Pride and (persisting) prejudice(s)
There has been significant progress for LGBT+ people over the last 60 years. For this, many
could be forgiven for thinking that Pride is no longer required, and that the ‘work’ is ultimately
done. This year’s Kennedy Report highlighted many significant barriers for LGBTQ+ surgeons
at work [1]. Unfortunately, similar data do not exist for anaesthetists. In this article, we aim to
come together to celebrate the progress that has been made, but also to reflect on the lasting
impact these inequalities still have today.
How it was - a personal perspective
by Dr Andrew Hartle
I grew up pretty typically: born in the ‘60s; child of the ‘70s;
medical school in the ‘80s. Outed in the ‘90s – typical for a gay
man. I looked like other children but felt differently; an age of
innocence was ignorance, but with realisation came shame.
Different wasn’t normal: knowing winks between adults about an
‘unmarried’ TV actor made their mark.
Teenage and puberty only made my feeling ‘other’ stronger. I
made few friends, seeking success areas like schoolwork. Sex
education was limited to rabbits, and no-one cared how they felt.
Actual sex was still illegal until 21. Poofs on TV (Are You Being
Served?) were camp and (not) funny, naughty vicars the staple of
Sunday tabloids. There was no Section 28, but there was nothing
positive about homosexuality to promote! Furtive delving into
dictionaries/encyclopaedias was not helpful. Parents, teachers,
and others were not to be asked and the secret (and shame) kept
hidden.
In 1996 a Sunday tabloid outed me, the RAF suspended me, then dismissed me.
Brideshead Revisited, around my A levels, was the first romantic
gay portrayal I’d seen, but it ends badly for everyone. I went
hopefully to university, even visited Castle Howard, but 1980’s
Leeds wasn’t Evelyn Waugh’s Oxford. I had my first fling, then
saw Horizon’s Killer in the Village episode. Before then being gay
was shameful, now AIDS made it potentially fatal. The negative
stereotype of the gay community was continually promoted (Box
1). There was little mention of LGBT in medical school except
the more salacious parts of forensic medicine, and lazy exam
stereotypes about alcoholic actors, STDs and HIV. One medical
student flamed out of the closet as President of GaySoc, and
another wore an earring!
So I never really left the closet, even after joining the RAF (to
understand the psychology, read ‘Velvet Rage’ by Alan Downs).
Having survived one RAF Police investigation and a security
vetting, by 30 I made cautious, justifiably paranoid, steps outside
Narnia. I visited the NHS and had my first long term relationship. The NHS was no more gay-friendly than the RAF, and my
boyfriend was as closeted as me. The few out doctors were very
brave...or stupid!
In 1996 a Sunday tabloid outed me, the RAF suspended me, then
dismissed me. One very supportive professor helped me return
to the NHS, but it wasn’t easy – I was once ordered from theatre
for a compulsory HIV test. The RAF had rules and followed them;
the NHS made them up!
So for 25 years I’ve been out. I’ve broken pink ceilings at my
hospital and the specialty as an ‘establishment’ gay. We now
have equal age of consent, civil partnerships and marriage, the
Equality Act, Queer as Folk and It’s a Sin. LGBT service men and
women wear uniform in Pride parades, but changing the law
doesn’t change how other people feel. My husband and I still
won’t hold hands in the street – how much better is life now?
How it is
Imagine your first day in a new hospital. You have successfully
obtained an ID card and changing room codes. You know that
you will soon have to decide when and if you want to ‘come out’
to your new workmates.
Anaesthesia is anecdotally thought to be one of the more diverse
or progressive subspecialties, however, there are persisting
barriers to trainees being open. For many LGBT+ anaesthetists,
‘coming out’ is an ongoing process. While overt prejudice is
largely considered unacceptable, more subtle, clandestine
manifestations of homophobia and transphobia persist. In
conversation with a consultant about my recent annual leave, I
was asked who I had gone on holiday with. I’m ashamed to say
I simply replied “Alone”, and completely erased the presence
of my partner. A few hours earlier, I had heard that particular
senior use the word poof when talking with one of his consultant
colleagues.
Anaesthesia is anecdotally thought to be one of the more diverse or progressive subspecialties, however, there are persisting barriers to trainees being open.
The success of training is hinged upon the relationship between
trainee and trainer, and LGBT+ trainees may be concerned by
inherent bias. Seniors may select trainees for opportunities, or
perhaps even consultant jobs, based on a personal assessment
of ‘quality’. Key to tackling this is a department of visibly diverse
seniors with widespread experiences that can lead to equity of
opportunity for their trainees.
LGBT+ doctors have also reported feeling discomfort about
having certain assumptions made about them. This can range
from being asked to work during school holidays and Christmas
breaks to finding that hospital policies were not designed for
them. Labyrinthine at the best of times, HR frameworks on
maternity and paternity leave frequently make no mention of
non-traditional family structures.
How it could be
A BMA survey of lesbian, gay, and bisexual doctors found that
over 70% had experienced some form of harassment or abuse
about their sexual orientation, with 12% in the workplace; only
a quarter had reported it to a senior [2]. The survey generated
action points but concluded that mandatory online diversity and
equality training was not useful.
Working alongside a good role model, who creates a precedent
for openly discussing their life, can be transformative. Local
LGBT+ networks allow safe spaces and are a more formalised
way of creating connections.
In the 2018 National LGBT survey, 21% of transgender patients
revealed that their specific healthcare needs were not met
or considered [3]. Trans health education should begin at
undergraduate level and continue throughout postgraduate
training. Further education and cognisance will also allow us to
improve the workplace for our transgender colleagues.
Working alongside a good role model, who creates a precedent for openly discussing their life, can be transformative.
We’ve come a long way. There are many milestones to be proud
of. However, we must all accept that a person’s sexuality and
gender identity are fundamental to who they are, and have an
impact on every area in their life. If you are reading this and
weighing the balances of coming out in your workplace, the overwhelming probability is that you will be warmly accepted.
However, it is our collective responsibility as a specialty to ensure
continued, structured moves to ensure equity of opportunity
for all.
Stuart Edwardson
ST5 Anaesthetics and Intensive Care Medicine
South-East Scotland
Vice-Chair, Association of Anaesthetists Trainee Committee
Leyla Turkoglu
CT1 Anaesthetics
East of England
Andrew Hartle
Consultant Anaesthetist
St Mary’s Hospital, London
Past President, Association of Anaesthetists
Twitter: @scotgasdoc, @leylsturk, @startle65
Figure 1 below. Comparative timelines show ideas entirely unrecognisable from the start, with progress pioneered by seemingly controversial characters. Interesting comparisons: the Royal College was established in the same year as Section 28; sugammadex seems recent but preceded legalised marriage equality by six years. Thanks to Anaesthesia Heritage for the photographs.
References
- Royal College of Surgeons of England. The Royal College – our
professional home, 2021. https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity-review-2021/ (accessed 8/7/2021).
- Association of LGBT Doctors & Dentists and British Medical Association.
The experience of lesbian, gay, and bisexual doctors in the NHS, 2016.
https://www.bma.org.uk/media/4225/bma_experience-of-lgb-doctors-and-medical-students-in-nhs-2016.pdf (accessed 8/7/2021).
- Government Equalities Office. National LGBT Survey: summary report,
2018. https://www.gov.uk/government/publications/national-lgbt-survey-summary-report/national-lgbt-survey-summary-report#the-results
(accessed 8/7/2021).