Of the problems raised by 67 GPs, practice managers, and hospital specialists such as urologists and psychiatrists, advised by the MDU over the past five years (2008-12), many arose from poor communication and misunderstandings. Examples include ensuring medical records were updated to reflect the patient's new gender, addressing patients who have changed gender or are living in their preferred gender with the correct name and title, and keeping patients informed of any delays in treatment.
Dr Carol Chu, MDU medico-legal adviser said:
"The numbers of cases notified by our members is quite small and this is probably partly a reflection of the number of people who consult doctors for transgender advice, such as requesting a gender reassignment. As a result, some doctors, particularly GPs who don’t specialise in this area, may feel that they do not have enough experience of treating transgender people.
"By identifying the common themes in these cases, we hope to help our members better understand the legal and ethical issues involved. For example, doctors need to be aware of the discrimination laws such as the Gender Recognition Act 2004, which allows people to change gender and the Equalities Act 2010 which includes gender reassignment as one of nine protected characteristics which cannot be used as a reason to discriminate.
"Doctors should also bear in mind the GMC's guidance in Good medical practice (2013), whichsays that you must treat patients fairly and with respect whatever their life choices and beliefs."
Of the cases notified to the MDU, most involved doctors seeking advice (30), while in 24 cases an NHS complaint had been made. Negligence claims accounted for 11 cases and the remaining two cases involved a GMC complaint and a report to the coroner.
The commonest queries from doctors were about changing or amending the patient's records, which accounted for 22 cases. In 17 cases the patient had complained about the management of their treatment and medication, including delays, while nine cases were about disclosing information to third parties such as other clinicians, social workers and the police. In seven cases, patients complained about the communication skills and attitude of medical staff and in three cases the patient was dissatisfied with the outcome of surgery.
Examples of the types of case included:
• A patient wanted their previous gender and references to gender reassignment surgery to be removed from their medical records.
• A relative complained that a 17-year old patient was given female hormones and referred for gender reassignment.
• A patient complained that a GP had mentioned a previous gender reassignment procedure in a referral letter to a hospital specialist.
The MDU offers this advice to doctors who have transgender patients:
• Familiarise yourself with trans issues, for example by reading the Department of Health's 2007 publication, An introduction to working with transgender people.
• Take care to address patients who have changed gender or are living in their preferred gender by the correct name and title.
• Be aware of discrimination laws and ensure patients are treated fairly and with respect.
• Ensure records are updated with the patient's new gender for all ongoing medical care and that inappropriate requests for screening are not sent, eg. cervical screening. The integrity of the old record should be protected however.
• Ensure patients are aware of the need to share information within the immediate healthcare team, for example when referring a patient to a urologist.
• When sharing information with third parties, be careful to only disclose the minimum information necessary. You will usually need to seek the patient's consent, unless it is in the public interest to share information without consent.