Contextualizing the LGBT Patient in the Health Care System

The Institute of Medicine (IOM) in its report, The Health of Lesbian, Gay, Bisexual and Transgendered People: Building a Foundation for Better Understanding, recommends that data on sexual orientation and gender identify be collected and included among other demographic information routinely stored in patients’ electronic health records. The intent of the IOM recommendation is to improve clinical care and to facilitate research that can address health inequalities among LGBT persons. The reality is that many LGBT persons remain reluctant to disclose their sexual orientation or gender identity, or have that information documented in the electronic health record – even when sexual orientation or gender identity is material to a medical diagnosis or treatment. This reluctance should be contextualized within the backdrop of a health care system where many lesbian, gay, bisexual, and transgendered persons have had negative, invalidating or discriminatory experiences when attempting to access health care, during their care or treatment, or during the care and treatment of a same-sex partner. As the Institute of Medicine observed, it is necessary to create a care environment in which individuals who have historically been stigmatized and discriminated against feel safe providing this information. What steps can health care organizations take to demonstrate trustworthiness with respect to the collection and use of information related to sexual orientation or gender identify? Should clinicians’ elicit this information as a routine part of clinical care?