General Practitioners Who Exhibit Resistance to Sex Gender and Sexuality Variance

Tracie O' Keefe, BA


Issue 2
May 1998

In the normal course of events in medicine of any kind the doctor listens carefully to their patients, takes the information that the patient is giving, and adds to it the doctor's estimation of events. This gives rise to the classic phrase of in IN MY PROFESSIONAL OPINION.

Normally, a well-trained and empathetic practitioner would then check back with the patient to see if the patient is happy with the diagnosis. If the patient is not, then there is a need for the practitioner to re-examine the facts. In the case of someone who may be considered to be not in full possession of their faculties or in good mental health there is a need for the doctor to guide the patient towards the correct course of treatment.

For the most part, a doctor who has little or no experience in dealing with people who have sex dysmorphobia (an unhappiness with the physical sexual constituents of the body), gender issues or varying sexualities, needs to be guided by expert opinion. Here the patient should have the right to choose the qualified experts that carry out the kind of examinations or assessments that may be needed to support a diagnosis.

However, we need to consider that clinicians of any sort come from profuse kinds of backgrounds. Some may have religious convictions, be members of cults, or have certain narrow-minded social constructs. In other words, proportionally, there are just as many rednecks in medicine, psychiatry, psychology and psychotherapy as there are anywhere else.

At medical school, on psychology courses, and during training as therapists, the training in the sexualities and sex and gender variance is nothing less than abysmal. Medical students get 20 minutes on sex and gender dysphoria, psychologists try not to go with any opinion that might be considered unsupported by a cacophony of empirical studies, and therapists often wear the hat that is applicable only for their school of therapy.

When it comes to considering the medical and psychological needs of those who are sex, gender, or sexuality variant, there is no absolute truth to be found in any book, since each person's experience is genuine. Every patient must be treated as an individual and the old medical maxim of listening to the patient to get the correct diagnosis must apply.

A good clinician will be open to suggestion and will listen to other practitioners who are experienced in the field in which the patient's condition falls. Just occasionally there will pop up a doctor who, because of their own beliefs and personal convictions, will dispute the diagnoses or advice of specialists. This does not stop with one specialist - they will also disagree with several specialists who do not come up with the same opinions as the doctor thinks they ought to have.

These doctors not only do not have training in sexuality, sex and gender issues, but are driven by a compulsion to push their patients into convenient boxes that will suit their idealism. Furthermore they may purposefully be trying to deprive their patient of the kind of treatment they so desperately need by suggesting that hip replacements or heart surgery are more important than counselling, therapy, surgery or hormone treatment. Such moves by doctors are an abuse of the doctor-patient relationship, but they get away with it because they have the privilege of having MD after their names.

I wish I could say that the opinions of these particular general practitioners of medicine come about solely through ignorance, and that further training would help them to understand the issues better, but that would not be correct. For some practitioners of medicine further training will not change their minds because the divisions are based on their own prejudices.

However, it would be unfair to cite only general practitioners of medicine as being guilty of this abuse of process between the doctor and patient. Psychologists, psychiatrists, therapists and social workers do, at times, exhibit the same behaviour, but my contention here is that the general practitioner of medicine is the primary source carer of a patient's physical and mental health and therefore this could be considered as the greatest betrayal.

My experience at the end of the 20th century is now that these kinds of doctors are rarer than they were some years ago; those who think homosexuality is an abomination, anything other than the missionary position is a slight against God, and that gender or sex variance is either a physical deformity or a mental illness. However, they are out there and patients are putting their trust in them, only to be abused and denigrated for asking them for help with their problems.

After due consideration, my best advice to patients and specialists is to avoid these kinds of doctors like the plague. It is not always immediately obvious that such doctors are hostile to their patients' causes because they can employ many different delaying tactics for treatment or put obstacles in the patients' way. Eventually though, when such prejudices do come to light, the doctor needs to be confronted and, if they do not adjust their situation, then another doctor needs to be sought. I would like to ask the reader to try and educate such clinicians but I think that would be bad advice. If a doctor has a patient with a condition that they do not understand then it is up to the doctor to seek to educate themselves; that is part of their job and they have a duty to do that. If this is not happening, no amount of pressure from external sources can force a doctor to conform.

All good clinicians are constantly seeking ways to increase their knowledge, retrain, research and most of all undergo peer supervision. Peer supervision can also mean pairing up with clinicians who have the same ideas as oneself, which, of course, would perpetuate more prejudice of the same kind.

Dr Tracie O'Keefe DCH is a clinical hypnotherapist, psychotherapist, and counsellor formerly practising at The London Medical Centre, Harley Street in the UK. Now the Director of the Sex, Gender, and Sexuality Identity Clinic, at The O'Keefe Institute, Sydney, Australia.
In asociation with Katrina Fox, she is the author of a number of books, details of which may be found on her website:
Their latest publication is Finding the Real Me: True Tales of Sex & Gender Diversity, published by Jossey Bass Wiley
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