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."
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.
Listening to Patients
"In general, we are more resistant to asking for confidential information in the ED," he said, but reading the narratives of some of the patients in the survey has changed his mind.
Two of the comments presented at the meeting:
- "If you are counted, if you are visible, it's sort of another form of recognition at and institutional level." – 47-year-old "queer female"
- "It helps avoid an uncomfortable situation that may arise. Opens the door to communication between the doctor and the patient." – 40-year-old white, male physician
Still, asking these questions represents a major cultural change at a time when ED staff are dealing with other demands. Schuur said it is hard to predict how staff will respond.
"We have advanced practices around LGBT health care and LGBT practices for employees, yet we had the [greatest] challenge (of the four cited) in getting nurses to adopt this practice," he said.
Hospital administrators will need to work with both staff and the LGBT community to identify what needs to be done to prepare for SO/GI reporting.
There is no "one-size-fits-all" solution, Haider said.
But, hospitals need to realize that this kind of reporting is becoming routine: "The patients want it, the regulators want it, so we need to do it."
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Tinker Ready is a contributing writer at HealthLeaders Media.