Elliott and colleagues1 add to the growing body of evidence regarding health disparities, in both health status and quality of care, among lesbian, gay and bisexual (LGB) populations. In work that highlights the utility and value of including measures of sexual orientation in population-based surveys, the authors found that sexual minority groups in England had poorer self-assessed health status, and more frequently reported a longstanding psychological condition than heterosexuals. Disparities among bisexual groups were especially pronounced. LGB patients’ experiences with care were poorer as well.

Unfortunately, the current study did not measure clinical or diagnostic outcomes, so it does not truly tell us about the health of sexual minorities in England writ large, but rather provides a window into respondents’ subjective sense of their own health. Further, questions related to quality of care provided no indication as to whether the poor experiences were the result of perceived provider biases related to sexual orientation (or any other bias, for that matter) or some other factor.

Nevertheless, there are important clinical implications associated with the study’s findings. In particular, more frequent reports of poor doctor communication among sexual minorities must be considered. The significance of provider communication to health outcomes is well established.2,3 Yet, it is questionable whether medical schools are training students to effectively communicate and work with diverse populations, particularly lesbian, gay, bisexual and transgender groups.4 Poor provider communication may compound and exacerbate existing health disparities among sexual minorities by causing them to delay seeking care, or to subsequently avoid care altogether. Addressing health disparities necessarily requires multi-faceted and multi-level approaches. Ensuring culturally competent and appropriate care, which includes effective provider communication, is a necessary part of the solution.