Creating a welcoming environment.

It is important to create a welcoming space for LGBTQIA+ patients to bring their full selves to clinical appointments. Clinicians should work towards unpacking their assumptions, biases, and expectations of LGBTQIA+ patients. 

• Ensure that all staff (e.g, reception, front line, providers) introduce themselves to patients using their pronouns and stating their role within the clinic. Doing so provides the patient clarity as to who they are engaging with, as well as ensuring their safety and comfort to share their pronouns (if they choose) during their clinical appointment. 
• Collect SOGI (Sexual Orientation, Gender Identity) information from your patient in order to better understand your patient and their specific health needs. This can be done via intake paperwork, or during the clinical appointment. Patients may not always feel comfortable volunteering this information, and clinicians  can open the doors for these and any other health-related conversations in a nonjudgmental environment. Remember: only use this information in clinical appointments when it is relevant to the conversation.
• Be aware of specific issues, both social issues and mental health disparities, that impact LGBTQIA+ patients. Examples of these include coming out, having children - adoption or reproductive, increased prevalence of depression. Knowing this information and providing guidance on these topics will strengthen the patient’s trust and engagement.
• Another important issue to remember is that while LGBTQIA+ populations are often combined as a single group for research and/or clinical purposes, each of these identities represents a distinct group with their own specific health needs. 
• The experiences of LGBTQIA+ individuals are not uniform and are shaped by intersectional identities and factors such as race, ethnicity, socioeconomic status, geographical location, disability, religion, and age.

Language matters.

Language matters when discussing and approaching LGBTQIA-centered care. As a health care professional providing care for all, it’s important that you use inclusive, patient-centered language. 

• On intake forms, expand current options to be more inclusive. 
• For marital status, the form might read, “Relationship status: Married, Partnered, or Other”.
• When asking patients to provide their names, it’s also helpful to include an additional space indicating “Preferred Name” and “Pronouns.” 
• Use an individualized and holistic approach by asking patients about their health priorities and goals. Acknowledge previous healthcare experiences with an attitude of respect and advocacy.

Collect routine sexual history from LGBTQIA+ patients.

• Asking about a patient’s sexual partners and practices is a good example of patient-centered care. A sexual history followed by appropriate, targeted discussion about ways to stay healthy can also enhance the patient-clinician relationship.
• Studies show that 85% of LGBTQIA+ patients want us to ask about sexual issues. Sexual history can come up naturally when talking with a patient as part of the social history. It can also be asked in relation to their past medical history or history of reproductive health.
• Before starting, you can let the patient know that you ask sexual history questions of all patients every year as part of their routine care. 
• You can use a statement such as:
• “I am going to ask you a few questions about your sexual history. I ask these questions at least once a year of all my patients because they are very important for your overall health. Everything you tell me is confidential. Do you have any questions before we start?"
• If patients want to know why you need to ask these questions, and why they are important to their health, you can use statements such as:
• “Your sexual health is important for your overall emotional and physical health.”
• “We ask these questions every year because it is common for people’s sexual behaviors and partners to change over time. These questions can also help guide a conversation about ways to protect yourself from sexually- transmitted diseases, unwanted pregnancy, or other things that may concern you. It will also give you an opportunity to talk about problems with, or changes in, sexual desire and functioning.”
• If the patient declines to complete a sexual history with you, ask if there is another member of the clinical care team with whom they might be more comfortable. If they have already provided this information to someone else (e.g. a social worker), see if they will sign a release to allow primary care to obtain that information.
• Be straightforward, but sensitive and open to different sexual expressions. Avoid passing any judgment based on the patient’s responses. Don’t assume people are limited to certain kinds of sex based on gender (i.e. include questions about insertive sex).
• Ask open ended questions:
• “Who are you having sex with?” 
• “What kinds of sex are you engaging in?” 
• “Which body parts of yours touch which body parts of your partner?” 
• “Are you engaging in sex for pleasure or do you feel forced in any way?” 
• “Are you engaging in sex for money, housing, drugs, or any other service?”
• “Do you feel safe in your current relationships?” 
• “Do you feel empowered to tell your partners to use condoms?” 
• “Are you using any prosthesis or toys for sex? Are you sharing these?”

Respecting privacy.

• Before asking any personal questions, first ask yourself: “Is my question necessary for the patient’s care, or am I asking it out of curiosity?” If it’s for your own curiosity, it is not appropriate to ask.
• Ask yourself: “What do I know? What do I need to know? How can I ask for the information I need to know in a sensitive way?”
• If your question falls outside these parameters, you can later educate yourself about LGBTQIA+ people with the resources listed in this guide.

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