The woman, a stay-at-home mom in her 30s, had bronchitis and I was about to write a prescription for antibiotics. I'd never met the woman before--she was one of my colleague's patients. "When was your last period?" I asked. She told me. "Are you using contraception?" She said she wasn't. "Are you sure you aren't pregnant?" She was sure. "How can you be sure?" I asked. "Because," she said, "I'm married to a woman."
Arg! I thought. How could I, with over 20 years experience in practice, be so bumbling! A rookie mistake, to assume what ought not be assumed. Someone who comes to the doctor feeling rotten from bronchitis shouldn't have to deal with feeling misunderstood, too. Next time, I thought, I'll be more sensitive.
Recommendations just released from Fenway Health, though, remind health care providers that asking patients about their sexual orientation isn't just about sensitivity. Healthy People 2010 and 2020, statements of public health goals established by the U.S. Department of Health and Human Services, outline the health disparities faced by individuals who identify themselves as lesbian, gay, bisexual, and transgender (LGBT). A few of these include: discrimination in housing and health insurance for LGBT people; increased incidence of suicide, alcoholism, and tobacco use; increased risk of STDs for gay men; increased incidence of obesity in lesbian and bisexual women; decreased cancer screening and preventive services for lesbians; increased cardiovascular disease for transgender people; and increased violence against LGBT people.
The Fenway recommendations include suggestions for how health care workers can elicit information about a patient's sexual orientation. There are many reasons doctors fail to inquire about patients' sexual orientation: We may lack of awareness of the large numbers of LGBT people in the population; we may lack awareness of the particular health risks LGBT people face; we may feel embarrassed; we may be concerned about "insulting" the patient by asking about sexual orientation.
All of these reasons have more to do with the ignorance and biases of even the most well-meaning doctor than with the needs of the patient.
Thanks, Fenway Health, for reminding us of that.
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