www.mddus.com


Do you make assumptions about your patients’ sexuality? M


OST doctors would no doubt like to think they treat all patients equally, regardless of race, gender, beliefs or sexuality. But have you ever stopped to think about the assumptions you


make about patients’ lifestyles and the impact that might have on the treatment you provide? One common assumption a doctor can make


is in regard to a patient’s sexuality. Unless they have been informed otherwise, it is likely a GP will assume their patient is heterosexual and subsequent health advice could be influenced by this. Recent research carried out in this area


found that lesbian, gay and bisexual (LGB) patients are still subject to discrimination and poor care so why not pause for a moment and consider the assumptions you make and the treatment you provide for your patients? Any form of discrimination is wrong and could spark patient complaints that may lead to charges of professional misconduct. A report on the Guardian’s Healthcare


Professionals Network in September described the experiences of a lesbian patient in Stockport who said: “The GP at my surgery consistently and frequently assumes I am straight, ending up in embarrassed conversations when they realise their mistake. I feel I am treated abnormally and discriminated against regularly.” Charity Stonewall recently produced its Gay


and Bisexual Men’s Health Survey in which 34 per cent of gay and bisexual men who accessed healthcare services in the previous year reported having a “negative experience” related to their sexuality. One 24-year-old who responded to the


survey said: “My GP assumes I sleep around just because I’m gay”, while another says he was given medical advice that “assumed I was HIV positive”. A 40-year-old


respondent said: “I came out to my new local GP and when I informed her she physically moved back in her chair”, while another described being unable to “be myself” with health professionals, explaining: “If I thought that they were trained and sensitive to lesbian, gay and bisexual issues then perhaps I would be able to. My main concern is coming out and having to talk about my sexual health rather than my real health issues.” One respondent reported overhearing a


receptionist say on his arrival at the surgery: “The poof is here for his appointment” and another commented: “There was no visible commitment to equality. I saw lots of posters about services for disabled people and the elderly, but nothing for lesbian, gay and bisexual people.”


The Guardian’s report highlighted results


from the independent GP Patient Survey 2011 in which almost 10,000 LGB people responded. It found that these patients were almost twice as likely to rate their GP as poor or very poor, when compared to heterosexual people, across a range of measures. One in 10 lesbian, gay, bisexual and trans individuals have avoided using public services for fear of homophobia, while one in five healthcare professionals have admitted to being homophobic. Confidentiality is also a big issue for LGB


patients. One person who responded to the Stonewall survey said: “My doctors had written on a letter I took to the hospital after breaking my wrist HOMOSEXUAL in big letters for the A&E staff to see. Also, every time I saw a different doctor and they would pull my details up on the computer it would say HOMOSEXUAL in big letters.”


Expectations The General Medical Council makes it clear that doctors “must never discriminate unfairly against patients. Nor must they allow their personal views about their patient’s sexual orientation to prejudice their assessment of their clinical needs or delay or restrict their access to care.” The regulator, in conjunction with


Stonewall, has produced an information leaflet (www.tinyurl.com/cbyrlqs) for this patient group informing them what they should expect from the doctors treating them and what to do if they experience poor care. It highlights elements of Good Medical Practice which tells doctors “you must not express to your patients your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.” This applies to doctors’ personal beliefs about sexual orientation. It


training in how to treat LGB patients. Consider using inclusive language, referring to “partner” rather than husband/wife. It is equally important not to make assumptions about a patient’s lifestyle, while practices and hospitals should ensure they have relevant information posters and leaflets available for LGB patients. Stonewall also make a number of other


recommendations for healthcare professionals. The first is the importance of understanding the specific health needs of LGB patients which relate to much more than just sexual health. Figures show they are more likely to attempt suicide, self-harm, take drugs, experience domestic abuse and have depression than straight peers. The recommendations also encourage


practices and hospitals to have a clear, visible policy that states discrimination will not be tolerated against people due to their sexuality. They also advise healthcare professionals have a clear policy on confidentiality to reassure LGB patients who may be considering disclosing their sexuality. It’s recommended also that a sexual orientation field should be made available on all confidential electronic patient record systems. Doctors are also encouraged to undergo


training to better equip them to treat LGB patients. The Stonewall survey found only a quarter of gay and bisexual men said their healthcare professional acknowledged their sexuality after they had come out and only one in eight said they were told their partner was welcome to be present during a consultation. In February 2011 Manchester-based charity


“ The specific health needs of LGB patients relate to much more than just their sexual health”


adds that it is unlawful under the Equality Act 2010 for doctors to discriminate against LGB patients.


The leaflet goes on to highlight issues


raised by Stonewall such as an incident where a doctor refused to offer a smear test to lesbians or another case where the doctor told others a patient is gay when this had nothing to do with their treatment. A major factor in overcoming discriminatory


practice is ensuring healthcare professionals are suitably informed and receive appropriate


the Lesbian and Gay Foundation launched Pride in Practice (www.lgf.org.uk/ prideinpractice), a benchmarking tool (backed by the RCGP) that identifies GP surgeries that are fully committed to ensuring LGB patients are treated fairly and able to discuss issues openly with healthcare providers. Surgeries interested in registering are sent a toolkit containing factsheets and other resources outlining how they can make positive changes. Practices then undertake a self- assessment and are awarded a gold, silver or bronze Pride in Practice charter mark plaque,


depending on the level of service they provide to LGB patients. So remember, don’t make assumptions or


judgements about a patient’s sexuality or lifestyle, acknowledge their sexual orientation if they do discuss it with you, always treat them with respect and dignity and make sure you understand the specific health needs of LGB patients.


Joanne Curran is an associate editor of GPST


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16