Elusive inclusivity

Respect and dignity, compassion and the belief that everyone, no matter who they are, counts.

These concepts are not simply abstract notions and wishful ideas, but core and codified values enshrined within the NHS’ constitution.

Yet for many of the health service’s lesbian, gay, bisexual, queer or trans doctors and healthcare staff, these inclusive ideals are still very often a world away from their day-to-day experiences in hospitals, GP surgeries and other healthcare settings.

Part of a report into the experiences and perspectives of almost 2,500 doctors and medical students, the BMA’s Sexual orientation and gender identity survey has lain bare the extent to which ignorance, prejudice and even hostility towards people with certain sexual orientations and gender identities persist within the NHS in 2022.

‘For years I have felt uncomfortable everyday just by being myself at work,’ one gay and trans junior doctor tells the BMA.

‘Even when there are supportive and tolerant members of staff around, I can’t tell where the next homophobic comment or deriding statement, look or question about my professionalism will come from, often just because I wear a rainbow badge. I find it easier and safer to change the way I present to reduce suspicion.’

Conducted between January and March this year, the survey found that while 46 per cent of gay, lesbian and bisexual doctors and students reported being open about their orientation almost the same percentage (43 per cent) told of experiencing homophobia or biphobia on at least one occasion in the previous two years.

‘During foundation training a senior registrar referred dismissively to gay men as f****ts,’ one junior doctor tells the survey.

‘Raised with hospital [and] was dismissed as said registrar was “experiencing a lot of stress and so we need to be understanding.” No support given to either myself or other LGBTQ+ identifying trainee present.’

Among those responding to the survey identifying as trans, just 34 per cent said they were fully open with colleagues and patients about their gender identity, with 49 per cent saying they had experienced at least one instance of phobic behaviour in the same period.

‘My educational supervisor thought it was funny that people used they/them pronouns when talking about me,’ says one GP trainee.

‘She refused to use they/them, saying that I am “obviously female” so she would use she/her. She also said if I wouldn’t use male or female pronouns then she would refer to me as “it”.’

As well as overt forms of discrimination, 67 per cent of LGBQ respondents to the BMA’s survey highlighted how they had to contend with stereotypes and assumptions about their character and behaviour because of their sexual orientation.

A further 61 per cent of LGBQ respondents and 66 per cent of trans respondents to the survey said that they had faced invasive questions about their personal lives when in the workplace, while 57 per cent of LGBQ and 85 per cent of trans doctors and students felt an expectation to ‘educate others’ about their sexual orientation or gender identity.

‘When peer colleagues do find out that I am a bisexual woman, more likely in social situations, it is met with questions about lesbian encounters,’ one junior doctor tells the survey.

‘I have once been told that it makes me “more attractive”, and I have also been told on one occasion that “you must be so tempted to cheat”’

‘Constant misgendering is unfortunately just a regular thing even with colleagues that are supportive and try to make some effort,’ says one queer and trans junior doctor.

‘It is just so emotionally exhausting having to correct people all the time. It shouldn’t be up to me to have to educate people about non-binary identities.’

While stereotypes and prejudice undoubtedly have a harmful effect on individuals’ wellbeing, the survey also found that they could negatively impact professional development and career paths.

Fifty-six per cent of LGBQ respondents to the survey said that they had felt undermined in their place of work or study because of their sexual orientation, while 32 per cent said their professionalism had been questioned or doubted as a result of their sexual orientation.

Within the survey, one gay junior doctor recalled how his supervisor had tried to talk him out of his preferred career path.

‘When I was applying for medical training with the aims of becoming a geriatrician my clinical supervisor, who was a geriatrician, suggested I consider an alternative speciality as older people “do not like people like you”.’

Trans doctors and students meanwhile, related similar experiences

‘I have had my transgender status disseminated as gossip amongst former and current work colleagues been told openly that, had I been “outed” as transgender at interview,’ says one trans consultant.

‘[I have] been told by my clinical director that the ability to do my job could be affected by “the high rates of psychiatric illness amongst trans people” and I have been excluded from meetings with visitors to the department, in case I “upset them.”’

For those left feeling unsupported, undermined or singled out because of sexual orientation or gender identity the detrimental impact can be profound and even cause some to call into question their future in medicine.

Eleven per cent of LGBQ+ respondents to the BMA’s survey say they had either left or considered leaving their job or medical school because of discrimination on the basis of their sexuality, with this figure rising to 29 per cent for trans respondents.

The BMA’s survey also asked those taking part to identify who in their medical school or workplace they were most likely to experience homophobic, biphobic or transphobic behaviour from.

Dishearteningly, 35 per cent of LGBQ+ respondents and 31 per cent of trans respondents said that senior doctors or colleagues as the most likely source of this behaviour.

‘It is difficult to feel accepted within the medical community when I have witnessed so many of my colleagues being openly homophobic,’ one lesbian junior doctor tells the survey.

‘This has led me to consider leaving medicine in the longer term. I do not feel I can be myself when I am at work for fear of discrimination.’

Despite its more damning findings, there were some signs of encouragement found in response to the survey.

Sixty-three per cent of LGBQ+ and 46 per cent of trans respondents said they thought the medical profession has, overall, become more inclusive in the past five years.

Furthermore, 61 per cent of trans respondents and 72 per cent of LGBQ+ agreed or strongly agreed that the people they worked or studied with were supportive of LGBTQ+ people.

That more change is needed if the medical profession and NHS are to become ever more inclusive, those participating in the survey were in no doubt.

Participants outlined a range of recommendations for change which, taken together, they felt could begin to make a difference both at an individual level in medical schools and workplace and in the broader cultural climate of the profession.

These include amending undergraduate and postgraduate medical curricula to contain mandatory education with respect to physical and mental healthcare needs specific to LGBTQ+ people and ensuring that exams and assessment scenarios no longer perpetuate stereotypes about staff or patients from these groups.

Those taking part in the survey also endorsed calls for all medical schools and trusts to review their existing equality and diversity training to make sure it is LGBTQ+ inclusive, and for the NHS in all home nations to develop consistent methodologies when gathering data on the experiences of LGBTQ+ staff.

There was also support for all organisations linked to healthcare, including Royal Medical Colleges and the BMA, to commit to reviewing organisational policies to assess inclusivity.

In their forewords to the report, BMA deputy chair of council Emma Runswick and chair of representative body Latifa Patel described the prejudice and discrimination experienced by LGBTQ+ staff, as both ‘serious’ and ‘unacceptable’.

As the first openly LGBTQ+ chief officer at the BMA, Dr Runswick said she had personal experience of the type of behaviour outline in the report, adding that overcoming bigotry in medicine and the health service, was something that all medical professionals had to work towards.

She says: ‘There has been progress for LGBTQ+ people in institutions over the last decade, from updated policies to recognition of Pride month. Initiatives like the NHS Rainbow Badge have become more widespread. However, attitudes and workplace cultures have often lagged.

‘This report describes where we are now, but it also outlines suggestions for how to continue progress for LGBTQ+ people. We hope that all colleagues will join us in the struggle for LGBTQ+ rights, against homophobia, biphobia, and transphobia.’

Warning that ‘no one should face hatred, hostility or discrimination because of who they are’, Dr Patel said that it was critical that medical schools, workplaces and professional organisations learn from the report’s findings and take action.

She said: ‘The findings of this report can, and must, galvanise action to address gaps in education and training and to overhaul discriminatory systems and practices that allow unacceptable prejudices to continue to blight working lives.

‘It must also serve as an opportunity for every one of us to reflect on how we treat the people around us, our colleagues and patients, to ensure that everyone is treated with dignity and respect.’