Heal thyself

February 4, 2009

Bird of Paradox logoI haven’t been registered with an NHS doctor since my teenage years, over 35 years ago. Although I’m thankful that I’ve never had any “serious” illness or other condition requiring medical intervention, the downside is that I’ve never had any real reason to re-register as I’ve moved from place to place during my life.

Now and again, the thought crosses my mind that I really should register, and the recent heavy snowfall here in London (and consequently slippery pavements) has brought that thought back to the front of my mind.

In Monday’s Guardian newspaper, the London Ambulance Service was reported as saying that it received 2,200 requests for help before noon today [2 February 2009] – about 50% more than usual, while the BBC News website carried the following quotes:

Dr Charles Gutteridge, medical director of the Barts and The London NHS Trust, said: “We’ve seen a dramatic increase in people with simple strains and minor fractures of the ankle, elbow, forearm and shoulder.”

[…]

“The ones we have seen slipped while walking to work.”

Chief Operating Officer, Rob Ashford, said: “Yesterday we had a steady stream of people who had slipped and hurt themselves.”

“In some cases it was as simple as an elderly person going out to retrieve their morning milk and slipping.”

And I have to say that I’ve been wondering what I would do if I should fall and hurt myself on my walk to or from the Tube station. It’s only about a mile or so, but in the suburban area where I live, the local authority hasn’t carried out any gritting or other clearance, leaving the footpaths in quite a treacherous condition.

All of this may seem like much ado about nothing, but my perspective on it is definitely shaped by personal experience as much as by my being a transsexual woman in her 50s…

A couple of years ago, before leaving for my GRS in Thailand, it occurred to me that it might not be a bad idea to register with a local GP in case I should suffer any post-surgery complications on my return.

(Although, given the denial of access to meds and surgery of Debbie Davies by her local Primary Care Trust (PCT), how successful any request for post-operative care would have been remains a moot point)

A couple of weeks before I left for Bangkok, I attempted to register with the practice nearest to my home; it’s literally at the end of the road and can be only a few minutes’ walk. I think it was one of the most unpleasant encounters with a healthcare worker that I’ve ever had. From my personal journal:

Monday 03 September 2007:

In which Helen tries – and fails – to register with her local NHS doctor

Having left work early to avoid the chaos of this evening’s Tube strike, I thought I’d put the enforced free time to good use, and register as a patient at my local GP’s surgery. Spot the mistake…

First, the receptionist told me that my passport and driving licence were unacceptable as proof of identification. Funny that, because the bank had accepted them only a couple of hours before, when I went in to arrange the wire transfer of the balance of my surgery fee… Okay, no problem, a quick walk back to the flat, pick up my Council Tax notification letter, electricity bill, phone bill and water bill. Back to the doctor’s surgery where the receptionist also asks for my passport – apparently it’s also required but isn’t enough on its own. Is she making this up as she goes along? She photocopies the passport and the Council Tax form (but not the utility bills she’d requested) – “for our records”.

Then she gives me two forms to fill in: a little purple thing – a GMS1, apparently. Like this one (PDF) – even though I’d already produced my medical card (a real antique: the date of issue is given as 4 January 1973). And I was required to complete their own in-house patient questionnaire, too. So I sit quietly and fill them in like a good girl. Hand them back to the receptionist.

“You haven’t put the name of your last doctor”, she says.

“Because I don’t remember. I haven’t seen a doctor since I was in school. That would be 35 years ago.”

“Well, what was his address? We can track him down from that.”

“Hicksville, North Wales.”

“What street?”

“I have no idea. It was 35 years ago. I was 16.”

“Hmm. And where did you live before you moved to London? And when did you move to London?”

Thinks: Wh-a-a-a-t? “Stringtown. And five years ago.”

The receptionist writes down these two vital pieces of information on the forms and turns to her computer. Clickety-clickety.

“The nurse can see you on Friday morning.”

“I’m sorry but I have to work. I was hoping I could do this while I was off work because of the Tube strike – it finishes on Thursday night so I’ll have to go back to work on Friday. I’m not ill. I don’t need to see a nurse. I don’t need to see any medical people. I just wanted to register as a patient. That was all I wanted to do. I just thought I should.” (Helen shrugs, suddenly and unexpectedly close to tears)

“Hmm. The nurse could see you next week.”

“I told you: I have to work. Look you’ve read my form, you know I’m gender dysphoric. I go for surgery in two weeks. I. Just. Wanted. To. Register.”

The receptionist is looking at me blankly. I realise I’m wasting my time.

“Look. I tell you what: why don’t we just forget it, eh?”

And I picked up the stupid forms, and I left. Came home in tears.

So that’s that: How to register with a GP. Or not.

In fact, it’s not how the registration process should work, at least by my reading of that last link (How to register with a GP), which states only that:

To register with a GP, you can visit your local GP surgery and request to register with them. They may ask you for your medical card details.

So where did all the other bureaucratic procedures and requirements come from? Some weeks later, at my first post-op appointment with the gender doc, I asked about the process of registering with a GP, and related the tale of my failed attempt. The doc was sympathetic and agreed that it really shouldn’t have been as complicated and stressful as that. Which is all well and good but even now I’m still not registered with a GP.

As I mentioned at the start of this piece, I’ve been concerned (again) about not being registered in case I should require the same sort of basic medical care as the 2,200 other Londoners did on Monday.

But there’s a twist: there are two specific issues I’d like to settle, both are related to my being transsexual, and an NHS GP could quite feasibly help with both.

First is the question of the prescription of my estrogen patches. As things stand, I’m able to obtain them through the gender doc when I go for my regular appointments. Until now, these have been every six months. After my next one, in March, they will reduce to one annual appointment. The point is not so much to do with access to a doctor for my checkup and blood tests, it’s more to do with being able to obtain my patches on the NHS. At the moment, being a single adult in full-time employment, I would pay top dollar for any NHS medical treatment (it was a factor in my choosing to transition privately) – but should I become unemployed for whatever reason, then at least I wouldn’t have to find the approximately £300 that I’ll now need to budget for annually (appointment (say £100), blood tests (say £70) and 12 packs of Estradot (say £120)).

There’s also the question of whether a regular GP would actually know what to look for in the results of my blood tests and at our annual consultation…

The second issue I have is one which is unquestionably related to my transitioning: vocal surgery. Although I had a year of speech therapy (£80 a session), finding a voice that enables me to ‘pass’ less unsuccessfully has always been beyond me. Blame half a century of testosterone damage for that. It has reached the point where my speech therapist has said that a small procedure known as Crycothyroid Approximation would probably be the best outcome to my difficulty in finding and maintaining a suitable vocal pitch. A referral from an NHS GP would mean this could be carried out at minimal expense to me; whereas if I went privately, it would cost in the region of £3000. It’s something that I would dearly love to have done; my voice is a constant source of distress to me, particularly on the phone. But £3k is way out of my range right now, and with no referral, then it has to remain on my wish list, even though I have written confirmation from my speech therapist that it would be of benefit to me, no question.

So there’s quite a lot hanging on my being able to find a trans-friendly GP in the London area – or perhaps I should say a trans-friendly GP’s receptionist? – and as time passes, I become more aware that I really need to get this sorted out sooner rather than later.

But it’s easier just to let things slide – keep my head in the sand and my fingers crossed that I stay in reasonably good health – than to have to undergo another humiliating and stressful encounter with a receptionist who plainly saw her role in healthcare to be that of a gatekeeper, not a facilitator. That kind of treatment I consider to be more damaging to my sense of well-being than being able to access the actual health services appropriate for a transsexual woman.

9 Responses to “Heal thyself”

  1. Ruth Moss Says:

    Someone I know had real problems registering with a local GP about a year ago. He did not want to give the name of his last doctor as he didn’t want his nervous breakdown & suicide attempt on file, because some public sector employers are a bit weird about mental illnesses when doing the requisite medical. The receptionists simply would not let him register until he gave the name of his previous doctor, and in the end he did.

    I really hope you manage to register with an NHS doc. £3k is a *hell* of a lot of money to pay for something that ought to be free. Could you telephone them first to ask what their procedure for registering is? Would your gender doc give you a recommendation for a good GP?

  2. Anji Says:

    Are there any trans groups in your area who might be able to recommend a trans friendly doctor/surgery? I’m sorry it’s proving so difficult for you. I thought the whole point of the NHS was for universal healthcare – surely that should mean equal, cheap/free and easily accessible to everybody?!

  3. Helen G Says:

    Ruth, Anji: I’m sure other non-trans people are also subject to similar degrees of intrusion (as your friend’s experience suggests, Ruth) but to healthcare professionals – in my case, the receptionist – who clearly have preconceived (and wrong) understandings of what the term ‘transsexual woman’ means, it becomes a case of their professionalism taking a back seat to their prejudices.

    Which would be, well, ‘bearable’ isn’t quite the word, if it wasn’t for the fact that they wield an awful lot of power over those members of the public for whom they are the first point of contact. And the old ‘first impressions’ maxim is one which cuts both ways, unfortunately for all concerned. Although I’m not fond of going through trans 101s with complete strangers in semi-public waiting rooms, in those circumstances it may well have had a happier outcome for us both had she simply asked what it meant. The receptionist was clearly clue-free, but I can only guess that misplaced pride – and a sense of being entitled to make snap value judgements – prevented her from asking.

    Ruth, the mental illness aspect is complicated: gender dysphoria is actually classified as a mental illness, but my experience is that any mental health problems I experience don’t occur because I’m gender dysphoric, they occur as a consequence of trying to manage it. The most common manifestation of it for me is depression (which I cope with as best I can and without meds because I’ve never been formally diagnosed with it, because I don’t have a GP to discuss it with). The cherry on the cake was my gender doc suggesting, in one of his reports, that I might also be bi-polar, although he didn’t actually pursue it any further – again, I suspect, it was/is something that would be better taken up by a specialist after referral by my non-existent GP.

    As regards recommendations from others, I’ll be honest, it’s not something I’ve ever had the opportunity to discuss with other trans women in my area, because I don’t know any! My experience of the trans community, such as it is, is that it’s very fragmented – as far as I know there aren’t any trans specific places we all hang out socially. There are support groups like TransLondon and Spectrum, but I’ve never really felt inclined to attend any, partly because I find socialising hard, partly because the idea of travelling home alone, at night, on public transport scares me witless.

    A further subtext in the recommendations debate from the point ov view of healthcare professionals seems to be that their own ethics codes prevent them compiling any such list as it could be construed as showing bias, and consequently leaving them exposed to the threat of litigation.

  4. LawSchoolAlumnus Says:

    You don’t say (and I don’t mean to pry) whether you have a GRC or not. Under Section 9 of the Gender Recognition Act, the gender (and sex) of a GRC-holder is changed for ALL purposes. ALL PURPOSES.

    ALL PURPOSES includes all purposes includes medical purposes.

    This means that if you have a GRC you can have estrogen prescribed against a diagnosis of estrogen deficiency i.e. as a woman, the same as a non-trans post-menopausal woman, or a woman born without ovaries. Moreover as a woman you have no cross-gender identification and hence no GID etc..

    But if you don’t have a GRC then you are still legally male and the estrogen prescription will have to be against a diagnosis of Gender Dysphoria (or equivalent), i.e. diagnosed as a man. It’s crucial that if you have a GRC you do not let them put you down as “M” in the records, and IT IS VITAL to file a formal complaint if they try to. Crucial, you cannot let this stand or be damaged forever.

  5. Ruth Moss Says:

    Helen I hope you didn’t think I was being all “but cis people have problems too!!!!11!” I’m very sorry if it came across that way. Was just sympathising about shiteness of Doctors’ Receptionists, not trying to downplay the discrimination you’ve experienced as a trans woman.

    I suppose, it is pointless making a complaint?

    Also, are there no support groups that meet during the daytime, to save the fear of travelling alone at night?

  6. Helen G Says:

    LawSchoolAlumnus: Thank you for this; it’s a(nother) key point in this whole mess – the legal inconsistencies.

    When I began transitioning, no excuses, I quite simply failed to grasp the significance of the Gender Recognition Certificate (GRC) and was therefore a little too laidback about obtaining the “proof” needed to demonstrate that I had started ‘living in role’ (sorry about these horrible alienating jargon phrases).

    Consequently, I am now 18 months post-op, with all my documentation changed – passport, driving licence, Deed Poll, Council Tax, bank, NI, HMRC, you name it – except my birth certificate. Which I can’t change until I receive my GRC. And which, as you rightly point out means that I am not yet ‘legally Helen’ and cannot therefore make use of the protection afforded by the Gender Recognition Act.

    On the plus side, I reach the magical milestone of being able to provide two years’ documentary proof later this month – and have an appointment with the gender doc early next month, to start the ball rolling.

    Sometimes the lights all shine on me
    Sometimes I can barely see
    Lately it occurs to me
    What a long, strange trip it’s been

  7. Helen G Says:

    Ruth: No, of course I didn’t read it that way! Truth to tell, I read your comment and worried that I might be coming across in a similar way, “oh transsexual women have it much worse”. It’s not a competition, right?!

    Really I was just ranting about how access to healthcare suddenly seems to gain several layers of complexity the minute you let on that you’re trans. But, of course, because of the specific healthcare needs of being trans, it’s not something you can be silent about when you are, in fact (as LawSchoolAlumnus pointed out above) Not Legally Helen.

  8. queenemily Says:

    Right. I really do understand people who are stealth to their GP doctor, because the response is *so* immediate and so frequently awful. Paradoxically, in order to receive decent health care, some people don’t mention relevant health details like hormone dosage and their own specific configuration of bits, which could be dire if you had something like cervix or prostate cancer :(


  9. […] I went to my (non-existent) GP and said I was depressed, there wouldn’t be anything like the same pressure on me to […]


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