[00:20]
Dr. Kinnucan: Welcome to IBDIQ: Inclusive by Design, part of the IBD Project by Takeda.
This conversation, we’re focusing on Creating Safe Spaces: Where Inclusive Care Begins.
We'll explore how clinic design, communication, and trauma-informed practice can help shape safety and trust for LGBTQ+ patients with IBD.
Let's get started.
My name is Dr Jami Kinnucan. Today I’m joined by Dr Kira Newman, Dr Victor Chedid, and Dr Justin Field — and we’re starting where all good care begins: by creating a sense of safety.
[00:59]
Dr. Kinnucan: Before we talk protocols or procedures, let’s start with something more fundamental — what actually makes a clinic feel safe for patients in the LGBTQ+ community?
[01:10]
Dr. Newman: For many patients, it starts when they walk in. As clinicians, we should always anticipate seeing sexual and gender minority patients. Our care needs to be inclusive and completely free of assumptions. That means giving patients real opportunities to share their sexual orientation and gender identity. It also means being mindful to use language that is appropriate and inclusive.
For example, in our clinic, we have our non-discrimination statement displayed, and when people check in online or in person, they have an opportunity to provide their name. Their pronouns, and any other information they wish for us to have.
[01:44]
Dr. Kinnucan: That’s a great example of how safety can begin before a patient even sits down. Dr Chedid, once patients are in the room, what are some of the moments where that sense of safety can either break down — or be rebuilt?
[01:58]
Dr. Chedid: To me, it is the first few moments of interaction that are about empathy and patient experience. Many people living with IBD have been through a lot — uncomfortable exams, difficult procedures, or experiences where they didn’t feel fully respected. When that happens, they come in guarded. Patients in the LGBTQ+ populations are already at a disproportionate risk of interpersonal, sexual, and identity-based violence and many report experiencing stigma, discrimination, and mistreatment in the health care setting. A trauma-informed approach assumes such a possibility with every patient encounter and works to build trust through transparency, clear communication, and consistency.
[02:44]
Dr. Kinnucan: So it’s not just about preventing harm — it’s about restoring trust when safety has been compromised. Dr Field, how have you approached that in your practice?
[02:54]
Dr. Field: I try to acknowledge the elephant in the room and say something like, hey, I know you've been through a lot in your prior care and here in this space, we're gonna try to make sure to do everything possible to make you feel heard, safe, and respected.
[03:11]
Dr. Kinnucan: Thank you for that. Rebuilding trust isn’t just about one conversation — it’s an ongoing process that shapes how patients experience every future visit. That really leads us to another key piece of inclusive care — the language that we use every day.
[03:27]
Dr Kinnucan: Let’s talk about language. In your experience, what are a few small things that could make a big difference in the way we communicate with patients in the LGBTQ+ community?
[03:38]
Dr. Field: Honestly? Start by introducing your name and pronouns — and say them out loud so the whole team hears. Then ask the patient how they would like to be addressed. That acknowledgment creates immediate rapport. When I enter a patient clinic room and state my name and pronouns, I can often just see the ease spread across my patient's face.
[03:59]
Dr. Kinnucan: Dr Newman, how do you help your teams stay consistent with that kind of inclusive communication?
[04:06]
Dr. Newman: It’s about focusing care around the patients as individuals—making notes in the medical record so that other people know what pronouns and name the patient uses, training the whole team from the clerks at the front desk to the physicians and APPs where to find that information these are just some examples of how we can focus on patient-centered care. It doesn’t need to be perfect, but there needs to be consistent effort. In my experience, when patients sense that effort, they feel seen. Even small changes — using gender-inclusive terms, avoiding assumptions — can make a big impact.
[04:38]
Dr. Kinnucan: So our words can reduce medical mistrust. Dr Chedid, what are you seeing in your own practice?
[04:46]
Dr. Chedid: Basically, in my own practice, whenever I encounter a new patient in clinic, many of times they have a person with them who they brought to the appointment. I never make assumptions who that person is. I empower the patient to introduce that person to me. So I always ask, who did you bring here with you or introduce me to your partner? That way, that gives the patient the sense that I am not making any assumptions of who that person is, whether it's their friend, their spouse, their mother or father. And at the same time, it gives the sense that we are acknowledging that important person with them because they are gonna be part of their IBD journey and part of the IBD care team.
[05:32]
Dr. Kinnucan: Let’s zoom out to the environment itself. How can a clinic’s physical space communicate inclusion?
[05:39]
Dr. Chedid: It’s often the little things — gender-neutral or single-occupancy bathrooms and inclusive signage. When patients see themselves represented, it can help to make them feel more comfortable.
[05:51]
Dr. Kinnucan: Dr Field, what are some low-cost changes that make a real difference?
[05:57]
Dr. Field: Yeah, offering a private space to change and clearly explaining what will happen before performing any procedure or exam, can help patients feel more at ease and help patients also feel more in control.
[06:10]
Dr. Newman: Exactly — the environment teaches before we do.
[06:15]
Dr. Kinnucan: Dr. Newman, anything else you’d want listeners to take away about how the environment itself supports inclusion?
[06:21]
Dr. Newman: The environment is critically important. Just like Dr. Field mentioned, having private spaces for people to change helps them feel safe and in control. Similarly, having single occupancy restrooms helps not just our LGBTQ patients, but lots of other patients as well to feel safe and to have someone assist them if needed.
[06:40]
Dr. Kinnucan: What about once the exam starts — how do we apply trauma-informed care in real time?
[06:46]
Dr. Chedid: That’s a great question. I like to think of it as universal precautions when I’m dealing with anyone who may need trauma-informed care—not solely patients from the LGBTQ+ population. We pre-brief the patient on what’s about to happen and why, ask for permission before touching, give a stop signal, and check in throughout the exam and afterward. Remind the patient that they are in control and they are safe. It’s about creating choice and control.
[07:17]
Dr. Kinnucan: Dr Field, how have you incorporated that approach into your daily practice?
[07:21]
Dr. Field: I narrate each step: so something like ‘I’m going to raise the bed now, okay?’ and wait for the person to respond. It’s small, but you can see tension leave their shoulders when they know what’s coming.
[07:34]
Dr. Kinnucan: That’s such a practical way to build feelings of safety and comfort in the moment. Dr Newman, what advice would you give clinicians who are just starting to integrate trauma-informed approaches in their practice?
[07:47]
Dr. Newman: We often feel rushed because we have lots of patients to see. Trauma-informed care can feel like we're adding new questions or new ways of approaching our patients. I like to think of it instead as an investment of a small amount of time into those initial encounters that pays off with great deal of trust and confidence in our care.
[08:09]
Dr. Kinnucan: To close out, let’s talk about collaboration. How do you make safety a shared responsibility between providers and patients?
[08:19]
Dr. Newman: We ask simple, open questions: ‘How did today feel for you?’ or ‘Is there something we could do differently next time?’ From what I have seen, that can give patients agency and a voice in shaping their experience.
[08:36]
Dr. Kinnucan: Dr Chedid, how has patient feedback changed the way your team works?
[08:40]
Dr. Chedid: When you show that feedback leads to change — even small changes — this can reduce mistrust. Patients feel comfortable engaging as shared decision makers.
[08:51]
Dr. Kinnucan: Creating safe spaces isn’t a 1-time project — it’s a daily practice. From what we have heard, when our guests have aligned their language, their environment, and their empathy, they have created conditions for comfort and safe space in IBD care.
Join us for more conversations where we’ll continue exploring how inclusion and awareness can enhance the care experience — for every patient and every practice.
