Coming out: Reflections on UKRCO 2017

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So, last week I did a talk at UKRCO 2017 on “Coming Out in Healthcare”. The focus was on patients and healthcare professionals who are LGBTQ, and how we can normalise the coming out process. I had an amazing time at the conference, and met a lot of wonderful people I have so far only known on Twitter. While I was there my friend Rachel Harris gave me some wise doctoral advice – “don’t forget to write this up for your reflective portfolio”.  Not having one of those, I decided to blog it. I’ve been reading and writing (and presenting) on LGBTQ issues in healthcare for what seems forever (although realistically it can only be a year or so) – and overall had a good response. Often LGBTQ people will come up afterwards and tell me about their experiences in healthcare (some funny, some just WTAF). Many straight people will comment that it has “made them think” or the talk “opened their eyes” – which is also gratifying.  The UKRCO post-talk activity was definitely the most positive/funnest/most affirming so far.

The best part was afterwards (on Twitter as well as IRL) talking with a diverse group of people, gay, straight, differently gendered – medical imaging people, radiation therapists, managers and leaders . For example, I met a brilliant undergrad student who was volunteering at the conference and doing research on examining radiographers’ knowledge of care for trans patients. Her impetus was listening (as a first year) to how staff around her had talked about a trans woman who was being treated for prostate cancer. She wanted to change that conversation.  I think what struck me about all the interactions with LGBTQ colleagues were the things we have in common. Coming out stories were shared, some were easy – some painful to talk about even now. There was a lot of discussion about how we manage our identity at work, who knows, who doesn’t – who is cool with it and the inevitable horror stories of the times it didn’t go well (for us as well as for patients).  Most of us remembered patients who were LGBTQ that we clicked with – some of us wore rainbow lanyards, lapel pins or just gave off a strong gay vibe!  We talked about gender – and being gendered – and the difficulty of finding a sweet tailored suit (and not a cocktail dress) to rock up in for the inevitable conference gala dinner.  It was so great to be in the gay-zone and get that sense of support and affirmation – most importantly that my research is on the right track, the stuff I experienced at work hasn’t gone away, and that people are really receptive and keen to learn how to improve care for patients.

In my talk I used a clip from the fabulous Macmillan* “LGBTQ experiences of cancer care” video series where Lesley (a lesbian living with ovarian cancer) talks about her discomfort with knowing some of her nurses were lesbian but closeted. She says “it’s about equality really….” – she is out, why are they hiding that same thing from her? This prompted an interesting side discussion about “should LGBTQ staff HAVE to come out” – where I think (fairly obviously) the answer is “of course not”.  Issues ranged from legislative concerns (where we can’t discriminate against anyone based on sexual orientation etc.) to colleagues saying “well, should I wear a badge that says I am a Christian, Muslim?” One person said that “it’s about being professional” (not talking about their sexual orientation at work) – which ties into a lot of the research that shows it’s often homo, not hetero-sexuality seen as “unprofessional”.

Next week is my comprehensive exam that will assess whether I am ready for candidacy and the research part of my EdD. This week has been a gift in terms of giving me insight into what it is like “out there” and validating my topic as one that is important, relevant and likely to make a change in practice.   Now onward!

*Macmillan have some really good resources, including the recent “Supporting LGBT people affected by cancer” article and the “No one overlooked- experiences of LGBT people affected by cancer” report

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Posting while female

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I love interacting online. My Twitter friends and colleagues have enriched my professional life and offered lots of opportunities for collaboration, research, lecture opportunities and general social banter. I have many “friends I haven’t met yet” that are a source of support for my writing and study, and whose work I follow with interest and admiration. Social media has widened my world and I am all the better for it.

I post as a radiation therapist, researcher, woman, mum and lesbian. I often talk about work, what I am doing, what other people are up to – and my posts and my interests reflect the intersection of all my identities.  Work can be tricky though. Usually when an organization dips its toes into the swirly maelstrom of social media it begins with risk management. Often this results in a policy or statement – and usually that statement is more a list of what not to do. Of course we need to protect patients’ privacy, and be professional about how we conduct ourselves online. Moaning about work on an open platform is probably not a good idea as it’s easy to figure out who is saying what about where (or whom). I find, though, that these kinds of guidelines often scare people – I’ve asked at work a couple of times if I can tweet about an interesting project (for example) and invariably the response is “we should check with the communications office”.  So it’s a balancing act between the personal and the professional – which is the subject of some research I am doing at the moment for my EdD. When we are at work we want to “be professional”. In healthcare this usually means adopting a neutral persona, not bringing our “private life” into the workplace and so on. But our (unstated, often unexamined) norm for “professional” is male – part of the long association of women with hearth and home, and men with work. This spills into all sorts of areas, obviously there’s a long history of gender occupational inequity where women (still) earn less than man in many cases, hold less senior management positions and still shoulder the majority of domestic (unpaid) work. None of this is news.

What is also fairly well known is the amount of hassle some women get online when they start to talk about these things and start pushing into territory traditionally occupied by men. Examples abound, including the horrendous abuse the Gamergate women endured and the ridiculous fuss made about the Ghostbusters remake and subsequent trolling of Leslie Jones. Social media has also been used to fight back – such as the fabulous #DistractinglySexy campaign by female scientists reacting to Tim Hunt’s unfortunate sexist remarks. It’s part of the risk of posting anything while female – and is more risky if the stakes are higher and you’re questioning long held gender norms.

Most of my online interactions are overwhelmingly positive. However a few are not. A few examples include a few nasty tweets after I posted something pretty innocuous with #EverydaySexism. One persistent guy bombarded me with information about “reverse sexism” and why men were oppressed by female-only spaces. He helpfully also sent me a couple of emails to follow up as I obviously didn’t understand how feminism worked. A few times people have demanded to know why I am making a fuss, as no one is directly oppressing me. If you are a feminist, it seems, you are in charge of the party manifesto and responsible for all actions taken since Simone de Beauvoir. It always amazes me how angry some of these men are. You can express all sorts of daft things online but once you start flirting with feminism you’re fair game. I posted a question on a closed professional FB group yesterday – asking about gender mix in a (technical) subspecialty of our profession. After my research I was wondering if this non-patient area attracted more men.  Not because it is a leadership role, but because people working in that area do less “emotion work” (usually associated with women).  The majority of the responses were helpful and neutral, and didn’t seem to confirm what I thought at all (which was useful!). However, a couple of the guys seemed to think I should shut up and sit down. I was surprised and shocked; this site has always been a great source of information and collaboration. Why (I thought as I opened a bottle of wine at home) would anyone express this online to their colleagues all over the world? If I had been looking at race, would they have told me to back off because things were fine just the way they were? There are loads of amazing feminist men that will read this with sympathy and understanding, and thank goodness for them because they are helping us change things one unpleasant interaction at a time. In the meantime I decided to share this (after a lot of thought and with names changed) because this happens and if we don’t talk about it and/or step in it will continue.*

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*And a virtual sisterly fistbump to “Sarah J” !

Your tissues have issues

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I went to my first Yin yoga class last week. Rather alarmingly I was the only person who showed up, which meant I got a lot of personal attention. The instructor, Lisa, gave me the run down – Yin is meant to go deep, to the level of the fascia, and poses are held longer than traditional yoga. There is lots of time to reflect, Lisa told me, and sometimes emotions will rise up. “Your tissues,” she said, “have issues”. The hips hold anger, our shoulders are stiff and sore because they often hold the weight of the world.

I loved this, as I lay with my face on a bolster in child’s pose, I thought about the reading I had been doing about embodiment, how feelings can become carried in the body. In my “real life” as a radiation therapist and researcher, I have pretty much stripped the emotion from my academic work. Although as clinicians we need to be empathetic, compassionate and connect with the people we meet in the treatment room, this caring and warmth is discouraged in a publication. We can get angry at the system, the restrictions, the endless edicts to measure more, work harder – but that is tamped down when we’re at the podium talking about the latest lean initiative and how it makes our work lives better. I’ve said before that starting this doctorate has reintroduced me to finding other ways to speak and share, ways that involve hearts as well as minds.

Scientific dispassion emerges from the old idea that research should be value neutral, conducted by a dispassionate observer. This (male, White, Christian etc) constant observer is mainly unquestioned. It was a revelation to begin to read some feminist researchers who pointed out that this doesn’t always serve us well (at least the non-White, non-male portion of the population). My chosen lens is critical theory, where people feel pretty passionate about stuff! It is meant to be emancipatory, to make a difference in the world – emotions are part of the work, not a distraction to be written out. Feelings including pain, old hurts, injustices can be triggers to make things right, to change (at least part of) the world. Shame and rage can become the motivation for striving for recognition and political resistance, sometimes it is only by “regaining the possibility of active conduct that individuals can dispel the state of emotional tension into which they are forced” (Honneth, p. 138).

Feminist research eschews the emotion vs reason binary and admits us, whole, into the messy business of finding out. Emotions are triggers that something is up, can flag a wrongdoing, transgression or injustice. Our prof this week told us “you are allowed to be passionate”  – and I agree, without that why would we be doing this often difficult and frustrating work?

Reference:

Honneth A. The struggle for recognition: The moral grammar of social conflicts. 1995.

Where does this quotation end?

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….said my prof as she tried to unravel my latest draft paper. A good question and one I have been mulling over at length.  In the spirit of academic metaphors, at the moment I feel my reading is like a game of pick up sticks or perhaps Jenga. I can’t touch one thing, or idea, without bumping up against another.  A good friend who has been through this told me that “after the proposal” was the best time in her professional doctorate, you have the ground work done and can actually get on and do the thing you’ve been working towards for (often) years.  That bit before the proposal though, and before the comprehensive exam? That’s the teetering Jenga tower, the mess of sticks … the time when you realise how much you don’t know and what it’s going to take to stand up in front of the comprehensive exam panel, your supervisory committee and convince them that you’re ready to get going.

So my reading has been around theory, both queer and feminist, and then a quick tour around my conceptual framework – meaning what concepts will be foundational to my future work and how do they fit together? My research question is how do LGB radiation therapists manage their identities at work? How do they negotiate the complexities of coming out – and how do they decide? When you unpack this idea it’s obvious some work will have to be done on non-heterosexual identities, what “being out” means and why it’s (still) an issue. Our fundamental idea of being “professional” relies on an underlying and usually unarticulated assumption that the person at work is male (rational, unemotional), straight, white, able bodied etc. (Colgan and Rumens, 2015).  So sexual orientation in the workplace is an area of research that has examined this tension – with a small subset that looks at the health care workplace.  It’s also good to see a growing body of work on improving the experience of queer patients, this will also be important to look at – although most of it assumes they (we) are a “problem” to fix  (with our inconveniently high rates of cancer, mental illness and whatnot).

From my own experiences, I think the results won’t be unequivocally “this is what it is like”, but I do have a sense that some of the issues above will be important. There are likely others that I can’t see yet, or might not know until I have talked to the participants of the study. But I’ve already found a chance reference; discussion or recommendation can open up a new way of looking at something.  A paper I found by accident, for example, that looked at how LGB practitioners manage clinical examination of their patients (including scenarios where they may have a chaperone for an opposite-sex patient). The authors concluded that:

 (LGB) healthcare professionals engage in a complex interplay of identity management strategies to avoid homophobic abuse; as a signal of safety from homophobia and understanding for their lesbian, gay, and bisexual patients and as a desexualisation strategy principally for gay men and their women patients. (Riordan, p. 1227)

 I love the idea of “a signal of safety” – healthcare professionals flagging to queer patients that they are understood, and that they are safe to come out. We strive for that level of cultural competence and empathy for many different groups; it’s rarely discussed for queer patients.  One part of the Jenga tower, one of the entangled sticks but hopefully one that will remain.

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Concept map exercise

References:

Colgan, F., & Rumens, N. (2015). Understanding sexual orientation at work. In F. Colgan & N. Rumens (Eds.), Sexual orientation at work: Contemporary issues and perspectives. New York, NY, USA: Routledge

Riordan, D. C. (2004). Interaction strategies of lesbian, gay, and bisexual healthcare practitioners in the clinical examination of patients: qualitative study. BMJ, 328(7450), 1227–1229

What’s the question???

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Our last summer course was intended to get us to take the first steps towards our research question. We looked at conceptual frameworks and methods, literature reviewing and tried to find a “home” – or a way of thinking about research that felt right to us. We all vaguely knew what our fellow-cohort members were thinking about investigating but we workshopped, we brainstormed with flip charts, we picked holes and (sometimes) we patted backs. A few people have thrown out the research thoughts they started with and found new ones, job roles have changed, interests have shifted and the cold light of day is starting to show some of the cracks in our idealistic initial ideas.

One of the reasons I wanted to do this degree was the luxury to be able to focus on a substantial piece of research. I had always wanted to re-examine my experience as a queer health care professional (HCP) – partly for me, as I get older I find I want to look at things from another angle, perhaps to see what I missed the first time. The other reason is that quite a bit of attention has been paid to making the experiences of LGB patients better – but almost all research that looks at HCPs is from a deficit perspective – focusing on negative experiences such as bullying or homophobia in the workplace. I think it is a lot more nuanced than that – I know that LGB staff can help LGB patients feel more “at home” –  but I also think that the delicate and daily dance of coming out still looms large in many HCPs’ lives and that we can do a better job at understanding, and supporting, us/them.

So after a brief dalliance with patient experiences (see last blog!), and a pretty hot and heavy flirtation with Dorothy Smith this summer (of Institutional Ethnography fame), I am back to the beginning.  Last year I was thinking of using interviews, and phenomenology – but the further I travel, the more I want to bring my own experience into the mix. Isn’t that why I got into this? In one of my assignments I talked about this process being like a “late life coming out” and after having stood up a few times and “exposed myself” as a lesbian behind a podium talking about my recent paper…..in front of my actual work colleagues, peers and friends…..that is exactly what it feels like.  I wrote in February about finding my research voice – it’s clear that my voice is critical, and very personal.  I mean critical in the way described by Kinchloe and McLaren (2005, p. 304) in that research can never be entirely neutral or value free, and that “mainstream research practices are generally, although most often unwittingly, implicated in the reproduction of class, race and gender oppression.”

This fall I am looking at narrative inquiry (my last elective) – and reading a lot! In health care storytelling pops up in narrative medicine (described in this Ted talk by Rita Charon) and in illness narratives like those of Arthur Frank in “The Wounded Storyteller” where he explores the very human need to make sense and meaning from illness (interestingly, he says that he wrote it partly as an exercise in “self-healing . . . to assure myself I wasn’t crazy”).  As a lifelong lover of reading, I think I may have found the perfect fit for my research approach!

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