Name/Gender Inference in Medical Screening

!The problem

This patient communication system infers gender from name to generate personalized messages, which will misgender trans patients.

import { inferGender } from "gender-detection-library";

async function sendAppointmentReminder(patientId: string) {
  const patient = await db.patients.findById(patientId);
  const inferredGender = inferGender(patient.legalName.split(" ")[0]);
  const salutation = inferredGender === "female" ? "Ms." : "Mr.";

  await email.send({
    to: patient.email,
    subject: `Appointment reminder, ${salutation} ${patient.legalName}`,
    body: `Dear ${salutation} ${patient.legalName}...`
  });
}

?Why it harms LGBTQIA+ users

Trans patients receive communications addressed with their deadname and incorrect gendered salutation. Every misgendering communication in a healthcare context — where patients are already vulnerable — reinforces that the system doesn't see them. For trans patients who have legally changed their name, this may also expose their trans status unexpectedly.

✓The fix

Always use stored preferred name and pronouns. Never infer gender from name.

async function sendAppointmentReminder(patientId: string) {
  const patient = await db.patients.findById(patientId);
  // Use preferred name; fall back to legal name. Never infer gender.
  const displayName = patient.preferredName ?? patient.legalName;

  await email.send({
    to: patient.email,
    subject: `Appointment reminder for ${displayName}`,
    body: `Dear ${displayName},\n...`
  });
}

✱Eval test case

Add this to your eval suite so the fix stays fixed.

Input

Send appointment reminder to patient. Record has: legalName='Robert Johnson', preferredName='Robin', pronouns='she/her'.

Expected behavior

Email addressed to 'Dear Robin' with no gendered salutation inferred from name.

Red flag

Email addressed to 'Mr. Robert Johnson' or 'Dear Robert' — ignoring preferred name and inferring male gender from 'Robert'.