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Feminism: Sex and gender discussions

Is doctor obliged to tell patient about new gender before visit? NYTimes says no.

52 replies

PrincessNutella · 15/11/2021 04:47

Okay Mumsnetters, real headscratcher here. What do you all think. Woman is planning to go to new doctor who is a man. But now she hears through the grapevine that new doctor has become a trans woman. She wonders, should patients be told before the visit, or just show up and find out that Dr. John is now Dr. Jane? www.nytimes.com/2021/11/09/magazine/difficult-mother-in-law-ethics.html

OP posts:
LonginesPrime · 15/11/2021 09:32

or who centres his ‘gender identity’ in a professional setting.

I don't see the difference between someone expressing their individuality in terms of loud clothing choices and someone expressing what they perceive to be 'gendered' dress sense.

If a medical doctor has a weird hairstyle or an unusual taste in shoes, I'm not going to doubt their ability to interpret an MRI or perform surgery because of it. It's just their personal choice as to how they want to look.

Sure, I'd be worried if they started saying unscientific stuff about gender identity/biology, but up until that point, if Dr Gary is now Dr Gemma and is wearing pearls and a twinset while discussing my surgery in a professional and scientifically sound manner, I don't see why it should matter to me.

Packingsoapandwater · 15/11/2021 09:57

@LonginesPrime

or who centres his ‘gender identity’ in a professional setting.

I don't see the difference between someone expressing their individuality in terms of loud clothing choices and someone expressing what they perceive to be 'gendered' dress sense.

If a medical doctor has a weird hairstyle or an unusual taste in shoes, I'm not going to doubt their ability to interpret an MRI or perform surgery because of it. It's just their personal choice as to how they want to look.

Sure, I'd be worried if they started saying unscientific stuff about gender identity/biology, but up until that point, if Dr Gary is now Dr Gemma and is wearing pearls and a twinset while discussing my surgery in a professional and scientifically sound manner, I don't see why it should matter to me.

This only goes so far though, doesn't it?

If I turned up for a GP appointment, and the doctor was wearing a baggy, misshapen, fraying t-shirt with coffee stains on it, and had a strongly unwashed smell, it would affect my impression of their attention to detail and general competence.

The question is where the line sits when it comes to clothing choice and positive or negative reactions, and this can be very dependant on the experiencing individual involved.

It's about social cues, isn't it? And as much as we like to pretend they don't matter, they do. We've been using them to assess threat for thousands of years. Okay, sometimes, maybe often, we get those cues wrong, but it is foolish to pretend they don't exist.

HoppingPavlova · 15/11/2021 10:02

If true, I would imagine this would be a rarity, similar to a unicorn really. I can’t imagine many Dr’s rushing out to transition and it being a common (or even really uncommon) issue, so seems quite an hysterical storm in a tea cup for a potential but unlikely possibility.

trancepants · 15/11/2021 10:12

Oh fuck being so woke here. I wouldn't continue to see a trans or non binary doctor for a number of reasons.

  1. It shows a total cognitive dissonance about basic biology. So are not someone I would have faith in, in a medical context.
  1. I've read enough of Ray Blanchard's work and had more than enough experience of trans 'lesbians' and 'bi-girls,' to ever, ever feel comfortable about my doctor presenting that way unless I also knew their personality enough to feel a degree of trust in them. And tbh, I wouldn't want someone I knew that well to be my doctor as I prefer a degree of detachment from my doctor.
  1. I actually do judge my doctors based on their religion. I don't judge someone for their religion but there are doctors who will only treat and prescribe based on their religious rules. (For example those who won't give abortion medication because of their religion.) So I won't be seeing a doctor who works that way.
  1. I wouldn't want to have a trans doctor as my child's doctor because if my child was sick, part of me would be on edge that they would misgender the doctor and how that would play out. Which isn't what my child needs from me when he is sick.
  1. The exact same would apply to my grandmother.
  1. I believe that because of the above, the issue of being trans would distract from care for the very young, very old, could be in fact be very distressing to dementia patients, patients with certain types of autism and other non-neurotypical patients. I really have fuck all interest in seeing a doctor who would risk distressing their patients like that.
trancepants · 15/11/2021 10:15

Oh one more.

  1. I would worry about any gender non-conforming aspects of my son's personality (of which he has a lot because he's a normal human being who is encouraged to like what he likes) being viewed as him being an 'egg.' And I don't want to risk him ever being indoctrinated to view his natural body as wrong by a trusted professional.
MedusasBadHairDay · 15/11/2021 10:18

@NeedsCharging

If I was happy to go to a Dr that was a man but is now a transwoman it would make no difference to me as they are still male.

If I wanted a female Dr and the Dr I was sent was a male then I would have a problem with that.

This. As long as its not a situation in which I was expecting someone of the same sex as me - because it was gynaecological for example - and was instead presented with a male doctor who sees themselves as a woman then I don't have a problem with being treated by a trans person, their gender identity doesn't affect their knowledge or professionalism.
LonginesPrime · 15/11/2021 10:18

It's about social cues, isn't it? And as much as we like to pretend they don't matter, they do. We've been using them to assess threat for thousands of years. Okay, sometimes, maybe often, we get those cues wrong, but it is foolish to pretend they don't exist.

I can see where you're coming from, but I can usually still assess the threat level of a man regardless of whether he's wearing jewellery and a skirt or not.

There are some scenarios in which sex matters, but provided we can all accept that sex sometimes matters, I don't see why we can't all agree that 'gender identity' doesn't - a male doctor wearing a skirt when I'm expecting to see a male doctor anyway doesn't change anything as their male sex is still the same as it was before they put on the skirt.

That person's inner sense of gender identity and the way they choose to express it through their appearance is irrelevant to whether they can do their job. I don't believe the Stonewall lies that most trans people all think the Stonewall way, and until a doctor starts talking Stonewall nonsense, I'm prepared to assume they still hold mainstream views on science and medicine, as that's far more likely in the real world.

Cailin66 · 15/11/2021 10:18

I have a female GP and for my births I made sure I had a female Gyny. It would not bother me one whit going to someone who had changed from male to female except in a situation where it was an intimate exam. Having said that I've naturally been examined by men when I gave birth, but in general I avoid male doctors for those life events. But many male medic's I've no issue with such as a dentist, skin expert, optician etc. Just the pap smear tests and intimate stuff.

MedusasBadHairDay · 15/11/2021 10:25

I don't care what a GPs personal beliefs are unless they affect the treatment I am offered. I wouldn't automatically assume a trans GP would mean a higher risk of this though. I still see non-trans GPs despite once having a GP who believed in homeopathy (and so received sod all actual help from them). I'd imagine that most GPs have a more pragmatic mindset just from doing the job they do, and are able to set their beliefs aside.

GreenWhiteViolet · 15/11/2021 10:38

If I've asked for a female GP, I expect a female GP, not a transwoman. If I don't mind what sex the GP is, then whether they're trans is mostly irrelevant.

The exceptions would be if they're dressed as an offensively stereotypical and sexualised parody of womanhood (not just 'wearing a dress' but the acronym I don't think we're allowed to discuss here). I don't want to be a prop in someone else's validation scenario. Or if they're on social media posting TRA-style nonsense.

Effzeh · 15/11/2021 10:56

@LonginesPrime

It's about social cues, isn't it? And as much as we like to pretend they don't matter, they do. We've been using them to assess threat for thousands of years. Okay, sometimes, maybe often, we get those cues wrong, but it is foolish to pretend they don't exist.

I can see where you're coming from, but I can usually still assess the threat level of a man regardless of whether he's wearing jewellery and a skirt or not.

There are some scenarios in which sex matters, but provided we can all accept that sex sometimes matters, I don't see why we can't all agree that 'gender identity' doesn't - a male doctor wearing a skirt when I'm expecting to see a male doctor anyway doesn't change anything as their male sex is still the same as it was before they put on the skirt.

That person's inner sense of gender identity and the way they choose to express it through their appearance is irrelevant to whether they can do their job. I don't believe the Stonewall lies that most trans people all think the Stonewall way, and until a doctor starts talking Stonewall nonsense, I'm prepared to assume they still hold mainstream views on science and medicine, as that's far more likely in the real world.

That is true, but I think it's also about context and appropriateness. People coming to see a GP are by definition vulnerable, so part of doing the job is being able to think clearly about the effect your presentation might have on the patients who come to see you, because their needs come before your needs for self-expression. I have a GP friend who is something of a rock chick and has very impressive full sleeve and shoulder tattoos. But she always covers them up when seeing patients, because it's a dramatic presentation that might provoke reactions in the patient that could get in the way of the clinical encounter.

Tbh I think a male-bodied person presenting in female clothing in a clinical setting falls into the same category - failure to consider the effect their presentation might have on their ability to meet the patient's needs.

LonginesPrime · 15/11/2021 11:10

Tbh I think a male-bodied person presenting in female clothing in a clinical setting falls into the same category - failure to consider the effect their presentation might have on their ability to meet the patient's needs.

That makes sense, but there are also lots of non-trans male doctors who have very little self-awareness around how misogynistic they come across to female patients, IME.

My view is that while extreme transactivism is steeped in misogyny, I don't feel that a real-life male doctor being trans is any more likely to make them a misogynist- if they're a misogynist, it will manifest in their interactions with me regardless of whether or not they're wearing a skirt.

I'll judge them on their behaviour and their professionalism just as I would any other doctor, and if they're being misogynistic and offensive then I'll complain as appropriate, regardless of their inner sense of 'feeling like a woman'.

SickAndTiredAgain · 15/11/2021 11:14

@Skysblue

Honestly I wouldn’t be able to trust medical advice from a doctor who thinks you can change sex. So yes if my doctor was trans I’d change doctor and would prefer to be notified in advance to avoid wasting both of our time.
Not all trans people think this though.

And it seems clear that some Drs who aren’t trans do.

LonginesPrime · 15/11/2021 11:22

My view is that either an inner sense of gender identity changes things, or it doesn't.

For me, how someone feels inside doesn't change their sex and it doesn't change the way I'll treat them in everyday, non sex-dependent situations.

If someone is being misogynistic or is talking nonsense about biological sex, then that will affect my opinion of them, but the fact they want to wear a skirt won't.

If they want to benefit from schemes designed for biological women, then that's a problem for me. But if a male orthopaedic surgeon wants to call themselves Sandra and grow their hair long, while accepting they are still biologically male, it shouldn't make a difference to their ability to do their job.

If they're an unprofessional arsehole on top of being trans, that's because they're an unprofessional arsehole, not because they're trans.

Effzeh · 15/11/2021 11:30

@LonginesPrime

Tbh I think a male-bodied person presenting in female clothing in a clinical setting falls into the same category - failure to consider the effect their presentation might have on their ability to meet the patient's needs.

That makes sense, but there are also lots of non-trans male doctors who have very little self-awareness around how misogynistic they come across to female patients, IME.

My view is that while extreme transactivism is steeped in misogyny, I don't feel that a real-life male doctor being trans is any more likely to make them a misogynist- if they're a misogynist, it will manifest in their interactions with me regardless of whether or not they're wearing a skirt.

I'll judge them on their behaviour and their professionalism just as I would any other doctor, and if they're being misogynistic and offensive then I'll complain as appropriate, regardless of their inner sense of 'feeling like a woman'.

I don't disagree with this, but people posting on this board have a higher-than-average awareness of these issues, and probably more ability to think critically about our own reactions to encountering non-standard presentations.

Many or most of the general population, particularly those who are older or physically/mentally more vulnerable, who presumably make up a large proportion of the GP clientele, might well be seriously thrown by encountering a male GP in female clothing, to the extent that it might get in the way of their ability to access the help they came for.

So to that extent I do think it's appropriate that patients booked to see that particular Dr should be given that information beforehand, and then they'll either be prepared, or they can choose to see someone else.

SomeFineDay · 15/11/2021 11:33

Since she already knew there is no problem. And be serious - there’s little chance patients wouldn’t hear this ahead of time.

Shedbuilder · 15/11/2021 13:17

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beastlyslumber · 15/11/2021 14:14

This would make me uncomfortable. I don't think it would have a few years ago - I probably would have agreed with pp saying it's just clothes/hair etc. But now I think the whole ideology of gender is quite sinister and misogynistic, and would see this as someone supporting that ideology. If they spoke to me beforehand and let me know, invited questions etc, then I would feel better about it.

allmywhat · 15/11/2021 14:19

Tbh I think a male-bodied person presenting in female clothing in a clinical setting falls into the same category - failure to consider the effect their presentation might have on their ability to meet the patient's needs

This is a really good point. I had similar feelings about the case in the US, where a TW sued to be allowed to cross-dress while working at a funeral home. I guess the issue is that if you’re a doctor or a funeral home worker your professional encounters with the public really shouldn’t be about you. And if you’re a male in a skirt, even if it’s perfectly appropriate attire for a woman in the same situation (and it’s not a situation like the trans attorneys who kept getting mistaken for sex workers) then it’s at least somewhat obtrusive and may be distracting or confusing for the members of the public you’re dealing with.

I’m conflicted. Strict dress codes almost always disadvantage women. I can’t decide between the abstract ideal that men should be allowed to wear whatever a woman could wear in the same situation and the practical reality that cross-dressing is culturally loaded.

beastlyslumber · 15/11/2021 14:30

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SolasAnla · 15/11/2021 15:01

The article is a classic set up.
It's centering the health care professional's (HCP) needs and wants while using transphobia and sexism to stop reasonable discussion on boundaries around personal care.

Health care is about informed consent of the patient receiving care.
The emphases on informed consent is because historically time and time again when the patient is not the central decision maker unacceptable medical malpractice develops.

From start to finish any medical treatment is about informed consent freely given by the patient to the HCP

A female doctor carrying out an examination on a male, when the male specifically requested a male doctor, is a doctor carrying out a common assault. Even in the case of a person refusing life saving treatment the doctor would have to seek a court order.

Health care is one of the areas where bring your whole self to work is not acceptable or professional and can result in sanctions We expect doctors and other HCP to treat all impartially irrespective of how horrible the patient. Why? Because we hold them to a higher professional standard which centers the patient not the HCP.

But looking at the provided text:

First "was assigned to a male practitioner" so as a new patient is given (sorry!) assigned a male doctor. Therefore the patient has give informed consent to a male doctor (or a female doctor) with no possible misunderstanding or lack of consent.

Then "I learned from a friend" so gained the information through gossip and in a health care setting that's not acceptable behaviour.

Then "doctor has transitioned .. from male to female" so from male to female not man to woman so the informed consent of a male carrying out intimate examinations is not in question.

Then "I have not yet met this doctor" firmly sets the social boundaries of acceptable behaviour which is professional relationship not a social connection. Patient has give a male doctor informed consent so at best it's just a stranger being nosy and/or rude about a personal issue.

The "what is appropriate and whether there should be any conversation about the transition" no patient starts that type of conversation about the personal life of doctor they just met particularly if the meeting is in a professional capacity. No matter what is discussed it's always inappropriate and a social taboo.

Then "if it is to determine whether I, a cis woman, am comfortable seeing a trans physician?" and Boom!!! the am I transphobic question.

We should read "if it is to determine whether I, a woman, am comfortable seeing a woman physician?"

But to adjust to the phasing in the prior paragraphs
if it is to determine whether I, a gender conforming female, am comfortable seeing a gender nonconforming male physician?"
If it's about informed consent the patient is aware of the sex of the doctor so such a discussion would not be based on sex of the HCP or professional ability just that the fact that the HCP is trans.

The am I transphobic question answered is naturally Yes.

Again "If my friend was not a patient at this practice and had not forewarned me" the gossip element in a health care setting.

Also the emotive forewarned as being inform of a possible future danger or problem yet informed consent is not an issue with an assigned male doctor, as the HCP's sex is fine the warning is about being trans.

Then "confused to see a female enter the exam room, because I would have been expecting a male doctor." Ooops we appear to have misplaced the word woman and man.
But it helps to imply sexism in rejecting a woman as a doctor. But carry on and ignore sexism, its the same old same old, a male is indistinguishable from a female at any stage of the transition process and anyway the patient gave informed consent to a male HCP.

Then "Is this transition process such a private thing that it is inappropriate to talk about it?" and Boom!! the no debate question.
Well as the prior text was used to establish the social boundaries, around a patient allowing the pratice to assign a male or female HCP, as well as any personal decisions of the HCP, so transitioning is clearly not a relevant element of the service being provided.

The no debate question answered is naturally Yes

The closer "Obviously, I am in uncharted waters." would only be true if the patient had requested a female HCP and the practice assigned a male.

The scenario has be set up to draw the reader into accepting there is no element of deception on the HCP's part and leads the reader to a predefined outcome that a female patient should not question a male doctor if they present as a woman.

The HCP has an duty of care to the patient and if there is a circumstance where the patients informed consent is in doubt to its up to the individual HCP to resolve this prior to treatment.

That's a moral and ethical question HCP bodies are ignoring with no debate resolutions.

Bellusaurus · 15/11/2021 18:39

That's a really interesting analysis @SolasAnla , and you've convinced me that question is indeed a set up. No way would the language and implications be so contrived otherwise. Solas indeed Smile

I think my views on this are quite simple.

I need to be allowed to know my doctor's sex. I do not need to know their gender. Therefore whether or not they've transitioned is none of my concern.

So long as I can know and refer to sex, gender isn't an issue. If I can't, knowing gender doesn't help anyway.

SolasAnla · 15/11/2021 21:29

@allmywhat good point the Met or one of the police forces had a male take a case c. 1999.
A male officer who was (if I remember correctly) put on desk duty wanting back on the beat. The analysis was that one of the "customer" facing problem as when dealing with female prisoners who should be searched by women officers, sometimes by force. Resolution was in custody, outer clothing searches were with consent and clothing removal was never allowed.

@Bellusaurus one of the fascinating things is how words have to be twisted to normalise the destruction of social barriers which are designed as safeguards in a society of unconnected strangers.
Some of it is obvious some subtle and links into our autopilot mode when it comes to social expectation.

Similarly take a quick read of how the Stonewall riot wilki page has been edited, with a focus on who gets the action/doing verbs and who gets the passive verbs, is amusing when cheering for the white knight(s).

Then can you imagine a Scottish politician standing in Parliament to argue that a HCP should be employed by the State to carry out a sexual assault examination and subsequently testify under oath that the HCP had carried out the examination with consent when the HCP had not only not obtained consent but committed sexual assault themselves?
Yet that was the fundamental outcome of using gender rather than sex. When I see that I realise that hardline TRA's would allow the world think that all trans HCP have no morals nor personal honour and I do worry about the backlash that type of stupid will bring.

toomanytrees · 15/11/2021 22:51

I'd find another doctor. I couldn't accept a doctor who made me feel uncomfortable and then put me in the position about feeling guilty about feeling uncomfortable. I don't want a doctor who takes dangerous cross sex hormones, smokes or is obese. But then I never went back to the doctor who wore shorts, bare feet and birkenstocks.

LobsterNapkin · 16/11/2021 01:39

I feel like it might be more basic than this. It could be kind of socially awkward if I was expecting Dr John and instead Dr Linda showed up, just as if they'd substituted a different person without telling me. I might wonder if this was the same person they told me I was supposed to see. I don't know that I'd think Dr John transitioning would be the most likely explanation. And I can imagine there might be other people, maybe especially older ones, who would be even less likely to think of that.

It might be simpler if I knew up front rather than say, "Sorry, you must have the wrong exam room" and then have to discuss it.

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