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What’s your ethnicity, income, sexual orientation? Asking personal questions at St. Michael’s Hospital

Toronto, October 2, 2013

By Dr. Fok-Han Leung

Dr. Fok-Han Leung
Dr. Fok-Han Leung, staff physician in the Department of Family and Community Medicine

Providing equitable care is important to us. In order to do that, we need to measure equity, so we need data on things like our patients’ income, race and ethnicity, immigration status and sexual orientation on top of the regular patient demographic information, such as sex, date of birth and home address.

Asking patients about this stuff can be uncomfortable, but here’s why it’s important. With this data, for the first time, we’ll be able to really understand who our patients are and as a result, provide more appropriate care.

So our Family Health Team tried it out. A team at St. Michael’s worked with Mount Sinai, CAMH and Toronto Public Health to develop the questionnaire, and we each piloted it in different parts of our organizations. St. Michael’s ran a trial with about 400 patients at our 80 Bond health centre, where I work.

While patients were waiting for their appointments, we gave them the questionnaire on tablets (with a clerical staff member there to answer any questions). We wanted to see what kind of data we’d get, but we were also interested in seeing what the process and experience would be like for patients.

Screenshot of questionaire
Health equity questions patients are asked to answer in the waiting room before their appointments.
Patients were generally quite willing to participate. Some folks did ask us why it was important that we know their income levels. So we explained to them that income and health are closely linked, and knowing more about our patients’ needs can help us better plan our services.

Let me give you an example of how this information would be useful to both a patient and a health care provider. If you came in to see me because you were suffering from migraines and you checked off that you earned an income of less than $30,000 per year and had five dependents, I’m not going to prescribe you expensive medication that you probably couldn’t afford if you aren’t covered for it.

At a system level, this information will help us to plan services accordingly, to improve not only equity, but outcomes, access and patient experience. Another example: if we found out that Southeast Asians of a particular sexual orientation had low rates of screening mammography, we could target interventions more appropriately and direct resources to where it’s needed most.

My hope is to be able to provide the highest quality of care to our patients regardless of any health equity issues. If we do have issues to address, which we know we do, this information is going to help us resolve them at the individual and system levels.

The pilot is complete and we’re getting ready to roll it out across all our family health centres. If you had access to this type of information, how could it help you to plan care in your area?

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.