Do Ask, Do Tell



The work of doctors, nurses, and other health care providers is at the heart of the health system, and care encounters based on mutual engagement and trust are essential for the health and wellbeing of all patients. Patients are more likely to establish effective therapeutic alliances with providers who demonstrate knowledge of, and sensitivity about, their communities and concerns. As such, regardless of whether the focus of the visit is a routine check-up, symptom presentation and diagnosis, or treatment, providers need to have information that allows them to understand their patients’ backgrounds and life experiences—including sexual orientation, gender identity, and related information such as preferred name, preferred gender pronoun, and families that may include a same-sex spouse or partner. Clinicians also need to understand clinical issues that may arise due to anatomical incongruence between a patient’s sex assigned at birth and gender identity, as described in more detail in the section entitled “How to Use the Data.”

A growing awareness among providers of LGBT patient needs is reflected in recent changes that are prompting health professional educational institutions to include LGBT health issues on a more routine and consistent basis. For example, the leadership of the Association of American Medical Colleges (AAMC) has publicly endorsed support for LGBT students and faculty and has committed to improving how curricula at medical schools address LGBT health issues. (22) The AAMC also established the LGBT & Disorders of Sexual Development (DSD)-Affected Patient Care Advisory Committee in 2012 and is actively collecting curricular tools for teaching about LGBTI health issues in MedEdPORTAL. (23) In November 2014 this advisory committee published Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators. (24) The guide provides strategies for educating medical professionals in LGBT and intersex health disparities; ensuring inclusion and equality in health care for these populations; developing professional competency objectives to improve health care for lesbian, gay, bisexual, transgender, and intersex (LGBTI) people; integrating these competencies into medical school curricula; and assessing learning and evaluating the impact of curricular and campus climate initiatives.

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