Employee & Community Health

LGBTQI patients: How telling can help your health

6/3/2019 by Drs. Cesar Gonzalez and Dagoberto Heredia

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We learned from the "don't ask, don't tell" policy that it doesn't work — particularly when it comes to giving our LGBTQI patients the most appropriate care. But we also recognize that the fear of stigma, discrimination, negative reactions and even denial of care can keep patients from revealing their gender identity or sexual orientation to their health care providers. Here are three reasons how "telling" — and making sure it's part of their electronic health record — can help support LGBTQI patients' health. 

#1: Helps minimize barriers to health care

Asking questions about gender identity and sexual orientation can help minimize barriers between patients and care providers, letting patients know they're seen, heard and respected, while keeping this information private and confidential. By sharing information with them, providers and care teams can use names, pronouns, and other language to respectfully communicate with their patient. Collecting information about gender identity and sexual orientation and documenting it in the patient's electronic health record can reduce stress for them at future appointments or emergency department visits. 

These questions also may make non-LGBT-identified individuals feel more comfortable discussing issues of sexual, gender or reproductive health. 

#2: Provides basis for delivering the most appropriate care

Knowing a patient's self-identification helps providers and care teams identify the patient's risk factors and recommend screening, prevention and treatment of medical conditions likely in this group. Health care providers may not consider medical conditions related to the patient's anatomy due to assumptions based on appearance. For example:

  • Rates of cervical cancer are higher among cisgender lesbian and bisexual women compared to cisgender heterosexual women. By informing the patient of these statistics, the provider can discuss with them the need for cervical cancer screening. 
  • In transgender women who undergo gender-affirmation surgery, the prostate is kept intact. Without this information, the provider may not consider a different diagnosis or recommend screening for prostate cancer. 
  • If a patient was assigned male at birth, but has female gender identity, the provider will want to know if they've ever had a discussion with a gender specialist or if they've had hormonal or surgical interventions, which may create a risk factor for certain treatments. 

#3: Encourages comprehensive care, fosters patient-provider relationship

The role of the clinician is to provide patient-centered care founded on scientific evidence, clinical expertise, availability of resources and equity. With the knowledge of a patient's self-identification and sexual orientation, providers can make referrals and coordinate resources tailored to the patient. 

Knowing that their health care providers know, patients often feel more affirmed and understood by their care team, which may strengthen their engagement with a treatment plan. 

Dr. Cesar A. Gonzalez is a consultant in Employee and Community Health's (ECH) Division of Integrated Behavioral Health (IBH) and serves as clinical director of the Transgender and Intersex Specialty Care Clinic at Mayo Clinic in Rochester. He also is the associate program directory of the Family Medicine residency for Mayo Clinic. 

Dr. Dagoberto Heredia is a clinical psychology fellow in Employee and Community Health's (ECH) Division of Integrated Behavioral Health (IBH).