Document Type


Publication Date

Fall 9-30-2020


Mentored Undergraduate Research Awards


The standardized documentation clinicians use to record evaluations of a patient are called Subjective, Objective, Assessment, and Plan (SOAP) notes. Consistent pronoun documentation and usage in these notes is especially important for affirming transgender and gender non-conforming patients as this population experiences significant health disparities linked to medical mistrust. A sample of SOAP notes (n=286) was taken from standardized patient encounters at the University of Louisville School of Medicine in 2017 (n=137) and 2018 (n=149). There were five case iterations of the standardized patient based on gender identity. The notes were coded using the software Dedoose for the following themes: pronouns clearly established, consistent pronoun usage, no pronoun usage, and disregard for established pronouns. Pronouns were clearly established in only 27.27% of the notes (n=78/286). Non-cisgender patients were more likely to have pronouns that were clearly established (41% vs 5%). Consistent pronoun usage was most often observed among the notes of cisgender patients. Inconsistent pronoun usage and disregard for established pronouns was observed most often for genderqueer patients (16%, n=14). Complete absence of pronoun use occurred in the notes of trans women (7%, n=3), genderqueer patients (8%, n=7), and cisgender women (3%, n=2) patients. These notes demonstrate a lack of rigor in recording pronouns accurately and consistently for patients, which can be profoundly detrimental to non-cisgender patient care. These discrepancies can be remedied by including training about gender-affirming care and interacting with non-cisgender patients in the clinical skills curriculum.