A few weeks ago, the British Medical Journal carried an interesting editorial summarising some of the findings of a small-scale survey of how UK gay, lesbian and bisexual healthcare professionals manage their sexual identities in the context of clinical work. Some of it really struck a chord:
The finding that lesbian, gay, and bisexual practitioners are deeply preoccupied with issues of managing their identity will not surprise readers who are familiar with the literature on social identity and stigma. Although health professionals may resolve in advance either to be open about their sexual orientation (to "out" themselves) or to avoid disclosure (by trying to "pass" as normal), it would be unrealistic to think that every routine consultation could be prefaced by an explanation of sexual preference. Most practitioners find themselves carefully negotiating their way through interactions, making decisions from one moment to the next about how relevant their sexual identity may be to the situation and just how open to be. Thus in a single day a gay doctor might find himself "passing" to avoid homophobia but also revealing his homosexual identity to show affinity with a gay patient, or as a desexualisation strategy to resolve problems in examining a woman patient. "Passing" may involve conformity with self protective routines based on cultural assumptions of heterosexuality, like the use of chaperones for female patients examined by male doctors. Many lesbian, gay, and bisexual practitioners follow this practice despite the sense of irony that it engenders. This movement between different personas can generate real tensions as, for example, professionals ponder what will happen if attempts to "pass" are undermined by the subsequent discovery of sexual preference.
At just what point lesbian, gay, and bisexual identity becomes relevant to the interaction and needs to be disclosed is not straightforward. My guess would be that a substantial number of patients expect this information to be communicated before a physical examination is carried out. Lesbian, gay, and bisexual practitioners face the difficult talk of constructing a version of ethical practice, which balances the principle of informed consent against freedom from discrimination. As Riordan says, very little exists in the medical school curriculum or in continuing professional education that helps prepare lesbian, gay, and bisexual practitioners to chart a course through these dangerous waters.
Although I'm now at a level where I rarely have to perform physical examinations (I have people who do that for me, darling), I'm certainly aware of times when I've had to make the snap decision as to whether to grin and bear a patient's anti-gay tirade or say something - and I've been in plenty of situations where a devoutly religious individual (and this has happened with Christians, Muslims, Jews and Hindus) has made the assumption that I'm heterosexual and asked after my wife. I'm then stuck with the dilemma of whether to "out" myself (knowing they'll likely have a negative reaction and the therapeutic relationship will be compromised), answer curtly, evasively or non-committally (which tangles me up in deceit-by-omission) or lie outright (which I've never done, but which would make me feel crap).
What do people think? Studies show general preferences along lines of gender: women tend, on the whole, to prefer female doctors; men prefer male. Are there situations in which you'd want to be aware of your doctor's sexuality? |
