NHS update on recording patient sex and gender identity

[Whatchamacallitt]

For a long time sex has been erased and replaced with gender identity. Trans-identified people actually lose out the most with this. There have been cases of trans-identified women having heart attacks, pregnancy emergencies, and kidney failure missed due to clinicians relying on normal male test ranges or presumed male sex. There have been issues for trans-identified men too but unsurprisingly it is the women who have suffered the most due to these policies.

Fortunately the NHS Core Information Standard has been updated to make 'sex at birth' a mandatory data item, with the option to record gender identity separately for patients who feel they have one.

(I don't personally believe in gender identity but recognise it is a genuinely held belief for many trans-identified people and also that it could be helpful information in the context of an altered body due to medicalisation.)

let me give you the only possible answer: a clinician, at the point of treatment. Therefore that information must be immediately available to the clinician.

As a retired clinician I agree with this 100%. Sunni's relentless whining that he should be allowed to hide his sex won't prevent this happening.

Any other answer misunderstands the responsibilities that HCP’s have for their decision making.

The idea of expecting life-affecting medical decisions to be made by people whose regulators (rightly) breathe down their necks looking for cases of error, while denying those professionals access to basic information about a patient’s physiology, is laughable.

If you want doctors to do only a semi-competent job, deny them information about who they’re treating.

"What systems? How will they determine this?"

These systems already exist throughout healthcare. The question isn't whether healthcare systems can manage this—they already do. It's whether birth sex should be treated in the same way as other potentially sensitive information like sexual orientation, HIV status, safeguarding information, autism diagnosis, etc, etc, the list goes on! Or whether it's necessarily to mandate a rule for birth sex specifically that it must be universally visible across all healthcare contexts and the justification for this.

It's whether birth sex should be treated in the same way as other potentially sensitive information like sexual orientation, HIV status, safeguarding information, autism diagnosis, etc, etc, the list goes on!

All information in medical records is potentially sensitive.

None of those things are denied to clinicians who deem them relevant, and the decision as to whether those things are relevant are made by clinicians. Birth sex is the same.

I can't see how that will work tbh. A blank Sex field will indicate that the person is transgender anyway. An incorrectly completed Sex field will be a medical danger to the patient, a professional danger to the person treating them, a safeguarding failure in some situations and will feed false data into the NHS. Plus, it will mean that the Sex field cannot be trusted by practitioners, which is not acceptable for those of us who want our correct sex recorded and trusted (the vast majority, including some trans people) .

I think the best solution is a Sex (observed at birth) field for everyone. Obviously there will be further information in the notes if a patient is taking cross-sex hormones or has had organs removed or re-fashioned.

Sex is important, even vital, in so many medical contexts. It's just not reasonable to ask for us all to have it hidden away somewhere, accessible only on demand, simply because a subsection of transgender people are unhappy with it.

I've stated multiple times in this thread that I'm female and that my birth sex is female. Referring to me as "he", while calling me "whiny" is a personal attack rather than a discussion of the issues, and it's disappointing behaviour from someone who has identified themselves as a retired clinician. It is also telling that you have chosen to imply I am male or trans as a rhetorical tactic to undermine my credibility.

If you have a substantive response to my points about patient privacy, confidentiality and information governance in healthcare, I'm happy to discuss those.

accessible only on demand

Accessible “on demand” is fine: have a little black square you have to click on (like they do on Reddit) if you must. Who cares. But all clinicians need access to that information like they do to all other medical information at their own professional discretion. We cannot have a situation where for some providing treatment, clicking on that little black square says “error: denied: this information is not available to you due to patient privacy”. At which point, what value is the little black square? “On demand” is mere semantics, if it is provided on demand to everyone entitled to see a patient’s medical record, as in fact it must be.

Absolutely right. And when you have substandard medical care as a result, be sure to thank @MashaPav for prioritising your feelings over your health.

You're getting frustration as you present no credible arguments. Apart from the risible "I want my birth sex kept confidential so the NHS should compromise all record keeping in order to pander to me".

Arguing that birth sex should be confidential is laughable. It's part of a stream of laughable nonsense demands coming from transactivists (TWAW etc) and I understand that they've got used to compliance due to the "sacred caste" syndrome.

It's anti social and disrespectful to the rest of society to spend so much time trying to mould systems for such a niche fantastical belief that birth sex must be kept secret. It's toddler level magical thinking and has no place in society or in influencing aspects of health care.

Why are you happy to reveal your birth sex to strangers on the internet but not to doctors providing you treatment?

You do know that, on occasion, ICU nurses round a corner and see a fully dressed patient, still with shoes on, still on a trolley, having a tube shoved down their neck to save their life? The patient is so ill that they've just been whipped up from A&E and treated without any history, any medical information except perhaps their name and date of birth.

It is vital that people aren't wasting time working out whether to treat them as Tom or Tracey.

We aren't talking about minor cosmetic surgery here, we're talking about life saving measures.

I have my annual health check this week and the GP's receptionist gave me a urine sample bottle, on which she had printed out and stuck a label indicating my name, NHS number, dob and sex. On demand is going to have to include receptionists, who are no doubt aware that all information about a patient is strictly confidential.

Name and date of birth are for identification; they key to the medical record. And they are checked, for example, before providing medication.

But I don’t see why sex has to be on a wrist band. What are the good reasons for this?

Samples go to a lab. The clinicians there will, I assume, have baseline data that they measure what they're testing for against. Some of the measurements will be different for each sex. What's within normal parameters for men might indicate a problem in a woman and vice versa. It's possible that because the NHS no., which used to indicate sex, can no longer the trusted it has to have its own field. It may be that sex was always recorded separately. I think it's imperative now that it has its own field.

Exactly. It’s the last card they have to play.

Is this in reply to me? I'm talking about specimen samples, not wristbands.

No, it is never appropriate for the sex field to deliberately show incorrect information. “Trans women” are male, not female. And “trans men” are female. The idea that you think it would be acceptable to lie demonstrates your clear bias and agenda here.

it was prompted by your post but not directed to you.

If clinical decisions about test results from samples are made only reference to the information on the label then sex on sample labels would be needed. (I suspect decisions are not in fact made only by reference to the label.)

Are there any good reasons sex is printed on wristbands? Open question to all.

The information on a wrist band isnt just random. Its all useful information needed.

Abusive men are trying every trick in the book to treat sex as if its confidential information because they are trying to remove sex for safeguarding.

Their aim is for adult men to be in spaces with girls and women. They will use any opportunity.

If sex isnt routinely acknowledged it eventually becomes taboo to ask.

If we trust men to tell HCP their sex when its relevant, are we going to trust men to reveal their sex in single sex spaces? Why leave it up to abusive men to judge when information about sex is relevant?

You’ve not really given any valid reasons why there should be some sort of omertà on people’s sex in their medical records beyond the idea that it might give some a fit of the vapours. Many have pointed out to you that if there was such an omission it could lead to not just suboptimal, but potentially dangerous, treatment outcomes for trans people. There is no justification for making medical record keeping more Byzantine than it already is (as anyone who lives in area with split NHS trusts can attest), and to be quite honest someone who can’t cope with the idea that such information is part of their confidential medical records is not a person who is mentally sound enough to be making important decisions about their own healthcare, and should be provided with the psychological support they so obviously need for their worryingly poor mental health.
Basically, what you’re arguing for is deeply irresponsible.

Sadly, after a few years of being 'woke' to this ideology, I think you are correct.

For clarity, sex is printed on wristbands and sample bottle labels because it’s a helpful pillar in safeguarding?

And safeguarding is stronger when we take extra opportunities to distinguish men from women, and therefore we should do so even if there’s no direct need to distinguish between the sexes?

I would hope that you enjoy the best of both worlds? Sex based care based on your medical status and respectful treatment according to your preferences, as long as it doesn't compromise your health care?

I fully agree. We have to stop pandering to this damaging idea that people can change their sex markers. All these loopholes will need to be closed.

I personally think it would be much more healthy for these people to acknowledge that they can’t change their biological sex. I’m tired of people falling over themselves to prop up their false beliefs and walk on eggshells around them, and demonise anyone who won’t, like Sandie Peggie, the Darlington nurses and Jennifer Melle.