Exploring the implications for health professionals of men coming out as gay in healthcare settings.

Coming out as gay is a social process which redefines the relationship between the persons who have decided to disclose their homosexuality and their listeners. This paper, drawing upon Bakhtin's (1984) theories of dialogue, the coming-out literature of gay men and lesbians and contemporary literature on doctor-patient communication, explores the coming-out experiences of gay men with their general practitioners and sexual health clinic staff. The findings are based upon a study of 38 gay men and 12 health service managers in London. The informants were recruited purposively to reflect some of the diversity of the London setting; recruitment was carried out through the channels of gay voluntary organisations and through snowballing. Semi-structured interviews were conducted and a grounded-theory approach was adopted. It was found that coming out in general practice was often/mostly followed by silence/noncommunication on the part of the practitioner; coming out could, however, result in an improvement in communication if the patients were well supported and assertive. If coming out in sexual health clinics did not result in improved communication, the informants in this study were likely to change clinics until they did find improved communication. This paper raises questions about the communication and training needs of general practitioners. It also raises questions about inequalities of access to 'respectful' sexual health clinics; while men who are articulate about the narratives of their lives as gay men are able to exercise informed choices, there were grounds for concern about the choice behaviours of men who are less articulate about their life narratives.