Transvox - Working with Healthcare Providers to improve Cancer and General Healthcare Services

[00:00:07] [SPEAKER_01]: Hi and welcome back to Transvox. It's been my pleasure over the last few weeks to introduce

[00:00:12] [SPEAKER_01]: a sort of British project which has been looking at cancer screening within the context of wider

[00:00:18] [SPEAKER_01]: provision of NHS services to the trans plus community. And it's been great to meet various people

[00:00:24] [SPEAKER_01]: reporting back on the project, telling us how it's been going, bringing different perspectives

[00:00:28] [SPEAKER_01]: and such like. And today I'm delighted to be joined by Casey Monday who we met before

[00:00:35] [SPEAKER_01]: way back in April of six, Katie with Stevie Corbyn Clarks when you're telling us all about the project

[00:00:40] [SPEAKER_01]: at the beginning and here you are near the end of it and you know it's going to be excellent to

[00:00:44] [SPEAKER_01]: hear what's been happening, what's been going on, what's been happening and in terms of

[00:00:49] [SPEAKER_01]: conclusions, next steps and such like but I'm also delighted to welcome Dr Virginia Quiney

[00:00:55] [SPEAKER_01]: who's been part of the process and has interesting insights to bring about not just what happens in

[00:01:01] [SPEAKER_01]: healthcare around the trans community and our experiences but also about the healthcare practitioner

[00:01:05] [SPEAKER_01]: and what's going on for them as well. And maybe exploring a little bit about the

[00:01:10] [SPEAKER_01]: culture between us and how we make the best of what's going on. So first of all welcome

[00:01:15] [SPEAKER_01]: to the pair of you, maybe Katie you want to say a few words about yourself and remind

[00:01:19] [SPEAKER_02]: everybody who you are. Oh I'm Katie Monday, I use they then pronouns, I'm a community researcher

[00:01:27] [SPEAKER_02]: mostly at the moment I'm doing work around cancer services for disabled people and neurodivergent

[00:01:33] [SPEAKER_02]: people but also as part of the trans aware cancer care project which as you say is you know just

[00:01:40] [SPEAKER_02]: coming to the end but the end of phase one and there hopefully you know things cross phase

[00:01:47] [SPEAKER_02]: too will be starting in April so that's me. Let's more to hear about that then.

[00:01:52] [SPEAKER_01]: So do you mind Dr Virginia, how would you like to be addressed? Oh Virginia is fine.

[00:02:01] [SPEAKER_03]: Fantastic so just tell us about yourself Virginia. I'm Dr Virginia Quiney, I am a GP,

[00:02:07] [SPEAKER_03]: I work for the Wessex Cancer Alliance in a GP role. I also do locom GP work in the

[00:02:14] [SPEAKER_03]: Portsmouth and Southeast Hampshire area and I've got involved in this project a little bit later on

[00:02:23] [SPEAKER_03]: and I went to one of the meetings in the summer and it's as a result of that that we're doing

[00:02:30] [SPEAKER_03]: this podcast together today and as Katie says hopefully as we draw this phase to a close there

[00:02:38] [SPEAKER_03]: will be more to come later on. Fantastic well Katie tell us a little bit about the project

[00:02:44] [SPEAKER_01]: as the structure and where we are then at the moment. So I think we started, oh don't ask me

[00:02:50] [SPEAKER_02]: when we started nine months ago a year ago sounds about right and it was basically about

[00:02:58] [SPEAKER_02]: with Bournemouth University and help and care which is charity around health and well-being

[00:03:03] [SPEAKER_02]: and bringing community researchers so people such as myself who are trans or gender diverse

[00:03:10] [SPEAKER_02]: and going out and talking to different wonderful trans plus people at various different places

[00:03:16] [SPEAKER_02]: doing arts based workshops but also just using arts to open up a conversation around

[00:03:23] [SPEAKER_02]: healthcare more generally but also cancer services. So anything from

[00:03:29] [SPEAKER_02]: being asked to go in for a screening and whether you went in or not all the way through to kind of

[00:03:34] [SPEAKER_02]: diagnosis treatment and aftercare and any support you may or may not have had throughout the whole

[00:03:41] [SPEAKER_02]: process. So we've went to Pride events and also booked kind of like private events as well

[00:03:50] [SPEAKER_02]: for people to come and come and talk to us and every participant was given well actually

[00:03:57] [SPEAKER_02]: a few people made more than one including me a square either pink white or blue and the idea is to

[00:04:04] [SPEAKER_02]: create a giant trans plus well transgender flag and then to have that go on a bit of a bit of a tour

[00:04:13] [SPEAKER_02]: around the country and a part of that which we're just seeing at kind of nearer the end of

[00:04:20] [SPEAKER_02]: phase one was to talk to practitioners like Virginia about okay so if we've got all this really

[00:04:26] [SPEAKER_02]: good information that trans people have entrusted to us what happens next how do we make that you

[00:04:32] [SPEAKER_02]: know if people have said this is really good practice I'd like to see some more of it how do

[00:04:36] [SPEAKER_02]: we do that or I don't go into the doctors because I don't trust this or what how can we work together

[00:04:43] [SPEAKER_02]: to make healthcare more accessible to trans plus people. Interesting and it's a subject close to

[00:04:49] [SPEAKER_01]: every trans person's heart isn't it irrespective of a femo mask that relationship with a

[00:04:56] [SPEAKER_01]: specific health provider or a particular service is really interesting and certainly in groups that

[00:05:03] [SPEAKER_01]: I run you know it's one of the most contentious things is that relationship so Virginia how did

[00:05:08] [SPEAKER_03]: you get involved with the process? As part of my work with the Wessex Cancer Alliance

[00:05:14] [SPEAKER_03]: I go to the personalised care programme board meetings which basically focuses on the

[00:05:20] [SPEAKER_03]: personalised care aspect of cancer and I'm the GP representative for that and this project came up

[00:05:28] [SPEAKER_03]: during that meeting and the person who brought it to the meeting said well we what we're really

[00:05:36] [SPEAKER_03]: missing in this project is some primary care input so basically some when we say primary care

[00:05:42] [SPEAKER_03]: that's essentially the sort of GP world if you like secondary care would be the hospital setting

[00:05:48] [SPEAKER_03]: so I volunteered to get involved and go along to the next meeting to see if there was if there

[00:05:58] [SPEAKER_03]: was anything that I could I could add really in any input that I could give.

[00:06:04] [SPEAKER_01]: Great fantastic and for those that don't know I mean Samson obvious phrase but does

[00:06:08] [SPEAKER_01]: personalised care mean what I think it means which is care that's personalised?

[00:06:14] [SPEAKER_03]: Yeah essentially it does I mean personalised care is something that's running through

[00:06:21] [SPEAKER_03]: different aspects of NHS care both in the hospital setting and in primary care and it's about

[00:06:27] [SPEAKER_03]: basically giving people autonomy about their about their health care and trying to make

[00:06:32] [SPEAKER_03]: it more personalised to them there's quite a structure to it and different ways in which

[00:06:38] [SPEAKER_03]: it's done and certainly within the cancer arena there are lots of different projects

[00:06:43] [SPEAKER_03]: and different strands running through the personalised care agenda so there's things like

[00:06:50] [SPEAKER_03]: rehabilitation and rehabilitation getting somebody fit if you like for cancer treatment

[00:06:56] [SPEAKER_03]: and then helping them afterwards that doesn't just mean physically fit but it sort of means

[00:07:01] [SPEAKER_03]: in all aspects so psychologically and the other aspects of their lives as well and that's just

[00:07:09] [SPEAKER_03]: sort of one part of personalised care so there's the meeting draws together lots of different

[00:07:14] [SPEAKER_03]: strands of work that are going on from the cancer point of view across the cancer workforce

[00:07:22] [SPEAKER_03]: and as I say this project was one of the things that was happening.

[00:07:26] [SPEAKER_01]: Yeah fascinating oh great and I guess you work with other charities as well because

[00:07:31] [SPEAKER_01]: things like financial care and such like it must be part of that wraparound process so I can see why

[00:07:37] [SPEAKER_01]: other charities involved in this themselves that's fascinating. So Katie I get I mean are we allowed

[00:07:43] [SPEAKER_01]: to ask what sort of themes have been emerging from the trans trans plus side?

[00:07:49] [SPEAKER_02]: Yeah we've just been actually working over this on the last couple of days because we had

[00:07:56] [SPEAKER_02]: 92 people create squares and have conversations with us 92 something like that so nearly 100 people

[00:08:02] [SPEAKER_02]: share their experiences with us. There was a lot of concern around distrust

[00:08:11] [SPEAKER_02]: which I share as well if I'm honest with you and you know just being worried about being misgendered

[00:08:22] [SPEAKER_02]: and being dead named is certainly something that that kept coming up and this idea around

[00:08:31] [SPEAKER_02]: just exhaustion of having to not only advocate for the reason that you've gone to the doctors or

[00:08:39] [SPEAKER_02]: you've gone to the hospital or anything else but also just getting your name your name respected

[00:08:46] [SPEAKER_02]: and your pronouns respected and yes big access issues with that and obviously the knock on effect

[00:08:54] [SPEAKER_02]: to not just physical help for mental health as well. Yes and I'm guessing we're picking up here

[00:09:01] [SPEAKER_01]: small things like pronouns and such like but actually systemic things like databases

[00:09:06] [SPEAKER_01]: and medical records and such like is it does that appear because that's something I hear a lot

[00:09:13] [SPEAKER_02]: is that part of an issue? Yes I think so yes definitely part of a bigger issue

[00:09:18] [SPEAKER_02]: and even includes things such as if your sex markers are changed on your paperwork

[00:09:26] [SPEAKER_02]: then people miss out on screenings that actually make sense for their body as opposed to

[00:09:33] [SPEAKER_02]: what people might think makes sense for their gender and their sex marker

[00:09:38] [SPEAKER_02]: so that happens quite a lot and I think just generally and we saw this in the disability

[00:09:44] [SPEAKER_02]: project as well is there's a certain amount of uncertainty around screening anyways

[00:09:51] [SPEAKER_02]: will they will I be asked to that what age will I be asked to that how often is that

[00:09:56] [SPEAKER_02]: can I take someone with me like what is going to actually happen when I go in there

[00:10:02] [SPEAKER_02]: and that was definitely brought up as well but almost as a secondary part to

[00:10:09] [SPEAKER_02]: when I go in there will will I be respected for who I am as a whole individual person

[00:10:14] [SPEAKER_02]: when Virginia was talking about personalized care and kind of touching on that point.

[00:10:19] [SPEAKER_01]: But it's important as well to say before we go back to Virginia to comment on this perhaps is

[00:10:25] [SPEAKER_01]: I'm assuming not everyone was negative.

[00:10:30] [SPEAKER_02]: No had a fantastic

[00:10:34] [SPEAKER_02]: yeah it's really strange because when we were when we were theming things yesterday and

[00:10:42] [SPEAKER_02]: it was pretty tough going in a lot of ways we had to stop for a little while got a bit emotional

[00:10:45] [SPEAKER_02]: in the middle there for me you know someone said that they'd had a really good experience at one

[00:10:52] [SPEAKER_02]: of their hospitals you know his name was correct he was his pronouns were used properly and when he

[00:11:00] [SPEAKER_02]: was discharged from care you know even one of the practitioners said like he was a pleasant gentleman

[00:11:05] [SPEAKER_02]: you know and I think that quote and that story brings up two things for me is that

[00:11:18] [SPEAKER_02]: in some ways that the bar is quite low for what we what we assume is good care

[00:11:24] [SPEAKER_02]: you know getting names and pronouns correct but there's also another thing there under his story

[00:11:32] [SPEAKER_02]: about the fact that you know I wouldn't if everyone who I worked with was a man or masculine

[00:11:40] [SPEAKER_02]: I wouldn't call anyone a pleasant gentleman like that's a very specific thing for a very specific

[00:11:46] [SPEAKER_02]: person so there was obviously a good rapport good connection there you know and part of the square

[00:11:56] [SPEAKER_02]: that he made had had a little thank you card in it addressed to address the hospital so

[00:12:04] [SPEAKER_02]: so it's all these like I said earlier it's not just us going oh this is terrible and this is

[00:12:08] [SPEAKER_02]: dreadful and there are terrible dreadful things but there are also like yeah quite a few pockets

[00:12:15] [SPEAKER_02]: of very very good stuff that's just how to expand that and I think that's I think that's important

[00:12:20] [SPEAKER_01]: to say isn't it because I think we we don't want to be part of a narrative that's demonizing people

[00:12:27] [SPEAKER_01]: in the healthcare profession because actually my experience of practitioners at an individual level

[00:12:31] [SPEAKER_01]: is that the vast majority of them have been unfailing a helpful positive you know warm

[00:12:37] [SPEAKER_01]: sympathetic and actually what we've cared about really most of all is my health and getting

[00:12:42] [SPEAKER_01]: better and which is the thing I'm most interested in as well as my health and gets it better if

[00:12:47] [SPEAKER_01]: I've got to go and deal with that and as someone's had cancer myself then you know I've I've

[00:12:51] [SPEAKER_01]: gone through that process as well so but my experience a lot with a lot of this is a trans

[00:12:56] [SPEAKER_01]: person is that a lot of healthcare practitioners sort of don't know what to say they've heard

[00:13:01] [SPEAKER_01]: the the narrative about when a weaponized militant trans people who are you know screaming

[00:13:07] [SPEAKER_01]: the gate sort of thing or there's a there's a lot of negativity and I think a lot of

[00:13:11] [SPEAKER_01]: healthcare practitioners get a little bit unsure of what I don't know what to say so I'll sort of

[00:13:17] [SPEAKER_01]: not say anything I'll say something awkwardly and it's worse than than just not saying anything

[00:13:22] [SPEAKER_01]: so I wonder Virginia if you can give us a bit of a perspective of what it's like

[00:13:25] [SPEAKER_03]: from the sort of healthcare practitioner side. I think it it's a it's a good question really

[00:13:35] [SPEAKER_03]: I think it kind of depends on where you're coming from and what your experience is what your knowledge

[00:13:44] [SPEAKER_03]: is. Rinai was at their meeting and saw the squares they they presented the squares as a

[00:13:53] [SPEAKER_03]: sort of little video with some of the squares shown in a narrative over the top and it was a really

[00:13:59] [SPEAKER_03]: powerful thing I thought and actually hit home two things firstly as Katie was saying when you get it

[00:14:08] [SPEAKER_03]: right how good that is but then the flip side of that when you get it wrong how potentially

[00:14:15] [SPEAKER_03]: devastating that can be for somebody and not just for that particular encounter or appointment

[00:14:22] [SPEAKER_03]: but for the future of the healthcare and as a healthcare professional watching that I thought

[00:14:29] [SPEAKER_03]: gosh that feels almost so fragile a thing because you've got this chance to get it right and make a

[00:14:35] [SPEAKER_03]: real positive difference you've also got the opportunity to get it wrong and then make and

[00:14:41] [SPEAKER_03]: then make things a lot worse so there's almost this fear I suppose and I don't know if I

[00:14:50] [SPEAKER_03]: I can't possibly speak for every healthcare practitioner but I think

[00:14:55] [SPEAKER_03]: if you don't know much about something and you're scared of getting it wrong there is a fear there

[00:15:01] [SPEAKER_03]: and if you know the impact that could have on somebody else if you do get it wrong then

[00:15:05] [SPEAKER_03]: that probably makes that that fear worse and so if I think there's I've definitely had come

[00:15:14] [SPEAKER_03]: across training for healthcare professionals in terms of pronouns and the language to use but

[00:15:21] [SPEAKER_03]: I think it is still a relatively new thing and not every healthcare professional will have come

[00:15:26] [SPEAKER_03]: across that or had that training and even if they have there's always potentially going to be

[00:15:34] [SPEAKER_03]: an element of your you have to think about it it's not your necessarily your defaults

[00:15:42] [SPEAKER_03]: and so you'll have to be sort of maybe thinking and doing things slightly differently you might

[00:15:48] [SPEAKER_03]: be almost second guessing yourself and thinking oh did I get that right did I get that right

[00:15:52] [SPEAKER_03]: and so potentially that can make those consultations a little bit more awkward if the

[00:15:59] [SPEAKER_03]: healthcare professionals feeling a little bit uncomfortable say or scared about saying

[00:16:06] [SPEAKER_03]: we're doing the wrong thing and then the patient is maybe a little bit anxious about oh gosh how's

[00:16:12] [SPEAKER_03]: this going to be and you've got two very anxious people trying to have a good a good consultation

[00:16:20] [SPEAKER_03]: so I suppose it would be lovely in an ideal world if healthcare professionals could feel more

[00:16:28] [SPEAKER_03]: confident about getting things right but also be able to navigate the situation if they don't

[00:16:37] [SPEAKER_03]: and and maybe if I can ask Katie a question or both of you really what would you

[00:16:44] [SPEAKER_03]: say to a healthcare professional who was feeling that way and wasn't sure how to get it right

[00:16:51] [SPEAKER_02]: I'll let you answer that first Katie is under host yeah okay um yeah it's a really that's a really

[00:16:57] [SPEAKER_02]: good question um as people even when I talk about myself in the third person I still misgender

[00:17:06] [SPEAKER_02]: myself sometimes right accidents happen things happen we get things wrong and I don't think

[00:17:13] [SPEAKER_02]: there's necessarily a problem with getting things wrong because we have to do things wrong until

[00:17:18] [SPEAKER_02]: we get things right right we're all just going to wave a magic wand and everyone's going to be

[00:17:24] [SPEAKER_02]: trans affirming and know and know what's going on I think it's the the humility of a practitioner

[00:17:33] [SPEAKER_02]: or whoever is getting it wrong so if someone says um and even if it was someone said on

[00:17:42] [SPEAKER_02]: somebody else's behalf you know actually my pronouns are they them or just like

[00:17:46] [SPEAKER_02]: just a polite reminder that's my thing just a polite reminder that I use they then pronouns

[00:17:52] [SPEAKER_02]: it's just kind of accept that and move on not turn into this big kind of flustery mess of oh my

[00:17:59] [SPEAKER_02]: goodness I knew you were it was they them pronouns and oh I've got they always bring up a a relative

[00:18:05] [SPEAKER_02]: oh I've got a I've got a cousin's my cousin's best friend is old trans and I should really know

[00:18:11] [SPEAKER_02]: they're so you just like that's a lot it's a lot for trans people to have to listen to day in day

[00:18:19] [SPEAKER_02]: out but it's also a lot of pressure that practitioners are putting on themselves to be perfect

[00:18:25] [SPEAKER_02]: perfect to anything so um that for me is the biggest thing is checking in with people

[00:18:32] [SPEAKER_02]: to begin with any ways around pronouns and various other things um and then just

[00:18:40] [SPEAKER_02]: just feel the fear and do it anyways you know there must be other communities like ourselves

[00:18:48] [SPEAKER_01]: the Virginia who um we you uh medical professionals deal with where you know they're sensitive

[00:18:54] [SPEAKER_01]: communities that have all sorts of different issues and challenges so it's surely you know

[00:19:00] [SPEAKER_01]: we're not unique as a community we're just a small very probably not that often seen

[00:19:06] [SPEAKER_01]: community in a doctor's surgery and certainly a doctor's I went to recently said I've never

[00:19:10] [SPEAKER_01]: met trans person before there you go you know what are you saying congratulations I'm your first

[00:19:17] [SPEAKER_02]: today it's all right you met the best one so you don't need to talk to anyone out you probably

[00:19:24] [SPEAKER_01]: have met one we just didn't know and that's that's my usual answer but but but there must be other

[00:19:30] [SPEAKER_01]: communities so how do how do healthcare professionals deal with other communities

[00:19:34] [SPEAKER_01]: because one of the things I thought you was interesting you said there was that you know

[00:19:38] [SPEAKER_01]: when you got the chance to get the relationship right and if it's right it's right forever and

[00:19:41] [SPEAKER_01]: if you get it wrong it's wrong forever and I suppose my response to you is that it's not

[00:19:44] [SPEAKER_01]: wrong forever it's only wrong to the end of the point where you put it right and um and I

[00:19:50] [SPEAKER_01]: wonder whether we've become overthought in our relationships with each other as two different

[00:19:55] [SPEAKER_01]: communities because we both have a vested interest we both have the same outcome we want

[00:20:00] [SPEAKER_01]: and I'm just wondering where where a bit like Katie's sort of demonstrating this pragmatism that

[00:20:05] [SPEAKER_01]: comes with this it says well if you've never met a trans person before all I want are this

[00:20:10] [SPEAKER_01]: what I need is some medication I want some share can I have some shared care please

[00:20:14] [SPEAKER_01]: and I'll either get it or I won't and you know which case I have a set of um you know choices

[00:20:19] [SPEAKER_01]: in front of me surely it's the job of the healthcare professional to enable me to make

[00:20:23] [SPEAKER_01]: my decisions for me and to input on a medical base and then I'm not expecting

[00:20:28] [SPEAKER_01]: them to be my social carer or my my adult carers that were I just want them to be a medical professional

[00:20:34] [SPEAKER_01]: so I just wonder whether are under whether we over dramatize this relationship between the

[00:20:41] [SPEAKER_01]: two communities and this may be an age thing as well because I'm slightly older than everybody in

[00:20:47] [SPEAKER_01]: the room and I just wonder whether sometimes it's different rules for different generations

[00:20:52] [SPEAKER_01]: and you must see that anywhere with medical treatment and care with different groups so

[00:20:59] [SPEAKER_01]: there's a lot there to unpack but um you did ask a question and I do tend to answer them so

[00:21:05] [SPEAKER_03]: what would you pick out of that I suppose um well thank you very much for answering and

[00:21:13] [SPEAKER_03]: you're right I think we as healthcare professionals we do see lots of different

[00:21:18] [SPEAKER_03]: well lots of different people and those people will be parts of different communities and different

[00:21:23] [SPEAKER_03]: social groups and you know as we talked about with personalized care everybody is an individual

[00:21:29] [SPEAKER_03]: so um I suppose the way I tend to approach it and particularly as a locum GP who often is just

[00:21:35] [SPEAKER_03]: meeting people for the first time is just trying to get to know that person in front of me

[00:21:43] [SPEAKER_03]: and pretty quickly to establish a report to have a good consultation and so that that's sort of the

[00:21:51] [SPEAKER_03]: nuts and bolts of it if you like the essence of it and so trying to pick up on what you know what

[00:21:57] [SPEAKER_03]: they want to be called and there'll be lots of people who will want to be known by a name

[00:22:02] [SPEAKER_03]: that's different to their given name um and so sometimes that will be on the notes and sometimes

[00:22:10] [SPEAKER_03]: they will say oh please call me whatever and then so it's sort of all part of the same thing and

[00:22:18] [SPEAKER_03]: I think there will always be differences say for example cultural differences whereby I'm not going

[00:22:25] [SPEAKER_03]: to know all the ins and outs of all the cultural differences of all the people that I see um but

[00:22:31] [SPEAKER_03]: it's I suppose about just establishing the rapport with that person and hopefully you know

[00:22:36] [SPEAKER_03]: they will tell me or show me if I've if I've got something either wrong or that's not ideal

[00:22:45] [SPEAKER_03]: and I think when you do have a relationship with a healthcare professional over time that

[00:22:49] [SPEAKER_03]: becomes easier because they get to know who you are and what you're like and what your preferences are

[00:22:55] [SPEAKER_03]: and and yeah it could be that we've kind of overdramatised this but clearly there are still

[00:23:03] [SPEAKER_03]: issues because otherwise we wouldn't be running the project and we wouldn't be hearing all these stories

[00:23:09] [SPEAKER_03]: where people aren't getting the care that they would like and the care that they should have

[00:23:14] [SPEAKER_03]: because of these these issues that still exist. Yes no and I'm not trivialising the issues at

[00:23:20] [SPEAKER_01]: all I think it's it's more situating them in in the sort of the real narrative of what's

[00:23:29] [SPEAKER_01]: going on isn't it it's more about that and it's also situating the narrative in the sense that

[00:23:34] [SPEAKER_01]: everybody has this shared concern of actually just getting better and I think sometimes I don't know

[00:23:39] [SPEAKER_01]: what your view is here there's a difference between someone coming for a say coming for treatment

[00:23:43] [SPEAKER_01]: for cancer and I'm sure Katie's got a view on this as opposed to coming for treatment for

[00:23:48] [SPEAKER_01]: gender issues because I sometimes think there's a difference in that approach because often the

[00:23:54] [SPEAKER_01]: most fraught decisions we have are around gender problems but again I might be wrong on that but

[00:24:00] [SPEAKER_01]: I just wonder Virginia how how you see that as being different. I suppose there will be some

[00:24:08] [SPEAKER_03]: consultations where actually gender doesn't really enter into it there's a person in front of

[00:24:14] [SPEAKER_03]: you they're not well the reason they're not well is nothing to do with their gender

[00:24:18] [SPEAKER_03]: and the treatment would be the same whatever gender they are and so in some ways that

[00:24:25] [SPEAKER_03]: doesn't come into it but I suppose the gender would come into it if you as a healthcare professional

[00:24:32] [SPEAKER_03]: misgendered them or got that wrong then it might come into the consultation and then I suppose there's

[00:24:39] [SPEAKER_03]: there's sometimes an overlap I think with with coming in about cancer depending on the

[00:24:44] [SPEAKER_03]: site of the cancer because if it's a you know a body part that is more gender specific then

[00:24:50] [SPEAKER_03]: that might be bring up the gender issues more so than say about that isn't where the gender might

[00:24:58] [SPEAKER_03]: not really come into it again so I think it's really situation dependent. Yes what do you

[00:25:06] [SPEAKER_02]: what do you say think about that Katie? Yeah I don't know that I have an amazing amount to add

[00:25:11] [SPEAKER_02]: to what Virginia said um I just yeah there's just additional things with gender identity healthcare

[00:25:20] [SPEAKER_02]: along with waiting lists and various other things as well and I think

[00:25:27] [SPEAKER_02]: if and when people are let down by gender identity healthcare than that

[00:25:34] [SPEAKER_02]: there's also a distrust there I would say a lot of the time in a space where

[00:25:40] [SPEAKER_02]: you know people should be able to experience we I think we spoke about this last time we

[00:25:47] [SPEAKER_02]: spoke to each other actually for Gillian about trans joy and what trans joy could actually look like

[00:25:54] [SPEAKER_02]: in healthcare and you I think a lot of people who have an experience gender identity healthcare

[00:26:01] [SPEAKER_02]: especially as it is now would be under the false assumption that it's you know bish bash

[00:26:08] [SPEAKER_02]: bosh and you know you're looking and feeling and doing what you need to do within you know

[00:26:16] [SPEAKER_02]: a certain amount of time and that's just not not the case. So what's going through my hand is this

[00:26:22] [SPEAKER_01]: even we've got an expert in the room uh medical expert because I've always wanted to ask this

[00:26:28] [SPEAKER_01]: question so forgive me it might be outside the scope of this conversation but I'm going to

[00:26:32] [SPEAKER_01]: ask it it's just too good opportunity so how do I get the best out of my health professional

[00:26:38] [SPEAKER_01]: as a trans person how do I do it?

[00:26:43] [SPEAKER_03]: That's a good question um I suppose I'd I'd wonder what does the best what do you think the best is

[00:26:55] [SPEAKER_03]: are you asking how how do you get your healthcare professional to relate to you better or

[00:27:04] [SPEAKER_03]: what what is it that you think offers as the best out of them? I often wonder whether it's best

[00:27:11] [SPEAKER_01]: better for a trans person to come and say hey I'm trans this is what I'm looking for this is what

[00:27:14] [SPEAKER_01]: I'm expecting I am nervous I have not met a doctor before I am frightened that you're not going to

[00:27:19] [SPEAKER_01]: do this I wonder if there's like a sort of a sort of process um where we can go in and

[00:27:26] [SPEAKER_01]: you know actually that'll help a medical practitioner say oh I see where you are okay

[00:27:31] [SPEAKER_01]: let's settle you down and let's let's have a conversation about each of those things I mean

[00:27:35] [SPEAKER_01]: that's I suppose what you know is that a useful process for example for people?

[00:27:41] [SPEAKER_03]: Ah I think I think that's a really I think it's an interesting question because I also think

[00:27:48] [SPEAKER_03]: it depends on the healthcare professional which I know isn't really going to be necessarily the

[00:27:53] [SPEAKER_03]: most helpful answer from my perspective if the patient came in and said that it would be

[00:27:59] [SPEAKER_03]: like they laid their cards on the table and I it would make my life slightly easier because

[00:28:04] [SPEAKER_03]: I think okay well now I understand what your concerns are and what you want to get out of this

[00:28:10] [SPEAKER_03]: consultation and from a healthcare professional we spend a lot of our time trying to get get

[00:28:17] [SPEAKER_03]: information out of people um you know whatever their gender and whatever communities they're from

[00:28:22] [SPEAKER_03]: we've got someone in front of us who's by definition not not well because they come

[00:28:27] [SPEAKER_03]: to see us and then we've got to try and work out why they're not well and some people are naturally

[00:28:32] [SPEAKER_03]: quite good at saying oh I've had you know these symptoms for this long these are the other bits

[00:28:38] [SPEAKER_03]: that I've noticed and but sometimes but actually quite a lot of people are not like that and

[00:28:44] [SPEAKER_03]: they'll give you a bit of a story and things will be a bit vague and it's it's my job to try and

[00:28:50] [SPEAKER_03]: extract the the bits of information that are going to help me to work out why why is this

[00:28:55] [SPEAKER_03]: well why is this person sat in front of me today um what's what's brought them in um

[00:29:01] [SPEAKER_03]: what might be going going on and so if somebody comes in kind of lays it all out it does potentially

[00:29:09] [SPEAKER_03]: make the process easier then I've got things to work with and and and can work with that

[00:29:14] [SPEAKER_03]: person to say right okay well how are we gonna sort this out um but that would also depend on

[00:29:23] [SPEAKER_03]: so it depends on the type of healthcare professional you saw because some some

[00:29:26] [SPEAKER_03]: healthcare professionals are don't necessarily respond so well to that and they might

[00:29:34] [SPEAKER_03]: prefer to kind of get there themselves in a way potentially um and some people might not actually

[00:29:44] [SPEAKER_03]: feel comfortable doing that because I think when you I think as healthcare professionals we can

[00:29:50] [SPEAKER_03]: sometimes forget the how people feel when they go to the doctor I mean any going to the doctor

[00:29:57] [SPEAKER_03]: because for us it's a day at work it's a workplace it's routine it's it's normal for people coming in

[00:30:03] [SPEAKER_03]: to see a doctor or a healthcare professional it's not they're not there because they're

[00:30:10] [SPEAKER_03]: feeling normal they're not there because that's part of what they normally do they're there

[00:30:14] [SPEAKER_03]: because they're unwell and or worried about something or things aren't going right so there's

[00:30:20] [SPEAKER_03]: already that level of anxiousness and vulnerability there in the first place and then you add to that

[00:30:26] [SPEAKER_03]: when you put other potential barriers in place for example a gender issue or or a communication

[00:30:32] [SPEAKER_03]: issue or a disability or something which potentially adds on top which might make it harder for

[00:30:38] [SPEAKER_03]: that person to get the best out of their healthcare professional so it's probably about you may find

[00:30:47] [SPEAKER_03]: you get different techniques work with different people if you um you know as you found Gillian

[00:30:53] [SPEAKER_03]: with your doctor um you found a way to get the best out of him for you and perhaps that's

[00:31:01] [SPEAKER_03]: what it's about I personally I don't think it would be a bad thing if if someone came in

[00:31:06] [SPEAKER_03]: and said the scenario you presented me with because I find that quite quite good to work with and

[00:31:13] [SPEAKER_03]: showing vulnerability you know then what that person's worried about but that but not if a body will

[00:31:19] [SPEAKER_01]: feel comfortable do that I don't suppose no but I think sometimes there's a there's a fear isn't

[00:31:25] [SPEAKER_01]: there and you know and I suppose what we're trying to say today is if you have a symptom

[00:31:29] [SPEAKER_01]: and if you're worried about an aspect of your body which is gender or non-gender related

[00:31:33] [SPEAKER_01]: because it's health related um fundamentally going to say I have a practitioner because they are very

[00:31:39] [SPEAKER_01]: interested in helping you I mean that you know that's their job is to help you sort out that issue

[00:31:45] [SPEAKER_01]: irrespective of gender and just imperative you get that thing right or wrong if you especially

[00:31:49] [SPEAKER_01]: got a cancer symptom you have to put you have to focus on the real fear and and go and get that

[00:31:54] [SPEAKER_01]: that treatment and I think Katie sometimes I just wonder whether we um I don't know whether

[00:32:00] [SPEAKER_01]: we overemphasize the fear side of going to see the doctor maybe there's too much narrative in the

[00:32:05] [SPEAKER_02]: trans plus community I don't know what what are your thoughts um what um fear is in

[00:32:12] [SPEAKER_02]: of like transphobic kind of microaggressions and stuff like that um very possibly and I think

[00:32:21] [SPEAKER_02]: that that exists within kind of like disability that's definitely come up throughout the disability

[00:32:26] [SPEAKER_02]: project as well and just in my life as a disabled person for the last 34 years but

[00:32:33] [SPEAKER_02]: but there are also things for my life personally I'll give you two examples that happen within

[00:32:39] [SPEAKER_02]: two weeks of each other um or my so this was happened a little over three years ago

[00:32:49] [SPEAKER_02]: because I was pregnant with my little boy and I was going to go see my midwife and lovely

[00:32:55] [SPEAKER_02]: jubbly and and then she was asking me about you know whether I was going to try breastfeeding

[00:33:02] [SPEAKER_02]: um and I said oh you know yeah we're going to give that a go kind of thing and um nowhere on my

[00:33:06] [SPEAKER_02]: paperwork my non-binary or trans I just I don't I just don't bother having it on there um and when

[00:33:12] [SPEAKER_02]: I tell you these stories you'll understand why um and then she was saying oh no but we can't

[00:33:19] [SPEAKER_02]: call it that anymore oh we can't call it that anymore yeah and I thought I know what she's

[00:33:23] [SPEAKER_02]: going to go on about yeah and the tone that she's doing it in is telling me that this is not going

[00:33:28] [SPEAKER_02]: to be a conversation that I want when I'm like heavily pregnant seeing my health visit my health

[00:33:34] [SPEAKER_02]: midwife um and she said oh because you can't call it that anymore you have to call it

[00:33:38] [SPEAKER_02]: breastfeeding and I said well no actually hang on a minute this is something they're trying in

[00:33:45] [SPEAKER_02]: in the Brighton area and we're in Hampshire um and it's not a legal requirement of any

[00:33:51] [SPEAKER_02]: way shape or form it's just a nicer way of talking to people about their body in a way that makes sense

[00:33:57] [SPEAKER_02]: to them um and she didn't seem she seemed a bit miffed by that answer that I knew more than

[00:34:04] [SPEAKER_02]: more than she did about that she seemed to be a bit miffed by that um so I left that rather

[00:34:09] [SPEAKER_02]: rather annoyed at that um and then two weeks later I was at my dentist and he was asking about

[00:34:18] [SPEAKER_02]: all the sex of the baby and I told him and he said oh yeah because you know a woman's born a woman

[00:34:24] [SPEAKER_02]: and had a man's born a man and and I just thought what if is everyone drinking at the moment like

[00:34:29] [SPEAKER_02]: what is going on with these healthcare professionals they're not only are you talking

[00:34:33] [SPEAKER_02]: about stuff that is exceedingly bigoted not actually based in um fact anyways um

[00:34:41] [SPEAKER_02]: and then that you want to share that with me

[00:34:45] [SPEAKER_02]: like what is it about what kind of bigotry thing am I putting down that you guys seem to be

[00:34:50] [SPEAKER_02]: picking up because I'm not that person so um so it will be things like that and I'm sure that

[00:34:58] [SPEAKER_02]: people have had worse besides that that people just go yeah you know it's not safe for me but

[00:35:04] [SPEAKER_02]: but I'm a bit more like usually and I think I'm very pragmatic like I have um chronic health

[00:35:11] [SPEAKER_02]: conditions like I need to go get things sorted so if I'm going to be called all the wrong things

[00:35:16] [SPEAKER_02]: under the sun and get called a lady about eight million times then I'm going to go head first

[00:35:22] [SPEAKER_02]: through that because I've got a son and I've got my own health to look after like but there are

[00:35:28] [SPEAKER_02]: plenty of people talking to people at the trans wear cancer care thing I just said I'm never

[00:35:33] [SPEAKER_02]: going to go in for that I'm not going to go in for it from a mammogram yeah I will never go in for

[00:35:40] [SPEAKER_01]: screening um but it's important to say as well there are people like Virginia who are empathetic

[00:35:48] [SPEAKER_01]: I can't say empathetic that's the word I can't just I could never get out anyway I've said it now

[00:35:53] [SPEAKER_01]: a kind and caring and all that sort of stuff and I've met other gps and on the south coast

[00:35:58] [SPEAKER_01]: and they're and they're great there's there are there they go from being very caring and pathetic

[00:36:03] [SPEAKER_01]: through to non-committer and pragmatic through to just this just let's just get through it and I think

[00:36:09] [SPEAKER_01]: and I think there are a lot of good doctors out there who I just I think you're right about the

[00:36:15] [SPEAKER_01]: maternity services because it's a much more gendered world anyways and it's it's a very

[00:36:20] [SPEAKER_01]: tricky thing I know uh there are lots of new groups in the in the world around

[00:36:24] [SPEAKER_01]: ovarian cancer and parenthood groups and such like which are coming out to deal with the trans

[00:36:29] [SPEAKER_01]: mask thing but and sorry I didn't mean to trivialize that story there but I think it's

[00:36:34] [SPEAKER_01]: a really important to to balance this out because what we don't want to do is

[00:36:39] [SPEAKER_01]: is we don't want to put and I know none of us do here we want people to know that if there's

[00:36:43] [SPEAKER_01]: any symptom like you've just sold gay to any symptom at all irrespective how you treat it

[00:36:48] [SPEAKER_01]: if you've got any something to do with you know any sort of especially to do with cancer

[00:36:51] [SPEAKER_01]: you the earlier the earlier you see people the better isn't it so 100 you sometimes just have to

[00:36:58] [SPEAKER_01]: you know get such a geordie expression to fess up get there and you know get the treatment

[00:37:02] [SPEAKER_01]: because actually sometimes you know sometimes those things are more important is that good message

[00:37:08] [SPEAKER_01]: to Evigina to to make sure that we're battering home this can I just add something to that um

[00:37:13] [SPEAKER_02]: because I think it goes also back to what Virginia was saying earlier about the fact that um

[00:37:23] [SPEAKER_02]: if you get it right then it starts like a long yeah good wonderful journey of healthcare together

[00:37:33] [SPEAKER_02]: you know um that possibly sounded sarcastic but I but I genuinely think that's true um

[00:37:39] [SPEAKER_02]: but if you get it wrong that's a lot harder to recover from and I think that the the point

[00:37:45] [SPEAKER_02]: of me sharing my stories is that um yeah illustrates that point yeah like that it's you know the the

[00:37:54] [SPEAKER_02]: hundreds of times that I've been to see the doctors I will remember um you know the fat

[00:38:00] [SPEAKER_02]: phobia the misogyny and the transphobia much more than I will the hundreds of other times that

[00:38:07] [SPEAKER_02]: I've been you know really sorted out with various different things so I'm going to let Virginia

[00:38:11] [SPEAKER_01]: come back in a minute because it sounds like we're having a right all go or not but I have to

[00:38:14] [SPEAKER_01]: say one last thing I do think some of this is based on host codes as well and I live in the

[00:38:19] [SPEAKER_01]: parts of the country where we have magnificent healthcare I mean really many people move

[00:38:25] [SPEAKER_01]: to this part of the country so I'm not going to say where we are because we don't want more

[00:38:28] [SPEAKER_01]: people arriving here but I do think where you are has a significant impact on this in the culture

[00:38:35] [SPEAKER_01]: of different parts of the UK so Virginia um as sort of wrapping up coming to wrapping up time

[00:38:40] [SPEAKER_01]: are there any sort of thoughts that you would like to share with us as a way of summarizing

[00:38:44] [SPEAKER_03]: the sort of discussion you you want us to have? I think I agree that for anybody if they've got I

[00:38:57] [SPEAKER_03]: mean the message that I would love to get out for it is if anybody's got any concerns about their

[00:39:01] [SPEAKER_03]: health about their bodies that they definitely should go and raise that with a healthcare professional

[00:39:07] [SPEAKER_03]: but there are barriers to that there are barriers to that for people in all walks of life it's

[00:39:14] [SPEAKER_03]: difficult to get an appointment at the moment and it can be difficult to get across what you're

[00:39:21] [SPEAKER_03]: worried about even if you haven't got any other barriers in the way and then when you add in if

[00:39:27] [SPEAKER_03]: it's something to do with gender then that as Katie was saying sometimes in the bits of

[00:39:34] [SPEAKER_03]: healthcare that are quite gendered so for example maternity services then that can be a challenge

[00:39:40] [SPEAKER_03]: in itself and cancer screening again because you've got two of the three screening programs that are

[00:39:47] [SPEAKER_03]: that are gendered so that can be really difficult to to navigate as well and I do feel that overall

[00:39:53] [SPEAKER_03]: it probably is going to end up with a change in language and a change in sort of in how

[00:39:58] [SPEAKER_03]: that's communicated but that isn't going to happen overnight that's slow so on an individual

[00:40:03] [SPEAKER_03]: level you it's about people I suppose in some ways you have to be a bit brave don't you to

[00:40:11] [SPEAKER_03]: to go and say something and then if you get a good response and a good reception you kind of think

[00:40:17] [SPEAKER_03]: great okay I can do that but if you just get another experience that's not great

[00:40:26] [SPEAKER_03]: and puts you off you potentially some people will only need a few of those to think right

[00:40:32] [SPEAKER_03]: I'm never doing that again and that's that's what I think is really quite sad and that's

[00:40:36] [SPEAKER_03]: the what will be wonderful to be able to change so that people do generally get a better response

[00:40:46] [SPEAKER_03]: from healthcare professionals and I I think things are starting to head that way but obviously

[00:40:52] [SPEAKER_03]: you're never going to reach everybody but if we can change systems and change culture

[00:40:58] [SPEAKER_03]: that will gradually trickle through and hopefully allow more people to have a much better experience

[00:41:06] [SPEAKER_03]: and I suppose if you have a bad experience with somebody maybe next time if you really don't want

[00:41:13] [SPEAKER_03]: to see that person make make him a point with a different person if you can you may get

[00:41:18] [SPEAKER_03]: a different experience and healthcare professionals are people too that sounds awful thing to say

[00:41:25] [SPEAKER_03]: but if you know there are long hours in general practice and if you're towards the end of the day

[00:41:32] [SPEAKER_03]: or tired just stressed or hungry you see somebody you might not actually be at your best even if you

[00:41:36] [SPEAKER_03]: are quite normally a caring and empathetic person so there might be a there might be a reason

[00:41:43] [SPEAKER_03]: that you might not get the best response nothing to do with with gender or anything else it might

[00:41:47] [SPEAKER_03]: just be your healthcare professional is tired and worn out quite keen to go home

[00:41:51] [SPEAKER_03]: worried about something else and you get a bit shortchanged

[00:41:57] [SPEAKER_01]: yeah fantastic well anything else to add Katie or we are we nearly there

[00:42:02] [SPEAKER_02]: I have a couple of things to add just to Virginia's point about the changing culture

[00:42:10] [SPEAKER_02]: throughout the NHS now I don't work within the NHS but was asked to cervical screening a

[00:42:17] [SPEAKER_02]: couple of weeks back and even the paperwork from the last time I got it has changed significantly

[00:42:24] [SPEAKER_02]: like it's now it's not just women everywhere it's people with cervix or people you know and

[00:42:34] [SPEAKER_02]: not women at all in some of the pages as well it's the kind of thing that I highlight and put

[00:42:40] [SPEAKER_02]: trove of treasures back there it's just the kind of things that I do in my life

[00:42:45] [SPEAKER_02]: and also that you can take people along with you to doctor's appointments

[00:42:50] [SPEAKER_02]: I think there's been a confusion or a worry

[00:42:57] [SPEAKER_02]: since the COVID lockdowns about whether you can take people in with you whether you should

[00:43:02] [SPEAKER_02]: take people in with you so if you're feeling particularly fragile worried anxious for whatever

[00:43:09] [SPEAKER_02]: reason going into your GP you can take someone with you that's another thing and also if you are a

[00:43:18] [SPEAKER_02]: trans or queer person and you're listening to this and you think it's very confusing about

[00:43:24] [SPEAKER_02]: the screening I'm worried about the screening there is a fantastic charity called Outpatients

[00:43:29] [SPEAKER_02]: who do all of their work and their campaigning around LGBTQIA plus cancer experiences

[00:43:37] [SPEAKER_02]: they have done like a massive campaign called what's best for my chest around chest and breast screening

[00:43:45] [SPEAKER_02]: so it's very trans very trans friendly it's run by trans and queer people so

[00:43:53] [SPEAKER_02]: like if you're sitting here thinking oh I've got more questions after listening to this

[00:43:56] [SPEAKER_02]: go and have a look at Outpatients they're fantastic

[00:43:59] [SPEAKER_01]: and I'd be lovely, Gignette if I could ask you to come back another time and actually

[00:44:03] [SPEAKER_01]: we really sort of unpack this subject in a little more depth if you'd be up for that

[00:44:08] [SPEAKER_01]: yep I'm happy that'd be great Katie I know we've met more than once on this podcast so please

[00:44:14] [SPEAKER_01]: you're always welcome to come back so I feel I don't even need to offer you the invitation

[00:44:20] [SPEAKER_01]: no I'm just here you'll probably be booking a slot

[00:44:23] [SPEAKER_02]: I should just be here

[00:44:25] [SPEAKER_01]: but thank you both so much it's been really interesting and I'll link to all the various

[00:44:30] [SPEAKER_01]: bits and pieces from the show notes and thank you for spending a lot of time with us today

[00:44:34] [SPEAKER_01]: I really do appreciate it perfect thank you thank you you take care

[00:44:44] [SPEAKER_01]: thanks for listening to this episode of Trans Vox it's been a joy to have you with us

[00:44:49] [SPEAKER_01]: if you want to make contact with us you can contact us at gillianarttransvox.com.uk

[00:44:58] [SPEAKER_01]: and if you'd like to support the work we do please go to Patreon and go to Page Trans Vox

[00:45:03] [SPEAKER_01]: and all of our money goes to our nominated charity and Jen you've chosen the charity for

[00:45:08] [SPEAKER_01]: the next number of episodes which one have you chosen?

[00:45:11] [SPEAKER_00]: Our charity is called Beyond Reflections which is a charity that provides support

[00:45:17] [SPEAKER_00]: and counselling to trans people non-binary people and their friends

[00:45:20] [SPEAKER_00]: and their families across the UK an amazing charity doing some amazing work really important so

[00:45:26] [SPEAKER_01]: please if you can give. Great and if you want to go and have a look at Beyond Reflections

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