Liaising with health professional colleagues
When referring a patient to a hospital either for scheduled or unscheduled care, it is important to ensure that the referral contains information relevant to the presenting condition. It would be inappropriate to mention a person’s trans status when referring them to a dermatologist to have a sebaceous cyst excised, for example.
However, there are several clinical scenarios where providing information about birth assignation is relevant, for example with certain sex specific organ-based complaints, issues pertaining to hormone medications, when requiring the application of a different sex-specific reference range, et cetera.15 Where feasible, patient permission should be sought, and an explanation given as to why it is important for the receiving clinical team to know.
It might also be helpful to make allied staff aware in order that due attention can be given to ward placement, as assessed on a case-by-case basis. The provision of healthcare for trans people is premised on equality not tolerance. Consequently, the current NHS policy (NHS England and NHS Improvement, 2019) respects that and is in keeping with the spirit of the Equality Act (2010).16 In cases of early or non-transition, a dialogue may be required to establish where a patient would be most comfortable.
Working in a sensitive way, you can help to ensure that your trans-masculine patient requiring gynecological care is admitted onto a general surgical ward and indicate that a trans-abdominal ultrasound scan might be considered first if they aren’t comfortable with the use of a trans-vaginal probe. Indeed, trans people often worry about downstream care, particularly where there has been an experience of negative attitudes or lack of knowledge or understanding from healthcare professionals. Inequality when accessing services remains an issue for trans people and other minority groups.17,18
From a legal perspective, ‘gender reassignment’ is one of nine protected characteristics under the Equality Act 2010, and it extends to those proposing to undergo as well as undergoing or having undergone a process of reassignment. This is inclusive of social as well as medical transitions – medical treatment access is not necessary to be protected by the Act. Discriminatory behaviour from healthcare staff can lead to disciplinary procedures, which may culminate in dismissal.
The Gender Recognition Act 2004 provides a mechanism for trans people to apply for a Gender Recognition Certificate (GRC).19 This allows adjustment of the birth certificate, thus adjusting sex for legal purposes, albeit with exceptions. The GRA 2004 provides safeguards for the privacy of individuals with gender incongruence and restricts the disclosure of sensitive information. The Act makes it an offence to disclose protected information (i.e., a person’s gender history after that person has changed gender under the Act) when that information is acquired in an official capacity. This means that the protected information should only be disclosed when it is to another health professional for a medical purpose, and there is a reasonable belief that the patient has consented to the disclosure.
Practical Tip
Where possible, it is good practice to seek the permission of your patient to document their birth assignment (i.e., trans status) or relevant aspects of their transition history when referring to health care professional colleagues. Furthermore, be able to explain why disclosure of this kind is clinically relevant or otherwise in their best interests .