7 Questions with LGBTQ+ Advocate, Dr Luke Flower

We asked Dr Luke Flower about his work in advocating for care of transgender and gender-diverse patients.

1. Thank you for speaking with us, Dr Flower. Can you start by introducing yourself for those who may not yet know you?

   I’m an intensive care medicine registrar with an anaesthetic background and a PhD student at the Victor Phillip Dahdaleh Heart & Lung Research Institute at the University of Cambridge, where my research focuses on immune dysregulation in acute respiratory distress syndrome. 

   I also have an interest in healthcare inequalities and, over recent years, have worked with colleagues from across the UK and globally to try to improve the care of LGBTQ+ patients. I was fortunate to join the Intensive Care Society’s EDI Working Party at the start of my specialty training and have since had the privilege of working alongside many inspiring clinicians (including Dr Kamilla Kamaruddin and Dr Stuart Edwardson) to advocate for the LGBTQ+ community across research, perioperative care, and intensive care. Our work has expanded to include joint initiatives with the Royal College of Anaesthetists, the Association of Anaesthetists, and the Faculty of Intensive Care Medicine, as well as several universities and NHS Trusts. We’ve also had the opportunity to collaborate with colleagues internationally, including in the U.S., Australia, and France. 

   None of this work would have been possible without the support of everyone involved and the invaluable contributions of transgender and gender-diverse colleagues.

    

2. In your advocacy work, do you often encounter anxieties from other anaesthetists about providing care for patients who are transgender or gender diverse?

   For a lot of people, discussing sexuality and gender identities can feel awkward and often leads to misunderstandings. 

   If you were to ask most anaesthetists, “Are you happy to have a discussion with a patient who is about to have major surgery, and there’s a chance they will not survive the operation?” the answer would likely be yes. But if you ask, “Are you comfortable talking to this patient about their gender identity, pronouns, and any gender-affirming treatment they may have had?” many would find that more challenging - even though they already have the skillset for such conversations.

   I think it’s often a case of “we don’t know what we don’t know”. We aren’t taught [how to approach conversations about gender identity] in medical school, or during postgraduate training, so how are we supposed to learn this? 

3. Can you explain why it’s important to overcome those anxieties and to have that conversation about gender identity with patients?

   For transgender and gender diverse people there are several important considerations to be aware of in the perioperative setting. One simple starting point is just to acknowledge and use people’s correct pronouns – this small act can go a long way to helping patients feel more comfortable, in what is often a scary situation.

   There are also important medical considerations to keep in mind. For instance, some patients may be taking gender-affirming hormone therapy, which can affect drug interactions and may carry specific perioperative risks that we need to be aware of. Patients may also have had gender-affirming surgeries that alter their anatomy (e.g., their airway), or use devices like chest binders that can alter ventilation mechanics.

   Whether for the social, courteous aspect of care, or to know a patient’s medical background so we can react in an emergency setting, it’s important to have the conversation [about gender identity] with patients.

4. What is your advice for anaesthetists to help them have that conversation?

   As with any patient, regardless of their background, our goal is to provide the best possible care. That means asking the questions necessary to do so - and importantly, explaining to the patient why you're asking, especially when the questions are personal.

   Another important thing to acknowledge is when conversations need more privacy than the ‘soundproof curtains’ we often use in hospitals can provide - and when a private room might be more appropriate. Give people the space for what can be a big thing to share.

5. We are talking during Pride Month. Speaking for yourself and your patients, what does Pride Month mean to you?

   Pride Month means a lot to me and I’m sure also to my patients. It probably means even more to me now that I’m out and more confident about my sexuality. To me Pride Month is several things. It’s a celebration of the LGBTQ+ community, what people have achieved and the progress we’ve made. But it’s also important to remember it was born out of the Stonewall Riots and necessity for change. I’m lucky – I work in a diverse and inclusive research institute, I have very supportive PhD supervisors and colleagues, accepting family and friends, and a brilliant husband. I’m also aware of the privileges I have as a white cis man. However, I recognise that many individuals in the UK and globally do not share the same privileges. I think it’s important to acknowledge we’ve come a long way, but we have a long way to go. We can’t sit on our laurels and take it for granted.

6. You mentioned Pride month is about LGBT allies too. What does being a good ally look like?

   The best allies I’ve had are those senior to me who gave me confidence. It’s great when you have mentors who are inclusive and bring people up. It’s being willing to ask questions and being visible. Making an active effort and calling things out when necessary. What has always meant the most to me is when people speak up in response to homophobia , instead of letting it go unchallenged - especially when I was more junior and didn’t have the confidence to do so myself.

7. What advice or opportunities can you suggest to people wanting to get involved in LGBT advocacy?

   There are great resources within medicine. GLAAD (The Association of LGBTQ+ Doctors and Dentists), is one, also the Intensive Care Society’s resources page has podcasts and articles. I was involved in the first guidelines for perioperative care for transgender patients, published open-access in Anaesthesia. Beyond that, look locally in your region and your trust to find opportunities to learn and get involved.