Discrimination in Practice

When we think about discrimination against minorities we tend to think of people like Rick Perry or Fred Phelps spouting nonsense on TV. That sort of thing doesn’t happen much in the UK. Outright bigotry is reserved for lunatic fringe political parties, Conservative members of the House of Lords, and of course the Daily Malice. Nevertheless, discrimination can still be widespread, it just takes place behind closed doors, or convenient excuses, so that people can pretend that it doesn’t happen.

What has prompted this post? Well, some of you may be aware that the Malice and similar publications often devote a lot of column inches to complaining about trans people getting treatment on the NHS. You may not be aware that they routinely inflate the cost of this treatment by an order of magnitude or so in order to generate more outrage, but given that they lie outrageously as a matter of course you have probably guessed.

This is, however, a real issue. Amidst all of the outpouring of support that the My Transsexual Summer TV series received, the one genuine sour note I detected on Twitter (as opposed to the deliberately offensive trolling) was that people didn’t want NHS money spent on trans people. It is a difficult argument to have, particularly with people whose relatives need life-saving operations and are seeing waiting lists get ever longer.

Of course there is another side to it as well. Many of my activist friends wanted Lewis to stand up to his local health authority and demand treatment, which legally he is entitled to do. If people don’t do that then the NHS will continue to get away with denying treatment to trans people. But fighting could have taken a very long time, and been emotionally draining, and I don’t blame anyone who doesn’t feel up to that battle.

However, the whole question as to whether you can go private or not is moot if no private practitioner is available. For surgery UK-based trans people routinely go overseas, but that’s a one-off process. Treatment for transsexuals requires lengthy psychiatric counseling, monitoring through a two-year “real life test” in which you have to prove that you are comfortable living in your preferred gender, and a lifetime of hormone treatment. These things are not easy to get access to.

To start with some health authorities have been caught operating blanket bans on any gender treatment, even though this is illegal. And if you can get a referral, waiting lists can be years long, not just months.

Think about that for a moment. You go to a doctor with a condition that is known to result in abnormally high rates of suicide, and you get told that you won’t be able to see a specialist for a year or more. What does that tell you about how much the NHS cares about you?

Even when you have successfully transitioned, you still need those hormone treatments. Many GPs refuse to supply the necessary prescriptions. Indeed, some refuse to take trans people as patients at all. On a personal note, almost all of the health services I have used since transitioning have had to be purchased privately because NHS staff were either unable or unwilling to supply them.

What is the medical establishment’s reaction to this? Are doctors grateful that private practitioners exist so that valuable NHS funds can be spent on other services instead? Not a bit of it. What they are actually doing is conducting a campaign to drive gender specialists out of private practice through the use of malpractice suits. There isn’t enough business in gender medicine to support a lot of private practice. The one person in the UK doing the job back when I transitioned has since been struck off the medical register. His successor has now been put on probation by the General Medical Council (GMC), and if things go as I expect an excuse will be found to bar him from treating gender patients soon as well.

Obviously there are serious issues in play here. Treatment of people with gender issues is a difficult process, and you can end up making matters worse by allowing patients to proceed with surgery when they are not suitable for it. Nevertheless, the standards for treatment are continually evolving and are by no means subject to general agreement. It is therefore fairly easy to generate a malpractice suit on the basis of differences in approach. The GMC isn’t giving out any details to justify their decision. The doctor in question isn’t allowed to discuss the case, beyond saying that the complaint against him was raised by NHS staff.

At best this is restraint of trade by an already massively over-subscribed service seeking to eliminate all possible competition. More likely it is professional jealousy — one supposed expert in a highly complex area of medicine insisting that he alone knows how to treat patients. It would not surprise me to find out that this was an attempt to shut down access to treatment for trans people unless they conform precisely to one aged, straight, white male’s view of gender normative behavior.

Of course the decision was announced in the run-up to the holidays, thereby ensuring that very little can be done about it for several weeks — another clue that the GMC knows that this is a politically motivated action rather than one taken in the best interests of patients. There’s no point in anyone trying to do anything right now. But I will most definitely come back to this in the New Year. It is quite annoying enough to have to pay for medical services that other British taxpayers receive free as a matter of course. The thought of being unable to access those services at all because the GMC will not allow anyone to provide them privately makes me very, very angry indeed.

2 thoughts on “Discrimination in Practice

  1. Hmm, I did a little digging and realised — to my abiding sorrow — that the first doctor mentioned was the dear fellow who saw me in Wimpole Street (or was it Harley Street) in the late spring of 1978, when the world was new and young, and so was I. I suppose that the second mentioned was the fellow who took over his practice when he retired.

    This whole business leaves me feeling very cold and sad; I still recall said first doctor’s evident compassion for my cicrcumstances, as a rather distraught young waif from the Colonies, having flown the whole way over across the Arctic not knowing what sort of reception I’d find in London. As it turned out, a good reception; a trip to a skilled surgeon ensued in fair order, and the rest was the sort of history that probably won’t ever be told because, like most others of my time, I chose to drop out of sight thereafter, as one normatively did in those simpler times.

    I sense that whatever acceptance had gradually grown, concerning our lot, has almost entirely melted away under the relentless bright lights of the tabloid press. This is not at all a lovely state to be contemplating on a chilly December evening far away from London.

    Thank you, much, for letting us all know of what’s being going on, over across yon Pond.


    from the boreal forest of Cascadia

    1. Thanks for writing, Elane. I’m glad that you too got friendly and supportive treatment in the UK. Sadly I suspect that it is precisely the fact that private practitioners have empathy for their patients that causes them to be regarded with suspicion and distrust by the medical establishment over here.

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