Why Medical Records Should Include Patients’ Sexual Orientation

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Many factors that can affect a person’s medical needs and risks — like age, race and income — are included in studies of health, but others like sexual orientation and gender identity are not. Now a new report from the Institute of Medicine (IOM) suggests they should be.

Like any other demographic group, the report argues, gay, lesbian, bisexual and transgender patients may have specific health concerns. So the report recommends including sexual orientation and gender identity information in government-funded surveys, and further suggests that physicians include similar data in patients’ medical records. That will not only help improve health outcomes for individual patients, but also give researchers a better understanding of the population’s unique health challenges, which have not been well studied.

“At a time when lesbian, gay, bisexual, and transgender individuals — often referred to under the umbrella acronym LGBT — are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status,” states the report, which was released last week. “The IOM finds that to advance understanding of the health needs of all LGBT individuals, researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research.”

Combined with other factors like age, ethnicity and socioeconomic background, a patient’s sexual orientation can create specific risk profiles. For example, LGBT teenagers have higher risks of depression, suicide and substance abuse than straight teens. Also, aging LGBT individuals are more likely than other seniors to rely on friends for caregiving, mostly because they are less likely to have children. But data on these groups are spotty and incomplete, which makes it difficult for doctors and public health officials to serve their needs.

As the Advocate reported:

To date, research that exists on LGBT groups has focused mainly on gay men and lesbians, and has concentrated on adult subjects more than adolescents and the elderly. “The research is not adequately addressing subpopulations, particularly racial and ethnic groups,” [Robert] Graham, [committee chair of the report and a professor of family medicine at University of Cincinnati College of Medicine,] said at a Thursday press conference in Washington, D.C.

Though the report’s authors emphasized the need for more data on sexual orientation and gender identity from federally funded surveys, a requirement that federal agencies collect voluntary data was not ultimately included in the health care reform bill passed last year.

But talking about gender or orientation with certain groups could be tricky, especially in a doctor’s office. Teens may worry about prejudice on the part of their doctors, or may not trust that the information will be kept from their parents. Further, homosexuality remains less accepted among certain minority groups and religious communities, complicating accurate reporting.

Ultimately the IOM report recommends that more resources be dedicated to recruiting LGBT volunteers for studies funded by the National Institutes of Health, in order to identify the health needs of their communities. “This report is an important step in identifying research gaps and opportunities, as part of an overall effort to understand and address the health needs of lesbian, gay, bisexual, and transgender people,” said Secretary of Health and Human Services Kathleen Sebelius. “We look forward to continuing our work to address these needs and reduce LGBT health disparities.”

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