What should your NHS Medical Record hold about you? Sex or gender Identity?

[Barracker]

Twitter Poll

There are very specific rules within the NHS relating to what sex/gender data should be held on our medical records and how it should be used.

(And those rules are not being followed)

But if you're on twitter you might be interesting to see how this poll is working out.
I'm really interested in any responses from anyone working in the NHS who ever handles medical records. Do they know whether they are handling sex or gender data?

It's good to see so many trans people commenting that birth sex matters on there. Also the poll results are interesting!

Renal function values depend upon sex
Definitions of renal failure depend upon sex
Normal blood pressure ranges depend upon sex
Cardiovascular risk assessments depend upon sex
Screening programmes depend upon sex
Manner in which a heart attack presents depend upon sex
Response to some drugs depends upon sex

Do I really need to go on?

Just from what I've read, I think the NHS records gender ID now but writes it under "sex."

Sex for medical records but the option to record your preferred name and title (which may not match your sex) seems the most sensible way.

(which I obviously disagree with - they should record the medically relevant fact SEX, which cannot be changed - and then have an optional extra for gender id if needed to help guide patient interaction)

Sorry cross-post, Penguin

What should be on NHS records: both sex and gender. If someone has had hormones or surgery to alter secondary sexual characteristics, that also needs to be recorded.
Gender (sex role behaviours) are medically important. Behaviour is a major risk factor in many health conditions, some obvious (STIs), some less so (social norms around diet and exercise).
It seems reasonable to me, and probably a requirement under GDPR, that people should get correspondence addressed to their preferred name and title, which will often indicate gender. That should be recorded separately from sex observed at birth.

NHS clinician here. Patient records hold info on “sex” and should record what is stated on birth certificate

Biological sex necessary for some tests in NHS an interpretation of the results

Honestly, it’s utterly ridiculous that individuals cannot see that males and females have different

Funnily enough this isn’t just an issue with regards to Gender/Sex.... I work in the industrial sector as a site nurse advisor, I undertake spirometer (breathing) tests which require sex (I.e at birth), and ethnicity (I.e heritage/origin) in order to determine a set of predicted values for an individual to be judged against with regards to their lung function. The amount of employees I’ve encountered over the years who claim that it’s degrading and or racist to record someone either as a “gender” or “ethnicity” that they don’t identify with simply astounds me. I genuinely couldn’t care less how you identify, the simple fact of the matter is that if you were born as a male of asian descent you will be expected to achieve a vastly different level of lung function than a female Caucasian....

Sex is important for all the reasons stated.

When we admit patients we do make a note of religion, favourite foods, hobbies, job etc (depending on why they're being admitted, age, dementia etc) and gender is more akin to that kind of data imo. There was no need for my DD's nurse's form to ask "gender" for a 1 minute flu vaccination appointment, but there would be if she was being admitted to a ward or treated for ongoing MH issues.

Surely your medical record should still hold your birth sex even if you change your birth certificate? It's important to know what the biology of the patients is!

Abitlost
Are you sure that's accurate?
Because looking the GMC website under Trans guidance:
SEX-
A patient’s request to change the sex indicated on their medical records should be respected; they do not have to have been granted a Gender Recognition Certificate or have acquired an updated birth certificate for this to be changed.

www.gmc-uk.org/ethical-guidance/ethical-hub/trans-healthcare#confidentiality-and-equality

And it also says you can get a new NHS number with no reference to biological sex:

NHS number

If your patient is to be issued with a new NHS number which has no reference to their sex at birth, you should explain to them that they will not automatically be contacted regarding current or future screening programmes associated with their sex at birth, and discuss the implications of this. Decisions about screening should be made with patients in the same way as any other decisions about their health.

I am an nhs Gp and our records state gender not sex. A patient can be registered as their preferred gender if they wish with no checks. They are then treated as a completely new person with no attachment to their previous notes so you would not necessarily know about there past-only if they told you or if you had known them from before. There is no recognition of birth sex which obviously messes up various templates we use and screening data.

I had a peak trans moment at work years back (before all this was a big deal) when a PSA (prostate specific antigen) blood test was requested for a woman. Computer said no because women don't have prostates.

I remember thinking it daft that you can be officially recorded as a woman when you biologically aren't one.

Sex - gender is irrelevant. If you are seeking sex realignment treatment then that will be in your medical notes surely?

How can a surgery function if Miss Fred Jones is getting smear test and mammography call ups but not prostate checks? If the staff have to ponder calling Fred up because they know that Fred has a prostate but point g this put could open them up to a lawsuit - or a sad horse-face photo in the Guardian and death threats on social media?

It's science, stupid!

@heresy is correct. I work in this specific area and patients need to be aware that if they change their sex on PDS (person demographic record), which they can do, they won’t be called for screening appropriate to their biological sex.

Local systems update demographic data (if spine compliant) from PDS, so this includes breast screening, cervical screening etc.

Screening have what is known as a cohort, which includes age and sex.

Patients do not have to have completed a full transition to change their sex either. Some choose to keep their NHS number and change the name & sex, some prefer a completely new record.

New record? Would it contain details of 'past' medical treatments?

This is the outcome of a badly thought out law. Statistics will become meaningless
How will future services be planned

@Fekko

The demographic record doesn’t contain clinical details, so no, past treatment records would not be there.

Clinical records are captured at a local level, on hospital patient admistration systems or your gps system, for example. They update demographic information from the “spine” only.

The “spine” kind of links all these systems.

Your doctors surgery would most likely still keep one record though or the patient would have no medical history. Same for secondary care.

National screening systems that call patients for screening would call a adult human female for, say, breast screening, if their PDS record said female.

It is possible to opt out of screening cohorts.

gender is irrelevant

while I don't have a gender ID and think it's all bollocks, lots of people do, and it's good to record that as it may help with treating them appropriately (so a transwoman who needed to stay overnight in hospital could be placed in ward that's already mixed sex, or be put in a side room on a male ward)

so the answers to gender should be male / female / none I would say, and obviously a person's actual sex should be recorded separately.

NHS clinician here. Patient records hold info on “sex” and should record what is stated on birth certificate

so for the 5,000 people with a GRC, their medical records hold the wrong sex, which could lead to inappropriate treatment. How worrying for them

And the two other responses from medical staff......god it's so scary that respecting someone's feelings is more important that providing them with the correct medical care. yikes.

So, I could tell my GP I now identify as a man and have my medical records changed tomorrow? Or even request a new NHS number altogether? What about services I already use? Could I tell my MH worker that Jane Bloggs no longer exists so their services are no longer required and have my entire MH history stricken from the record?

Could I scrub my medical history of the times I’ve been sectioned and hospitalised? That would be useful.

Badstyley that... what could go wrong?