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GMC - confidentiality for transitioned people is not assured unless specified in consultations.

A recent discussion with the UK's General Medical Council has revealed that their expert does not expect doctors outside of specialist gender clinics to know that gender reassignment is protected information, and therefore the protections afforded by gender recognition certificates do not apply. They do concede, however, that it is best practice to assume that it is. This contradictory position was found after a complaint to the GMC after a patient who had applied for a GRC, and was therefore in theory protected, had "gender reassignment - born male" in bold at the top of a letter following a consultation for anxiety. The GMC was asked what trans people who did not want their gender history disclosed to anyone with access to their notes should do, and they replied that they "do not give advice", however, they also say "you may choose to refer to the GRA in consultations and highlight that you do not want information regarding gender reassignment shared as it is protected and you hold a GRC".

Trans people who live in stealth or those who are particularly worried about discrimination are particularly at risk, because strict controls over who has access to protected information ensures that they are treated without prejudice, commonly experienced during interactions with healthcare professionals. About 30% of patients report delaying or not seeking healthcare because of fear of prejudice and experiences of discrimination, and sharing such information, even with "another healthcare professional" creates significant barriers to healthcare. Often such information is shared regardless of a trans patient's medical condition and whether gender reassignment has any relevance at all. Section 22 of the Gender Recognition Act 2004, does not have a clause which allows sharing of protected information medically - even "with another healthcare professional", although this has been reported as a frequently cited defense for inappropriate disclosure.

Doctors have been reported as outing their patients in a number of ways, frequently it's clear that there's malicious intent. One patient, who had had genital reconstruction, had her GP write to her pain clinic (unrelated to lower surgery) in her local hospital saying she had a medical history of "erectile dysfunction". Another patient had her referral to a hospital delayed as the hospital did not know whether to put her on a "male" list or a "female" list, despite having genital reconstruction over a decade before. Her treatment, therefore, was significantly delayed. Such disclosures are commonplace, causing distress for transsexual people, and confusion to those treating them. We believe that more awareness and training on protected information is still required to instill trust and confidence of trans people who have medically transitioned. It should not be the burden of the trans person to take up valuable consultation time, where it is difficult to speak up and when you are at your most vulnerable, to train doctors in confidentiality and protected information in order to prevent future discrimination. "Trans broken arm syndrome" is a known phenomenon in the trans community and reported in academic circles, posing significant risks to the mental health of trans people, and placing numerous and unnecessary barriers to care.

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