There’s no place for politicians in the medical exam rooms of the nation

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Katharine Smart is a pediatrician and a former president of both the Yukon and Canadian Medical Associations.

The medical exam room is for the doctor and their patient. Full stop.

This simple truth forms the foundation of medicine and is not something I ever thought I would have to make the case for when I first became a doctor 24 years ago. But here we are, so let me say it out loud: Politicians have no place in the rooms where patients share their most intimate concerns and fears with their doctors.

As a pediatrician, my relationship with my patients is at the core of what I do. Without that relationship and trust, I cannot give them the care they deserve. There is no greater privilege than being entrusted with a person’s most private fears: their pain, their vulnerability and even their shame. But every privilege carries a responsibility. In the doctor-patient relationship, that responsibility is to create a space that is safe, compassionate and above all, confidential.

When governments begin to legislate what care we can offer, which treatments we’re allowed to prescribe, or that we must ignore evidence they dislike, trust will inevitably erode. Patients may hesitate to be honest. They may withhold what matters most. And when fear replaces safety in the exam room, everyone loses.

This belief is what compels me to speak out against Alberta’s Bill 26, which directs doctors on how they can and can’t care for patients under 18 who are questioning their gender and in need of support. It’s also why I support the Canadian Medical Association’s constitutional challenge, which seeks to protect the right of patients to make the best decisions for their own health in consultation with their families and doctors.

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I completely understand that people have concerns. The vast majority of parents want what’s best for their children, and no parent wants their kids to make choices that will cause harm or regret. It’s important that parents and loved ones understand that doctors are extremely cautious when treating young patients. For example, in my practice in the Yukon, we work in a team with a psychologist and nurse practitioner. Treatment decisions don’t happen overnight. There is close follow-up and we are guided by evidence-based guidelines published by the World Professional Association for Transgender Health.

Central to my medical practice is to meet patients where they are. My job is to listen. Mental health concerns are evaluated and addressed as part of gender-affirming care. There is a lengthy consent process, and all the risks are talked about, ideally with families or loved ones. I don’t meet a patient and put them on hormone therapy the next day. The term “gender-affirming care” refers to a whole spectrum of treatments, including just listening and affirming a patient’s choice of identity. It’s a small minority of my patients who ultimately end up on puberty blockers or hormone therapy.

For the youth who do receive treatment, it’s often transformational. Many have carried the fear of rejection and of no longer being loved. Being accepted for who they are is like lifting a weight off them. Their confidence grows and they move forward with a newfound sense of lightness. I have seen over and over again how young people thrive when they are able to live in their full identity.

Alternatively, transgender youth who don’t receive care are at an increased risk for negative health outcomes, including depression, anxiety, eating disorders, self-harm and suicide, as noted in research reviewed by the Canadian Pediatric Society.

Bill 26 says that politicians must have a seat in our exam rooms. Doctors may be forced to choose between offering evidence-based care that is in their patients’ best interest, and breaking the law. And while this particular legislation is about gender-affirming care, who’s to say that next time it won’t be about prescribing mental health drugs, birth control or Viagra?

Here’s the thing: There is a clear role for government to play in our health care system. At a time when 6.5 million Canadians don’t have access to primary care and emergency-room closures are routine, we desperately need our elected officials to invest in solutions that will improve access to care. There is so much work that needs to be done that will have a lasting positive impact on the health of Canadians, and it’s needed urgently.

Alberta’s Bill 26 is a distraction from the real work that Canadians need all level of governments to do to fix our collapsing health care system. By politicizing and polarizing the doctor-patient relationship, the legislation stands between a small group of marginalized youth and the care they may desperately need. If this precedent is left to stand, the care and treatment that you need may be next.