At County Health System , providers and staff often struggled to recognize SOGI data 's relevance for care , further informed by anticipation of patient expectations when discussing gender and sexuality . Despite acknowledgement of " openness , " several health care workers still expressed discomfort around asking patients the SOGI items , suggesting the questions broached a previously unacknowledged boundary of topics appropriate for clinical discussion ( Cruz , 2020 ) . Patients typically did not expect to discuss such issues when seeking care in this clinical setting , as described by one staff member :