80% of ER Providers Hesitant to Ask Patients About Gender, Sexual Orientation

Tinker Ready, June 30, 2016

For emergency medicine clinicians who learned to defer to patients' privacy on sexual orientation and gender identification, asking questions is a major culture change.

As HHS moves toward advancing healthcare equality,  patients are generally comfortable with emergency department physicians and nurses asking about sexual orientation and gender identity (SO/GI).

But 80% of ED providers surveyed said they are hesitant to ask for fear of offending patients.

The survey of 1,617 emergency room patients and 429 providers found that only 11% of patients said they would object to a doctor or nurse's query about SO/GI.

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"The providers say, 'I am going to treat everyone the same,'" said Adil Haider, MD, of Brigham and Women's Hospital in Boston. "But, that's not what the patients want. They want to be recognized for who they are."  

Adil Haider, MD
Adil Haider, MD

The data was released in Boston on Wednesday at the Academy Health annual meeting of health services researchers.

It comes from an ongoing study comparing two approaches to collecting the SO/GI information to determine "the best patient-centered approach."

The research is taking place at emergency departments at two academic medical centers and two community settings.  

The preliminary report comes as the Department of Health and Human Services moves toward requiring the option to record a patient's SO/GI in electronic health records.

The Institute of Medicine, The Joint Commission, and LGBT advocates have all called for greater reporting of SO/GI data to improve care and research and to address care disparities. 

The researchers are comparing two approaches: In one group, a nurse asks for the information. In the other, patients have the option to self-report while filling out the registration form.   

Potentiality Stigmatizing

Jeremiah Schuur, MD, an emergency medicine physician at Brigham and Women's, told a story of a pregnant patient who came in after being hit by a golf ball. Schuur addressed the man in the room as her husband, only to find out that the other woman in the room was the patient's wife.

"This revisited on me the importance of doing this in a systemic way," he said.

"I am quite well informed, but in our normal operations, there are many ways that we are set up to not acknowledge people for who they are."  

Schuur said he was taught that SO and GI were potentiality stigmatizing and could negatively affect a patient's life or work if disclosed.

Asking for the information is even more complicated in the ED where care is often delivered in hallways or behind curtains, and providers don't have established relationships with patients, he said.

Tinker Ready

Tinker Ready is a contributing writer at HealthLeaders Media.

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