People missing out on cancer screening recalls to due gender not sex being recorded.

[HidingBehindTheWallpaper]

https://www.independent.co.uk/news/uk/home-news/sex-data-gender-identity-nhs-police-review-b2718090.html

If only someone could have foreseen this!

A nurse saying she attributed someone's abdominal pain that has been bad enough to take them to the emergency room to obesity of all things. I don't believe such negligence wouldn't have happened with a 'female' patient either if that's her attitude. There are plenty of urgent conditions for males and females .with abdominal pain in an emergency setting to be considered before anyone would or should write of pain as coming from obesity 🤨

As far as I can see, the patient did not immediately declare the pregnancy, and from the headline it appears that the patient didn’t realise that pregnancy could have been a possibility. The staff believed the health records saying the patient was male The nurse observed that the patient was obese, not that obesity was the cause of the abdominal pain.
It seems it was only with further investigation that the pregnancy was discovered.

Surely the ideal situation for a trans person is to be treated as their preferred gender and in accordance with the sex/gender markers on their health record. It is a bit rich to then claim that initial triage assessments were made and incorrect treatment was given and that it somehow part of some evil trans persecution.

If you read the full article, not just the metro summary, they did declare the pregnancy. The nurse even ordered a hospital pregnancy test in light of the declaration. They just didn't rush to follow up the tests or seemingly believe the patient because of the nurses assumed they probably couldn't be pregnant despite the fact it had been clearly explained the patient was a trans man, with ovaries, not taking testosterone i.e., could very well be pregnant ,which she knew given she ordered a pregnancy test. The test result just weren't actioned until later by another HCP. It does say that the nurse assumed the likely diagnosis was obesity and discontinuing blood pressure medication. I'm really failing to understand how an example of a transgender person receiving inadequate and negligent healthcare is being twisted to be the trans persons fault given they were completely clear about their trans status.

"Though she had respectful intentions and nominally acknowledged the possibility of pregnancy by ordering a serum hCG test, she did not incorporate that possibility into the differential diagnosis in a way that would affect ensuing classifications and triage decision making. Despite communicating that he was transgender, Sam was not evaluated using pregnancy algorithms. Having no clear classificatory framework for making sense of a patient like Sam, the nurse deployed implicit assumptions about who can be pregnant,4 attributed his high blood pressure to untreated chronic hypertension, and classified his case as nonurgent."

How exactly is it rich to claim the treatment was wrong when it was wrong? And where am I claiming evil trans persecution? I'm saying it's an example of a lack of awareness around healthcare for trans people and that's why some of the language changes are actually helpful in people's implicit assumptions. Whether you like the phrase women and pregnant people, this is a clear case where it would be helpful for a HCP to be familiar with such wording because clearly this person's sex marker stopped her engaging her brain with all the other relevant pregnancy signs.

@Pombearsallday "Having no clear classificatory framework for making sense of a patient like Sam"
The male / female classificatory system is more than adequate, and had it been maintained this nurse wouldn't have been confused.
Maybe a superior breed of nurse would be able to speak Butlerese in her handovers but it's not actually going to be conducive to improved healthcare outcomes for any patients.
Keep the waffle to the academy, where such-and-such studies professors can wang on about how many genders can dance on the head of a pin to their hearts' content(s?).
ED triage needs to be kept as simple as possible.
From someone who has not only "worked in a hospital," as you euphemistically put it, but has also worked in a hospital, in ED, as a nurse.

To add: What this novel "clear classificatory framework for making sense of a patient like Sam" actually means is "getting used to the idea that not everyone with <<MALE>> on their hospital notes is actually male."
Which is mental energy that can't always be afforded somewhere like ED.
Yes, the nurse messed up. She got confused, there were tragic consequences to her mistakes.

Had it been a pleasant, quiet, private clinic they were in it would have been possible to do the mental acrobatics involved in talking to Sam as if Sam is a man while at the same time thinking of Sam's signs and symptoms as those of a woman.
There is so much going on in the mind of a nurse who is triaging a patient (and there's never one patient at a time, is there? How many other algorithms was she running in her own mind at the same time about all the other patients presenting?). The mental effort of talking to and referring to a person as if they are male, while computing the risks as if they are female, is enough to mean mistakes are more likely.
And after all this, I don't understand what the obsfucation /achieves/. Trans men are female. What is the point of pretending they are male? Does it make it easier for people who are shocked by gender non-conformity? Pretend this bearded woman is actually male? Carry the pretence so far that you falsify their medical records?
What is all this in aid of?

Yes but she was given all the relevant information to place that patient within that classification. There was no lie about the patients biological sex. If you're going to base your actions not on the information provided to you but solely by the systems that's dangerous as that could easily be wrong. Clearly you want to insist that the sex marker says female, but I'm not sure how you're certain that wouldn't lead to the same negligent care due to lack of awareness about trans people given the patient was masculine presenting and could even have been registered with a very male name. She had all the relevant info that alerted her the patient could be pregnant, she even ordered a pregnancy test based on it! The fact that she then didn't triage the patient as possible pregnancy complication is inexcusable, the sex marker did not stop her from following up the tests quicker, getting an abdominal examination, a scan etc. Her triaging decision that the abdominal pain was caused by obesity and stopping blood pressure medication should absolutely have not been a first diagnosis in an ED setting without ruling out any other differential diagnosis whether the patient was male or female. I'm horrified that as an ED nurse you don't see any other error in the care and this is somehow all the fault of a sex marker, you seem to be excusing a lack of a proper handover of pretty basic information on the patient as "waffle" which is concerning. How is explaining "patient is a trans man and possibly pregnant" so much more time consuming and confusing for medical professionals than "female patient possibly pregnant to the point that you'd miss following up on ordered tests because you're only looking at the sex marker?

See you're projecting so much information that isn't in the article. No where is it even suggested that more time or effort should have been spent in speaking to Sam like a man. It's not even saying that all those who are registered as male may not be and you need all this time and effort to figure out who is who. The lesson was that if you have a patient who clearly TELLS you they aren't biological male and lists of the reasons they could be pregnant, you LISTEN and act accordingly. No one is asking you to coddle them or their gender identity, they're asking you to do your job properly and take a careful medical history and act on it accordingly. If you read the article it has some very good example of other implicit bias that can affect people's care, assuming that an older patient couldn't be presenting with an STI, assuming a patients risk factors based on your perception of their race. It might do you and your patients some good for you to read it.

@TheCourseOfTheRiverChanged Do you also think it's excusable for a triage nurse to not adequately record a patients disclosure of sexual trauma and request for a female HCP for example? Is a patient with additional needs and their required adjustments too complicated and mental gymnastics to hand over to other colleagues in a busy ED department, you find it acceptable for a patient passport to be ignored for example? You've never dealt with a patient with mental health issues presenting with a physical problem, and all the adjustments and communication that requires in handover? When you play down 'accomodating' trans people, it makes it sound like you're not offering good care to other patients as well because the accomodations and skills people are asking you to implement in order to provide trans people with good care are required for lots of other patients.

Absolutely this.

I certainly agree a request for female clinicians is something that can get lost in a busy ED. It can be exhausting self-advocating and having to make the request over and again after every shift change.
I've wittnessed such coldness from a triage nurse referring to the patient infront of her, with dual disability and an awful history of sexual violence, as "another one of these" and an eye roll.
It's a really difficult place to work and lots can go wrong. I don't do that sort of work anymore. It took a lot out of me.
I'm not sure how this relates to making hospital records and decision making matrices more complicated than necessary? Male / female works fine and I do not believe another novel classificatory framework will improve any patient's care or outcomes.
Are you able to have a stab at explaining to me what such a novel classificatory framework, one that involves a kind of pretence that some female people are male, is in aid of?
(I actually have very strong feelings about how easy you find it to equate requests from female patients for female clinicians, and the challenges of providing care that is safe in all ways for women who've experienced sexual violence, with a change in institutional practice towards putting a "male" sex marker on the medical records of female people with a particular gender identity (and vice versa). Lets just say, the medical establishment haven't rushed to embrace trauma informed care in quite the same way they've embraced gender identity informed care.)
edit: this is a reply to @Pombearsallday's reply to me

I actually have very strong feelings about how easy you find it to equate requests from female patients for female clinicians, and the challenges of providing care that is safe in all ways for women who've experienced sexual violence, with a change in institutional practice towards putting a "male" sex marker on the medical records of female people with a particular gender identity (and vice versa).

Firstly, I'm not equating those two things at all and my point was even regarding anything institutional. My examples, whether you agree with it or not, were that the required practice is the same between listening to a female patient telling you relevant information about their trauma and a trans person telling you relevant information about their sex as to how it relates to their symptoms. When you dismiss the latter by saying departments are too busy, that's just not good enough especially to then blame the trans person for their still birth which is how this story was linked (as an example of a delusional trans person causing their own bad health outcomes) when it's actually an example of a HCP failing a patient. I have very strong feelings about how as an ED nurses, your attitude towards relevant patient information not being communicated because it's "waffle" is very blase particularly when it has a bad clinical outcome. Lots of patients have "waffle" for all sorts of reasons, and I don't think as a HCP you should downplay it, or is it only with a trans patient that it's waffle and acceptable to not be included in handover? That was my question. Perhaps (hopefully) you don't work in the UK or within the NHS because it's not acceptable policy for patients whether traumatised, disabled, or trans to have to advocate for themselves "again and again" especially not when it's something as basic as what has brought them to ED.

They wouldn't need to repeatedly advocate if they had the correct sex markers on their paperwork.

Of course it's not "policy' for patients to have to repeatedly advocate for themselves! I was describing a failure in the system! Are you being deliberately obtuse?

"as an example of a delusional trans person causing their own bad health outcomes"
That is not the crux of the issue. The institutions have changed the way they record patient data, so sometimes "male" means "male" and sometimes it means "female with a gender identity." No individual trans person has it within their power to transform how a health service records their data. This thread is about an institutional problem, about decisions taken at the highest level by policy setters, decades ago. Yes, some people have given negative and even dismissive opinions of individual trans people who play along with these institutional changes. But by trying to draw it back to the fragmentary, isolated actions of individuals you're diverting attention from the systemic problem, and source of confusion.
I'm finding this conversation difficult because you have really badly misrepresented things I've said. I don't know if it's difficulty comprehending what I write or a deliberate effort to paint me in a bad light. But, I'll try for a third time, any chance you could have a go explaining what the reasons for these institutional changes are (i.e. recategorising some female people as male)?

"Are you suggesting that the pregnancy or trans status wasn't believed and they thought it was a man falsely claiming to be pregnant and therefore not investigated because they will only provide pregnancy care for people with a F sex marker? "

Since only females can get pregnant, then yes, I would like the sex marker to reflect sex and not gender identity, and yes, I would like pregnancy care to be available for females, not males. Because there's no point providing pregnancy care to males, they cannot get pregnant.

Trans identifying males cannot get pregnant. Trans identifying females, like in this tragic story, can get pregnant.

Language matters.

It strikes me that all of this is very simple to solve. All files have two boxes. Sex, meaning how you were born, and gender, how you identify, would like to be known etc.

Sex is important medically. You can’t identify your way out of pancreatic cancer.

More importantly, you can't identify yourself out of cervical or prostate cancer.

I agree, it seems very simple to solve using two different markers.

I meant prostate. How I managed to end up with pancreatic I don’t know!

"Should never happen . Things that should never happen happen every day, and often this is because information was unclear or because communication was imperfect. Simple accurate language avoids some of those problems.

Going back to an earlier part of the thread, complicating language by changing "women" to "women or people with a cervix" does have consequences. Someone with poor language skills can miss the meaning of a more complex sentence completely. I have a peculiarity that I struggle with comments in upper case, and also with those terms and conditions documents where defined terms are in bold type. They are supposed to be particularly clear!

Slightly off topic, but it isn't straightforward - Cervix comes from the Latin word for neck, so your cervical spine is the first seven vertebrae in your spine and cervical spondylosis is neck pain, and cervical myelopathy is a loss of function in the arms or legs because of compression of the spinal cord in the neck.

However, cervix commonly refers to the 'neck' of the womb, so cervical cancer refers to this part of the body and is sex specific.

Luckily 'woman' is an inclusive simple word that refers to sex.

Slightly off-topic, but many people struggle with upper case - it's because fluent reading ability depends to an extent on recognising the shape of words rather than reading letter by letter. It's why road signs are generally lower case.

But that wasn't the case that was linked as an example of a delusional trans person causing their own bad health. It was simply bad care - we don't take things that clinicians get wrong and blame the patient when they told the HCP they could be pregnant and a pregnancy test was ordered to confirm and then just not followed up several hours later.

I don't think the cervical screening programme is an example of changing women. Women are still included it just also details that people with a cervix are eligible. It comes with a very clearly worded leaflet explaining exactly what a cervix is and what cervical screening is. I don't think the suggestion it's confusing has any real evidence. Even with women reporting they didn't know where a cervix was on a diagram knew what a cervix was. I agree with you on the capital letters and I think most medical leaflets should be in a style now that doesn't include unnecessary capital letters.

"Women are still included it just also details that people with a cervix are eligible. It comes with a very clearly worded leaflet explaining exactly what a cervix is and what cervical screening is."

All these people are women. 'Woman' is an inclusive noun that refers to sex and makes no judgement on identity. I don't think anybody with a cervix is confused about their sex, but I am sure that many women do not have the language skills to read a leaflet.

Failing trans-identified females more than anyone else. There are young women missing out on vital cervical screening for a cancer that is amongst the most treatable when caught early. Females having heart attacks are having their bloods measured using male scales. Obviously there is harm to trans-identified males too, but since most blood test parameters are lower for females it is far more likely to be women affected. But vulnerable and mentally ill young women are just cannon fodder for this men's right movement. I know those young women want their sex marker changed but this is a case of safeguarding and they need to be protected from their own self harm by medics who should know the value of biological truth and fact.