‘I need to be able to relax at work and not consume energy hiding or pretending’
‘… there are lots of allies around me but they don’t know how to speak up’
‘Small visual cues can help … something as small as having a poster supporting LGB health services can send a message to LGB patients and staff that they are in a safe environment’
(BMA, 2016, The experience of LGB doctors and medical students in the NHS)
Since October 2017, there has been considerable media coverage about the sexual orientation monitoring (SOM) questions that are being asked by healthcare providers. These questions are used to find out if people, regardless of sexual orientation, are accessing the right services, at the right time and are able to talk about their full healthcare needs. That has been the purpose of introducing SOM, since research continues to show that lesbian, gay and bisexual (LGB) people have poorer health outcomes compared with heterosexual people. Yet, the introduction of SOM revealed the persistence of homophobia and biphobia in socio-cultural thinking in the country.
For instance, there has been little awareness or discussion about the fact that many healthcare workers identify as lesbian, gay and bisexual. The default is that the people asking the SOM questions will invariably be heterosexual – which is not the case.
For this post I wanted to review studies and articles about the experiences of LGB people who work in healthcare in the UK. Unfortunately there are very few studies in this area and other than a major piece of work commissioned by the British Medical Association in 2016, I could find very little in the way of analysis of LGB healthcare workers.
In general, across healthcare professions, those who identify as LGB continue to experience homophobia and biphobia in the workplace which contributes to fear and anxiety about work. A common theme is the reluctance of LGB staff to approach equality advisors, human resources or occupational health for help and, as a result, there is a lack of clarity and understanding about the rights of LGB people in healthcare settings.
What is it like for LGB people working in healthcare?
- Many feel excluded, isolated and fearful due to their sexual orientation, at different points of their career and/or different periods in the same workplace.
- People are often wary of being open about their sexual orientation with people they are newly working with, until they have weighed the situation up.
- Juniors staff are often cautious of being open with more senior staff and fear damage to career progression prospects. For example, the perception is that the medical hierarchy is particularly strong, and that juniors are hugely dependent on the say-so of their seniors for advancement in their careers.
- Many keep quiet on the subject with those whom they know to hold strong religious views.
- It is often throw-away comments, rather than direct abuse, that actually has a lasting negative effect on the confidence of people about being LGB in healthcare. This is due to the frequency of the comments, the fact it can trigger memories of earlier homophobic, biphobic and transphobic experiences, the unexpected nature of them and the historical context of long-term discrimination towards LGB people. This contributes to heightened emotional vigilance about anticipatory discrimination and contributes to individuals isolating themselves further.
- There is general fear that if a person comes out in the workplace, they will be seen differently by people they work with. Many voiced a preference for their sexual orientation to be revealed organically; although there is acknowledgement that this may not always be possible.
- LGB people have had to remind senior staff that they do have families too and sometimes children, just like heterosexuals, and therefore they should not be expected to work over family holidays based on an assumption that they do not have families etc. purely because they are LGB.
- The cycle of coming out in each new working environment can be draining especially if there are no cues to suggest that it is a safe space.
- For those who are open about their sexual orientation in the workplace, there is a sense of discomfort in their exchanges with colleagues and clients rather than direct homophobia.
Top 5 initiatives for employers
- Ensure employees are aware of LGB inclusion in policies. Even if an individual is uncomfortable about speaking to advisors face-to-face, they should be able to access policies which explain their rights in the workplace.
- Run year-round campaigns around major LGB days such as Pride, history month etc., to build a reputation of being an inclusive employer. This can help raise awareness among all staff and deter people from bullying and harassing LGB staff in the workplace.
- Ensure there are support measures in place for LGB staff who experience discrimination at work – repeated and constant micro-aggressions around sexual orientation can have a cumulative impact leading to stress, diminshed work-life balance, increased absence from work and leaving the workplace.
- Prepare equality training sessions for all staff (e.g. at induction or training updates) which explicitly talk about homophobia and biphobia and types of discrimination in the workplace.
- Consider developing and sustaining an allies initiative – change is unlikely to happen without wider support.
GLADD – The association of doctors, dentists, students who identify as lesbian, gay, bisexual, trans, queer or questioning.
Collier R. Promoting pride in practice. CMAJ : Canadian Medical Association Journal. 2012;184(15):E789-E790. doi:10.1503/cmaj.109-4296.
Eliason, M.J. & Schope, R. Journal of the Gay and Lesbian Medical Association (2001) 5: 125. https://doi.org/10.1023/A:1014257910462.
Gibbons, M., Manandhar, M, Gleeson, C. and Mullan, J. Recognising LGB Sexual Identities in Health Services.
Stevens, PE (1995) ‘Structural and interpersonal impact of heterosexual assumptions on lesbian health care clients’, Nursing Research, 44(1): 25–37.