Everything doctors need to know about patient sexual orientation, gender identity

Many health experts believe that by knowing whether a patient is lesbian, gay, bisexual, transgender or straight, physicians can be more alert to a person’s medical needs and more thoughtful in interactions.

Additionally, by understanding a patient’s sexual orientation or gender identity, a clinician can be better equipped to address some of the more common physical, mental and social needs of each population.

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“I took care of a gay patient who was the victim of a hate crime; he sustained a traumatic brain injury. Knowing my patient’s and his partner’s sexual orientation from the very beginning allowed me and other members of the care team to provide very specialized comprehensive care,” says Michael Mencias, MD, hospice medical director at MJHS, Brooklyn, New York. “For example, we were able to provide and recommend very specific social services to both men that addressed their isolation, loneliness, fear, anger, depression and other concerns that are common for this population and victims of such a crime.”

Amy Stulman, NP, One Medical Group, Washington D.C., says that being “in the closet” is a major impediment to developing a meaningful patient/clinician relationship.

“If you can’t be yourself and talk honestly and openly, your provider can’t provide the best care,” she says. “There’s a number of cases where knowing sexual orientation and gender identity is important.”

For instance, during a well-woman visit, it’s appropriate to first determine the relationship status and the current partner’s sex in order have a meaningful conversation about a range of topics including sexual health, risk-appropriate STI screening and reproductive health and/or contraception.

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Or a transgender patient who is on hormones may have specific health needs related to current gender or assigned sex at birth. For example, a trans woman might still have prostate problems, and a trans man still needs routine pap testing. 

Next: Don't be afraid to ask

Donna Futterman, MD, a pediatrician and director, adolescent AIDS program for the Montefiore Health System, has long worked with LGBT youth and feels it’s the obligation of every doctor to treat and understand their patients as an individual and what specific health issues they may be facing.

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“Questioning those identities puts you right in the path of several important medical issues that the provider needs to know,” she says. “We should care about who our patients are and what their issues are and understand the unique vulnerabilities facing the LGBT community.”

Don’t Be Afraid To Ask

For some patients, this information can be very sensitive, and physicians are sometimes wary about making anyone uncomfortable by broaching the subject. However, many believe a doctor shouldn’t be afraid.

“I ask for a patient’s sexual orientation/gender identity just as I ask any other question, however, before I begin, I pre-emptively say that I ask this same question to every patient so no one feels profiled or discriminated against,” Mencias says. “If a patient feels uncomfortable or becomes anxious after I pose the question, or refuses to answer, I do not force the issue-I just move on.”

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Asking about sexual orientation can be even more uncomfortable for the provider than for the patient.

“Studies show patients do not mind being asked these questions and that they prefer to be asked,” Stulman says. While some doctors may be uncomfortable bringing the subject up, it’s necessary and he suggests using clear language to asking a transgender or LGBT patient about their sexual practices.

Next: Establishing a safe connection

Futterman notes that a patient can be at the beginnings of their LGBT journey or still not out to family members, and that can lead to them being less than truthful with their physicians.

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“We recently had a young person who is gay and felt his parents were anti-gay, so he did not want to disclose to them that he was gay but was engaging in high-risk sexual experiences with other men and definitely was a candidate for PrEP, a prevention pill for HIV,” she says. “The problem was he couldn’t afford to take it because he was on his parent’s insurance and didn’t want them to know, so didn’t tell his doctor.”

That’s why establishing a safe connection between doctor and patient is so important.

Setting the Scene

A welcoming environment can encourage a patient to voluntarily give a doctor information without the need to even ask for it. Mencias says physicians and other clinicians can do many things to create a welcoming environment for all patients.

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“Examples include LGBT flags in front of a doctor’s office, gender neutral and gender-specific bathrooms, as well as displaying company/clinic/organization brochures and packets that say you are LGBT friendly and highlight how you profile culturally sensitive, compassionate care,” he says.

Physicians who can affirm they are an LGBT friendly provider or an LGBT expert can go a long way toward putting a patient at ease and building a meaningful relationship.