I am Janice Turner's No 1 fan - another excellent article

Don't choose medicine then

I know, selma

On the plus side, I've been looking to change career for a while now ....

I was told by our PSHE lead that if a child were to ask me if a trans pupil was now the opposite sex, and I were to reply that they weren't, I could be in serious trouble

'We have always been at war with Eastasia.'

@theendisnotnigh

Thanks for taking the time to read the training materials. I thought I'd posted a reply to you but I can't see it on this thread.

I completely agree with what you've said about being manipulated, but I didn't realise I had been until you pointed it out!

The sad thing is that those of us who work in schools are in a great position to challenge gender stereotypes but all the focus seems to be on affirming and validating people who want those stereotypes to be even more deeply entrenched.

I was told by our PSHE lead that if a child were to ask me if a trans pupil was now the opposite sex, and I were to reply that they weren't, I could be in serious trouble

It seems truly to be a minefield!

Cross posted with Selma

But does "cannot give such consent" mean that the patient is incapacitated in some way? It still implies that explicit patient consent is required by law to gain the exemption by my reading.

Hi Poppy, I think the key bit in the paragraph you quoted is, "it is not an offence for the disclosure to be made by a health professional if it is made for medical purposes and the person making the disclosure really believes that the individual has given consent to the disclosure or cannot give such consent.

So it is not an offence if it is for medical purposes AND (a) the HCP genuinely believes that consent has been given or (b) the patient is unable to give consent - in which case you would be making a best interests decision under the MCA in the same way as for any patient who lacked capacity.

But (a) and (b) are likely to be very rare scenarios. In most cases, a trans patient will be capable of giving consent. If you disclose trans status without that consent, you are certainly in breach of GMC guidance and potentially committing a criminal offence.

That's really alarming Selma and clearly you have direct clinical experience of this.
This was the paragraph I was basing my info on:
"Statutory Instrument 2005 No. 635 introduced some additional exceptions to Section 22 so that it is not an offence for the disclosure to be made by a health professional if it is made for medical purposes and the person making the disclosure really believes that the individual has given consent to the disclosure or cannot give such consent. ‘Medical purposes’ includes the purposes of preventive medicine, medical diagnosis and the provision of care and treatment. There may still be gender-speci c treatment such as that related to screening for breast or prostate cancer where surgery has not taken place. A ‘health professional’ means a registered medical practitioner, a registered dentist, a registered pharmaceutical chemist, a registered nurse, a person who is registered under the Health Professionals Order 2001 as a paramedic, or operating department practitioner. It also includes a person working lawfully in a trainee capacity in any of the professions specified."
Taken from guideline CR181 by Royal College of Psychiatrists www.rcpsych.ac.uk/files/pdfversion/CR181_Nov15.pdf
Perhaps things have changed since then. I think either way I'd be having a chat with my indemnity organisation before I did anything....

And I am completely outraged that it is a criminal offence to tell the truth about any individual's sex. Not specific to healthcare - it is totally wrong that the state is compelling us to lie.

Yes I agree. This law should never have been passed.

Well, there would be no point referring a patient without his permission - which would have to include agreement to share the information that s/he has a prostate in this scenario. My worry about patient safety when I originally posted was more about delay, especially for suspected cancers, as a lot of these use referral pathways with rigid criteria and tick boxes - if you don't appear to fit the criteria, for example if you are a 'woman' on the prostate pathway, you are likely to be bumped off the urgent referral route and might wait a lot longer to be seen routinely.

And I am completely outraged that it is a criminal offence to tell the truth about any individual's sex. Not specific to healthcare - it is totally wrong that the state is compelling us to lie.

That's incredible selma. So in the case below you'd have to not share with the consultant your suspicion of prostate cancer if the patient wanted to continue to be known only as female ? That seems extraordinary and as if you are being told to collude in a dangerous delusion.

Thanks Selma.

The links that I originally posted about this are here and here

Hi everyone, I am the other doctor you are talking about (have name changed). We have a number of trans patients in the surgery so have had to take advice about this. I am afraid it is not correct that doctors can disclose trans status if relevant to the patient's health care. In fact, in one recent case in Scotland, a GP was even criticised for disclosing trans status to a colleague in the same practice And it is potentially a criminal offence - see the Pulse article link.

The other doctor who posted about this specifically said that she had been told it was a criminal offence to tell literally anyone else without permission, as pp said. As far as I know explicit consent for anything other than to prevent a serious crime or as part of legal proceedings would be more or less obligatory under the DPA as this is sensitive personal data. Not just best practice. I don't think there is an exemption for medical treatment, they have to consent.

This link seems to confirm this. It's very interesting.

www.pulsetoday.co.uk/your-practice/regulation/qa-recording-gender-in-medical-records/20008359.article

Poppyred85

Thanks for answering. Is it possible to double check that? The only reason I say is because it is in direct conflict with what this other GP said.

She was quite adamant when questioned. Not to mention outraged.

Is it at all possible that she has different guidelines to you?

Thank you so much Poppyred. That's what I suspected re. puberty blockers. I'll try to have a dig around on PubMed.

Retreat
I'm yet to have a patient present to me to request referral to a GIC or have a patient on hormonal treatment but I'm not based in a big urban practice so can't really comment on how common it is. I think anyone who plays down the potential risks of some of these drugs is being somewhat disingenuous. There isn't enough data to know long term about the effects of using these drugs in teenagers but we do know that there are risks associated with their use in other patient populations, including risk of osteoporosis, blood sugar and blood fat abnormalities, liver problems as well as more "routine" side effects such as mood changes, nausea, headaches. It appears that transwomen who use oestrogen therapy are at increased risk of developing breast cancer.
Looking for research is difficult! I tend to use Pubmed www.ncbi.nlm.nih.gov/pubmed/ for literature reviews but that's tricky even when you know what you're looking for and have specific search terms. Sorry I can't be much help in that, and I'm not sure if much research is actually being done in those areas.
Datun
My understanding of current guidance is that we are allowed to disclose to other professionals that someone has undergone transition or previously lived under a different sex/ is still in possession of ovaries etc when it is directly relevant to their health and medical care. As I understand it, to use the example you posted, I would be allowed to disclose to the specialist that I am referring to that while the patient may be Mr X I am concerned about the possibility of ovarian cancer as Mr X has transitioned but still has them. It's also suggested that this is done with the patient's consent and I think that would widely be considered good practice. If I'm referring someone I routinely discuss with my patients why I'm doing it and I think most GPs do the same. My reading about this also seemed to say that transmen who still have a cervix should be included in cervical screening and mammography programmes unless the opt out, but I have no direct experience of this.

They should never have written into law that a person can pretend to be the opposite sex to that extent that they can deceive doctors, the police etc. They could still have had equality and anti discrimination legislation without it. This is where we went wrong.

Poppyred85

I also have a question.

We had a doctor on here earlier in the year who said they were not allowed to divulge the sex of a trans patient when referring them to a specialist, if that patient asks them not to.

In fact it was a criminal offence (not civil, criminal).

It meant that she could only refer them with a note saying this person has a pain in their 'stomach area' (whilst thinking it was ovarian cancer), but could not directly say something that revealed their natal sex.

It was assumed, I think, that no one with an ounce of sanity would want to be ambiguous about their sex if it was detrimental to their health.

But given that the trans-ideology is not characterised by rationality, indeed it is driven by subterfuge and opacity, it seems an extraordinary law to have to adhere to. Time wasting in the extreme.

Poppyred one question (since you're here, hope you don't mind). What is your opinion about prescribing puberty blockers to teenagers? Are the risks as low and effects as reversible as transactivists claim? Have there number of requests increased in your experience?

I'd also like to gauge the number of patients presenting with trans medical issues, including gender confused teenagers, in comparison to the the number of females with MH issues that stem from e.g. sexual abuse, DV. But have no idea where to find properly researched statistics. Do you have any pointers?

Thank you!

Poppyred thank you. That's a really helpful clarification.

Today 11:22 Hayesking

Isn't our actual DNA male or female? Noone can change their DNA can they? The whole thing is mind boggling.

Correct. And yes, it's that stupid.

Yes, very helpful @Poppyred85. Thank you