Question

According to the New York Times article “G (a) y and Transgender Patients to Doctors. We’ll Tell. Just Ask.” By Jan Hoffman, May 29, 2017 (see attached), clinicians may have more sensitive interaction and thereby be able to provide better care by knowing if the patient is g(a)y, lesbian, bisexual, transgender, or straight. Although federal agencies are pushing health care providers to ask, the majority of doctors, nurse practitioners and nurses do not. The belief that patients will refuse to disclose their sexual orientation seems untrue as only 10% of lesbian, g (a) y, bisexual, and heterosexual in a randomized study said they would not answer a sexual orientation question. Based on the New York Times article "G( a)y and Transgender Patients to Doctors: We'll Tell. Just Ask." ( https://nyti.ms/2seU9JI ) and any other relevant literature, discuss why you believe healthcare providers often “skip” the sexual orientation question. Furthermore, what do you suggest can/ should be done to make it easier to disclose the information and open the line of communication? How may it improve care? 150 words

Answer 1

The disclosure of sexual orientation must be essential in planning and providing efficient care to the patient. The lack of disclosure of sexual orientation may cause recommendation of inappropriate health services to participants. There must be efforts to promote discussion of sexual orientation within the primary health care setting for better care.

The misconception of the care providers regarding the patient's response to the questions related to sexual orientation imposes lack of knowledge on the same or assumption of the sexual orientation. Many types of research suggest that most of the LGBTIQ people are open to questions regarding sexual orientation. The fear of violating the ethics also hinder the healthcare personnel from collecting information from the LGBTIQ people.

The knowledge on sexual orientation can suggest the specific diagnostic and preventive measures for routine health care, like hepatitis A and B vaccinations, and often, testing for HIV and sexually transmitted infections (STIs). The assumption of health care providers such as the patients are heterosexual, they may neglect essential screening, diagnostic, or preventive health measures. In order to provide optimal care and minimization of transmission of human immunodeficiency virus (HIV) and STIs, healthcare providers must be aware of each patient's sexual orientation and behaviours.

Many studies suggest that primary care providers (PCPs) are not universally comfortable with homosexuality in the past and the recent studies show improvement in the comfort level. The education and further training in this area can help to improve this situation.

The lack of education regarding sexuality during medical school may be a contributing factor. The suboptimal rates of sexual orientation disclosure to care providers may also be a reflection of providers' discomfort. The disclosure rates are more among white men and individuals who believe their provider is homosexual. In many situations, the providers simply may not include sexual orientation within their usual pattern of history-taking. The compulsory inclusion of sexual orientation information can improve the practice of the disclosure.

How to improve care:

·         Be open to the patient’s reaction and do not personalize it, as they may have experienced insensitivity, a lack of awareness, or discrimination in the past from other healthcare personnel.

• Apologizing if the patient is uncomfortable
• Do not assume someone’s gender or sexual orientation based on their appearance.
• Use neutral questions like “How may I help you?” instead of “How may I help you, sir?” or use “The patient is here in the waiting room.” Instead of “He is here for his appointment.”
• The patient’s identification of their sexual orientation may always reveal what kind of sex they engage in, and vice- versa
• Listen to the patient, how they e describe their own identities and partners--use the same terms while communicating, if comfortable.
• Use the patient’s preferred name and pronouns when talking about a patient.
• Keeping up with terminology LGBTIQ instead of outdated terms
• Ask the patient about their preferred name or pronoun and ask sorry If you accidentally use the wrong term or pronoun