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Should all patients be asked about their sexual orientation?

BMJ 2018; 360 doi: (Published 17 January 2018) Cite this as: BMJ 2018;360:k52
  1. Richard Ma, NIHR doctoral research fellow1,
  2. Michael Dixon, general practitioner2
  1. 1Department of primary care and public health, School of Public Health, Imperial College London, London UK
  2. 2Devon, UK
  1. Correspondence to: R Ma{at}, M Dixon christine{at}

NHS England’s recent recommendation that professionals ask patients their sexual orientation at every opportunity is essential to improve services for non-heterosexual patients, says Richard Ma. But Michael Dixon thinks this erosion of medical autonomy is political correctness gone mad

Yes—Richard Ma

After decades of campaigning by lesbian, gay, bisexual, and trans (LGBT) charities such as Stonewall and the LGBT Foundation, sexual orientation became one of the nine protected characteristics written into the Equality Act 2010.1 It would seem a logical and welcome step for NHS England to include sexual orientation monitoring (SOM) in health and social care systems.2 In practice all professionals would ask patients how they define their sexuality during every encounter. Patients can, of course, refuse to answer.

However, some doctors and patients have expressed concerns about this policy, citing reasons such as intrusion or invasion of privacy, fear of causing offence, doubts about relevance, data security, and that it is a tokenistic gesture that will not make a difference. While I understand these concerns, they result in inertia; and failure to act undermines hard fought rights of LGBT patients to better healthcare.

Flawed assumptions about need

We already fail the LGBT community by not recognising, or by making incorrect assumptions about, their needs. A Stonewall commissioned survey of nearly 7000 gay and bisexual men found that smoking, alcohol, and drug use were more prevalent in this group compared with men in general.3 More specific health needs include mental health: 6% of gay and bisexual men aged 16 to 24 have attempted to take their own life in the …

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