Thread for discussing how women can ask NHS for female HCPs

Women who are already extra vulnerable (due to being chronically or acutely ill, survivors of abuse, or more than one of the above) just shouldn't be being put in the position of having to worry about how to choose the exact right wording in order to not offend and not be painted as a bigot! It is so unjust that this is something women have to fear when already in situations that are very scary and often already retraumatising for various reasons (eg invasive procedures that are essential for care).

A male medical professional gaslighting his patients that he is female follows that same power dynamic and would be extremely triggering.

And those of us who have experienced abuse are more likely to have had a negative response to stating the obvious when someone is lying to us, or not being believed. I often feel as though I'm lying and no one's going to believe me when I'm telling the truth.

This scenario reminds me of my carefully made birth plan which was roundly ignored -- with hindsight for ease of the dept.
In the stress of the moment I felt more unable to speak up than if I hadn't made a plan.
The next times, I didn't make a plan and decided there'd be a discussion as we went along. Still hard to do but I wasn't going into the situation in the knowledge my wishes had been deemed not important/not necessary/not deliverable/impractical, or whatever. I felt I it put me on a more equal footing.

If a woman requests a female practitioner and a male shows up, it could make women feel in a weaker position for feeling able to speak up, her voice having already been ignored.

In the two situations I've had with men at sensitive medical appointment, at a gynae appointment other women had already set a precedent when their name was called by a male doctor to ask for a female. This was immediately respected. I heard the doctor joke in good humour that no one wanted him that day. The fact he'd accepted that women wanted to see a female with good humour made me feel I might have said yes to him on another occasion.

In the second scenario a male doctor was already in the room for an echocardiogram. He offered a female doc or a chaperone. I didn't feel either were necessary and it was one of the most positive and reassuring experiences I've had of a medical examination. It was something about the honesty in him acknowledging that I might have my own reasons for being uncomfortable or distressed at a name carrying out the procedure and making sure he really mitigated for that.

In a situation where there's a dishonesty from the start - a male claiming to be an actual woman, not acknowledging that in this situation his sex may be an important factor to me, then my gut instinct is going to be screaming that something is wrong.

I have written to my local trust asking to clarify the wording I would need to use to be seen by a same sex clinician.

I have pointed out that previously I believed asking for say "a female doctor" would be sufficient but following this employment tribunal it's clear that some doctors understand the word female in a different way to me.

I have offered the wording "of the class of humans whose bodies are designed around large gametes who agree that they are of the class of humans whose bodies are designed around large gametes" but have suggested this is more than a little clunky and have asked for them to clarify to me the words I would need.

I look forward to their response!

Thanks for starting this thread. Three years ago I was diagnosed with endometrial cancer and was treated for it. All the way through I have asked for female healthcare staff, which has been honoured on the whole, although I have had to repeat over and over and over again my experience of sexual assault to justify this. I live in an area with a very high Muslim population, so that could be a factor in the hospital being accommodating. There have been a couple of times I've turned up and there's been a man there, including when I can see it says very clearly on the appointment list female only, but appointments have been rearranged, although that has affected my treatment.

I think people just don't get it, it's not simply a preference, I feel like every bit of my body would just scream out at the prospect because of childhood trauma. It's a neurological thing not just a thinking thing. I've had such bad experiences with men who I was supposed to trust that I can't see how there is any way I could suspend my experience. I have refused cancer checks on the basis that there was only a man there to do it, and I felt he'd been patronising and condescending to me. I've had lots of counselling and I don't think this will ever change, because there are a lot of dodgy men out there, I would be lying to myself if I thought that all men were trustworthy. It makes me feel panicky just sitting on the safety of my sofa thinking about it, and I really worry about getting old and being in hospital and having no control over it.

If I was presented with a trans woman I think I would panic about whether to judge my own eyes, even though somebody was obviously a man, I would question this, and obviously as other people have said be worried about being called a bigot and refused treatment. I do wonder whether I would go ahead and then feel I'd been assaulted.

Hopefully, I am well and stay well, although it would be an issue in the future as I get older.

I find it quite difficult to talk about all this as the experience is pretty recent

The area that's not been mentioned much in association with this case is the care sector, especially for women and children. And especially for disabled women and children. Who suffer the highest rates of sexual abuse.

How can we guarantee single sex provision for our most vulnerable?

If Upton wins this there is no safeguarding in the nhs.

I seem to be very lucky in that my local gp are very clear about offering female chaperones, and they way they say it, I know they mean women.

Really useful thread thank you

Sandie's case is going to have enormous impact across so many areas of the nhs

Not only this we need reassertion of the principle we'll receive HONEST care.

I of course think patients should be able to request single sex care but for me the issue is more about honesty. And Upton would claim he WAS providing single sex care to women because he's 'female', because he's delusional and despite his male anatomy.

I'm actually ok with male doctors for some things (this is personal to me, other women would not be) but what I'm not ok with is a doctor who is forcing me to lie and lying to me. I'd rather a standard male HCP who is honest about his sex than a transwoman. For two reasons: firstly i find it offensive if a TW expects me to lie and pretend I think he's a woman when I don't, secondly many transwomen are autogynephiles and I'm not ok being an unconsenting participant in someone else's fetish. Particularly when receiving medical care, when the focus should be on me and where that TW is being paid to do a job, not have his fantasies fulfilled.

We really need a definitive statement in law that people are entitled to same sex (meaning natal sex) care in all medical settings. With of course some provision for emergencies and life threatening scenarios, but no scope for BS around claims of being "intersex" or "biologically female" due to sex being "nebulous". Somehow this has to be legislated and made absolutely clear. As so often, it's vulnerable disabled and elderly women who are most at risk.

That's really interesting about the Duty of Candour, @CarefulN0w. So much food for thought on this thread already.

I've been ruminating about the NHS Duty of Candour while reading the SP threads.

The professional duty of candour is a professional responsibility to be open and honest with patients and families when something that goes wrong with their treatment or care, causes or has the potential to cause, harm or distress.

Although intended to be about being open with patients and families when things have gone wrong, the underlying principles are openness and honesty. This includes colleagues as well as patients.

As a doctor, physician associate, anaesthesia associate, nurse, midwife or nursing associate, you must be open and honest with patients, colleagues and your employers.(gmc guidance)
There is a whole bunch of stuff on timely reporting of incidents and near misses which doesn't appear to have applied to U or Fife, but that isn't my main point here.

Dr knickers on fire has lied to patients and staff repeatedly and has indicated that he will continue to do so. His lies may have caused distress and harm to patients and certainly have the potential to do so.

It would seem that other staff in the department have also lied to patients and each other, either deliberately or by omission.

It is essential, that people like U are not enabled to mislead patients and families. Other HCP have a duty to stop going along with the fiction of U as a woman. Not only should they not be afraid to be honest, it is crucial that they are to prevent patient harm.

Relevant policies to request if people are so minded would include, consent, duty of candour, chaperoning, dignity and respect and safeguarding.

Thank you for doing that.

My situation is even more complex because of what happened in my family.

I don't trust people who tell me men are women or seek to gaslight me, and it totally undermines my lived experience of how it's affected me.

Trying to 'reeducate' me would add fuel to that.

Effectively if they are only validating identity of one party they simply couldn't begin to help and can only do more harm.

This is why I really feel it's necessary to SEE the coercion and the problems with behaviour that surround affirmation only.

The GMC replies to Baroness Nicholson on this, the said they have to record doctors gender and not their sex. As if patients are looking up their doctors to find out the doctor's special snowflake feelings about themselves, and not an actual fact that impacts patient care. Captured fuckers.

I’ve emailed Sex Matters this evening outlining how worrying this is and asking if they might consider a campaign on the issue of women being able to request female HCPs without fear of repercussions or being ignored.

Yes. I would also contribute to a crowdfunder for a challenge from Sex Matters to the GMC over registering gender not sex for those on the register. A number should stay with you for life.

The world is getting more and more bizarre as Phil Banfield of the BMA (the one whose supposed to be reviewing the Cass Review to indicate the ways in which it is wrong and is full on TWAW) is currently leading a BMA charge against the GMC over confusing language and patient safety (blurring job titles and who 'counts' as a medical professional):

Today, the BMA’s case against the GMC begins, challenging the use of 'medical professionals' and the blurring of lines between doctors and non-doctors - putting patient safety at risk.

https://x.com/TheBMA/status/1889675011968938267

Could someone tell the GMC this? I’ve fed back to them via the email on their web site [email protected] but so far no response.

They used to include doctors’ sex on the GMC Register. A few years ago, they switched it to show gender (So for example, Theodore/Beth Upton is shown as having a female gender). This is confused and confusing, no use to patients.

If the GMC no longer reliably supply this information, where are patients supposed to get it from?

Grrrrrrr.

The blatant co-option of racism in order to shut women up and make them play along with some men's fantasies, in a healthcare setting, gets me raging.

The single sex wards policy in my Trust explicitly aligns women wanting a single sex bay to racists. I'm not at work so can't c&p the exact wording but it's approximately 'just as racism expressed as discomfort will not be entertained, nor will transphobia expressed as discomfort be entertained'. As we've seen from the tribunal, there is no way for women to express that they want a single sex space,that won't get us accused of transphobia. The comparison infuriates me because (aside from being hugely offensive both to women with genuine well founded concerts and to those who actually experience racism and get dragged in as a prop) it doesn't even stand up - racists have never been offered or promised single race wards, that's not a thing the NHS says they have, but women have been explicitly told we will have single sex wards and then when we ask for them, we're smeared as bigots.

My Trust's patient info leaflet says 'you will be cared for in a single sex bay' yet then does a bait and switch because if a man with special feelings wants in, you will be gaslit and called a bigot if you object that you're not getting what we told you you could have. And patients are gaslit - the clear instruction to staff in the policy is that to discuss the trans patient would be breaching confidentiality and result in a disciplinary and possibly reporting to the police as a hate crime . So staff are in an impossible position too, if a patient asks 'is that lady y'know, a lady?' they either risk a disciplinary or lie to that patient's face that there are only women on the ward.

This issue is misogyny on steroids. Women are purely there to validate the male's identity, and are not permitted any feelings of our own other than full affirmation. My Trust's policy is bad but it's not an outlier, I've seen similar from other Trusts.

And yes I have fought it, and the Trust stands by the policy. Pre Forstater the outcome was that I had to go on re-education camp training to learn how to better understand the needs of transpeople (I raised a concern about women yet the response is all about trans, shocker); since WORIADS I've got braver and last time I put in writing that sooner or later something terrible and completely avoidable will happen because of this policy (but only to a woman so who gives a shit right?) and I can't stop that but I have got the paper trail and they will not be able to pretend that they didn't know what the risks were, because I've clearly pointed them out and they've deliberately chosen ideology over women's safety.

This is what institutional capture is. There are no means and no words women can use, to get the single sex spaces we are told we have. We can only have those spaces by chance, if no men currently want them.

That ended up a bit long!

Foran:

Dr Upton appears to be operating from the presumption that there is a legal right to keep information about one’s sex private in the context of providing intimate care and examination to female patients who have requested female only care and who have been told that is what they will receive. This is not accurate as a matter of law.
…
There is no right to keep information about biological sex from patients who have requested female only care, particularly in relation to care involving intimate touching of genitals or where the patient requires intimate care as a result of sexual assault.

https://thecritic.co.uk/patients-have-a-right-to-know-a-doctors-sex/

EDI training should be looking at stuff like how women respond differently to certain situations and why they don't do things like complain and how can you encourage them to do so and to give more honest feedback. It should be looking at how and why paternalistic attitudes in medicine hurt women more than men. It should be looking at how to better inform women about their rights and how to identify when things have not followed protocol. It should be looking at how sex based issues / medical conditions have impacts on every day life in different ways and how we can do better at coping with those as a society so they aren't so life limiting.

But nope. We instead get GI Joe and Barbie, and pink brains and blue brains nonsense which weirdly DOESN'T look at male/female pattern behaviour at all!

Totally nailed it @RedToothBrush. 👏

I’ve emailed Sex Matters this evening outlining how worrying this is and asking if they might consider a campaign on the issue of women being able to request female HCPs without fear of repercussions or being ignored. I am also going to write to the GMC along similar lines.

You’re right that we so often don’t complain or make ourselves heard on issues because women are conditioned to put up with things. If you were exposed to a situation where you felt pressure to accept a trans woman HCP and felt violated by that examination, it could be so so hard to complain - for fear of repercussions, for wanting to avoid reliving the trauma, for struggling to have the ‘right’ language to describe it or perhaps even because you felt that it was wrong for you to even feel violated because TWAW. But in Dr U’s world - no complaints/ no challenges = no problem. And as you say, that’s a pervasive attitude.

Being 'put on the spot' changes the power balance.

If you've been waiting for months for an apppointment and then someone says 'are you ok with a male doctor', then you may well give a different answer than you would if you were asked the same question BEFORE you were put on the waiting list.

In consumer regulation we understand the principles of 'high pressure' sales tactics which include putting customers on the spot by saying 'if you don't buy it now, you'll lose the opportunity/won't get such a good deal' to try and pressure a sale then and there. We also understand issues like trying to make sales in situations where someone feels they have to say yes to avoid upsetting someone or feel unable to say no because the salesman is between them and the exit. We also understand concepts of why you shouldn't make high pressure sales pitches to vulnerable persons, especially when they are on their own.

Because we KNOW that people don't necessarily feel confident to assert themselves or to question things when they are put on the spot BECAUSE THEY FEEL PRESSURED.

Yet this known psychological effect seems to be totally forgotten in medicine.

Personally I really struggle as I automatically go into flight or fight and have trouble expressing myself - to a point where its problematic. Its eased by support and building up relationships.

I now have certain things written onto my notes to try and mitigate this.

The other key point is the lack of understanding of a lack of official comments; NHS Trusts are often under the misguided understanding that no complaints = no problem. It doesn't. You have to understand who complains and why, and also understand why people DON'T complain even when they might be unhappy and what barriers they might face to making complaints.

The really good example of all this, was Bounty sales in maternity wards - it broke a whole pile of issues over feeling pressured but also being unaware of it upsetting huge numbers of women who were complaining about their experience on MN but there were no official complaints. Upon doing so probing it became apparent most trusts were NOT centring the interests of women who'd just given birth not really being in a state to be approached in bed for sales and why being put on the spot was inappropriate and why they weren't complaining.

One of the biggest inhibitors is that women are conditioned to put up and shut up. They 'don't want to make a fuss'. They want to be nice and 'don't want to upset people'. Even if the issue is completely deserving of a complaint.

Keeping in mind how the top decision makers are policy makers in the NHS are male (even though the majority of the workforce is female), and not only that but high achieving, assertive males at that - it doesn't enter heads how women often don't feel they can say no, even when they want to. By the same token, women who work in healthcare are also so used to it, they often don't appreciate how women don't understand the system and their rights and don't know they CAN say no. Or just think they will get second class treatment for being difficult if they say no.

The process of consent and women feeling they have given consent freely needs to be better understand.

Remember the word yes, is not necessarily enough either. Consent is only valid if the yes is made whilst not under 'undue pressure'. And this is part of the ethical conduct policies of the NHS, GMC and various other applicable medical bodies in the UK.

Arguably, if you are in a situation where you feel threatened that if you don't consent to a transwoman you won't get treated because you will be labelled as transphobic, thats technically invalid consent because you've done so under undue pressure... Its not ok.

This lack of understanding of power imbalances, failure to consider things through the eyes of women, failure to understand the ethics of consent and an absence of complaints and how it disproportionally affects women causes its own issues - its definitely a contributing factor behind why we've had so many scandals particularly affecting maternity departments.

Its HUGE. And all this EDI stuff isn't touching on the practical stuff relating to this because its too busy telling women NOT to complain about men claiming they are biological female.