September 2025 correspondence

Exclusionary language has no place in AJGP

Thank you for publishing the article ‘General practitioner disaster support for pregnant women, new mothers, infants and young children: Findings from the Babies and Young Children in the Black Summer (BiBS) study’ by Hamrosi and Gribble (AJGP Jan–Feb 2025).

The article provides valuable insights into disaster support for parents and young children. However, we would like to express concerns regarding its language and the implications for patients and clinicians.  

Academic and clinical discussions about parenting, birth and infant care should be guided by both scientific evidence and inclusivity. While the article asserts that these experiences require a binary gender approach, its own language primarily refers to ‘caregivers’ and ‘parents’ without substantiating a strictly binary classification. Additionally, there is no indication in the method that gender data were collected from participants, making the assumption of binary gender roles problematic from both methodological and ethical perspectives. The definition of women as ‘adult female people’ within the article raises concerns about its intent and implications. Attempts to strictly define women are widely recognised as organised trans-exclusionary rhetoric¹ and contribute to the marginalisation of transgender and non-binary parents. Parenting, infant care and breastfeeding as the domain of two binary genders is by no means a settled issue.² Given the well-documented barriers that lesbian, gay, bisexual, transgender, queer, intersex, asexual and other (LGBTQIA+) individuals face in healthcare^3,4 – barriers that likely extend to disaster-response settings – we question whether such language serves an evidence-based purpose or instead fosters exclusion and harm.  

Beyond the impact on patients, we are also deeply concerned about the message this sends to gender-diverse clinicians and the wider LGBTQIA+ medical community. The Royal Australian College of General Practitioners (RACGP) has a responsibility to create a professional environment where all general practitioners feel valued and respected. Endorsing language that has been used to exclude and stigmatise transgender and non-binary individuals risks alienating LGBTQIA+ doctors, trainees and medical students.⁵ As a journal representing the RACGP, AJGP plays a critical role in fostering evidence-based, respectful and inclusive discussions within the medical community. The College must take care not to provide implicit support for language and narratives that exclude or stigmatise already vulnerable groups. 

Authors

Gillian Riley FRACGP, DRANZCOG (Adv.) General Practitioner, Watson General Practice, Canberra, ACT

Portia Predny FRACGP, Vice President, AusPATH, Sydney, NSW

Melanie Dorrington FRACGP, General Practitioner, Watson General Practice, Canberra, ACT 

Competing interests: None.

AI declaration: The authors advise that there was use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and accept full responsibility for all content. Details on how AI was used have been declared to the Editors.

References

1. Amery F, Mondon A. Othering, peaking, populism and moral panics: The reactionary strategies of organised transphobia. Sociol Rev 2024;73(3):680–96. doi: 10.1177/00380261241242283.
2. García-Acosta JM, San Juan-Valdivia RM, Fernández-Martínez AD, Lorenzo-Rocha ND, Castro-Peraza ME. Trans* Pregnancy and lactation: A literature review from a nursing perspective. Int J Environ Res Public Health 2019;17(1):44. doi: 10.3390/ijerph17010044.
3. Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth: Research evidence and clinical implications. Pediatr Clin North Am 2016;63(6):985–97. doi: 10.1016/j.pcl.2016.07.003.
4. Baldwin A, Dodge B, Schick VR, et al. Transgender and genderqueer individuals’ experiences with health care providers: What’s working, what’s not, and where do we go from here? J Health Care Poor Underserved 2018;29(4):1300–18. doi: 10.1353/hpu.2018.0097.
5. Kilicaslan J, Lewis J, Kennon T, Lane R, Petrakis M. Healthcare professionals’ experiences and perceptions about LGBTIQA+ safety and responsiveness in a mainstream Australian health service: Qualitative findings. Arch Psychiatr Nurs 2024;48:85–92. doi: 10.1016/j.apnu.2024.01.017.

Reply: Exclusionary language has no place in AJGP

We would like to thank Drs Riley, Predny and Dorrington for their letter. We acknowledge that, with increasing cultural salience of the concept of gender identity, more individuals are expressing a gender identity that differs from their sex. Some advocates therefore request that terms directly referring to sex, such as ‘women’ and ‘mothers’, be avoided.

In regard to our research, we recruited ‘parents’ and ‘caregivers’ for our study; however, we found a clear sex-based difference in experience between mothers and fathers. We thus referred to ‘women’ and ‘mothers’ where relevant. When we asked study participants about their gender identity, none indicated any sex–gender identity discordance. However, several indicated gender identity was a concept not applicable to them. We reject the notion that the long-established (>1500 years) definition of women as ‘adult female people’¹ is problematic, especially in a medical journal.

We agree that in providing individual healthcare, it is essential to use language aligning with each person’s preference. We acknowledge the rich diversity of parents and caregivers across race, religion, culture, education, disability, health, socioeconomics, sexuality, gender identity and family constellations. Appropriate language to ensure individuals feel safe, respected and welcome will vary. For gender-diverse people, this may include avoiding references to sex wherever possible. However, it should be recognised that documenting the sex of all patients remains important. Misrecording and/or misreporting of sex has resulted in serious harm.² Hospitals in a number of jurisdictions have instituted policies ensuring accurate recording of sex for reasons of patient safety and data integrity.³ General practitioners have a role in patient education in regard to this.

In public health communication and policy, there are numerous examples of confusion and other unintended consequences of avoiding sex-specific language. Research is needed to properly assess the extent and context of these impacts and to explore how they might be mitigated.⁴ We recognise the language challenges in this space, which have important implications for general practice. We welcome robust discussion and the development of policies that provide guidance on language use and resources for those with specific language needs.  

Authors

Michelle Hamrosi MBBS, BBiomedSc (Hons), FRACGP, IBCLC, DCH, General Practitioner and Lactation Consultant, Surf Beach Surgery, Batemans Bay, NSW; Clinical Lecturer, School of Medicine and Psychology, Australian National University, Canberra, ACT

Karleen Gribble BRurSc (Hons), PhD, Adjunct Professor, School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW

Competing interests: None.

AI declaration: The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript.

References

1. Oxford English Dictionary. ‘woman, n.’: Oxford University Press. Available at www.oed.com/dictionary/woman_n [Accessed 11 July 2025]
2. Stroumsa D, Roberts EFS, Kinnear H, Harris LH. The power and limits of classification – A 32-year-old man with abdominal pain. N Engl J Med 2019;380(20):1885–88. doi: 10.1056/NEJMp1811491.
3. Department of Health (DoH). Guidance note: Inclusive collection and reporting of sex and gender data. DoH, 2024. Available at www.health.vic.gov.au/publications/inclusive-collection-and-reporting-of-sex-and-gender-data [Accessed 11 July 2025].
4. Bartick M, Dahlen H, Gamble J, Walker S, Mathisen R, Gribble K. Reconsidering ‘inclusive language:’ Consequences for healthcare and equitableness of a growing linguistic movement to address gender identity with a path forward. Sex Reprod Healthc 2025;44:101088. doi: 10.1016/j.srhc.2025.101088.

The COVID-19 pandemic highlighted trainee burnout – as time passes, we cannot lose sight of this issue

The COVID-19 pandemic has been a highly stressful period for many doctors, particularly those on the front lines of care. Working in a rapidly evolving clinical and administrative landscape, the pandemic served to shine a spotlight on burnout in medicine. Indeed, in a recent systematic review and meta-analysis, we identified that the volume of literature examining burnout in postgraduate medical trainees more than doubled during the pandemic.¹ Within that review, we ran a subgroup analysis specifically focusing on general practice trainees and found no significant differences in their burnout scores during the pandemic. We argue that these seemingly counterintuitive results are understandable by the simple fact that they mask the burnout reported by this group before the pandemic. The same subgroup analyses demonstrate that general practice trainees’ depersonalisation (indicative of severe burnout)² was elevated prior to the pandemic. Further, although there was not a significant elevation in these trainees’ emotional exhaustion scores, during the pandemic, general practice trainees’ emotional exhaustion was significantly elevated when compared with normative data.¹ Concerns regarding burnout in medical trainees long predate the onset of the COVID-19 pandemic.³ One positive side effect of the pandemic has been the increased attention on this issue, as evidenced by the literature on this topic doubling in the past five years. However, it therefore stands to reason that trainee burnout will long endure after the pandemic subsides. The risk we face is that the spotlight shifts away from trainee burnout. We encourage these findings to demonstrate the critical need to avoid this mistake; supporting the wellbeing of our trainees is essential for a sustainable, thriving medicine and, as such, a sustainable, thriving society.

Authors

Shaun Prentice MPsych (Clin), PhD, Associate Clinical Lecturer, School of Psychology, Faculty of Health & Medical Sciences, The University of Adelaide, Adelaide, SA; Research Officer, General Practice Training Research Team, Royal Australian College of General Practitioners, Adelaide, SA

Diana Dorstyn MPsych (Clin), PhD, Associate Professor, School of Psychology, Faculty of Health & Medical Sciences, The University of Adelaide, Adelaide, SA

Jill Benson AM, MBBS, MPH, PhD, Adjunct Clinical Associate Professor, School of Medicine, Faculty of Health & Medical Sciences, The University of Adelaide, Adelaide, SA; National Lead Medical Educator – Remote Supervision, General Practice Training, The Royal Australian College of General Practitioners, Adelaide, SA

Competing interests: None.

AI declaration: The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript.

References

1. Prentice S, Dorstyn D, Massy-Westropp N, Benson J, Elliott T. Burnout before and during a pandemic: a systematic review and meta-analysis of 48,698 trainees. Med Educ 2025. doi: 10.1111/medu.15760. Epub ahead of print.
2. Leiter MP. Coping patterns as predictors of burnout: The function of control and escapist coping patterns. J Organ Behav 1991;12(2):123–44. doi: 10.1002/job.4030120205.
3. Hawk JE. Sources and levels of stress in family practice residents: A descriptive study. Dissertation Abstracts International 1983;43(11-B):3720.