A GP writes on why she does not provide 'gender affirming' care'diverse patients

[ArabellaScott]

https://genderblog.net/a-message-to-you-gps/

A measured, thoughtful, and well referenced piece, considering the ethics and potential liabilities for GPs treating trans identifying patients.

Argh, I'm editing on my phone and the title has gone all over the place. Sorry.

Should be 'A GP writes on why she doesn't provide gender affirming care to trans and gender diverse patients'

Thank you for sharing.

It's interesting seeing Nick Wallis stepping further into this space. Obviously the blog is by a GP but his foreword lends a credibility that may help the Guardian/BBC reading public to be more tuned in to the idea of a scandal that's hiding in plain sight, given his key role in amplifying and exposing what was happening in the Post Office scandal.

It's also incredibly reassuring to hear a GP speaking out in such a clear way.

"It goes on to state that misgendering can make people feels disrespected. This is the language of activism. Using these pronouns is part of affirmation"

I'm concerned about vulnerable adults as much as vulnerable children, but it makes sense to start with children first because we have the schools' KCSIE guidance which is statutory and highlights the risk of social transition. It's time for counselling services, schools and Children's Services to wake up. Putting children onto this affirmative pathway is the antithesis of support. It's collusion and it's leading to harm. First do no harm.

Schools are at the coal face of child protection statutory guidance. Ideally, they should be firstly understanding and upholding the statutory guidance (too many schools don't seem to understand the meaning behind "social transition is not a neutral act" from the Cass Report) and lobbying the DfE to widen it across the whole Working Together framework. If this can be put in place, there would be a clearer understanding, as per the schools' KCSIE guidance, that being LGB and T (gender questioning) are two very different things, from a risk perspective. This could also lead to a better understanding of banning "conversion therapy" practices for both children and adults.

What a mess we have made

This is excellent. It is only weakened by the fact that it is anonymous though I understand the need completely. Just makes it harder to gain traction.

The only bone I have to pick is the reference to shared care documents with GICs. I can't speak to Chalmers or M'cr but my experience is that most NHS GICs will not write SCAs. They write letters to the GP which are more like instructions, rather than true shared care. The RCGP have taken to calling this seems to refer to this as 'collaborative care' though use of either word is arguable. In reality it takes a brave GP to refuse such 'recommendations', given that GICs are a commissioned secondary care outfits, despite all the good arguments this GP makes.

There appears to be a basic misunderstanding of the Equality Act, which leads GPs to fear being accused of discrimination, if they do not give these patients what they want. This is not in fact what the Equality Act states, but rather that they must not be discriminated against, hence should not be treated any differently because of their protected characteristics.

I think a comparison could be made, with patients who demand antibiotics, when they have a viral infection. It would be pointless and ineffective.

Thanks for the useful insight.

I think this letter is probably going to be most thought provoking for other doctors.

It sounds like a difficult position to be in if there's pressure from GICs, who are largely staffed by activists/true believers.