In conversation with: Dr Ronx

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In conversation with: Dr Ronx

As they continue the exciting journey of publishing their first book, Amazing Bodies, we sat down with Dr Ronx, a trans non-binary emergency doctor and activist.

We explored the number of challenges faced by LGBTQI+ medical professionals and the measures needed to create a more supportive environment for patients and staff.

Can you tell us about your journey as a trans non-binary emergency medicine doctor and your career outside it?

When I joined the NHS, I was very androgynous and identified as a lesbian and as she/her. 

Lots of people used to ask my friends, "Is Ronx trans?" and my friends would say, "No, Ronx is just Ronx." It wasn't until about four years ago that I realised I didn't like she/her. 

Working in healthcare, I was fortunate because people called me "Doctor", so I wasn't really ever gendered at work. Still, when I was, it didn't sit comfortably with me. When I say gendered, I mean people calling me both she/her or he/him - neither of them sat well with me. I never really understood why, but I knew I had a visceral repulsion to those words being my pronouns. 

At the time (about five years ago), lots of my friends were starting to adopt gender-neutral pronouns. I didn't quite get it then and found it challenging to understand and incorporate the language. But I remember a day when I was with my agent, and I was like, "I think I want my pronouns to be they/them - I think I'm non-binary", and she just said that's fine basically.

I was a regular presenter on Operation Ouch then, and my pronouns were she/her on that programme. When we changed my pronouns on the show, we didn't make much of a fuss about it, we just incorporated they/them, and it worked. 

I then realised that it wasn't quite enough for me. I don't want to be a man, but I appreciate masculine/masc attributes, so the term trans non-binary fits. Sometimes I have to take a moment to think about what that means to help people understand - to me, it makes perfect sense - but when you try to explain it to people, it can be hard for people to understand. I'm trans because my gender doesn't match what I was assigned at birth, but I also have no gender, so I'm non-binary. I'm trans non-binary.

Being trans is a liminal space for me, where I'm masc, so I have masculine attributes, but I'm not a man if that makes sense. At work, my colleagues refer to me as they/them, and they do try very hard! 

I'm not overly fussed about what patients call me because when I'm at work, my job isn't to centre myself but my patients. My name badge says they/them, and if patients notice that and use correct pronouns, then great, but if they don't, such is life. At work, I can deal with that. People are at their rawest in the accident and emergency department. I can't say, "I know you're having a heart attack, but my pronouns are they/them". I can always tell them just to call me doctor. 

As a queer, black, androgynous intersectional feminist, how has your identity influenced your experiences within the medical field? 

Before identifying as trans/non-binary, it was important to me to make sure I was hot on making sure I understood how people identify and making sure queer people felt comfortable in A&E. 

I always tried to be as open and non-judgemental as possible. So I guess the only thing that's really changed since adopting my pronouns is that people who identify as trans or non-binary feel more comfortable in my presence. 

I would say that some of my work colleagues are thinking more about their pronouns, their sexuality and how they navigate the world. I think it just led to people around me thinking more about existences that aren't their own with more depth. 

Have you experienced discrimination or lack of support within the NHS because of your gender identity or sexual orientation? If so, how did you handle those situations?

When I was less confident and less sure of who I was and where I was going, I'd say things stuck with me because I didn't know who I was if somebody used the wrong pronouns, was homophobic or racist. I had this visceral feeling of "Oh my god, I'm so othered, I'm so different." 

In those instances, my support was my friends. I had some LGBTQI+ friends at work, and we'd speak about stuff, but the friends I've had outside work I've known since medical school, or before, so they know me. I always had them. 

You mention this is before you were confident in yourself, was there anything you did that contributed to your confidence growing in these environments and situations? 

The family I've curated! I went out with them, hung out with them, and went to lectures and events together.

I also went to speaking events, like gender studies open lectures. I heard other people speak on their experiences and how people were trying to change systems. This made me feel more secure that I wasn't alone and people were trying to change things.

I also went to speaking events and free lectures at universities. I heard great humans speak, like Angela Davis and Kimberle Crenshaw, about their lived experiences and how to be an activist and interrogate the status quo and systems.

This made me feel more secure that I wasn't alone and people have always been and continue to enact change.

How do you approach situations involving inappropriate behaviour or discrimination now?

I'm less tolerant as I've grown into my existence and become more confident. So I have a zero-tolerance policy for racism, homophobia and rudeness. I understand that people come into A&E at their rawest and not always in their right mind, and it's a case-by-case situation.

So someone might call me a bitch. I know they're in pain, and I'll let them know that that's inappropriate and I won't tolerate it, but we can start again. However, if someone is persistently racist or homophobic, it's important that this isn't tolerated. If the patient hasn't got a life-threatening condition, asking them to leave must be a seriously considered outcome.

Most hospitals have a zero-tolerance policy on abusing staff, but the difficulty is balancing what's happened vs what's going on. Zero tolerance sounds great, but kicking someone out who might be bleeding or has an injury we haven't assessed is difficult. We then ask someone else to see them, which almost negates their behaviour because it says you've misbehaved, but we'll get someone else to see you.

I do like to give people chances, but I also want my colleagues to see that they don't have to put up with bad behaviour and have a safe space to work.

It can be difficult because it can feel like you're always creating drama. But when you live within the intersections, in my case, when you're a queer, black and working-class person, people judge you. It can be covert or overt, but you must live within those intersections to see the subtleties in people's behaviour.

I'm not here saying everybody must be aware of this at all times, but the best thing you can do for their colleagues who live on the intersections is actively listen to them and believe them so they feel seen, heard and respected.

When I say someone has called me a homophobic, transphobic or racist slur, I need to be believed and supported. It's not that the patient is terrible and I'm good type of thing, but it's about how we can resolve this situation in a way that's safe for the patient and in a way that colleagues feel supported - it's complicated. There's no firm answer.

In your opinion, what are the key challenges faced by the NHS when it comes to creating safe working environments for LGBTQI+ staff?

We have to be honest with ourselves and understand that these systems were created long before different personalities and people were accepted and celebrated. We're evolving much faster than our systems are evolving. 

In the beginning, I was really cross with the fact there were gendered toilets, that I couldn't have my pronouns on my badge and that people didn't get it. But I had to take a step back and realise our systems are due for reform, and unfortunately, the cogs in those worlds are moving much slower than the ones in everyday life. 

Once I realised that and that perhaps my role wasn't just to live authentically but to live in a way that can help make change happen, things felt a bit easier. It can be really easy to be angry with your healthcare practitioner and be like, "why don't you get it!" But there also has to be an insight and an understanding that many people don't live within my bubble, you know? 

I've created a safe family bubble of people who get me, understand me and want the best for me. But I've curated that, and there's a stark contrast in understanding moving into the wider world. Realising that people are moving more slowly is frustrating and confronting. But once you become comfortable, you realise that being yourself is how change is made. 

What measures should the NHS take to create a more inclusive and supportive environment for LGBTQ+ people? As both patients and members of staff?

It's so multifaceted - change is either grassroots or top-down. 

Grassroots are amazing, and many organisations are trying to make changes within big systems. But a lot of them are charities and voluntary-led. If we think LGBTQI+ rights are important and to be more nuanced trans rights, we need to put our money where our mouth is as a society. 

LGBTQI+ people should be involved in legislation. It's great having advisors or MPs that are allies, but we need to see people who look like us and have lived similar experiences in decision-making positions when it comes to policy, guidance and just visibility. 

In your view, how can medical education and training be improved to better prepare healthcare professionals to support LGBTQ+ patients and colleagues?

At university, I can't remember a stand-alone moment when we were introduced to LGBTQ+ healthcare. It was always incorporated into sexual health, which feels ridiculous and also sexualises our existence when actually we're more than who we have sex with. There's more to LGBTQI+ healthcare than sexual health. 

I think there should be teaching that isn't opt-out and delivered by LGBTQI+ folk. At the moment, a lot of teaching is done in what we call mandatory teaching, so it's just lumped into inclusivity and diversity. 

We know a lot of Gen-Z identify as pansexual, and we know that lots of people are exploring their sexuality at an older age. We know that trans youth are dying by suicide at an absolutely ridiculous rate that we should be ashamed of. And so it's not that I think everyone should know the nuances of LGBTQI+ existence, but we all should be open.

When patients or colleagues are discriminatory at work, there should be fixed and easily accessible ways of flagging that. LGBTQI+ staff don't necessarily need special attention, which can sometimes be isolating because you don't come to work to talk about how you identify. But I think there needs to be mindfulness from those in charge that people living within the intersections experience professional life differently and require support. 

I don't know what that support looks like, whether it's talking therapies, ensuring that LGBTQI+ groups for professionals exist, and there's funding for that. LGBTQI+ groups exist in the NHS, and I'm in the process (and it is difficult because I'm so busy) of setting up a trans and non-binary NHS worker's Instagram page. 

But even with things like that, people are scared. Some people are trans but, for want of a better word, are assimilated into the gender they have chosen and don't want people to know they're trans but want a community. 

Then there are people like myself who are okay with people knowing and also want community. Creating a safe community for all is really difficult and complicated.

Have you witnessed any positive changes or progress within the NHS regarding LGBTQ+ inclusivity since you began your career? Are there any specific initiatives or developments that have had a significant impact?

There have been loads - like having pronouns on badges is massive!

Lots of toilets in hospitals are non-gendered. I'd say that the increase in awareness of trans and gender healthcare is really positive. I know the waiting lists are appalling, but the fact that gender care exists is huge.

It's now within the GMC guidance that doctors familiarise themselves with minority groups, and there is firm guidance on trans healthcare. For example, there's guidance on how doctors, GPs especially, should be competent in prescribing bridging hormones for those who haven't or are yet to be seen at a gender clinic.

There are also specialist LGBTQI+ sessions at most sexual health clinics and more specialities in medicine are creating guidelines which include the nuances lived experiences of patients. For example, trans-masc and non-binary antenatal services.

The desire is there; it's just individuals lead the action. It doesn't always feel like it's led by a national consensus that this should be done. LGBTQI+ rights seem to be at the bottom of the list. When prioritised, people seem to think something else, like cancer care, must have been deprioritised. It feels as though the NHS has always been sold as something with a model of scarcity, which just isn't the case.

We need to see it as though everyone needs to feel safe and have access to healthcare that feels nuanced for them instead of being a finite pot where some people get a big pot, and others will get a big one the next time.

I know this is how those in charge sell it - I wish we could reframe it.

What advice would you give LGBTQ+ individuals considering a career in medicine, particularly within the NHS?

My advice for anybody who wants to do medicine, regardless of who they are, is that you really need to want it. The landscape of medical school and university has changed since I graduated 12 years ago.

Pastoral care has really improved, especially post covid, but university is an industry working inside capitalism, and like any industry in a capitalistic society, everything is money driven. 

So when it comes to the health and well-being of students, I'm not saying that's not prioritised, but ultimately you have to have some self-awareness of when you need help, especially if you're in the LGBTQI+ community.

I joined the LGBTQI+ society, and there were barely any black people. I joined the African Caribbean society, but there were few queer people, so I had a big culture clash. Finding your people is really important!

People aren't necessarily going to ask if you're okay, so it's key to find your community and resources. Find your people!

You're now officially an author! Can you tell us a little more about your new book and how your medical career and being trans non-binary influenced it?

My new book is called Amazing Bodies. I never thought I'd be an author! 

The book is about the human body, but it's like people are doing it through my eyes. The illustrator, Ashton Attzs, is fantastic and is also trans non-binary.

My passion is young people and kids. I really want them to have and see ideas of existence that are beyond their immediate world. I want them, especially black and brown kids, to know that there isn't one monolithic way of existing and that people are multifaceted.

It's not that I want all kids to be doctors, but I'm passionate about the human body and that kids understand their bodies. For those who want to be doctors or are thinking about any careers in science I want them to know who I am, because I thoroughly believe that #youcannotbewhatyoudonotsee and when they see me, I want them to know it’s possible for them to BE anything.

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