Thread by @tribunaltweets

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

DRW cont: ongoing process. SJ: where there are a number of risks, surely there should be more documentation of the discussion of those risks. DRW: if you wish we could talk through those risks.

SJ: are the risks and considerations of Stage 2 much more important than the blocking. DRW: it is actually a lower risk treatment than the puberty blocker and in gender affirming hormones we give a natural occurring hormone that half of the population produces naturally.

SJ: what about haemoglobin? DRW: testosterone makes the red blood cells of the patient look like male red blood cells. It's not abnormal.

SJ: back to the consent. It refers to counselling and that's its required. DRW: I don't know when I wrote this consent form but I don't think I believe in requiring counselling for my patients.

SJ: back to the chronology. There was a breakdown in communication between the family of Patient A and the clinic. DRW: I feel terrible that this patient was let down by my assistant and that this fell between the cracks. There were some bulk emails.

DRW cont: Email said 'I'm writing a book to help the treatment of young transgender people and gave a separate email address'. Did the provision of this email address cause the breakdown. SJ: the result of the communication breakdown

SJ cont: was that they did not attend GIDS and GIDS was trying to pry information out of the family. DRW: Then Patient A returned to DRW and there was a consultation with a deeply distressed patient.

SJ: quotes email from DRW to mother of A. 'The Tavi doesn't own you'. 'I have no doubt that the prescription of T was appropriate and I know you believe this as well.

SJ: is there any assessment of the capacity of consent other than the documentation of the consent process? DRW: the assessment of capacity is a multi-factoral process that began with emails from mum and a poem from Patient A.

SJ: with a patient who is presenting with distress doesn't the capacity decision need to be made immediately around the time that consent is made. DRW: distress is a state of mind, not necessarily a mental disorder. Capacity doesn't come and go.

DRW cont: Patient A's learning about testosterone and what it would do to his body had developed long before he came to me.

SJ: Gender GP website said it was run by a multidisciplinary team of doctors, psychologists, counsellors and administrators. Is this a fair statement of your team: DRW: yes.

SJ: no further questions on Patient A. Tribunal chair: we will restart tomorrow with other areas of examination at 9:30 End of thread 9. @Justabaker17 finishes.