Is the Topic Too Personal?
Doctors ask their patients a lot of highly personal questions. They’ll tackle serious topics such as domestic violence and depression, and have no problem asking their patients potentially embarrassing questions about bowel movements and menstrual cycles.
But when it comes to gender identity and sexual orientation, many doctors avoid the topic.
“They’re worried that asking about someone’s sexual identity is too personal and won’t be perceived as clinically relevant,” says Liz Margolies, executive director of the National LGBT (Lesbian Gay Bisexual Transgender) Cancer Network, who conducts cultural competency training sessions for doctors. “They are afraid to ask because they think it will be too intrusive.”
But here’s the thing, Margolies says. “We want to be asked.”
Being Aware of LGBT Health Disparities
Research suggests there are significant health disparities between LGBT individuals and the broader population because of the social stigma and discrimination they may face. LGBT individuals experience high rates of psychiatric disorders, substance abuse, and suicide, according to the US Department of Health and Human Services (HHS), as well as health issues stemming from violence and victimization, lack of family support, or social acceptance.
Those disparities have been compounded by professionals who have often made LGBT patients feel unwelcome, says Dru Levasseur, a senior attorney with Lambda Legal, an LGBT legal advocacy organization.
In 2009, Lambda surveyed nearly 5000 LGBT individuals and people living with HIV. More than half the lesbian, gay, and bisexual people surveyed and 70% of transgender respondents reported experiencing discrimination in a healthcare setting or receiving substandard care. Almost 27% of the transgender and gender-nonconforming respondents told Lambda researchers they’d been denied care at some point and many respondents said they’d interacted with healthcare professionals who refused to touch them or spoke harshly to them. The Lambda survey also noted that fear of discriminatory treatment created a barrier that discouraged LGBT individuals from seeking care.
In an effort to bridge the healthcare gap, the Institute of Medicine (IOM), The Joint Commission, and HHS have all emphasized the need to better understand the health risks and barriers faced by members of the LGBT community. The IOM and The Joint Commission have pressed for routine documentation of patients’ sexual orientation, and HHS is working to spur healthcare organizations to collect sexual orientation and gender identity data by making it a requirement for electronic health records (EHR) meaningful use certification.