#online patient appointment booking system

[logicspicesoftware]

Make Appointments Easy with Doctor Appointment Scheduling Software

Managing appointments doesn’t have to be stressful for doctors or patients. Doctor Appointment Scheduling Software makes it easy to book, manage, and track appointments in just a few clicks. Whether you’re a doctor, clinic, or hospital, this software by Logicspice helps you stay organized and on top of your schedule.

With Doctor Appointment Booking Software, you can:

Easily manage patient appointments without the hassle.

Send automatic reminders to patients, reducing no-shows.

Access your schedule anytime, anywhere with cloud support.

Customize the software to fit your practice’s needs.

Say goodbye to appointment mix-ups and hello to smoother, stress-free scheduling with Patient Appointment Scheduling Software. Try it today and make booking appointments easier for everyone!

[itfrontdeskus]

How does your patient appointment booking system work?

Patients are able to effortlessly make appointments with their healthcare providers by utilizing our system for patient appointment booking system, which is a tool that is both user-friendly and efficient. The patients can begin the process by logging into our web platform or mobile app. 

Once logged in, they will be able to search for available doctors based on the specialties, locations, and availability of those providers. Following the selection of a preferred physician, the following step entails picking an appropriate time slot from the offered list of available appointments that have been made accessible. If it becomes necessary, our system also allows for the rescheduling or cancellation of appointments. 

Our system not only allows users to make appointments, but it also sends helpful reminders by text message and email notifications before scheduled visits. This helps to reduce the number of patients who do not show up for their appointments and increases overall attendance rates. In addition, in the event that any difficulties are encountered when making use of our service, our team of devoted customer support experts is always accessible to provide assistance to customers. 

Overall, we are really proud of the fact that we offer a patient appointment booking system that is not only user-friendly and dependable but also optimizes productivity while providing high-quality care services to any and all patients who make use of it.

[rbbrduck]

Healthcare Mobile App Development Company Reimagining Healthcare

Healthcare Mobile App Development Company redesign outdated IT systems, refactor the code and migrate legacy applications to newer platforms, giving them a new lease life.

[perhaps-in-anotherdream]

[CN] Victor’s R&S: Between Silence (Eng Translation)

“Every choice he makes inevitably leads to the right path.”

⌚ This post contains detailed spoilers for a R&S, 无声之间, that is yet to be released on the global server. ⌚

•─────⋅◍♡◍⋅─────•  

[Subbed Video: Fully Voiced]

This R&S accompanies Victor’s S2 CH 41-44 karma.

Victor’s dialogue’s will be in bold and italics, and the others’ dialogues will be only in bold.

【Chapter 1】

The events of the first three chapters took place when Victor was around 22-23 years old. They elaborate on the beginning of Victor and Ronan’s friendship.

A small recap for those unaware: Ronan is one of Victor’s closest friends. He was a young director looking for opportunities to start his career, and young Victor was just building up LFG back then. After proper evaluation, Victor invested in Ronan’s project. Ronan’s project later won several international awards, and with that, the still learning to walk LFG also got its first base for spreading its wings. Ronan later became a world-renowned director (the CANNES winner apparently), LFG became “LFG,” and Victor became “Victor.”

Ronan appeared in Victor’s Taste of Life MQ, Garden Date, and 5th Birthday Story, and was mentioned by Victor in the R&S Finally, We Meet Again. Victor and MC also discuss “Ronan x Victor” friendship in the S2 CH 41-44 call~

—

Victor’s gaze was indifferently fixed on the only source of light in the dimly lit study room–– the movie playing on the computer screen. His face was partly illuminated by the flickering light, and he seemed a little lost in thoughts.

A few days ago, when Victor returned from a business trip to a neighboring city, he was stopped by a young man as soon as he stepped out of the taxi. He enthusiastically helped Victor retrieve his luggage from the trunk and immediately began “confronting” him in a familiar manner as if they had already known each other for a long time.

“CEO Victor, your company is not that large. Why do you still use an appointment system? It seems frivolous.”

✄┈┈┈┈┈┈

Victor bowed slightly and took the suitcase back into his hands, not intending to pay much attention to the stranger’s rudeness. Although it hadn’t yet been three years since LFG was founded, it had already gained a reputation for its sharp and cutting-edge investment strategy. This visitor was not the first young person to show up uninvited.

“Moreover, I couldn’t find any way to book an appointment online. So I had no other option but to wait here patiently. It’s been five days already, but luckily, I finally managed to secure an appointment.”

Victor’s gaze toward him was crystal clear, indicating, “Let’s talk business.” But the young man seemed to be oblivious to the implied meaning.

“Ah… I understand. There must always be sales promoters swarming at your door, and that’s why you guys have this regulation, right?”

✄┈┈┈┈┈┈

The space between Victor’s eyebrows knitted into a frown,

“Your behavior has served as a good example of the necessity of this regulation.”

Seeing that Victor was about to leave, the young man blocked his path with a grin on his face,

“Sorry about that. I tend to think in a scattered manner. Please don’t take offense, CEO Victor.”

Following this, he extended his hand toward Victor,

“Let me formally introduce myself. My name is Ronan, and I’m a film director. I have a feature-length movie script that I’ve been polishing for a long time, and I hope that LFG can invest in producing the film.”

Victor didn’t lift his gaze and simply dropped one word in a concise manner,

“Reason.”

✄┈┈┈┈┈┈

“Although I don’t understand business, LFG is different from other companies. They have already shown their ambition to venture into other industries even in their early stages, which aligns with my aspirations.”

Victor detected a hint of arrogance in Ronan’s words that seemed to come from nowhere, and his brows furrowed slightly, 

“What I’m asking is, why should LFG invest?”

Seeing the youth frozen in place, Victor walked around him and continued on toward the company. However, he had only taken a few steps when he suddenly heard a voice calling out to him from behind, “Wait a minute!” The young man ran up to him again, rummaged through his belongings, and finally handed a hard disk to Victor,

“My answer is in there.”

✄┈┈┈┈┈┈

The hard disk contained nearly 20 short film works that Ronan had shot previously as practice pieces. 

As the end credits of the last short film were displayed on the screen, a flicker of keen interest emerged on Victor’s previously impassive face. The short films, though, had some roughness and immaturity, but they couldn’t overshadow the unique talent of the creator. He got up and walked to the window, pulling open the heavy curtains. The gentle morning light filtered through the gauzy curtains and poured into the study. It turned out that without even realizing it, he had actually stayed up all night watching those clips.

Victor took out his phone and dialed a number,

“Prepare a report on the development of the film industry in the past five years.”

✄┈┈┈┈┈┈

In the afternoon of that day, an investment decision meeting was held in the conference room of LFG.

“Although there haven’t been any mistakes in CEO Victor’s decisions so far, the profits of the high-speed railway industry have only just begun to show. Given LFG’s current circumstances, it won’t be appropriate to hastily jump into a new industry.”

“A film production cycle is time-consuming, and even aside from the question of whether or not the investment will be profitable, it will take a long time for the money to flow back in. With LFG’s current financial situation, we likely won’t be able to afford this gamble.”

“While the policies may have become more favorable recently, it would still be unwise to stake our all in the investment of a single movie.”

….

✄┈┈┈┈┈┈

This investment decision was seeing the most unified opposition since LFG was founded. However, everything that was happening now was well within Victor’s expectations. After listening to all the opposing views, he responded to everyone’s concerns with perfect composure.

“Currently, there is indeed not sufficient data to support this investment decision. The sole convincing factor is that every investment decision made by LFG in the past has yielded good returns. And I believe that this time will be no exception, although the process may be relatively long.”

“Aside from the budget sheet displayed on the big screen, I’ve already asked Goldman to send the script of this project and the director’s past works to everyone’s email. Perhaps the works will be more persuasive than my empty talk.”

✄┈┈┈┈┈┈

“Rather than whether or not this movie will bring financial gains to LFG, I’d rather see LFG seize the right opportunity to set foot in the film industry. The film industry will soon enter a period of rapid development, and by grasping the current opportunity, LFG can establish a mutually beneficial relationship with the entire industry.”

Victor’s tone was unhurried and measured. But as it fell into the ears of the investors, it was akin to an indisputable judgment.

A few days later, the investment resolution for Ronan’s film project was approved by LFG.

—

•─────⋅◍♡◍⋅─────•  

—

【Chapter 2】

Ronan’s first movie stirred a small sensation after its release, and after gaining recognition from many industry veterans, he grew rapidly at a breakneck pace. With the constant flow of inspiration, he created two more films in quick succession, while LFG continued to firmly occupy the top spot as the producer of his films since the beginning. When he was almost wrapping up the shooting for his third film, Victor received multiple invitations from Ronan to visit the set under the guise of “guiding the work.”

A faint sense of misgiving arose in Victor’s heart. Although Ronan had an unconventional personal style, as a director, he had always maintained enough professionalism and aesthetic sense and would not be swayed by the opinions of the investors. At that time, he happened to be on a business trip near the filming location and drove to the set on the outskirts of the city.

✄┈┈┈┈┈┈

However, he wasn’t expecting to be greeted with the sight of Ronan exploding on the props team as soon as he stepped onto the set. 

“The precondition of all you guys’ work here is to respect the film! Respect the audience! Your small mistake has directly caused five scenes to be re-shot, not to mention going over budget. Now the entire crew is spending extra time and effort to mend your error!”

Signs of anger loomed on Ronan’s face as if he was trying his best to restrain himself from smashing the script in his hand onto the other person’s head.

The Ronan in front of him was a far cry from the unconventional and unruly image he had in his memory, causing Victor to inevitably be a little flabbergasted. He stood there waiting on the side for quite a while until Ronan came rushing over.

“Ahh... sorry for making you wait! Would you like to have something to drink?”

✄┈┈┈┈┈┈

“Water.”

Ronan wiped off his sweat and took Victor to the RV, where the director’s crew took a break. However, upon opening the freezer cabinet, nothing else was inside except cans of beer packed to the brim.

“Will this do?”

“...I drove here.”

As if oblivious to Victor’s speechless expression, Ronan put the beer back into the freezer and sat down opposite him in a carefree manner, gesturing animatedly with his hands.

✄┈┈┈┈┈┈

“I had originally calculated the exact time and wanted you to witness the grand finale. But you also saw the situation just now. Things don’t always go according to the plans.”

“How do you plan to handle this situation?”

“We have no choice but to reshoot. But don’t worry, I’ll ensure we do it in the most cost-effective method possible. Rest assured, it won’t  go over budget.”

Ronan shrugged his shoulders in feigned nonchalance, but Victor’s keen perception picked up on the subtle traces of putting on an act in his tone.

“If the method you’re talking about is to film it all in one take using a long shot, then I suggest you ask for a budget increase from me.”

✄┈┈┈┈┈┈

Hearing Victor’s words, Ronan was a bit taken aback and stared with widened eyes,

“Have you been taking film courses? How do you even know about cost-effective filming methods?”

“How much budget do you need for the reshoot?”

Seeing Victor’s serious expression, Ronan cupped his fist in the other hand, an expression of gratitude written across his whole face,

“About 3 million yuan. Thank you so much in advance, CEO Victor. You are the godparent of this film! I’ll definitely put your name at the top of the director’s acknowledgments!”

✄┈┈┈┈┈┈

Victor remained stone-faced in the face of his teasing:

“No need. You may have misunderstood. For me, achieving the expected goal takes precedence over everything. Economizing the cost is only a small number, but compromising the quality of the film would affect the expected return on investment.”

Probably aiming to appease Victor’s concerns, Ronan gave him his sincere assurance,

“Don‘t worry. I won’t be careless with any of the shots.”

Not receiving a response from Victor, he took a brief pause and jokingly said,

“Hehe, do I need to win a major international award for you to have faith in me?”

Victor didn’t continue that conversation and left with the parting remark, “Make sure to not just talk the talk. Let me see your capability with the finished project.” But Ronan knew that Victor had faith in him.

✄┈┈┈┈┈┈

Victor was just about to start the car when he heard a knock on the car’s right window. He turned to the source of the sound and saw Ronan outside the car, panting heavily, holding a bottle of water as if he had just run a great distance to reach him.

“Thanks.”

Victor took the water after opening the window,

“By the way, your acting skills are really poor. It’s best if you just stick to being a director.”

Despite being called out, Ronan remained unperturbed and smiled instead, resting his hand on the window frame,

“I’ve been dedicated to being a director all along. Earlier, when I mentioned winning an award, I was dead serious. So if that day ever comes, how about treating me to a drink at a bar, CEO Victor?”

—

•─────⋅◍♡◍⋅─────•  

—

【Chapter 3】

The film that Ronan had placed great expectations upon encountered a strong setback in the local theaters even before receiving the results of its entry into the international film festival. Due to the mismanagement in scheduling by the theaters, the film was forced to release earlier than planned. The marketing and promotion team was caught off guard, having no time to prepare, and many people were unaware that it had already been released. As a result, the film suffered from poor box office performance and received a lackluster public reception, which was not surprising considering the circumstances.

The following day, Victor was reviewing the box office prediction trend chart as he prepared in advance for LFG’s next weekly investment meeting. After the weekend drew its curtain, the film’s already disappointing performance experienced a sudden and drastic decline, reminiscent of a fall from the cliff. It seemed that the film’s box office failure had become inevitable. Recalling Ronan’s spirited demeanor when talking about his aspiration for the film winning awards, Victor decided to go and watch the movie to experience it firsthand.

✄┈┈┈┈┈┈

Due to a scarce number of screenings, Victor could only manage to buy a ticket for a late-night show. By the time he walked out of the theater, it was already dawn, and he found himself to be the sole audience member in the entire screening in the empty cinema hall without the sight of any other viewers. Coincidentally, as Victor entered the elevator, the projectionist in charge of the screening happened to be getting off work and shared the elevator with him.

“Ah, the movie has a high level of artistic quality. It’s the best one he has directed yet. It’s a pity that it’s not commercial enough to make money.”

In response to the projectionist’s remark, Victor nodded politely and replied:

“Mm, it’s indeed remarkable. As for whether it’s a pity or not, each film has its track suitable for only itself.”

With a “ding” sound, the brief conversation came to an end as the elevator doors opened.

✄┈┈┈┈┈┈

Just as he stepped out of the elevator, Victor’s phone in his pocket vibrated. He received an MMS from Ronan, containing a screenshot of an email confirming his film’s selection for the CANNES Film Festival. The message was accompanied by a grinning face emoji.

Just as Victor’s “congratulations” message was successfully sent, Ronan couldn’t contain his excitement and immediately called him,

“Reporters are all waiting in line to interview me. But I wanted to call you first. Isn’t that very thoughtful of me?”

Without waiting for Victor to respond, Ronan carried on excitedly,

“I’m actually booking my plane ticket right now. After the film festival wraps up, it’d be the perfect opportunity to reward myself with a long vacation! I’m planning to visit Île Saint-Honorat near Cannes. Ahh, the sunshine! The beach! The sea! I already can’t wait to melt away in the Mediterranean sea breeze!”

✄┈┈┈┈┈┈

His irrepressible excitement flowed from the rising inflection of his voice.

“If I remember correctly, that e-mail was just to notify you that you’ve been nominated.”

“Being nominated is the first step to actually winning the award. When I get back, you better be ready to take out for a drink. I’m gonna need at least a whole case of beer.”

Ronan continued in a dissatisfied tone before Victor could respond,

“Come on? You’ve invested millions in me, yet it’s so difficult for you to treat me to a simple drink? Forget it, I’ll just…”

“Sure, we can have a drink. But since I’m the one treating, I’ll choose where we go.”

✄┈┈┈┈┈┈

After hanging up the phone, Victor found several new emails expressing their interest in collaboration in his inbox, all from astute film and TV companies.

“It seems that tomorrow’s investment meeting will go smoothly,”-- Victor thought to himself. Although he didn’t hesitate when making the decision initially, he could not help but feel a sense of joy as the dust settled and everything fell in the right direction in the end.

As these thoughts circled his mind, Victor walked towards the vending machine outside the movie theater. He inserted a few coins, and moments later, a chilled can of beer dropped from the dispensing slot.

—

•─────⋅◍♡◍⋅─────•  

—

【Chapter 4】

Chapters 4 & 5 of the R&S cover the events between S2 CH 38-39. It begins with the scene after he had replaced the twelve main gods of BS, and the ending scene of the R&S, yes, is the “Stop time for me, Victor” scene of S2 CH 39 after clearing all split routes; the most crucial junction~

—

The waning moon sinks into the dense clouds, and the night sky is bathed in a blurred, pale luminescence.

The comet remains suspended midair, framing the entire Loveland City in a treacherous and enchanting ambiance. The city has lapsed into a state of deathly stillness.

In the depths of the BS Hall, the cascading dark red curtains appear eerie and terrifying under the reflection of the thick, dark night. The central seat in the hall remains unoccupied. Numerous figures stand scattered throughout the hall, engaged in discussions. The sound of conversation fills the air, giving the impression that the main gods seem to be working intensely. Despite so, there’s an underlying current of restlessness and turmoil in the air.

As Victor descends the stairs, his composed footsteps draw the attention of the crowd, causing their gazes to converge on him in unison.

✄┈┈┈┈┈┈

Victor walks towards Poseidon and asks,

“How is the progress?”

“We haven’t been able to reach Helios yet.”

Victor’s gaze sweeps across the faint golden arc of light beneath the hall’s dome. A thin layer of frost seems to settle on his face as he says,

“I hope I don’t have to emphasize once again how tight the time is.”

Poseidon nods and exits the hall. Another tall, short-haired youth swiftly walks up to Victor and says,

“BOSS, multiple calculations have consistently proven that our estimated countdown time is indeed relatively accurate, with an error margin that can be kept within 2 minutes.”

“It’s not enough. It needs to be precise down to the second.”

✄┈┈┈┈┈┈

“Understood.”

The young man nimbly turns around and returns to the side of the woman wearing glasses. In front of them, a massive depiction of the development history of civilizations on Earth is displayed. Each key milestone of the birth and extinction of civilizations is illuminated, shining brightly. The two people close their eyes, and countless lines weave through the points of light. They interconnect in an orderly and systematic pattern, and gradually, numerical values representing units of time emerge on the line segments.

As the main gods return to their tasks, everything appears to be the same as it was earlier. However, with Victor’s presence, the restlessness that was lingering in the air before has unknowingly melted away, vanishing into thin air.

✄┈┈┈┈┈┈

The mechanical sound of a violin suddenly resounds, piercingly echoing throughout the hall. Standing by the door is an unexpected guest. Victor looks up and, upon recognizing the visitor’s face, dismisses the twelve main gods, leaving only the two of them in the spacious hall. 

“Zero, I believe we’ve made our point very clear already.”

The other party seems oblivious to the implied urgency in the words and remains unperturbed as he says,

“We have observed new omens appearing along the world-lines.”

Victor raises his eyebrows, indicating for him to go on.

✄┈┈┈┈┈┈

“There might be different potential futures for this world. It remains uncertain which path the new future will follow, and perhaps it could be even worse than the current situation.”

Victor’s eyes are filled with indifference as he responds,

“Time is precious. You can just state your purpose in coming directly.”

Zero pauses and looks straight into Victor’s eyes, speaking slowly,

“The SpaceTime Bureau welcomes powers formidable enough to confront and observe the unknown. Therefore, my invitation to you still stands. You and I both know that venturing into the unknown is not the optimal option.”

✄┈┈┈┈┈┈

“Whether an option is the best has never been the basis for my decision-making. For me, the one and only valid prerequisite is whether or not I desire to make that choice.”

Victor speaks in an indifferent tone, yet every word carries the confidence of having victory within his grasp,

“And once I make a choice, I will ensure it becomes the most correct one.”

Zero chooses not to persuade any further, and as he departs, the gates of BS close behind him. Even though Victor has never had any regrets about his decisions, he cannot, however, escape the realization that even the right choice sometimes comes with an unbearable price. For instance, there is one such image that remains etched into his memory and which he still refuses to recall to this very day––

The utility room of the cruise ship. The bewilderment and perplexity in her gaze as she looked at him.

[Tidbits]: Reference to [S2 CH 31]

✄┈┈┈┈┈┈

Even if her forgetting him had lasted for only a brief moment, the shock it brought to Victor’s heart might outlast even the longevity of his own life.

The sound of bells chiming outside the building reaches Victor’s ears and brings him back to reality, jolting him out of his tangled thoughts. He walks towards the window and pushes open the heavy panes, allowing the chilly wind to fill his nostrils. Gradually, he regains his composure.

He takes a deep breath and directs his gaze toward the bell tower of the church. The hoarse tolling of the bells startles a flock of crows into sudden flight. They circle above the church for a while, adding another layer of desolation to this already lifeless city. The church spire blends into the profound darkness of the night. The entire city seems to be silently awaiting the arrival of doomsday.

✄┈┈┈┈┈┈

But in the next second, from a distance, Victor spots a familiar figure breaking through the night, running towards his location vigorously.

The darkness of the night intensifies,  and a cluster of blazing flames has already flared into existence in the silent void.

—

•─────⋅◍♡◍⋅─────•  

—

【Chapter 5】

Victor is not surprised by the scene unfolding before him, and a small smile forms at the corner of his lips.

The church bells continue reverberating, but by the time the sound travels to Victor’s ears, it carries a much brisker tone.

Unbeknownst to him, a gauzy layer of starlight has cascaded upon the church’s stained glass windows at some point. The soft halo of pale light gently dances, casting swirling and elusive shadows that can be seen even with eyes closed.

✄┈┈┈┈┈┈

The running girl closes the distance more and more, with her long hair casually flowing down in loose waves, drawing a beautiful arc in the air. Despite there still being a considerable distance between them, Victor feels as though he can see the girl’s face clearly. He is certain that her eyes now are sparkling with a resolute glimmer, powerful enough to pierce through the darkness of the night. With this thought, a wave of fervent sensation surges up from deep within his heart.

Suddenly, Victor feels as if he has been blessed.

It’s not about whether every decision he makes ultimately leads to the perfect outcome, but rather the fact that he has always been granted the opportunity to make choices.

It’s as if, at this moment, he can cast aside all social roles and simply be “Victor,” allowing himself to be there for the girl wherever she needed him and creating a space where she could find him at any time.

✄┈┈┈┈┈┈

The feeling of being needed by her, of being able to help her–– these aspects bring Victor a profound sense of happiness. It seems that this happiness is enough to make the long days ahead, in which he may be forgotten by her, a little less painful to endure.

Victor nods slightly in the direction of the church, solemnly expressing his gratitude for this blessing within his heart.

Victor turns around and ascends the steps, summoning all the main gods to take their positions,

“Suspend all matters at hand.”

A murmuring commotion rises among the main gods, as they are puzzled about why BOSS has chosen to halt their activities during such a crucial moment when the end of the night is just about to descend.

✄┈┈┈┈┈┈

Before those impatient inquiries can escape their lips, though, Victor’s cold and commanding demeanor instantly silences them.

His gaze sweeps over the crowd, ensuring that every main god is present, before finally settling on the entrance not far away. The main gods, following his line of sight, turn their heads toward the entrance as well.

A few seconds later, the BS door is pushed open with a resounding sound.

The girl appears at the far end of Victor’s unwavering gaze, gasping for breath. He, with a stern and proud expression, leads the main gods toward her until she can see him. It’s only when the girl has a clear view of him does Victor halt his steps.

✄┈┈┈┈┈┈

As those bright, sparkling eyes gaze at him from afar, and their eyes interlock, Victor’s heart is flooded with a myriad of complex and indescribable emotions. There is a sense of relief that the situation has unfolded according to his expectation, a deep sense of gratitude that she is standing before him at this moment, and a profound pride for her that emanates from the depths of his being… just as these emotions are about to pour out of his heart sincerely, he casts his gaze downward. He leads the main gods to step aside in the shadows, creating the path for the girl to ascend the platform.

As he watches her walk step by step toward the long-unoccupied seat, Victor knows that regardless of what she might ask for, he has already prepared himself to do all that he can and give his everything for her.

—

[jeraldnepoleon]

Switching to G-Health from Grapes IDMR: Discover New Advanced Features

In the ever-evolving world of healthcare technology, Grapes IDMR has taken a bold step forward by reintroducing G-Health, an advanced mobile app that revolutionizes the way patients manage and access their medical records. From keeping track of lab results to booking appointments with top doctors, G-Health is designed to offer a seamless, user-friendly experience for patients and their families. Whether you’re managing a single person’s healthcare needs or organizing health records for your entire family, G-Health brings convenience, security, and functionality right to your mobile device.

Let’s explore the new and improved features of G-Health, and how this app can transform the way you handle medical information.

What is G-Health?

G-Health is the newly rebranded version of Grapes IDMR’s healthcare management app, designed to give patients a simple, intuitive way to manage their medical records. This app is your one-stop solution for accessing vital healthcare information, making appointments, and ensuring that all your important medical data is stored securely. With a focus on efficiency and ease of use, G-Health empowers users to stay on top of their health without the hassle of paperwork, phone calls, or endless hospital visits.

Key Features of G-Health: What’s New and Improved

1. Effortless Appointment Booking

Booking an appointment with a top doctor near you is now easier than ever with G-Health’s streamlined booking system. Say goodbye to long phone calls and endless waiting times. With just a few clicks, you can schedule an appointment with leading healthcare professionals in your area.

The app provides detailed information about available doctors, including their qualifications, areas of expertise, and patient reviews. You can select the doctor that best fits your healthcare needs and choose a time that works for you. This feature is a game-changer for patients who need to see specialists but struggle with finding the right time or location for their appointments.

2. Seamless Access to Lab Results and Discharge Summaries

One of the standout features of G-Health is the instant access to lab results, discharge summaries, and prescriptions. There’s no longer a need to wait for a doctor’s office to call you back or to sift through piles of paper. As soon as your results are ready, they are automatically uploaded to your G-Health account.

Patients can review their lab results at their convenience and get a detailed breakdown of their health status. This is especially useful for patients who are managing chronic illnesses or those who require regular check-ups. Having access to these documents allows you to make informed decisions about your health, without unnecessary delays.

3. Centralized Family Health Records

Managing the health records of an entire family can be overwhelming, especially when it involves tracking medical files for different family members. G-Health simplifies this by offering a centralized platform where you can view and manage the medical records of your entire family in one place. Whether it’s your children’s vaccination records, your spouse’s prescription history, or your lab test results, everything is accessible with just a few taps on your mobile device.

This new feature is particularly helpful for parents who need to stay updated on their children’s health, allowing for easy access to pediatric records. It’s a single app that caters to the entire family, removing the need to juggle multiple healthcare platforms.

4. Secure Payment and Avoiding Hospital Queues

Hospital visits often come with long lines and waiting times, but G-Health has eliminated this issue by offering online payment options. You can pay for your consultations and treatments directly through the app, bypassing the need to wait at the hospital. This feature not only saves time but also ensures a more efficient and stress-free experience.

Additionally, the cashless payment system helps avoid unnecessary contact, a key benefit in the post-pandemic world. You can view past payments, receive payment reminders, and keep track of all transactions for insurance and tax purposes.

5. Timely Medication and Appointment Reminders

Missing an important medication dose or forgetting about a doctor’s appointment can lead to serious health consequences. With G-Health, this is no longer a concern. The app offers customized reminders for both medication schedules and upcoming appointments Like chemotherapy and Radiotherapy many more, ensuring you never miss a dose or an important healthcare event.

This feature is particularly beneficial for individuals managing chronic conditions or elderly patients who need regular medication. The app will send you push notifications or reminders based on your personalized settings, helping you stay consistent with your treatment.

Why Switch to G-Health from Grapes IDMR?

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[riomed]

Dermatology service requires excellent care, smooth coordination and precise management. With Cellma, dermatologists can employ patients’ data, facilitate administrative duties, and reduce the burden on healthcare professionals. Online appointment booking system allows the dermatologist to schedule appointments and have automated reminders to keep the patient flow consistent and improve the compliance rate.  

[sarvodhyahospital]

Heart Hospital in Greater Noida West

Introduction to Heart Hospital in Greater Noida West

At the Heart Hospital in Greater Noida West, we are dedicated to providing exceptional heart care. Our hospital is designed to meet the needs of patients requiring advanced cardiology services.

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[allthecanadianpolitics]

Patients for lab services in Saskatchewan will soon be able to book appointments online by April 2023.

In a release, the Saskatchewan Health Authority (SHA) stated it will begin expanding its online patient booking system to include lab services.

“A total of six lab sites will go live by April 2023 including Moose Jaw (3 sites), North Battleford, Prince Albert, and Swift Current,” stated SHA.

Patients would be able to book appointments online for blood and urine collection, ECG, blood and urine collection and ECG and glucose tolerance test.

The executive director for the SHA’s Laboratory Medicine Clinical Services stated this upcoming expansion will be a huge step forward in their efforts to maximize efficiency and ensure safety in the delivery of lab services. [...]

Continue Reading.

Tagging: @politicsofcanada

[clindcast]

Beyond the Consult: Enhancing Patient Engagement with ClinDCast's Integrated Features

Telehealth has redefined patient-provider interactions by eliminating physical barriers and offering convenient access to care. However, a successful telehealth experience goes beyond just video consultations. It's about fostering patient engagement, empowering individuals to actively participate in their healthcare journey. Luckily, ClinDCast understands this and goes beyond basic video conferencing, offering a suite of integrated features that enhance patient engagement in meaningful ways.

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Patient Portals: A Gateway to Healthcare Information: ClindCast's secure patient portals provide a one-stop shop for managing healthcare needs. Patients can access their medical records, lab results, medication lists, and appointment history, all in one place. This transparency and accessibility encourages proactive engagement in their health.

Remote Monitoring: Taking Control of Health Between Visits: ClindCast's integration with various wearables and monitoring devices allows patients to track vital signs, symptoms, and medication adherence remotely. This data empowers both patients and providers to make informed decisions and identify potential issues early on, leading to improved outcomes.

Personalized Communication and Education: ClindCast allows for secure messaging between patients and providers, facilitating ongoing communication and addressing queries outside of scheduled appointments. Additionally, the platform can deliver educational materials and resources customized to patients' specific needs, fostering proactive engagement and health literacy.

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The benefits of ClindCast's integrated features are not just theoretical. Numerous healthcare providers and patients have experienced firsthand the positive impact on engagement:

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Unlocking the Potential of Patient Engagement:

ClinDCast's commitment to comprehensive telehealth solutions goes beyond basic consultations. By integrating features that support appointment scheduling, patient portals, remote monitoring, and personalized communication, the platform fosters a more engaged and collaborative healthcare experience. This approach empowers patients to take control of their health, improves communication with providers, and ultimately leads to better healthcare outcomes for everyone.

Ready to Experience the Difference?

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[ukrfeminism]

15 minute read

An overhaul of medical care for transgender minors is exacerbating bottlenecks in England, Reuters found, leaving thousands of patients in limbo and adding to years-long treatment delays. The crisis comes amid a broader debate on appropriate care for rising numbers of teens seeking help in Europe and the United States.

DOVER, England - On an October morning in the living room of a modest family home in this coastal town, Miles Pitcher, 17, received a message that would change his life.

It came from GenderGP, a private online health service that treats people suffering from gender dysphoria – the distress of identifying as a gender different from the one assigned at birth. The doctors had reviewed his case, the message said, and would prescribe the testosterone that would help Miles develop the facial hair, deeper voice, broader physique and other characteristics aligned with his gender identity. It would put an end to the menstrual periods he dreaded.

Miles gestured at his phone, speechless. He shook his head, and, beaming, showed the message to his mother as their pet dog Moose bounded around the room.

"Finally," he said. "Something being done."

Miles, assigned female at birth, has identified as male since he was 14. Yet until he got that message, he was stuck in limbo for three years, one of at least 8,000 young people in England and Wales waiting to receive gender care from the state-funded National Health Service (NHS) as of October, a Reuters review of NHS documents shows.

The UK government has promised to overhaul the youth gender care system, after it was deemed inadequate by England's regulator of health and social care. Some clinicians had complained that England's only state-run youth gender clinic was too quick to offer medical treatments to young people. And many families protested over the distressingly long wait for a first appointment – an average of nearly three years, a Reuters analysis of the clinic's records found.

In July, the NHS said it would close the sole clinic, known as the Tavistock, next year and replace it by spring 2023 with regional centers to better accommodate a fast-growing patient population. Its plan calls for the centers to operate under new treatment guidelines, informed by the best available medical evidence for treating transgender adolescents and the most in-depth review of care conducted by any country.

But the reality is already falling short of those ambitions, creating new delays and uncertainties, according to Reuters interviews with transgender teens and their families as well as physicians and government officials involved. They described a deeply flawed system that is now hobbled by a toxic political climate around gender care.

Young people like Miles say their only option is to turn to private providers such as GenderGP, which is registered in Singapore and thus operates beyond the supervision of the NHS. The company says under-18-year-olds make up a growing portion of its UK patient population, with about 800 youth currently on its books.

"I wish we didn't have to exist," said Dr Helen Webberley, who founded GenderGP with her husband. Both once worked for the NHS. "But we are years away from the NHS pulling themselves together on this."

The NHS's proposed new treatment guidelines were altered after they were reviewed earlier this year by a Conservative government wary of medical interventions for transgender adolescents, Reuters found. Gender clinicians say the proposals now depart from international treatment protocols, which support gender-affirming care. Pioneered more than 20 years ago in the Netherlands, such care can include everything from supporting a social transition – using a person's preferred pronouns and name – to counseling and medical interventions, including drugs that pause puberty.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

An ongoing review commissioned by the NHS highlighted another problem. Led by Dr Hilary Cass, a prominent pediatrician, the review found that practitioners across the country might be referring patients with gender concerns to the Tavistock without first addressing mental health issues such as depression, according to an interim report released in February. Such practices may have contributed to the clinic's fast-growing waiting list, the report said.

Annual referrals to the clinic have surged from 210 a decade ago to 5,234 in the financial year that ended in March 2022.

According to NHS documents seen by Reuters, there were 7,696 minors on the waiting list for a first appointment as of July. Just over 1,000 young people were referred to the Tavistock from April to October and are awaiting attention, the clinic says.

"I'M STILL YOUR CHILD"

In 2019, a 13-year-old Miles began exploring his relationship with his changing body, wearing baggy clothes. He cut his hair short and began sampling videos from transgender teens on YouTube.

At first, "it was denial – those guys are cool, but I'm not like them," he said. "Then slowly, I thought, 'what they're talking about is exactly what I feel. So maybe I need to actually look at this.'"

He came out to his close friends, who were supportive. In February 2020, Miles left a letter on his bed for his parents, just before heading to school.

"Dear Mum and Dad," it read. "I am transgender. I identify as male. I'm still your child."

His mother was taken aback. "I was a little bit fearful, because I didn't understand it," Connie said. She texted Miles at school. "We'll talk about this in a few days," she wrote. "We love you."

That November, an NHS doctor referred Miles's case to the Tavistock. Miles was excited, hoping to receive puberty blockers but realizing that, given the long waiting list, he was likely to be too mature for them by the time he was seen.

As he waited to hear from the clinic, he began his social transition, dressing like a boy and using male pronouns. He started to wear a binder to conceal his breasts and, on occasion, padding known as a packer inside his underwear to give the look of male genitalia. He took a contraceptive pill to limit the frequency of his periods.

Last year, he legally changed his name – his parents paid, as a gift for his 16th birthday. Miles now studies at school in a co-educational class. He is attracted to boys.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

Another mother, Liz, said her teenager has been on the Tavistock waiting list for three years after being referred by their family doctor. Assigned female at birth, the child came out as a transgender boy at school, but Liz and her husband do not use his chosen pronouns. Instead, they use a gender-neutral nickname, saying that they want to keep their child's options open.

Liz said the child has autistic traits, depression and childhood trauma, and has experienced years of severe homophobic bullying. Liz declined to make the child available for comment.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

The gender-care revamp became further entangled in political upheaval after Prime Minister Boris Johnson resigned in September. Both his successors, Liz Truss and Rishi Sunak, voiced their opposition to the use of what they described as "irreversible" measures for transgender young people earlier this year.

Neither Truss nor Sunak's office responded to a request for comment for this story. Sunak has said under-18s should be protected from "life-altering treatments."

A few weeks into Truss's tenure, in September, the NHS briefly posted a draft of its proposed new treatment guidelines on its website, then removed them. The guidelines were re-released on Oct. 20, the night Truss resigned.

A Reuters review of the original draft shows key passages were changed by the time they were re-released.

Both versions of the guidelines say only medical professionals may refer young people for gender care, and call for a meeting between clinicians before a child is added to the waiting list. New clinics will be led by medical doctors rather than psychologists, they say.

The guidelines also say young people who, like Miles, obtain medicines from providers that are not regulated in the UK should be referred to local authorities – such as police and social services – once the NHS takes on their case.

The NHS has said separately it would only prescribe puberty-blocking drugs for transgender teens "in the context of a formal research protocol." It has not specified how gender-affirming hormones would be prescribed, although it also suggests enrolling young people into a clinical trial in the future.

However, the revised guidelines say adolescent patients would require a gender dysphoria diagnosis from a specialist clinician before their social transition would be supported by the NHS, rather than, as at present, relying on the statements of an adolescent.

The changes around social transition appeared after the draft was sent through government approval processes within the Department of Health and the Prime Minister's Office, rather than the NHS or gender experts, two people involved in the process said.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

The draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

The NHS doesn't cover the cost of Miles's private treatment Read full story. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

O nce assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

" These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

M iles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

" That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

M ost of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

F or young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

T he draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

T he NHS doesn't cover the cost of Miles's private treatment. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

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Streamline Your Appointment Scheduling Process

Setting up an effective appointment scheduling system is crucial for healthcare professionals in the digital era. Today's patients demand easy and simple ways to make appointments with their healthcare providers. Healthcare professionals must embrace technology and streamline their appointment scheduling procedures in order to achieve these goals and remain competitive. This article will discuss the value of effective appointment scheduling and management for healthcare professionals and offer practical advice on how to improve your online presence by streamlining your appointment scheduling process.

The Significance of Efficient Appointment Booking

Effective appointment scheduling is essential to the success of medical practices and goes beyond just convenience. The following are some solid reasons in favor of healthcare professionals giving their appointment scheduling procedure top priority:

1. A better experience for patients

Convenience and responsiveness are valued by patients. Patients can simply arrange appointments without making long phone calls or waiting around thanks to an effective scheduling system. Consequently, patients have a better overall experience.

2. Enhancing Online Presence

In today's digital age, maintaining and gaining new patients both depend on having a good online presence. It is much simpler for potential patients to identify and make appointments with your practice when your appointment scheduling procedure is effective.

3. Time Management Improvements

Healthcare professionals can better manage their time and assign slots by streamlining appointment scheduling. Patients may experience shorter wait times as a result, and the practice may earn greater revenue.

4. Lessening of Administrative Workload

The administrative load on medical staff can be significantly reduced by automation and appointment booking efficiency. As a result, there will be fewer scheduling mistakes, fewer missed appointments, and more time for other crucial activities.

How to Increase Your Online Presence

Before getting into the intricate details of scheduling healthcare appointments, let's talk about how important it is to build a successful online presence. The ability to draw in and keep patients depends heavily on having a strong online presence. Here are some tips for improving the quality of your online presence:

1. Build a user-friendly website

As a virtual storefront for your practice, your website. Make sure it is responsive to mobile devices, user-friendly, and informative. Important details about your services, your contact information, and how to schedule an appointment should be simple to access for clients.

2. Improve your SEO (search engine optimization)

Spend money on search engine optimization (SEO) to raise the visibility of your website in search engine results. To make sure that potential patients can discover you online, choose pertinent keywords relating to your practice and geographical area.

3. Make use of social media

Social media platforms that encourage active involvement can help you connect with your audience and develop a devoted following. Regularly distribute educational content, client recommendations, and practice updates.

4. Promote Online Evaluations

Positive online comments and evaluations have a big impact on patients' decisions. Encourage satisfied clients to provide testimonials on sites like Yelp, Google My Business, or Healthgrades.

5. Spend money on advertising

To reach prospective clients who are actively looking for healthcare services, think about investing in pay-per-click (PPC) advertising campaigns on websites like Google Ads and Facebook Ads.

It's time to concentrate on the topic at hand: effective appointment scheduling and management for healthcare professionals, once you've built up a solid online presence.

Efficient Appointment Scheduling for Healthcare Professionals

There are various essential elements and techniques that go into effective appointment scheduling for healthcare professionals. Let's examine these in more depth:

1. Introduce an online system for bookings

Consider developing an online booking system to simplify the appointment scheduling procedure. Patients can now check available timeslots and make appointments whenever it's convenient for them, round-the-clock. For a seamless patient experience, make sure your online booking platform is user-friendly and mobile-responsive.

2. Make a landing page that includes time slots

The creation of a dedicated landing page on your website with clearly marked time slots is a useful strategy for enhancing your online presence and streamlining appointment booking. This landing page should list available appointment times so that users can quickly choose a time that works for them and make an appointment.

3. Provide automated reminders

By using automated appointment reminders, you may decrease no-shows and missed appointments. To ensure that patients don't miss their booked appointments, these can be communicated via email, SMS, or even phone calls.

4. Use Appointment Scheduling Software 

The entire procedure can be streamlined by using appointment scheduling software created for healthcare professionals. A few things to look for include syncing your calendar, storing patient data, and integrating with your website and electronic health record (EHR) system.

5. Make Flexible Booking Options Available

When making appointments, patients have varying preferences. While some people might prefer contacting your office, others might prefer online scheduling. Provide a variety of booking choices to appeal to a larger patient base.

6. Effectively Manage Waitlists

An effective waitlist management system will enable you to fill any last-minute cancellations or openings even if your schedule is fully booked. When a good appointment becomes available, let the patients on the waiting list know.

7. Monitoring and Analyzing Data

Analyze your appointment scheduling process's data on a regular basis. Make data-driven decisions and better optimize your time management by examining booking patterns, busy times, and patient preferences.

8. Train Your Employees

Your staff's training is just as crucial for effective appointment scheduling as technology. Make sure your staff can assist patients with any booking questions and is proficient in using your scheduling software.

9. Give security and privacy top priority

When adopting online booking systems, it's critical to give security and privacy top priority due to the sensitive nature of healthcare data. Make that your scheduling program conforms with any applicable laws, such HIPAA in the US.

10. Collect patient feedback

Finally, actively solicit patient feedback regarding their scheduling experience. Utilize their suggestions to identify areas in need of improvement and make the required modifications to continuously improve the process in its entirety.

Conclusion

Healthcare professionals that want to improve their online visibility and give clients a better experience need to schedule and manage appointments effectively. You may expedite your appointment scheduling process and set up your practice for success in the digital age by using an online booking system, developing a landing page with time slots, and using the tactics described in this article. To address the ever-changing needs of your patients and your practice, prioritize a strong online presence, embrace technology, and continually improve your scheduling processes.

[doccure-dreamguys]

Why Online Appointment Booking is a Must-Have for Modern Clinics

In today's fast-paced world, time is of the essence. People are looking for ways to make their lives more efficient and convenient, especially when it comes to healthcare. With the rise of technology, patients are no longer content with waiting on hold or standing in long lines to schedule an appointment with their healthcare provider. That's where online appointment booking comes in.

At Doccure, we understand the importance of modernizing the healthcare industry. That's why we offer an online appointment booking system that makes it easy for patients to schedule appointments with their healthcare providers. Our system is designed to streamline the process, making it more efficient for both patients and providers.

Benefits of Online Appointment Booking

Convenience: Patients can easily book an appointment at any time from anywhere, without the need to wait on hold or stand in long lines.

Time-saving: Providers can save time by eliminating the need for manual appointment scheduling and reducing administrative tasks.

Improved patient satisfaction: Online appointment booking can help to improve patient satisfaction by offering a more convenient and efficient way to schedule appointments.

Reduced no-shows: Automated appointment reminders can help to reduce no-shows by reminding patients of their scheduled appointment.

Features of Doccure Online Appointment Booking

24/7 appointment booking: Patients can easily schedule appointments online, 24/7.

Automated appointment reminders: Doccure sends automated reminders to patients to reduce no-shows and increase patient attendance.

Real-time availability: Patients can see real-time availability of their healthcare provider and select an appointment time that works best for them.

Multiple provider support: Our online appointment booking system supports multiple healthcare providers, making it easy to book appointments with various providers.

Customizable: Our system is customizable to fit the needs of each healthcare provider, with the ability to set up unique schedules and appointment types.

In conclusion, online appointment booking is a must-have for modern clinics looking to improve efficiency, convenience, and patient satisfaction. With Doccure's online appointment booking system, healthcare providers can streamline their appointment scheduling process and improve the overall patient experience.

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Mobile App Development For Healthcare Reimagining Health and Wellness

Mobile App Development For Healthcare Streamline and consolidate patient data and test results via a central storage hub – for seamless access that drives customer satisfaction.

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Practice Management | Agima Medical Management

All Day-to-Day Full Practice Management!

Medical Practice Management systems allow physicians to quickly book appointments and manage schedules.

We also allow patients to book their own appointments online. Avail the services within good price range here.