Thread for discussing how women can ask NHS for female HCPs

@RedToothBrush thank you for that detailed post.

I am currently pregnant again and going through NHS maternity services and my experiences in my first pregnancy massively reduced trust in the doctors and the policies in that area of medicine. There seem to be real problems with coercion, not properly explaining risks and benefits to women, patronising them and generally undermining their confidence in themselves and their bodies. I have countless friends who have had traumatic birth experiences after being induced for reasons that aren’t even in the NICE guidelines and aren’t evidence based.

There is definitely a wider issue in the way the medical profession treats women.

One thing that I was thinking about earlier is how it can actually be quite intimidating to ask for female care in the first place. I remember during my last pregnancy hearing the lady in the cubicle next to me being told she should have a sweep and the male midwife then doing it. I remember thinking ‘oh gosh if he asks me, I don’t know if I’ll be brave enough to say I want a female midwife, but also I really would rather a woman do it’. To have that request then be directly disregarded by a trans woman arriving, would just be impossible.

Plus, you’re also in the position of needing medical care for whatever reason. There’s an element of ‘don’t bite the hand that feeds’ - you don’t want to be denied the care you need, or worse, entrust your person to someone who you might have pissed off, so there’s an immediate power imbalance there too.

Many women who prefer female practitioners will make arrangements ahead of time to ask for them, e.g when booking an appointment. I’d be devastated to request a woman do my smear test and turn up and that woman be a trans woman. It would totally destroy my trust in the services offered.

On the one hand, it took an amendment by feminist MPs in Scotland (#sixwords) to insist that raped women had a legal right to forensic examination by a woman not a transwoman "for the word gender subsititute sex"

I didn't know about that, but also cant understand why an amendment would be needed as it is in fact the treatment and support of women who have been raped that are given as example of when the SSE apply.

Or is this just part of Scotland thinking that aren't covered by the UK wide EA until they were challenged by the UK Government?

I haven't been on the other threads (or rather I couldn't keep up) but this seems really important and as an issue has come up on other threads.

The reality as Labour keeps telling us by referencing "safe spaces" there is a legal route to have women (biological) only service provision. The problem is too many health services have been Stonewalled and accept the misrepresentation of SSE being based on sex.

• The Equality Act allows for the provision of separate or single sex services in certain circumstances under ‘exceptions’ relating to sex.
• To establish a separate or single-sex service, you must show that you meet at least one of a number of statutory conditions (set out in this section of the guide) and that limiting the service on the basis of sex is a proportionate means of achieving a legitimate aim. For example, a legitimate aim could be for reasons of privacy, decency, to prevent trauma or to ensure health and safety. You must then be able to show that your action is a proportionate way of achieving that aim.
• There are circumstances where a lawfully-established separate or single-sex service provider can prevent, limit or modify trans people’s access to the service. This is allowed under the Act. However, limiting or modifying access to, or excluding a trans person from, the separate or single-sex service of the gender in which they present might be unlawful if you cannot show such action is a proportionate means of achieving a legitimate aim. This applies whether the person has a Gender Recognition Certificate or not.

The sad part being that some of us will have memories of when this would have been the normal approach, and sadly shows how the TRAs have been so sucessful.

So maybe it is going to take a campaigns specifically on this area of service provision.

And whilst some NHS trusts will say it is financial issues that means this cant happen, this isn't true if male doctors / nurses are not normally pary of certain health procedures but TW are.

Sadly it is going to take years if not decades to undo the damage Stonewall have done.

(I quoted the EA as explained by the EHRC in case anyone writing to their MP or whoever might find it useful to quote. https://www.equalityhumanrights.com/equality/equality-act-2010/separate-and-single-sex-service-providers-guide-equality-act-sex-and

IANAL and I'm not sure what legal rights we have in this. On the one hand, it took an amendment by feminist MPs in Scotland (#sixwords) to insist that raped women had a legal right to forensic examination by a woman not a transwoman "for the word gender subsititute sex"

But on the other hand, if a GP surgery employs a male nurse to do cervical smear tests and does not offer a female alternative (which a poster raised on another thread, and I am so sorry for that) then that does sound like illegal sex discrimination. Especially if that stops women coming forward for screening.

For intimate examinations/treatment I would rather be seen by a female HCP although I have been treated by a male gynaecologist in the past and he was fine. What does bother me from the issue above about an expressed wish being followed in the NHS is that faced with a transwoman I would be worried about their underlying motivation to be trans. I know not all will be AGP but a good proportion are.

Thanks for this great thread.

It is so revealing to think about consent in the context of trauma and threat responses. Women very often have trauma-related reasons to say no to a male Dr. This is a form of 'flight' response, ie to get away from a situation that feels threatening to her.

We now, unbelievably, have a situation where that trauma response becomes the subject of a moral judgment, ie branded 'bigotry'.

@RedToothBrush thank you. What an excellent post. As a fat woman I have often avoided seeking unrelated healthcare because of the anticipation (from extensive experience) of medics shoehorning unasked for, unnecessary and unhelpful advice on dieting. The assumption that I am not aware that I am fat, nor that it may impact some areas of my health, or that eating less equals weight loss is infuriating and distressing.
I am/ was a senior nurse educated to degree level with a lifetime experience of diets and a truly encyclopaedic knowledge of the calorie content of every possible food but all they see is fat woman, must be stupid.

@OuterSpaceCadet thank you too. A topic which is much on my mind given I need surgery in the near future. Also your explantation of freeze, disassociate and appease which is exactly what I do. I have not seen it written in this way before. I feel better now that I have the words to explain it clearly and simply.

Basically it comes down to issues with behaviour NOT issues with identity.

Dr Margaret McCartney has written in the past about authoritarianism approaches in the NHS in relation to smears and weight. Her point in that pushing to hard on this, NHS policy can cause harm especially to vulnerable individuals by breaking trust and making women feel like they are not being listened to, because the focus is on something unrelated to their primary concern. Example: if you have a concern about your heart that should be the primary thing - being given a scolding about how your smear isn't up to date or that you aren't trying hard enough to lose weight - then you harm the doctor patient relationship and the patient is more likely to simply disengage at risk to themselves. This is poor practice. Taking the time to build a relationship and trust may offer an opportunity to approach these subjects in time, but if a patient says no, that should also be respected and they should not be badgered. McCartney's point was if you go too authoritarian on one thing, it can impact on health in a completely unrelated area - and it might be the area which will kill them, not the thing you were badgering them about.

We saw the same pattern with Covid. An authoritarian approach has the impact of actually driving up refusal rates in certain groups because people don't respond well to this method. Instead targetted soft approaches to key communities by informing and letting people make a choice themselves are proven as more effectively overall.

On a personal level, I had an ELCS for extreme birth fear. There's two types of fear - primary tokophobia and secondary tokophobia - primary is if you have never had children before and second is for subsequent pregnancies ususally with the first having been traumatic in someway. The research into both reveals that they require two different approaches but both centre on building up trust between a patient and the team treating them. Overall, if they request an ELCS, giving permission for one early on builds that early on. Both groups required extra support through the pregnancy. But they found a curious thing. The secondary group, even though permitted to have an ELCS, with the additional support during pregnancy and having rebuilt trust, if they had a robust birth plan a great many of this group changed their minds and went ahead and attempted a VB and even if it didn't result in that, a majority felt much better about the birth and found it healing. And birth trauma may not be a result of a terrible physical birth - it can be purely psychological and - all about not being involved, being out of control, being belittled and disrespected.

My point being and Margaret McCartney's being that the doctor patient relationship rests on patient trust and how the patient feels being centred. Better outcomes and recovery times across the board in all manner of areas are associated with care where patients feel respected, listened to and involved.

If NHS policy is to totally ignore patient concerns over trust and being respected in terms of their wishes they are actively and knowingly going to harm patients because this pattern is so well known in medicine. Thats why doctors are supposed to be trained in ethics and bedside manner.

This ISN'T a trans issue as such. Its a trust issue.

My issues with doctors are closely linked with power and control issues and having a problem with paternalistic and patronising attitudes to me. The dynamics of a doctor having a status over me and feeling like there is an imbalance of power is at the heart of my concerns.

And this is why women are particularly vulnerable across the board. They are conditioned from birth NOT to assert themselves and not to challenge when they feel uncomfortable.

If I'm honest here frankly given my experience and my awareness of power dynamics with the trans issue, and then seeing a case like this playing out in a court, its not really lending itself to being willing to put myself in a situation with a doctor I felt was fundamentally sexist and willing to call me 'aggressive' because of my long documented anxiety issues. I am ill, not angry. Deesculation by listening should come before barring a patient. Quite frankly its unprofessional and lacking in understanding of the importance of trust issues and power imbalances between doctors and patients to be suggesting otherwise. Upton's conduct in court, undermines trust in ALL trans doctors because there is such militancy on the subject and Upton's words are being validated and replicated by multiple people on online forums that anyone can see - it ISN'T just Upton as an individual. Its the collective militancy against female patient autonomy and trust.

Ironically if someone declared themselves as trans from the outset and was fine with me being gender critical, I'd be much more open to be treated by them, if I woman wasn't available. Because they've seen me, respected me and understood that a difference of opinion does not equal hate nor wishing them harm - because its about issues with power dynamics and treating individuals as individuals. Be my equal, reassure me and it will be recipricated. Be prejudice towards me or lie, and it'd be a hard no.

It is the very act of deception, authoritarian over riding of my feelings, a lack of empathy and the denial of the realities of sex that are the problematic part. Because those are where the power issues and trust issues lie. Not the fact someone wants to dress/live a certain way. Live how you want, just don't force me to comply or for it to have a negative impact on me. Time and again we see 'be kind' as a total one way street - thats not equality and it needs to stop.

Crucially, if someone has a different religion or culture or colour of skin, thats not overriding or affecting that delicate balance of power and trust. As a patient I am there to get medicial help, I am not there to provide validation for a staff member. And thats the point. Mutual respect and empathy.

The second that a patient is used as a tool for validation in ANY WAY by a staff member, thats where the line has been crossed between centring the patient and instead switches to centring the staff member. That includes pronouns.

Honesty and transparency HAS to be central. If you lie about ANYTHING, you lose that. Not just for you as an individual doctors, but for all the others doctors you work with. Everyone after has to spend a lot more time restoring that.

Any doctor (and this includes others who facilitate lies), shouldn't be treating patients if they dont understand this as they risk harming vulnerable patients. Anyone in management who fails to recognise this, is undermining safeguarding protocols and well stood principles about how good relationships mean quicker diagnosis, quicker recovery and quicker discharges - in other words they are cost effect in the long term.

None of this is progressive to ignore how patients feel on this and to ignore the reality that women ultimately have good reason to distrust ALL males on an instictive level and asking them to ignore this instict just isn't workable nor in the best interests of absolutely anyone.

Without prejudice to whether a female chaperone should be an acceptable compromise, I see no reason whatever to suppose that a trans HCP and a trans chaperone should not sometimes coincide.

a while ago a woman put a sign she’d made on her hospitalised mother’s noticed board saying “female only carers” with the relevant legislation at the bottom of it.

she laminated it so it was compliant with infection control.

The details are lost to me - can anyone remember this?

I can't see a scenario where it is likely that you would have two trans practitioners in the same room as you. Or a male and chaperone being a trans woman etc

The likelihood is determined by the number of trans identified men on the shift, not the number of trans identifying people the general population, though.

If one or more professional on the ward is a trans identified male, it means that these scenarios will happen. To avoid it happening, the hospital will have to treat these professionals as male.

If a clinician offered me a chaperone before treatment, it would be reasonable to expect a woman chaperone. Its reasonable to expect a high number of women working in healthcare, its not demanding the unusual. I shouldnt have to clarify, and i shouldn't be put in the position to be vulnerable in a room with two men.

It shouldnt be up to patients to know the language of trans ideology or to understand and work within HR policies. If HR policies clashes with patients rights and expectations, thats something for management to have anticipated and dealt with long before patients are involved.

KJK had a female on her show that was offered a chaperone, for an intimate exam with a doctor she had known for a decade and said chaperone was a man pretending to be a woman.

She only knew because she could see his huge feet during the exam.

@OuterSpaceCadet I can only really speak for myself. Working it through, it's not the sex that's the issue for me but the violation of boundaries. I'm thinking back to my mum's end of life care last summer. She was cared for by a whole range of people, male and female. Each one introduced themselves and each man, without exception, checked that she (and after she lost consciousness, we) were okay with them caring for her in that moment. Every time I replied, "My mum's a nurse. She'd think being a nurse is much more important than what sex you are. Thank you." I absolutely stand by that. I'm pretty sure I'd reply the same if a transwoman asked in the same respectful way.

But blowed if I'd let Dr Upton and his sense of raging entitlement anywhere near her.

Isn't it that for intimate examinations you're always offered a chaperone? There are plenty of małe gynaecologists/ doctors already and I've been to a female GP before who also offered a chaperone.

I can't see a scenario where it is likely that you would have two trans practitioners in the same room as you. Or a male and chaperone being a trans woman etc

I'm not in the UK any more but maybe everyone needs to write to their MP and the local NHS chiefs beween now and before this case restarts. So that key quotes can be referenced on the Tribunal Tweets substack.

I don't know if this helps anyone else, but I have just this moment sent this to my MP:

I have been listening with increasing horror to the evidence given by Dr Theodore (now 'Beth') Upton in the case of Mrs Peggie v Fife, 4104864/20/4. Briefly, Dr Upton is a transwoman (i.e. a biological male) who used the female changing room of the hospital at which he worked as an A&E Doctor. Mrs Peggie, a female nurse of 30 years experience, is alleging sexual harassment, harassment related to a protected belief, indirect discrimination and victimisation. The hospital and Dr Upton are co-respondents.

Dr Upton gave evidence on Monday 10th February to the effect that he would proceed with an intimate examination on an unwell female patient who has already requested same sex care. He would only desist if the patient both identified that he was male and refused him in person. His position fails to take into account that:

1. The patient's consent is predicated on same sex care. Dr Upton is both legally and biologically male. This examination would therefore be assault.
2. The refusal requires that the patient recognise that he is in fact male. Whilst this is normally obvious, the patient's ability to assess this may be impaired by the injury or health condition that has brought her to A&E; by a preexisting impairment such as a learning difficulty or visual impairment; or by drugs or alcohol. She may also simply be too intimidated in the moment to refuse.Patients who are unable to make a snap judgement that he is in fact male (or lack confidence in that assessment) could therefore be subject to an examination on terms they have already refused.
3. It underestimates the sheer courage needed to challenge a doctor who is claiming to be female when the patient has already requested same sex care. Given the inherent power imbalance between a doctor and an acutely unwell patient, particularly in an emergency setting, this is both exploitative and highly unrealistic.

Dr Upton has also made clear that any such refusal would be an act of bigotry akin to declining a doctor because of their race. This matters, because this would normally be documented on the notes and could be grounds to refuse a patient care. Again, the power imbalance here is real, significant, and would make it very difficult for a woman to refuse him.

It is not consent if we are afraid to say no.

I hope you appreciate my horror at this situation. If you do, I would be grateful if you could table the following question to ask the Health Secretary:

"What does a woman requesting same sex care for an intimate procedure have to say to ensure that she is not treated by a man who identifies as a woman, without being assessed as a bigot?"

I look forward to your response

I freely admit to pinching the best bits from posts from the very many articulate and outraged women on the other threads.

edit - sorry wrong thread!

I've asked for the above picture to be deleted, this one has names and numbers removed.

You can request a change of healthcare professional at any time without having to give an explanation.

In this situation if you felt strongly you could simply request someone else, you would not have to say why.

The GMC have got themselves in a mess. This confusion in their systems is indicative of that.

IMHO they should collect and publish doctors’ sex and trans status, because that is what patients need to know. So doctors should accept that. They have accepted in the past (before trans became an issue) that it was fine the GMC published whether they were male or female, so really this would just be an updating their approach and systems to take account of modern mores.