According to an article published in Reuters Health, doctors should ask adolescents about their gender identity – Dr Helen Webberley couldn’t agree more….
Following the recent article in Reuters Health, I can already hear the distant comments and objections from medical colleagues who might think such the idea of asking young people about their gender identity preposterous.
Since qualifying as a doctor in 1992, I have heard many similar protestations relating to common health issues:
- Blood pressure testing: GPs simply do not have the time to check people’s blood pressure on a regular basis.
- Sexuality: If I ask someone whether their partner is male or female, I could cause great offence.
- Obesity: It simply is not my role to discuss weight and teeth health with the children brought in by their parents for something completely unrelated.
- Contraception: Women requesting the morning after pill will not welcome being ‘lectured’ about ongoing contraception.
- Abuse: If someone mentions inappropriate behaviour by someone close to them and I ask about it, I may be opening up a can of worms.
- Smoking: It is not my business whether or not someone wishes to smoke in their own home.
- Depression: If someone looks sad and I ask them about it, it may take ages to give them the support they need.
There is a similar theme running through these recalled objections made by doctors. There is the fear of causing offence, the worry about taking the lid off something that you wish you’d never asked about, ‘wasting’ precious time on matters that delve just that little bit deeper into the individual’s broader wellbeing than you may have wanted.
“The topic of gender variance is relatively new in many people’s minds. Training was not routine when most of us were in medical school, and current postgraduate education is sparse. Many doctors are well aware that their own skills and knowledge in helping those who need assistance in either working out their feelings in terms of their gender, or taking the steps towards transition, can be severely lacking. So it is understandable that they might be nervous about starting such a conversation.”
Immediate questions may lead to illogical conclusions – if our patient is not questioning their gender, are we causing them to do so by the mere mention of the issue? Will doing so cause offence among those who are not questioning their gender? The truth is that everyone is different and while the majority may see this as a simple question requiring a yes/no answer, others may not.
One thing I am certain about is that, for some, it will be the olive branch for which they have been desperately searching. It can be terrifying to raise the issue. To ask your doctor something so tricky, confusing, controversial, unknown – where does an adolescent even begin to find the right words? If a doctor can open the door just a little way, then maybe the patient can come in. And even if that time isn’t quite right, the door can be left open for future access. The very root of holistic, wholesome healthcare.
So how can we raise the subject of gender in a way which puts the adolescent patient at ease?
My advice is to keep things simple:
- Can I just ask some general questions about you so that I can get to know you better?
- Some people don’t necessarily feel as female or male as they are expected to, is that something that has ever crossed your mind?
- Sometimes people are presumed male or female by the outside world but in reality that doesn’t quite fit. Have you ever felt that way?
- Is there anything else I can help you with today, you are free to ask me anything you’d like you know.
- There is a lot of talk about gender issues with young people these days, if there was anything you wanted to ask me, then do feel free.
There is an excellent resource for doctors developed between GIRES and the Royal College of General Practitioners which can be found here.
Lack of knowledge and fear on our part is not an excuse. If our patients would benefit from us asking some trickier questions, then let’s arm ourselves with the knowledge and tools to help them.
If you are a GP or healthcare provider and would like to know more about how best to support transgender patients, please feel free to contact us via our Help Centre.