Kathy Mariani, MD, is a primary care physician at South Burlington Family Medicine. She describes why including information about sexual orientation and gender identity (SOGI) as part of the Epic upgrade will empower clinicians to provide the best care for our patients.
What is your experience with SOGI issues and caring for LGBTQ+ patients?
I’m a cisgender woman – meaning I identify with the gender I was assigned at birth – and issues around SOGI were new to me at first. But during my eight years as the women’s health coordinator at the Center for Health and Well Being at the University of Vermont, I developed some confidence and competence around prescribing and caring for transgender students because there was a high need. It’s become one of the most rewarding things I’ve done in medicine—helping people to transition, feel supported and thrive.
Can you share a specific example of how patient care will improve once SOGI information is available in Epic?
A woman friend of mine once asked me, “What’s with you doctors? Why is it that every time I go for an annual appointment, they ask me if I need birth control? I’ve been with a female partner for 15 years.” I told her it was a computer issue. There’s no way every doctor could remember everything about every patient. If your doctor had a medical record that very clearly stated your sexual orientation, you wouldn’t have that awkwardness every time you go to the doctor.
You say it’s all too easy to make assumptions about SOGI. What experiences can you share?
One time, I was seeing twins who had just been adopted from oversees. I addressed both women in the room as if they were the moms. Halfway through the appointment, one of the women looks at me and points to the other: “This is the nanny. My husband couldn’t come today,” she said. I had assumed the wrong sexual orientation. Another time, I had a new young patient who was on testosterone for a medical condition. I didn’t have the electronic health record and assumed, wrongly, that they were transgender.
You’ve said your nurse colleagues often have questions that collecting SOGI information will help answer. Examples?
When we’re giving the flu shot, we’re supposed to ask everybody who’s female if it’s possible she could be pregnant? Since we don’t know if somebody’s possibly a transfemale or transmale, should we ask everybody before we give the flu shot if they could be pregnant? That’s a really legitimate question. Epic will help us with the foundational information, so we can start having these conversations with confidence.
Who will ask patients about their sexual orientation?
Clinicians only. It’s important to make sure that our employees feel like they’re not being asked to invade somebody’s privacy. And it’s important that patients don’t feel like their privacy is being invaded. But asking about sexual orientation and partners is natural for primary care doctors as part of a routine visit.
Who will ask patients about their pronouns and gender identity?
Any patient-facing member of our staff. Some of the check-in questions, both in person and over the phone, will be along the lines of: “Your insurance company identifies you with a pronoun. What would that be? Is that the one you use?” This is creating a cultural shift. If you ask everybody these questions, you’re normalizing it so that there’s not one small or minority population that’s being marginalized.
Why is it so critical that we pay attention to SOGI in this purposeful way?
This is not just a nice thing to do. I don’t mean to be dramatic, but it’s life and death for LGBTQ+ people. The research shows they have a high risk for suicide. And the research also shows that a supportive environment makes all of the difference.