Gender again. Sorry!

[icowden]

They have reclassified it into the same chapter ... that doesn't conflate the two issues as being as one.

The chapter is the medical subset. Gender incongruence is a subset of Sexual Conditions.

Here is the tree for SNOMED CT:

• CLinical finding
  • Disease (disorder)
    • Mental disorder (disorder)
      • Identity disorder (disorder)
        • Gender identity disorder (disorder)
          • Gender dysphoria (disorder)

In SNOMED Gender Identity disorder is still a branch of Mental disorders. SNOMED is widely being adopted to replace ICD10 rather than moving to ICD11. ICD10 and 11 may still be used but are diagnosis coding sets rather than medical coding sets.

The critical thing with SNOMED is that you report at key branches. Any researcher looking at mental disorders for example will automatically include everything under that branch, including Gender dysphoria.

 

[monkers]

Yes. My thinking is that I am not sure how much better it sounds to have a diagnosed sexual condition over a diagnosed mental health condition. Both of these things would seem to contradict the notion that somehow transgender is innate.

Your employer says that gender identity is innate.

Gender identity is a way to describe a person’s innate sense of their own gender, whether male, female, or non-binary, which may not correspond to the sex registered at birth. Gender identity should not be confused with registered sex at birth, or with sexuality or who someone is attracted to.

Guidance on the differences between sex and gender have been published by the World Health Organisation and the Office of National Statistics:

• Definition of Gender - WHO

https://digital.nhs.uk/data-and-inf...s-and-other-vulnerable-groups/gender-identity

The problem for your employer is that on the one hand it has obligations to the WHO and on the other to the UK government, meaning that it is an onerous position. To follow international standards of care it observes the WHO, while at the same time is obliged to follow UK law.

This is why trans people say the Gender Reform Act requires change, because the hands of the NHS are tied to a UK law that is in contradiction of what they consider best practice.

Gender Identity Code (new code for MHSDS v5.0 and IAPT Data Set v2.1)​

This is now the priority data item on gender identity. This data item captures how patients tell providers how they would like their gender recorded by the service. Providers should collect/verify this information from/with patients and not extracted or assumed from NHS Spine data.

Gender Identity Same at Birth Indicator (new code for MHSDS v5.0 and IAPT Data Set v2.1)​

This is also now a priority data item to provide a complete understanding of the patient’s gender. Providers should proactively ask for this information as part of the demographic information discussed with and requested from patients. This should be done by asking the patient the question, not by making assumptions from other data provided.

Person Stated Gender Code (existing code)​

This is no longer a priority data item. It records the gender information that the GP holds from the NHS Spine and providers do not need to request this data from patients. If no GP data is available to complete this, it can be left blank on provider systems. This data item is now low priority to complete as it does not reflect best practice in recording gender identity. It has been retained as it matches the gender data item in the NHS Spine and so retaining it avoids any potential issues with data linkage and matching.

The NHS no longer collects data from GPs as a data priority item; instead it takes data from how patients Self-ID.

 

[Rusty Nails]

 

[icowden]

Your employer says that gender identity is innate.

I am not employed by the NHS. I sometimes do contractual work for them (and sometimes for private providers). They actually say that gender identity is a way to describe a person's innate sense of their own gender. That isn't *quite* the same thing as gender being innate.

The problem for your employer is that on the one hand it has obligations to the WHO and on the other to the UK government, meaning that it is an onerous position. To follow international standards of care it observes the WHO, while at the same time is obliged to follow UK law.

And it doesn't help that both the UK Gov and the WHO use two coding systems that now contradict each other (and both have to be recorded in a sense). To explain this more fully:-

Your doctor has access to a medical EPR which miraculously has ICD-11 on it. They record a diagnosis of Gender Incongruence which would be considered a Sexual Health Condition under ICD-11. The system automatically crossmaps ICD10 and 11 codes to SNOMED CT or offers a browser for the clinician to confirm the SNOMED coding for that condition. The only possible code within SNOMED CT falls under mental health. When the DOH analyse the datasets that they have been sent they will be treating Gender incongruence as a mental health condition.

The NHS no longer collects data from GPs as a data priority item; instead it takes data from how patients Self-ID.

Spoiler - it doesn't. Firstly GP Data comes under the commissioning dataset. The quote you were looking at refers to the Mental Health dataset and the Improving Access to Psychological Therapies Dataset, and so is about recording gender as part of Mental Health care.

But - lets have a look at the Commissioning Dataset TOS (tech spec). Patient characteristics captures person stated gender code. This is now backed up with a second code for "gender identity same at birth indicator".

It doesn't help that the NHS Data Dictionary does not yet contain Gender Identity Code - which just illustrates how disjointed these information resources are. But remember that this code is only for mental health and IAPT. Not commissioning. Also for current submissions the correct code is person stated gender - gender identity code and the indicator are currently experimental data items.

 

[monkers]

They actually say that gender identity is a way to describe a person's innate sense of their own gender.

If it isn't quite the same, kindly explain the differences.

 

[monkers]

The only possible code within SNOMED CT falls under mental health. When the DOH analyse the datasets that they have been sent they will be treating Gender incongruence as a mental health condition.

Yes, but isn't this because SNOMED CT that you work with is the version that is specific to England, presumably to take account of the vagaries of outdated English law.

If you have access to SNOMED for other countries that have passed Self-ID into law, perhaps you'll check to see the differences.

 

[icowden]

Yes, but isn't this because SNOMED CT that you work with is the version that is specific to England, presumably to take account of the vagaries of outdated English law.

No SNOMED CT is a universal coding system. Although we use an English version, this is just a version of SNOMED with UK Extensions (additional UK specific coding, spellings, assessment scales and screening procedures) . If you look in the SNOMED international edition you will find the same codes and descriptions. The local extensions for different countries will have translated versions of the same coding.

 

[icowden]

If it isn't quite the same, kindly explain the differences.

Simple "Gender is innate" suggests a factual, provable statement that can be backed up by science. It suggests that this is something you are born with.

"describing a persons innate sense of their own gender" suggests that we are looking at an opinion or feeling that someone has. And as we are measuring a person's own self assessment of their feelings, that this is not something fixed.

Although to be fair, the philosophical definition of innate is that something originates in the mind.

 

[monkers]

Simple "Gender is innate" suggests a factual, provable statement that can be backed up by science. It suggests that this is something you are born with.

"describing a persons innate sense of their own gender" suggests that we are looking at an opinion or feeling that someone has. And as we are measuring a person's own self assessment of their feelings, that this is not something fixed.

Although to be fair, the philosophical definition of innate is that something originates in the mind.

Gender identity is innate. 'Gender' is usually said to be a social construct, hence it changes over time and varies between cultures.

Rather than reducing gender identity to a feeling, if you consider it self-knowledge like sexual orientation, then you'll be that much closer to understanding.

 

[monkers]

No SNOMED CT is a universal coding system. Although we use an English version, this is just a version of SNOMED with UK Extensions (additional UK specific coding, spellings, assessment scales and screening procedures) . If you look in the SNOMED international edition you will find the same codes and descriptions. The local extensions for different countries will have translated versions of the same coding.

Those of us who are not SNOMED developers will not have the same access to the literature.

 

[monkers]

No SNOMED CT is a universal coding system. Although we use an English version, this is just a version of SNOMED with UK Extensions (additional UK specific coding, spellings, assessment scales and screening procedures) . If you look in the SNOMED international edition you will find the same codes and descriptions. The local extensions for different countries will have translated versions of the same coding.

I've looked into this, and what you say does look correct.

This means that SNOMED is not fit for purpose if it continues to be out of kilter with the WHO.

Somebody needs to raise this with them.

 

[AuroraSaab]

Gender identity is innate. 'Gender' is usually said to be a social construct, hence it changes over time and varies between cultures.

There's no proof gender identity even exists, nevermind that it's innate. The whole idea of 'gender identity' rests on Man-made stereotypes of male and female behaviour, dress, roles etc. Without those stereotypes there's nothing to transition to.

If two babies, one male one female, were shipwrecked on an island and miraculously lived until adulthood, how would they know their 'innate' gender identity? Without stereotypes of male and female dress and behaviour around them to refer to what would be their frame of reference for having say a 'male' gender identity? Their sex would be male and female and they would likely know their sexuality, but how can gender identity be innate when it can't exist without reference to already the long established regressive stereotypes of what 'man' and 'woman' means?

There's no evidence, as far as I know, that elderly gay people with dementia forget they are gay. There does seem to be some evidence that elderly transgender people forget they have transitioned. Why would that happen if gender identity is innate?

https://www.google.com/amp/s/www.bbc.com/news/uk-wales-43365446.amp

 

[Bromptonaut]

If two babies, one male one female, were shipwrecked on an island and miraculously lived until adulthood, how would they know their 'innate' gender identity? Without stereotypes of male and female dress and behaviour around them to refer to what would be their frame of reference for having say a 'male' gender identity? Their sex would be male and female and they would likely know their sexuality, but how can gender identity be innate when it can't exist without reference to already the long established regressive stereotypes of what 'man' and 'woman' means?

Interesting scenario and one partially explored, albeit with kids who'd already got gender identity, in the film The Blue Lagoon.

But what you pose has no contact with the real world where kids have gender models from day one. A youngster at 4 or 14 with knowledge of what society spells out as/for gender id means can they ID a mismatch between what they feel and what's expected.

 

[multitool]

If two babies, one male one female, were shipwrecked on an island and miraculously lived until adulthood, how would they know their 'innate' gender identity? Without stereotypes of male and female dress and behaviour around them to refer to what would be their frame of reference for having say a 'male' gender identity? Their sex would be male and female and they would likely know their sexuality, but how can gender identity be innate when it can't exist without reference to already the long established regressive stereotypes of what 'man' and 'woman' means?

They wouldn't know their biological sex either

 

[icowden]

Those of us who are not SNOMED developers will not have the same access to the literature.

Actually most of it is freely accessible.