UC Davis Health System is poised to become the first academic health system in the nation to have its physicians ask sexual orientation and gender identity questions as part of a patient’s routine clinical assessment. By standardizing the collection of this information through the electronic health record, UC Davis officials say its health-care providers will be able to reduce health disparities among lesbian, gay, bisexual and transgender (LGBT) populations by having a better understanding of each patient and being able to provide more well-informed medical advice and care.
“The LGBT community suffers heartbreaking levels of health problems in part because most physicians don’t ask about sexual orientation or gender identity, and many patients don’t tell their health providers,” said Ed Callahan, associate dean of academic personnel, who is leading a health system task force to address the issue. “We already ask questions about race, ethnicity and preferred language to help make our health-care services appropriate and responsive to the needs of very diverse patient populations. Adding LGBT questions to the clinical conversation can lead to more positive health outcomes for those populations, too.”
Beginning this week and continuing over the next several months, the health system will accelerate its LGBT-care initiative. The effort includes a questionnaire that will be sent throughout the health system to enable physicians to identify themselves as LGBT-competent providers. The questionnaire will be accompanied by additional information and helpful resource links regarding sexual orientation and gender identity issues. A web-based list of UC Davis physicians who are LGBT-competent is also being developed.
“Identifying LGBT-competent providers is an important step for us,” said Suzanne Eidson-Ton, associate clinical professor of family and community medicine and a task force member. “We don't expect these providers to necessarily have all the expertise in LGBT health conditions, but they will be comfortable, or committed to becoming comfortable, talking with LGBT patients about their lives, their families and, most importantly, their health. We want all patients to feel welcome and included here at UC Davis.”
In 2011, the Institute of Medicine reported that lesbians, gays, bisexuals and transgender individuals, including children, often suffer physical and verbal bullying and sexual abuse, which results in increased levels of depression and anxiety. Those problems are thought to trigger maladaptive coping behaviors such as higher rates of tobacco, alcohol and drug use as well as increased rates of self-harm, including suicide attempts. According to the report, other ineffective coping attempts include radically changing eating patterns and early exploration of sex. These attempts to cope do not deal effectively with the anxiety and depression but appear instead to establish bad health habits that may help explain why LGBT patients suffer disproportionately higher rates of physical health problems than other patient populations.
“LGBT patients report higher rates of cancer and appear to have more advanced cancer when diagnosed,” said Callahan, who recently presented the health system’s new initiative at an Institute of Medicine workshop. “One of the reasons might be because they avoid or delay seeing doctors and thus don’t receive cancer screenings as frequently as heterosexual patients. Sexual orientation and gender identity can be uncomfortable and highly sensitive subject areas. Many LGBT individuals want their doctors to know that type of information, and doctors need to have it, but it is not shared often.”
At the direction of Claire Pomeroy, UC Davis vice chancellor for Human Health Sciences and dean of the School of Medicine, the health system established its task force in 2009 to prepare for including sexual orientation and gender identity in the electronic health record (EHR) and increase awareness among physicians and staff about the importance of LGBT health issues. The group documented LGBT health disparities and investigated strategies for improving care in preparation for modifying the clinical protocol in the electronic health record. The group identified several ways to improve care, including enhancing the clinical atmosphere to ensure that patients would feel respected and comfortable sharing information.
The 16-member task force has developed specialized education and training modules for physicians and students to improve their understanding of LGBT populations and enhance their communication skills with patients. The team is conducting workshops, giving grand rounds presentations and preparing to post training sessions online. Hendry Ton, associate professor of psychiatry and behavioral sciences and a task force member, oversaw the creation of a new, four- year competency-based LGBT health curriculum for medical students. Another task force member, Julie Weckstein, one of the health system’s licensed clinical social workers, founded GLEE (Gays, Lesbians, Everyone who cares, Employees), a program to raise awareness among staff and help celebrate events such as the annual National Coming-Out Day. These efforts have been a key in positioning UC Davis Health System as a national leader in health-care equality as measured by the Healthcare Equality Index program at the Human Rights Campaign.
The new initiatives of the Task Force include building a database of LGBT-competent providers and a voluntary survey for patients who use MyChart. Providers across the health system are being invited to identify themselves as LGBT-competent. LGBT patients frequently seek LGBT-competent providers but the health system has not had a systematic listing of those wanting to declare their willingness and ability to provide LGBT care. This list is critical because of a questionnaire soon to be sent to patients with MyChart accounts. My Chart is the health system’s online communications tool that gives patients secure access to appointment scheduling and parts of their medical record. Patients will be asked if they want to include sexual orientation and/or gender identity in their electronic health record (EHR). The information will be accessible only to the patient’s health provider.
“Protecting patient privacy, like patient safety, is critically important for us,” said Callahan. “We’re committed to keeping all of the safeguards for securing electronic health information in place. We’re also determined to improve quality of care by making sure our health-care teams understand the unique health problems facing LGBT populations and helping LGBT patients self-identify to their providers.”
Callahan and the other task force members anticipate that the new initiative may prompt short-term discomfort among some providers and staff because it addresses sexuality and gender issues that have not been commonly discussed before in the clinical setting. But they are optimistic the new initiative will soon become a routine part of the clinical care process.
“No one will be expected to change his or her personal or religious beliefs about sexual orientation or gender identity,” added Callahan. “But every patient must be treated with the respect. Just as we are committed to never treating anyone differently because of their race, ethnicity or language, we are also committed to treating everyone fairly no matter what their sexual orientation or gender identity. We simply want to provide a comfortable clinical environment where information can be easily shared so that every patient gets the best possible care.”