Why GMC’s apology to LGBTQ+ doctors is everything and nothing

After Andrew Hartle was outed by a tabloid newspaper in 1997, he was ordered to resign by the air force to comply with the British military’s ban on LGBT staff (doi:10.1136/bmj.q406).1 Hartle was able to continue his career as a doctor outside the military without professional censure, unlike at least 40 male doctors who were investigated by the General Medical Council for criminal convictions under homophobic laws that were in place in the UK into the 1980s. Legal, public, and professional harassment wasn’t confined to male doctors.

This week the GMC has apologised (doi:10.1136/bmj.q405).2 “For this,” it says, “we are truly sorry.” The apology follows work by the GMC’s LGBTQ+ staff network, supported by external partner organisations and endorsed by senior executives at the GMC. The apology has been rightly welcomed internally and externally. Hartle accepts that apologies can be powerful, but he also warns: “Apologies change everything, but they also change nothing.”

The apology doesn’t change the distress that LGBTQ+ staff have historically experienced or the impact on their careers and their families. The apology doesn’t change the distress that LGBTQ+ staff are experiencing today: a recent survey found that discriminatory behaviour is still common in medicine, and over 70% of respondents felt unable to report their experiences to anyone.

The GMC accepts that “more still needs to be done to support LGBTQ+ doctors and patients.” Yet the question remains whether a specific apology (and the offer of an apology letter) goes far enough. Will the GMC offer compensation to families and next of kin? What will the GMC do to improve working environments for LGBTQ+ staff, including moving to a culture that makes staff less reluctant to report discrimination? What other discriminatory practices will the GMC now apologise for?

The apology follows hard on the heels of an embarrassing climbdown by the GMC about its failure to consider a complaint against cardiologist Aseem Malhotra for misinformation about covid-19 vaccines (doi:10.1136/bmj.q433).3 It emerges against a background of longstanding controversy over the GMC’s discrimination against ethnic minority doctors and overseas graduates (doi:10.1136/bmj.p1295).4 It arrives at a time when doctors complain of a climate of fear over being referred to the GMC for something trivial (doi:10.1136/bmj.o2619).5 It comes, too, in the middle of a dispute over the GMC potentially taking action against doctors who have committed “criminal” acts during climate protests (https://ukhealthalliance.org/news-item/a-letter-to-the-gmc-on-doctors-convicted-of-offences-related-to-protests-on-climate-change-and-nature-loss).6 This is all before we introduce the mess that the GMC finds itself in over the regulation of physician associates (doi:10.1136/bmj.q156).7

The GMC has a reputation to rebuild. Its apology over regulatory action against male doctors convicted under homophobic laws is good and important. The GMC’s staff, external lobbying groups, and senior management deserve credit. But how genuine the apology is will be seen in the experiences of current LGBTQ+ staff and those in other minority groups. In that sense, an apology is everything—and it is truly nothing of itself.