The discrimination is doubtless partly since doctors and dentists are recruited from, and so merely reflect, a still heavily homophobic society; and partly since success and career progression in medicine and dentistry is still largely related to how your senior colleagues perceive you rather than your ability to do the job.

And it seems our poor LGB docs and dents need all the help they can get, facing homophobic discrimination from their employers, colleagues and patients alike. Students are regularly "sent to Coventry" once outed, receive abusive notes or are isolated socially; qualified pros have their careers held back, their same-sex partners left off social invite lists or their HIV status inappropriately questioned - there are even tales of some doctors being hounded out of areas once patients discover their sexuality, their transfer supported by local NHS Trusts who feel it is easier to move the doctor than to confront the homophobia.

"If you live in a large urban centre," continues Dr Varney, "you may be able to access clubs and pubs and other social groups. But that assumes you are 'out' and comfortable to attend venues where you might bump into patients. Moreover, medicine is a very small world, and once an individual selects a particular area or discipline they may be one of under a hundred trainees or consultants in their region, where everyone knows everyone else and no one's business is their own."

Adds Dr Saunders: "Many LGB doctors and dentists are 'out' outside work and 'in' inside work, expending a lot of energy to maintain their 'double life', often at great strain to their own mental health. Some prefer the relative 'anonymity' of hospital practice whereas others prefer the more 'intimate' experience of working as a GP - fine, unless you end up working in a homophobic surgery."

GLADD agrees that LGB nurses face many of the same issues as doctors although their unions have traditionally been more supportive and their career progression is generally more transparent and merit-based.

THE CHAPERONE SYSTEM

The BMJ (British Medical Journal) recently suggested that gay doctors may - under the same rationale - be obliged to reveal their sexuality to patients prior to intimate examination, so that (say) a male patient can have a straight male chaperone when examined by a gay male doc.

GLADD has grave reservations about possible discrimination. Probes Dr Saunders: "Doctors have a duty to conduct themselves in a professional manner and it is our view that it is perfectly possible to achieve this without needing to reveal one's sexual orientation. Should straight doctors, for example, approach all their male patients saying, 'Before I examine you, I just have to declare that I am heterosexual and happily married with three children'?"

LGB doctors are not alone in leading a "double life": the vast majority of gay patients may be 'out' down the GUM clinic but - perturbed by potential breaches of confidentiality, perhaps to other medical staff, receptionists, family, or financial services companies - are still very much 'in' with their GP. Reveals Dr Varney, shockingly: "Evidence suggests gay patients are even using GUM clinics to access more generic health services rather than disclose to their GPs."

PRIVACY CONCERNS

Moreover, the ABI (Association of British Insurers) have just (October 2004) issued guidance to their members which should now mean the removal of personal questions that have hitherto been specifically asked of openly gay men when applying for insurance products. However, such questions will be replaced with a new "common question" to be asked of all supposedly "at risk groups" - regardless of sexuality - so it remains to be seen if this will make that much difference in practice. A gay individual who practices safe sex might not appreciate being lumped in with an "at risk group".

Whatever, it will take twelve months for the guidance to filter through and, meantime, practice varies widely. Confesses Dr Saunders: "I recently completed an application for income protection insurance which still asked completely inappropriate questions."

Apart from trying the GUM route, some anxious queer sufferers - those that can afford it - flee to pricy private gay-run affairs on Harley Street and the like: yet another symptom of a medical profession that but woefully engages with its LGB patients.

"A patient-healthcare professional relationship is based on trust," Dr Varney insists in earnest. "If a patient is withholding information about themselves which might have a major impact on their life and wellbeing, then this relationship is flawed. It could delay diagnosis of some medical conditions or end up with you not receiving the most appropriate advice or treatment."

CONFRONT HOMOPHOBIA

"Future doctors have a responsibility to their colleagues and patients," Dr Sam Everington, co-chair of the BMA's Equal Opportunities Committee, says, "Sexual orientation should be included in the medical school curriculum and will help create a health service environment where all doctors can achieve their full potential and all patients be treated with the respect they deserve."

Medicine is a very traditional heterosexual environment that struggles to meet its clear duty of care to LGB patients and can be even harsher on its own LGB pros. The BMA's recent remarks are welcomed, but - as Dr Varney concludes: "We are on a path, yet slowly moving."
Additional Reporting: Ross van Metzke GayWired.com

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