Doctors Should Include Gender Identity and Sexual Orientation in Medical Records

A patients medical records include all sorts of information. Now some doctors are pushing to add sexual orientation and gender identity


When a doctor pulls a patient’s medical records, she can see all sorts of information—age, sex, weight, height, eye color, last checkup and the like. But some doctors are pushing to add two new pieces of information to that list: sexual orientation and gender identity. They argue that knowing those bits of information can not only help doctors treat patients better, but could also increase the amount of data the medical community has on them.

In a paper published in the journal LGBT Health, the researchers pointed out that doctors do know about some health disparities in the LGBT community—issues like “lower rates of cervical cancer screening among lesbians, and mental health issues related to minority stress.” Gay men are more likely to become infected with HIV, and lesbian women are more likely to be obese than their heterosexual or bisexual neighbors. Lesbians are also less likely to have health insurance. Most transgender women have prostates, but many don’t go in for prostate exams. Transgender men have breast tissue that could develop breast cancer, but few go in for mammograms.

These researchers argue that gathering data on sexual orientation and gender identity could help doctors better understand patient risk, just as gathering data on race can. According to the Center for American Progress, a liberal think tank based in D.C., collecting this data could be useful in helping insurance companies understand the needs of the LGBT community and designing effective outreach projects. Knowing a patient’s sexual orientation can help doctors ask about family support—a factor that predicts rates of depression, alcohol and drug abuse and risky sexual behavior.

But there are downsides to collecting this kind of information. Some patients worry about discrimination based on their gender identity or sexual orientation, a fear that is not unfounded. Other patients are worried about confidentiality and privacy—a problem exacerbated by the digitization of records. In 2011, nearly 5 million medical records were stolen in Texas. The Affordable Care Act does explicitly forbid discrimination based on everything from race to gender identity, but that doesn’t necessarily mean that patients won’t be discriminated against in practice.

In 2012, the U.S. Department of Health and Human Services decided against adding gender identity and sexual orientation to electronic health records, but they are still talking about it. The University of California at Davis’s Health System recently became the first academic system to include sexual orientation and gender identity in their electronic health records. But the practice is far from widespread. These researchers think it should be.

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