Dr Justin Varney from GLADD (Gay & Lesbian Association of Doctors & Dentists) salutes progress but diagnoses issues still affecting LGBT patients in the UK today.

All of us will, at some point, come into contact with a doctor - even if it is only when were born and to certify our death.

Thankfully, from a gay perspective, progress has definitely been made, in recent years: to support not only LGBT medical professionals, but also LGBT patients.

Both the NHS Constitution and NHS Trust single equality schemes make it clear that the third biggest employer in the world is committed to delivering a non-judgmental service for all. Every Trust has to undertake equality impact assessments that include looking at how policies and strategies impact on LGBT communities.

Moreover, the Department of Health has published guidance and briefing papers on LGBT health issues, including resources for transgender youth; and core standards for training on sexual orientation. The British Medical Association has published resources on sexual orientation and there have been NHS floats in the London Pride parade for the last four years.

Confidentiality is also one of the sacred tenets of the medical professional and the General Medical Council has produced a leaflet for the LGBT community highlighting how, as a patient, you can complain if your right to confidentiality has been breached. Patient Advice & Liaison Services (PALS) and Complaints teams exist in every hospital and Primary Care Trust - to help patients, including LGBT ones, navigate the NHS and understand their rights.

However, looking forward, significant challenges remain for gay patient care.

There is huge debate about the NHS electronic patient record and whether sexual orientation or gender identity should be included. Views are strong on both sides, but more and more parts of the NHS are recording patients sexual identity alongside their ethnicity, age and gender. This is fundamentally important since if, as a community, we want services that are accessible and useful to us, we need to stand up and be counted in this confidential and safe way. Unless an organization can measure its proportion of LGBT service users, it has no way of gauging how well it is serving this part of its community; and could be in breach of the Sexual Orientation legislation on goods and services provision.

Research indicates that many LGBT people still dont feel safe or comfortable coming out to their doctors. This is a challenge for both patients and professionals. If your doctor doesnt know you are gay then they wont offer you hepatitis B immunisation, in line with national guidance. If you are male, and they dont know your partners name is Jim, then they wont offer to include him when planning your care.

Doctors routinely ask personal questions in order to understand and support their patients - from how many times you go to the loo to how often you have sex, and with who. Being a doctor is a bit like being a detective: if you dont have the facts, you cant solve the case.

UK studies have also repeatedly shown that LGBT people take more risks with their health; and are less likely to adopt screening opportunities for diseases like cancer. Higher rates of smoking mean that more gay men and lesbians will get lung cancer, emphysema and chronic airways disease. Gay men use more drugs, and for much longer, than straight men; and young gay men are six times more likely to attempt suicide than their straight peers. 1 in 4 gay men and lesbians experience domestic abuse from a partner, ex-partner or family member - and yet there are no dedicated refuges for gay men in London; and the national helpline, Broken Rainbow, bounces along on a wing and a prayer.

I may sound like a kill joy, and Im all for a bit of fun in moderation, but - as a community - we will have to face up to demons such as addiction and excessive alcohol intake, or accept the fact that gay men and lesbians will continue to die significantly younger than their straight counterparts. The continued impact of smoking will see cancer and coronary heart disease become the number one killers in our community. Additionally, sexually transmitted diseases and HIV have not gone away - and gay men are still more likely to be infected than heterosexual men across the country.

Our health is our responsibility. We choose whether or not to pick up those cigarettes and light them; order, and down, that sixth shot in a row; or have unprotected sex with random strangers. Our health, our choice.

GLADD (Gay & Lesbian Association of Doctors & Dentists) is a membership organization for LGBT doctors and dentists, plus medical and dental students - www.gladd.org.uk

SUGGESTED PULL-OUT QUOTE:

Many LGBT people still dont feel safe or comfortable coming out to their doctors.

Or

Being a doctor is a bit like being a detective: if you dont have the facts, you cant solve the case.

Or

Studies have repeatedly shown that LGBT people take more risks with their health.

Or

As a community, we will have to face up to demons such as addiction.

Or

We choose whether or not to pick up those cigarettes; order that sixth shot in a row; or have unprotected sex with random strangers.

Adrian Gillan