Is Now a Good Time to Ask a Personal Question?

My Epic EMR discourages me from closing each office note without addressing the gender identity questions that are now suddenly mandated.

According to the American Journal of Public Health,

“Sexual orientation and gender identity (SOGI) information from patients in health care settings and entering the data into electronic health records (EHRs) have been recommended by the Institute of Medicine, the Joint Commission, and other medical and policy experts as key steps to measuring and addressing multiple health disparities among lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations. Routine SOGI data collection and reporting are considered critical not only for population health management but also for facilitating clinical decision support and promoting culturally affirming, patient-centered care.”

The same article reports that during the first year that this data collection was built into EMRs, 77% out of a combined patient population of over 25 million did not have the answers to these questions documented.

We have asked sensitive questions all along: Do you smoke, how much do you drink, how many sexual partners have you had in your life, did you ever think of killing yourself, are you the victim of domestic abuse?

I am not as convinced as many others about the validity of such rapid-fire questioning during the check-in process for a routine visit. And I am particularly concerned that sexual orientation questions delivered in a mechanistic fashion not only have limited accuracy but can go either way in terms of doctor-patient relationship. Some patients may be ready on that day to reveal such things, others who are not, may be seriously offended.

For me, this latest mandated probe illustrates this country’s two opposing views of the purpose of the doctor-patient visit and the two opposing views of the purpose of the patient medical record.

Is the purpose of the visit and the office note to give the patient the medical advice they seek, or is the purpose to collect statistical information for medical, actuarial, sociopolitical and public health purposes? The question is rhetorical. The record is certainly not, and much of what we do in our clinic visits also is not, for the patient.

Yes, I am old school, but medicine is an old practice. The doctor-patient relationship has its foundation in Hippocrates. Only lately have bureaucrats and statisticians hijacked this ancient tradition of privacy. If no medical record existed, I would feel much more at liberty to ask all kinds of probing questions, but neither I nor my patients have full confidence in HIPAA and confidentiality in today’s typical office environment.

I have written about this many times. What is it with our obsession with questionnaires?

“It seems odd to me that medical students and other staff categories have to take classes in cultural sensitivity and at the same time have a requirement to probe for personal secrets early in their interaction regardless of the age or cultural background of our patients.”

And

“The common screening test most clinics use, PHQ-9, asks blunt questions about our emotional state for the past two weeks. This, in my opinion, fits right into the new American mass hysteria of sound bites, TikTok, Tweets, Facebook Stories, instant messages, same-day Amazon deliveries and our worsening pathological need for stimulation and instant gratification.

Two weeks??

Does anybody need to be labeled with a mental illness that will follow them for the rest of their life because of a fleeting emotional funk?”