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There's a specific type of news story that works like a Rorschach test for whether you believe in the official version of reality that institutions present, or the messy, underground reality of actual human beings. The recent case of Dr. Samuel Stefan, a colorectal surgeon at Queen Alexandra Hospital in Cosham, is a perfect example. The headlines are all about a "doctor struck off after stripping naked in a toilet and propositioning a colleague." It's framed as a story about a predatory surgeon and a bunch of shocked, innocent victims.
But if you actually read the Medical Practitioners Tribunal Service (MPTS) report with any kind of awareness of how the modern world works, you'll spot a massive hole in the story where a very popular yellow-and-orange smartphone app should be.
The tribunal tells us that Dr. Stefan had been "chatting to a colleague online" even though they were "unknown to each other." They arranged to meet in a toilet. The colleague, we're told, thought this was a "mutually convenient place" and "did not plan to have sex" with Dr. Stefan. When the cubicle door opened to reveal a naked surgeon beckoning him over, the colleague was "shocked, numb, and scared."
Let me just pause here to appreciate the absolutely wild level of benefit-of-the-doubt the MPTS is giving this situation. We're apparently living in a world where the Medical Practitioners Tribunal Service believes that two men who've never met, after chatting on some unnamed internet platform, regularly arrange to meet in a hospital toilet cubicle to do... what, exactly? Exchange sourdough starters? Talk about the finer points of laparoscopic mesenteric excision? Compare notes on the hospital's pension scheme?
If you follow the link to the actual MPTS ruling, you'll come across gems such as:
Sounds silly?
Sorry, Mr. A, it sounds retarded. But I'm impressed at the chutzpah. Maybe he wanted to apply mouthwash to your cock too, to be extra safe. You "get to know each other" in public toilets in much the same way that "Netflix and chill" involves ardent attention to the best of the Silver Age of television.
Of course, there was catfishing involved:
Unless the "online platform" was LinkedIn and the "chat" was about a job opening in the proctology department, there's exactly one reason why two men who don't know each other arrange a meeting in a toilet stall. That reason is Grindr. And the main purpose of a Grindr meeting in a toilet stall is definitely not a "mutually convenient" chat.
The tribunal's choice to just accept the colleague's claim of shock at face value suggests one of two things. Either the MPTS members are literally the last three people in the UK who don't know what a hookup app is, or they're putting on some kind of elaborate legal performance where everyone pretends the "victim" was just an innocent bystander who stumbled into the world of public sex by accident.
If you're a man and you arrange to meet another man in a toilet stall after an anonymous internet chat, the "naked" part of the reveal is usually what "meeting" means. The idea that this was some kind of ambush on an unsuspecting guy requires us to believe in a level of innocence that would make a Victorian governess look like a hardened cynic.
And yet, this is the story the tribunal went with. Why?
Maybe it's because the legal system just doesn't have the right words for "misunderstood sexual subcultures." In the official world of the General Medical Council, there are only Doctors and Patients, or Harassers and Victims. There's no category for "Two guys who tried to have a quick hookup during a shift, but one of them got cold feet or thought the other was being way too weird and decided to blow the whistle to save his own ass."
To be totally clear, Dr. Stefan sounds like a nightmare. The report lists other incidents where he tried to kiss colleagues or repeatedly touched the genitals of junior doctors on the wards. Groping people while they're trying to do their rounds isn't a "misunderstanding of subculture." That's just being a sexual harasser. If the tribunal wanted to strike him off for the ward-groping alone, they would've had an open and shut case that didn't require them to pretend a toilet meeting was some kind of platonic coincidence.
But the toilet incident is the one in all the headlines. It's the "deplorable behavior" that the public finds most shocking. And because it's the main charge, the tribunal has to treat the colleague's story as the gospel truth. They have to believe that a grown man walked into a toilet to meet an internet stranger expecting a perfectly normal, non-sexual encounter.
This creates a really weird set of incentives. If you're a junior doctor and you get involved in some risky, slightly unprofessional behavior (like meeting a senior colleague for a hookup in the hospital)*, and it goes badly, your best move is to claim you had no idea what was happening. You have to play the "shocked and numb" innocent to avoid getting caught in the fallout from the other person's misconduct. The tribunal, meanwhile, has to go along with this performance because admitting otherwise would mean acknowledging that NHS hospitals are places where people have complicated, messy, and sometimes illicit sex lives.
The MPTS is obsessed with "public confidence." They mention it specifically: "The Tribunal was of the view that public confidence would be undermined if Dr. Stefan was permitted to practise."
Public confidence is a weird thing. It's rarely based on actual truth, it's based on keeping up a certain appearance. The appearance here is "The Medical Register is a Sacred List of Saints." If the tribunal admitted that Dr. Stefan and his colleague were probably engaging in a common, if risky, gay subcultural practice, it would mess up the appearance. It's way better for "public confidence" to pretend that Dr. Stefan is a lone predator lurking in toilets, jumping out at innocent men who were just looking for a "mutually convenient" place to stand around.
Why did such a murky outcome where neither the primary accuser or the defendant come out smelling of roses collapse into such a binary outcome? We might prefer thinking about it as legibility, in the same sense as Seeing Like A State. The state and its institutions (like the GMC) need the world to make sense in a certain way. A "predatory doctor" makes sense. A "messy situation involving two men, a hookup app, and a complete disaster of professional boundaries on both sides" doesn't make sense. It's too complicated. It raises too many questions about what else is going on in those toilets. It suggests that the hospital isn't just some sterile place of healing, but somewhere humans with hormones and smartphones actually exist.
(And absolutely don't ask about what happens on the beanbags, the ones in the mess)
Watch what happens when you try to tell the truth:
"Dr. Stefan and Mr. A met on Grindr for a bathroom hookup. When Dr. Stefan turned out to be older and a different race than his profile pictures, Mr. A got uncomfortable and left. Later, when Dr. Stefan was under investigation, Mr. A decided to protect himself by claiming he never intended a sexual encounter."
Now what? Now you have to ask: Is catfishing someone on Grindr professional misconduct? Is meeting a colleague for bathroom sex professional misconduct, or only if one person changes their mind? If Mr. A was also planning to have sex at work, does he also get sanctioned? What's the standard? How do we enforce it?
This is all rather inconvenient. Messy.
So the tribunal goes with the version of reality that makes the most sense in their framework, even if it's the version that makes the least sense to anyone who's lived in a city in the last twenty years. They treat the colleague's "shock" as a medical fact rather than a legal move.
We should also think about the "timeline concern" the panel mentioned. Dr. Stefan was already under investigation for the toilet incident when he allegedly went on to grope people on the wards. This is where my sympathy for the "he was just a guy on Grindr" defense completely disappears.
If you're a surgeon and you've just been caught in a toilet cubicle with your pants down, and the GMC is breathing down your neck, the rational response is to become the most celibate, professional, and invisible person in the history of medicine. You should be the guy who won't even look at a colleague's thigh, much less touch it.
The fact that Dr. Stefan apparently kept making unwanted advances while actively under investigation suggests a level of impulsiveness or lack of reality-testing that's genuinely incompatible with being a surgeon. Surgery is all about extreme impulse control. It's the ability to stand still for six hours and make movements measured in millimeters. If you can't stop yourself from grabbing a junior doctor's genitals while the medical board is literally in the middle of deciding whether to end your career, you probably shouldn't be holding a scalpel inside someone's abdomen.
So yeah, the guy had to go. Getting erased from the register was the only possible outcome. Even if there's no evidence that he was a threat to the general public (or an incompetent surgeon), he certainly was a menace to any nearby twinks, and not a great colleague.
(This is dry British understatement, before someone gets their knickers in a twist)
But I still can't get over the toilet thing.
I keep imagining the tribunal members sitting around a mahogany table, reading the transcript. One of them says, "So, he met a man he didn't know in a toilet stall. Why would he do that?" And another one says, "The witness says it was a mutually convenient place. Maybe the library was full?" And they all nod seriously, recording in the official judgment that this was a believable and logical chain of events.
There's a real cost to this kind of institutional blindness. When we force people to lie about the context of their lives to fit into the "victim/predator" binary, we lose the ability to actually regulate professional behavior effectively. If the NHS wants to stop people from having sex in the toilets, they have to admit that people want to have sex in the toilets. They have to deal with the reality of workplace culture, the stress of the job, and the way technology has changed how colleagues interact.
Instead, we get this whole show. We get a "Digital Reporter" (are there any analog ones left?) writing about "deplorable behavior" like we're still living in 1955. We get a tribunal that pretends Grindr doesn't exist. And we get a medical register that's "protected" from a man who was clearly falling apart, but for reasons the tribunal is too "proper" to actually spell out.
Dr. Stefan didn't show up to the hearing. He offered no remorse and no attempt to fix things. He's basically vanished from the profession, likely on a one way flight to Romania. Maybe he figured there was no point in showing up to a trial where the fundamental premise of the "crime", the toilet meeting, was being discussed in language that had nothing to do with the reality of what actually happened.
In the end, the system worked. A surgeon who didn't have the basic judgment to function in a professional environment was removed. The "public confidence" has been "maintained." But as I read the article, I can't shake the feeling that the only person who's truly "shocked, numb, and scared" is anyone who expects our public institutions to have even a basic understanding of how modern humans actually live.
Queen Alexandra Hospital will keep on functioning. The toilets will stay "mutually convenient" for all sorts of activities. The GMC will keep striking people off using the moral language of the mid-20th century. And the rest of us will keep reading these articles, squinting at the space between the lines where the real world, messy, sexual, and mediated by technology, is hiding in plain sight.
It's a comfortable fiction. It's a world where doctors are either saints or monsters, where toilets are just places for quiet reflection, and where online chatting between strangers is always leading up to a polite conversation about the weather. It's a world that doesn't exist, likely never has, but it's the only one the MPTS knows how to deal with.
*It's worth noting that Stefan was a SHO/Senior House Officer. That's an antiquated but commonly used term, and it absolutely doesn't mean a doctor very high up the totem pole. That doesn't necessarily mean that he wasn't senior to many people, but they'd have to be interns of one flavor or another.
Updated version on Substack, with a few juicy extras.
My girlfriend and I live right next to a shopping centre. The public toilets are on the second floor, and owing to their relative seclusion (you have to walk down a long hallway, at least a hundred metres from the nearest shop) are a popular spot for gay men to meet up for dogging/cottaging. They're generally used not by out-and-proud types, but by closeted gay men with wives and children who wouldn't be caught dead setting foot in a gay bar. Standard procedure is for these men to find an empty cubicle, open Grindr, and camp until a willing participant makes themselves available.
When I mentioned this to my girlfriend, she was appalled. It never ceases to fascinate me, the kinds of behaviours that are seen as perfectly normal within the gay community, and what straight people think of them when confronted with them. The gulf between the sanitised "love is love" omg yass queen slaaay portrayal of the gay community, and the gritty reality (of rough sex in public toilets between two men who met each other all of two minutes ago, literally don't know each other's names, at least one of whom presents himself as straight and has a wife and children) is almost incomprehensibly vast.
Most important question is, how do you know this? Especially the exact standard procedure?
I experimented with Grindr many years ago and was invited to a toilet cubicle in this shopping centre by an Irishman in his forties, who I can only assume had a wife and children. I decided I'd rather be sodomised for the first time by a handsome Brazilian in an actual bed in an apartment.
I just realized that the secretly-gay-family-man phenomenon is a complete mystery to me. Not the sex part, but the family-raising part. What's in it for them?
From a female perspective, so much of heterosexual family/married life seems like a hugely complicated problem of channeling the flow of male sexual appetite to incentivize prosocial behavior, like running a complicated steam-powered manufacturing plant or something. Yet this mid-40s Irishman signs on for (at least some part of) the burdens of married life with no libidinous prompting at all, no little penis angel goading him at any point? Even for someone from a conservative culture, can it be worth going to that level of heroic effort just to convince your mates that you're really, truly not gay?
I would never have sought treatment for same sex attraction if family life hadn't had appeal. Raising children(not babies but kids), for one thing. And you do realize that dishes are, like, part and parcel of the whole 'eating' thing? There isn't a universe where chores just don't get done. If you live alone that just means you don't get to split them.
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Some relevant reading -
https://en.wikipedia.org/wiki/Down-low_(sexual_slang)
This is why medicine uses "MSM" (men who have sex with men) because of people who do that, have corresponding risk factors, but deny gayness.
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They might be bisexual. They might want kids. They might be severely repressed and in partial denial, or caved to societal or familial pressure. Or all of the above.
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I suspect that a lot of these men were in denial about their sexuality for decades, and by the time they realised what was really going on they were in too deep. But rather than coming clean, they just pursue anonymous gay sex on the down low.
I get denial temporarily suppressing the Irishman's awareness of desiring men. I get denial making him able to white-knuckle it through successful intercourse with a lady. But like half of the culture war hereabouts is people pointing out that there's no earthly reason a man would ever want to do the dishes, change a diaper or go for that promotion at work, if it weren't for his burning innate desire to also get laid. So here's a person who doesn't even especially desire that, but he's signing on for the dishes and diapers anyway?
Why do men have affairs? I think there's a certain element of "have the domestic life where someone runs the house, cooks the meals, we have a comfortable life together, then for the hot kinky sex I hit that sexy co-worker/neighbour/woman I met while on a work trip" for some guys.
One is the support structure of ordinary life, one is the no-strings attached, no responsibilities, we just meet up for sex and maybe some romance and then I go home to my wife and don't have to have discussions about taking out the bins or whose turn it is to cook dinner with my mistress.
I imagine some MSM men are "yeah of course I like having my cock sucked, everyone likes that, it's just way easier to get guys to do it on a casual basis but that doesn't mean I'm gay".
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Humans are complex beings, even men. Family life used to be the norm and promoted in the media. It's not inconceivable that a man might want a Norman Rockwell family to feel complete and get sexually aroused by muscular male-presenting buttocks. With gay marriage being legal in the US and thus inevitably normalized it has become easier to square the circle, but someone older didn't have this option.
Yeah, there's similar drives behind surrogacy debates, and toward the gay mentor/'uncle' stuff comes from similar sources for men who can't have kids by blood.
It's... not a great situation. Even the best-case scenario for a 'down low' gay guy in a het marriage -- a wife that's aware and accepting, the guy being able to hit her needs, and a limited number of external partners that aren't Catching Feelings -- there's a tendency for them to kinda detonate as often as they work out. And most don't really achieve that level of openness, either out of fear or cowardice about coming clean to the wife, or inability to think with their bigger head if they try to button it up.
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I reckon it's probably a case of a typical-mind fallacy. Growing up, these men would have understood that their peers craved sex with women. The first time they had sex with a woman, it probably wasn't wholly unpleasant (after all, it's a bit like having sex with a man), but they may have felt a certain feeling of anticlimax, a sense of "is that it?" But they probably assumed this is what it's like for everyone, and they've heard so much about how sex is so much better when it's with someone you love. After meeting a nice girl and getting to know her, the sex becomes a bit more enjoyable because of the greater emotional intimacy, even if they can't quite shake the feeling that this isn't exactly what they were led to believe about sex. They assume this is what everyone feels about sex. The idea that they could only feel true sexual fulfilment by having sex with a man never even occurs to them, because as far as they're concerned, they have achieved true sexual fulfilment. Having started on the path of the traditional success script, they continue down it: marriage, mortgage, kids. They suppress the nagging feeling that sex with women wasn't all it was cracked up to be.
Then upon reaching middle age, they experience a sexual awakening. Maybe the wife's out of town, they fire up Pornhub and accidentally-on-purpose open the gay section instead of the straight section; maybe they're in a bar, another man makes a pass at them and they feel not repulsed but excited. Whatever it is, the sexual excitement they experience is nothing compared to that when they were having sex with a woman. All of a sudden it clicks: this is what it must feel like for their male peers when they have sex with women. "The internal experiences I've been having all these years are totally different from those my friends were having when they were having sex with women."
Having had this realisation, the morally upright thing to do would be one of the following:
But these men are stuck between a rock and a hard place: desperately wanting to act on their desires, but not wanting to bring scandal upon themselves or their families, and reluctant to alienate their friends with their newfound realisation. Instead of doing the most or second-most decent thing, they take the maximally cowardly third option: not telling their wives anything, but acting on their desires by having illicit trysts with strange men.
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Was it at least a nice shopping center?
Not at all. Not the worst but nothing swanky.
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