Thread 7 (accidentally ended Thread 6). 22 - 9 - 2021. SJ: now discussing Patient A going for follow up with Prof B on 3 March. Prof B says A is 'initially depressed and angry calmer now'. A did not react well to blockers. Is this a pattern of not settling on blockers.
DRW: I understand the depression and anger was to do with not progressing to testosterone rather than a poor reaction to the blocker. SJ: at the time you are making a judgement to prescribe testosterone, when did you meet A? DRW: 22 March.
SJ: documentation of consultation between DRW, A, A's mother. Some confusion that A's mother says there is already a prescription on 22 March 2016. DRW says first prescription was April 2016.
SJ: sets out history, A has lived as boy all his life, no mental health issues at all. DRW: no mental health issues that would impact the ability of the patient to manage or make a decision about this. SJ: mum considering going to Germany for private treatment.
SJ cont: there was no history of obtaining hormones illegally. DRW: Patient A had not been allowed to access Stage 2 of treatment by GIDS protocol and mother was considering alternatives such as going abroad.
SJ: the only way for Patient A to start testosterone is to seek private treatment. I will refer A counselling and wish you to prescribe the blockers and the testosterone. DRW: I don't remember if I discussed counselling with Patient A.
SJ: was there something that concerned you so you considered counselling? DRW: No, it was defensive medicine, probably to meet GP expectations. SJ: you mentioned that you respect the protocols of GIDS, do you stand by that? And if so, what protocols do you respect or not?
DRW: I was attempting to be publicly respectful to my colleagues but I think medicine should be individualised and protocols should not be rigidly applied. Also, withdrawing access to medicine if a patient goes private is against BMA guidelines.
SJ: to the GMC you have been quite strident about the impact on Patient A about the decision not to prescribe the hormones. You've been quite critical of that protocol. DRW: I need to consider this in the round. SJ: there is a response to Prof Hindmarsh. End of Thread 7.

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More from @tribunaltweets

23 Sep
Afternoon session about to start.
Simon Jackson (SJ), QC for the GMC, will continue to examine Dr. Helen Webberley's (DW) decision-making from 2016 re. Patient C, a 10 year old living as a boy. Jackson will pick up the issue of consent to medical treatment.
[Thread 3].
Opening remarks: Panel Chair says they would like to hear from Patient A and Patient A's mother tomorrow.
SJ: Dr Webberley can I take you back to Patient C, to deal with issue of consent. 9th Feb 2016. Looking at the records, around the timing of the patient's consent signature, what was the dialogue b/w you, Patient C and patient C's mother?
Read 74 tweets
23 Sep
The session is now resuming with Simon Jackson's (QC for the GMC) examination of Dr. Helen Webberley's decision-making re. Patient B who was 16 years old when first referred to Dr. Webberley, in 2016.

[Thread No. 2]
SJ: Can I take you back to p.446 on Patient B. Against background of issue of how possible changes would be managed and desirability of managing them within MDT with specialist endocrinology input...
SJ ctd: You deal with issue of commencement with analogues and then say: 'we could also swap to injections to T as well, but the one big issue is who will do the prescribing, will your GP be happy to do this?' Is this in context of increased dose?
Read 52 tweets
23 Sep
We are starting. We are continuing with Simon Jackson's examination of HW. She is being asked to speak to Professor Hindmarsh's complaint to the GMRC.
24th March 2016 is a letter from HW to Patient A's GP. But HW not sure if it's in the bundle and asking the chair. This may be returned to later.
IS (for defence) has interrupted to give important update. At 8am this morning, GMC has said it no longer wants to call Patient A or their mother - after hearing the evidence from DW yesterday. It's a surprise, says IS.
Read 78 tweets
22 Sep
Thread 9. SJ: back to Patient A. Discussion of whether counselling was required or needed. DRW: it was never my practice to say 'you must have this before that, or that before you're allowed this'.
SJ: a consent form was sent on 23 March, is this the first time they had seen the consent form? DRW: I don't remember how we did the consent. SJ: did you have a dialogue and talk through the consent form with the patient? DRW: we talked through the issues,
DRW cont: I don't remember if we got out the piece of paper and went over it line by line. SJ: should there not have been a dialogue between you, the patient and parents. DRW: the piece of paper is one part of the consent process. Consent is an
Read 16 tweets
22 Sep
Thread 8 of 22 - 9 - 2021.
SJ: now referring to series of correspondence between DRW and Dr Hindmarsh and Dr H's complaint. Quote 'furthermore I believe that a clinician was inflicting torture on Patient A by refusing to prescribe hormones for A'
SJ cont: I brought this up because you said that you respect the protocols of GIDS. DRW: I was attempting to acknowledge that other protocols and approaches can exist and can be followed. SJ: do you respect that he was following protocols.
DRW: the clinician in question wrote the protocol that he is following and I set out my feelings in detail for Prof Hindmarsh. SJ: you also said the Patient A was severely distressed. When and how was this distress presented?
Read 22 tweets
22 Sep
Thread 6: 22 - 9 - 2021. SJ: you did not indicate that periodic review, follow up and reassessment was required. DRW: that's not how I phrase it but I was continuing to give holistic care and monitoring. SJ: Dr MW says 'counselling should continue'.
Did this occur? DRW: We talked about it. I don't recall what happened but I see that we referred to Shelley. Also A was getting support from Mermaids youth groups and resources. SJ: should you not follow up on the referral?
DRW: my approach is to make services available to patient but not to mandate the counselling at any particular time but enforcing such services is not beneficial to the therapeutic relationship.
Read 8 tweets

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