Caring for Unique Families: Say the Right Thing with Confidence

unique families

“I just don’t want to say the wrong thing.”

“If I lack confidence around a certain patient, I don’t engage with this patient as much.”

“I wish there was a handbook for dealing with all these different family types.”

All of these comments have been spoken in my Serving the Unique Family trainings. We all want to avoid offending or hurting unique patient populations such those in the LGBT+ community, those involved in adoption or surrogacy arrangements, and other unique patient populations. We want to know the most respectful terminology and not feel awkward using it.

You should know that these families appreciate any attempt to use updated, accurate language, and it’s worth any initial awkwardness when your patients see that you are willing to try.

The Neutral Compassionate Approach

Our Unique Families Program™ started over 18 years ago, after my own personal experience becoming a unique family. My husband and I adopted all three of our kids as infants and had vastly different experiences in the hospital interacting with healthcare professionals. I created the first and only hospital-based adoption support program in the nation at Parker Adventist Hospital south of Denver.

It was not far into that decade-long endeavor from 2004 to 2014 that I found the “neutral compassionate approach.” We focused on this approach for our families and found that it overlapped into multiple unique patient populations.

Terminology for Adoptive Families

Adoption is filled with outdated, inaccurate terminology. When a patient has placed her child for adoption, she didn’t give up her baby. She chose adoption.

She also did not “put up” her baby for adoption, as that terminology dates all the way back to the orphan trains in the late 1800s, when close to 250,000 children were loaded on trains heading west from the east coast between the years of 1854 to 1929. On stops along the way, they were “put up” on train platforms for the local town folk to come pick children to take home.1 Clearly this is not how adoption is practiced today!

A patient considering adoption may choose to parent; she doesn’t keep her baby. Why the difference? “Keep” is a completely passive verb, and we all know parenting a baby is anything but passive.

Terminology for Surrogate Families

Surrogacy arrangements utilize terms for the birthing patient like surrogate or gestational carrier, never surrogate mom. Those involved are used to terms such as these, and the parent(s) waiting for their child to be born to a surrogate are referred to as intended parents until the birth of their child. Then, of course, they are just the parents.

Terminology for LGBT+ Families

LGBT+ parents are best called by their first names, rather than their parenting roles. If parenting roles have been shared, certainly feel free to use them. If one parent is Mom and the other is Mama, it is respectful to mirror those terms when caring for your patient. These conversations are good to have in your initial assessment or interview. Each person is their own expert and should be included and collaborated with for health issues so that we, as health care professionals, can provide the best care.

Pronoun clarification is also key when addressing those in the LGBT+ community—and actually is appropriate for all patients. Asking a patient’s personal pronouns is totally acceptable. He may say, “My name is Michael, and my pronouns are he, him, his.” Or Jaime could say, “My pronouns are they, them, theirs.” Many people identify as non-binary—neither female nor male—and it’s essential we honor their pronoun requests.

Many parents, regardless of their own gender identity or expression, may request that you not use gender-identifying pronouns when caring for their little one. Instead of he or she, they may request that you use terms such as:

  • The baby (Has the baby eaten?)
  • They (Have they eaten?)
  • The child’s name (Has Casey eaten?)

Between honoring pronouns, clarifying roles, and respecting the parent or parents’ wishes, you can immediately create a neutral compassionate environment to offer care.

Those considering adoption, utilizing a surrogate, or in the LGBT+ community are just a few of the unique family patient populations we care for within our Unique Families Program.™ However, awareness of updated language is just the first step in showing neutral, compassionate care.

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Understanding the Role of Our Own Beliefs and Experiences

As we have learned while working with hundreds of healthcare professionals across the country, updated language is not enough to ensure neutral compassionate care for these families. To truly offer care in a non-judgmental, non-biased way, we all must be aware of our own personal thoughts, beliefs, experiences, and feelings about each unique patient population.

We all carry “suitcases” with us that are filled with these thoughts, feelings, religious beliefs, and even stereotypes—and no judgment is intended on any of that! Being aware of even some of the thoughts you have had as you read this article will help you put them in your suitcase to ensure you set those thoughts aside as you move into a space of compassion.

Our goal for the work we do is that each of us becomes very aware of our thoughts, be able to define what we keep in our suitcases, and leave those outside the room when caring for our patients. Most of our unique family patients are expecting to be judged—or even expecting to not receive a high level of care. For example, 73 percent of transgender patients and 29 percent of lesbian, gay, or bisexual patients reported they believed they would be treated differently by medical personnel because of their LGBT+ status.2 Unique families tend to be hypervigilant and expect to not receive neutral compassionate care, but when we use current, respectful language and keep a clear awareness of our thoughts and beliefs, they will be pleasantly surprised by the high level of care they can now receive from all of us, no matter their history or their story.

One day at a time. One patient at a time. And don’t just rely on language to show respect for those you care for. Value each patient with your actions, whether they align with what you carry in your suitcase or not. As you start hearing your own thinking, be reminded that we all have thoughts, feelings, and biases, but there is no better space for healthcare professionals and patients to meet than on the common ground of mutual respect and neutral compassionate care.

To learn more about our comprehensive Unique Families Program, visit our website at

  1. Blakemore, E. (2019). ‘Orphan trains’ brought homeless NYC children to work on farms out west. Retrieved 12/7/20 from
  2. Lambda Legal. (2010). When Health Care Isn’t Caring: Lambda Legal’s Survey of Discrimination Against LGBT People and People with HIV. Lambda Legal: New York.