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Changing perceptions

Jennifer Trueland looks at issues surrounding the treatment of transgender patients – an often misunderstood group

At a conference some 10 years ago, Michael Chambers* was discussing the meaning of the word transsexual with another delegate. When asked the reason for his interest, Mr Chambers replied that he was a transsexual person himself.

'So why do you still wear the beard?' came the bewildered response. 'I said to him, "No, no, the other direction",' says Mr Chambers. 'He wasn't being rude: he just didn't think that trans men existed. There's a lot of ignorance out there.'

Mr Chambers, a senior physiotherapist, is doing his best to counteract this lack of awareness. To that end, he proposed a motion at this year's CSP Annual Representative Conference calling for a briefing paper on the subject (see Frontline, April 4).

This was passed and will now be considered by the Society. According to Mr Chambers, there is a dearth of information around transgender issues and how they relate to healthcare as well as other aspects of society. But does this have an impact on care?

'Yes, I believe it does,' he says. 'Although I think awareness is improving in society as a whole, there's still a long way to go. Partly it's a question of getting people to think about the issue.

In the ARC motion, we used the example of hydrotherapy - what do you do if you run single-sex hydro sessions and you have a pre-op trans woman as a patient? How do you ensure her dignity and the dignity of the other patients?'

Other issues could include patients who are reluctant to remove clothing, perhaps because their breasts are bound or because they have scarring, or a female patient who says she had been treated for prostate cancer.

'I don't necessarily have the answers – and I don't necessarily think the CSP briefing document should come up with the answers – but I think it could be used to help departments draw up their own guidelines,' he says.

One difficulty, according to Mr Chambers, is getting transsexual people to keep appointments with physiotherapists or, indeed, anyone in the NHS. 'Trans people will sometimes do anything they can to avoid health services because they are worried about how they will be treated,' he says.

Definitions

Claire McNab, vice president of Press for Change, a campaigning group fighting for rights for transsexual people, agrees. 'Part of the problem is that once trans people have been through the gender reassignment process, many do not want anything to do with medicine again.

Trans people can have difficulty accessing care because oftenthe clinician can only see one thing - the gender reassignment.' There are no hard and fast figures on how many people can be considered as transgender, partly because of problems with definition.

For example, Press for Change believes that 5,000 people in the UK have changed gender, but that many more have some level of gender variance. 'It depends on where you draw the line,' says Ms McNab. 'Do you include a man who has cross-dressed once, or someone who spends a lot of time cross-dressing but who goes to work as a man? Do you count butch lesbians?'

When it comes to drawing up a briefing paper, Ms McNab warns against being too prescriptive. 'My message is really quite simple. People should listen to their patients - that's by far the most important thing.'

That's likely to be the approach taken by the CSP in any briefing document it might draw up. Indeed, many of the specific issues raised by Mr Chambers are already covered in the CSP's Rules of Professional Conduct.

These include referring to people by their name and gender of choice, and how to treat patients who do not want to remove clothing.

Ignorance

CSP negotiating officer Sarah Trivuncic, coordinates activities for the organisation's three diversity networks: black and minority ethnic; lesbian, gay, bisexual and transgender; and disabled members.

She says: 'I feel that transgender people are the last group that it's somehow OK to be disparaging about. I've heard people being disrespectful about trans people in a way that they wouldn't be about other minority groups – probably because of embarrassment and ignorance.'

She says any briefing paper produced will involve the LGBT network and external organisations, and will draw on experience of tackling discrimination against other minority groups, such as lesbians and gays. It will also look at what other organisations have done, although this is comparatively little.

For example, in 2003 the Royal College of Nursing published a document looking at next of kin issues in lesbian, gay, bisexual and transgender patients, but the RCN has no briefing on the transgender group in general. There can, of course, be employment issues for transgender people, among them, inevitably, physiotherapists.

Mr Chambers's experience has been positive. He changed gender in 1997 when he was working as a junior physiotherapist in Glasgow. 'Everyone was extremely good about it. I was on a rotation and I finished one rotation as female and started the next one as a male.

I was always open about it and willing to answer questions from colleagues - I'd rather they asked me if they wanted to know something. I suppose it helped that I was a union rep and a bit mouthy anyway,' he adds. He doesn't believe that his experience has had much of an impact on his physiotherapy practice, but was aware of people treating him differently as a man.

'I got a huge amount more respect from the medical profession as a male and patients were more likely to call me doctor whereas before they'd call me nurse,' he says. 'I think it had an impact on my confidence really.' He's delighted that conference backed the motion.

'A high profile briefing paper is what we need to raise awareness,' he says. 'If that encourages people to think about it, then that's great. It'll be good for physios and good for patients.'

*Some names in this feature have been changed by request.

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