On 25 September, the GMC updated its guidance on decision making and consent. This guidance comes into play on 9 November 2020.
It is recognised that consent, information sharing and joint decision making are key components of the doctor-patient relationship and are fundamental to the provision of safe and effective healthcare that suits individual patients’ needs.
The GMC has laid out seven key principles, and two of them are key to the care of transgender patients in the UK:
- All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
- Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care.
Involved in decisions
Patients have the right to be given care that suits them and that they request. This, of course, does not mean that any patient can simply demand an operation or a medication, and be given it. However, if a recognised treatment for a recognised medical need is available, and a patient understands the risks, benefits and side-effects of either having that intervention, or not having that intervention, then the patient’s wishes should be a key deciding factor.
Informed decisions
The patient is an expert in their own body and mind, and the doctor is an expert in medicine and healthcare. This expertise must come together for the good of the patient. It is the duty of a doctor to give the patient enough information, in an understandable way, so that the patient is able to make decisions based on knowledge and fact. Rigid protocols and personal feelings must not prevent patients getting the care they are entitled to.
Capacity
It must be presumed that adults have the capacity to make informed decisions made jointly with their doctor. This means that they do not have to be mentally or psychologically tested to make sure that they are capable of making rational decisions about their health. If there are any issues that arise which are cause for concern, then the doctor may feel the need to reassure themself that the patient is able to make sound judgements. This is not an evaluation as to whether the doctor thinks that the decision is a sensible one, but rather that the patient is unrestricted on making that decision.
What else is new?
Paragraph 17 states:
You should try to find out what matters to patients about their health—their wishes and fears, what activities are important to their quality of life, both personally and professionally—so you can support them to assess the likely impact of the potential outcomes for each option.
You must seek to explore your patient’s needs, value and priorities that influence their decision making, their concerns and preferences about the options and their expectations about what treatment or care could achieve.
Paragraph 21 states that doctors must give patients:
clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action.
Evidence
The phrase “based on the best available evidence” is a new addition to this guidance. There are no published clinical guidelines for the treatment of transgender patients of any age in the UK. In the absence of any UK guidance, doctors should seek International, peer-reviewed publications.
Transgender Healthcare
There are recognised healthcare options available to transgender patients. They can undergo medical intervention to align their sex hormone profile, and surgical intervention to align their physical attributes, with the gender with which they identify.
These interventions should be readily available through joint decision making with healthcare providers. The patient must be guided by their doctor to make informed decisions for themselves. It should be presumed that patients are able to make the best decision for their situation, given correct and balanced information.
If you are a trans person, it is your right to access hormones and surgery on the NHS. It is your doctor’s duty to discuss the options available to you and to provide adequate information to enable you to make decisions about your care.
Photo by Cytonn Photography on Unsplash
Probably a hard ask but I would like some experience based guidance on a reasonable time frame for any element where a questionable “delay to be certain” might occur with some doctors. Cycling folk round endless sub analysis pathways where there is no strictly indicated need to do so could still I feel cause delay and suffering. I’m not expert on this I appreciate just trying to tighten up the route to care that is desired and necessary for the patient.
Thanks for your message. We are unable to answer patient queries in the comments section. Our pathway advisors are standing by ready to answer your questions via our Help Centre, https://www.gendergp.com/help-centre/ . Our response time is currently 24 hours for straightforward queries. More complex enquiries may take longer.
This fails to recognise that most doctors are both completely ignorant about trans medicine and completely unwilling to learn. Trans people, on the other hand, do huge amounts of research before approaching doctors. The reality is that when a trans person talks to a doctor, they are an expert in their own body and mind *and* medicine and healthcare, and the doctor is an expert in *absolutely nothing*. Doctors need to trust that we know what we’re talking about and give us whatever we want without question.
I’ve said it before and I’ll say it again: getting hormones should be as simple as getting cough medicine. I had Gender Reassignment Surgery in Thailand (with Dr. Suporn) in 2018, and only because GenderGP write me a surgery letter. Helen’s husband, Mike, wrote the letter, because Helen was under investigation by the GMC at that time.
I started self-medicating on hormones in 2016, because of how restrictive the NHS was, then later I got hormones from Richard Curtis of the now-defunct TransHealth company. I then went on private prescription with GenderGP for a while, but see here’s the thing: I got that prescription 6 weeks before my surgery. The NHS then gave me a prescription, 3 weeks before my Thailand surgery.
However, I had to go off of HRT for 1 month prior to surgery, so the NHS was very late to the party!
I fully welcome any and all improvements in NHS care, so that trans people can get the help they need. I would have preferred to just use them. I was raised with the lesson that public funded healthcare is the best thing.