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During my surgical training, whenever the conversation turned to relationships, one of my colleagues would always joke about his inability to get a date, then abruptly change the subject. I thought he might be gay but never asked him outright, because it didn’t seem important.

But one morning, while we working at the nurses’ station with several of the other doctors-in-training, I realized it was important, because at the hospital, he really couldn’t be himself.

Doctor and Patient Dr. Pauline Chen on medical care.

That morning, one of the senior surgeons stormed over. He had found one of his patients feeling slightly short of breath, no doubt because of an insufficient dose of diuretic overnight.

“Which of you idiots,” he growled at us, “gave my patient a homosexual dose of diuretic?”

It took me a moment to understand what the surgeon was trying to say. But when I finally did, I couldn’t help but glance at my colleague. He stood mute, his face ghost white.

Later that day, the group of us would rant against the surgeon and even make fun of him. But none of us, including that colleague and me, ever confronted him directly or reported the egregious remark. We were too scared. Doing so, we felt, would have been tantamount to saying we were gay or lesbian ourselves. And it wasn’t hard to realize that in an environment where senior doctors felt free to equate homosexuality with incompetence, such an admission would have clearly been a career-ender.

In a recent issue of the journal Academic Pediatrics, Dr. Mark A. Schuster, head of general pediatrics at Children’s Hospital Boston, lays bare the experience of being gay in medicine and the constant struggle to “choose between being a doctor and being openly gay.” The prose is riveting, but it is also difficult to read. For it delivers unflinching, evenhanded descriptions of a profession that is committed to helping others, yet is also capable of treating some of its own as aberrant.

Dr. Schuster describes being a medical student at Harvard in the 1980s, searching for guidance at a time when discussions on gay health were sandwiched between lectures on prostitutes and drug addicts. He hears about high-ranking medical school faculty members who actively block job or residency applicants they suspect to be gay. Another gay man, a law student he happens to know, is trotted into one of his medical school lectures as “a real live one” who would “tell us what it was like.” One of the few open faculty members finally advises him to remain closeted until after at least his first semester grades. That way, she explains, the school won’t be able to trump up academic charges as a reason for expelling him.

Most poignant, however, is what happens to Dr. Schuster toward the end of medical school. A powerful figure in the specialty he hopes to pursue quickly becomes a father figure, doling out advice to the young man and volunteering to write glowing recommendation letters for residency training programs. One day, Dr. Schuster decides to reveal to his mentor that he is gay. “I felt I had to,” he recalls. Residencies wanted leaders, and his most important experiences as a leader to date had been with a gay group. Moreover, he writes, “I didn’t want him to hear from someone else and think I didn’t trust him.”

His mentor’s reaction is silence. And a few months later, with only weeks to go before the deadline for submitting residency applications, he tells Dr. Schuster he will no longer write a letter of support.

“I felt blindsided; and there were no policies, no grievance boards and no mechanisms in place to protect us,” Dr. Schuster said when I spoke to him last week. There is no anger in his voice when he talks about his experiences. “It wasn’t just me, nor was it just the places where I was learning and working. There were a lot of doctors who had the same experiences as I did all over the country.”

Five years ago, Dr. Schuster was recruited back to Harvard after working for many years on the West Coast. Much has changed. The medical school and hospital where he was once encouraged to remain in the closet has now embraced him, as well as his spouse and his children. There is now an active support group for lesbian, gay, bisexual and transgender patients, families, employees and clinicians; Dr. Schuster originally delivered his essay as the featured address for its major annual event. In the wider culture, popular Web sites like the “It Gets Better” campaign feature LGBT doctors talking openly about their lives to help young people get through their teenage years.

“I have been very lucky that I can live and work in a place that is supportive,” Dr. Schuster said. “But I wrote this essay to help people remember. Because the world has changed so quickly, it’s become easy to forget that for many clinicians and patients who are lesbian, gay, transgender or bisexual, things haven’t changed at all.

“My experiences wouldn’t seem so quaint to them.”