Thread for discussing how women can ask NHS for female HCPs

[OuterSpaceCadet]

As suggested on the Sandie Peggie thread, a separate space for discussion.

KJK had a female on her show that was offered a chaperone, for an intimate exam with a doctor she had known for a decade and said chaperone was a man pretending to be a woman.

She only knew because she could see his huge feet during the exam.

I can't see a scenario where it is likely that you would have two trans practitioners in the same room as you. Or a male and chaperone being a trans woman etc

The likelihood is determined by the number of trans identified men on the shift, not the number of trans identifying people the general population, though.

If one or more professional on the ward is a trans identified male, it means that these scenarios will happen. To avoid it happening, the hospital will have to treat these professionals as male.

If a clinician offered me a chaperone before treatment, it would be reasonable to expect a woman chaperone. Its reasonable to expect a high number of women working in healthcare, its not demanding the unusual. I shouldnt have to clarify, and i shouldn't be put in the position to be vulnerable in a room with two men.

It shouldnt be up to patients to know the language of trans ideology or to understand and work within HR policies. If HR policies clashes with patients rights and expectations, thats something for management to have anticipated and dealt with long before patients are involved.

I'm actually not sure if I have always been offered a chaperone? I will pay closer attention in the future. I do always check with the booking staff that the HCP is going to be female. I am open about having PTSD even though I find these interactions difficult. I have experienced excellent trauma informed care from female HCPs lately for both smear tests and internal ultrasounds. I always email afterwards with positive feedback.

With regards to your scenario, with trauma it often means the worst has already happened. It is about managing the body's unconscious reactions as much as it is about mitigating further risk. Offering a person with PTSD a chaperone whilst a male HCP carries out an intimate procedure might be absolutely fine if the patient feels comfortable with the male HCP. This is tricky if you've never met him before. I couldn't feel comfortable with a male HCP who set about to deceive patients about their sex. That's already crossed a boundary for me, as described by liverstreaming. The chaperone in that situation may well be experienced as a hostile enforcer of the Orwellian situation.

The problem when male HCPs are dismissive or outright abusive to female patients is that it can be difficult to see it as a one-off situation or one bad staff member. The behaviour mirrors the dismissal and abuse that many women have already experienced in society/ at the hands of abusive men. When this dismissal and abuse is sanctioned by the NHS the situation is frankly terrifying.

a while ago a woman put a sign she’d made on her hospitalised mother’s noticed board saying “female only carers” with the relevant legislation at the bottom of it.

she laminated it so it was compliant with infection control.

The details are lost to me - can anyone remember this?

Without prejudice to whether a female chaperone should be an acceptable compromise, I see no reason whatever to suppose that a trans HCP and a trans chaperone should not sometimes coincide.

Dr Margaret McCartney has written in the past about authoritarianism approaches in the NHS in relation to smears and weight. Her point in that pushing to hard on this, NHS policy can cause harm especially to vulnerable individuals by breaking trust and making women feel like they are not being listened to, because the focus is on something unrelated to their primary concern. Example: if you have a concern about your heart that should be the primary thing - being given a scolding about how your smear isn't up to date or that you aren't trying hard enough to lose weight - then you harm the doctor patient relationship and the patient is more likely to simply disengage at risk to themselves. This is poor practice. Taking the time to build a relationship and trust may offer an opportunity to approach these subjects in time, but if a patient says no, that should also be respected and they should not be badgered. McCartney's point was if you go too authoritarian on one thing, it can impact on health in a completely unrelated area - and it might be the area which will kill them, not the thing you were badgering them about.

We saw the same pattern with Covid. An authoritarian approach has the impact of actually driving up refusal rates in certain groups because people don't respond well to this method. Instead targetted soft approaches to key communities by informing and letting people make a choice themselves are proven as more effectively overall.

On a personal level, I had an ELCS for extreme birth fear. There's two types of fear - primary tokophobia and secondary tokophobia - primary is if you have never had children before and second is for subsequent pregnancies ususally with the first having been traumatic in someway. The research into both reveals that they require two different approaches but both centre on building up trust between a patient and the team treating them. Overall, if they request an ELCS, giving permission for one early on builds that early on. Both groups required extra support through the pregnancy. But they found a curious thing. The secondary group, even though permitted to have an ELCS, with the additional support during pregnancy and having rebuilt trust, if they had a robust birth plan a great many of this group changed their minds and went ahead and attempted a VB and even if it didn't result in that, a majority felt much better about the birth and found it healing. And birth trauma may not be a result of a terrible physical birth - it can be purely psychological and - all about not being involved, being out of control, being belittled and disrespected.

My point being and Margaret McCartney's being that the doctor patient relationship rests on patient trust and how the patient feels being centred. Better outcomes and recovery times across the board in all manner of areas are associated with care where patients feel respected, listened to and involved.

If NHS policy is to totally ignore patient concerns over trust and being respected in terms of their wishes they are actively and knowingly going to harm patients because this pattern is so well known in medicine. Thats why doctors are supposed to be trained in ethics and bedside manner.

This ISN'T a trans issue as such. Its a trust issue.

My issues with doctors are closely linked with power and control issues and having a problem with paternalistic and patronising attitudes to me. The dynamics of a doctor having a status over me and feeling like there is an imbalance of power is at the heart of my concerns.

And this is why women are particularly vulnerable across the board. They are conditioned from birth NOT to assert themselves and not to challenge when they feel uncomfortable.

If I'm honest here frankly given my experience and my awareness of power dynamics with the trans issue, and then seeing a case like this playing out in a court, its not really lending itself to being willing to put myself in a situation with a doctor I felt was fundamentally sexist and willing to call me 'aggressive' because of my long documented anxiety issues. I am ill, not angry. Deesculation by listening should come before barring a patient. Quite frankly its unprofessional and lacking in understanding of the importance of trust issues and power imbalances between doctors and patients to be suggesting otherwise. Upton's conduct in court, undermines trust in ALL trans doctors because there is such militancy on the subject and Upton's words are being validated and replicated by multiple people on online forums that anyone can see - it ISN'T just Upton as an individual. Its the collective militancy against female patient autonomy and trust.

Ironically if someone declared themselves as trans from the outset and was fine with me being gender critical, I'd be much more open to be treated by them, if I woman wasn't available. Because they've seen me, respected me and understood that a difference of opinion does not equal hate nor wishing them harm - because its about issues with power dynamics and treating individuals as individuals. Be my equal, reassure me and it will be recipricated. Be prejudice towards me or lie, and it'd be a hard no.

It is the very act of deception, authoritarian over riding of my feelings, a lack of empathy and the denial of the realities of sex that are the problematic part. Because those are where the power issues and trust issues lie. Not the fact someone wants to dress/live a certain way. Live how you want, just don't force me to comply or for it to have a negative impact on me. Time and again we see 'be kind' as a total one way street - thats not equality and it needs to stop.

Crucially, if someone has a different religion or culture or colour of skin, thats not overriding or affecting that delicate balance of power and trust. As a patient I am there to get medicial help, I am not there to provide validation for a staff member. And thats the point. Mutual respect and empathy.

The second that a patient is used as a tool for validation in ANY WAY by a staff member, thats where the line has been crossed between centring the patient and instead switches to centring the staff member. That includes pronouns.

Honesty and transparency HAS to be central. If you lie about ANYTHING, you lose that. Not just for you as an individual doctors, but for all the others doctors you work with. Everyone after has to spend a lot more time restoring that.

Any doctor (and this includes others who facilitate lies), shouldn't be treating patients if they dont understand this as they risk harming vulnerable patients. Anyone in management who fails to recognise this, is undermining safeguarding protocols and well stood principles about how good relationships mean quicker diagnosis, quicker recovery and quicker discharges - in other words they are cost effect in the long term.

None of this is progressive to ignore how patients feel on this and to ignore the reality that women ultimately have good reason to distrust ALL males on an instictive level and asking them to ignore this instict just isn't workable nor in the best interests of absolutely anyone.

Basically it comes down to issues with behaviour NOT issues with identity.

@RedToothBrush thank you. What an excellent post. As a fat woman I have often avoided seeking unrelated healthcare because of the anticipation (from extensive experience) of medics shoehorning unasked for, unnecessary and unhelpful advice on dieting. The assumption that I am not aware that I am fat, nor that it may impact some areas of my health, or that eating less equals weight loss is infuriating and distressing.
I am/ was a senior nurse educated to degree level with a lifetime experience of diets and a truly encyclopaedic knowledge of the calorie content of every possible food but all they see is fat woman, must be stupid.

@OuterSpaceCadet thank you too. A topic which is much on my mind given I need surgery in the near future. Also your explantation of freeze, disassociate and appease which is exactly what I do. I have not seen it written in this way before. I feel better now that I have the words to explain it clearly and simply.

Thanks for this great thread.

It is so revealing to think about consent in the context of trauma and threat responses. Women very often have trauma-related reasons to say no to a male Dr. This is a form of 'flight' response, ie to get away from a situation that feels threatening to her.

We now, unbelievably, have a situation where that trauma response becomes the subject of a moral judgment, ie branded 'bigotry'.

For intimate examinations/treatment I would rather be seen by a female HCP although I have been treated by a male gynaecologist in the past and he was fine. What does bother me from the issue above about an expressed wish being followed in the NHS is that faced with a transwoman I would be worried about their underlying motivation to be trans. I know not all will be AGP but a good proportion are.

IANAL and I'm not sure what legal rights we have in this. On the one hand, it took an amendment by feminist MPs in Scotland (#sixwords) to insist that raped women had a legal right to forensic examination by a woman not a transwoman "for the word gender subsititute sex"

But on the other hand, if a GP surgery employs a male nurse to do cervical smear tests and does not offer a female alternative (which a poster raised on another thread, and I am so sorry for that) then that does sound like illegal sex discrimination. Especially if that stops women coming forward for screening.

I haven't been on the other threads (or rather I couldn't keep up) but this seems really important and as an issue has come up on other threads.

The reality as Labour keeps telling us by referencing "safe spaces" there is a legal route to have women (biological) only service provision. The problem is too many health services have been Stonewalled and accept the misrepresentation of SSE being based on sex.

• The Equality Act allows for the provision of separate or single sex services in certain circumstances under ‘exceptions’ relating to sex.
• To establish a separate or single-sex service, you must show that you meet at least one of a number of statutory conditions (set out in this section of the guide) and that limiting the service on the basis of sex is a proportionate means of achieving a legitimate aim. For example, a legitimate aim could be for reasons of privacy, decency, to prevent trauma or to ensure health and safety. You must then be able to show that your action is a proportionate way of achieving that aim.
• There are circumstances where a lawfully-established separate or single-sex service provider can prevent, limit or modify trans people’s access to the service. This is allowed under the Act. However, limiting or modifying access to, or excluding a trans person from, the separate or single-sex service of the gender in which they present might be unlawful if you cannot show such action is a proportionate means of achieving a legitimate aim. This applies whether the person has a Gender Recognition Certificate or not.

The sad part being that some of us will have memories of when this would have been the normal approach, and sadly shows how the TRAs have been so sucessful.

So maybe it is going to take a campaigns specifically on this area of service provision.

And whilst some NHS trusts will say it is financial issues that means this cant happen, this isn't true if male doctors / nurses are not normally pary of certain health procedures but TW are.

Sadly it is going to take years if not decades to undo the damage Stonewall have done.

(I quoted the EA as explained by the EHRC in case anyone writing to their MP or whoever might find it useful to quote. https://www.equalityhumanrights.com/equality/equality-act-2010/separate-and-single-sex-service-providers-guide-equality-act-sex-and

On the one hand, it took an amendment by feminist MPs in Scotland (#sixwords) to insist that raped women had a legal right to forensic examination by a woman not a transwoman "for the word gender subsititute sex"

I didn't know about that, but also cant understand why an amendment would be needed as it is in fact the treatment and support of women who have been raped that are given as example of when the SSE apply.

Or is this just part of Scotland thinking that aren't covered by the UK wide EA until they were challenged by the UK Government?

@RedToothBrush thank you for that detailed post.

I am currently pregnant again and going through NHS maternity services and my experiences in my first pregnancy massively reduced trust in the doctors and the policies in that area of medicine. There seem to be real problems with coercion, not properly explaining risks and benefits to women, patronising them and generally undermining their confidence in themselves and their bodies. I have countless friends who have had traumatic birth experiences after being induced for reasons that aren’t even in the NICE guidelines and aren’t evidence based.

There is definitely a wider issue in the way the medical profession treats women.

One thing that I was thinking about earlier is how it can actually be quite intimidating to ask for female care in the first place. I remember during my last pregnancy hearing the lady in the cubicle next to me being told she should have a sweep and the male midwife then doing it. I remember thinking ‘oh gosh if he asks me, I don’t know if I’ll be brave enough to say I want a female midwife, but also I really would rather a woman do it’. To have that request then be directly disregarded by a trans woman arriving, would just be impossible.

Plus, you’re also in the position of needing medical care for whatever reason. There’s an element of ‘don’t bite the hand that feeds’ - you don’t want to be denied the care you need, or worse, entrust your person to someone who you might have pissed off, so there’s an immediate power imbalance there too.

Many women who prefer female practitioners will make arrangements ahead of time to ask for them, e.g when booking an appointment. I’d be devastated to request a woman do my smear test and turn up and that woman be a trans woman. It would totally destroy my trust in the services offered.

Being 'put on the spot' changes the power balance.

If you've been waiting for months for an apppointment and then someone says 'are you ok with a male doctor', then you may well give a different answer than you would if you were asked the same question BEFORE you were put on the waiting list.

In consumer regulation we understand the principles of 'high pressure' sales tactics which include putting customers on the spot by saying 'if you don't buy it now, you'll lose the opportunity/won't get such a good deal' to try and pressure a sale then and there. We also understand issues like trying to make sales in situations where someone feels they have to say yes to avoid upsetting someone or feel unable to say no because the salesman is between them and the exit. We also understand concepts of why you shouldn't make high pressure sales pitches to vulnerable persons, especially when they are on their own.

Because we KNOW that people don't necessarily feel confident to assert themselves or to question things when they are put on the spot BECAUSE THEY FEEL PRESSURED.

Yet this known psychological effect seems to be totally forgotten in medicine.

Personally I really struggle as I automatically go into flight or fight and have trouble expressing myself - to a point where its problematic. Its eased by support and building up relationships.

I now have certain things written onto my notes to try and mitigate this.

The other key point is the lack of understanding of a lack of official comments; NHS Trusts are often under the misguided understanding that no complaints = no problem. It doesn't. You have to understand who complains and why, and also understand why people DON'T complain even when they might be unhappy and what barriers they might face to making complaints.

The really good example of all this, was Bounty sales in maternity wards - it broke a whole pile of issues over feeling pressured but also being unaware of it upsetting huge numbers of women who were complaining about their experience on MN but there were no official complaints. Upon doing so probing it became apparent most trusts were NOT centring the interests of women who'd just given birth not really being in a state to be approached in bed for sales and why being put on the spot was inappropriate and why they weren't complaining.

One of the biggest inhibitors is that women are conditioned to put up and shut up. They 'don't want to make a fuss'. They want to be nice and 'don't want to upset people'. Even if the issue is completely deserving of a complaint.

Keeping in mind how the top decision makers are policy makers in the NHS are male (even though the majority of the workforce is female), and not only that but high achieving, assertive males at that - it doesn't enter heads how women often don't feel they can say no, even when they want to. By the same token, women who work in healthcare are also so used to it, they often don't appreciate how women don't understand the system and their rights and don't know they CAN say no. Or just think they will get second class treatment for being difficult if they say no.

The process of consent and women feeling they have given consent freely needs to be better understand.

Remember the word yes, is not necessarily enough either. Consent is only valid if the yes is made whilst not under 'undue pressure'. And this is part of the ethical conduct policies of the NHS, GMC and various other applicable medical bodies in the UK.

Arguably, if you are in a situation where you feel threatened that if you don't consent to a transwoman you won't get treated because you will be labelled as transphobic, thats technically invalid consent because you've done so under undue pressure... Its not ok.

This lack of understanding of power imbalances, failure to consider things through the eyes of women, failure to understand the ethics of consent and an absence of complaints and how it disproportionally affects women causes its own issues - its definitely a contributing factor behind why we've had so many scandals particularly affecting maternity departments.

Its HUGE. And all this EDI stuff isn't touching on the practical stuff relating to this because its too busy telling women NOT to complain about men claiming they are biological female.

Totally nailed it @RedToothBrush. 👏

I’ve emailed Sex Matters this evening outlining how worrying this is and asking if they might consider a campaign on the issue of women being able to request female HCPs without fear of repercussions or being ignored. I am also going to write to the GMC along similar lines.

You’re right that we so often don’t complain or make ourselves heard on issues because women are conditioned to put up with things. If you were exposed to a situation where you felt pressure to accept a trans woman HCP and felt violated by that examination, it could be so so hard to complain - for fear of repercussions, for wanting to avoid reliving the trauma, for struggling to have the ‘right’ language to describe it or perhaps even because you felt that it was wrong for you to even feel violated because TWAW. But in Dr U’s world - no complaints/ no challenges = no problem. And as you say, that’s a pervasive attitude.

EDI training should be looking at stuff like how women respond differently to certain situations and why they don't do things like complain and how can you encourage them to do so and to give more honest feedback. It should be looking at how and why paternalistic attitudes in medicine hurt women more than men. It should be looking at how to better inform women about their rights and how to identify when things have not followed protocol. It should be looking at how sex based issues / medical conditions have impacts on every day life in different ways and how we can do better at coping with those as a society so they aren't so life limiting.

But nope. We instead get GI Joe and Barbie, and pink brains and blue brains nonsense which weirdly DOESN'T look at male/female pattern behaviour at all!

Foran:

Dr Upton appears to be operating from the presumption that there is a legal right to keep information about one’s sex private in the context of providing intimate care and examination to female patients who have requested female only care and who have been told that is what they will receive. This is not accurate as a matter of law.
…
There is no right to keep information about biological sex from patients who have requested female only care, particularly in relation to care involving intimate touching of genitals or where the patient requires intimate care as a result of sexual assault.

https://thecritic.co.uk/patients-have-a-right-to-know-a-doctors-sex/

The blatant co-option of racism in order to shut women up and make them play along with some men's fantasies, in a healthcare setting, gets me raging.

The single sex wards policy in my Trust explicitly aligns women wanting a single sex bay to racists. I'm not at work so can't c&p the exact wording but it's approximately 'just as racism expressed as discomfort will not be entertained, nor will transphobia expressed as discomfort be entertained'. As we've seen from the tribunal, there is no way for women to express that they want a single sex space,that won't get us accused of transphobia. The comparison infuriates me because (aside from being hugely offensive both to women with genuine well founded concerts and to those who actually experience racism and get dragged in as a prop) it doesn't even stand up - racists have never been offered or promised single race wards, that's not a thing the NHS says they have, but women have been explicitly told we will have single sex wards and then when we ask for them, we're smeared as bigots.

My Trust's patient info leaflet says 'you will be cared for in a single sex bay' yet then does a bait and switch because if a man with special feelings wants in, you will be gaslit and called a bigot if you object that you're not getting what we told you you could have. And patients are gaslit - the clear instruction to staff in the policy is that to discuss the trans patient would be breaching confidentiality and result in a disciplinary and possibly reporting to the police as a hate crime . So staff are in an impossible position too, if a patient asks 'is that lady y'know, a lady?' they either risk a disciplinary or lie to that patient's face that there are only women on the ward.

This issue is misogyny on steroids. Women are purely there to validate the male's identity, and are not permitted any feelings of our own other than full affirmation. My Trust's policy is bad but it's not an outlier, I've seen similar from other Trusts.

And yes I have fought it, and the Trust stands by the policy. Pre Forstater the outcome was that I had to go on re-education camp training to learn how to better understand the needs of transpeople (I raised a concern about women yet the response is all about trans, shocker); since WORIADS I've got braver and last time I put in writing that sooner or later something terrible and completely avoidable will happen because of this policy (but only to a woman so who gives a shit right?) and I can't stop that but I have got the paper trail and they will not be able to pretend that they didn't know what the risks were, because I've clearly pointed them out and they've deliberately chosen ideology over women's safety.

This is what institutional capture is. There are no means and no words women can use, to get the single sex spaces we are told we have. We can only have those spaces by chance, if no men currently want them.

That ended up a bit long!

Could someone tell the GMC this? I’ve fed back to them via the email on their web site [email protected] but so far no response.

They used to include doctors’ sex on the GMC Register. A few years ago, they switched it to show gender (So for example, Theodore/Beth Upton is shown as having a female gender). This is confused and confusing, no use to patients.

If the GMC no longer reliably supply this information, where are patients supposed to get it from?

Grrrrrrr.

I’ve emailed Sex Matters this evening outlining how worrying this is and asking if they might consider a campaign on the issue of women being able to request female HCPs without fear of repercussions or being ignored.

Yes. I would also contribute to a crowdfunder for a challenge from Sex Matters to the GMC over registering gender not sex for those on the register. A number should stay with you for life.

The world is getting more and more bizarre as Phil Banfield of the BMA (the one whose supposed to be reviewing the Cass Review to indicate the ways in which it is wrong and is full on TWAW) is currently leading a BMA charge against the GMC over confusing language and patient safety (blurring job titles and who 'counts' as a medical professional):

Today, the BMA’s case against the GMC begins, challenging the use of 'medical professionals' and the blurring of lines between doctors and non-doctors - putting patient safety at risk.

https://x.com/TheBMA/status/1889675011968938267

The GMC replies to Baroness Nicholson on this, the said they have to record doctors gender and not their sex. As if patients are looking up their doctors to find out the doctor's special snowflake feelings about themselves, and not an actual fact that impacts patient care. Captured fuckers.

Thank you for doing that.

My situation is even more complex because of what happened in my family.

I don't trust people who tell me men are women or seek to gaslight me, and it totally undermines my lived experience of how it's affected me.

Trying to 'reeducate' me would add fuel to that.

Effectively if they are only validating identity of one party they simply couldn't begin to help and can only do more harm.

This is why I really feel it's necessary to SEE the coercion and the problems with behaviour that surround affirmation only.

I've been ruminating about the NHS Duty of Candour while reading the SP threads.

The professional duty of candour is a professional responsibility to be open and honest with patients and families when something that goes wrong with their treatment or care, causes or has the potential to cause, harm or distress.

Although intended to be about being open with patients and families when things have gone wrong, the underlying principles are openness and honesty. This includes colleagues as well as patients.

As a doctor, physician associate, anaesthesia associate, nurse, midwife or nursing associate, you must be open and honest with patients, colleagues and your employers.(gmc guidance)
There is a whole bunch of stuff on timely reporting of incidents and near misses which doesn't appear to have applied to U or Fife, but that isn't my main point here.

Dr knickers on fire has lied to patients and staff repeatedly and has indicated that he will continue to do so. His lies may have caused distress and harm to patients and certainly have the potential to do so.

It would seem that other staff in the department have also lied to patients and each other, either deliberately or by omission.

It is essential, that people like U are not enabled to mislead patients and families. Other HCP have a duty to stop going along with the fiction of U as a woman. Not only should they not be afraid to be honest, it is crucial that they are to prevent patient harm.

Relevant policies to request if people are so minded would include, consent, duty of candour, chaperoning, dignity and respect and safeguarding.

That's really interesting about the Duty of Candour, @CarefulN0w. So much food for thought on this thread already.