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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Opening out perspectives
- Justin Varney (10 May 2004)
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What about professionalism?
- Jeremy Weinbren (23 May 2004)
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Patients are professional, too
- Vivien Stern (25 May 2004)
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Re: Patients are professional, too
- David Carvel (26 May 2004)
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Sexuality of health practitioners is complex
- Michael King, Irwin Nazareth (2 June 2004)
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Justin Varney, SpR Public Health London
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This is a really useful perspective on the experiences of doctors as individuals. To often as a profession we attempt to create carbon moulds of a white hetereosexual middle class image passed down from the generations before. As increasingly we see the proportion of women doctors rise and the growing numbers of ethnic minority doctors, there has been the begining of a discourse around diversity, yet it slow to progress. It is sad, that it took a significant payout on racial discrimination charges for the BMA to get it's own house in order in relation to race, and it has yet to do so in relation to the other strands of diversity. The Working Lives agenda has been keen to address the needs of flexible working for women with children but has yet to extend that to same-sex partners with adopted children or to address calls for same-sex partners pension rights. Perhaps because the economic imperative is not visibly there? One of the challenges facing sexual orientation issues is that this is the 'invisible' strand of diversity. Social preferences and legislative discrimination have left years of bigotry and prejudice engrained in common culture. How many medical school reviews have used an individuals gayness as a tool for humour or derision? How many view homosexuality only in the context of sexual health? Although in the past few years we have seen significant social change, one only has to look across at the US to see how far the pendulum can swing back the other way. In Michigan a bill is being proposed that gives doctors the right to refuse treatment to lesbian and gay patients on the grounds of religious and ethical belief, in a climate of such intolerance how out is it safe to be. This paper provides a great opportunity to raise the debate about the working lives of lesbian and gay doctors. Too often that debate is relinquished in favour of percieved greater needs. It is time that both the medical schools and the royal colleges actively engaged with all of the six legislative strands of diversity and addressed the needs of all of their members. Stepping outside a medical model and engaging in socio-cultural issues may be complex but it is not an excuse for apathy and neglect. Competing interests: Gay Doctor |
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Jeremy Weinbren, Consultant Anaesthetist (Chronic Pain) Hillingdon Hospital, Uxbridge, UB8 3NN
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I read with interest Dr Riordan's paper. My initial thoughts are along the lines of "but what about professionalism?". While I cannot be anything other than a heterosexual male when I am not at work, in the clinical setting, I am an asexual health care professional. Is this "passing" in the sense referred to in the paper? It is true that when examining female patients I enlist the help of a (female) nurse, and this is for two reasons. It is firstly to protect myself from any spurious claims of impropriety, and secondly for "support" for the patient - that is what they mostly expect. A chaperone most certainly does not function as any deterrent to inappropriate behaviour on my part, as the thought simply does not occur. I have no doubts about my own professionalism. The implication of all-pervading sexuality contained in the paper might be that, for example, all heterosexual male (and homosexual female) gynaecologists spend most of their working days in a state of sexual arousal. This is clearly nonsense. While I accept that we are all human, and that aspects of personality must pervade every interaction we have, I would be surprised and disappointed if any healthcare professional expected variance from standards of professionalism to be justifiable. I therefore argue that all healtcare professionals must adopt a "desexualisation" strategy - it's part of the professional role. Competing interests: None declared |
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Vivien Stern, Solicitor 30 Goldhurst Terrace, London NW6 3HU
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Dr. Weinbren's Response shows he has a highly professional approach to his work, and his view on this subject is absolutely the right one. However, nothing that he has written comes as any surprise. The vast majority of heterosexual male doctors do behave professionally when examining female patients. So how does he react to a female patient who says: "Thank you for offering me a nurse as a chaperone, doctor, but no, I do not feel I need her "support". I am fully confident that you will behave professionally during the examination, so please carry it out in private". I hope Dr. Weinbren's own high standards of behaviour allow him to recognize that patients too behave professionally and this needs to be respected if a patient wants to be examined in private. Competing interests: Heterosexual female patient |
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David Carvel, GP Biggar ML12 6BE, UK
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Vivian Stern introduces an interesting scenario, that if a patient explicitly declines the offer of a chaperone what does one (the doctor) do? This would most likely only occur in a trusting, long-term, professional relationship. In my experience such a situation has never occured but I dare say it might. I would probably request that the chaperone sit behind the curtain but within earshot. I would be suspicious if even this request/suggestion was refused. Competing interests: A doctor who pays ever increasing medical defence fees! |
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Michael King, Professor of Primary Care Psychiatry Royal Free and UC Medical School, London NW3 2PF, Irwin Nazareth
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Riordan's qualitative study of how gay and lesbian health professionals manage issues such as the physical examination is interesting and provocative. However, there has long been evidence that sexual orientation occurs, like most human characteristics, on a spectrum (1). Although there may be clustering at each end of this spectrum, the majority of people report at least some heterosexual and homosexual responsiveness. This is seen most clearly in same sex institutions and in soldiers' behaviour in wartime settings. It is possible that the extent to which people cluster at either end of the spectrum may be determined by factors such as social acceptability, political views and the legal status of gay and lesbian lifestyles. In countries like the United Kingdom many health professionals who regard themselves as gay or lesbian will have reflected about these issues. However, what about the much larger number of men and women who may experience arousal to other people of the same sex but are living to all intents and purposes as heterosexuals? It is these professionals who may be most vulnerable in clinical settings. Although an obvious solution is to recommend chaperones for all physical examinations, this only addresses one narrow part of the problem and is not always possible, particularly in primary care. In an accompanying editorial David Hughes calls for further research but perhaps this should be aimed at all healthcare workers (not just gay men and lesbians) for many of whom this matter may be relevant. References 1. Kinsey AC Pomeroy WB and Martin CE Sexual behaviour in the human male. 1948 Saunders, Philadelphia Competing interests: None declared |
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