A threat to trans patient care quality: gender markers, patient records, and population screening

[摘要] Patients in the UK are able to change the gender marker on their NHS patient record at any time on request.1 This can be undertaken without any prior contact with gender identity services, hormonal treatment or surgical intervention, or the acquisition of a Gender Recognition Certificate. Such a request triggers the creation of a novel NHS number and the importation of the patient’s medical information into a new patient record.Crucially, any reference to the patient’s previous gender identity, along with their original NHS number, is irreversibly omitted from the new patient record (reversal to the original gender identity would trigger the creation of a third NHS number).ERADICATING MEDICALLY USEFUL INFORMATION While this process serves to respect the patient’s right to personal privacy, the eradication of such medically useful information poses a challenge to the maintenance of high-quality care for trans patients, especially in the realm of population screening programmes.The NHS provides four adult screening programmes — for abdominal aortic aneurysm (AAA), bowel cancer, breast cancer, and cervical cancer — and invites eligible patients according to the age and gender marker recorded on their primary care patient record.While bowel cancer screening is offered to both men and women, AAA, breast cancer, and cervical cancer screening are only offered to single genders according to their sex-specific health risks: AAA screening is offered only to men, as the risk in men is substantially higher than in women; breast cancer screening is offered only to women, as the risk in women is substantially higher than in men; and cervical cancer screening is offered only to women, as men face no risk whatsoever.As such, patients whose primary care patient record contains a gender marker that is incongruent with their biological sex may not be invited to the population screening programmes appropriate for their sex-specific health risks.

[学科分类] 卫生学