Ashleigh explains "Trans Broken Arm Syndrome", otherwise known as "Diagnostic Overshadowing".

I recently found out the name for something I’ve seen a lot. We have a name for it, which is ‘Trans Broken Arm Syndrome’. Many trans people have experienced this when accessing healthcare, and it’s when medical staff assume that an ailment –any ailment- is being caused by the person being trans, up to and including broken bones because “well you take hormones and maybe that’s having an impact we don’t know about…” or something equally groundless. This is what we call trans broken arm syndrome, but the actual name for it is ‘diagnostic overshadowing’.

It obviously applies in other situations too, where a problem is misdiagnosed or missed completely because medical staff have all their attention focused on something else. On a day-to-day basis in trans healthcare this is often manifested by entirely unnecessary gender-related questions during appointments for other issues. But it was only recently I came across this more widely accepted term.

I think many of us have encountered this in some form or another. A nurse who performed my injections would ask me all of what we might think of as The Usual Questions. How old were you when you knew? Did you say anything? What did your family say when you did? Which do you do, synths or coding? All the trans stuff. After several appointments I eventually had to say “Look, I understand you’re curious but this isn’t strictly relevant here and you really have no idea how often I’ve told this story.”

And I do understand the curiousness and the human impulse to ask questions, to find out. I get that. But, I would very much like for people to have a care as to how and when they might ask those questions, if at all. Particularly in a healthcare scenario. At best, asking needless personal questions and focusing on a person's trans status is simply unprofessional and a waste of time. At worst, it could cost lives as appropriate treatment is delayed or denied entirely.

But, the LGBT community in general and indeed the LGBT Foundation in particular have been able to counter some of this poor practice in recent years. The occasion at which I learned the phrase ‘diagnostic overshadowing’ was during a meeting with staff of the General Medical Council, who used it to describe what we call trans broken arm syndrome. I have to say I was impressed. The GMC are aware of it and are taking it seriously, so I hope this translates into real action in terms of the information given to medical staff on taking care of trans patients.