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.)

@Sunnibee Any chance you might answer my question from yesterday:

Where will the information about the patient's sex be recorded then? You agree that it is important in some clinical contexts, so where will the clinician get the information from?

TIA

Yes, it’s all just bollocks spouted to try to dominate and control our conversations about FWR.

Apologies i didn't see your question yesterday.

For the overwhelming majority of patients, sex is and will continue to be straightforwardly recorded and this isn't an issue. The question is really about the relatively small number of people for whom birth sex is highly sensitive personal information. In those cases, it doesn't necessarily follow that it should be routinely displayed or shared across every healthcare interaction.

Where birth sex is clinically relevant, that information can be collected within the relevant clinical context or accessed when there is a legitimate clinical need. For example, sexual and reproductive health, obstetrics and gynaecology, fertility services or prostate care already collect highly sensitive information that isn't routinely visible to every clinician across the NHS.

More generally, healthcare systems are increasingly moving towards recording the specific anatomy or physiological characteristics that are relevant to care, rather than relying on sex as a proxy. Knowing whether someone has a cervix, uterus, prostate or is taking particular hormones is often more clinically useful than a single sex marker.

The issue is whether it is proportionate or necessary for information about a person's sex—which, for some people, may disclose highly sensitive personal information, including that they are trans—to be universally and mandatorily visible in every clinical setting without the patient's consent. Or whether healthcare systems can record and share that information in a way that is proportionate to the clinical purpose, as they already do for many other categories of confidential medical information.

If sex is irrelevant,either in treatment or in any other context, the field will not even be looked at.

When it is relevant, it needs to be clear, easily accessible and accurate.

A patients name is irrelevant for treatment, but we dont hide the detail until the patient consent to it being revealed.

You are assuming that if a minority of patients opt out, or have the field show incorrect information, or doesnt matter.

But if no professional knows if the field is accurate or not, it becomes useless for everyone and in every situation.

@Sunnibee For the overwhelming majority of patients, sex is and will continue to be straightforwardly recorded and this isn't an issue. The question is really about the relatively small number of people for whom birth sex is highly sensitive personal information. In those cases, it doesn't necessarily follow that it should be routinely displayed or shared across every healthcare interaction.

I'm not sure that I can see how that will help. If the sex marker isn't being routinely displayed or shared for a small group of people, then it will be obvious that those patients are transgender people.

You're presenting a false binary: either the field always represents birth sex for everyone, or it's useless.
In reality, for the overwhelming majority of patients the recorded field will align with birth sex.
That is how it is used and assumed currently and has always been. My medical records say I'm female, this is my birth sex, this has never been a question or a challenge in my medical care. So it is for the vast majority of patients.
For the small minority where the field doesn't align with birth sex, clinicians can obtain more specific information when it is relevant to the care being provided. That's how healthcare routinely handles sensitive or context-dependent information.

More generally, healthcare systems are increasingly moving towards recording the specific anatomy or physiological characteristics that are relevant to care, rather than relying on sex as a proxy. Knowing whether someone has a cervix, uterus, prostate or is taking particular hormones is often more clinically useful than a single sex marker.

A women without a uterus has a very different health profile to a man, who will never have had a uterus.

It could be significant if she presents with broken bones.

No one is saying clinicians are looking at sex only, but its often relevant and needs to be accurate.

More generally, healthcare systems are increasingly moving towards recording the specific anatomy or physiological characteristics that are relevant to care, rather than relying on sex as a proxy.

This is AI gibberish. You don't know what any of this means. You don't know when & why sex is relevant when a patient is being treated. It's not worth arguing the toss with you any more as despite the fact that you don't like the accurate recording of sex on NHS records this will be the norm going forward.

As I wrote in my first post on this thread

Short answer. Tough shit! Suck it up.
Long answer. Your birth sex is put on the NHS record that is created for you on the day you are born. It's going to be recorded whether you find it acceptable or not.

Medical information isnt just used for face to face patient care, where the patient is able to confirm the accuracy of the data.

Its used for analysis of outcomes, planning of services, the patient maybe remote or unconscious.

If there’s any trans people reading this just get a new NHS number and the anti trans bollocks goes away. Privacy should be in the patients hands, patient information shouldn’t be there to satisfy transphobes.
Sex does not matter and should be a voluntary field on any form.

I'm still not sure that I understand what you are saying. Do you think that the Sex field should be left blank for transgender people who opt for that, with the information recorded deeper in the patient's file? Or do you think that the field should be recorded with the opposite sex to that observed at birth?

I agree.

This conversation is shows how these men just want control and do not care about anyone else - other patients or HCP.

If sex is irrelevant, the NHS wouldnt be allowed to record it.

There are plenty of trans people who say that this is not a good idea, for all the reasons that have been discussed here.

I deliberately did NOT get a new NHS number in my country, precisely because I want to keep benefitting from the right health services for my sex. I want health care practicioners to automatically know I'm female, no matter how I present. I want to receive invitations to get screened for breast or cervical cancer, not prostate. I want the receptionist at the clinic to not wonder why the hell I'm booking an appointment with a gynaecologist. And so on.

In short: I want to receive the best health care possible, which means making damn sure my HCPs know everything they need to know about me, including that I'm female, trans, and took testosterone for years.

jeez louise, hopefully you're just being goady. If you really believe sex does not matter then you are not rational

Do you understand what “voluntary” means then?

Do you understand what "best possible health care" means? I want all trans people to receive that; you don't.

This is AI gibberish. You don't know what any of this means.

What gave you that impression? It's very basic english and simple to understand. What matters is what specific anatomy a person has and their physiological characteristics. Birth sex can be a useful proxy for that information, and sometimes, more rarely, it isn't. Sometimes a person's gender is more relevant if the person has been receiving hormonal treatments for a period of longer than 6-12 months. Sometimes a person's birth sex won't necessarily give you accurate information about their anatomy - e.g. if the person has a difference in sex development. Etc.

@Sunnibee I'm still looking for clarification here, thanks:

I'm still not sure that I understand what you are saying. Do you think that the Sex field should be left blank for transgender people who opt for that, with the information recorded deeper in the patient's file? Or do you think that the field should be recorded with the opposite sex to that observed at birth?

A gurney is rushed into A and E by two ambulance technicians. “This is Alex”, they say, “Alex has been in in a road traffic accident with severe abdominal trauma. We asked the computer and it said we were allowed to reveal that Alex has two ovaries and a uterus, fallopian tubes and a vagina. It’s very important that Alex’s birth sex is not revealed to anyone.”

If clinicians are denied access to a patient’s birth sex when it’s not clinically relevant, who are you suggesting will make the decision as to when they can access that information?

Either could be appropriate, depending on the patient's consent and the clinical context. My point is that birth sex doesn't need to be universally and routinely visible across every healthcare interaction. In many situations, a patient's gender is the more relevant piece of information. Where birth sex is clinically relevant, it can be recorded and shared where there is a legitimate clinical need.

Let me ask you yet again: who determines the clinical need to reveal someone’s birth sex?

The same way decisions are made about access to other confidential medical information: through the establishment of systems that determine which healthcare professionals can see different parts of a patient's record, depending on the role of the professional and the clinical context. This is already routine in the management of information across the health service. Healthcare systems already determine who can access sensitive information based on clinical need. There's nothing unique about birth sex that means it must be mandatorily and universally visible to every clinician in every encounter.

through the establishment of systems that determine which healthcare professionals can see different parts of a patient's record

What systems? How will they determine this?

“We’ll do it with systems” is an answer to every question and no question.

For I think the fourth time of asking: who will determine if a situation requires someone’s birth sex to be known?

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.