Lisa Lowery, MD, MPH, Adolescent Medicine 
Spectrum Health Medical Group
Helen DeVos Children's Hospital

The recent vote to allow gay marriage in New York state brought to mind the challenges that we, as healthcare professionals, face when our young patients have questions about or are struggling with issues related to their own sexual identity. 

As an adolescent medicine specialist, dealing with these issues is not uncommon. To encourage patients to share their concerns, it's important to create an environment in which your patients feel comfortable having such conversations. In my office, that means pamphlets and posters that demonstrate our support of our patients regardless of their sexual orientation. 

Why does this matter? Because as a primary caregiver part of your job is to ensure the safety of your patients. Yet a recent report from the Centers for Disease Control and Prevention found that gay, lesbian, and bisexual high school students were far more likely to engage in risky behavior such as smoking, drinking alcohol, and carrying guns than straight teens. The study of 156,000 high school students should be a "wake up call for families, schools and communities that we need to do a much better job of supporting these young people" said Howell Wechsler, the director of the CDC's Division of Adolescent and School Health. In an article on the study, Laura McGinnis, of the Trevor Project, said the teens are often driven to such risky behavior because they are "rejected by their families and other support groups."

As clinicians bound by our professional ethics to meet our patients wherever they are in order to provide the best possible care for them-regardless of our personal views on homosexuality. The American Academy of Pediatrics (AAP) issued its first statement on homosexuality and adolescents in 1983, revising it in 1993 and, more recently, in 2004. You can read it here. 

It notes that "Health care professionals should provide factual, current, nonjudgmental information in a confidential manner . . . The pediatrician should be attentive to various potential psychosocial difficulties, offer counseling or refer for counseling when necessary and ensure that every sexually active youth receives a thorough medical history, physical examination, immunizations, appropriate laboratory tests, and counseling about sexually transmitted infections (including human immunodeficiency virus infection) and appropriate treatment if necessary."

I try to stay away from gender-specific terms like "boyfriend" or "girlfriend." Allowing the teen to self identify provides you with the opportunity to ask more probing questions as needed. I find that asking if they have a special "friend" can help start the conversation. Another good way to start a conversation is to ask about bullying or if the teen is getting picked on. Also be alert to family issues around the teen's sexuality that could become divisive if not downright dangerous. And keep an eye out for signs of depression and other mood disorders, which are also extremely prevalent in this population.

If you're not comfortable talking about homosexuality with your patients, make sure you can refer patients to other community resources or even to another who can provide such support. This is also a recommendation from the AAP: "Any pediatrician who is unable to care for and counsel nonheterosexual youth should refer these patients to an appropriate colleague."

How do you get your patients to discuss concerns related to their sexual orientation?

Lisa Lowery, MD, MPH is an adolescent medicine specialist at Helen DeVos Children's Hospital in Grand Rapids, Michigan.