You'd be surprised how little some healthcare folks read into patient files if they don't think there's a need. When I went in for my hysto, it was very spotty as far as who knew what and when they knew it. My doctor and the resident under her had the most complete picture from the get-go. The anesthesiologist made a point to stop by a few hours in advance of surgery to talk to me and get the full picture, but her intern only stopped by to ask anesthesia-related questions. The nurse that brought me back basically relayed all the necessary information to the other nurses, but when I woke up I was in a different unit and one of the nurses there referred to me as 'she' before she saw what I looked like.
It really seems to depend on the place though. The transparency at my primary care doctor's office where I get my HRT done is excellent. Everybody knows exactly how I identify and has never made any mistakes with pronouns or names before I had it changed, even the folks working the front desk.
