The XX Factor

Doctors Aren’t Asking About Gender Identity or Sexuality. But Patients Need Them to Start.

Female patient, doctor with clipboard
This information is crucial to good care.


According to guidelines from the Department of Health and Human Services, medical providers should ask patients for information about their gender identities and sexual orientations. But in a recent survey of emergency-room practitioners, a large majority of respondents said they avoid asking these questions because they fear they’ll make their patients uncomfortable.

The research, published in JAMA last month, included interviews with 53 patients and 26 health-care professionals in addition to a survey of 1,516 potential patients and 429 doctors and nurses who work in emergency departments. Of those providers, 77.8 percent thought their patients would refuse to answer questions about gender identity or sexual orientation.

The potential patients surveyed, who identified all across the spectrum of sexual orientation, disagreed. Only 10.3 percent said that they wouldn’t provide this information to a doctor, even though it would be their right to refuse. Patients and medical providers agreed that it would be best to gather and give information about sexual orientation in a patient’s self-reported written or electronic form rather than a verbal conversation, in which an uncomfortable medical provider could introduce awkward phrasing or leading questions.

But introducing a moment of discomfort to a medical setting is far preferable to the potentially wrong or harmful assumptions doctors may make otherwise. Without knowing a patient’s sexual orientation, most doctors assume she or he is straight. Emergency-room patients might need or want to contact a partner, and asking a lesbian how she can reach her husband could make an already stressful situation even more upsetting for the patient. Some LGBTQ survey respondents reported that routine information-gathering about sexuality and gender identity would help normalize those very normal characteristics in the medical community. Many said it would help them feel “visible.”

That’s good for health care. Patients who feel seen and respected are more likely to be honest about their health, follow through on treatment recommendations, and come back to the medical facility with future issues before they become emergencies, an LGBTQ health advocate told HuffPost. It’s also good for public policy: There isn’t exactly robust data available on health in LGBTQ populations, but what little there is indicates troubling disparities—disproportionate incidence of mental health issues and substance abuse, for example—especially among transgender patients. Without proper data, health agencies and advocacy groups won’t know where to begin to address such needs. They won’t even know the need is there.

The Trump administration has been blocking attempts to get more and better data on LGBTQ Americans ever since the president took office. Trump’s Department of Health and Human Services removed questions about LGBTQ identity from two national surveys: one that informs social programs for senior citizens and one that concerns Americans living with disabilities. Many advocates had hoped that the 2020 Census would include a section that would allow people to self-identify as LGBTQ. In March, the Census Bureau briefly posted that it would, then quickly corrected the record—there will be no such question. Leaders of places like Iran and Chechnya, where the government perpetrates atrocities against gay people, have often claimed that accusations of such human rights violations could not be true, because there are no gay people there. Queer life in the U.S. is far less dire than that for most. But in those countries and in this one, to be counted is to exist.