Russell Reid and the Standards of Care – Surgical regret – changing back to previous gender
Main Article By David Batty
Tuesday January 20, 2004
[Abstract] Full Text [PDF]
Russell Reid is well known for promoting transgender surgery and treatment. Often seen on Kilroy and other uk discussion shows, he is never one to shy away from the media. He no doubt also attracts additional ‘custom’ to his private practice as a result.
Nevertheless, no doctor can be certain 100% that their recommendations will result in a successful outcome. All they are able to do is follow the guidelines and assess individuals to the best of their ability.
We have a comment at the bottom of this article by David Batty and we have a link to our newsletter archive. There you will find the story of another Russell Reid Patient who felt that his recommendations were insufficient we also comment on this too.
A Real™ media clip of Dr Reid defending his actions with a past client who expressed surgical regreat.
Movie View Movie 723 kb (to view download Real Alternative Video Player Free).
The UK’s best known expert in transsexualism is being investigated by the General Medical Council after claims he repeatedly put his patients’ health at risk, the Guardian has learned.
Consultant psychiatrist Russell Reid, a specialist in gender identity disorders (GID), allegedly breached standards of care by prescribing patients with sex-changing hormones and referring them for genital surgery without adequately assessing them.
Twelve cases in which Dr Reid, a member of the Royal College of Psychiatrist’s committee on gender identity disorder, allegedly broke the guidelines “to the detriment of the patients concerned” have been submitted to the GMC. It is alleged some people later regretted changing sex.
The complaint was filed by three of the UK’s most senior psychiatrists in GID, who work at the Charing Cross hospital’s gender identity clinic in west London: Donald Montgomery, James Barrett, and Richard Green, another member of the college’s committee.
Together with Stuart Lorimer, a senior registrar at the clinic, they allege Dr Reid has repeatedly breached guidelines set by the Harry Benjamin International Gender Dysphoria Association, based in Minneapolis.
The guidelines lay down “flexible directions” for the treatment of people with GID, which are not legally binding and may be modified to suit individual patients. The standards are “generally supported” by the college, though it does not formally recognise them.
The psychiatrists claim Dr Reid has not adhered to the guidelines’ minimum eligibility requirements for the prescription of hormones and referrals for genital surgery.
The guidance states patients should have been living in their desired gender role for at least three months before prescribed hormones, or had at least three months of psychotherapy.
Patients should also undergo a minimum of 12 months hormone therapy and live in their desired gender role for the same period before referral for gender change surgery.
Dr Barratt said: “I felt that Dr Reid seemed more often than not to prescribe hormones to patients in a manner contrary to published guidelines.
“He seemed too rapidly to refer patients for gender reassignment surgery, sometimes seemingly without the appropriate second opinions which would be required by the guidelines.
“Some of the patients would seem to have been inappropriately referred, and some to have later been unhappy with what had happened.”
But some of Dr Reid’s patients have defended him. Daphne Neal, an NHS nurse treated by him, said he had prescribed her with hormones earlier than the guidelines advise, but stressed she believed this was the best course of action.
She said: “It is fair to say Dr Reid prescribed me hormones earlier than the Harry Benjamin guidelines recommend, I was in fact prescribed hormones on my first visit.
“I felt that this was appropriate in my case. If I had not been prescribed hormones at that time I may have been forced to look for other sources, something I don’t really agree with, as the consequences can be dire.”
The guidelines state that it can be acceptable to provide drugs to patients earlier “as an alternative to black market or unsupervised hormone use”.
A GMC spokeswoman confirmed Dr Reid is under investigation.
He is due to appear today before the GMC’s interim orders committee, which could suspend him or restrict the work he can perform. These hearings are held when the council wishes to consider whether patients, the public or the doctor under investigation would be put at risk if they continue practising prior to a full investigation.
Regardless of the hearing’s outcome, Dr Reid will then appear before the preliminary practice committee on January 26-27. This will decide whether there should be a full inquiry by the professional conduct committee, which has the power to strike a doctor off the medical register.
There is disagreement among psychiatrists and the transsexual community over the period patients should spend living as their desired sex prior to treatment.
But Brian Ferguson, another member of the royal college committee, said in his view hormones should only be administered to a patient after “at least two or three” appointments.
Dr Ferguson, a consultant psychiatrist at the Nottingham Gender Clinic, said many psychiatrists would consider it “reasonable” for patients to live in their desired gender role for two years before surgery. He said he had seen a number of people who changed their minds quite late in this period.
News of the investigation has been greeted with dismay by many in the 5,000-strong transsexual community. Several support groups have launched a website backing Dr Reid.
Some fear the GMC inquiry could bolster opposition to the gender recognition bill, which is currently before parliament. The bill would allow transsexuals to gain the rights of their acquired gender. But it has been opposed in the Lords.
A spokeswoman for the Medical Defence Union, which is representing Dr Reid, said he did not wish to comment on the investigation at this stage.
Transgender Zone Comments
Sour Grapes? Reid is against the HB MAFIA!
OK! So lets take this all down to basics. The most simple way of looking at this complaint – is he is too quick? Ok he takes YEAR or say 3 months or even prescribes HRT immediately…
But there is one or two problems with these arguments…
First any GP with a prescription pad can prescribe – you can buy Prescription HRT online easily and cheaply without a prescription (or ‘script’ as the yanks call it).
Second a G.P has removed a certain amount of the uncertainty already by making the referral in the First Place!!!
OK lets look at the speed of referral for surgery:
A ‘nose-job’ (rhinoplasty) is serious, in fact any surgery is serious! People have died from complications of having teeth pulled – oxygen tubes have been known to block and cause brain damage etc… Where are the Psychiatric opinions here? After all god gave you that nose so get on with it! Or like the NHS ‘Real Life Test’ of 2 years for Transgender People they could be asked to wear a false nose for 2 years then if you still want surgery after 2 years they will refer you! If that were said about any other procedure the Dr would be laughed out of the doors of the hospital! – Yes the RLT is as absurd as that!!!
The argument that is often put forward is people need time to inform family and employers – this information can be offered by almost any half decent counsellor or website for transgender people in the UK. If they are not ready for surgery then they can create their own RLT, therefore empowering the patient to take responsibility for their own actions, rather than the litigious risks that surround psychiatric care.
The majority of transgender people do not approach psychiatric care – Eddie Izzard. It is only when surgery is mentioned do the psychiatrists have a monopoly yet they do not perform the surgery. So what their role actually is in the whole process is open to question!
Some people regret it – some people regret a rubbish nose-job too! – that’s the risk you take!!!
We have argued this point again and again!
We know the average time spent with a Psychiatrist at Charing Cross Hospital – with those very same doctors making that complaint is:
Under one Hour!
ok you get an appointment every 3 months that’s 4 hours a year!
times that by 2 and the result is they have known you for less than a working day and they are referring you for surgery!
If you take into account the fact that they probably forgot exactly what happened 3 months ago and any repetition, waffling and small talk for example – the actual counselling = 30mins if you are lucky! Probably more like 15 mins!!!
We are now down to under 4 hours!!! Now I don’t know about you but I am guessing that Russell Reid is not far off that either – as he offers mostly private care – chances are he takes longer with his clients!
If anything this case demonstrates one other thing.
If Standards of care are set in stone and it is no longer necessary to think for yourself as a ‘professional’ then the label of ‘professional expert’ is no longer required. Now this check-box routinised care has become commonplace surely a counsellor or practice Nurse could undertake this and make recommendations to G.Ps re: prescription HRT.
Maybe this also demonstrates something else – that Psychiatrists are no longer needed and that a G.P. should now refer direct to the surgeon – the RLT (Real Life Test) has now simply become a glorified waiting list that gets in the way of living a life!
Transgender people are fond of Doctors like Russell Reid simply because he gets on with the job!!!
Transgender Zone Team