Should Doctors Ask Patients About Their Sexual Orientation?

Shelly Reese

Disclosures

September 25, 2018

In This Article

Being Aware of Heterosexual Assumptions About Patients

Advocates say that asking about sexual orientation and identity may feel awkward at first, but it could prevent doctors from making heterosexual assumptions that have the potential to damage the doctor-patient relationship.

Schuur tells a story of once treating a pregnant woman who had been brought to the emergency department by a man and a woman. Schuur mistakenly addressed the man as if he were the patient's husband, only to learn that the other woman was her wife. The encounter underscored for him how easy it is in a busy clinical setting to make shorthand, societally ingrained assumptions about patients. "It reinforced for me the importance of systematically asking the question of all patients," he says.

While physicians and other healthcare workers may feel awkward or embarrassed when a patient is compelled to correct them, the situation can be worse for the patient.

"Correcting someone is hard for a patient," Margolies says, recalling an incident when a gynecologist asked if she was sexually active and immediately followed up by asking what type of birth control she used. "When I had to say, 'I'm gay,' I felt exposed," she says. "Keep in mind as patients are already exposed when we go see the doctor. We're sitting there in a paper gown, and we're vulnerable."

Confronted with that scenario, many LGBT patients simply refrain from correcting the physician, she says, and that can have serious consequences. "If people can't bring their whole selves into treatment they are either going to lie or they are going to leave."

There are a number of ways to avoid that scenario, Margolies says. Publicly posting a patient nondiscrimination policy is a good start. So is providing a welcoming environment that includes gender-neutral bathroom access, posters that reflect a diverse patient population, and intake forms that allow for more than two-sex and committed-relationship options. Importantly, doctors and other healthcare workers need to improve their cultural competencies, advocates say.

"Doctors treat people all the time who aren't like them," Levasseur notes. They need to develop the same types of cultural competencies to treat LGBT patients effectively and respectfully that they use to treat patients of different races, religions, and nationalities. Many institutions are already providing that type of training, Levasseur notes, and proactive physicians can find abundant resources online to further their understanding.

Margolies notes that it's important for doctors to understand that patients want to be called by their preferred names and gender identity even if their identification or insurance forms read otherwise. Patients want doctors to use their preferred pronoun when speaking about them to another member of their care team. But above all, she says, they want to be respected and cared for. Empathy is more important than semantics, and empathy begins with knowing the patient as a person.

"If you meet a trans man who was assigned female at birth you can't be expected to know what language he uses to refer to his body parts," she says. "Likewise if a woman is with her partner you can't be expected to know their relationship. Does she call her her wife? Her partner? It's okay to ask. People don't mind if you make mistakes if you are trying to get it right."

Margolies acknowledges that some providers may unfortunately have personal biases against LGBT individuals and may not be interested in creating a welcoming environment. She notes that most health systems and professional organizations, including the American Medical Association, prohibit discrimination based on sexual orientation or gender identity.[5] In addition, the Affordable Care Act prohibits sex discrimination in any hospital or health program that receives federal funds.[6]

"Physicians are permitted to hold any personal views they want when they are acting as individuals outside of their job," she says, "but when performing in their professional roles, all individuals are expected to act in ways that are in keeping with their mission and their professional code of ethics."

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