Out at work: being a gay doctor
How life has changed for gay doctors in the UK over the past 20 years
Twenty years have passed since Daniel Saunders wrote for the Student BMJ, and this time there’s a crucial difference.
In 1995, he wrote anonymously about being a gay medical student, for fear that revealing his name might damage his career prospects and alienate his colleagues. Now, he says he can be “open and honest” about his sexuality, as he reflects on two decades of progress for lesbian, gay, bisexual, and transgender (LGBT) doctors and students in the United Kingdom.
“People were very, very afraid [back then],” says Saunders, now a consultant oncologist at Nottingham University Hospitals NHS Trust. “Medicine was still very much a profession where it was largely not accepted to be out as a gay man or a lesbian woman. We used to meet in secret because people were very concerned about disclosure and the impact it might have on the way they were dealt with at work.”
Much of this progress can be attributed to a sea change in public attitudes towards homosexuality. Changes to UK law have also had a huge impact, culminating in the Equality Act 2010 making it illegal to discriminate against people on the basis of sexuality.
Coupled with this, career progression in medicine has moved from “word of mouth” to a more transparent, competency based approach, which has further reduced discrimination of all kinds—including overt homophobia, Saunders says.
For many, the 2013 legalisation of same sex marriage in England has been an even more important step, and provided additional impetus to be open with colleagues.
Tom Swaine, a fifth year medical student at Barts and the London School of Medicine, says dealing with his sexuality with colleagues has become much easier now that he can simply mention his husband in conversation. He tries to be as open as possible with his peers and supervisors, and he says he has experienced no negative reactions to date.
“I’ve spent a lot of my life working to become confident about being gay. That’s a personal achievement—I don’t want to have to hide that as part of my profession,” says Swaine. “It would send the wrong message as well, I think—that being gay is incompatible with being a doctor.”
The year 2015 also marks 20 years since the founding of the Gay and Lesbian Association of Doctors and Dentists (GLADD), of which Swaine is secretary. The association currently has almost 400 members.
Like Swaine, GLADD co-chair Becki Taylor-Smith, a year 2 core trainee in anaesthetics in the West Midlands, is “out” at work, believing it is “better to be open from the start.” She has not been afraid to challenge homophobia on the few occasions she has heard it, such as on a clinical placement when a fellow doctor, on learning that another colleague was gay, declared loudly in front of a busy waiting room that the idea of two men together “made him sick.” Taylor-Smith raised the incident with her consultant, who was supportive and pledged to deal with the problem with the doctor in question.
“I think we have a responsibility to challenge attitudes like that because it can affect patient care,” she says.
“If you’ve got a patient in the waiting room who is LGBT and they’re afraid about coming out or they don’t know how it’s going to be perceived in the consultation, and then they hear a doctor talking like that, they may not come out or reveal personal things about themselves which are relevant.”
Facts and figures
While there are numerous studies on the experiences of LGBT patients in the healthcare system, there are far fewer on LGBT doctors and medical students and how commonly they encounter discrimination or homophobia.
A 2001 literature review, published in The BMJ, concluded that there were “encouraging indicators” of progress, but it remained “difficult to assess whether gay, lesbian, and bisexual doctors have crossed a major threshold or will continue to struggle for equal treatment and respect from their peers.”
More recent insight comes from a 2014 survey of around 800 readers of the Health Service Journal—part of its inaugural LGBT role models supplement. Some 55% of respondents said their organisation had become friendlier towards LGBT employers and clients in the past five years, and just 13% said it had become less friendly. Alongside this, 85% felt supported by their colleagues and line manager.
Despite many positive changes over the past two decades, it is clear that there is more work to be done in making medicine a truly LGBT friendly profession.
Swaine says that while he has not experienced any outright homophobia at medical school or on placements, some of his peers report subtler forms of homophobia and the occasional snide remark, which can leave them feeling ostracised. Both he and Taylor-Smith know LGBT medics who still keep their sexuality secret at work for fear of negatively affecting their career prospects and relationships with colleagues.
Membership of GLADD is confidential, but people are often unsure whether to mention it on their CV—and some have been advised by colleagues not to do so, Taylor-Smith says. Many instinctively feel that specialties such as general practice and psychiatry are more “gay friendly” than others such as surgery or emergency medicine, she says.
Swaine adds: “We had somebody in GLADD who was a surgical trainee and she was absolutely terrified about somebody finding out because [she feels] it will have a negative effect on her career path. Statistics suggest that surgery is one of the worst specialties for undermining and bullying behaviour. We don’t meet many LGBT people who want to be surgeons, I think mainly because of that fear. It doesn’t seem like an appealing career for them because of the whole culture that goes with it.”
In response to this, a Royal College of Surgeons spokesperson said: “Discrimination against a doctor because of their sexuality is unacceptable and should be reported. It is also now mandatory for all consultant surgeons to undergo equality and diversity training in the work place. Through our ‘Opportunities in Surgery’ work we continue to support the increasing diversity in the surgical profession.”
For others, discrimination is more overt. Thirty six per cent of those in the Health Service Journal survey said they had experienced homophobic, biphobic, or transphobic comments from colleagues and 29% from patients or service users, and 18% had experienced discrimination or unfair treatment as a result of their sexual orientation. Only half of those who experienced negative behaviour or comments formally reported it.
Today, there is plenty of help and support available for LGBT doctors and medical students facing difficulties.
Besides GLADD, there are many advocacy and support groups such as Stonewall, the LGBT Foundation, and the Beaumont Society, which offer an array of online resources spanning everything from health and discrimination to parenting advice and how to report hate crimes. Within the NHS, the Health with Pride website offers extensive information for LGBT patients and healthcare professionals, and NHS Employers, the NHS Leadership Academy, and the BMA’s Equal Opportunities Committee, among others, all champion equality and diversity in the workplace.
The General Medical Council gives no specific guidance on issues around doctors’ sexuality, apart from general advice on maintaining professional boundaries and discussing personal beliefs with patients.
Swaine, who intends to become a general practitioner, says it would be helpful to have more concrete guidance, particularly about chaperones for intimate examinations and procedures. Although the GMC advises having a chaperone present regardless of gender, in reality they are often provided in general practice only when the patient is the opposite sex, Swaine says. This can put LGBT students in a difficult position when examining a patient of the same sex: logically a chaperone should be present, but requesting one could mean “outing” yourself when it may not be appropriate to do so.
GLADD is also hoping to develop guidelines for medical schools to improve their teaching on the specific healthcare needs of LGBT people. At present, such teaching is not consistent and often accompanies particular diseases such as HIV, which can lead to stereotyping, Swaine says. According to the Office for National Statistics 1.5% of the UK population— or 725 000 people—identifies as LGBT; however, organisations such as Stonewall estimate it more likely to be around 5-7%. Swaine believes students should be taught early on about the barriers to healthcare faced by LGBT people and how to avoid making “heteronormative” assumptions, such as assuming someone’s partner is the opposite gender when taking a social history. The focus should be on encouraging students to “be LGBT inclusive in their thinking and medical practice” across the board, as opposed to the narrow focus on specific pathologies that occurs at present, he says.
For every LGBT doctor and medical student who gets involved in politics and advocacy, countless more are quietly going about their day jobs just the same as everyone else.
Matthew Toal, a year 6 specialty training obstetrics and gynaecology registrar at North Middlesex Hospital, says he was initially cautious about revealing his sexuality at work, but now has a “happy and open” relationship with colleagues and hasn’t found it a major problem. He has never felt the need to join GLADD or any other organisation, but is reassured that support exists should he ever run into trouble.
“I’ve been pleasantly surprised by how accepting virtually everybody I’ve worked with has been,” Toal says.
Yet whether they realise it or not, today’s young medics surely owe thanks to those such as Saunders who fought to earn acceptance the hard way.
His efforts were acknowledged in 2014, when he was named one of the Health Service Journal’s LGBT role models for “the way he has consistently championed LGBT health and equality issues, both within the trust and the wider local community.” It represents quite a turnaround from the self doubting medical student too afraid to be named in these pages.
Saunders believes that while much has improved, there are still “hearts and minds to be won” and more subtle forms of homophobia to tackle. Acceptance of LGBT people can vary between organisations, he says, noting that even in 2014, several senior NHS managers refused to be named in the Health Service Journal’s LGBT supplement for fear it would be “career limiting.” Conversely, at the positive end of the spectrum, there were eight NHS organisations named among Stonewall’s top 100 gay friendly workplaces in 2015, including Nottinghamshire Healthcare NHS Trust in the top spot.
“By being open and honest you’re reminding colleagues that LGBT people exist, that we’re normal human beings just like everybody else, we have feelings, we’re professional and we’re good at what we do,” Saunders says. “The reality is, if people see that you’re a good doctor and a good colleague they will recognise that first and foremost.”David Brill, second year graduate medical student
1St George’s, University of London
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
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Cite this as: BMJ 2015;23:h4102