Are you straight? Gay? Male? Female?
A new Mayo Clinic study showed that up to 97 percent of patients are comfortable being asked questions about their gender identity and sexual orientation in a hospital setting.
So, in May, the Rochester campus of Mayo Clinic will begin asking patients to disclose gender identity and sexual orientation as Mayo switches to a new electronic health record and billing system. The Arizona and Florida campuses will follow suit in October.
Previous research, which had been conducted with providers more than with patients, showed that doctors and physicians were uncomfortable asking patients to share their gender identities and sexual orientations. In a 2017 study, 4 in 5 medical professionals thought patients would be offended if they asked about sexual orientation in an emergency department setting.
“They (doctors) thought we would be marking people, not personalizing healthcare,” said Joan Griffin, a health services researcher at Mayo.
That’s not to say that all hospitals have operated on a “don’t ask, don’t tell” system. Gender identity and sexual orientation could and can come up naturally in clinical conversations.
However, doctors feared wading into the “murky waters” of questioning patients without proper terminology, Griffin said, or stigmatizing an already stigmatized portion of the population.
However, the more recent study, now published in Health Services Research, demonstrates that patients are far less concerned — and often encouraging — of the questions.
As only 0.8 percent of the patients who participated in the study identified as non-straight, it’s hard to tell whether the LGBTQ+ population is as near-universally willing to self-disclose, according to the published study.
In the study, participants were split into two groups that answered a control form, without gender or sexuality questions, or one with those questions. Two of the 236 respondents in the second group identified as homosexual. The rest were heterosexual.
In 2016, a Gallup poll indicated that about 4.1 percent of the adult U.S. population identify as LGBT. That number is far above the share of non-straight participants in the study.
Almost all of the respondents were straight and white. Most were female. None of the participants self-identified as transgender.
But the results of the study have reduced fears of offending straight, cisgender patients. (Cisgender refers to people whose feelings of gender identity correspond to their birth gender.)
Gender identity and sexual orientation are two pieces of patient information that can help physicians provide better care, Griffin said.
LGBTQ+ people have much higher rates of addiction, tobacco-related issues, mental health disorders and suicide compared to straight, cisgender people. Identifying patients who might be at risk for those known issues can help doctors treat or prevent them, just as knowing somebody’s race helps doctors treat or prevent conditions that predominate in certain racial groups.
“We don’t have problems anymore when we ask about race,” Griffin said. “We’ve normalized it.”
Mayo Clinic’s women’s health clinic already asked patients about gender and sexuality, she added.
“There’s a lot of potential to help with preventative care services,” Griffin said. For example, lesbians are less likely to get regular pap smears and mammograms, she said. Providers who know that can recommend regular checks to LGBTQ+ women in their care, just as they would stress the importance of cardiovascular care to African-American patients.
However, it’s hard to tell how many of these health care disparities exist, as data on the LGBTQ+ population in health care is so sparse, Griffin said.
“We can begin to look at these with large groups,” she said. “Not just individual people.”
Knowing a patient’s sexual orientation could have a tangible effect on physical health care. Knowing a patient’s gender identity and preferred pronouns is also a patient care issue.
“When people come in, we want to be sure that we’re using the right pronoun for how they identify,” Griffin said.
The patients in the Mayo Clinic study came from a women’s health clinic, serving patients aged 18 years and older, a continuity care clinic predominantly serving patients aged 65 years and older, or a primary care clinic that serves a “rural community of less than 10,000 people.”
The findings may not generalize to all other areas in the U.S., according to Mayo Clinic’s press release, or across cultural groups.
Minnesota protects its residents against private health insurance discrimination based on sexual orientation or gender identity. Only 14 states do so, and not all of them protect against discrimination based on both.
Medicaid in Minnesota also explicitly covers health care related to gender transition, according to the Movement Advancement Project.
The researchers suggested that patients may benefit from a reminder of their health care provider’s nondiscrimination and confidentiality practices, and/or an explanation of why the information is being collected.
“There hasn’t been a lot of work in this area, so I think it’s exciting,” Griffin said.