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Hot Topics: Orientation and Gender Assumptions Can Harm Patient/Doctor Relationship

Jackie Werner Ethics, Hot Topics in Research, Psychology and Psychiatry

Provider Perspectives on the Application of Patient Sexual Orientation and Gender Identity in Clinical Care: A Qualitative Study

Dichter ME, Ogden SN, Scheffey KL. Provider perspectives on the application of patient sexual orientation and gender identity in clinical care: A qualitative study. Journal of General Internal Medicine. 2018. https://doi.org/10.1007/s11606-018-4489-4.

Background
The federal government and other organizations have recommended that healthcare institutions collect and document patient sexual orientation and gender identity (SO/GI) information in order to advance the understanding of the health of sexual and gender minority populations and to combat existing health disparities. Little is known, however, about provider perception of the clinical relevance of, or how they might use, patient SO/GI information in individual care.

Objective
To explore providers’ perspectives on and experiences with collection of patient SO/GI information and how the knowledge of this information may impact clinical care.

Design
Qualitative study using in-depth individual interviews of healthcare providers.

Participants
Twenty-five healthcare providers, including physicians, physician assistants, and nurse practitioners, from the fields of family medicine, internal medicine, gynecology, and urology within a single healthcare system in an east coast city.

Approach
Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using principles of grounded theory and thematic analysis to identify themes emerging from the data.

Key results
Providers recognized the importance of collecting patient SO/GI information for understanding population-level public health concerns and disparities, as well as understanding and respecting the context of patients’ lives. However, providers also emphasized the importance of knowing patients’ sexual behaviors and physical anatomy for addressing health risk and preventive care needs—and noted the distinction between these characteristics and patient SO/GI. Providers cautioned that assumptions based on knowledge of patient SO/GI may unintentionally obscure accurate profiles of patient behavior and anatomy.

Conclusions
Along with the potential benefits of routine collection of patient SO/GI, it is important that providers continue to inquire about patient behaviors and anatomy to inform individual risk and needs assessments. Findings from this study can inform the development of guidelines, trainings, and practices for incorporation of patient SO/GI along with existing assessment practices to improve individual and population health.