Beyond binaries: Transforming patient care through inclusion and workforce diversity

The Office for National Statistics (ONS) estimates that there is between 200,000 and half a million trans-identified and/or non-binary people over the age of 16 in the UK.  While the National Centre for Social Research data from 2023 shows Britain is generally becoming more liberal, prejudice towards transgender issues has actually increased. In 2023, only 64 per cent of the population – as opposed to 82 per cent in 2019 – said they had no prejudice towards trans issues.

The data suggests that there’s more of a need now than ever for cis-gendered (people who identify with the gender they were assigned at birth) health professionals to step up and be an ally. The chances are a good number of trans or non-binary people are, or will be, your patients or colleagues. 

This need is why the CSP professional committee set up a working group to develop guidance to help members improve the health of communities, and specifically people who are transgender, through high-quality physiotherapy.

And it’s why I’m speaking to Shannon Pinnington (they/he) during LGBT+ History Month, to discuss them being a member of that working group, about the new guidance, and their own experience as a transmasculine non-binary physiotherapist. 

Shannon’s path to physiotherapy

Shannon came out as gender-fluid during the Covid-19 pandemic, while they were a student at University of Salford. They now identify as transmasculine - an umbrella term for people who identify with masculinity and were assigned female at birth – and non-binary.

I’ve had previous colleagues asking really intense, inappropriate, and intrusive questions at work. It’s manifested as trauma for me.

Having always been interested in the human body, they saw physiotherapy as the perfect career combining their love of the human body with the opportunity to care for people and improve people’s lives. It may have taken a second degree to get here (their first degree was biomedical sciences from the University of Edinburgh), but Shannon is glad they did as they now work in a job they love for a trust they had great experiences with on placement.

Once qualified, Shannon looked for opportunities within the profession to connect with others and found the CSP LGBTQIA+ network. With the encouragement of colleagues such as Steph Land Shannon quite quickly became involved in advocating for queer people within healthcare, both patients and colleagues. 

The need for guidance

That passion led to Shannon being part of the group that developed the much-needed CSP guidance. The group included members of the CSP professional committee, the LGTBQIA+ network and the Pelvic Obstetric and Gynaecological Physiotherapy network, supported by CSP staff.

And patient voice was also important. The guidance draws on the experiences of patients from the working group’s focus group and offers those who are cis-gendered an insight into the lived experience of trans people, as well as providing advice on a range of practical topics such as how to make physiotherapeutic consultations and treatment inclusive. It even has some great explanations covering things such as being curious/educating yourself, using pronouns correctly and HCPC expectations of all regulated healthcare practitioners. 

If you haven’t read the guidance yet, Shannon encourages you to do so. They said: ‘It can be hard being trans. Making the effort to be inclusive is really important. Health inequalities are still so extensive, and trans people do experience them. So by putting the guidance into practice, even just starting with displaying your own pronouns, you can make things a little bit easier for them. 

‘Just show them that if they do need to access healthcare, that they’re going to be seen and understood a little bit more, and that you’re a safe space for them. It can make such a huge difference to a life.’

It’s not just Shannon who believes this. In the guidance itself, you’ll see this sentiment is shared by the patients who contributed to it. They share that when accessing healthcare, they’re expecting the worst, whether that’s intrusive questions or having to educate the clinician about being trans, rather than focusing on the injury or condition they need help with. You’ll find the link to the guidance and the CSP position statement on transphobia, in the box below. 

More change is needed

As a transmasculine non-binary person, Shannon has some sympathy for the issue transgender patients raised about having to be the person who educates others. And while the guidance was aimed at supporting transgender patients, some of the advice is equally applicable to working with transgender colleagues. So, by making healthcare more inclusive for patients you’ll be creating a more inclusive workplace for your colleagues too. 

And HCPC expectations are clear – it isn’t the responsibility of the patient to educate clinicians. And while many queer colleagues are happy to share their lived experience, they shouldn’t be the source of other’s learning.

Shannon says that they have been sharing their lived experience and involving himself in trans activism to improve experiences for other trans people, and also so that they can share on their own terms.

‘I’ve had previous colleagues asking really intense, inappropriate, and intrusive questions at work. It’s manifested as trauma for me,’ he says.

He continues that while conversing about queerness should not be avoided, people should be educating themselves, and Shannon adds he is happy to signpost to resources, including the CSP’s trans guidance and public sources of lived experience, which are common on social media.

But our society is moving forward. Shannon shares that they work with great colleagues who correct any mistakes they have made in the moment. They note how brilliant it is to work with colleagues who realise and apologise if they have unintentionally misgendered them. That openness and willingness to say I’m sorry means Shannon is much more relaxed because he isn’t constantly thinking ‘I’ve got talk to them later about misgendering me because that is such a stressful conversation to have!’

And, as Shannon notes, any one individual can only ever really speak about their own experience. As a transmasculine non-binary person, Shannon feels they have as much insight into the experiences of trans women as a cis-gendered person does. Which is why work conversations should be about patient care or their interests like discovering that Shannon is creative, enjoys spending time with their family and friends, likes going to the gym, loves guinea pigs, and fostered dogs over the Christmas period. Because our interests are the things that connect us. 

Learning about everything else can be saved for an internet search, social media scrolling or reading the CSP guidance on working with transgender people in physiotherapy practice.