The Lancet Student

Breaking down boundaries: discrimination within our health care system

This blog was submitted by ZKristensen on 9th February 2012.
Tagged with Transgender, LGBT, discrimination

"1 in 6 transgender individuals have faced discrimination at the hands medical ‘professionals’ within the NHS." Zoe Kristensen questions whether discimination in this area stems from a lack of education and guidance as to how those with differing gender identities might be treated.

I have watched with a great deal of interest the recent increase in coverage of stories pertaining to gender incongruence within the media and – in the past 6 months particularly – the attempts of various medical colleges, as well as the British government, to address problems faced in the provision of their care.In December of last year, the American College of Obstetricians and Gynaecologists were amongst the first to acknowledge the barriers faced by transgendered individuals in accessing health care and even went so far as to urge health care providers "to foster non-discriminatory practices and policies to increase identification and to facilitate quality health care for transgender individuals, both in assisting with the transition if desired as well as providing long-term preventive health care”. Shortly thereafter, the British government announced its ‘transgender action plan’ which they hope will address the inequalities faced not only in healthcare but other areas of life as well. Encouraging though this is, I'm forced to wonder whether change will ensue or whether it's nothing more than idealism and positive sentiment.

Perhaps the most interesting aspect of this is what the GMC have to say on the subject, or – more importantly – what it fails to say. In Tomorrow's Doctors – a publication which any medical student will tell you forms the cornerstone of medical teaching – the GMC went to great lengths to give an all-encompassing list of characteristics which a patient should not be discriminated against because of which, but fails to mention gender identity. Even more shockingly, a search of the guidance on the GMC website for any information pertaining to gender identity yields just one result – the somewhat ironically titled: ‘Maintaining boundaries: guidelines for doctors’. With this in mind, it's somewhat unsurprising that PFC reported that 1 in 6 transgender individuals have faced discrimination at the hands medical ‘professionals’ within the NHS. I personally, however, do not feel that the majority of discrimination in this area results from malice or even – in many cases – intent, but instead stems from a lack of education and guidance as to how those with differing gender identities might be treated.

It may come as a surprise to many that it has been estimated that 3-8% of the UK population identify as lesbian, gay, bisexual, or transgender (LGBT), which based on the 2001 census data is of equivalent size to somewhere between the combined Indian and Pakistani populations of the UK and the combined populations of all ethnic minority groups. However, whilst a significant amount of time is devoted within medical teaching programs to education about those from ethnic minority backgrounds, the same cannot currently be said for those who identify as LGBT. I am proud to be able to say that – after much lobbying – Warwick Medical School is discussing rectifying this for next year, however I feel that this is a change which is urgently needed at an institutional level rather than at the level of individual medical schools. Only by taking a unilateral approach will we ever manage to change the perception of the NHS as a discriminatory institution. In order to effectively treat transgender individuals we need to prove to them that we are worthy of their trust. After all …we're doctors.

Zoe Kristensen is a 1st year MB ChB Student at Warwick Medical School, University of Warwick