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Hello. Uh, welcome to this. Widening participation Women in surgery series on medal. Uh, my name is real quick, and I'm on the fine. I'm finally a medical student at the University of Edinburgh. Um, the host this evening. We're really glad that you've all joined us for this for this w PMN talk before we get into it. However, we have a very quick talk from our sponsors. MPs. So over to you, Jonathan, for this quick talk. Fantastic. Thank you. So, hello, everyone. We're delighted to be able to continue to sponsor these events on these different topics. So thank you for giving us the time to quickly speech, but just to introduce myself, I'm Jonathan. I am your dedicated relationship manager at the Medical Protection Society. So we are worldwide medical defense organizations. So we're one of the providers of indemnity for you were actually the worldwide leading medical defense organizations. So I want to quickly cover some quick slides for you. So obviously, as the majority will be aware now, um, medical protection is a g m. C. Requirement to adequate indemnity in place and for our membership, we provide that we provide you the right to request assistance. Who claims GM see issues, complaints, disciplinary proceedings and common accord hearings. So we cover quite a wide range of support for our doctors. And the way a medical defense organization works is that are doctors and members pay into the pot, and we use that pot of money to support the doctors who need it that year. So you're not just doing it for yourself. You're also doing it for the wider medical community. So here we are, as we mentioned, um, we are the world's leading medical defense organization for healthcare professionals, and more doctors trust Ear's than any other medical defense organization were non for profit. And we're member owns that. If when we do our members at the heart of all the decisions that are made, um, from our pricing to our products, to our services to our learning and development, it's all made for you. We support our members from university and beyond retirement because claims can arise from university while you're on placement, or if it's an act of good Samaritans or after you've after Doctor has retired and from an issue from five or 10 years ago, so we protect and support our members throughout their life. Really, we protect the interests and livelihoods of half care professionals worldwide, so that's just a quick diagram there. So when you start your NHS positions in F one, there is to it called NHS Indemnity. However, that only covers the patient for any compensation that needs to be paid. NHS indemnity is not enough to protect you in your career. Um, so your medical defense organization membership with someone like ourselves, Medical protection NBS would provide you the right to request assistance and support on stuff like coronary inquests complaints. Good Samaritans acts outside your clinical setting. GM see investigations and the list below there. So why would you choose us over any other medical defense organization? Well, that's a good, good question. We actually provide free membership throughout your whole student life, So you have access to all our resources that are doctors access. And also F one membership is completely complementary and free. So we're the only medical defense organizations actually provide your F one indemnity free of charge with the world's leading medical defense organization, and we're at the moment the most price competitive across your whole training. So it would be a great time to join and choose us. There is all the medical defense organizations around to do shop around, but at the moment we are the most price competitive, and our members see around about a saving of 50 to 100 lb over there training years. And we are also the UK's best rated. So we have the highest membership satisfaction scores. My email address is there for you. So if anyone has any questions about membership, feel free to drop me an email. And I've put the doctor joining form there as well and by QR code. So if you are company an F one do take advantage of the free F one indemnity as, um even if you are covered by someone else, extra protection and the extra resources you can access will be beneficial. And if there is any questions, do let me know. But take care and thank you. Thank you very much, Jonathan, for that for that talk. Um, so So now we can start with our event. So surgery still has a sort of long way to go with regards to inclusivity and diversity and we as w PMN kind of strive to can be part of this change. And so that's why we brought this monthly series, uh, which is usually delivered by inspiring women and allies from different surgical specialties. Usually eat Speaker is a leading surgeon, um, in their field and, uh, usually from widening participation backgrounds. And we're really excited that you're all able to join us tonight and and sort of listen to people who had, you know, who've navigated a surgical career and sort of maintain a work life balance and being from a widening participation background Night's event, our is all about LGBTQ plus in surgery. Um, and you know, you're all in for a treat tonight. Um, as we have three talks from three amazing and accomplished speakers, um, I will introduce them all as the evening progresses. Unfortunately, we had another speaker who had to pull out due to the emergency, and or we do apologize for this. Um, all three speakers are part of the Pride and Surgery four, um, which is a fantastic organization. That sort of advocates for diversity and inclusivity and surgery. Um, and I for what? I'm really excited to learn about this organization before I introduce the first speaker. I do wanna, uh, say please. If you have questions, please do put them in the chat, and I will read them out after the talks. So our first speaker is a is a trainee colorectal surgeon in Yorkshire who completed his primary medical qualification in Greece. Uh, he then went on to study at the University of Edinburgh. He represents international medical graduates and specially doctors as the equality, diversity and inclusion representative for the Association of Coal Coal Proctology of Great Britain and Ireland. He is the pride in surgery forums, outreach lead, and we'll talk about what the organization does, and his experience is a surgeon. So without further a do, uh, I'd like to introduce every Hi, everyone, uh, introductions were already made, so I'm not gonna say much else about who I am in terms of Post Normal's. But I'm just going to discuss about what, actually prisoners and how my life has been as an LGBTQ plus surgeon. Um, my problems for everyone is, uh, he and Kim. Uh huh. So what is prison? Uh, prison is, uh, an organization that was found, uh, pretty much since 2021 but, uh made its landmark appearance in the conference that was presented at the out of the college in March 2022. Uh, it started from the theater podcast initiative run by the RCs, where a few people, including Karen Mark Bagnall, uh, sat together and put this podcast together about what it is to be out and proud in surgery. Um, and the difficulties and also the positive aspects of this and what Christmas is a group of LGBTQ plus individuals and allies that are we're all working together towards the cultural change in surgery. Mm. Uh, what's our vision? What prisons vision is We want to see culture change in surgery such that LGBTQ plus members of the surgical team are well recognized, valued. They have their needs understood and their identities respected. And this this is key to inclusivity. And that comes not only in LGBTQ pluses, but in any inclusivity issues and prisoners values. Well, it's all about pride. We believe that sewing pride in our community it it just we we will manage to approach, are working enthusiasm and build upon the work of those who came before us. Uh, second of our values is about role models. We want to be role models because without role models you don't have visibility and that we, well, no visibility is key for any, uh, equality, diversity and inclusion issues. We want to be inclusive because we want our work to be inclusive in all parts of the LGBTQ plus community and of individuals from a diverse range of backgrounds. We want to approach issues using an intersectional lens and collaborate with other EDI organizations when appropriate. Uh, we want to be diverse, and we also want to be environmentally sustainable because we believe our work should not disproportionately impact the environment. We will consider ways of reducing our environmental footprint and ensure that any partnerships are with organizations whose actions are not significantly deleterious to the environment who we are. So, uh, combine these pictures from the, uh out of the college conference and you can see, uh, pretty much, uh, most of the people that are involved in, uh, prison. At the moment, there's many more that, but I didn't have good enough photos to actually create a nice slide of the bunch of people that are part of prison, and you can see here. This is, uh you can see here most of the people that form the the committee, I would say, And, uh, the rest of us, you'll meet us in due course. Uh, what's the future? The future for Prism involves creating a website, making ourselves visible. Uh, we want to have funding because with funding comes greater projects and greater prospects of what prison is going to be. Uh, there's gonna be a mentorship hub that that's part of, uh, the inclusivity and the diversity and becoming role models. Having mentors that are of LGBTQ plus background can actually just encourage those people that are behind the scenes that are not open. They having a mentor actually can make people progress and help them, uh, with further with their career. We want to establish an LGBTQ plus fellowship. But the details of that I'm not going to reveal any further because that's going to be something that we will discuss further on. And the most important thing. There's a conference coming in June 2023 which is a Manchester. The decks will be confirmed soon, so that's the bit about prison and, uh, carrying on further why I got involved in prison. Because I live my life as an open LGBTQ plus surgeon. And I want to show the people that yes, surgery at the moment is going through problems. But overall, yes, there's open surgeons out there and they do progress. And they do well in their career and life as an LGBTQ pill. A surgeon shouldn't be gray and boring. Like Spaghetti Junction in Birmingham actually should be, like, colorful, like this lovely umbrellas in Portugal and what I have achieved, uh, I've managed achieved quite a lot. I'm at ST six level in my colorectal training. I've managed quite a lot for my level. I've managed to become national representative inequality, diversity and I managed to get myself a partner as well. And I'm living my life, uh, as I was dreaming it, Uh, and who am I? Um, I've put this cake here because I've used this, uh, representation. I would say to describe what Intersectionality is and intersectionality is all about really having How shall I say that is that you can't really distinguish someone with an identity? Uh, their identity is the cake. You can just split their identity in pieces and actually studied properly and that that's who I am. I'm the cake. I'm not the individual ingredients. I'm not Greek. I'm not LGBT. I'm not a surgeon. I'm an LGBTQ plus surgeon who happens to be Greek as well. And that's how I want myself to be known as, uh and that's it. Really? Because you can't be what you can see. Uh, you really have to to showcase who you are in order to make surgery inclusive and to make surgeon inclusive. Uh, we need more data, and we need that data about patients' about surgeons. We want role models, and that's what Christmas is all about. We want visibility open, LGBTQ plus organizations, and we just need to be ourselves because this is key. Thank you very much. Thank you very much. Every that was a lovely talk. Uh, there's no questions in the chat as of yet, so I think we'll wait till the end of the of the off after all the talks are done, and then we can do questions later on. And can I please urge everyone in the audience? Please do send in your questions, um, for the end. So I think we can move on to the second talk. Um, So our second speaker, um, is a trauma or three, especially registrar in London, on on the Strattera rotation. Um, there the current vice chair of the Royal College of Surgeons of England. Uh, and they're on the pride in surgery form community. Um, they're all They're also the British Orthopedic Trainings Association, culture and diversity representative. They're very passionate about improve improving diversity and surgery and orthopedics. So in order to sort of improve the care that you know, that patients' receive, uh, this dog will sort of be on the health inequalities that the LGBTQ, that patient's face. So our next talker is Karen. Thank you very much. Mhm. I'm just trying to share my screen. Um, are you able to see my screen now? No, I can't see it. Mm. Um, I might have to So maybe, um, can you see it now? I'm not able to, Can you? I'm like, Can you see my screen now? Um, is it in a pdf format that is in a Sorry Karen is in a pdf format. Oh, big left. I think we'll just wait until did you join so I apologize for the technical district difficulties. I'm just gonna repeat. If there's any questions, please do Put them in the chat and I'll read them out every. Do you mind if I ask you a question about Intersectionality just while in case we're waiting, please? Yes. Oh, I think I can't joint, I think. Yeah, we can see your screen. I'm unable to see you, however, or hear you, though. Yeah. Karen, we can't hear you. Can you hear me now? Yeah, that's great. Perfect exit. Um, sorry. So this is just a bit introduction about who I am. Um, and, um, yes. I'm really happy to see speak clearly today about LGBTQ health and a bit of outline of what we'll be covering today In our talk is understanding bit about the LGBTQ population in the UK and the health inequalities that they face and why they are these barriers to healthcare that the LGBTQ community in particular, are at risk of. Um, I'll discuss a bit about the medical school curriculum as it stands and a bit about LGBTQ inclusive A in surgery to encourage you all to join surgery as it is, uh, increasingly diverse. and inclusive space. Uh, and we very much welcome your talent. So in the LGBT population in the UK, our annual population survey in 2020 found that 3.1% of the population identifies L G B, which is an increase, um, from 2019. So they're about 1.4 million people in the UK who identify as LGBT. They found that people aged 16 to 24 are most likely to identify as L G B um, and most, uh, 8% 8.0% of paper a 16 24 actually identify as within the LGBTQ community. The National LGBT Survey in 2017 received over 100,000 responses, which was the largest national survey in the world at the time. For the LGBTQ community, the health inequalities that, um, l g b t Q people face has been shown, uh, quite a common. Quite a lot of in the in the literature they they see that we found, uh, the society stigma. They're facing discrimination, harassment and denial of the civil and human rights. All of this, um, negatively impact the ability for the this community to maintain mental and physical health the same levels as people who are not in the community. They find that the violence and victimization of LGBTQ people often have long lasting effects on the interview and also in the community. And this. This is a significant risk factor to LGBT keep population, um, to not seeking healthcare to break it down into different domains of health and the LGBT and the health intercourse that they face. Research has shown that the LGBT key populations higher risks of chronic health conditions, including arthritis, heart attack, um, stroke, and also a higher risk of tobacco, alcohol and other substance abuse. They found that the this population are less likely to participate in cancer screening or to seek medical attention. In general, they found that the community have a lack of trust in providers. Um, they come from lower income societies and so they have the socioeconomic disadvantage. And they fear that healthcare providers are not aware of the healthcare needs. Specifically looking at particular groups, they found that lesbians and bisexual females are more likely to be overweight or obese and have disability, and they've also found that gained back sexual men are a high risk of HPV, um uh, virus due to, um, sorry. Anal cancer. Do the HPV infection but then are reluctant to seek medical attention or to take the HPV vaccine. There's a lot of info, data and literature out there about the mental health in the LGBTQ community, and in general, they have found that the LGBT population I a higher risk of mental health disorders, their mental health and their personal personal safety is affected by their personal family and social acceptance of their sexual orientation and their gender identity. They have found that there are often victims of bullying, verbal abuse and victimization, which leads to negative health mental health outcomes. Furthermore, a concealment or hiding or not coming out as an LGBTQ person is associated with an increased symptoms of mental illness. Furthermore, stigmatization and Miss Gender is also associated with increased psychological distress. They have a lot of lots of literature. Um, out there shows that the LGBTQ community higher rates of depressive symptoms compared to the heterosexual or system. The counterparts, um and there are also high rates of anxiety and anxiety disorder due to discrimination and internalized homophobia. When compared to CIS gender and heterosexual counterparts, specifically, we look at LGBT youth. They have found that, um l G b T u that 2 to 3 times more likely to attempt suicide. There are higher risk of depression, anxiety, body image and eating disorders and are five times more prone to substance abuse and risky sexual behaviors. LGBT um, elderly people are also high risk of isolations. And also, when we look at the transgender community, they have found that transgender community, uh, even further increased risk of facing prejudice, discrimination and stigma, which is associated with a higher risk of negative mental health outcomes such as depression and suicide. Sadly, then, this figure that transgender youth are 70 10 times more likely to have attempted suicide, so we can see that specifically also within the community. These figures are you know, they're they're they're serious figures because we have our young people who are who we know that are identifying more and more as LGBTQ at a higher risk of poor mental health. And we need to do something about that Look. It's like specific also sexual health. We found that LGBTQ individuals are at higher risk of HIV in 2019. Um, they found that Huk HIV diagnoses 40%. We're finding gained bisexual men and 37% homosexual people and also 28% in women. This, uh, this community is also at risk of sexually transmitted infections. However, there's also this misconception that that also comes with the, uh, particular groups in the LGBTQ community. Specifically, this is misconception that lesbian bisexual females only perceived to engage in same same sex intercourse and are therefore not not as prone to sexually transmitted disease or may not be offered. Um, uh, the HPV vaccine, for example. One study actually found that 70 to 80% of lesbian women actually had a sexual a male sexual partner in the past. Furthermore, LGBTQ community are more likely to be homeless or how lack of social acceptance by their family. And there's a general lack of social programs appropriate for this community. They've also found that LGBT people are more like to be a low socioeconomic status, so this increases their risk to health hazards, um, and decrease their exposure to health promoting resources as mentioned before, transgender individuals have, uh, even further risk for having poorer physical, mental and social health. Um, specifically, some uh, some issues that have been raised in the literature has found that transgender in Virgin, when they seek healthcare, it may increase their gender dysphoria, which causes stress and difficulty in finding someone who they feel comfortable with. For example, transgender men may avoid seeking cervical screening. Um, all translated, women may forego having prostate screening because this increases their gender dysphoria and their relationship with their body when they see health care. So one of the barriers that we have that we know for these populations in terms of seeking healthcare, um, we can define things into individual systemic and environmental for an individual. The virus that they may see is that they are discriminated and stigmatized within the healthcare system. Systemically. One of the barriers that, um, that we have in our current healthcare service is that our providers, our health providers like the cultural competence and the training and education to know how to provide culturally competent care for this population. Furthermore, the educated population may not feel safe in the environment that they're in the the current healthcare service is still very much substances gender, heteronormative and so these the LGBT community community do not feel safe in these spaces and therefore may see that as a barrier to seeking healthcare. Um, this is a 2017 survey produced, um, published in 2018. Um, and they found that LGBTQ people and 16% of people who access public health services reported a negative sexual, um, negative experience because of their sexual orientation. Furthermore, 30% reported negative experiences do their agenda identity and half of people found that they had long waiting time for mental health services. Overwhelming, um, number of people of trans people. I found that it had difficulty accessing gender identity clinics. So the healthcare experience, which LGBT people in general, is that they see healthcare as, um, healthcare professionals as a space that is homophobic and promotes heterosexual is, um and I don't feel like that they feel safe in those spaces. Uh, Stonewall survey in 2018, um, found the LGBT people. We're more likely to face discrimination attitudes and that our healthcare providers were lacking in awareness of their needs. So I want to discuss a factual competency in the healthcare provider. So cultural competence is defined as the ability of a provider and an organization to effectively deliver healthcare based on the meats, um, of social and the culture and interesting needs of their patients'. And the research shows that we're lacking in training and education for cultural competence to provide for the healthcare needs of LGBT keep people and in and in general, we need to try to challenge these heterosexual attitudes towards these behaviors and to these poor healthcare outcomes. So the recommendation is that, um we can What we can do to try to improve the health care provider for the community is to train just to provide training for LGBT care specific health needs for medical school onwards and to continue this education training after graduation. Furthermore, we can increase the physical space and in the safety and the physical space that the LGBTQ community, um, existence. So, for example, we can change the clinical environment, um, so that they feel safe through Ringo badges or having, uh, same sex partners on leaflets and pamphlets and also including, um, gender identity and sexual orientation options on medical records. Uh huh. Looking at the literature in the medical medical school curriculum, we have found that it shows that LGBT health, education, medicine, dentistry, and nursing is generally lacking. The medical students have expressed that they have very few opportunities to get experience in providing care to LGBTQ patient's. And in general, this is across not just in the UK but also in the U. S. And in Europe, people medical students do that their knowledge of LGBTQ healthcare, um, is lacking. And then that they feel ill prepared to take care of LGBT people and even less comfortable taking a sexual history. So how can we improve the medical school curriculum? We can incorporate r g B T Q health. Um uh specific needs into the curriculum through lecturers. Small group discussion's, um, ideally with people who are, uh, most probably part of the LGBT community so that people feel safe to ask questions. Yeah. Furthermore, it'll be, uh, next Step four will be considering. Excuse me, um, considering having dedicated LGBTQ health staff that are identified so that people know that these healthcare providers are available and patient's can can speak to us if they feel like they feel more comfortable to discuss their healthcare needs with us. Um glad which is associated about DBT doctors and and dentists have from guidance on how to provide LGBT health training and education in the medical school and also in further training after graduation. So if anybody's interested, I really recommend going on their website too, too. Understand what the what we have, what else we can do to further LGBT inclusivity in In Skyler medical school curriculum Doctor Michael Brady is our national LGBT health advisor. Uh huh. And they published the plan, Um, in 2018 which talks about other four properties, um, in the plan which is to advise and influence, um, different healthcare providers into increasing LGBT care health. Um, increase our data and monitoring of social orientation and gender identity further are researching by improving and increasing our evidence base, Um, so that we understand the needs of the LGBTQ community and also specifically for transgender people, and furthermore, to develop to further increase education training with with a medical school, but also within, um, the healthcare system on LGBTQ pay bills, healthcare needs. So we are part of prison and and, uh, every has very kindly spoken to you about it, and this was launched last year, and our aim is to show that surgery is an inclusive space for L G B T Q people and that part, in addition to trying to make surgery a more inclusive space for the community is that we're trying to improve LGBT health For what? For our patient's. Our next event is in Manchester, Um, our next article event in 2023. So if you're interested, please do, um, follow us on Twitter. Um, our website is coming, and it'll be really great to speak to you, Um, and to hear your experiences and to hear if you have any thoughts and ideas of how we can improve the health inequality within this community. So, in summary, LGBTQ people are faced social stigmatization and harassment, which negatively impacts the mental and physical health. And this exists in every domain physical, mental, social and sexual health. Uh, the social barriers to LGBTQ people seeking healthcare are, uh, individual systemic and also environmental. And at every level we can do something to address this we need. Overall, we need more education and training for LGBT health needs in medical school and also in postgraduate training. Further research is needed, um, to understand the needs of this community, but also specifically more research is needed for the transgender community. These are some of the resources. Thank you for listening. Thank you very much for that. For that fantastic talk. Um, I can see that. You know, people are paying questions in the chat, which is great. Please keep the questions coming, and we'll get to them all at the end. So now for the final talk of the night, Um, our next speaker is a consultant corrective surgeon. Um, and, you know, they were born Isle of Man a time when homosexuality was still illegal. Um, and, you know, after they were influenced by a by a very charismatic surgeon. Um, you know, they decided to sort of sort of go into surgery and kinda see how how the how things are short changed from what it was like then to what it's like. Now, Um, there are a mentorship lead for the l G B T Q plus Pride and Surgery Forum committee. And they've been a course director and coordinator for many Royal Corgis surgeons courses. Um, they're the foundation to, uh, program director at the Chesterfield World Hospital. Uh, and part of the role is to sort of offer careers, guidance and and pastoral support F two s and including those who are sort of contemplating creating surgery. Um, and, uh, they're told tonight is gonna be about how LGBTQ visibility improved patient outcomes. So, without further a do the last speaker tonight, uh, Mr Mark Bagnall Hello? Can you hear me? Yes. Can you see my side set? Sorry. Can you see my slides? Yes, I can. Perfect. That's really good. Well, almost. Yeah, then Well, thank you very much for inviting me to talk on the widening participation. Um uh, Forum. Hear as I said, As you said, I'm a colorectal surgeon, and I'm, uh, out and proud gay man. But I wanted to speak on something slightly different. I wanted to sort of touch upon, um my experience is, um, particularly, um, in how, By being out and visible, we can influence, um, how patient's perceive us. So, um, really, this is the title of my topic really? Is about being out to patient's, um, and one of the ways in which we can do this is, um, you know, the the not so subtle, Um uh, rainbow lanyards, the NHS rainbow badges, and also having name badges, Uh, with pronouns Odd. Which is the, uh, you know, several different ways. Which you can signal to people that you're an LGBTQ ally. Um, but they weren't introduced without a few hitches. So this is taken from a very familiar community forum where somebody was raising the issues of NHS badgers being raised in the workplace, uh, and raise some concerns to say that they're a bit uncomfortable with having to have a badge with their pronouns on. Um, and were they wrong to feel this way? Of course, this promoted a lot of debate. Um, as you tell, one of the consistent things you get on these forums is anonymity by the respondents. Uh, it's very tough to sell whether their healthcare professionals in their in their own right, whether they're just contributing to the debate. But people were saying that there's a lobbying agenda that politics behind it, that patient's would get, um, confused, Um, or that it's unnecessary that they could tip x out the pronoun bit. Um or why? Why does it Why why isn't it obvious? And what's the point of it? And that is virtue, signalling that it wasn't what Kate Granger originally envisaged with the Hello My name is campaign, Um, and saying that there's a very vocal, oppressive section of society that are demanding that badges be used, Um, and that the expectation was it only affects a very small minority of health care people. But on the other hand, in these forums there is the occasional glimmer of optimism where somebody was saying that actually, they wanted to become normalized, to help them that themselves feel valid in the workplace and to be more accepting for patient's. So what starts out as a very innocent and and helpful uh, campaign and an idea to improve the welfare of LGBTQ Patient's? Um, there's a whole raft of negative comments that come out of the woodwork. Virtual signaling. It's all about politics, um, forcing an agenda on somebody. Interestingly, somebody did say that if it's compulsory, then people may feel that they either have to conceal their gender identity or come out. But it's for the self interest of the wearer that it's a selfish need for validation that it doesn't instil the values that Kate Granger and the Hello my name is. Campaign originally came up with that alienates others, and it confuses patient's with dementia. Well, I want to tell you that based on my experience, is that, um, this hasn't been the case, So I want to explain to your patient I'm gonna call him Nick. A man in his forties admitted with Crohn's disease, and he had partial small bowel obstruction due to lots of fibrotic structures. It spent four weeks in hospital and from a combination of covid and being sort of stuck in a hospital ward on parental nutrition, he had had a pretty lousy time. And then he was facing surgery in the end, which involved resecting two areas of bowel and, uh, estimating them together. And he went to H D Post operatively and did very well. But it was due to be stepped down to the ward, and he tentatively asked me if he could have a side room. Now, this is a able bodied 40 year old man who's been in hospital. Yes, it's been been in a month, and it's a bit, uh, he's been through the ringer, but there was something going on as to why he wanted to ask me for a side room, and it turns out that he wanted to be able to hold his husband's hand and not be gorked out by other patient's visitors and staff. He felt very vulnerable. He didn't have to face any hassles. And he just wanted, um, to be, uh, with his loved one, without any hassles, without any justification. Now I was wearing a colored lanyard. I actually invited that opportunity to raise that discussion as to why he wanted a side room. And then it enabled me to bond more with the patient as well. I started to ask him about how his husband was, how he was coping, how he was feeling by all this, and they felt like they couldn't come in and visit. I have another patient we'll call patient Sam. Sam was a 50 year old male to female Trans Person had coming into the emergency apartment with an acute perianal abscess, highly anxious, feared of being judged and ridiculed, judged by their retire, judged by, um, negatively by healthcare professionals. And I was afraid to be stigmatized. However, after introducing myself and um, striking up a conversation, uh, we managed to move to a more discreet area. Um, I listened to her concerns. She had a post surgical a very short distance of a pirin e. Um, and the risk of fistula ation from this abscess was a real concern to her. I examined her with a chaperone with permission and then came up with a modified management plan. Uh, the abscess was needle aspirated. Uh, appropriate. Intravenous antibiotics were established and then converted to oral antibiotics. And the referrals made back to the private, uh, plastic surgeon that performed gender reassignment surgery again. Part of the feedback was the appreciation that I was wearing. Um um, information that would would make me more receptive for the for this individual to communicate their fears, Um, and to feel safer, um, in that environment and to have their consider their concerns noted. And listen to. And there's another patient of mine I'm gonna call Kyle. He's a gentleman in his mid forties. He has ulcerative colitis, and that's why I initially was introduced to him. I was performing a surveillance colonoscopy, taking, um, biopsies routinely throughout the bowel. His ulcerative colitis was relatively well controlled, but there was a slightly abnormal area right at the very low, low rectum. So I took some biopsies of this area particularly, and was then surprised that it came back as anal intraepithelial neoplasia grade three. Um, you know, and this is putting about high risk of developing, um, anal skin cancer. Um, so I arranged a follow up appointment with him, um, and discuss the needs for, um, performing a more thorough investigation. Um, taking skin mapping of the perianal area under a general anesthetic. And I was able to ask, and I was able to bring up sort of more sensitive and personal information. But I could tell that he was also tentative and holding back. And I did not wish to push this, um, so content of the procedure and, uh, then performed the operation. Unfortunately, is perianal histology came back as benign. Um, however, interestingly, subsequent, uh, endoscopy ease have shown continuation of a A and three in the lower rectum. But this time he came to his follow up appointment with a male partner and actually felt safe to be to be, uh, include his partner in the consultation, he felt that he would be able to be listened, uh, two, without any fear of judgment and to take his, uh personal considerations and expectations into consideration. We discussed the potential impact this would have on his personal life, uh, in terms of sex and his relationship. And after a positive, um, consultation. He preferred to continue a I and surveillance under my care despite moving house, uh, to further 45 minutes journey time away. Because of the previous poor experiences that he had endured in his local region, I'd like to think that these instances reflect how, uh, something as simple as a, uh, lanyard a name badge. A set of pronouns can include people and make them feel safe enough to initiate a consultation to bring up there. Um, the most important factors to them. So in conclusion, badges, lanyards, symbols, they're not designed to improve the ego or to force an agenda. They indicate safety. Someone is safe and friendly to approach for the LGBTQ community. This needs to be backed up. However, by providing compassionate, nonjudgmental care. You can't just walk, talk the talk, you have to walk the walk to and they are about the patient's. They are a symbol of safe, inclusive care, and they are also about the staff providing a safe, inclusive workspace, and they do improve the patient experience. Thank you very much. Thank you very much, Mr. Well, that was a That was fantastic talk. Um, so I guess we can move onto any questions. Um, and there was one that was sent in by Lilly Carter. Uh, the question is, does anybody have any tips and have to challenge negative comments and attitudes about sexuality and gender identity from colleagues? When at work, I think anyone of you I'm so I think that's fine. And I don't mind going first. I think in general we are. You know, we are living at a time where we are aware that discriminatory or homophobic comments or not tolerated. And I felt like if you if someone did say something and you spoke up, you are definitely in the majority when you agree that it's the wrong thing to say. But there have been instances where, uh, someone has made a comment and I'm nobody's saying anything, and I must admit it. It is scary to be the only person speaking up about it. Because you are putting yourself out there. You're putting yourself for a confrontation. But you know, I'm hoping that with the communities that we are building now, um, with, you know, prism and various LGBTQ so support groups that you don't feel like you're the only one and that you feel that you are speaking of for all the right reasons. So even though it can, it's still very challenging to speak up and challenge. Um, I try to make myself brave and do it because I know that behind me, our team of one of the people, and live behind your community and in general allies who support me. Yeah, that's fantastic. And and you know when when you do sort of do speak up. And what sort of been the reaction to that? Has it been usually positive? And what What do you think? I don't know. How about other people have experienced is speaking about one time they speak up, they're just kind of granted and and moved on. But by saying something, you show people around you in the room that that's not OK. It's not necessary just for the other person to here. It's also about who is around you to hear that you're challenging. Someone was speaking up against because it may be a medical student who is in the trial meeting or in the in in theaters with you. And they hear these homophobic comments or transfer your comments. And they will think that surgery is not a place for me. Because if they identify as LGBTQ or they are just they just see that that's very negative behavior. They don't want to come and join surgery so very much. I try to challenge these negative behaviors as much as possible, not just for the to the other person to try to change their views, but also to the people around me. Um, well, I've had the experience when I was in training of a consultant, actually, um, speak up and closed down banter in the coffee room. Um, it was perceived by the person that said it as an innocuous, um, comment. It wasn't even directed with any malice, but it was using, um, sort of derogatory language. Um, and my consultant, trainer at the time very quickly closed down that, and and I was, you know, at the time I was so used to sort of the background environment of how surgery was, and you just had, uh, except that there were people who would say things against all sorts of, uh, minority people. Um, and it was just water off a duck's back. But I'll never forget how he stood up at that moment and, uh, you know, risked alienating a friendship with a colleague. Um, but he did that because it was the right thing to do, and I realized that it was important. Um, and it did change my mindset. And I said that, um, you know, I'd be inspired to do that if it was ever to occur again, not just against somebody who's LGBTQ. But if someone says anything misogynistic, um, you know, or discriminatory in. Anyway, um, I, um you know, have, um, you know, seen various material inside, say, locker rooms, which I've, you know, reported and had taken down because it's, you know, offensive to some people. So and I think it's important that we have to have a safe work environment. People have to be, uh, feel that they are included and belong, um, to their, uh, to their workplace. And that requires people to challenge and people to support that challenge. Um, I think, yeah, that was very interesting. What you said about is what you just so used to the background when you're training like the sort of the comments, and I think it sort of shows we've progressed. However, based on top, we still have a long way to go. If that's that's my sort of takeaway. That's that correct, Would you say? Yeah, I think so. I think the fear is that what was overt discrimination? Um, maybe pushed, Um, two more covert, um, discrimination that the nice way of putting that consciousness bias? Um uh, the the the the impolite way of saying is there's still dinosaurs out there, but to be honest, what we what we walked past is what is the sort of environment we accept? Um, so I think it's up to people to be good role models to challenge inappropriate behavior. Um, you know, and not allow the culture in which, um, you know, these traditional bad behavior, um, flourished, Really? And we all know that there's good evidence that shows civility, um, saves lives. So actually, it does have a very real benefit to patient care, not just to the workforce. Thank you very much. Um, so we've got the question here. Um, how can allies help to remove some of the barriers? Names are mentioned in your talks in their own practice, You know, after they've sort of sought LGBTQ education. Yeah, I can answer some of that. I would say, uh, by demonstrating an NHS LGBTQ plus buds that would be quite useful. Demonstrating their pronouns, uh, is simple steps that can show to the patient's that actually, they do support that. That's one of the things that I found. That patient did approach me as they approached Mark as well. And that's how you can become an ally to start with. And that's the visible things. You can do other things like becoming inclusive in the workplace. Just getting introduced into your organization to your mom. Just explain that you're an ally. Get yourself known. Yeah, become visible. Yeah, that's most important, I think, from my perspective, um, as a surgeon in training, the fear is always that you have a a non supportive trainer. I think that if you are pro LGBTQ training for trainees, I think that's the best way in which you can support um, surgeons in training is to show that you are willing to help them and to listen, you know, because there's there's probably, um, uh, a fear that you, you know, we always want to talk about personal life in theater because, you know, we're in there for an hours and hours at a time, but we have to sort of feel safe before we can start talking about, you know, our partners and our husbands, our spouses and things like that. So I think setting up the the safety to actually have those conversations that that information will be used against us or training, withheld or anything I think is is quite important as a as a sort of fundamental ground rules of, Of, of getting to know your trainees and showing that you actually support them, I think is really important because I think that once a trainee feels, uh, safe to sort of open up and and be able to talk about, um uh, you know certain aspects of their life to the same extent that any non LGBTQ trainee can do. Um, I think it's a really sort of a nice way to make people feel included, too, because it's really quite difficult otherwise, to bond and to get to know somebody, Um, and knowing that, uh, that professional relationship can be built on and trusted and maybe even turn into a bit of a mentorship arrangement is very, very important. Thank you very much for that. Uh, this is sort of just a question for me. Uh, you mentioned sort of the opposition to these, you know, when this was first introduced, the land yards and the visibility you mentioned the opposition to it has that sort of died down. You know, now that we've sort of shown that's had a very positive influence and or do you think that's sort of still there? I think that people don't fully appreciate the benefit that it has. Um uh, I think that, you know, there's a backlash against anything because if people first thought, Oh, it's a waste of NHS resources. And then when it was pointed out that it was actually funded through charitable funds and had nothing to do with the NHS, Then people said, Oh, your virtue signaling. And people said, Well, actually, I want, you know, I want to show you, um, two other members of staff to families to patient's you know that I am supportive of LGBTQ people. Um, I think it's slowly becoming more and more acceptable and more and more accepted. Um, but the fear and the, um, negative connotations is still there to some degree. But hopefully as it becomes more commonly adopted, um, it will become less of an issue, right that thank you very much For that, um can always just mention to everyone that please fill out the feedback forms. That would be really helpful. Yeah, there was another question about you mentioned some figures about how there's obviously worse outcomes for LGBTQ people. Uh, why is it that LGBTQ people patient's sort of have an increased risk of sort of chronic diseases like arthritis you mentioned and things like stroke? Thank you for the question, and it's, I think it's over. In general, they they don't seek health care because they fear discrimination and they for stigmatization so they don't seek healthcare because they will wait to until they are absolutely, you know, at the very end of their disease. Until they realized that they need to seek healthcare because and then also we're thinking about a patient who lived in older, who have chronic health conditions. 2030 years ago, we were not talking about G B T Q people or LGBT health in this way. So they were of an era where it was even more, um, discriminatory. And so they didn't want to seek healthcare. They didn't feel like their healthcare providers understood their unique needs. Or they may judge them or have prejudice against who they are in terms of their sexual orientation. So it's, um, it's in general, it's about the lacking. They're seeking healthcare. And so they, um and they don't because they don't feel safe to go to their health provider. The They may not go to their follow ups. Um, they may not present themselves in the first place. And so these Kington all add up to increase the risk of chronic health conditions. Okay. Thank you. Thank you very much for that. Um, I have another question here. Um, is there any advice surrounding transgender patient's and making them feel safe on a on A on a particular gendered ward? Um, I think I think having gendered words, um, we can understand why historically that they're required. And when you have transgender patient's, um I think we should be doing our utmost to respect that, um, the gender identity that they identify with and to place them on the boards that they feel more safe on. I think if anybody, um, was to challenge that I don't really feel like they have a leg to stand on because this person is here for care. This this person needs care from us and what we and they are in a vulnerable position and ask your health care provider is we need to do our very best to make sure that they feel safe. Um, when they're in this, um, vulnerable state and to provide them with the safest environment, Um, so that they can recover and look after themselves. Okay. Thank you very much. Um, question about intersectionality. I think there was the analogy about about the cake and the ingredients. How much do you think that sort of affects you in sort of in medicine versus sort of in your own personal life? Uh, intersectionality is about, uh, every aspect of your life. You just can't be who who you want to be without, really? All the parts of your personality and your life intersect together. And this is what you project to the world. So that that's the analogy with the cake I wanted to try to explain. So that's my take on this. And I hope everyone has the same taken it in. The success rate is quite a complex term, and, uh, it's mainly used in sociology. So I just try to make it easy to for people to understand. I think in medicine, yes, you just have to be who you are. And that's it. Yeah, that's my take on this. Thank you. No, That's thank you very much. I think, Yeah, it's a very complex topic and beautifully talk a lot about it and spend a long time on it. Um, is there any other questions from anyone in the audience? I think I think that's all the questions that we have. Is there any final words that you would like to say come to out at the college 2023 in Manchester? We have a really good time and would be really interesting. I know that it was have a good time, but I should be a very interesting um day where we have lots of different talks about different topics. Um, anybody who's interested in surgery or who is on med Twitter, we might have recently seen that there was a bit of a Twitter, um, viral post that one because of a of a question about, uh, HIV and a homosexual man. And so it's about these issues that we face for within our community and within patient's health is still very much real. And there's a lot of work that needs to be done. And we need everyone to come and join us and support us, which whether or not you're in the community or you're an AL. I think it's just as important. And you will take just a smile out of it. I totally agree. Come join us in Manchester. Have a great laugh. Thank you for having us and guess Join us in months that Thank you. Thank you very much for joining. It was a really lovely talk. I really enjoyed it. And I hope everyone in the audience did too. Um and I think we can We can end it there. Thank you. Thank you very much. Thank you for having us. Thank you for coming. Thank you very much.