Should Doctors Ask Patients About Their Sexual Orientation?

Shelly Reese

Disclosures

September 25, 2018

In This Article

Physicians' Reluctance to Ask About Sexuality

But even as policy organizations and healthcare advocates emphasize the importance of asking patients about their sexuality, physicians on the front lines are loath to do so, fearing the question is too personal.

In a 2017 study published in JAMA Internal Medicine, 78% of emergency room doctors and nurses surveyed said they didn't think patients would answer questions about their sexual orientation and identity and would refuse to provide such information when asked in this setting.[3]

Even clinicians who have a special interest in sexual medicine may be hesitant to broach the subject. In a recent survey of 92 healthcare practitioners who are members of the Sexual Medicine Society of North America, only half said they routinely ask patients directly about their sexual orientation, according to Johns Hopkins researchers. What's more, over 40% of those who do not ask said that sexual orientation is irrelevant to patients' care.[4]

"I was shocked," said Amin Herati, MD, a urologist at Johns Hopkins Hospital in Baltimore, Maryland, and one of the study's authors. Herati notes that men who have sex with men are at increased risk for hepatitis, HPV, and anal cancer and require a different treatment for erectile dysfunction than men who have sex exclusively with women. "It was breathtaking to see how many members of the provider community thought it was irrelevant to ask and how many were simply counting on the patient to disclose that information."

Ironically, while physicians may hesitate to ask patients about their sexuality, patients don't appear to have many qualms about answering them.

Half of the patients surveyed in the JAMA study said they would provide sexual orientation information as long as it was documented in the same way as other demographic questions. Fewer than 11% of patients said they would be offended if such information were routinely collected in the emergency department, and only about 10% said they would refuse to provide the information.

In their qualitative comments, some patients told researchers that it was as foundational for physicians to know their sexual identity as it was for them to know their diet and exercise habits. Many noted that routinely collecting sexual orientation information as part of the demographic profile promotes greater societal recognition. As a gay female told researchers, "If you are counted, if you are visible, it is sort of another form of recognition at an institutional level."

Jay Schuur, MD, MHS, vice chair of clinical affairs for the department of emergency medicine at Brigham and Women's Hospital in Boston, Massachusetts, and one of the JAMA study authors, says that patients' comments underscore that asking about sexual identity in the emergency department is important even when it doesn't directly relate to the reason a person is seeking treatment. Having a more complete picture of a patient's life—such as whether they have a partner to care for them or a stable place to recover —enables healthcare institutions to provide better care.

"Historically we've been taught to ask prying questions only when they're relevant to the reason a person presents in the emergency department," he says, "but we've learned that there are some pieces of information—like asking about domestic violence—that are worth asking everybody, because if we don't make it a habit of asking all the time, it won't happen."

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