I have to ask elderly patients for their gender identity

[Crabbyboot]

Please can I have some advice on this, I have been told by my boss that i have to ask our elderly patients for their gender identity when they come to see us. Without giving too much away I don't work in the UK so I am not NHS. My boss also does not agree with this but she says we need to do it as the regulators require it as part of our standards. Bearing in mind that we are a medical department I feel that this is highly unscientific. Also given the demographic of our patients it is inappropriate. I don't know if I should bother fighting this, or if it is just something I let go and accept. If I fight it I would like some help to articulate myself properly and in a way that is legal so I can't loose my job. I partly feel like just complying but insisting that everyone at work refers to me as a he/him/his just to prove how silly it is.

Good point.

I'll be less forgiving towards those who continually force this issue and attempt to compel my speech on a coercive way. I often just

Oops..

I often just pity them and make allowances for their lack of life experience and perspective. But , you're right. Being young maybe isn't excuse enough for endlessly pressurising the rest of into complying with their denial of reality.

no, if they say wtf, you record that they have no gender identity. you are playing into the hands of trans bigots when you pretend they do

Can you record sex first and then ask about religion, then if they have a gender identity?

This way it doesn't sound like you think they look like the opposite sex, it's just a box checking about beliefs. Have a NA option as the religious question does. Enough NA and they'll see how stupid it is.

I agree that it is disrespectful and I would be furious if it was done to me - well, actually it has, and to everyone else who has an NHS Number, because the NHS records "Gender" not "Sex".

I have also already explained that when the NHS switched from "sex" to "gender" in 2007 that I refused to ask patients every time I saw them, which might be once a week, if they had "changed sex" since I last saw them.

I was responding to previous posts that focussed on the need to avoid causing distress and confusion to patients with dementia in the context of the OP, who does not want to risk losing her job:

"Please can I have some advice on this, I have been told by my boss that i have to ask our elderly patients for their gender identity when they come to see us. Without giving too much away I don't work in the UK so I am not NHS. My boss also does not agree with this but she says we need to do it as the regulators require it as part of our standards. Bearing in mind that we are a medical department I feel that this is highly unscientific. Also given the demographic of our patients it is inappropriate. I don't know if I should bother fighting this, or if it is just something I let go and accept. If I fight it I would like some help to articulate myself properly and in a way that is legal so I can't loose my job."

There are a multitude of ethical, clinical, scientific, political, regulatory, human rights and employment issues raised by the OP.

She is looking for practical suggestions and I have suggested others in previous posts.

In this instance, where patients with dementia are concerned, she needs to find a workaround to avoid causing them unnecessary distress and/or confusion while at the same time considering how best to challenge her employer.

She has already made the first step by asking for clarification about whether "gender identity" is replacing "sex" in the patient record or if it has been introduced as an additional field.

If the employer is replacing "sex" with "gender identity" then there are serious patient safety issues - exactly the same issues as there are in the NHS and have been since 2007.

If her employer, like the NHS, has a policy of placing patients on single-gender wards then it needs to ask about "gender identity" in order to operate that policy.
Whether or not one agrees with such a policy is a different issue.

To reiterate: the NHS has not had any single-sex wards since 2007 because it does not record a patient's sex - it records gender identity. Wards are coded as "Sex M or F", that is the only code for "sex" used by the NHS and the only reason it is there to mislead the public that there is such as thing as an NHS "single sex ward".

If you are an NHS patient then this is not a theoretical discussion: you have already been assigned a "gender identity" without your knowledge or consent and nowhere does the NHS record your sex.

Heath providers do need to know what medication patients are on, what surgical procedures they have had, any diagnosed mental health problems, and numerous other issues, eg. allergic reaction to latex, elasticated bandages or sticking plasters.

Recording "gender identity" (with a "None" option) as well as "sex" would be sensible only in as much as it flags up that the patient has a belief in "gender identity", and triggering further questions about medication, surgery, etc.

However, I am sure that there are better ways of doing this.

For example, someone who has medically "detransitioned" might report that they do not have a "gender identity" but it would still be appropriate and medically necessary for patient safety reasons to know about previous and current medication, surgeries, etc.

To return to the OP . . . The situation is complicated by the fact that her employer is, allegedly, requiring staff to request and record information on "gender identity" in order to meet "standards set by the regulator".

This suggests that there will be penalties, reputational and/or financial, if the employer does not comply. Her employer is therefore likely to want to force staff to comply. It might remind them that they will be in breach of contract if they refuse to follow its policies and procedures as part of their terms and conditions of service as employees.

If she were in the UK and failed to comply with "the reasonably instructions of her manager" in these circumstances then it is likely that Disciplinary Proceedings would be invoked and she could find herself out of a job.

The instructions would be "reasonable" because the employee is acting as an "agent" of the employer and the employer is bound by the standards set by the regulator.

I am not a lawyer - but I was a union rep throughout my working life. On an "if it was me . . ." basis, I think the OP is going about things in exactly the right way: gathering information to establish facts; finding workarounds in the meantime to avoid distressing her patients; sounding out the views of colleagues and managers.

However, the problem is unlikely to be solved unless and until the regulator changes the standards it has set.

@Bosky I think we largely agree but that does not make it OK to make things up which you would be if you pretended that people ha very gender identities or thatcyou can tell what they are by looking at them. It is the employer causing patient distress no the OP and she does not have to allow herself to be used as a tool of oppression in the way she would be if she took your advice.

Good point about the 2007 change. I will contact my GP and make sure they have not recorded a gender identity for me and complain if they have.

"she does not have to allow herself to be used as a tool of oppression"

Correct - she has a choice. She can choose to disobey her employer, be in breach of contract and get sacked.

"I will contact my GP and make sure they have not recorded a gender identity for me and complain if they have"

That will be really interesting! Well worth doing to see how your GP responds!

However, GP's are not part of the NHS. You GP might record your sex although I doubt it as GP records should be consistent with NHS records.

The NHS does not record sex, it records "gender identity". The record field is labelled "Gender" but it means "Gender Identity" - you can ask your GP to change it and your GP can then ask the NHS to change it on all your records.

This is how that works . . . remember when reading this that the NHS does not keep any record of your "sex" and has no means of doing so. The record of your "Gender" is not "alongside" or "as well as" a record of your sex - it records "gender" instead of sex.

Also remember when reading this that this has nothing whatsoever to do with the Gender Recognition Act or Gender Recognition Certificates - anyone can at any time ask their GP to arrange for the NHS to change the "Gender Field" in their NHS records. The GP and NHS have no discretion in acting on this request. A further scandal that endangers patients is that some parents have requested this change this on behalf of their young children:

Primary Care Support England: Adoption and gender re-assignment processes

Gender re-assignment process

It is important that practices are aware of the steps that need to be taken when a patient changes gender. Following the process will ensure continued patient care and ensure there isn’t an impact on your practice payments.

Please note: Patients may request to change gender on their patient record at any time and do not need to have undergone any form of gender reassignment treatment in order to do so.

When a patient changes gender, they are given a new NHS number and must be registered as a new patient at your practice. All previous medical information relating to the patient needs to be transferred into a newly created medical record. When the patient informs the practice that they wish to change gender, the practice must inform the patient that this will involve a new NHS number being issued for the them, which is not reversible. To revert back to their original gender, they would receive a third NHS number. The practice should confirm this has been discussed with the patient when notifying PCSE.

The process is as follows:

- GP practice notifies PCSE that a patient wishes to change gender via the enquiries form. The practice should include the patient’s name and NHS number in the notification to PCSE, plus confirmation that they have discussed with the patient that this will involve the creation of a new NHS number

- PCSE sends the GP practice a deduction notification for the patient and emails the main contact we hold for the practice (if available) the new details for the patient

- GP practice accepts the deduction and registers the patient using the new details provided by PCSE. Important: Do not update the patient’s original record with their new NHS number. If this happens they will not be registered and will miss out on continuity of care

- PCSE sends a new patient medical record envelope with the patient’s updated details to the GP practice

- GP practice creates new patient record using new details, and transfers all previous medical information from the original medical record. Any information relating to the patient’s previous identity should not be included in the new record.

- If the gender is being re-assigned from male to female, the screening team will contact the practice for no cervix confirmation

- If the gender is being re-assigned from female to male, screening will become the responsibility of the practice.

Continued at:
pcse.england.nhs.uk/help/registrations/adoption-and-gender-re-assignment-processes/

For more info on the background to how this all happened, Fair Play for Women has two very good articles:

How does the NHS record information about sex and gender identity?
16th June 2021
fairplayforwomen.com/how-does-the-nhs-record-data-about-sex/

Why isn’t the NHS collecting data on biological sex?
5th July 2021
fairplayforwomen.com/why-isnt-the-nhs-collecting-data-on-biological-sex/

*"she does not have to allow herself to be used as a tool of oppression"

Correct - she has a choice. She can choose to disobey her employer, be in breach of contract and get sacked.*

Clearly that is not the only choice. She can also ask and report back any anger, distress or confusion generated to her employer.

Exactly this. I'm often supporting a 90yo accessing healthcare.
They are v. deaf, with some mild confusion at times.
Can answer q's (when repeated) about age, where it hurts, consent to vax., etc. Cue serious confusion when hcp asks if their gender is the same as their sex.
I suggest that I've known them 20 years, pretty sure it is. Frowned at. Well, carry on shouting nonsensical questions at a 90yo if you like. Seems a waste of time to me.

You have to ask for their gender identity? I’d add in an extra question before that: “Do you have a gender identity?” The vast majority will say No, and then you can simply mark the Gender Identity question ‘Not Applicable’.

On the rare chance, your patient does have a Gender Identity, they’ll say Yes and you can then go on to ask them what it is.

Getting so silly now 🤣I think id probably just not do it personally.

You are right but she has already said that she wants to avoid causing her patients any distress. Other options have also been rejected.

I think this is the best answer so far:

BreatheAndFocus suggested

"You have to ask for their gender identity? I’d add in an extra question before that: “Do you have a gender identity?” The vast majority will say No, and then you can simply mark the Gender Identity question ‘Not Applicable’.

On the rare chance, your patient does have a Gender Identity, they’ll say Yes and you can then go on to ask them what it is."

For gods sake these threads.

If their gender and sex align then just tick the same answer for both.

No need to get wound up about it.

But how do you know they align without asking them? You surely don’t just make assumptions based on what they are wearing? Do you?

Yes I think this is probably the best solution.

I think that's actually considered a trans phobic thing to say. Besides which, as PP said, how would you possibly know? Most clothing is unisex and even those people wearing dresses may not consider themselves to be a woman as per the stereotypes of gender ideology. I don't and I look very much female

What do mean align?

Are you saying that all females must behave in a female way all the time and that is 'alignment'?

How many non female things must a female do or like to not have it 'align'? So knitting [check], cooking [check], cleaning [check], football [ALERT ALERT NOT ALIGNMENT]?

You people are fucking insane. None of this matters. What matters is the SEX of the human.

OMG That man has PINK SOCKS ON - quite fetch me the clipboard Jane.

That's obviously not a man if he has pink socks on Belinda. Go cancel yourself, and make an appointment with HR on your way out to collect your P45.

Cancel yourself Jan, you said HE - they are obviously now a they/them.

@AlisonDonut

I think you know what I meant but just in case you really are struggling:

If your sex is female - then tick female for sex.
If you feel your sex is accurate and describes you completely- then you would also tick female for gender.

You have all the information you need to fill out a form without writing an essay about it.

They aren't asking for your views on what other people identify as, or whether you think society is going to hell, or anything else.

Hi sweetie.

The OP said there is no box for sex.

Hope that helps.

This. I had to ask similar stupid questions in a previous job. Same with ethnicity people often looked at me as if I was stupid when they felt it should be obvious what they were.
I just apologised st the start (so it didn't seem like I was mocking any particular question) and said "some of the questions are a bit box-ticking but we have to fill them out I'm afraid, just let me know how you'd describe yourself even if you think it's obvious."

I would just ask if you have a male patient 'are you happy for me to put that your gender identity is male?' And the same for a female patient (in cases where you think this may cause offence) and for other patients just ask their gender identity. I wouldn't get too worried about it just explain these are tick box questions.

You have male patients and female patients. There are no other patients. Unless you have some aliens in your practice.

Jesus wept. The pussyfooting around this.

@AlisonDonut I agree but sometimes as health professionals we have to fill in such paperwork and follow guidelines so I was just suggesting a sensible way of framing this question to an elderly patient or someone who you thought would be offended (like yourself clearly). All other (didn't want to right non elderly etc) patients can just be asked the question.