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One is and artistic and expressive occupation. Stitching up a gay person wouldn't be perceived as a form of statement. But being required to produce work in the traditional style of a wedding photographer could be perceived as issuing a statement in support of the event.
If you sold signs, you shouldn't be able to decline someone a blank sign just because they are LGBT. But you shouldn't be required to design one that carried a pro LGBT (or any other kind) of message.
I see where you are going with that, and I follow. But what about when we get into healthcare that can be perceived as queer-specific?
Say, when a doctor refuses to do proper STD screenings for a gay man, refuses to prescribe PrEP or PEP, or refuses to authorize checks on hormone levels?
All taken from experiences me and my friends have had, by the way.
I wouldn't consider screenings or prescribing countermeasures to people who suspect exposure to medical threats particularly artistic or expressive. All those seem like pretty normal things for any sexually active adult to ask for regardless of sexuality.
Additionally those should be confidential so I don't see them as a form of compelled speech.