Physician-patient relationships among the lesbian and gay community

Objective: To document the concerns, perceptions, and experiences gays and lesbians bring to the physician-patient relationship, including their perspectives related to disclosure of sexual orientation. Design: Completion of a 64-item survey instrument. Setting: Participants were recruited through community-based health care and social service organizations serving the lesbian and gay community. Subjects: 575 lesbians and gay men, primarily from the New York metropolitan area. Measurements: Responses to questionnaire consisting of 64 scaled, multiple choice, and open-ended questions. Results: Most (87%) reported that their primary health care provider gives them the same quality of care as heterosexual patients, treats them with respect equal to heterosexual patients (87%), and is sensitive to gay and lesbian concerns (71%). Although 70% disclosed their sexual orientation to their provider, only 29% were asked their sexual orientation by their provider. Among reasons for nondisclosure, 47% were concerned about bad reaction or treatment. A sizable minority (17%) avoided or delayed seeking health care because of reasons having to do with their sexual orientation. Conclusions: The data demonstrate significant problem areas in physician-initiated communication about sexual orientation; in concerns about antigay discrimination in health care, insurance, and employment; and in avoidance of health services. It is hypothesized that these results represent a baseline for the most favorable health care environments for gays and lesbians. This study also highlights the importance of training medical students and clinicians to communicate better with patients, conduct in-depth sexual and family histories, and consider issues related to sexual orientation and homophobia, including identifying and confronting personal and institutional bias.