Without prejudice

Do all patients deserve to be treated equally, regardless of their sexuality? 

DO all patients deserve to be treated equally, regardless of their sexuality?

All doctors should answer “yes” to this question, but a recent survey suggests lesbian, gay and bisexual (LGB) patients are still subject to discrimination and poor care. Whether it involves making assumptions about a patient’s lifestyle or denying access to care, any form of discrimination is wrong and could spark patient complaints that may lead to charges of professional misconduct.

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 a 40-year-old said: “I came out to my new local GP and when I informed her she physically moved back in her chair.”

Another respondent 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.”

Other examples raised in the survey include one man who was given medical advice that “assumed I was HIV positive” and another who overheard a receptionist say: “The poof is here for his appointment.” 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.”

Confidentiality was a major issue for many who responded to the survey, as one 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.”

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 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 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 training in how to treat LGB patients. It’s 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.

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 FYi