NHS update on recording patient sex and gender identity

It's Chesterton's Fence.

I was a statistician in the NHS for years. Every piece of information collected had to be justified, we had to have a reason to share any piece of information.

No information is printed and shared randomly. If sex is on a wrist band its there for a reason. It may not be needed 99% of the time, but when it is, is crucial that everyone knows where to find it.

As much as they can, yes. Which means that I do get called "Ma'am" quite often, by people who have no reason to know yet that I'm trans, but then they correct themselves once they see me. I've certainly never run into anyone giving me a hard time because I'm trans. At worst, I keep getting called "Ma'am" by those specialists who see pretty much only women, and I can deal with that.

For example, a classic one is when I go and get blood samples taken. The receptionist sees me ("Sir"). Then she prepares the paperwork and sets is aside for the technician to pick up. I go in the waiting room. Then the technician arrives, takes my paperwork and goes calling for "Madam Seethlaw". I get up, they go, "Oh, sorry, Sir." And that's it. Note that if I wanted to avoid this, I could discreetly ask the recpetionist to make a note on my paperwork to call me "Sir". But I feel like this would call more attention to my being trans than a single "Ma'am", so I can't be bothered.

The only time it got weird was when I went to see a new gynae, and he didn't clock that I was a trans man. He was very visibly unhappy, until I clarified which equipment I'd been born with. Something, incidentally, which wouldn't have happened if there had been a "Sex at birth" field in my record. As it was, he could only go on with my NHS number, which as we know can be modified.

"Are there any good reasons sex is printed on wristbands?"

They shouldn't be. ISB 0099 is the standard for wrist band ID. There should be four identifiers: Forename, Surname, Date of Birth, NHS number.

Unconscious patients get wheeled into single-sex wards. If in doubt check wristband.

I do not have a gender, I reject gender. Gender is sexist stereotypes - obviously anyone who looks at me and is sexist will assume a gender for me because my sex is obvious, but non-sexist people will not and won't need to as gender is irrelevant, they will merely perceive my sex and get on with their day. I want my NHS records to have my sex clearly and visibly indicated to anyone who sees my records because they need to know whether to compare the levels of various things being detected in my blood samples etc against male or female averages to know what is elevated/insufficient. I want any "gender" box to be blank and always blank and never automatically filled in with the gender that a sexist person would expect from my body type, because there is no need for anyone who is treating me to know anything about the extent to which sexist stereotypes (ie gender) apply to me.

The idea that sex should be something private is very silly and it would be irresponsible and unprofessional for anyone working in healthcare to aid anyone in keeping it a secret, it would be openly encouraging malpractice failures with someone being given the wrong treatment for their body type. A female who has had drastic cosmetic surgery and takes huge testosterone doses is not the same as a male and needs to be treated by a clinical team who know them to be a female who has had drastic cosmetic surgery and takes huge testosterone doses. A male who has had drastic cosmetic surgery and takes huge oestrogen doses is not the same as a female and needs to be treated by a clinical team who know them to be a male who has had drastic cosmetic surgery and takes huge oestrogen doses. The NHS clearly knows this, and isn't afraid to say so any more.

I personally think it would be much more healthy for these people to acknowledge that they can’t change their biological sex. I’m tired of people falling over themselves to prop up their false beliefs and walk on eggshells around them, and demonise anyone who won’t, like Sandie Peggie, the Darlington nurses and Jennifer Melle.

I fully agree. We have to stop pandering to this damaging idea that people can change their sex markers. All these loopholes will need to be closed.

I would hope that you enjoy the best of both worlds? Sex based care based on your medical status and respectful treatment according to your preferences, as long as it doesn't compromise your health care?

For clarity, sex is printed on wristbands and sample bottle labels because it’s a helpful pillar in safeguarding?

And safeguarding is stronger when we take extra opportunities to distinguish men from women, and therefore we should do so even if there’s no direct need to distinguish between the sexes?

Sadly, after a few years of being 'woke' to this ideology, I think you are correct.

You’ve not really given any valid reasons why there should be some sort of omertà on people’s sex in their medical records beyond the idea that it might give some a fit of the vapours. Many have pointed out to you that if there was such an omission it could lead to not just suboptimal, but potentially dangerous, treatment outcomes for trans people. There is no justification for making medical record keeping more Byzantine than it already is (as anyone who lives in area with split NHS trusts can attest), and to be quite honest someone who can’t cope with the idea that such information is part of their confidential medical records is not a person who is mentally sound enough to be making important decisions about their own healthcare, and should be provided with the psychological support they so obviously need for their worryingly poor mental health.
Basically, what you’re arguing for is deeply irresponsible.

The information on a wrist band isnt just random. Its all useful information needed.

Abusive men are trying every trick in the book to treat sex as if its confidential information because they are trying to remove sex for safeguarding.

Their aim is for adult men to be in spaces with girls and women. They will use any opportunity.

If sex isnt routinely acknowledged it eventually becomes taboo to ask.

If we trust men to tell HCP their sex when its relevant, are we going to trust men to reveal their sex in single sex spaces? Why leave it up to abusive men to judge when information about sex is relevant?

it was prompted by your post but not directed to you.

If clinical decisions about test results from samples are made only reference to the information on the label then sex on sample labels would be needed. (I suspect decisions are not in fact made only by reference to the label.)

Are there any good reasons sex is printed on wristbands? Open question to all.

No, it is never appropriate for the sex field to deliberately show incorrect information. “Trans women” are male, not female. And “trans men” are female. The idea that you think it would be acceptable to lie demonstrates your clear bias and agenda here.

Is this in reply to me? I'm talking about specimen samples, not wristbands.

Exactly. It’s the last card they have to play.

Samples go to a lab. The clinicians there will, I assume, have baseline data that they measure what they're testing for against. Some of the measurements will be different for each sex. What's within normal parameters for men might indicate a problem in a woman and vice versa. It's possible that because the NHS no., which used to indicate sex, can no longer the trusted it has to have its own field. It may be that sex was always recorded separately. I think it's imperative now that it has its own field.

Name and date of birth are for identification; they key to the medical record. And they are checked, for example, before providing medication.

But I don’t see why sex has to be on a wrist band. What are the good reasons for this?

I have my annual health check this week and the GP's receptionist gave me a urine sample bottle, on which she had printed out and stuck a label indicating my name, NHS number, dob and sex. On demand is going to have to include receptionists, who are no doubt aware that all information about a patient is strictly confidential.

You do know that, on occasion, ICU nurses round a corner and see a fully dressed patient, still with shoes on, still on a trolley, having a tube shoved down their neck to save their life? The patient is so ill that they've just been whipped up from A&E and treated without any history, any medical information except perhaps their name and date of birth.

It is vital that people aren't wasting time working out whether to treat them as Tom or Tracey.

We aren't talking about minor cosmetic surgery here, we're talking about life saving measures.

Why are you happy to reveal your birth sex to strangers on the internet but not to doctors providing you treatment?

You're getting frustration as you present no credible arguments. Apart from the risible "I want my birth sex kept confidential so the NHS should compromise all record keeping in order to pander to me".

Arguing that birth sex should be confidential is laughable. It's part of a stream of laughable nonsense demands coming from transactivists (TWAW etc) and I understand that they've got used to compliance due to the "sacred caste" syndrome.

It's anti social and disrespectful to the rest of society to spend so much time trying to mould systems for such a niche fantastical belief that birth sex must be kept secret. It's toddler level magical thinking and has no place in society or in influencing aspects of health care.

Absolutely right. And when you have substandard medical care as a result, be sure to thank @MashaPav for prioritising your feelings over your health.

accessible only on demand

Accessible “on demand” is fine: have a little black square you have to click on (like they do on Reddit) if you must. Who cares. But all clinicians need access to that information like they do to all other medical information at their own professional discretion. We cannot have a situation where for some providing treatment, clicking on that little black square says “error: denied: this information is not available to you due to patient privacy”. At which point, what value is the little black square? “On demand” is mere semantics, if it is provided on demand to everyone entitled to see a patient’s medical record, as in fact it must be.

I've stated multiple times in this thread that I'm female and that my birth sex is female. Referring to me as "he", while calling me "whiny" is a personal attack rather than a discussion of the issues, and it's disappointing behaviour from someone who has identified themselves as a retired clinician. It is also telling that you have chosen to imply I am male or trans as a rhetorical tactic to undermine my credibility.

If you have a substantive response to my points about patient privacy, confidentiality and information governance in healthcare, I'm happy to discuss those.