difference between sex and gender. Sex refers to biological/physiological characteristics and gender is a social/cultural concept. Sex and gender are often used interchangeably, but the distinction is important, especially in medical software.

First up, we need to talk about the previous implementation in Cliniko. We have had a field named “Gender” in Cliniko, but we treated it as Sex. The options were Male, Female and Not applicable. We even had this field named as “Sex” behind the scenes. It did not handle the options well for Sex, and it certainly should not have been named Gender. This was a mistake and one that’s been around in Cliniko since 5th February 2011 (5 months before we launched Cliniko).

We’ve known for quite some time it needed to be changed, but the solution is not easy. We cannot trust the information currently stored in this field. We suspect many used it as “Sex”, but any that trusted our label of “Gender” could have entered different information. Not only socially, but medically it’s critical to be accurate here. For this reason, we’ve decided to deprecate this field and introduce new fields in its place. We no longer allow changes to the old Gender field, however, it will continue to be displayed for patients until the new sex field is set.

As of today, we’ve introduced two new fields: Sex and Gender Identity. Gender identity is a person’s sense of their gender. It is not necessarily related to sex, physical characteristics, appearance, behavior, or sexual orientation. We’re also introducing a new set of fields titled “Pronouns”, more on that below.

If you’re looking for more information about sex, gender, and gender identity, this Planned Parenthood article is a great place to start. https://www.plannedparenthood.org/learn/sexual-orientation-gender/gender-gender-identity

Both the Sex and Gender Identity fields allow for any specific text to be entered, but have some common options for convenience. For sex the options are: Female, Male, Intersex, Female to male, and Male to female. For gender identity, the options are: Agender, Androgyne, Gender fluid, Man, Nonbinary, Transgender, and Woman. If these are new terms for you, these pages from the nonbinary wiki are a great resource to learn more. https://nonbinary.wiki/wiki/Nonbinaryhttps://nonbinary.wiki/wiki/Binary_genders. Asking someone about their gender identity is a very personal question and is rarely required. We expect a large portion of Cliniko users will not need this, however for those that do, it’s very important.

We’re also introducing the ability to record a patient’s preferred pronouns. In English, the common third-person pronouns (he/him and she/her) imply gender. This causes people to make assumptions about a person’s gender based on how they look or behave. To avoid this there are many non-gendered pronouns, the most commonly used being they/them. This Lifehacker article is a great place to start learning more about gender neutral pronouns: https://www.lifehacker.com.au/2018/11/how-to-use-gender-neutral-pronouns/. And if you want to know even more, the nonbinary wiki has a lot of information: https://nonbinary.wiki/wiki/Pronounshttps://nonbinary.wiki/wiki/English_neutral_pronouns. We’re adding these pronouns to Cliniko to assist you and your team in referring to your patients/clients according to their preference.

When setting a patient’s pronouns, you’ll find options for common pronouns and the ability to provide custom text to allow for any preferred pronouns. When pronouns are set for a patient, they are shown on the patient’s detail page and on the appointment pop up. On both the patient form and details page, there are a set of example sentences to help demonstrate how the pronouns are used.

We know how important it is to accurately record Sex and Gender. Unfortunately, we’ve handled this very poorly until now. In making the changes you see today, we’ve now done the research we should have done long ago. We’re happy to properly empower our Cliniko users and ultimately their patients/clients to handle this with the sensitivity and accuracy it deserves.