NHS update on recording patient sex and gender identity

I mean, it’s not as though it would take an enormous amount of work to add another response to the list is it? So why isn’t it already there?

Since there are people who feel so strongly about not filling in a box marked 'gender' , a workable solution that could accommodate everyone could simply be a field that is:

Sex or gender (enter either as relevant):

Then there could be an additional option of "birth sex if different to the information entered above" - which patients could either fill out or leave blank.

They are both free to have opinions. Neither of them are free to make decisions about what information about their sex appears in their medical record and who can see it. That's a system-wide decision not a decision for each individual patient to make. Can you imagine the chaos if it was down to individual patients?

However, I absolutely think it’s a step in the right direction overall to have a (mandatory) sex field and (optional) gender identity one so that accurate data can be held for everyone.

Reception, yes, knowing someone’s “preferred pronouns” might be relevant if the person would find it upsetting to be referred to by their sex, but not having the person’s sex available to admin risks appointments being booked or cancelled incorrectly. Most of the other scenarios it would be far more useful to know the person’s sex and if they are taking opposite sex hormones, especially given that not all transgender people do so. Sex affects SO many things in medicine, the safest way is to have it available to all clinicians, not leave it to the patient to decide if it’s relevant to share.

What I'm arguing is that disclosure of information about a person's birth sex should be governed by the same principles as other sensitive information: it should be shared where there is a legitimate clinical need and an appropriate basis for doing so, not made universally visible by default regardless of context.

Where there is no clinical need for disclosure of birth sex, patients should have control over the disclosure of that sensitive information.

You seem to have missed the OP confirming that this is the new NHS process. Finally the needs of the majority in society are prioritised rather than niche demands from a tiny % of people struggling with their GI:

• Gender identity should ONLY be recorded if a person has a gender identity and wants it recorded in their healthcare record and a clinician decides it is appropriate to record it.
• Information about gender identity should ONLY be recorded if a person has a gender identity and wants additional information about it recorded in their healthcare record and a clinician decides it is appropriate to record it.
• Pronouns should ONLY be recorded if a person wants their pronouns recorded in their healthcare record and a clinician decides it is appropriate to record them.

Therefore data is accurate, patients are safeguarded, clinicians are protected from inadvertently treating men and women incorrectly and GI adherents get to have their GI & pronouns recorded

Seems a win win.

Edited to add that of course birth sex is not a special sensitive secret to be hidden on demand.

And you've disagreed with all the arguments that sex at birth is close to a universally needed piece of information in a clinical context. So we'll have to agree to differ on that.

Best to assume that disclosure is going to happen in a medical context to roughly the same extent as your age.

I tell a lie - I'm sure you wont be expected to keep repeating what sex you are in the way that patients are forever having to repeat our date of birth!

But the information will be there and equally visible to whoever needs it.

Best to assume that disclosure is going to happen in a medical context to roughly the same extent as your age.

Yes, I think that is where we are at.
HCPs will, as always, be expected to behave professionally wrt whatever medical or other information they glean from our notes.

I understand the proposed changes; that is precisely what is being debated.

You describe this as a "win-win", but that reflects a misunderstanding of the concern being raised by many trans people. The issue is not simply about having the opportunity to tick an additional box that says "gender". The issue is that some trans people would prefer their gender to be recorded as the relevant demographic information in routine healthcare interactions, with information about birth sex available only where it is clinically relevant.

This is a legitimate request. There are many clinical contexts where a person's gender is more relevant than their birth sex, and where unnecessary disclosure of birth sex may reveal sensitive information without a clear clinical justification. This raises legitimate questions about privacy, dignity and proportionality in the way healthcare data is recorded and shared.

Nor does accommodating these needs conflict with the needs of the majority of patients, for whom sex is straightforwardly recorded and remains an appropriate and relevant marker in many contexts. For most people, a male or female designation on a record aligns with their birth sex and does not create particular difficulties with care or confidentiality.

The question is how systems can work effectively for everyone: retaining access to clinically relevant information where it is needed, while avoiding unnecessary disclosure of sensitive personal information where it is not. Good information governance should be able to achieve both.

I don't think this discussion is becoming any more constructive, as it is clear that we are not engaging with the same underlying concerns. I'm going to leave the conversation here. Thanks to those who engaged with the substance of the issue.

Where there is no clinical need for disclosure of birth sex, patients should have control over the disclosure of that sensitive information.

There is always a clinical need for disclosure of birth sex just like age & medications & previous medical history (PMH) etc etc

We can agree both that sex is disclosed only in relevant clinical circumstances, and that it’s relevant in all clinical circumstances. That’s win-win.

Okay. We’ll have to agree to disagree; I don’t think it’s unreasonable to expect the same freedom of belief to be applied to religion and gender identity, but I can see that you do.

TRA want individuals to decide when and if they disclose their sex.

This is not reasonable.

They are disregarding other patients and professionals making clinical decisions.

Also, as discussed earlier, it makes no sense in practice.

If they passed, how would a patient know if their sex is relevant? Would HCP have to asked everyone to confirm their sex, just to make sure they arent talking with a passing trans person?

If its obvious they are trans, isnt this all patronising?

This is totally unacceptable though. I don't have a gender but I need them to know my sex. If there's only one field I either have to withold this vital information, or lie and claim a gender which I do not have. It is as insulting and demeaning as requiring every patient to declare a religion and not having "atheist" available as an option.

They don’t tell you they do it, they just assign your lady brain for you.

There are only two reasons why a trans person would object to others knowing about their trans status:

• they will no longer feel validated if for example they have to admit to being male since birth rather than being allowed to continue to pretend that they are female
• they don’t want their real sex known because they want to stay ‘under cover’ as the opposite sex - and that can only be for nefarious purposes such as access to other sex spaces etc

I can’t think of any personal information about me where it matters if a HCP knows that info - why should there be, they are there to help me, they need to know about me…

it is time that we stopped allowing our public systems to be twisted either to validate someone’s personal dysphoria, or to allow nefarious purposes to take place

so great changes…

No data field in any system should be used to record different categories of information. It makes the system useless for any kind of analysis.

If the same field is used for either birth sex or gender identification just as the patient chooses, then the system is fucked. They should always be separate fields.

Which is ridiculous because it then draws attention to something that wouldn't have been given a second thought. Female looking person has F or Female on wristband....ok. OR "Oh dear, why is there tape on this wristband. We need to sort that out because it's covering up the information..."

Strong disagree. The relevance comes from the fact that they have taken artificial hormones to change their phenotype (physical appearance) in order to obscure their genotype (sex). Therefore, their genotype is directly relevant, even if their hormone therapy requires contextual interpretation of their results.

They are not, and never will be, aligned with a genetically female individual with native hormones. The hormonal system is far more complex than that.