The Gendered Medical Council – 2

The GMC can’t tell you the sex of its doctors

A woman asks her local hospital:

Can you tell me how I could find out whether a doctor I’m referred to is female or male?

They reply:

You can access the GMC website where you can type in the Doctors name and it states whether they are male or female.

Easy. Just check the doctor’s registration details in the General Medical Council‘s register.

Except, the GMC doesn’t record the sex of doctors.

we don’t collect data on the sex of doctors

~ The General Medical Council

Instead (as if it was something meaningful and useful), they record doctors’ self-declared ‘gender’.

The woman is, of course, asking about the sex of her doctor. When it comes to a woman’s dignity and privacy, knowing the sex of her doctor can be vital. How her doctor chooses to self-identify is irrelevant.

What is even more confusing is that the GMC uses the terms female and male for this ‘gender’ when they are the universal terms for the two sexes.

So, although the hospital was correct when they said the GMC will tell you whether a doctor is female or male, this is utterly misleading because the GMC calls this ‘gender’, not sex.

So any woman wanting to ensure the doctor with whom they have an appointment is female is wasting her time asking the doctor’s regulator: they simply don’t know.

The woman in this case is former Senior Lecturer, Lesley Semmens, who asked her local Bradford Teaching Hospitals.

How did the GMC ever get itself into this mess?

The Medical Register

According to the GMC:

The medical register is a list of doctors in the United Kingdom, showing their registration status, training and other useful information.

The public version of the Medical Register (or, to give it its proper title, the List of Registered Medical Practitioners (LRMP)) can be searched by entering the doctor’s given name, last name or GMC number, with filters for ‘Gender’ and Speciality (on the GP register or the Specialist register):

I looked at the history of the GMC’s use of the term ‘gender’ in the first part of The Gendered Medical Council.

In recent months, I had been asking the GMC some questions about the information on doctors they make public (see the full conversation below).

We already know that the GMC will remove the ‘gender’ of a doctor from the public register on the simple request from a doctor, leaving a blank. I wanted to understand this more fully so I asked:

Also, on what regulations are you relying to remove a registrant’s gender from the public register?

They gave this extraordinary reply:

The regulations we operate under require us to collect gender information as part of the registration process.

…as detailed in Part 1 and they added:

But we don’t collect data on the sex of doctors – so we do not hold this information.

Let that sink in: the statutory regulator for doctors does not know the sex of any doctor. They don’t ask for their sex so can’t tell patients.

Patients are unable to check they are receiving same-sex care.

They don’t say why they believe a doctor’s ‘gender’ is in any way useful to patients nor why their sex isn’t deemed useful, if not essential, information.

But it’s worse than that.

Many who check the register will see female or male and assume that is the sex of the doctor without realising the GMC regards this is as their self-identified ‘gender’, not their sex.

But it doesn’t stop there:

We do not set our own definitions of sex and gender but draw on guidance provided by other organisations. In general, we understand gender to reflect the characteristics of women, men, girls and boys that are socially constructed, and sex as relating to the different biological and physiological characteristics of women, men and intersex persons.

We are aware of developments in the external landscape and next year we are using this learning to review the language and terminology that we use to collect diversity information to ensure this is up to date. When a doctor registers with us, we require them to provide their gender. We currently offer a choice of two options for them – ‘man’ or ‘woman’.

It’s astonishing to see the GMC refers to ‘intersex persons’ as if they were neither female nor male. This ‘othering’ of those with chromosomal conditions is unacceptable for a medical regulator.

It may have been deemed acceptable to use demeaning, regressive stereotypical notions of societal roles for the two sexes in Sir Lancelot Spratt’s time but society has progressed enormously since the 1950s.

But this regressive gender ideology has pushed back on progress and given us a time were ‘gender’ trumps sex; where patients are not permitted to know the sex of their doctor, even for intimate examinations and treatments.

What is the GMC for?

The General Medical Council is the body charged by Parliament to regulate doctors. They state:

We work with doctors, patients, and other stakeholders to support good, safe patient care across the UK.

Good patient care doesn’t extend to patients knowing the sex of their doctor, it seems.

Raising a concern

If a patient was led to believe she was going to be examined or treated by a female doctor but instead found out the doctor was male, she can complain to the hospital and the GMC (or, as the GMC put it, ‘raise a concern‘).

They have some restrictions:

Does misrepresenting your sex amount to fraud or dishonesty? Or discrimination?

Equality, not diversity

There’s a form to fill in but there’s ‘diversity’ information to collect first:

Since this is about not discriminating against anyone, it would be more accurate to refer to this as ‘equality data’, not ‘diversity’ data: it’s not trying to measure how diverse complainants are, but information to check they are not discriminating.

They title this ‘Protected characteristics’, but, of course, ‘gender’ is not a protected characteristic under the Equality Act 2010:

Female and male are the terms in the Equality Act relating to the protected characteristic of sex, so using them for a question on ‘gender’ can only be confusing and could lead to them gathering inconsistent and contradictory data.

‘Gender’ is also likely to be considered Special Category personal information under the UK GDPR. Sex is not, so conflating sex and ‘gender’ as they do may cause issues in processing the information lawfully.

Unfortunately, this sets the tone for the rest of the form.

Identifying the doctor you are complaining about

When it comes to identifying the doctor being complained about, the GMC requires the doctor’s last name and their ‘gender’ as mandatory fields: the complainant has to specify the doctor’s ‘gender’ with the options of ‘Female’ and ‘Male’ — there is no ‘Blank’ option and they can’t skip this question:

As the GMC has caved in to requests from some doctors to have their ‘gender’ removed from the public register, leaving a blank, a complainant has no way of knowing whether the GMC thinks the doctor’s ‘gender’ is ‘female’ or ‘male’ so can’t even provide this mandatory information so cannot complete or submit the complaint form.

Mum’s the word

One of the reports that the GMC disclosed in its responses to me was one about its decision to acquiesce to a doctor’s request to have her/his ‘gender’ removed from the public register.

Oddly, the GMC say this policy was in response to “requests from individual doctors, medical students and an organisation specialising in gender dysphoria and transgender health”. The GMC doesn’t name the organisation but it’s curious they would want to hide their ‘gender’ from their patients with, erm, gender dysphoria.

However, Rebecca Says No covered this in Doctor, No on her Substack, cross-posted on Graham Linehan’s Substack: Doctor, No – by Rebecca Says No – The Glinner Update. She exposed GLADD (The Association of LGBTQ+ Doctors and Dentists) as the lobby group who pressured the GMC to remove a doctor’s ‘gender’ marker on request.

The policy does not appear to be available on the GMC’s website.

The GMC describes this policy as ‘interim’ but it was published nearly four years ago. It also stated:

we will not publicise our approach to excluding gender from [the Medical Register]

Not only did they acquiesce, they decided not to tell anyone what they were doing.

Hidden

If you look up one of these doctors who have asked for their ‘gender’ to be removed, what do you see? Does it say: ‘Gender not given’? ‘Gender details removed on request of the doctor’? ‘Gender [blank]’?

The first screenshot below from the medical register is of a doctor whose ‘gender’ is displayed as Male; the second screenshot is a doctor whose ‘gender’ has been removed:

Spot the difference? It doesn’t just have the doctor’s ‘gender’ as a blank, the word ‘Gender’ has also been removed, making it difficult to realise the doctor’s ‘gender’ is missing. The GMC couldn’t have done more to mislead patients.

Summary

  • The GMC doesn’t give the sex of doctors on their medical register.
  • The GMC instead gives the self-declared ‘gender’ of doctors.
  • The GMC allows doctors to change the self-identified ‘gender’ of doctors from male to female or female to male.
  • The GMC doesn’t want to tell patients what they were doing.

This predominantly affects women who for reasons of dignity, religion, wellbeing or privacy want to know they are being examined or treated by a female doctor, not a male.

Conspiring to hide the sex of doctors from patients is extraordinary for a statutory body charged with regulating doctors and making sure they deliver good, safe patient care.

There is more to say about what the GMC revealed in these responses but they will be covered in future posts.

See no evil, hear no evil, speak no evil.

Appendix: Correspondence with the GMC

There is more to be said about the responses from the GMC, but these will be dealt with in future posts.

14 September 2023 — To the GMC
  1. Please provide the number of registrants who have requested that you not display her/his ‘gender’ on your public register and how many of these requests you have acceded to.
  2. Please provide the number of registrants for whom her/his ‘gender’ on your public register does not correspond to their sex. [Link]
12 October 2023 — Reply from the GMC

The regulations we operate under only require doctors to tell us their gender as part of the registration process.

Since 2019, we have granted 45 doctors’ requests to remove their gender information from the published version of the medical register. We still retain the information internally. [Link]

13 October 2023 — To the GMC
  1. Thank you for the reply. However, I had also asked for the “number of registrants who have requested that you not display her/his ‘gender’ on your public register”: have there been more requests than these 45?

If so, on what grounds did you refuse these requests? [Link]

  1. Also, on what regulations are you relying to remove a registrant’s gender from the public register?

Can you say when you will respond to the other FOIA request I submitted at the same time? [Link]

02 November 2023 — Reply from the GMC

We can confirm we have not refused any requests. The regulations we operate under require us to collect gender information as part of the registration process. But we don’t collect data on the sex of doctors – so we do not hold this information. [Link]

We are sorry that we cannot provide more information on this. Here is the response to your most recent request under the Freedom of Information Act. Section 34 of the Medical Act sets out what information we must include in the published version of the medical register. As gender is not included we have discretion not to publish it. [Link]

02 November 2023 — To the GMC with replies from the GMC on 07 December 2023
  1. What do you mean by the term ‘gender information’, what question/s do you ask applicants and what options do you provide as responses? [Link]

We do not set our own definitions of sex and gender but draw on guidance provided by other organisations. In general, we understand gender to reflect the characteristics of women, men, girls and boys that are socially constructed, and sex as relating to the different biological and physiological characteristics of women, men and intersex persons.

We are aware of developments in the external landscape and next year we are using this learning to review the language and terminology that we use to collect diversity information to ensure this is up to date. When a doctor registers with us, we require them to provide their gender. We currently offer a choice of two options for them – ‘man’ or ‘woman’. [Link]

  1. Can you confirm the latest version of The General Medical Council (Form and Content of the Registers) Regulations is the one dated 2015?

https://gmc-uk.org/-/media/documents/form-and-content-of-the-register-regulations_pdf-28140401.pdf 2/7 [Link]

The correct link is as follows: https://gmc-uk.org/-/media/documents/form-and-content-of-the-register-regulations_pdf-28140401.pdf. Yes, this is the latest version. [Link]

  1. If so, this states at 5. (d) that the register must contain the ‘gender’ of registrants: please provide a copy of your decision to not include the ‘gender’ of some registrants in the published register. [Link]

We have a copy of a paper considered and agreed by our Senior Management Team at their meeting on 13 January 2020. Twitter doesn’t allow us to attach PDFs, so if you’d like to see it, please DM us your email address and we’ll send it over. [Link]

  1. Why do you have ‘Female’ & ‘Male’ as the only two options for the ‘gender’ of registrants in the published register, particularly since these are not mandated by the Medical Act or the Regulations and why do you use these terms when they are the terms for the two sexes? [Link]

Historically we used ‘m’ for man and ‘w’ woman as designations in the published version of the medical register, which we refer to as the List of Registered Medical Practitioners (LRMP).

In 2016 we ran a public consultation on developing the UK medical register and feedback received through that process requested that we stop using man/ woman and instead use male/ female. In 2020 this change was made as part of a wider project updating how we display information on LRMP. We have searched our records and do not have any further documentation to explain use of the terms male/ female. [Link]

  1. Please provide a copy of your decision that ‘gender’ did not refer to the sex of registrants and your decision not to ask registrants for their sex? [Link]

We have searched our records and have not been able to locate a decision on this issue. [Link]

  1. What quality assurance steps have you taken to ensure that registrants have provided you with their ‘gender’ and not their sex, given that you classify their ‘gender’ using the binary terms for sex? [Link]

The way we collect diversity demographic information from doctors is self-declaration.  We do not routinely verify or quality assure gender data that is provided. [Link]

  1. If the published register doesn’t contain the sex of registrants, can you say how the public is supposed to check the sex of a registrant so she/he can make an informed decision about whether to consult a particular registrant? [Link]

We recognise that some people may want to use the register to find a doctor of a particular sex. However it’s important to note that, the primary purpose of the medical register is to give confidence that doctors practising medicine in the UK have the training, skills and experience needed to meet the standards that patients expect.

The data currently on the published register may not reflect, in all cases, a doctor’s sex at birth. In addition, we believe that patients who want to see a doctor of a particular sex or gender are more likely to seek this information from their local healthcare provider – not from our register. [Link]

13 December 2023 — Email from the GMC

Paper received from GMC, ‘Policy – RR – Exclusion of gender information from LRMP_Redacted‘. This was presented to the GMC’s Senior Management Team at their meeting on 13 January 2020.

Selected highlights from their gender exclusion policy:

Executive summary

In response to requests from individual doctors, medical students and an organisation specialising in gender dysphoria and transgender health, we have considered our policy on gathering information on gender from doctors and publishing that information on the List of Registered Medical Practitioners (LRMP). [emphasis added]

We propose an interim policy to not display gender information on LRMP when a doctor requests this, but that our approach to the collection of gender information is reviewed as part of a wider corporate discussion when the outcome of reforms to the Gender Recognition Act is published.

Recommendations

[Senior Management Team] is asked to agree:

  • our interim policy framework to remove or not publish gender on LRMP when a doctor makes a request; and
  • that we begin discussions with IS to understand if it is possible to override the current gender categories in the event that a doctor refuses to identify as male or female
  • that the issue of non-binary gender be considered further at a cross-directorate level when the outcome of the reforms to the Gender Recognition Act is published.

Next steps

22 As this is an interim policy which may change, we will not publicise our approach to excluding gender from LRMP, but we will respond to requests on a case by case basis*. [emphasis added]

* This is in line with our existing policy for excluding revalidation and information from LRMP

This existing policy for excluding revalidation and information from LRMP has (confusingly) the same title on the cover page as the gender exclusion report: 07—List-of-Registered-Medical-Practitioners—policy-framework-for-excluding-information_-76923791

Three monkeys image created by DALL·E 3