Ask, don’t assume, your patient’s sexuality, advises Callum Phillips

The first time I met my GP, she asked my sexuality. Initially, I didn’t realise the impact that those 10 seconds would have. As a university campus GP, she probably had more experience than most in having these conversations, and recognised the importance of offering a person an opportunity to express their sexuality before she assumed one. This was one of the few times a medical professional has not just assumed that I am a straight man, including those awful icebreakers at the start of the year with other medical students. Immediately, it felt like a proactively supportive environment—one where I could be honest about my health, not needing to self-censor what was going through my mind. 

My concerns are not unique. A higher proportion of LGBTQ+ patients delay seeking medical attention out of fear of discrimination; one in seven avoid it entirely. One survey found that 23% of LGBTQ+ people have experienced discriminatory or negative remarks by healthcare staff and one in four people had experienced a lack of understanding of LGBTQ+ health needs. As a medical professional, your LGBTQ+ patients may naturally distrust you and, given the underreporting of these issues, you’re unlikely to even be conscious of it. Around 5% of people aged between 16-24 identify as LGBTQ+, as well as 2% of the population as a whole, so this is a problem that is affecting more than a million people.

This avoidance has an impact on the health of LGBTQ+ people, a group in which 52% have experienced depression. and 70% aged between 18-24 felt that their life was not worth living in the past year. One in six drank alcohol daily, and one in eight have attempted suicide. There are higher rates of smoking among LGBTQ+ people and, depending on the particular subgroup, higher rates of anal or cervical cancer, obesity, cardiovascular disease, and sexual health concerns. This is a patient group that we are failing. 

We regularly pay lip service to “patient centred care” and having a “holistic approach to medicine,” but seem to easily forget how someone’s sexuality and gender identity directly results in a different set of needs. LGBTQ+ people should not be forced into systems that presume they are straight or cisgender, and which rely on them to risk setting the record straight when such a significant proportion of them have had negative interactions with healthcare professionals.

The way to move forward starts in medical school, with a new generation of doctors who appreciate the intricacies of LGBTQ+ stigma and how it can shape healthcare. Redressing current healthcare inequalities will mean dedicating some of the numerous assignments throughout our courses to addressing LGBTQ+ issues. But more than this, we should break down medicine’s implicit and explicit biases about the LGBTQ+ community by demanding positive representation of non-heteronormative relationships or families in lectures.

At medical school, we currently receive generic teaching on our communication skills, but in our contemporary, diverse society it’s important that this teaching keeps up with the times. If, as future practitioners, we’re equipped with an understanding of the unique issues faced by patients who identify as LGBTQ+, we can begin to overcome some of the accumulated mistrust between our two communities. Medical professionals must understand the healthcare needs of LGBTQ+ people and be comfortable in explaining how sexual orientation can impact health. 

These are big steps to take—and ones which must be done as part of a concerted effort. So, on an individual level, how can you begin to make a difference? I would encourage you to make at least this one small change moving forward during clinical contacts: ask, don’t assume, your patient’s sexuality. 

A heterosexual person may not even register or remember having been asked. As an LGBTQ+ person, it is something that for all the right reasons, I won’t forget. I can remember the name of every single healthcare professional who I felt was supportive and inclusive, and I remain incredibly grateful to them. They were immediately able to address what my issues and concerns were likely to be, they were able to ask pertinent questions that were applicable to my life, they were aware of the increased risks I would face, they were able to actually make a positive impact and help me.

Having seen both sides of the consultation, it is clear that we need to be aware of our patients’ sexualities, and the only way you’re going to be able to do that is by asking. Just, please ask it with the same generic politeness you’d ask about my lockdown weight gain—and when no one else is in the room. 

Callum Phillips is a final year medical student at the University of Southampton. Callum is a representative to the Coalition against Conversion Therapy and student representative at GLADD, The Association of LGBTQ+ Doctors and Dentists. 

Competing interests: Nothing else to declare.