It is dangerous to assume how others may behave. When a provider believes a particular person, group, or community has a characteristic or action, they risk overlooking potential conditions. Asking the patient about their definition of behavior, sexual activities, language, or terminology helps prevent misperceptions that endanger health. An example may be a person who does not consider themselves in terms of sexual orientation, that is, they do not identify as heterosexual, homosexual, bisexual or asexual, and may have sexual partners of both gender. Providers should avoid assuming that a lesbian, or her female partner, has never had intercourse with a male or has never been pregnant. Focus on questions about anatomy and behavior to gain information about potential health risks and opportunities for health promotion. Obtaining a sexual history—questions to consider and use 6 : • Are you sex ually active? • With whom do you have sex? • What parts of your body do you use when having sex? • What do you do to practice safe sex?
To obtain pertinent health-related information, it is important to ensure confidentiality and gather a complete sexual history during a nonjudgmental discussion. This sexual history form should be used with all patients in the healthcare practice. If staff members are obtaining this information, practitioners should display a privacy statement in the office and/or provide such a policy to patients. Ensuring privacy is important and should be guaranteed for everyone. Many forms used today assume heterosexual and monogamous behavior. Changing the form to include gender rather than sex, and providing the options “male,” “female,” “transgender,” or “both” to questions about recent sexual partners, recognizes that alternative relational patterns exist. This use of an inclusive form provides patients with the opportunity to provide accurate information.
CREATING A WELCOMING ENVIRONMENT
● Ensure that clinic staff is aware of the process for responding and reporting discrimination. ● The following ideas may improve the inclusivity of forms and help clinicians with in-person discussions: ○ Intake forms and electronic medical records/ patient portals should include questions about sexual orientation, gender identity, and sex assigned at birth. ○ Use neutral terms on forms such as “relationship status” instead of “marital status.” ○ Avoid referring to questions as “female only” or “male only” and instead leave a box for “not applicable.” ○ Ensuring that gender options include “transgender” and “nonbinary” allows for people to choose the option that most applies to them and offers an initial sign of acceptance. It may also be helpful to include a body map for patients to identify anatomic elements of their bodies. There should also be a space about how they would like to be referred to including asking about preferred pronouns. ● Train front desk staff to avoid assumptions about identity and teach techniques to clarify ambiguity in a patient-centered way. Front desk staff should not make assumptions about patients’ gender or sexual identity or the gender of their spouses/ partners, and they should use gender-neutral terms whenever possible. When it is unclear or a staff member is unsure, she or he should ask the patient how they would like to be addressed. By anticipating the event where there may be a discordance between names/genders on official identifications or insurance forms and what a patient is currently using, staff members can more
LGBTQ patients often assess a clinical practice for clues to help determine what information they feel comfortable sharing with a healthcare provider. The following are among the measures that can promote a more welcoming environment and encourage patients who are LGBTQ to access care: ● Post a rainbow flag, pink triangle, unisex bathroom signs, or other LGBTQ-friendly symbols or stickers. ● Exhibit posters showing racially and ethnically diverse same-sex couples, transgender people, or posters from nonprofit LGBTQ or HIV organizations. ● Display brochures (multilingual when appropriate) about LGBTQ health concerns. ● Distribute or visibly post a nondiscrimination statement stating that equal care will be provided to all patients, regardless of age, race, ethnicity, physical ability or attributes, religion, sexual orientation, or gender identity/expression. ● Display magazines or newsletters about and for LGBTQ and HIV-positive individuals. ● When possible, diversify staff. Hire openly lesbian, gay, bisexual, and/or transgender staff, who can provide valuable knowledge and perspectives about serving LGBTQ patients, as well as help patients feel comfortable. Ensure non- discrimination statements are included in job postings. ● Review and consider rooming and visitation policies to ensure they are inclusive. Physicians communicate an impression of their practice and can set a positive tone with patient intake forms. These inclusive forms can help patients feel more comfortable and open about their sexual orientation or gender identity/expression.
Book Code: CT24CME
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