Thread for discussing how women can ask NHS for female HCPs

[OuterSpaceCadet]

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

This is a topic close to my heart for obvious trauma related reasons.

The current court case has highlighted that NHS records gender and not sex of its staff. However the NHS also claims on its website to care about informed consent.

It has also highlighted that a situation can arise where a man in the position of Dr can say - in court no less - that he is biologically female.

I know that trauma isn't the only reason a woman might need care from a female HCP, but it's worth mentioning that women with trauma might be completely unable to ask to see another Dr when faced with a surprise male in the consulting room. The trauma reactions of freeze, disassociate, and appease can happen outside of conscious awareness and are our body's way of attempting to keep us safe in the face of danger. Other women may avoid routine appointments altogether if they cannot be sure of a female Dr.

Thanks @OuterSpaceCadet, I agree this is an important discussion that merits its own thread. Good suggestion @alisondonut.

Just copying over my post from the other thread:

1. I get why people are asking how we can ask this without getting a trans woman, but all of that is expecting average women to have any idea of the intricacies of gender identity theory. I can’t imagine my grandma knowing what a ‘cis’ woman is or ‘assigned female at birth’ means, even if we put aside the fact that expecting patients to understand such concepts means forcing them to engage in a contested belief system.
2. I don’t think one can underestimate the guts you’d have to have to refuse a trans woman doctor when you have already requested female care and you are then presented with a trans woman. It’s a direct challenge to you isn’t it? They understood your request, ignored it, presented you with a male who identifies as female and now you have to have the guts to say ‘not you’ in a way that somehow doesn’t offend. It’s absolutely insane to think that most women in that situation, knowing what happens to ‘transphobes’ would feel free to say what they really want. Plenty of women (me included) find it hard to be assertive at the best of times, let alone faced with such a direct challenge, in a setting which already had a power imbalance and when you are already vulnerable.

Yes Pepe. Re point 2, the male Dr in that scenario is already showing you they disregard your boundaries. That is already abusive regardless of what happens next.

I’m sorry to hear of your past trauma @OuterSpaceCadet

But yes you’re totally right, the trauma response could make it impossible to challenge even if you wanted to say something.

It is so so hard to advocate for yourself in a medical setting and in my view the GMC need to make absolutely crystal clear that a request for female/ same sex/ woman only care is a request for a biological woman (I.e. excluding a trans woman) and that it is to be treated as such and trans women HCPs do not attend in that situation unless the patient has specifically freely said that’s okay.

On the trans man question I think that’s harder because she would be biologically female but her male presentation may be alarming or distressing to some women.

For doctors, the GMC Register records gender (not sex). So there is no help there.

The GMC reply to Baroness Nicholson’s letter (she published it on X) is that where a doctor changes name (as most transitioners do), they keep a confidential record of the connection between the old record and the new record for ‘administrative and regulatory purposes’, with access restricted to the few staff who need to see it. In other words, they keep it a secret from patients.

https://service-manual.nhs.uk/content/how-we-write

https://www.nhs.uk/conditions/consent-to-treatment/

These are the NHS pages on their commitment to using plain English and informed consent.

Their current set up seems to contradict both.

Slightly different but I had an OP last year. It was private but only day case and I was put in a ward not a private room. I immediately asked if it was female only, the nurse knew exactly what I meant and assured me it was. I can't remember her exact words but something like 'they would be given their own room'.

I do think this is difficult. I like to think I am a strong woman but at you are often very vulnerable in medical situations. I have decided to always ask for a natal woman and let those around me know this.

Given the way things are at the moment tools seem that if someone has a GRC then in the eyes of the law they are the gender they say they are and a person would be discriminating if they refused to be treated by them in the same way that if they refused because the person was black.

I had another situation where I changed consultant because I couldn't understand him, he had a heavy accent, and I felt he was dismissive of me. This again was private but was a gynaecologist appt. I'm not sure if I could have done this in the NHS.

Anyway I think the only way around this is for women to push back and refuse although the medical profession seems totally captured and women still seem to be seen as 'making a fuss'. I also think that unfortunately too many women seem 'fine with it' so it's a real battle.

Good idea for a thread.

I posted this on one of the Peggie threads but they move so fast it's hard to find it. Worth noting this hear, just a part of what women might want to do in their particular area/NHS trust etc. even before you find yourself in a situation where you could be vulnerable or unconscious or scared etc.

https://x.com/allanpetrie91/status/1889591533013242177?s=46

"In response to NHS Taysides Intimate Personal Care and Chaperoning Policy (Adult and Child). i have sent this letter.

Subject: Grave Concerns Regarding Policy and Legal Compliance (Intimate Personal Care and Chaperoning Policy (Adult and Child)

Dear Ms Connor

I am writing to express my deep concern regarding the information contained within NHS Tayside Intimate Personal Care and Chaperoning Policy (Adult and Child).
This policy appears to be an ill-thought out, politically motivated initiative that lacks respect and dignity for some of the most vulnerable members of our society. It is shocking and unacceptable that such a policy would be proposed, given the clear breaches of legal protections that it entails.
Breach of Legal Protections
The policy in question purports to align with existing legal frameworks, but a careful examination reveals that it in fact contradicts and undermines fundamental legal rights. Specifically, it appears to breach the following:

1.The Equality Act 2010:
This legislation provides distinct protections based on Sex and Gender Reassignment as separate protected characteristics. Policies that fail to differentiate between the two may result in unlawful discrimination against individuals whose rights are specifically protected under this law.

2.The Human Rights Act 1998:

This Act guarantees the right to privacy, dignity, and non-discrimination. The implementation of policies that disregard biological sex in favour of gender identity alone could infringe on the rights of women, particularly in healthcare settings where sex-based protections are vital.

3.The NHS Constitution:

The guiding principles of the National Health Service require patient centred care that respects the specific needs of individuals. A failure to recognise and accommodate the unique medical and biological needs of individuals based on sex undermines these commitments.

4.Offences Against the Person Act 1861
It is essential to remember that medical professionals, like all individuals, are bound by the Offences Against the Person Act 1861. While they are legally permitted to carry out procedures that would otherwise constitute assault, such as physical examinations, injections, and surgeries, this is only lawful with the informed consent of the patient.
Without such consent, any physical intervention, regardless of intent, constitutes assault under the law. This includes a woman’s explicit refusal to be examined by a biological male doctor, requesting a same sex doctor is a valid and lawful exercise of bodily autonomy. Any attempt to proceed without consent, or to pressure a patient into accepting an unwanted examiner, is a breach of legal and ethical standards and may constitute criminal assault under this Act.

Sex v Gender: A Crucial Distinction.

It is particularly alarming that a health service policy does not differentiate between Sex and Gender, given that both are distinct and have different legal and medical implications.

Sex is a biological classification (male or female) based on reproductive anatomy and genetics. It is immutable and has direct implications for medical care, such as differences in disease risk, drug metabolism, and specific healthcare needs.
Gender is a social and psychological identity that may or may not align with an individual’s biological sex. While gender identity could be a consideration for personal and social recognition, it does not replace or override the biological realities that must be considered in healthcare.

Differential Legal Rights
The legal framework recognises and protects sex and gender separately.
Sex-Based Protections: Women have the right to single sex spaces in certain contexts (e.g., hospital wards, prisons, and changing facilities) under the Equality Act 2010.
Gender-Based Protections: The Gender Recognition Act 2004 allows individuals with a Gender Recognition Certificate (GRC) to be legally recognised as their acquired gender, but this does not erase sex-based rights or override biological considerations in all circumstances.

By failing to uphold these legal distinctions, the policy in question risks violating the rights of vulnerable groups, particularly women and those with specific medical needs based on biological sex.

I urge you to reconsider the implementation of this policy considering its legal and ethical shortcomings. Policies within the health service must be based on clear, lawful, and evidence-based considerations that respect the dignity, privacy, and rights of all individuals, particularly the most vulnerable in our society.

I would appreciate a response outlining how these concerns will be addressed and what steps will be taken to ensure that legal obligations are met. I look forward to your prompt attention to this serious matter.

Yours sincerely,

Allan Petrie
Chairperson
Glenlaw House parent/carer support group"

But equally I think it's important to think how we can 'arm' ourselves with whatever information we can to rely upon in 'the moment' when faced with an HCP like Upton or his many supporters. So I'm hoping someone will post something that helps with that too.

The letter also stated that since 2015 i think it was. there has been no need to record sex, only gender, so we really need to find out how that decision was taken [on every female in the country's behalf, without permission] and how it can be revised back to sex.

If anyone has a copy of that letter to hand, before I go and find it, can they post it?

Got it. Not sure how easy this will be to read.

And what is the Sullivan Review?

I read somewhere recently that the GMC say they are going to drop recording gender. If I can find it again, I’ll post it.

My guess is they have realised it is a hot potato so are getting themselves out of it. It dumps the problem somewhere else.

The GMC see fit to publish doctor’s qualifications, which is one of the key criteria for me in selecting a doctor (in situations where I’d be able to). For me, the doctor’s sex is another key criteria in at least some matters. I think the GMC should publish this, and doctors should accept patients need to know.

Applies to other HCPs too.

The letter states that two gender options are available 'man' or 'woman' but this is a lie. The options shown are 'male' or 'female'.

There's no guarantee that 'man' or 'woman', 'male' or 'female' can be taken to mean what sane people know them to mean. Particularly after the demonstration by Upton who completely pretzeled the language. With some individuals getting a straight (fnarr) answer is akin to deciding which is the safe door when one guardian always lies and one lets him.

The GMC have got themselves in a mess. This confusion in their systems is indicative of that.

IMHO they should collect and publish doctors’ sex and trans status, because that is what patients need to know. So doctors should accept that. They have accepted in the past (before trans became an issue) that it was fine the GMC published whether they were male or female, so really this would just be an updating their approach and systems to take account of modern mores.

You can request a change of healthcare professional at any time without having to give an explanation.

In this situation if you felt strongly you could simply request someone else, you would not have to say why.

I've asked for the above picture to be deleted, this one has names and numbers removed.

edit - sorry wrong thread!

I don't know if this helps anyone else, but I have just this moment sent this to my MP:

I have been listening with increasing horror to the evidence given by Dr Theodore (now 'Beth') Upton in the case of Mrs Peggie v Fife, 4104864/20/4. Briefly, Dr Upton is a transwoman (i.e. a biological male) who used the female changing room of the hospital at which he worked as an A&E Doctor. Mrs Peggie, a female nurse of 30 years experience, is alleging sexual harassment, harassment related to a protected belief, indirect discrimination and victimisation. The hospital and Dr Upton are co-respondents.

Dr Upton gave evidence on Monday 10th February to the effect that he would proceed with an intimate examination on an unwell female patient who has already requested same sex care. He would only desist if the patient both identified that he was male and refused him in person. His position fails to take into account that:

1. The patient's consent is predicated on same sex care. Dr Upton is both legally and biologically male. This examination would therefore be assault.
2. The refusal requires that the patient recognise that he is in fact male. Whilst this is normally obvious, the patient's ability to assess this may be impaired by the injury or health condition that has brought her to A&E; by a preexisting impairment such as a learning difficulty or visual impairment; or by drugs or alcohol. She may also simply be too intimidated in the moment to refuse.Patients who are unable to make a snap judgement that he is in fact male (or lack confidence in that assessment) could therefore be subject to an examination on terms they have already refused.
3. It underestimates the sheer courage needed to challenge a doctor who is claiming to be female when the patient has already requested same sex care. Given the inherent power imbalance between a doctor and an acutely unwell patient, particularly in an emergency setting, this is both exploitative and highly unrealistic.

Dr Upton has also made clear that any such refusal would be an act of bigotry akin to declining a doctor because of their race. This matters, because this would normally be documented on the notes and could be grounds to refuse a patient care. Again, the power imbalance here is real, significant, and would make it very difficult for a woman to refuse him.

It is not consent if we are afraid to say no.

I hope you appreciate my horror at this situation. If you do, I would be grateful if you could table the following question to ask the Health Secretary:

"What does a woman requesting same sex care for an intimate procedure have to say to ensure that she is not treated by a man who identifies as a woman, without being assessed as a bigot?"

I look forward to your response

I freely admit to pinching the best bits from posts from the very many articulate and outraged women on the other threads.

Thanks @Liverstreaming for sharing that. I'm working up to writing to my MP too. It will be useful to collect responses back?

The TRA appropriation of racial equality struggles and the way GRC / trans status is used to obscure the sex power imbalance reminds me of the story behind the invention of intersectional feminism. Something similar feels needed. It seems utterly impossible that anyone seriously believes that a piece of paper / idea inside a man's head (coupled with optional hairstyle and lippy) magically erases or even inverts the multiple power imbalances inherent between a male HCP and a female patient.

I'm not in the UK any more but maybe everyone needs to write to their MP and the local NHS chiefs beween now and before this case restarts. So that key quotes can be referenced on the Tribunal Tweets substack.

It's probably worth mentioning that a common objection to women attempting to keep their right to request female HCPs is to use the excuse of staffing difficulties and emergency scenarios.

Personally, I think emergency situations are very different to needing a female HCP to conduct a smear test or mammogram. Undergoing emergency health care is likely to be a somewhat traumatic experience regardless (although infinitely preferable to the alternative!). But routine and non-emergency appointments should not be traumatising or re-traumatising for patients. The NHS should not be inflicting avoidable harm or operating a system that excludes a section of society.

I can only speak for myself here though. I don't know if a person whose request was based on religious or cultural grounds would feel differently.

Isn't it that for intimate examinations you're always offered a chaperone? There are plenty of małe gynaecologists/ doctors already and I've been to a female GP before who also offered a chaperone.

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

@OuterSpaceCadet I can only really speak for myself. Working it through, it's not the sex that's the issue for me but the violation of boundaries. I'm thinking back to my mum's end of life care last summer. She was cared for by a whole range of people, male and female. Each one introduced themselves and each man, without exception, checked that she (and after she lost consciousness, we) were okay with them caring for her in that moment. Every time I replied, "My mum's a nurse. She'd think being a nurse is much more important than what sex you are. Thank you." I absolutely stand by that. I'm pretty sure I'd reply the same if a transwoman asked in the same respectful way.

But blowed if I'd let Dr Upton and his sense of raging entitlement anywhere near her.

Yes I totally get that re boundaries.

Because of my history my starting point is female only. However there's a male Dr at my (large) practice who I can imagine I'd be ok with for an intimate procedure. There's another I wouldn't be ok with. This is all due to how my previous interactions with them have been.

My local hospitals are vast however and it's unlikely I'll see the same HCPs.