Are questions regarding a patient’s sexual orientation appropriate when not medically relevant?
Yes, according to most patients surveyed about routine collection of sexual identity data in the emergency department (ED).
Such information is important, patients said, for the sake of the health care provided as well as for recognizing and normalizing patients who are lesbian, gay or bisexual.
"Our patients are telling us that routinely asking all patients who come to the ED about this information creates a sense of normalcy toward people of all sexual orientations and signals that each patient is equally welcome here, including the 3-10% of Americans who identify as lesbian, gay or bisexual," said researcher Adil Haider, MD, MPH, director of the center for surgery and public health at Brigham and Women's Hospital, Boston.
Interestingly, health care professionals who were asked the same question, regarding the appropriateness of sexual orientation inquiries, recognized the importance of sexual identity data – but only when the information was directly relevant to a patient’s care.
Perhaps another survey question for the study, published in JAMA Internal Medicine in June, sheds some light on why clinicians tend to stay silent when the information doesn’t seem to directly affect medical care.
When asked if they thoughts patients in the emergency department would refuse to provide their sexual orientation if asked, 77.8% of physicians and nurses said yes. Yet only 10.3% of patients reported they would withhold such information.
"Health care providers haven't collected these data, at least in part due to fear of offending patients,” said researcher Brandyn Lau, MPH, CPH, assistant professor of surgery at the Johns Hopkins University School of Medicine, Baltimore, “but this study shows that most patients actually would not be offended."
Patients who are bisexual, the study found, were almost double as likely as patients who are straight to refuse to provide sexual orientation information. Yet population-weighted results found that just 16.4% of patients who identified as bisexual would refuse to share their sexual orientation.
The preferred method of sexual orientation information collection, agreed patients and clinicians in the survey, is nonverbal self-report.
Americans in the LGBTQ (lesbian, gay, bisexual, transgender, questioning) population historically have poorer overall health and less access to health care and insurance compared with Americans in the heterosexual population.
In addition to communicating acceptance and normalization, routine collection of sexual identity information could enhance the care of adults who identify as LGBTQ, researchers said.
"Unlike racial/ethnic and age data, information about sexual orientation and gender identity has not been collected routinely in health care settings, which limits the ability of researchers and clinicians to determine the unique needs of the lesbian, gay and bisexual communities," said Lau.
Closing the disclosure gap could begin to turn things in a better direction.
"We need to make collecting sexual orientation information a regular part of our practice, similar to how other demographic information such as age and race is collected,” said Lau. “And because I don't think providers will start consistently collecting these data on their own, clinics and hospitals need to mandate it.”