The RACGP has recently updated its standards to recommend that GPs separate the collection of sex and gender information, with hopes that it will not only help practices be more inclusive but also radically improve the available data on sex- and gender-diverse Australians.
This may go some way to make up for a missed opportunity to collect LGBTI+ data: this year’s census contained nothing on sex- and gender diversity, despite a campaign and high-level support for including such questions.
And don’t worry – many clinical information system vendors are already working toward a solution for recording the additional sex and gender variables.
What has changed
The RACGP recently released the Standards for General Practice (5th edition) and it introduces new methods of collecting and recording information about patient sex, gender, variations of sex characteristics and sexual orientation.
In this context, “gender” refers to the social and cultural differences in identity, expression and experience as a man, woman or non-binary person.
Sex refers to a person’s sex characteristics at that moment in time.
In a nutshell, doctors are asked to demonstrate that patients’ assigned sex at birth, current gender identity and intersex status are recorded separately in clinical software.
Additional new recommendations are to hold clinic meetings to “discuss and identify” the unique needs of lesbian, gay, bisexual, transgender and intersex patients (LGBTI+) patients, or to display a pride flag.
These primarily relate to core standards two and seven, which cover culturally appropriate, respectful care and the content of patient health records respectively.
“For instance, at Criterion QI2.1 – Health Summaries, the Standards currently require practices to collect, where relevant, the details for a patient’s current health summary, such as adverse drug reactions, current medicines list, health history, and so on,” Dr Tim Senior, a member of the RACGP Expert Committee on Standards for General Practices, told The Medical Republic.
“We’ve added a new, unflagged Indicator, QI2.1C, which encourages practices to also keep record of each patient’s assigned sex at birth and gender identity.
As new additions to the Standards, all the added detail on sex and gender are suggestions of practices which clinics “could”introduce but are not essential for accreditation.
“This is not a new mandatory requirement for practices, but we hope it reinforces the consideration of collecting and recording this information and flags to the clinical information system vendors that their products need to include functionality that lets practices accurately record the details they need,” Dr Senior said.
Why it changed
On a granular level, the college hopes to create a more inclusive environment.
“The most basic reason why GPs and patients should care about this, is that it allows people who have often experienced discrimination to feel comfortable and seen in the practice,” Dr Senior said.
“This allows people to feel safe in disclosing potentially uncomfortable information, without feeling that they will be judged or discriminated against.”
Taking a wider lens, though, these changes bring RACGP standards up to date with the Australian Bureau of Statistics’ gender, sex and sexual orientation standard.
The ABS recommendation itself only came about recently; this story actually starts with this year’s census.
Despite a campaign backed by numerous health, disability and LGBTI+ advocacy groups which called for “appropriate and meaningful” data collection on sexual orientation, gender identity and intersex status, the 2021 census did not measure this variable in the Australian population.
Collecting this data, they argued, would be “crucial” for designing and implementing evidence-informed health interventions in the queer community.
Documents released under Freedom of Information laws reveal that Health Minister Greg Hunt and the Department of Health had explicitly expressed support for additional census questions measuring LGBTI+ Australians.
The group that largely drove the census campaign, LGBTIQ+ Health Australia (previously the National LGBTI Health Alliance), redirected its efforts once census questions were finalised.
“Through some of the conversations that we were having with the ABS around the questions that would go into the consideration for inclusion in the census, we started to have conversations about how else – if we weren’t in the census – how else we would be able to gather data about ourselves,” LGBTIQ+ Health Australia CEO Nicky Bath told TMR.
It was here that Ms Bath and her colleagues seized on an opportunity: the ABS standard for sex and gender variables was up for five-yearly review.
At that time, the ABS standard for sex and gender – which dictates how those questions are asked on all ABS surveys – only had two variables (sex and gender) and three input options (male, female and other).
With the census already “been and gone”, Ms Bath instead advocated for a complete overhaul of the ABS standard.
The updated 2021 standard now includes additional variables measuring variations of sex characteristics and sexual orientation, as well as more input options for some questions.
For instance, the 2021 variable for gender has the input options of man/male, woman/female, non-binary, different/other term and an option not to answer.
“[My thinking was that] if we can get a new standard embedded as soon as possible, we’ll start capturing data that we don’t currently have today, and we’ll start doing that before 2026, when the census is,” she said.
“The more that this standard is embedded into day-to-day systems, the less people will be bothered by being asked those questions in the census.”
Why did the ABS change the standard?
This was not the first time that the team behind the ABS sex and gender standard had considered updating the questions and measures they used.
“People weren’t happy with [the previous] options,” ABS gender statistics team acting assistant director Cate Cocks said.
“Having other as the third category [for sex and gender] made it seem othering for people who didn’t choose male or female.”
Formulating the new variables, the team worked with a reference group of LGBTI+ people, state and territory governments, academics, non-government organisations and national statistical organisations in other countries.
By standardising the way sex, gender and sexuality are recorded, data on these populations not only becomes clearer, but people within those communities are put more at ease.
“It’s easier for people to respond in a way they are comfortable with,” Ms Cocks said.
Gender statistics team director Dr Helen Rogers, who previously worked on a longitudinal study of Australian children, echoed her colleague’s words.
“I guess it’s nice for anybody – having had responses from these children that we followed over a long time – to see themselves in a survey,” she told TMR.
“If there is just a sex question and it says male and female, and we ask that a birth and never ask it later, people feel that they’re not in this, they’re not part of the survey or they’re not part of what’s been asked because they can’t see themselves in there.”