[easytiger]

If you attend a gp they usually write a referral there and then or have a letter you can pick up at the end of the day/next day. In 100% of the 12 or so times I have got referrals that is what happened. Even gets printed off and a copy handed to me. If they don't there is usually a reason. I've also had GPs say I didn't need referrals (but I usually don't go expecting one). It is the GPs medical choice to not refer you if they don't see it necessary. They will usually always write the letter if you tell them you will do the desired medical pathway privately. They are more likely to gatekeep NHS resources as of course they will have to account for them. E.g. recent A&E referrals by GPS were being tracked by dinner A&E departments as lots of gps fob off patients to them.

A lot of the NHS is also just bad. Run badly and incompetent. I've had treatment follow ups go missing in the system. But, alas, I don't have a systemic discrimination pseudo complex to fall back on.

When you say refused to help them I presume you ask yourself why? And I presume your definition of the word refused is correct?

Lol. 20 years? What

[DanBC]

You're getting a lot wrong because you're focussing on regular referral from GP to secondary care, and not from GP to specialist commissioning.

> 20 years? What

This was the actual, not reported, wait list for Tavistock. The reported list was shorter because the way the NHS counts it meant that many patients were simply not counted.

[eesmith]

> If they don't there is usually a reason.

What if the reason is they think gender therapy is a "frankly self indulgent procedure"?

As you heard from the video, the first GP did not give a referral after more than seven months, and the second had to be persuaded.

And this appears to not be an isolated case.

> It is the GPs medical choice to not refer you if they don't see it necessary.

Addressed directly in the video - the NHS rules do NOT give the GP that choice:

] So when he said, "I'm sorry, I can't send you to the clinic," I pulled [the NHS rules] out, and I said, "Actually doctor, you not only can, you are required to."

A quick DDG search finds confirmation at https://www.rcgp.org.uk/policy/rcgp-policy-areas/transgender... saying (emphasis mine):

] The Royal College of GPs recognises that GPs are not experienced in treating and managing patients with gender dysphoria and trans health issues. Gender dysphoria and gender identity issues are not part of the GP curriculum or GP Specialty Training, and GPs are currently required to refer patients experiencing gender dysphoria to gender identity specialists for further assessment and treatment advice.

> And I presume your definition of the word refused is correct?

What about the video made it seem like "refused" was an incorrect term?

I guess that perhaps after waiting another 6 months the GP might have sent in the referral, so it wasn't a direct refusal. But, seriously? Is that your point?

Furthermore, she discussed how delays like this can be viewed as "Nonperformative speech", which "is how an institution can appear to be doing something about a problem whilst actually very deliberately doing nothing.". That's how it ties into the "Philosophy" part of "Philosophy Tube."

> Lol. 20 years? What

This was all addressed in the video. Quoting from it:

] Well at time of recording, the largest clinic in London has 11,407 patients on its waiting list. Last month they offered first appointments to 50. That means that if you were referred today, you will be waiting for 19 years. And that's not 19 years for healthcare, either. That's 19 years for a first appointment, .... That's actually better than it used to be. When I was referred, it was 26 years.

While I found the video very well put together, with superb references to Catch-22, you don't need to watch it to get the content. I went to https://www.downloadyoutubesubtitles.com/ , pasted in the YouTube URL, selected the British English closed captions, and used that for the above cut-and-paste.

[easytiger]

> As you heard from the video, the first GP did not give a referral after more than seven months, and the second had to be persuaded.

How do you know the referral was medically necessary? Just because someone gave in in the end doesn't mean it was a boolean decision.

Perhaps there is more to running the NHS than saying everyone who is demanding elective procedures should get them in 18 weeks. It would be lovely if it were true but i know people who, thanks to the NHS and its political football nature, have died or are dying or left to suffer for years in physical pain.

Obviously the real wider debate is why the NHS, which should be the most efficient possible organisation is in fact a horror show (if your demands are an infinitely scalable healthcare solution). When it was "founded", or rather when it appropriated the nation's existing medical infrastructure (GPs are still all private) the scope of treatment was . If you think <current year> sudden new demands such as trans services (practically unheard of 20, which were invented in the modern era thanks to innovation in medicine to allow indulgences unknown to human civilisation before the technology existed - i think resources can be better used. Private options are available as are used by others for similar things. The DDOSing on the NHS is bad enough.

Thanks for the https://www.downloadyoutubesubtitles.com/ tip. Useful.

[eesmith]

> How do you know the referral was medically necessary?

What does "medically necessary" mean to you? Does it include changing the gender identifier on your passport?

Quoting the video:

] Once you're in the medical system, you can also change the legal sex that is recorded on your birth certificate and your passport. In England, you cannot change either of those things without first obtaining a doctor's permission.

> Perhaps there is more to running the NHS than saying everyone who is demanding elective procedures should get them in 18 weeks.

Which has diddly-squat to do with the issue.

According to the NHS, gender dysphoria is a medical condition, and treatment is not viewed as an elective procedure. This has been the case since 1999, as the video points out:

] The diagnostic requirement is very baked into the NHS and British law. In 1999, there was a landmark legal case. A trust in Lancaster announced they weren't gonna fund transition anymore on the grounds that it was "merely cosmetic," and they were sued by three trans patients who said, actually, it was necessary to alleviate their gender identity disorder, as it was called at the time. The patients won, which meant that we have a right to free transition,

And according to the NHS Constitution, patients have a right to start care within 18 weeks of referral. https://www.gov.uk/government/publications/right-to-start-co... .

Not 19 years.

> have died or are dying or left to suffer for years in physical pain.

Yes, it's tragic, and shouldn't happen.

But don't let that become the excuse that others must suffer as well.

> practically unheard of 20, which were invented in the modern era thanks to innovation in medicine to allow indulgences unknown to human civilisation before the technology existed - i think resources can be better used

We know you think transgender care is "frankly self indulgent procedures", so of course you would think that.

Your viewpoint is not backed by medical evidence nor British law.

Further, as the video points out, "if a cis woman goes through menopause, she can get oestrogen from her GP. If a trans woman wants it, we have to go to the gender clinic".

Why that disparity? Estrogen for feminizing hormone therapy is about as old as the NHS itself (eg, Christine Jorgensen in the 1950s), so you can hardly claim it was 'practically unheard of 20 [years ago]'.

And hormone therapy is cheap. Assuming https://www.fiscaltiger.com/the-cost-of-gender-transition/ is right, generic estradiol costs about $4/month and the anti-androgen spironolactone costs between $4 and $12 per month. And that's retail prices the US, not wholesale prices the NHS can get.

Not everyone wants gender affirming surgery. They still need to get a referral from the GP for hormone therapy, or to change their passport gender marker, and the waiting list is years long.

[easytiger]

> And according to the NHS Constitution, patients have a right to start care within 18 weeks of referral. https://www.gov.uk/government/publications/right-to-start-co... .

They can type things like that all they like. They don't reflect reality. My cousin, in daily pain, was told he'd have to wait 5 years for a kidney op last year. This year he nearly died from a resultant infection. Why do you think repeating a meaningless target is useful? It is ignored completely. And not availing of it doesn't make you special.

> > practically unheard of 20 [years], which were invented in the modern era thanks to innovation in medicine to allow indulgences unknown to human civilisation before the technology existed - i think resources can be better used

A handful of historical examples from recent post war years is not a trend. If it were a real need of real people, rather a byproduct of something else, it might have been more of an issue over the past 20k years. But the reality is, low latency comms networks in the past 15 years are the main driver.

> Further, as the video points out, "if a cis woman goes through menopause, she can get oestrogen from her GP. If a trans woman wants it, we have to go to the gender clinic".

Because one is medically indicated to help people and the other is pretty much a recreational drug not medically indicated for that purpose.

> And hormone therapy is cheap. Assuming https://www.fiscaltiger.com/the-cost-of-gender-transition/ is right, generic estradiol costs about $4/month and the anti-androgen spironolactone costs between $4 and $12 per month. And that's retail prices the US, not wholesale prices the NHS can get.

I presume you mean by trans woman, biological male. They can't undergo the menopause. If you want it as a recreational drug, then buy it yourself. Surely there are plenty of private doctors willing to write any script if the medical need is thusly so obvious?

[eesmith]

> My cousin, in daily pain, was told he'd have to wait 5 years for a kidney op last year.

Was your cousin waiting for an organ transplant? That was one of the explicit exceptions on the list.

https://www.gov.uk/government/publications/right-to-start-co...

] There is often a period of time between the need for a transplant being identified, and a suitable organ for transplantation becoming available. Therefore, where first definitive treatment requires the patient to be added to a transplant list, then the patient’s clock should stop on the date that they are added to the list, and when this is communicated to the patient. Where a donor has already been identified (for example, a family member), then first definitive treatment would usually be the start of treatment itself.

Don't let the suffering of your cousin become the excuse for why others must suffer as well.

> over the past 20k years

At https://en.wikipedia.org/wiki/Third_gender points out, non-binary gender has been around for at least 4 thousand years, and across many cultures, including "Some traditional Diné Native Americans of the Southwestern US acknowledge a spectrum of four genders: feminine woman, masculine woman, feminine man, and masculine man."

Just because you don't know about it doesn't make it not true.

Do you also believe, like President Mahmoud Ahmadinejad, that there are no homosexuals in Iran?

That seems an equally willful ignorance of human nature.

> the other is pretty much a recreational drug not medically indicated for that purpose.

Not according to your own NHS and court decision.

Just because you believe it, doesn't make it true.

And read the transcript, or watch the video, because it responds to just about every point you've made, and in more detail than I care to copy&paste.

[easytiger]

No. It was obviously not a transplant.

Yes I'm familiar with modern sociology and anthropology and their attempts to reinterpret via cloudy misinterpretation of certain non Western European (thus necessarily unfamiliar) cultural artifacts to retrofit them into a pseudo history to reinforce 21st century created paradigms of gender.