"Hi, my name is Allyson. My pronouns are she and her."
Squinting back at me from the hospital bed is a wiry man with a head of wispy white hair. His puffy eyes take the usual route: first my face, then a flicker over my half-buzzed hair, then a scan down my chest and hips in my black unisex scrubs.
"What did you say your name was?" he asks, his face still vaguely confused.
"I’m Allyson," I say. "I’m a physical therapist here at the hospital. Your doctor asked me to come by and see how you’re getting around."
As an acute care physical therapist, I have interactions like this every day. Many patients are initially unsure of my gender. I'm 5 feet, 6 inches tall, flat chested, with an athletic build from a decade playing rugby. My wavy red hair stands up tall in the front, with a close fade on the sides.
I have never been good at pretending to be anything but myself. Since the age of 4, I have insisted on dressing and acting like the gender-nonconforming person that I am. Early in my career, I worried that my queerness and androgyny would be seen as unprofessional or distracting — or worse, that my gender expression would get in the way of building trusting therapeutic relationships with my patients. Over the past eight years, however, I've come to understand that the opposite is true: The foundational tenets of my identity — fluidity, authenticity, and vulnerability — help me be a better clinician.
Unlike many medical interventions that are largely passive on the patient's end, physical rehabilitation is a collaborative, dynamic process. All physical therapists use different approaches to connect with and motivate the people we care for; this flexibility helps us respond to a given patient’s needs at a given time. For me, my gender fluidity frees me to access a range of communication strategies and emotional states in order to establish safety and trust.
Patients with critical illness, significant weakness, or fear of falling may feel safer and more capable in the hands of someone who appears physically strong, is confident, and gives clear instructions (stereotyped as a more masculine style). Other patients may need someone to listen to their story, empathize, and link their personal narrative to their therapy goals (what some people might think of as more feminine interactions). I access both of these motivational styles from within my own identity. Because people don’t know what box to put me in, I am freed (at least partially) from gendered social expectations. Although my style may fluctuate somewhat depending on the patient, it is always a genuine reflection of myself.
I chose to be open with my identity at work because the burden of secrecy distracts me from focusing fully on my patients. And as any busy clinician knows, fragmented attention is a detriment to quality care. For me, authenticity is requisite for a mindful presence at work.
My authenticity and vulnerability at work also have grown my empathy for the lived experiences of others. Nothing taught me this more dramatically than the experience of working in the hospital into my last month of pregnancy, drawing plenty of confused stares from patients and colleagues. Enduring the recurrent scrutiny of the public eye in my androgynous pregnant body awakened me further to the experiences of people who move through the world with amputated limbs, staggering limps, and conspicuous scars. It is not the same experience for many reasons but unwanted attention for one’s physical presentation is draining and distracting.
For me, the emotional and psychological cost of being closeted at work is far more harmful than occasionally dealing with skeptical or even openly hostile patients or colleagues. But my choices are my own; there are LGBTQ+ clinicians who feel that their gender identity or sexual orientation has no place in their interactions with patients. I respect that this is a highly individualized balance for each provider that may fluctuate over time, even from patient to patient.
I also understand that many other providers — those with marginalized identities (and often intersecting marginalized identities) — face much more complexity (and bigotry) in their patient interactions than I do. For these and other reasons, some providers may prefer to leave certain aspects of their identity out of the therapeutic alliance. I honor and respect those decisions.
What drives my own decision is my belief that LGBTQ+ providers belong in clinical care, and we deserve to bring our whole selves to work. But that alone won't get us where we need to be: The healthcare community needs to more fully embrace fluidity, authenticity, and vulnerability as valuable aspects of care and healing.
Everyone would benefit if providers of all genders fully embraced their authority and assertiveness without being labeled bossy, bitchy, or cold; or if they could express warmth, empathy, or sadness without having their masculinity called into question. When we are less rigid, more emotionally engaged, and more authentic, we not only offer our patients better care, but we provide them a model for self-care by insisting on our own humanity, wellness, and wholeness.
Sutkowi-Hemstreet PT, DPT, is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy. She is a faculty development resident with the Doctor of Physical Therapy Division.
This perspective first appeared in an APTA publication in February 2023.