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Fenway Health urges doctors to talk with patients about sexual orientation, gender identity

While there is great diversity among people who identify themselves as lesbian, gay, bisexual, or transgender, it’s clear that the group as a whole experiences significant health disparities, many linked to social stigmas.

They have higher rates of psychiatric disorders and substance abuse, and are more likely to experience violence. Gay men are at higher risk of some sexually transmitted diseases, and lesbian or bisexual women are more likely to be overweight. Transgender people may be at greater risk for cardiovascular disease because of hormone use. On top of that, finding health care providers capable of addressing their specific needs is difficult.

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“In order to understand and address LGBT health disparities, we as health care providers need to better understand who our LGBT patients are,” said Dr. Stephen Boswell, president of Fenway Health.

The research institute at Fenway Health, which has long provided specialized LGBT care, has published two policy briefs meant to jumpstart conversations between doctors and patients. The first lays out reasons for asking patients about their sexual orientation and gender identity.

“If LGBT patients are told why it is important to gather such information, and that such information will be kept private and confidential, most will be forthcoming with this information,” the brief reads. “Provider knowledge about their patients’ sexual orientation and gender identity can facilitate optimal care.”

The second brief is a how-to, including a sample question for patient registration forms that reads “Do you think of yourself as,” with boxes to check indicating homosexual, heterosexual, bisexual, something else, or uncertain.

The brief also encourages open conversation with patients about their lives, swapping questions like “Are you married?” for “Do you have a partner?,” and affirming patient confidentiality in such conversations.

Globe correspondent Neena Satija reported in October on the barriers to care faced by the LBGT community. She wrote that “a competent doctor isn’t always enough.” The language on intake forms and conversations with receptionists matter, too.

“There’s a real shift in our culture now from overt homophobia to more covert homophobia,’’ Tina Gelsomino, an administrator at Brigham and Women’s Hospital who co-chairs a group that represents LGBT staff, told Satija then. “It’s not necessarily what people say, it’s sort of what they don’t say.’’

The institute is distributing the briefs by e-mail and as printed copies. For more information, see the Fenway Health website.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.
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