Coming Out in Radiation Therapy: A Narrative Inquiry

Abstract

The healthcare environment reflects and embeds sociocultural norms, including heteronormativity (the system that works to regulate behaviors and societal expectations tied to the presumption of heterosexuality and an adherence to a strict gender binary). Heteronormativity pervades workplaces through policies, cultural norms and informal interpersonal interactions. Coming out, rather than being a one-time event, is often a process of continual identity management. Subsequently, there is evidence that lesbian and gay people (LG), both patients and healthcare professionals, engage in significant emotional work to manage who they tell about their sexual identity, and in what circumstances. For patients this can result in barriers to healthcare that can substantially affect their health and wellbeing. Healthcare professionals, like radiation therapists (RTs) are subject to explicit and implicit bias, and may feel they need to disguise or downplay their sexual orientation at work. Research in this area is sparse, and mainly examines the experiences of physicians and nurses. This qualitative study explored the issues of LG RTs and their experiences with managing sexual identity in the workplace, and how this has impacted their relationships with co-workers and patients. The research used an authoethnographic narrative inquiry approach. Narrative inquiry incorporates story-based methods to acquire a deep understanding of the ways in which individuals make sense of events and phenomena. Autoethnography is the use of individual personal experience to understand and reflect on a broader culture. In this case three LG participants from a large urban cancer centre worked with the researcher to co-construct stories of coming out in the radiation therapy work environment using their shared personal histories. An iterative development process was used. This comprised of working through field texts (individual and group conversation transcripts, memos, messages, emails and self-reflective diary entries) to interim texts (composed and negotiated draft stories, revised transcripts and discussions) to research texts (the final stories). The co-constructed stories include fictionalised narratives of coming out (or not) as a radiation therapist at work, relationships with patients and peers, the experiences of sexual minority patients and the researcher’s accompanying lived and embodied research journey. They are written in a variety of genres and from a number of different perspectives. The results showed the participants engaged in highly contextualized and continual identity management which depended on a series of different strategies or tools. Additionally, it was clear that both the discourse around professionalism, and the pervasive biomedical healthcare culture served to further inhibit disclosure at work. There is growing evidence that some patients from minority groups, including LG patients, feel more comfortable and have better health outcomes when treated by healthcare professionals from the same background. For RTs, coming out at work might be a risky business. However, it seems likely that focused attention on improving the work environment so RTs can be open about their identities in the professional setting would be beneficial for both patients and staff.