Sexual Orientation Monitoring in Health Care Settings: When Should Clinicians Ask?
Some clinicians have expressed concern regarding the proposed National Health Service recommendation.
In an opinion piece published in the BMJ, two clinicians from the United Kingdom shared their arguments about whether all patients should be asked about their sexual orientation during every health care encounter.
England's National Health Service (NHS) recently made a recommendation that physicians ask patients about their sexual orientation at every opportunity. Richard Ma, MD, National Institute for Health Research doctoral research fellow at the School of Public Health at Imperial College London in London, UK, argues that while some assume sexual orientation monitoring in healthcare systems is only relevant in sexual health-related consultations, this narrow view ignores that sexual orientation is not only about sex, but is also about history, culture, lifestyle, and struggle against discrimination.
The lesbian, gay, bisexual, and transgender (LGBT) community has some very specialized healthcare needs that must be addressed, and to do so, these patients must be identified. Dr Ma sums up his argument, writing “Sexual orientation monitoring is necessary to make the health service for LGBT patients fairer. If we don't count our LGBT patients, they don't count.”
In contrast, Michael Dixon, MD, a general practitioner in Devon, UK, suggests that making doctors ask all patients about their sexual orientation is “political correctness gone mad.” He acknowledges that there are times when it is appropriate for a physician to ask a patient about his or her sexuality, but he states that for many people sexuality is a private matter.
Although the stated goal of the NHS recommendation is to stop discrimination under the Equality Act, Dr Dixon feels that the best way to avoid discrimination is to not know people's sexuality in the first place.
Dr Dixon argues that the NHS recommendation symbolizes the continuing erosion of medical autonomy and the beginning of an era in which general practitioners become “politically correct robots practicing medicine by the numbers.” He writes, “In good medical practice, the patient's own needs, wishes, choices, beliefs, culture, and perspective should come first… Ultimately it should be up to the judgement of each GP as to when it is appropriate or useful to ask such questions.”
Ma R, Dixon M. Should all patients be asked about their sexual orientation? BMJ. 2018;360:k52.