Impact of gender change in health care

[mids2019]

Just wondering if any one has thoughtful the ramifications of self gender identification in healthcare?

I was once present at a strange meeting where it was suggested all patients needed to be asked their pregnancy status (dismissed with a bit of laughter by other staff) but I guess this my become more serious.

There are risked I guess as someone going through a clinical pathway as female identifying as male and not being asked pregnancy status.

In most clinical areas sex definitely needs to be known (biological) for swift and accurate diagnosis.

Will there be safeguards in healthcare systems to avoid errors if further legislation created extended rights for transgender people?

It's an incoherent mess OP but the responsible adults appear to have left the building leaving the aggressive lobby groups / useful idiots in charge. They continue to demand ideological changes so we are left with medics spouting incoherent mantras and gobbledegook in place of facts, science and ethical decision making.

Sadly there will be a range of casualties before the investigations / reviews happen and ethical medicine returns.

This is an interesting point to raise.

I think the answer to your question is no. The fact that the NHS has brought in changes to allow a change of sex marker and to limit or erase previous medical records with apparently minimal regard for risk is a major concern.

It appears that there is minimal consistency across the NHS with some GPs refusing to prescribe cross sex hormones, some GPs working with the gender clinics and some are providing a ‘bridging prescription’ where a patient reports that they are self medicating with drugs bought from the internet and wants the GP to prescribe officially ahead of a gender clinic appointment.

There are so many opportunities for failure in communication and missed screening or other vital information. Some GPs are changing a patient’s sex marker and then adding a secret ‘doctorspeak’ cide to indicate birth sex. This sounds dangerous.

This is all happening already, I can only see it getting worse if the numbers rise.

Will there be safeguards in healthcare systems to avoid errors if further legislation created extended rights for transgender people

Bizarrely the activists pushing for this seem to not be remotely interested in patient safety and in some instances seem to be working against it.

I agree with the above.

The specific case in mind was oncology where pregnancy status is asked before a CT scan (fairly routine as ionizing radiation to a foetus is to be absolutely avoided). I think there is no way staff are going to ask 20-50 year old males about pregnancy status with a straight face. You face patients questioning staff competence.

Medics make a huge number of assumptions when diagnosing based on sex , it defined the anatomy that needs to be treated. Confusion in this area is simply dangerous.

Would make sense that health care professionals are able to keep in record biological sex to prevent error. I feel this needs to be a consideration going forward. Disease is no respecter of self identification

When a patient transitions, they have the right to request a new NHS number and have the gender marker changed on their records - in effect, a new medical record.
There is currently no facility to have sex and gender recorded separately, so unless their doctor was aware of this (in large practices where lots of locums are used, or where a patient moves regularly this could easily be the case) it could lead to adverse clinical outcomes for the transgender individual.

• Blood test results could be filed as 'normal' when they're anything but, as the acceptable ranges differ for males and females.
• People won't be called for screening, for example AAA, cervical PAP tests, breast screening.

It is actually in the best interests of a transgender person to have their sex recorded accurately on their medical records - which doesn't happen at the moment. I gently questioned this with a senior staff member (we're both non clinical) a few years ago, about how this change would affect the care of the person concerned and was instantly rounded upon, but came across an article on this in the BMJ yesterday.

Forgot to add...

Surely the onus is on the trans patient to inform their doctor of their actual sex. If they refuse to do so, any resulting damage/death is entirely the patient’s fault. I would be incensed if doctors ended up in court for not being bloody mind readers.

To be honest, I really hope the NHS doesn’t spend too much time on this. I think there should be some kind a a form to sign that failure to disclose the sex you were born with may lead to wrong diagnosis, suboptimal treatment and ultimately death. And then get on with it.

I think there is a much bigger problem with the horrifically high maternity death rate for black women. And (from what I understand) suboptimal cancer treatment in some areas. And the currently high waiting lists for all kinds of non-urgent procedures. And the list goes on.

I don’t think that the NHS realistically can be held responsible for people who deliberately obscure data which can be crucial to diagnosis and treatment.

NHS data on patients includes a marker as to whether sex assigned at birth matches gender ID. That does all the work required, though wider awareness of this would help.

datadictionary.nhs.uk/attributes/gender_identity_same_at_birth_indicator.html

I don’t think that the NHS realistically can be held responsible for people who deliberately obscure data which can be crucial to diagnosis and treatment.

The need to obscure data and facts seems to be central to trans ideology and the journey to 'becoming your true self'

Ive noticed that GIDS gives children helpful advice on their website on how to change sex/gender markers on things like health records and passports.

[quote DadJoke]NHS data on patients includes a marker as to whether sex assigned at birth matches gender ID. That does all the work required, though wider awareness of this would help.

datadictionary.nhs.uk/attributes/gender_identity_same_at_birth_indicator.html[/quote]
That refers to elements in datasets.

But is there a marker on everyone's health records, at their GP surgery, clinic, hospital or other healthcare setting, associated with their current and any previous NHS number, noting their Person Gender Code and also their Person Phenotype Sex Code?

Every single one?

I doubt it. That’s why wider awareness would help.

@TinyRebel

I agree with your segment entirely (I could think of other examples). Safety is paramount.

Additionally clinical trials etc split results by sex so you do not wish skewed results by misgendering.

@DadJoke

I doubt it. That’s why wider awareness would help.

Or maybe the NHS could just have a record of sex at birth for patients. As was pointed out to you on another thread, by someone who checked their own records, the data was incorrect/incomplete.

NHS IT systems are hard enough to manage as they are, trying to maintain consistent and complete data on the entire population - we don't need to add any complication. Getting it wrong could lead to severe consequences for the patient.

And as pp says, it is a terrible responsibility to place on the frontline medical staff to expect them to treat patients correctly while withholding vital information. The emotional consequences for a doctor who inadvertently kills someone through incorrect treatment for their sex would be awful and it is unfair to place this burden on them.

@mids2019

I agree with the above.

The specific case in mind was oncology where pregnancy status is asked before a CT scan (fairly routine as ionizing radiation to a foetus is to be absolutely avoided). I think there is no way staff are going to ask 20-50 year old males about pregnancy status with a straight face. You face patients questioning staff competence.

Medics make a huge number of assumptions when diagnosing based on sex , it defined the anatomy that needs to be treated. Confusion in this area is simply dangerous.

Would make sense that health care professionals are able to keep in record biological sex to prevent error. I feel this needs to be a consideration going forward. Disease is no respecter of self identification

I’ve recently had 2 different MRI scans. Each time I had to complete a checklist. I was asked my name, age, sex, and a whole load of yes/no health questions. One which made me chuckle was whether I could be pregnant or not. I’m 61. My dh had the same questionnaire when he went for a scan too. It also asks about any regular medication, so cross sex hormones would come into that. So the question is asked, maybe not verbally. I would say that the onus needs to be on the patient to make it known to medical staff, where relevant, what their sex at birth was, and if they are taking any sex hormones.

@TinyRebel

When a patient transitions, they have the right to request a new NHS number and have the gender marker changed on their records - in effect, a new medical record. There is currently no facility to have sex and gender recorded separately, so unless their doctor was aware of this (in large practices where lots of locums are used, or where a patient moves regularly this could easily be the case) it could lead to adverse clinical outcomes for the transgender individual.

• Blood test results could be filed as 'normal' when they're anything but, as the acceptable ranges differ for males and females.
• People won't be called for screening, for example AAA, cervical PAP tests, breast screening.

It is actually in the best interests of a transgender person to have their sex recorded accurately on their medical records - which doesn't happen at the moment. I gently questioned this with a senior staff member (we're both non clinical) a few years ago, about how this change would affect the care of the person concerned and was instantly rounded upon, but came across an article on this in the BMJ yesterday.

My understanding from what I’ve read is that if a patient wishes to change their ‘gender’ marker ‘ name etc with their GP, they are also informed about sex - based screening, to ensure they are not missed off the correct ones.

To be honest, I really hope the NHS doesn’t spend too much time on this. I think there should be some kind a a form to sign that failure to disclose the sex you were born with may lead to wrong diagnosis, suboptimal treatment and ultimately death. And then get on with it.

That would be a terrible way to go about it, in my opinion. There should be much better advice given to trans people about the impact of not making the NHS aware of their biological sex. Organisations representing transgender people are being negligent if they are not making the need to do this explicit. NHS also has a role to play.

www.health.com/condition/pregnancy/transgender-man-pregnant

I can't access the article, but more on this case, here

www.nejm.org/doi/full/10.1056/NEJMp1811491?query=featured_obstetrics-gynecology

The trans ideology is that binary biological sex does not exist snd that sex is bimodal. This is breathtakingly stupid (our species is perpetuated by sexual reproduction FFS, every living human is testament to this, Intersex people living with a condition that affects their sex anatomy or physiology should not be made subjects of false witness). All Doctors and biologists know that correct attribution of biological sex is crucial for safe research and treatment but that's just their truth, innit.