Sexual orientation monitoring and documentation: intrusive or important for patient care?

Abstract

Patients’ sexual orientation is perceived as a difficult topic and one frequently avoided by GPs.1 The 2010 UK Equality Act2 made discriminating against people due to nine characteristics, including sexual orientation, illegal and also created a legal requirement for organisations, including the NHS, to promote equality for lesbian, gay and bisexual people (LGB), including transgender individuals. The General Medical Council3 (GMC) website has guidance regarding sexual orientation instructing doctors against discrimination,4 which highlights to medical students the inequality of health care for LGB. An article by the LGB charity Stonewall contains recommendations for GP care,5 and in April 2014, the GMC wrote a leaflet in conjunction with Stonewall for LGB patients clarifying their expectations for medical care.6 Most of the cited recent research on sexual orientation has been written by or in conjunction with LGB charities leading to potential selection bias. Research by Stonewall found differences between the health needs of LGB and heterosexual patients. LGB patients have twice the incidence of mental health disorders including depression and suicide. Uptake for health screening is reduced in LGB; only 64% of lesbians had had a cervical smear compared with 80% nationally. Overall, they engage in more health-adverse behaviours; such as, smoking, alcohol excess, illicit drugs, and risky sexual behaviours.7,8 The Manchester Clinical Commissioning Group, as part of their Building Health Partnerships project with the Lesbian and Gay Foundation (LGF) undertook a LGB patient survey: …