Canadian Medical Association Journal 1996; 155: 972-977
[en bref]
© 1996 Nancy Robb
When Dr. Gary Gibson went to medical school in the early 1960s, homosexuality was rarely discussed. "You just didn't see gay people," he recalls, "so it just didn't exist as far as everybody was concerned."
But Gibson knew he was different, and he often went to the library to look up homosexuality in medical textbooks. "I can remember finding very clinical descriptions like 'deviant' and 'illness,' " he says, "and I can remember thinking, 'this is not me. I have no attraction to women, but . . . I feel perfectly OK. I'm achieving, I'm at the top of my class, and I do well at everything else that I do.' "
Gibson suppressed his feelings until the late 1970s. By then a prominent family physician in Cambridge, Ont., he made a personal commitment "to make it or break it by age 40, which was 1981. I was going to get my act together, know who I was and be ready to live who I was, or forget it."
He lived up to that promise, give or take a year. He suffered few social or professional repercussions, although his sexual orientation cost him some patients at first and, he believes, the presidency of the College of Family Physicians of Canada.
Today, Gibson is a proponent of gay and lesbian rights in medicine. "The coming-out process is initially an internal thing, acknowledging who you are, what you are," he explains. "For me, it was a slow process. Nowadays, medical students, doctors and patients do it much, much earlier because they've got role models and so forth."
But as Gibson knows only too well, coming out in medicine isn't easy. In a recent survey, for example, the US-based Gay and Lesbian Medical Association found that 59% of gay, lesbian and bisexual physician and medical student respondents had suffered discrimination on the job or in training.
Last spring, CMAJ interviewed gay and lesbian medical students and residents across the country. In the following excerpts, they talk about their experiences in medicine. In some cases, names have been changed at the student's or resident's request. This is indicated by an asterisk.
Marie*, 24, had heard that McMaster University was gay-friendly, and she hasn't been disappointed. "Here at Mac in medicine, I have just had the greatest coming-out experience," says the first-year medical student. "People have been so positive."
Although she hasn't come out to any faculty members because she worries about encountering "internal biases," she has told several peers. "The more people I come out to the better I feel because it's a matter of being myself versus trying to be something I'm not," she says.
Her class has other gay students, and the medical school has a gay and lesbian students' association with 15 to 20 members, but she would like to see more gay and lesbian issues in the curriculum and wishes "the tolerance and acceptance" she has witnessed extended to her social life. "I would like to be able to take my girlfriend to a social function and have no head turn twice," she says.
"I would like all [gay and lesbian medical students] to feel comfortable and not have to be afraid," she adds. "I would like to be able to use my name for this article and not have to worry about the consequences."
She has similar hopes for medical practice. "I want to be out in practice. It's not something I advertise, it's not something I'm going to be showy about, but I would like to be able to introduce my partner and feel comfortable about who I am and what I am . . . .
"This kind of thing does weigh on my mind as much as what I want to do with my life. One of the difficult things about being a young lesbian physician is that . . . for all the other considerations that everyone has -- family, money, location -- I also have my identity."
Ron* hit bottom last January. Late one night, about 4 days before a major exam, the upper-year medical student at the University of British Columbia (UBC) was "sitting in his apartment, very tired, very tired of studying, very tired of living, looking at my wrists, thinking, 'If I were to kill myself, that's not how I would do it.' "
He had decided to start coming out the summer after his first year in medicine. "I was deathly afraid that anybody would find out in the medical school itself," he recalls. "There's actually a vocal minority in my class that's quite homophobic, and I found it very difficult to come out to anyone in my class because I thought it would ruin my medical career.
"I thought that if people found out I was gay, they wouldn't accept me. I would face a lot of rejection and a lot more hurdles than I already had to face in the context of medical school."
Ron wants to specialize in psychiatry, but worried the profession would view him as a lesser doctor -- unable to tend to the needs of heterosexuals, for example, or "more prone to improprieties" with patients. "People make a lot of assumptions about you if you're gay," he says. "People assume nothing about you if you're straight."
Even though the seven or eight people he told -- the first was a classmate -- were largely supportive, he still harboured fears of being ostracized. In 199596, his "big coming-out year," his marks and his self-esteem plummeted. When he went to see a psychiatrist last winter, he "clicked off seven out of nine symptoms for clinical depression."
Today, his fears "aren't as real" as they were 6 months ago. He's "not totally out" -- he hasn't told most members of his family -- but he has found a stable relationship and, through UBC, a support group for gay and lesbian physicians.
He says it helps to have successful role models and to realize he's not alone. When he attended one of the group's social functions, he ran into some classmates and some students from upper and lower years. "I just feel more comfortable knowing there are people in medical school who are gay and coping well with it," he says.
Benoit Dubé, 27, didn't think his sexual orientation influenced his decision to enter medicine, but as time wore on the fourth-year medical student at l'Université de Montréal realized he wanted to work with gay patients and become a role model for young people "struggling with gay issues. I thought, 'Just because you're gay you shouldn't be afraid to pursue your goals,' " recalls Dubé, who wants to specialize in psychiatry or family medicine.
He hasn't always been so open. In his first year, Dubé avoided many of his gay peers because he didn't want his sexual orientation to pose any problems. Perhaps with good reason. When an HIV-positive man gave a lecture at the school, a student sitting beside Dubé said, "We should just let him croak because he was careless and it was his fault, so he got what he deserves."
At the time, Dubé was too shocked to challenge the remark. Tired of keeping quiet and feeling isolated, however, he eventually began to seek out some gay friends and to speak up on gay issues in class when it was warranted. He still doesn't believe in making a point of telling people he's gay, but he no longer lets derogatory comments from students go unchallenged.
With clinicians, it's another matter. When a surgeon recently made some "gay-bar jokes" during an operation, "I didn't say anything," he recalls. "I'm sort of at the very bottom of the medical hierarchy. I just felt intimidated."
It hasn't been all bad, by any means. After reading Dr. Clément Olivier's book on caring for HIV patients, Dubé arranged for Olivier to speak at the school. About 250 students attended. "People I didn't know would meet me on the Metro . . . and say, 'Thank you very much for inviting that speaker,' " Dubé recalls. "I never said I was gay, but I think . . . the other students deduced I must be if I took the time and energy to organize such a talk."
He doesn't seem to mind. "I'd rather be assertive than defensive. I can't go through life worrying about what other people think."
When Dr. Dwight Ferris took nursing in the early '90s, he more or less kept his sexual orientation to himself. He had been fairly open for a few years, but now he was trying to improve his grades to get into medical school.
"You don't know who's on the other end of your résumé or your letters, and it's something they may use against you without your knowledge," says Ferris, 29. "It was something I had to think about very carefully before I applied."
But after he arrived at Queen's University in 1992 he didn't try to conceal his homosexuality. Friends who visited his apartment saw photos of him and his partner. In second year, after his partner joined him in Kingston, Ferris brought him to medical school functions. Moreover, the medical school addressed his invitations to "Dwight Ferris and partner."
"I've had a very positive experience here at Queen's, I have to say," says Ferris, who graduated this year and is on his way to UBC to take internal medicine. "I was elected class president in second year with the full knowledge of my classmates that I was gay. I was elected . . . medical student society president in third year, again being quite open about my sexuality."
For Ferris, two events epitomize his reception in Kingston. As president of the medical student society, he and his partner sat at the dean's table at the medical school formal. Dr. Duncan Sinclair, then the dean, "is from another generation, but he was very comfortable and very accepting," Ferris says.
The same year, a closeted upper-year student sought his advice on coming out and thanked him for being an inspiration. "I couldn't have had any greater praise than that," says Ferris
Dr. Jill Tinmouth "vowed to be out from day one" in medical school. As an undergraduate at New York University, she wore gay t-shirts to class and talked openly about her girlfriend. She also headed up gay and lesbian student organizations at the university and national levels.
When she applied to the University of Toronto for an internal medicine residency, she declared her sexual orientation on her application. "I imagine it was of concern to them in some ways," she says. "We talked about it briefly in my [admissions] interview, and it was clear they weren't going to discriminate against me on that basis."
But the first-year resident at the Wellesley Hospital wouldn't have had it any other way. "It's important to have gay and lesbian physicians, just as it's important to have black physicians and white physicians and Asian physicians, so that . . . people are exposed to us in medical school and as colleagues and we're there as resources," says Tinmouth, who wants to specialize in infectious diseases or women's health. "I can't be a resource and a role model if I'm closeted.
"I had been relatively closeted as a teacher, and I found it very uncomfortable to be in that position. People are worried about the price we pay for being gay and lesbian in terms of active discrimination, but they also forget the price we pay when we hide ourselves."
The 30-year-old resident went to the right hospital. Except for a little awkwardness, as well as some patient care she hasn't "been hugely pleased with" and one medical student's complaint about comments made by a staff physician, she says the Wellesley is "a very gay-friendly place." It serves a large gay community in downtown Toronto.
"I've even had attendings here tell me that they feel my life experience has contributed positively to my approach to medicine and to my approach to patients and the way I deal with my colleagues," Tinmouth says. "That's pretty amazing in some ways."
For Paul, the turning point came in his third year of medical school at the University of Western Ontario. Dr. Gary Gibson gave a lecture on the stresses of clerkship and, while telling a story about a suicidal gay student, revealed to the audience that he was gay. "The whole class gasped, especially me," Paul
recalls.
As a second-year family-medicine resident at McGill University, Paul knows several gay physicians. But until he met Gibson in 199293, he had never known a gay person. "If only he had appeared in a lecture in first year, maybe medical school would have been so much different," Paul says.
"It was a nightmare. I had compensated for being gay by having so much fun in life." But when he enrolled in medicine, "all of a sudden my life wasn't fun any more. I had to face the future." And his sexual identity. "One grows up thinking gay people are such horrible creatures. I couldn't imagine coming out, ever."
Off-colour jokes by students and, later, insensitive remarks by surgeons on hospital wards reinforced his fears. So did the curriculum. "We had one half-hour lecture devoted to sexual orientation and transsexuals," Paul recalls. "At least [the professor] did say that homosexuality isn't considered a disease any more."
He "survived his first 2 years by telling his parents" and "just scraping through." When Gibson appeared suddenly in third year, he invited gay students to call him if they needed to talk. "I went to him and I broke down," Paul recalls. "I said, 'I hate being gay, I wish I wasn't gay. How can I hope to do well? How can I be trusted as a doctor?' "
Gibson set him right. "I just thank God that I met him," Paul says. "It's so important to have openly gay doctors in medical school for the support."
Today, at McGill, Paul is out to his fellow residents, and he assumes some staff physicians know as well. Once in a while, he gets calls from closeted people. "I like the fact that they hear of me," he says. "When one's out, it helps other people."
A year after he entered medical school in 1989, Tony* started seeing a woman. He had come out to his parents at age 15 and had been openly gay for about 10 years. "I guess I was just overwhelmed by the straightness of medicine," he recalls. "I felt it would be an easier career, an easier life to be straight."
But the relationship didn't last.
"I decided that I couldn't keep up the pretences," he says. "Part of it was coming to terms with the fact that I didn't need to bow to the pressure that I thought was abundant. In medicine, it's okay for nurses to be gay but generally less so for doctors."
Now a third-year anesthesia resident in Toronto, Tony won't lie about his sexual orientation. He simply avoids discussing his personal life at work. "I'm careful to use politically vague terminology when I talk about my spouse," he says.
Not that his associates have given him much cause for concern. "I have been impressed by the way I've seen my colleagues handle gay-sensitive issues," says Tony, noting that he tries to maintain decorum among staff during operations on gay patients. "I've never felt like I've seen a gay patient mistreated, except by one anesthetist . . . who refuses to stick needles in people he thinks are gay" or "to entertain pain management in [HIV-positive] patients."
"That was kind of difficult for me," he says. And it was a reminder of his own vulnerability as a resident. Tony hopes to be "more out" once he gets a job, but for now he worries about things beyond his control, such as the resident-evaluation process.
His caution may be justified. A closeted lesbian specialist who sits on various committees at a Toronto hospital recently told him that issues like sexual orientation "do come up" during the hiring process. "She has more of an inside view of homophobia," he says. "That's not a world that I've seen yet, and it's kind of scary."
Ann* won't reveal where she is training. Nor will she disclose her specialty. She'll only allow that she's in year five of a surgical residency. "It would be professional suicide to say anything more than that," she says. "Physicians know how homophobic some of their colleagues are."
In her first few months of residency, a remark by the chief resident set the tone. He smiled at her and said, "Come on, we know you're a dyke, so quit trying to hide it."
At the time, she was just beginning to acknowledge her sexual orientation. But even as she became more comfortable with herself over the next few years, she didn't tell any of her peers or attending staff. "Gay-bashing jokes" and "limp-wristed gestures" at the scrub sink -- or a week of jokes following grand rounds that touched on sexual orientation -- made her feel too vulnerable.
But she paid the price. "The professional relationship is improved by being able to disclose personal information about yourself," she observes, "and as a closeted resident, I was at a disadvantage to develop more of a relationship with my staff physicians because of the homophobia I saw in them.
"At one point, my program director suggested that I develop a social life outside medicine, that it would help me be a better doctor. I tried to tell him I had a wonderful social network and my weekends were filled with activities with friends, but he said I should be more honest with myself."
Ann, a stellar resident, obliged by asking a gay friend to pose as her boyfriend. "He wanted to help me, and it did," she recalls. "People in the hallway congratulated me on having such a wonderful boyfriend and for being in this relationship and having found myself."
She probably wouldn't resort to such deception today. The presence of a dozen gay or lesbian physicians at her current hospital has made her feel comfortable enough to tell half her department. She's even quick to respond when someone makes a crude remark.
"I'm just so happy that I'm at a point now that I can use humour to defend myself in the workplace even when there is a sexual context to it," she says. "Life's good."