Sickening

What do you do when your GP refuses to treat you for a rare medical condition? A friend of mine would like to know.

Since 2009, she’s been jumping though hoops trying to access treatment for her gender dysphoria. Having taken the daunting step to confront her gender identity issues, she’s also had to battle a team of GPs intent on denying her treatment to which she is legally entitled in this country. She shouldn’t have to wait for it; not without good cause.

 

I asked her to send me a timeline of events, so that I could pass her details onto someone who might be able to help her. My friend appreciates her privacy, but she is also keen to share what she has been through with the rest of the trans community. I’ve kept it anonymous, but just take a look at how she’s been messed about:

Over the years I have seen many different GP’s but they have all been under the supervision of my Primary GP Dr XXXXX X XXXXX.

  • I was referred by Dr X XXXXXXX to see a psychiatrist for Gender Assessment on the 20/10/2009.
  • I was seen by Dr XXXXXX XXXXXXXXXXXX on the 18/02/2010 where she made my initial referral to Charing Cross GIC.
  • CHX acknowledged my referral on the 13/04/2010.
  • Letter received from CHX on the 20/05/2010 offering me my 1st appointment with Dr Lorimer for the 26/11/2010.
  • New member of staff joined CHX and I received a letter on the 02/07/2010 informing me that I would now have my 1st appointment with Dr Christina Richards on the 10/08/2010 and my appointment with Dr Lorimer would be my second.
  • My appointment with Dr Lorimer on the 26/11/2010 resulted in him referring me to Dr Leighton Seal for assessment of Oestrogen and requesting an application for Hair Removal to be actioned by my GP (this never happened).
  • Appointment made to see Dr Lorimer on the 30/03/2011.
  • Letter received from CHX on the 14/12/2010 for an appointment with Dr Seal on the 16/12/2010. • My appointment with Dr Seal resulted in him requesting my GP to start me on Warfarin and once I was at a stable level then begin Oestrogen with agreement from Dr Lorimer.
  • My GP stated that they do not refer nor could not begin a warfarin treatment and that I would need to seek the referral from CHX to my local Hospital. I would have to take this up with Dr Lorimer when I next saw him.
  • My appointment with Dr Lorimer on 30/03/2011 resulted in him reiterating that I was suitable for treatment and that the GP should refer me for Warfarin to begin my Oestrogen treatment as soon as possible. A copy of the Pan London shared guidelines was sent to my GP.
  • Letter received from CHX on the 31/03/2011 for an appointment with Dr Seal on the 17/06/2011 for an Oestrogen review.
  • I was finally referred to the Warfarin clinic by my GP and began my treatment on 23/05/2011.
  • My appointment with Dr Seal on the 17/06/2011 was unfortunately a waste of time from Dr Seal’s point of view. He had expected me to have been “warfarinised” and on a course of oestrogen by the time I had seen him but, due to my GP’s unwillingness to treat me, I was only on Warfarin. He advised me that he would contact my GP and remind them that they had a duty to begin my Oestrogen treatment ASAP, as per the shared care guidelines.
  • Letter sent to my GP from CHX dated 07/07/2011 enclosing shared care agreement again and requesting they start my treatment. GP claims that this letter was never received by them.
  • Appointment with my Primary psychiatrist Dr X XXXXXXXX on the 21/07/2011 to discuss anti-depressant medication and my general well-being where out of the blue he mentioned that Dr Az Hakeem had been contacted and had met with the practice to talk to the Dr’s regarding treatment trans patients (though I am the only trans patient they have) and had information for me. I told Dr XXXXXXXX that this was not something I was interested in pursuing, due to Dr Hakeem’s history.
  • Letter sent to my GP from CHX dated 22/07/2011 again enclosing shared care agreement and requesting again the start of my treatment.
  • Appointment with my GP on the 27/07/2011 to discuss finally beginning treatment and prescribing of Oestrogen where I was basically told that the GP was unhappy to prescribe the HRT and that they would not go further with treatment as none of the GP’s are comfortable with the treatment, potential side effects or legal responsibilities.
  • Some hours later my GP called to confirm that they had informed CHX that they were unwilling to treat me as per the discussion in my appointment and that in his word’s that treating me was “not his cup of tea”

In conclusion, I have spoken again to CHX who have advised they will write yet again to my GP, but that ultimately I may have to change GP practice – although I may find that I am faced with the same problem again.

This is outrageous. I truly hope that anyone else having a hard time accessing medical care will contact any of the various organisations, like the Gender Trust and GIRES, who can help tackle such injustices. I also find it more than a little sinister that Az Hakeem has somehow found his way into the mix: thank goodness my friend had some prior awareness of him.

The bottom line is, you don’t have to put up with this. If you find yourself in this situation, report your “care” providers to the General Medical Council. And remember: your doctor is meant to help you get better – not push you into a depression.

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11 thoughts on “Sickening

  1. Thaniel says:

    This happens all over the world. Trans people die because they’re refused medical treatment, simply b/c some doctors decide the Hippocratic Oath is conditional. One question: Why can’t the shrink prescribe the estrogen for her? Some kind of bureaucratic thing?
    Good luck with the fight!

    • Hi Thaniel; thanks for commenting. As people often have to travel quite far to attend a Gender Identity Clinic, it is impractical for patients to receive their prescription from the GIC. The GIC’s simply wouldn’t have the time and resources for this either. I think that, in cases like this, these rules are incredibly frustrating, but I can see why they are in place. It’s just such a shame that they can’t simply write my friend a prescription and end her misery – and I do not use that word lightly. The real life test can be a real pain without hormones.

  2. C says:

    GPs refusing treatment is a huge problem. I hope she complains to the GMC, and it might be worth her getting advice from a solicitor.

    I’ve had GP notes shredded twice to prevent legal or disciplinary action against practices. Once was refusal to treat a non-trans related matter due to “discomfort”, the other was refusal to continue post-op maintenance HRT after moving practice. I only concluded that the notes had been deliberately destroyed after another GP told me he was suspicious that that was the case.

    Nothing has changed in the past decade and I think that as a community we need to encourage and support people to take action – in the current climate GMC action would pragmatically be best.

  3. janefae says:

    Practically…and happy to talk to the individual in con fidence if they so wish, they are entitled to change GP. The formula to use is a “breakdown in trust” between GP and patient.

    Usually, this formula gets used by GP’s wishing to remove you from their list. But you can play the card as well.

    If this particular case happens to be in Camden, then it is a situation of which most people active in the trans community are already aware. Effectively, the individual needs to put her foot down and refuse to accept any GP within the Camden area.

    IN terms of referral to the GMC…slightly thorny one there. I’m afraid, given the nature of current treatment for gender dysphoria, the refusal to treat might actually be upheld – so would be really unwise to take this case forward without thinking through the grounds very very carefully.

    Because a precedent which supported the GP’s position could actually make things worse for dozens more trans individuals throughout the country.

    Where it may be possible to get the GP is in respect of the introduction of Az Hakeem. That feels thoroughly unethical and may, on its own, be grounds for action.

    jane
    xx

  4. K says:

    I too have had many problems with my GIC in terms of responses, delays, and outright baffling bewilderment in one case. For me Im certain it wasnt vindictive.. merely half-assed administration.

    A request for voice therapy. 6 months with no action. Queried at subsequent GiC meeting “we faxed them, didnt you hear back?” A further 3 months later Speech therapy dept local to me contacted after being contacted themselves only days beforehand.

    Lost appointments – no fun when the GiC is more than 3 hours drive away.

    ..and crucially worst of all was the declining of a request for a treatment which is routinely carried out within the NHS south of the border, but which was deemed to be “cosmetic” and “probably should have the GRS first anyway” – showing a complete lack of comprehension with what was being asked for (Cricothyroid Approximation)

    Lots of positive action from GP coming up against a brick wall at board-level. Just about to write my latest request to the GiC for help, having suffered increasing bouts of depression due to the issue. 😦

    K

  5. Jonie Heath says:

    You need to be aware that, despite the Equalities Act being passed in 2010, it is only NOW that some of its provisions are being rolled out in practice. For instance, up until now it has been perfectly legal for a GP to refuse all or any treatment to, eg, a transgender person.

    Over the next few weeks, that will become illegal and GPs will HAVE to offer treatment to all people that are covered by the defined diversities in the Act. We (Kent Trans Forum) had a delegate at the GEO trans health workshop the other day and it was clear that a lot of training is now needed in the GP area and that the GEO and NHS will be looking to organisations like ours to assist in this.

    Jonie

    • janefae says:

      Jonie,

      I’d say there are two or three issues here and therefore still a need to tread carefully.

      First, the EA talks about the protected characteristic of transgender once someone has commenced treagtment for gender dysphoria: if the GP is gatekeeper to that treatment (and diagnosis) you are in a catch-22: there’s no discrimination until the diagnosis is in; and no diagnosis unless the GP allows you forward to be diagnosed.

      Second, there are two quite separate issues here. One is whether a GP will deal with an individual as ts once the diagnosis is in and i’d agree that the EA seems to say they must.

      However, you do then hit issues of individual conscience and medical ethics and the one big get-out for GP’s doing what Paris has documented is: virtually NO transition treatments are licensed as such.

      Therefore, GP’s can – and do – argue that since drugs are not licensed for purposes of transition, they are only acting ethically in not doling them out for those purposes.

      I don’t agree with that, but, given the promise given to one or two high profile regretters being prepared to sue…one can see why some GP’s are just back-covering. Even my grs, which still feels magical, could not go ahead without a “second opinion”. Why?

      That opinion is useless to me and, since i was paying, was just an extra £300 wasted expense – mostly for the purpose of protecting the medical staff involved against the possibility of me suing them. That sucks! I’m paying a premium because some twonks get it wrong, can’t take responsibility for their own actions – and sue…

      jane
      xx

  6. […] guess, its to do with thinking through the implications of a very good exposé posted by Paris Lees on her own blog, about GP(‘s) refusing to treat trans […]

  7. Christabel says:

    I know of somebody who is currently in a very similar situation and it disgusts me. This is a recognised condition so what right does a medical “professional” have to say that treating it isn’t his “cup of tea”??? We pay our taxes too don’t we? For the record i’m treated privately and get my hormones/drugs mailed from the clinic – I pick up a good stack each time i’m there too. It’s do-able. My GP has always been happy to do blood tests but as budgets are tightening it’s getting more difficult…

  8. […] gender clinic recommended her for hormone replacement therapy over a year ago, but her doctor(s) refuse to prescribe it. In desperation, she decided to ask the internet for help (my answer to […]

  9. Hamish says:

    I know this was ages ago, but still feel the urge to comment. WTF were the GPs thinking, getting Az Hakeem involved? He pushes reparative therapy – what conservative Christians in the US Deep South are pushing! There’s just no words to describe how angry I am about your friend’s situation.

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