Re: [Health-dev] [bug #46665] sex should not be required

[Luis Falcon]

Hi Marc & team !

Oh long discussed GNU Health topic about sex, gender and
uncertainty .... let me try to answer ....
 
On Sat, 12 Dec 2015 18:30:10 -0500
Marc Murray <address@hidden> wrote:

> On Sat, 2015-12-12 at 11:21 +0000, Luis Falcon wrote:
> > Follow-up Comment #1, bug #46665 (project health):
> > 
> > Although it can happen, in daily, interactive operation is
> > statistically unremarkable. Most demographics are initially taken
> > and reviewed in presence of the person, or automatically filled in
> > at the moment of birth.
> > 
> > We should not put an option "Unknown", since it could lead to input
> > errors and it clutters the selection option.
> > 
> > The scenario where we could not have the value is when doing batch
> > input of demographic data coming from other system, and the value
> > was not set at origin (because the field was not required ;-) ).
> > 
> > What we could do, is having a boolean field "Unknown sex", and use
> > states in the sex field, setting it to required whenever the
> > "unknown sex" field is False. 
> > 
> > Thoughts are most welcome.
> >   
> Just two comments from me:
> 
> ONE: Even though most demographics are collected interactively with
> the patient present and conscious, some are not. We should not make
> those other situations impossible to deal with. The input errors or
> cluttering of the selection option are less of an issue than being
> able to represent the truth.
Unlike sex, gender is dynamic, and it can change during a person's
life. The person section (party) is about administrative and
demographics, not medical information. The legal sex (gender) at the
person demographics is not for medical purposes.


If you're looking for the "truth" on the physical sex, then a
correct history, neonatal info, anamnesis and physical examination by a
health professional will take you to the right path. 

More on gender vs sex in the next paragraph...

> 
> TWO: Though rare, there are people born with confusing sex
> characteristics. While it's okay to force these people to choose male
> or female when building restrooms, it's not okay to force the doctor
> or other health professional to choose because of a software
> limitation. This could lead to inappropriate care or validation
> issues e.g. a female with testicular issues.
Let's not mix medical and administrative/legal concepts.

GNU Health records the physical sex of the patient at birth
(neonatal info), and it clearly states "It might differ from the current
person sex", so the health professionals have that information ready.
Ambiguous genitalia is a medical concept documented in GNU Health in
the neonatal information. 

Also, do not forget the most important factor. The human factor:
Anamnesis and physical examination ("from head to toe" ...) are part of
our job as health professionals. 

Let's not confuse the physical sex with legal or gender. This
issue has been brought up several times already, and I will change the
term "sex" for "gender" in the person (party) model.

> 
> Incidentally, this is one of the first customisations made for use in
> Jamaica. We added unknown as the third option for sex. It is still
> needed even if you make sex a non-required field.
Beauty of Free Software you're free to customize GNU Health to fit
your country needs ! 

But remember that GNU Health is much more than a medical system, and
it can be linked to civil administration offices. If the civil office
makes a query (birth / death cert, etc...), what are they going to put
in those fields when they get the value of "Unknown" ? It comes down to
legislation and current laws. If "unkwnown sex" is a valid option to set
in the Jamaican birth/death certificate, national ID or passport, then
in OK. Otherwise you're going to be getting many calls from the guys at
those departments :)

There are countries that have incorporated another options to the
passports. For instance, I've read that Australia has included the "x"
for intersex people, and the transgenders get to choose their new
gender (male / female). 

Let me know your thoughts.

Bests,

> 
> Those are my thoughts on the issue. 
> 
> ---
> Marc
> 
> 
> 
> 
> 
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> > 
> >   <http://savannah.gnu.org/bugs/?46665>
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