“Shame on you calling yourself a woman!” “You are the reason women are suffering and dying!” “She should be struck off!” “No wonder women are scared to go to their GP!”
These are just a few of the many upsetting comments I received online after I used gender-inclusive language to speak about raising awareness of cervical cancer during a media round.
As a doctor, it is my responsibility to ensure that my patients receive the best care, and this goes beyond symptom and disease management. It means managing patients as individuals, respecting their choices, and empowering them with the information they need to improve their health.
When I was training to become a GP, my tutor told me: “Your patient will not remember much of what you said but they will always remember how you made them feel.” This particularly resonated because of an incident which took place during my teens when I accompanied my gran to hospital for an appointment.
She could not speak any English and I was there to translate. My gran liked to be heard, and though she couldn’t communicate verbally, everyone knew her from her dramatic mannerisms. However, during this appointment the receptionist went over to the nurse, not realising we were within earshot, and said: “It’s that crazy Pakistani woman again!”
What annoyed me at the time was not the fact that the nurse called my granny crazy, or that she was racist – because I was used to the odd racist remark – it was the fact that she got our background wrong. I remember asking my mum why we were always assumed to be Pakistani, when we were Indian, and she replied: “because we look the same, just ignore it.”
I have never been able to ignore it, because when you strongly identify with something that affirms your sense of self and belonging, it matters to have it corrected. In a similar way, I empathise with anyone who has been excluded and whose identity has not been acknowledged both in everyday life and mainstream discussions.
At medical school, we were taught about conditions as binary entities. There was women’s health and men’s health, but what about the millions of people whose sense of personal identity and gender didn’t correspond with their birth sex?
In most healthcare systems including the NHS, people can still only register as either male or female which excludes those who are transgender or non-binary. This can influence the subsequent care they receive because unless they inform their doctor of their sex assigned at birth or which organs they have, they could potentially miss out on vital care. Right from blood test reference ranges to screening tests and drug dosages, the parameters are set as binary, male or female.
Gender is a fundamental component to many decisions in medicine, but for an unacceptable and painfully long time healthcare systems across the world have excluded transgender people, putting them in a vulnerable position. In the UK, people are invited for their screening tests depending on the gender registered on their medical records, which leaves trans people at risk of not being invited for screenings if their records are not up to date.
I have patients who identify as males but come in for their cervical smears, coil fittings, breast examinations and one who gave birth to a beautiful baby. I also have patients who identify as women but have had testicular lumps or required prostate interventions.
When we speak about medical conditions and are raising awareness of diseases, it is important to use inclusive language so that everyone knows symptoms to look out for and when they must seek help. When I say, “women and people with a cervix,” I am not taking away the fact that cervical cancer is a serious women’s health issue, because it is.
But there are also people who have female anatomy but don’t consider themselves female – I need them to come forward for their screenings too. So increasingly you will hear doctors and healthcare workers using respectful and inclusive language to ensure everyone understands key health messages and can then relate them to their own individual situations.
There is much still to learn in modern medicine about managing patients from the LGBTQ+ community. I am learning all the time and I am delighted that we are teaching our medical students about the needs of our transgender patients too.
Using inclusive language doesn’t make me less of a woman, and it should have nothing to do with who I am or what I personally believe, because as a doctor my job is to help save lives and that includes every person I ever get the privilege to care for.