Under the scope - Medicine through an LGBT+ stethoscope - reflections on being out in medicine

February in the UK is lesbian, gay, bisexual and trans history month, a month long celebration and recognition of LGBT+ people in society. The 2024 theme is LGBT+ Medicine , an opportunity to explore the role of LGBT+ people in medicine, the difficult history contemporary as well as ancient which institutionalised and harmed LGBT+ people, as well as the current health inequalities affecting LGBT+ people.

It is important to understand that being lesbian, gay, bisexual or trans has not always been welcomed or supported by the medical profession, despite clear evidence for centuries that same sex attraction is a natural part of humanity and is common in nature in many species.

It wasn't until the 10th edition of the International Classification of Disease in 1990 that homosexuality was eventually removed, despite removal in the early 1970s from the mental health classifications in the Diagnostic & Statistical Manual (DSM) . Many LGBT+ people have experienced the medicalisation of their identity , and still some face the abuse of conversion therapy and discrimination in accessing healthcare. Across the world in 65 different countries and jurisdictions private, consensual same sex sexual activity remains a criminal offence with 12 countries retaining the death penalty for being gay, lesbian or bisexual.

It is against this history that in 1976 Dr Martin Hamilton-Farrell and five other medical students came together to form the Gay Medics & Dentists Group in London, a group that evolved over time to become the Gay & Lesbian Association of Doctors and Dentists (GLADD), a national network in the UK of LGBT+ doctors, dentists and medical & dental students. Having been involved in GLADD over the years I have seen first hand the importance of visible LGBT+ role models in medicine, I have also experienced the discrimination that still exists.

Many years ago I was staffing a GLADD stand at a community Pride (I think it was Leicester) wearing my surgical scrubs and white coat and suddenly a mother came rushing towards me hauling her adolescent son by his ear. "There" she said pointing at me "Just because you are gay, doesn't mean you can't get good grades and go to medical school and become a doctor, just like this bloke". The poor boy flushed bright red and slipped out of his mothers grip, mouthing sorry he edged away, she smiled sweetly at me and said "thank you for being here, it's important" and chased after him. That was back in the early 2000's and GLADD was creating leaflets about LGBT+ people and cancer, heart disease and diabetes, trying to raise awareness that health inequalities affected LGBT+ people and that they should look after their own health. At that time national policies and the focus of most charity work was mainly focused on sexual health and HIV prevention, although groundbreaking work like Diagnosis Homophobic (1998)

A few years later I was lucky enough to be coordinating the NHS float in the London Pride Parade, the first time that there had been a single presence bringing together healthcare professionals under a single group in the parade. It was a powerful presence with over 60 people dressed in medical uniforms on a 40ft truck going through central London. I remember clearly the moment we turned the corner down to Piccadilly which is where the anti-LGBT protesters are shouting their hate towards the marchers. We had some students on the float so we quickly moved them to the far side to keep them away from this hate, and formed a wall facing the abuse. Ahead of us was the teaching trade union float and the abuse they received was truly vile, but as we came towards this group the shouting slowed down and then stopped. I could see the perplexed faces and the thought processes going on in the protestors, they were wrestling with their views against LGBT+ peoples and the fact that in front of them were doctors, nurses, physios and paramedics, people who saved lives and might one day save theirs. As we passed they stayed silent, their words still on placards but their mouths closed. Once we had passed, I heard the shouting start again, but for those short minutes the respected us enough to stay silent. Later that same day out in the festival part someone randomly grabbed me, shook my hand and gave me a hug 'Thank you, thank you for being visible, it meant a lot to me' and then they danced away. It was brilliant to see how this visibility has now rippled across the world with GLADD type networks and floats in Pride parades from Sydney to San Diego.

Being visible as a gay man, lesbian woman, bisexual person or trans person remains an act of bravery in medicine. I know personally I have lost jobs because despite being the best candidate (that's what I was told rather than my ego!) the employer didn't want an openly gay man working for them, especially not one who spoke openly about LGBT+ issues.

Very early in my career I was told by a well meaning educational supervisor who told me that a career in paediatrics was unwise for a gay man, as public perception wouldn't trust a gay man with children (this was the late 1990's).

Slightly later on a very senior medic took the few minutes of privacy in a lift to give me the advice that 'you're too gay to be promoted to anything meaningful in medicine, tone it down a little and balance it out', the irony being this was on the way to them giving a speech for LGBT History Month that I had co-written for them!

Later still I had a job offer withdrawn without reason, several years later a member of the panel told me that the chief executive of the organisation had objected to the appointment and over-ruled the appointment panel scoring because they didn't want to have a senior openly gay man in the organisation.

More recently a community leader felt they should advise me that my openly gay visibility was a sticking point for them and they felt it was impairing our working together, I listened to what they had to say and understood it came from a position of compassion not hate, but also played back to them how it felt from my side to hear this and we ended the conversation on good terms both understanding each other a little better. In contrast many others, especially from faith communities, have fed back privately that me openly talking about my husband in the same way that others mention their wives, not making a big deal about it, but simply stating the fact, has helped them as they navigate difficult space in faith and sexual orientation and gender identity politics, they may not share my sexual orientation, in the same way I don't share their faith, but our mutual respect is a powerful bridge and we can, and do, work constructively together.

I have learnt that jobs that don't allow you to be your full authentic self are not jobs that allow you to grow and develop, nor do you do your best in them. I suspect if I had ended up working for any of these people then I wouldn't have been happy, nor would have they. I don't regret these missed opportunities, and I have had a great career so far and I hope that it continues to offer me growth that celebrates my authentic self, I've certainly found that in brilliant organisations like Public Heath England and Birmingham City Council where there has been clear recognition that diversity of all forms brings something valuable to the leadership table.

Fortunately through GLADD I met people like the brilliant Dr David Harvey , a paediatrician who was instrumental in creating breast milk banks to support the babies of HIV positive women and had been the royal paediatrician to Princess Anne and Princess Diana's children. Professor Mike King , icon in psychiatry, and the phenomenal obstetrician Prof. Susan Bewley , who all inspired me, and taught me, that I could be anything I wanted to be in Medicine.

Hiding yourself, redacting your life, and having to continually watch what you say takes energy, and that is energy that you are taking away from being your best self at work, as well as having a big impact on home life. In the end it just isn't worth it..

Organisations that actively work to promote diversity and inclusion, that investing in supporting LGBT+ visibility as strongly as they do faith and ethnic visibility, and challenge themselves to consider 'what more can we do' in meaningful ways, are employers that we should all be seeking out, especially in medicine.

So this UK LGBT+ History Month take some time to learn about the LGBT+ people who are seeing us safe, making medical breakthroughs and having an impact, because they are an essential part of our healthcare system and our medical history.