Trans patients who change sex in medical records face ‘unintended negative consequences’

Allowing transgender patients to change their sex on medical records poses a risk to their health, new guidelines for the Scottish NHS state.

A draft policy, drawn up by the Scottish government, admits to “unintended negative consequences” of a trans-inclusive policy, which allows patients to wipe references to their biological sex and instead be recognised in line with their gender identity.

The Scottish government has previously insisted allowing records to reflect a patient’s “lived identity” has led to “improved patient experience” and “enables better healthcare planning”.

However, in a major about-turn, proposed new guidelines acknowledge a “clinical risk” if medical staff are kept in the dark about a patient’s birth sex.

It warns that some medical tests could be misread and incorrect treatments given as a result.

‘Hard to see benefits’

“The classic example of where this could create a problem is in haemoglobin, where abnormal readings can be a red flag for cancer,” one clinician working in Scotland told The Telegraph.

“The healthy ranges are different for men and women, so if it is assumed a sample has come from a male when in fact it’s from a female, really vital information could be missed.”

The policy in Scotland allows patients to change a digit of what is known as a CHI number – a unique code given to every patient. The ninth of the 10 digit code is always an even number for women and odd for men.

Patients are allowed to change their officially recognised NHS sex simply by making a request to their GP, with staff told that “no evidence is required”.

“The CHI number was meant to follow a patient from the cradle to the grave, to make sure everyone is easily identifiable and prevent mix-ups,” the clinician added.

“It’s very hard to see any benefits in allowing patients to change it, especially as medical records are already confidential and doctors would only share information on biological sex if it’s relevant.

“The fact that they have now admitted there is a risk but apparently now are just going to carry on anyway makes this even stranger.”

‘Unintended negative consequences’

The SNP government ordered a review of their records management policy for health and social care, with a draft of the new guidelines sent out to NHS staff for consultation in December.

The proposed update states that the long-standing trans policy, in place for at least the last decade, could have “unintended negative consequences to [a patient’s] overall health where they have chosen a name and gender identity that differs from their current legally designated name and sex assigned to them at birth.”

It adds: “Decisions based on, for example test results, can differ between those with chromosome XX and those with chromosome XY due to the physiological and biological differences.

“Therefore there could be a clinical risk if the biological sex is not known by the clinician, as treatment may be required to be based on the patient’s sex at birth instead of their gender identity.”

The draft guidance calls for patients to be made aware of the dangers when requesting a change to their sex in health records, which was absent from the previous version of the policy.

Those who change their sex in medical records are also not always automatically called for relevant cancer screening programmes, such as breast and cervical screening for biological women who identify as male.

Changes to IT systems were introduced in a bid to fix the issue for those who changed records from 2015, with those who did so earlier asked to self-refer.

Despite the concerns, the SNP government recently committed to reviewing whether Scotland’s health records system could be amended further, to recognise non-binary people, who identify as neither male nor female.

A Scottish Government spokesperson said: “Patient safety is always the Scottish Government’s highest priority. We recognise the need to ensure that no-one risks missing important information or appointments relating to their care.

“This document is in draft form and is currently with stakeholders for their views. We will publish our agreed policy in due course.”