Research on doctor/patient interaction

New research concerning interaction between medical personnel and LGBT people has been published in JAMA.

Guidelines from the Department of Health and Human Services call for medical providers to ask patients for their gender identity and sexual orientation, so that data can be collected about possible disparate treatment and to normalize LGBT identifications in the medical community.

The research, published in JAMA last month, included interviews with 53 patients and 26 health-care professionals in addition to a survey of 1,516 potential patients and 429 doctors and nurses who work in emergency departments. Of those providers, 77.8 percent thought their patients would refuse to answer questions about gender identity or sexual orientation.

The potential patients surveyed, who identified all across the spectrum of sexual orientation, disagreed. Only 10.3 percent said that they wouldn’t provide this information to a doctor, even though it would be their right to refuse. Patients and medical providers agreed that it would be best to gather and give information about sexual orientation in a patient’s self-reported written or electronic form rather than a verbal conversation, in which an uncomfortable medical provider could introduce awkward phrasing or leading questions.

Or, you know, the medical personnel might think LGBT people might be too embarrassed to identify themselves, rather than the more obvious possibility that the medical professionals might themselves be the people who are embarrassed.

Note: Those who said they would decline to answer were found to be more likely to be bisexual.

Clinicians weren’t saying the information wasn’t important.. “It was mostly paternalistic: ‘We don’t want to make anyone feel different.’ But it turns out to be that, ‘Doctors, you may have the best of intentions, but your patients want to be asked.

Patients are saying that you’ll make us feel more comfortable if you ask — and ask everyone, so that normalizes the questions.

--Dr Adil H. Haider, lead author, Brigham and Women's Hospital, Boston

Introducing a moment of discomfort to a medical setting is far preferable to the potentially wrong or harmful assumptions doctors may make otherwise. Without knowing a patient’s sexual orientation, most doctors assume she or he is straight. Emergency-room patients might need or want to contact a partner, and asking a lesbian how she can reach her husband could make an already stressful situation even more upsetting for the patient. Some LGBTQ survey respondents reported that routine information-gathering about sexuality and gender identity would help normalize those very normal characteristics in the medical community. Many said it would help them feel “visible.”

In a survey of 101 transgender patients, 89% thought it was important for primary care providers to know their gender identity, while only 57% thought it important for their health care providers to know their sexual orientation.

But safeguarding patients who do disclose is essential, said Sean Cahill, director of health policy research at the Fenway Institute in Boston. “In many states without nondiscrimination policies,” he said, “disclosing can open them to more discrimination without redress. They can be denied services.”

We also have to push for more protections.


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Though its odd that health care professionals have no problem asking so many other invasive questions, but get uncomfortable asking about gender identity and sexual orientation.

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