My blog inspiration today comes from an exchange this morning on Twitter. The original tweet was from @radiographerben who posted a poll asking if people would be comfortable wearing a pin “advertising” their sexual identity and/or gender orientation like staff at Marks and Spencer in the UK are able to do. There were a few options from “sure” to “er, no”! Comments varied from my straight out “hell yes” to more cautious responses, including @SophiaEThom’s concern about dealing with possible reactions from patients. The badge in question identifies the wearer as a member of the LGBT+ at M&S employee network and supports Stonewall’s amazing Come Out for LGBT campaign which encourages visibility in all areas of life.
Stonewall (a UK group who support LGBT people) also run a Diversity Champions program for workplaces. They cite that LGB employees who are comfortable being out at work are 67% more likely to be satisfied with their sense of achievement and trans employees 77% more likely to be satisfied with job security. While this type of initiative and workplace training is becoming more common in the private sector, healthcare workplaces are slower to catch up. Often the focus is on improving LGBT patient experiences, and there is a lot of work to do in this area. When we look at LGBT staff, the picture is less clear. Being out at work is important, but how out are we when we work with patients? Do we think, like one physician participant in a UK study that:
The hospital is not ready…for a camp acting doctor…because it brings sexuality into the public eye, and is the workplace the right place to do that? I think the answer is no because it’s at the expense of the patients.
LGBT staff routinely manage their identities at work, in a way that some other marginalised groups aren’t able to. We have the choice (usually) to come out or not – to pass or tone down our sexual identity. The idea of wearing a badge or other signifier bypasses that choice and makes our identity visible, which can sometimes feel uncomfortable.
So, why bother? If we set aside the evidence that being open about who we are makes for a better work experience – why should we be open around and with patients? As Sophia said, this brings an element of risk. Why open ourselves up to the possibility of a negative reaction, despite all our equality policies, diversity mission statements and the general feeling that it’s 2017 – and OK to be whoever we want to be? One reason might be that it makes it a little bit easier for our LGBT patients.
The 2011 Institute of Medicine report suggests that the barriers to equitable health care that LGB people face can “profoundly affect their overall well-being”. Our LGBT patients often feel invisible in a system that doesn’t see them for who they are. We know there are steps we can take to make this better; one is having visible LGBT staff to care for them. A nice example is this blog post by Roger Newman, a gay man living with cancer, discussing his experience in hospital:
I hardly dared mention a partner and I even found myself begging him not to kiss me when he visited me. His response, as expected, was ‘bollocks to ‘em, I love you’, but on his visits I could see the eyes taking it all in; sorting and codifying the resulting information. I found myself telling him that it was OK for him because he could take our lifestyle back home with him whereas I was left to deal with the consequences. I was profoundly disturbed by having these feelings and I felt guilty about them, but the fact was that there I felt and believed myself to be different. I pondered how much I would have loved to have had some ‘out’ LGBT staff around me, so that I didn’t feel so isolated and had more confidence to be me. Just someone with a ‘Me Too’ badge on them, would have helped.
I’ve also written about this before, and in talks I have used a clip from the Macmillan “LGBTQ experiences of cancer care” video series where Lesley (a lesbian living with ovarian cancer) discusses her discomfort with knowing some of her nurses were lesbian but closeted, when she could have used the support.
My research is about how the identity disclosure decisions we make at work might affect relationships, with our colleagues and also (perhaps more importantly) with our patients. As I read through my interview transcripts, the daily (and often unrecognized) work we do to tone down our queerness is a common theme. But my participants realize that our difference can make, well, a difference. In an older post I quoted a paper by Riordan who wrote that LGB healthcare professionals may use their identity as a “signal of safety” to flag to LGBT patients that they are understood – in my opinion the use of a badge or lanyard is just that.