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Shredded notes: realities for trans people seeking healthcare

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If you were told about a clinician who had recently shredded their patient’s notes and refused to see them further because of their own discriminatory views about what the patient was disclosing to them and the procedure they might want, would you believe it was true?

At a union conference for healthcare staff this week I learned this was unfortunately the kind of reality transgender people face on a regular basis.

The person who shared this story explained it was the first GP they had told about being trans. What I think shocked me the most was not the discrimination itself – though of course that was unpleasant – but the fact this was a GP; someone who was in a position to use their expertise to help another person, and yet in this case abandoned them.

As the session, at Unison’s annual health conference in Liverpool last week, continued it became clear that such treatment by fellow health professionals was not uncommon.

Research has found that 86% of trans people experience discrimination at work and 30% have had health professionals refuse to discuss surgery with them, the speaker explained.

The most familiar experience for them personally had been ignorance among co-workers. “I’ve had people say things to me like, ‘Oh surely if someone is trans, they must need to have all surgeries, because otherwise you’re not really trans, right?’,” they said.

“The experience was met with a murmur of shocked reactions across the audience”

“Another really horrible thing I had said to me once was,‘Surely if a trans person doesn’t go all the way with surgery, then doesn’t that mean no one will want to love them?’,” the conference audience heard.

The next experience that was shared – described by the speaker as the “absolute worst” thing that had happened to them – was met with a murmur of shocked reactions across the audience.

“I went into work one day and the subject of chest surgery came up and one of my co-workers, who thankfully doesn’t work there anymore, said to me, ‘It’s a shame you’re getting chest surgery because I bet you have a good pair under there’,” they said.

Hearing these issues reminded me of a 2016 Royal College of Nursing survey. It found almost 80% of nurses had never received any training about how to care for transgender people, despite around three quarters having seen people from this patient group in their work. I wondered how far education could make a difference.

“Awareness about being trans has improved in recent years”

Of course, the problems didn’t just stop with staff. At Unison’s conference, speakers also explained how funding cuts to services were creating challenges.

Awareness about being trans has improved in recent years, meaning more people are being referred to gender identity clinics. But this is creating a bottleneck in some parts of the country, with appointment waiting times reaching about 12 months and staff and clinics unable to cope with demand.

“Arguments between services over which one should pay for treatment has left trans people without access to care”

Meanwhile, there are cases where trans patients are seemingly being pigeon-holed and sent to specialist clinics as a sort of ‘one stop shop’ – for example, being discouraged from accessing talking therapies through mental health services and instead being told to go via a gender identity clinic. In other cases, arguments between services over which one should pay for treatment has left trans people without access to care.

Unison members at the conference voted to carry a motion that called on the union to campaign against the cuts, highlight the funding crisis in gender identity services, share the findings from research it had commissioned on this issue, and promote its work around creating equality for trans workers.

But I couldn’t help but think one of the first ports of call should be to campaign specifically for education opportunities.

If clinicians were better trained about the issues faced by trans people and how to provide care for them, surely this would not only improve care but could also instantly help to create a whole army of advocates for this patient group.

Whichever route is prioritised, going by the strength of feeling at last week’s conference on this issue, I feel hopeful that the story of the paper-shredding GP will be banished to the realm of myth soon.

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