As part of a series of articles tackling diversity and inclusivity in dentistry, Sharon Kaur speaks to Robbie Stewart about how the LGBTQ+ community is represented and supported in the profession and how we can do more.
Over the last few months, I have been writing articles exploring some of the most topical issues around diversity and inclusivity in dentistry.
Racism and sexism are things I have experienced myself directly. But when I was asked to write about the LGBTQ+ experience, I had to think about it from a different perspective.
As someone who is not part of that community but who is a trainer, mentor, practice owner, employer and, most importantly, mother, I feel like I have a responsibility and duty of care to create an environment that is conducive to inclusivity and safe for others to live and work in.
Zero tolerance
Essentially, what it comes down to is embracing equality and diversity within our practices and sector. This I feel extremely passionate about.
Your sexual orientation is a protected characteristic. You cannot favour or discriminate against anyone because of a protected characteristic. And neither should you want to.
I am not prepared to be part of a society that is judgmental and discriminates against people because of their sexual orientation, gender, disability or race. And I will bend over backwards to ensure that I help create a society that is more favourable and kinder to the younger generation.
I have a son and a daughter, so that is my sole aim in life now.
Ultimately, as with any type of discrimination, it comes down to professionalism. We are in a caring profession that is about looking after people. You can’t be in a position where you pick and choose who you want to look after or who you employ just because of their sexual orientation. If you do, you’re in the wrong profession.
We wouldn’t accept it if a patient said: ‘I’m not going to see that gay dentist.’ There is zero tolerance.
So why is it any different if a staff member is saying these things? It is zero tolerance all around, and someone’s sexual orientation is not relevant.
Creating an inclusive, supportive workforce
People who contribute to a negative, divisive and discriminatory atmosphere usually don’t just do it as a one-off.
Employers and managerial staff should remain very alert to this. If you detect homophobic, transphobic or other discriminatory behaviour within your team, nip it in the bud. If not, it will escalate.
Make equality and diversity training a core requirement and have clear policies in place.
As the Stonewall and Yougov report on LGBT experiences in the workplace says: ‘By allowing staff to be themselves in the workplace, employers can create an inclusive, supportive workforce and get the best from everyone.’
This is just as important when it comes to our patients.
As Nick Coller explains in an article on how dental teams can help the LGBTQ+ community overcome some of the challenges they face when accessing healthcare: ‘Part of our duty of care to our patients is to ensure we treat them without discrimination.
‘This can mean challenging our own preconceived ideas and prejudices towards members of society that we might not come into regular contact with outside of our working environment.’ 2
I am not a member of the LGBTQ+ community. In fact, I have very few interactions with anyone who is from that community within the profession.
My experience is limited to stories told to me by others who have faced discrimination, and that got me thinking.
Are we inclusive of the LGBTQ+ community within our profession? Could we do more?
So, I asked my friend Robbie Stewart if he would speak openly about his experiences as a gay man in dentistry.
Robbie’s story
I qualified as a dental therapist in 2018, and, to be honest, I didn’t really think too much about the fact I was gay. Probably because the role I was applying for was mainly female-dominated.
There are a lot of females in the profession, and a lot of my friends are girls. So I never really thought twice about it.
I would have felt differently if someone had told me to go and be a builder. Then I would have felt very much more reserved.
I grew up in a family where men do ‘men’s stuff’, and women do ‘women’s stuff’. My mum’s a hairdresser, and my dad’s an electrician, so that’s what I was used to.
Going into something where it was quite neutral, I felt confident.
In fact, the idea of gender roles seems to have more stigma.
I don’t feel like I have been discriminated against in the workplace because I’m gay. Although I know not everyone has the same experience.
However, sometimes I do feel it, particularly with middle-aged men. They assume that the hygienist will be a woman.
When I walk in the door, you can see that there’s instantly a barrier put up.
Discrimination is happening all the time. Sometimes we might not be aware of it. But just because I’ve not specifically gone through it, that doesn’t mean it’s not happening.
The LGBTQ+ community is a minority community. So obviously, there’s a little bit of underrepresentation in the profession. But, as someone who is part of that community, I haven’t really seen any major representation of anyone who’s openly gay, or waving the flag saying: ‘This is how you include the community.’
So, here are my thoughts on how we can be more inclusive for our patients, colleagues and peers.
1. Have an open-door policy that clearly welcomes LGBTQ+ patients to your practice
Dental anxiety is common as it is. But there is evidence to suggest that people who identify as LGBTQ+ face unique fears and challenges when accessing healthcare services.
I think practices could have a more open-door approach, starting from the registration process.
There is now a whole spectrum of gender identities. So it is worth considering adding more options to the registration form than just male or female.
Also, consider adding to registration forms an option for how someone wants to define themselves. They may wish to use the pronouns ‘they’ or ‘them’ as opposed to ‘he’ or ‘she’.
If a practice doesn’t have options available, then the patient will already feel underrepresented.
As Andrew Gilliver, pride in practice coordinator at LGBT Foundation, says: ‘Patient forms and medical histories with no representation of diverse sexual orientation or gender are a sign that LGBT people are not acknowledged.
‘Collecting a range of demographic information can help us to avoid assumptions and initiate conversations around our patients’ identities, using correct pronouns and discussing wider health issues relevant to them personally’ (Gilliver and Dimitroff, 2021).
As well as asking patients what pronoun they prefer to use, it is worth asking them if they have a preferred name.
Someone who is transgender may have a preferred name. Even if they haven’t legally changed their name yet.
You can’t have your legal name changed on a medical document. If you know what their preferred name is, you could use that when you call them from the waiting room.
There is a good article on Dentistry.co.uk about the treatment and care of the LGBTQ community, which is worth reading.
The BDA also published an informative article in 2019 about what dentists can do to support LGBT patients. And one in the October 2019 edition of BDJ in Practice about dental care for the LGBT community. Both of these are worth a read (Gilliver and King, 2019).
Among the recommendations was finding out what local LGBT services are in your area. Share that information with your patients.
It says: ‘Familiarising yourself with LGBT services can also help you to understand the challenges faced by your LGBT patients.
‘Signposting to a mix of mainstream and LGBT specific services will help your patients to have confidence in you and your practice’ (Gilliver and King, 2019).
2. Understand LGBTQ+ specific health concerns, such as the link between sexual health and oral health
Dental professionals are well placed to give patients advice on sexual health based on their oral health. But we do not receive comprehensive training on treating the LGBTQ+ community.
Everything I’m stating now is not what I learned at university. I have just taken it upon myself to educate myself about it.
One way to open the door to this conversation is to have an option for sexual orientation on your registration form. It might sound like a question that’s quite personal, but there’s a lot of articles and studies on how your sexual orientation and your sexual health have an influence on your oral health.
There are also certain risk factors that we might associate with gum disease or oral cancer, for example.
In addition, HIV, HPV and syphilis are all conditions that we can diagnose in the mouth.
As Gilliver and Dimitroff (2021) advise: ‘Proactively engaging in conversations with patients can help them to be more aware and informed about their oral health and the effects of STIs on the oral cavity.
‘It also indicates that they are in a safe environment where they can discuss any concerns without fear of judgement.’
I feel like HIV still has such a massive stigma. It is probably one of the biggest things that, as a healthcare professional, you think, if I catch that, that’s it, my career’s over.
There’s not a lot of talk about supporting healthcare professionals who may undergo a scare or who even have HIV. It’s very stigmatised.
Many people don’t know, for example, that anyone who has HIV and who is on good medication can’t pass the disease on. And there’s now a medication that people can take, similar to the oral contraceptive for women, that helps prevent contracting HIV.
In addition, patients may worry about discussing HIV with their dental professional. They may have experienced discrimination or even been refused services or care in the past. This is not right.
HIV positive patients have the same rights to dental care as everyone else. So I think it is our duty as dental professionals to educate ourselves about HIV and understand the implications in relation to oral health (Gilliver and Dimitroff, 2021).
As one gay patient noted: ‘There is a missed opportunity in the context of the role dentists play in sexual health.
‘I take my sexual health seriously. And in my view, dentists are well placed to advise on sexual health. Specifically on their patient’s mouth/gum health.
‘In my experience of attending dental surgeries over the years, I have never noticed any displays of leaflets on sexual health. Or indeed any clues the practice is “LGBT-friendly”. It’s ok to ask about sexual health.’
The LGBT Foundation did a great article about sexual health and why dentists should know about it. I highly recommend reading it.
3. Mental health and the LGBTQ+ community – how this impacts oral health
There is evidence that mental health challenges such as depression, anxiety and stress are more prevalent within the LGBTQ+ community.
This can lead to coping mechanisms such as drug use, smoking, alcohol abuse, and eating disorders, impacting oral health.
As dental professionals, we should educate ourselves about this and speak openly to our patients about it.
4. Mind your language
The language we use and allow in our practices is key too.
I had a patient who came in yesterday and said: ‘Oh, I’m a right poof when I come to the dentist.’ And to me, that word makes my skin crawl.
Surely people know it’s associated with a derogatory term for people who are gay?
It was probably an ignorance thing. But it’s something that maybe we could educate people on a little bit more. If a work colleague said that, I’d call them out and educate them there and then. But it’s difficult with patients.
You should never feel uncomfortable. If anyone is acting in that manner in the workplace, you should raise it to your manager, the practice owner or human resources. This is an employment issue.
I believe we all have a role to play in making dentistry more inclusive for the LGBTQ+ community. Even if you are not part of that community, you can become an ally for your staff, team members, colleagues, friends, and patients.
As Gilliver and Dimitroff (2021) wisely says: ‘Allies play an important role in standing up for their friends, colleagues or patients’ rights. They provide effective services and supporting LGBT+ people to raise their voices and be heard.’
Read more from Sharon Kaur
References
Gilliver A and Dimitroff D (2021) Ten things dental students can do to support LGBT+ patients. BDJ Student 28: 18-22 (2021)
Gilliver A and King T (2019) Dental care for the LGBT community. BDJ In Pract 32: 33-4
