Monday, 14 November 2011

Name Change and Transitioning Problems

The last few weeks have been full of  "interesting" events and "fun" times with regards to my bank and doctor.

Bank Problems

My bank is Santander, previously known as Abbey National, and is based in Spain. When I changed my name via Deed Poll back in August 2011, I contacted all of the businesses and organizations that I am involved with to inform them of the change. All of them changed my details without any hassle, except for Santander. The branch manager said that because my chosen title (Ser - a gender neutral version of Sir) is not available on their drop-down list they could not change my name in their systems. The manager was very nice and sympathetic and informed me that she would contact someone higher up to see what could be done about it.

Fast forward a few weeks and I went back to my branch to get an update. Unsurprisingly, there wasn't one. My next course of action was to contact Santander's Customer Complaint Department. On the 30th of September, 2011, I received a letter from Sarah Nielsen, the Service and Control Manager in my new name informing me that "unfortunately your change of detail request is not compatible on our system, so therefore we are unable to complete your requests".

Under the advice of a retired police officer friend, on the 11th of October, 2011, I sent a letter to Santander's Customer Complaints Department informing them that "under the Data Protection Act, as you are holding personal data about me, you are legally obliged to ensure that all data you hold about me is correct and up-to-date," and that since their "current systems may not have the option for Ser..., then I will accept the use of Reverend as my religion believes that everyone is a reverend or pastor; alternatively, I will accept the use of no title. However, please note that I would prefer a change in your system to allow gender-neutral forms of address in the near future so that all of my correspondence between myself and different companies are the same."  Their reply, which I received on the 7th of November, 2011, reiterated that they are unable to change my records to reflect my new name and title. 

Today I contacted the Financial Ombudsman Service to ask for their help to resolve this matter. The lady I spoke with was very nice and understood my unhappiness about the situation. She agreed with me that Santander should update their systems to allow titles to be typed in and to allow "other" as a gender choice. She told me that they have until the New Year to contact me. If they don't contact me by then or they still refuse to change my records to reflect my name change, then we will be taking it to the next stage. 

Transitioning - Conventional Care vs Informed Consent

At the end of September, 2011, the World Professional Association for Transgender Health (WPATH) published the 7th edition of  their Standards of Care (SOC). This version of the SOC strongly encourages a GP-centred local care path and the use of Informed Consent. Yet when I approached the topic to my GP, he dismissed the idea, saying that Halton's PCT and the NHS instructed medical providers to use the Conventional care path. 
The conventional care path follows a very rigid procedure - the patient sees their GP, the GP refers to a local psychiatrist who then refers to a Gender Identity Clinic and the patient goes to the GIC for everything transition related. This may not seem like a bad path, and for many it works fine, but for those of us who live hours away from the nearest GIC, it can be very stressful and time consuming. 

The GP-centred local care path with informed consent is much better for those of us who don't have a GIC near by. It allows us to access everything locally with the GP acting as a gateway to all the services which the patient needs. This path is less stressful because it entails less time off work, less time away from family, and less travel time for the trans* person.

Not being happy with my GP's dismissal of my preferences, I asked some transgender friends about their care path. Several of them, both in America and in England, have gone the GP-centred local care path, so I know it can be done.
After doing some searching online, I found the name of the chairman of Widnes practice based commissioning (PBC) and his email and sent him the following email:

Dear Dr. Schofield,

As a resident of Widnes and a transgender person, I would like to ask you why it appears that Halton PCT is not updating their policies and ensuring providers follow significantly updated guidelines regarding the Standards of Care for transgender people.

My current GP is Dr. Gunaseelan who is located at the Widnes Health Resource Centre on Caldwell Road. When I approached him for help in starting my transition, I expressed a preference to having GP-centred local care using the Informed Consent method as suggested in the 6th and 7th Editions of the WPATH Standards of Care. (Information on these methods can be found on http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_089939.pdf (section 3) and http://www.gires.org.uk/assets/DOH-Assets/pdf/doh-hormone-therapy.pdf (starting on page 14).)

My reasoning behind this is simple - I am a single parent and travelling to either Charing Cross or Leeds Gender Identity Clinic would be very difficult for me. Having my treatment GP-centred, using local care and Informed Consent would make my transitioning process easier and less stressful for me and my son. However, my GP dismissed my wishes and has insisted on following the conventional care path which includes a diagnosis of Gender Identity Disorder by a Psychiatrist (which is highly discouraged in the 7th Edition of the WPATH SOC) and a referral to a Gender Identity Clinic.

When I asked him why he is insistent on going down the conventional path, he said it is because Halton PCT and the NHS has not instructed the GPs to use the WPATH SOC.

Is this true? And if so, why have Halton's GPs not been encouraged to follow these new standards? Doctors are expected to keep their knowledge up to date regarding new insights/advances, as I'm certain you know.

Please, if you could let me know what Halton PCT's views are about this, I would be greatly appreciative.

Thank you for your time and attention to this matter.

Sincerely yours,

Muir 
Hopefully I will receive a reply from Dr. Schofield or one of his associates in the next few days. When I do, I will post it in a new entry.

It isn't my goal to get any one in trouble in either of these matters. I do however, hope that by pressing the issue I get help not only for me, but for others who may be going through similar circumstances either now or in the future. I don't want anyone to have to go through all of this if they don't have to.  

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