Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Why sexual orientation and gender identity in the EMR matters 


Always ask patients about their gender identity, preferred name, pronouns, and how they define their sexual orientation. This builds trust and helps your patients feel safe to return for follow-up. 

“Hello Robert, . . . or do you go by Rob or Bob? Maybe Robert prefers Alice or Cassandra?” 


Asking someone their preferred name isn’t a new idea, we do it all the time. We ask new acquaintances their preferred name, not their legal name, on a daily basis as part of developing a new relationship. Does your best friend go by Elizabeth? Maybe she prefers Liz? Or Beth?  


Patients feel comfortable when you call them by their preferred name, and it helps to solidify the patient-clinician relationship. For patients for whom their legal first name is stereotypically assigned to one gender that doesn’t represent their current gender identity, use of their legal name can feel hurtful, cruel, and embarrassing, especially when used in a public setting such as the waiting room.  


I ask all patients their preferred name so that I can update the name field or put a pop-up in the EMR. I receive quizzical looks from patients for whom this information feels obvious, but I get looks of relief and understanding from patients who are grateful to update their chart to reflect their gender identity. Staff are also grateful to know by what name a patient prefers to be addressed so that they don’t embarrass anyone.  


It’s taken me over 10 years of practice to learn how to ask certain questions. I needed time and experience to learn how to approach sexual health and identity. For example, years ago I used to ask, “Are you sexually active?” I now ask, “When you’re sexually active, are your partners male, female, or both? Cis or trans?” I ask this question in the same way with every patient, every time. Using nonjudgmental language free of bias is part of giving excellent care.


A common request from patients in primary care is asking for STI testing. A common response by many healthcare professionals is to place an order for bloodwork and urine testing and move on. If my patient has a penis, but is a receptive partner only, then I’m not meeting my patient’s needs by only ordering bloodwork and collecting a urine sample. I may miss bacterial infections in the throat or rectum that require treatment. He/she/they are not receiving high quality care. I often say, “I need to know who puts what where to make sure I don’t miss anything.” Helping my patient to feel safe to share their sexual orientation, behaviors, and practices with me is how I can let them know that they and their partners are safe. I’m not just their clinician, I’m their ally. Here’s a few things to keep in mind: 


1. Be consistent in asking the same questions in the same format to every patient, every time, so that the question flows and sounds sincere.  


2. Update the EMR with preferred name, preferred pronouns, sexual orientation, gender identity, and organ inventory if available. If there’s not a designated field for these, use a pop-up. This will benefit front desk staff and medical staff who are addressing patients in a public setting. Everyone will be grateful.  


3. Instead of asking, “Name and date of birth,” at the beginning of an encounter, try asking, “What’s your preferred name, date of birth, and preferred pronouns?” 


4. Avoid making assumptions about a person’s preferred name, pronouns, gender expression, marital status, or sexual partners. Ask.  









his piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.