Wellbeing of gay, lesbian and bisexual doctors

British Medical Journal,  Feb 17, 2001  by Brian P Burke,  Jocelyn C White,  Daniel Saunders

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Summary points

While research has investigated doctors' attitudes towards homosexual and bisexual patients, relatively little attention has been paid to gay, lesbian, and bisexual doctors

The factors most likely to affect the wellbeing of such doctors are homophobia, discrimination, the challenges of medical school and residency, and lack of support systems

There is documented homophobia among doctors and directors of medical school education

Gay, lesbian, and bisexual doctors experience verbal harassment or insults from medical colleagues, and many believe that they risk losing their job if colleagues discover their sexual orientation

Although the situation has improved, more needs to be done to enhance the wellbeing of gay, lesbian, and bisexual doctors

Gay, lesbian, and bisexual doctors have long had a largely covert presence within the medical profession; their visibility is a relatively recent phenomenon. The American Psychiatric Association's landmark decision in 1973 to remove homosexuality from the nomenclature of psychiatric disorders was a major catalyst for this, allowing homosexual and bisexual doctors to take tentative steps into the culture at large. A search of the medical literature yields information on medical attitudes towards homosexual and bisexual patients, but little about homosexual and bisexual doctors themselves. Their challenges and triumphs are likely to be similar to those of other minority groups within the profession, except that they can choose whether to make their minority status known to patients and colleagues.[1 2]

Although societal tolerance towards sexual minorities has greatly improved since 1973, "coming out" as a homosexual or bisexual doctor remains a difficult decision, with both personal and professional consequences. Such doctors have to ask themselves several questions in deciding whether to come out:

* If I come out during medical school will it affect my grades or my ability to get into a competitive residency programme?

* Will I have the support of my classmates or will I be ostracised?

* Can I even be a homosexual or bisexual paediatrician, gynaecologist, or urologist?

* If I become a specialist, will my openness negatively affect referrals to me from colleagues?

* Will patients shun me?

* Can I practise in a small town, or am I consigned to a large metropolitan area?

Wellbeing implies personal and professional satisfaction and the ability to effectively integrate the two to form satisfying relationships with patients and colleagues and to attain their respect. In this article we review the literature on those factors most likely to affect the wellbeing of gay, lesbian, and bisexual doctors: homophobia, the difficulties encountered by homosexual and bisexual medical students and staff, and anti-homosexual discrimination. We also suggest directions for future research in this topic and ways to enhance the wellbeing of gay, lesbian, and bisexual doctors.

Methods

We conducted a search of the Medline database from 1966 to June 2000 using the search terms "gay," "lesbian" "bisexual" or "homosexual" and "physician," "doctor," or "health professional" and "professional practice" We limited our search to papers written in English. We reviewed the references of the selected papers to identify studies missed by our initial search.

Homophobia

Several studies have looked at the existence of homophobia within the medical community. In 1982 Mathews et al sent a questionnaire to all members of the San Diego County Medical Society to elicit attitudes towards homosexual patients and colleagues.[3] Using the validated heterosexual attitudes toward homosexuality (HATH) scale, they found that 23% of respondents had homophobic attitudes (37% scored in the homophilic range, the rest were neutral). In four specialties (orthopaedic surgery, obstetrics and gynaecology, general and family practice, and general surgery) over 30% of respondents displayed homophobic attitudes. A 1988 survey of family practice residents at nine university-based programmes in southern California showed overall that 20% of male residents were homophobic (compared with only 3% of women).[4]

The rise of AIDS drew fresh attention to gay men and gave homosexual and bisexual concerns a new visibility. Some homophobic views were probably softened through empathy, while others hardened amid increasing vitriol directed at the gay community. A 1989 survey of 1745 third year residents in internal medicine and family practice looked at attitudes toward caring for patients with AIDS and toward homosexual people in general.[5] Of the respondents, 35% agreed with or were unsure about the statement "Homosexuality is a mental disorder," while 20% admitted that they weren't comfortable in the presence of homosexuals.

Perhaps the most egregious example of homophobia within the medical literature is a 1984 editorial in the Southern Medical Journal.[6] The author speculates on the aetiology of AIDS and, citing biblical quotations, concludes that "homosexual men [are] reaping ... [the] expected consequences of sexual promiscuity" and that "homosexuality is a pathologic condition." The author suggests that doctors should "seek reversal treatment for their homosexual patients just as vigorously as they would for alcoholics or heavy cigarette smokers."