Question 3 - Rupert

Rupert, 12-years old, comes to see you with their mum, complaining of cough, increased shortness of breath and wheeze. They are a known asthmatic who is usually well controlled but it’s the viral season. While taking the history, you notice that Rupert appears to be wearing a blouse rather than shirt as part of their school uniform. When you examine the chest, you find that they are wearing a sports bra.  There is occasional expiratory wheeze but no crepitations.

Rupert is afebrile and has a normal respiratory rate. There is no tonsillar exudate, but the pharynx and ear canals are a little erythematous. When performing a peak flow, you notice their painted finger nails. Rupert puts the flow meter down and looks at their mum, clearly embarrassed and a little upset.

Mum explains that Rupert wishes to be called Jodie and asks if you wouldn’t mind using female pronouns. You glance at the record and notice the GIDS (Gender Identity Development Service) referral.

You glance at the record and notice the GIDS (Gender Identity Development Service) referral. What do you do next:

A

Suggest to mum that it might be a little too soon for Rupert to already be dressing as the opposite sex in public and that “he” is likely to be bullied for doing so

B

Add a read code of ‘transsexualism’ to the medical records

C

Agree to the name, but propose that Jodie should probably wait until she has a diagnosis from GIDS before presenting in this way

D

Acknowledge this and offer to make a note of it on the record

E

Move the consultation away from viral wheeze and on to gender identity

 

 


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