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.)

I'm struggling with how this plays out in practice. Telephone call... Voice often sounds like natal sex. Visually, very few would pass. If you can neither see nor hear the patient, you have to know the sex to make a sound clinical assessment.

Both should be free to make those decisions for themselves as adults with legal capacity who have a right to make decisions about disclosure and access to personal information and decisions about their own healthcare.

You have a right to refuse healthcare. You don't have the right to demand it or request it on the basis of false information that you provide. You don't have the "right" knowingly to decieve a healthcare provider into giving you incorrect and possibly harmful treatment for your sex. It's unfair to the person treating you, as much as anything else.

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.)

Yes, I imagine that M/F is automatically printed out as part of the identifier for a particular patient (name/dob/nhs or hospital number/sex). The sex will be taken into account, if applicable, when the clinician reviews the results and will be downloaded from the notes (not the sample bottle, which is long gone).

You are conflating a lot of different things here.

No one is arguing that clinicians should be misled or that patients should receive treatment based on false information. The question is whether there should be a mandate for birth sex to be routinely and universally displayed across all clinical encounters - whether that is proportionate, justified and the impact of such a rule on the privacy of trans patients.

Nor does recording a person's gender necessarily amount to "false information". In many healthcare interactions, a person's gender is the more relevant demographic characteristic, while birth sex is a separate piece of clinical information that may or may not be relevant depending on the context.

The debate is about how healthcare systems should record and disclose different types of information—not about whether clinicians should be deceived.

You seem oddly over invested in this issue. Do you have a trans relative?

Its as bonkers as me not wanting everyone to know im menopausal, so demand that I can decide who needs to know my date of birth and when.

Everyone else can record their true date of birth, but i can have a false one or have it blank depending on my mood.

In many healthcare interactions, a person's gender is the more relevant demographic characteristic

Can you give some examples, and would this be gender in addition to sex or instead of sex?

Nor does recording a person's gender necessarily amount to "false information". In many healthcare interactions, a person's gender is the more relevant demographic characteristic

Will anyone think of enbies and agenders?

The relevance isnt their gender. Its the drugs and surgery they have had.

Why is my investment any stranger than yours? This is a matter of public policy and we have opposing opinions on the matter.
I am concerned about a huge range of human rights and social justice issues.

Why is my investment any stranger than yours? This is a matter of public policy and we have opposing opinions on the matter.

I'm a retired NHS consultant so have a professional interest. You are not trans yet are arguing on behalf of what you think trans people want. Do you have a trans relative? Is that why you are so obsessed with this issue?

I don’t have a gender and will only accept a gender field if there’s a ‘none’ or ‘not applicable’ option, the same as with the religions question. Like you, I will not accept some sexist person deciding to allocate a gender to my record anymore than I would accept having religious belief ascribed by someone who believes in gods.

The debate is about how healthcare systems should record and disclose different types of information—not about whether clinicians should be deceived.

You say potato, I say potato.

Booking and reception - how the patient is called from the waiting room, correspondence, and respectful communication.

Mental health services - social role, lived experience, and gender identity may be highly relevant to assessment and therapeutic rapport.

Breast screening - trans women who have undergone years of oestrogen therapy may require breast assessment.

Bone health - this is affected by hormone balances

Endocrinology - hormone results are affected by hormone therapies.

Laboratory interpretation of blood results - for some patients on long term hormone therapy reference ranges may be according to gender rather than birth sex.

Furthermore, there are all kinds of clinical contexts where birth sex is not relevant at all, and more important is treating the patient in a manner that is compatible with their dignity, safety and privacy, e.g dermatology, orthpaedics etc, etc etc.

Exactly, spot on analogy!

Yes so the best approach is to have a mandatory sex column and an optional gender one.

Not a single one of the examples here that are clinical interactions render birth sex less relevant than aquired gender.

And this is what currently happens, they ignore the sex field and use the “gender” field to record both sex and gender identity.

If there was no capture in the NHS the whole idea of recording gender instead of sex would have been dismissed a long time ago. There is very little justification and what there is is purely ideological and emotive, as we can see from the attempts on this thread.

Fortunately this is what is stated in the implementation guidance:

• Gender identity should ONLY be recorded if a person has a gender identity and wants it recorded in their healthcare record and a clinician decides it is appropriate to record it.
• Information about gender identity should ONLY be recorded if a person has a gender identity and wants additional information about it recorded in their healthcare record and a clinician decides it is appropriate to record it.
• Pronouns should ONLY be recorded if a person wants their pronouns recorded in their healthcare record and a clinician decides it is appropriate to record them.

As such, I think that's a fair compromise.

Well we can have a totally separate thread about social use of pronouns etc, but this thread is mostly about clinical situations.

For the gender identity to be meaningful in a clinical situation, you also need to know the person's sex. The patient cannot judge whether or not their sex is important. Only the clinician can do that. I agree that gender identity could be useful additional information in the clinical examples you give.

The above being in reference to the new system, not what has been done in the past. 'Sex at birth (observed)' is now mandatory, the others are optional and will only be applied to trans-identified patients who wish this information to be recorded. They will be blank for most people.

Yes, I think this is certainly better than what went before.

I would suggest that trans-identified people take up the offer of a gender identity marker. It will prompt the clinician to asks further questions, if relevant, such as questions about hormones, surgery, timescales and so on. Ofc that info should be buried somewhere in the patient's notes anyway, but I think we have all experienced time-strapped clinicians needing to be prompted to retrieve vital information about aspects of our treatment.

The gender identity field appeared on the main patient administration system in the trust I work in a year or two ago and obviously isn’t mandatory and for most people is blank. However, there isn’t currently a ‘none’ or ‘n/a’ response possible which there is for the religion field. Since there is equal validity to having a gender and having a religious belief there should be the same availability to record one’s non-belief, imo.

I think this is making something out of nothing to be honest. It's not necessary information to record about most people but could be medically relevant to trans-identified patients.

Making a fuss about something that doesn't need to be recorded about you because you want the option to have the equally irrelevant 'none' written in reminds me of when some straight couples argued they should also have the right to a civil partnership. Like yeah, maybe, but it's a non-issue and seems petty.

I disagree. I think in a world where there’s an assumption that everyone has a gender identity it’s important to be able to say you don’t, just as in the days when it was assumed everyone had a religion people had to stand up to say they didn’t.