Sexual Orientation and Gender Identity on Medical Records

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In a country where a broken finger can end up costing you more than a second-hand car if you don’t have health insurance, you don’t tend to put huge amounts of faith in public health care. The US has never been known for its nation wide coverage, yet there has been some effort to make sure people in need of care can get it without going bankrupt. In a 2011 report by the Institute of Medicine, the issue of whether sexual orientation and gender identity (SOGI) should be visible on patients’ medical records was brought up. It was presented that this information would be essential in achieving the Healthy People 2020 goals set by the US government, and especially to target LGBT health disparities.

You do not have to search far and wide to find statistics about the disparities in mental health between LGBT and straight individuals, possibly warranting this change. However a report published in the LGBT Health journal outlines various other reasons why these health checks may even save lives by making sure more LGBT people get screened for diseases they may otherwise not be screened for. One example used in the report is lesbian women not getting screened for cervical cancer as often as their straight counterparts. Further with trans individuals, it can be important for doctors to know the patient’s full medical background. This is crucial in cases with transwomen who still have a prostate and transmen with a cervix so that both in turn get screened for prostate and cervical cancer respectively. Where this may be far from an ideal situation for the patient, perhaps reminding them of a painful time in their past, it can still be vital for their health.

However, the problem to me arises if patients are forced to disclose information to a doctor they do not feel comfortable discussing the topic with, or further if they fear this information may result in prejudice or discrimination. It seems a bit unfair for a country that still has several states where discrimination based on sexual orientation or gender identity is not outlawed, to ask for information that can result in worse not better care for patients. If there is even a small risk of being discriminated in healthcare or health insurance because of information you are asked to give for health reasons, many people could be put in an extremely uncomfortable, not to mention unfair situation.

Luckily though, we live in a society where at least on the surface, this type of discrimination is unacceptable. In the US any hospital or insurance company receiving state money, and this means healthcare providers receiving Medicaid or Medicare funding are not allowed to discriminate. There was also a Joint Commission requirement in 2012 that hospitals adopt a SOGI non-discrimination policy. This is crucial if any of the true goals of this program are to be achieved. The report claims that this initiative aims at discovering and reducing health disparities in the LGBT population, but if the precondition for why these disparities don’t emerge in the first place isn’t tackled, then the initiative itself will do little. If the requirement to reveal SOGI information in fear of discrimination will discourage people from going to the doctor in the first place, I’m afraid even less people will get the care or screening they need.

Therefore, at first when I read an article about this topic I was very sceptical of the idea. It sounded like a chance to group LGBT people together and to examine them for health issues that weren’t necessarily the result of their sexual orientation or gender identity but rather how it was treated by society. By this I mean the sex education young LGBT people are given about the importance of safe sex and still getting screened regularly. Not to mention mental health issues largely resulting from discrimination and homophobic attitudes in society.

However after reading the entire report that has support from over 142 organisations, especially LGBT and HIV/AIDS organisations, and seeing the legitimate health reasons behind it, it seemed a lot more sensible than what I had feared it might be. The initiative is to be discussed this year and if accepted would start in 2016. The information on SOGI given by patients would be voluntary, confidential and only included in medical records at the patients consent. In addition doctors would be trained in dealing with LGBT issues in a sensitive and respectful way, as well as explaining why SOGI information is essential to have on medical records. This is already done with respect to cultural concerns, as well as when collecting race and ethnicity information for medical records. This paired with zero tolerance for discrimination is something I would be comfortable with.

To read the full report go to: http://online.liebertpub.com/doi/full/10.1089/lgbt.2013.0001