in the ability of the health care profession to provide quality, accessible care for LGBT people. “That is an important theme that we need to keep in mind,” said Makadon.

At one time, hospitals were taking the lead in eliminating health care disparities among minority populations, but that role is now being shared more equally by community health centers and a variety of enabling organizations. Nonetheless, hospitals continue to be a key leader in this area, and the American Hospital Association (AHA) has issued the Health Research and Education Trust Disparities Toolkit for collecting race, ethnicity, and primary language information from patients. In issuing this toolkit, the AHA noted that disparities in health care can be addressed through a quality-of-care framework if data on race, ethnicity, and primary language are available. A 2003 report from Physicians for Human Rights, The Right to Equal Treatment, reiterated this message when it stated that data collection is not only central to quality assurance but also to help ensure nondiscrimination in access to care.

Makadon said that by the same token, health disparities that affect LGBT people will only be addressed if the health system collects data on sexual orientation and gender identity. The IOM, in its report The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, noted the direct benefit of collecting data on sexual orientation and gender identity for individual patients. Only by asking patients about their LGBT status and collecting data on the LGBT population will it be possible to end LGBT invisibility in health care. As Makadon put it, “I would say that unless we can do something about collecting data on LGBT people, we can’t assure anyone that LGBT people are receiving quality care.” He then asked the workshop audience to think about the following questions:

  • Has a clinician ever asked about your sexual history, including behavior, health, and satisfaction?
  • Has a clinician ever asked you about your sexual orientation?
  • Has a clinician ever asked you about your gender identity?

Based on his experience, Makadon estimated that 10 to 20 percent of people would answer yes to the first question, but that close to zero would answer yes for the second and third questions. Given that there are medical issues related to sexual orientation and gender identity, it seems that it would be difficult to provide good medical care for LGBT people without that information, and it is equally challenging to assess the quality of care being provided to the LGBT population. He also remarked that the invisibility of the LGBT population results from a combination of patient reluctance to divulge information on sexual orientation or gender



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