Incorporating Sexual Orientation and Gender Identity (SOGI) in Medical Records

Importance in Healthcare

• Understanding and recording SOGI in medical records is crucial.
• Helps in providing respectful and accurate care.
• Recognizes diverse needs and experiences of patients.

Biological Sex

• Traditionally defined by sex chromosomes:
  • Y chromosome = male.
  • Two X chromosomes = female.
• Complexities
  • Some individuals may have a Y chromosome but lack specific male-encoding genes, appearing female.
  • Gene expression varies: high testosterone/low estrogen or vice versa.
  • Presence and sensitivity of hormone receptors also vary.
  • Intersex individuals may not fit into standard male/female definitions.
• Conclusion: Biological sex exists on a spectrum.

Gender Identity and Gender Expression

• Gender Identity: A person's own sense of their gender.
• Gender Expression: How they present themselves to the world.
• Varieties of Gender Identity
  • Binary identities: Man, Woman.
  • Non-binary identities: Multiple genders, gender fluidity, Two Spirit (Native/Indigenous).
  • Transgender: Gender identity different from sex assigned at birth.
  • Non-identifiers: Those who do not subscribe to any specific gender label.

Sexual Orientation

• Not determined by biological sex or gender identity.
• Types:
  • Heterosexual: Attraction to a different gender.
  • Gay: Attraction to the same gender.
  • Bisexual: Attraction to two or more genders.
  • Pansexual: Attraction to any gender.
  • Asexual: No sexual attraction.
• Terminology is fluid and evolving.

Pronouns and Names

• Common pronouns: He, Him, His; She, Her, Hers; They, Them, Theirs (gender-neutral).
• Example: "This patient's name is Sam. They have diabetes."
• Dead Name: Previous name that a person no longer uses after changing their gender expression.

Misgendering

• Referring to someone by the wrong pronoun or dead name can cause harm.
• Leads to shame, loss of self-esteem, harassment, discrimination.
• Impacts willingness to seek medical care.
• Survey Findings (2011 National Transgender Discrimination Survey):
  • 28% postponed medical care due to discrimination.
  • 19% were refused medical care.
  • 28% experienced verbal harassment by medical professionals.

Collecting and Using SOGI Data

• Essential for assigned sex at birth, gender identity, and pronouns.
• Documented in electronic health records (EHR).
• Best Practices:
  • Ask for SOGI data respectfully without assumptions.
  • Example: "I want to address you the way you want to be addressed, can you tell me your name and pronouns?"
  • SOGI data is not fixed; it can change over time.
  • Apologize and correct mistakes if wrong pronoun or dead name is used.
• Administration
  • Assigned sex at birth may be asked for insurance/billing, confirmed with ID (e.g., driver's license).
  • Sexual orientation considered private, asked only if relevant to care.

Recap

• Healthcare systems collect and report SOGI data.
• Definitions:
  • Sexual Orientation: Whom you're sexually/romantically attracted to.
  • Gender Identity: How you identify yourself.
  • Sex: Biological attributes.
• Asking for and using correct pronouns shows respect and improves care quality.