Tuesday, November 07, 2006

The Other Side of the Story

My Lunacy post has gotten picked up by Transcending Gender, where several commenters are very upset about the possibility that transfolk might be receiving substandard care in emergency rooms.

In response to this, let me make a few points:

First, ED staff truly do vent out of earshot of all kinds of patients in all kinds of ways; they don't single out sexual minorities. (Trust me on this one!) But they're also professionals, and I've never seen patients -- even overtly obnoxious, aggressive ones who were actively harrassing the staff -- receive anything less than the best medical care that was available. Verbal venting by staff, even (or especially) when it sounds very unkind, is a way of blowing off steam. This is certainly one of the most off-putting aspects of ED culture; as far as I can tell, it's also one of the most universal.

I was unable to spend more time with this particular patient because he (she? I still don't know if the patient was trans or simply cross-dressed) was so consistently surrounded by caregivers asking questions about medical history and current symptoms. This patient was receiving a great deal of focused and professional attention; what little of that I could hear sounded entirely appropriate.

Many months ago, I heard a nurse in the department educating a colleague about the importance of using correct pronouns with a transgendered patient. That nurse, unfortunately, wasn't working the other night. The comments I heard upset me, and still do, but I strongly suspect that they're a function of ignorance, not deliberate malice. (If I get the chance, I'll ask Cool Nurse to speak to the others; they'll listen to CN far more readily than they will to me.)

I'm somewhat educated about these issues because I know several transfolk. Many people don't. I suspect that when I used the word "transgendered" with the one nurse, I got such a blank look because I was literally speaking a foreign language. I suspect that many people, even medical caregivers, don't know enough about the issue even to know what they don't know.

Which brings me back to the question I asked in my original post, which no one's answered yet. What kind of education do emergency-medical personnel get about gender and sexual identity? If they don't get any, how can that be changed? And I'm not just talking about recognizing risk factors and health hazards; I'm talking about learning how to recognize when "difference" isn't a medical risk factor.

Update:

Kim has responded to the education question in this feisty post. If all medical staff were like her, the question never would have come up in the first place!

16 comments:

  1. In answer to your question, I would say, "darn little to none". That applies to all nurses, not just ED folk. As nurses we are taught to critically think through situations, and provide certain standards of care. I cannot remember any part of any class that dealt specifically with transgendered (or cross dressing) issues..

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  2. Thanks for the response, John. That's interesting (and a bit scary, since people in the process of gender reassignment are on meds, hormones, and I presume might have medical issues around that).

    How about broader cross-cultural training? I mean, ED staff have to be able to deal with anyone who comes in the door, right? Where I am, we don't even have 24/7 Spanish translation coverage.

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  3. Hi Susan, thanks for this great discussion. Is it possible that Cool Nurse might ask for the floor for a few minutes at the next staff meeting to raise this issue and the points she explained to the colleague? I posted a request for resources for this need on TG.

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  4. Thanks for the comment, Jen! I'll talk to Cool Nurse about it if I see her, or possibly to my supervisor; because I'm a volunteer, I need to go to actual staff people to try to get anything done. (Example: There's a small room off the ED where the friends and families of code patients wait for word. The lighting in there was horrible for months, and making people sit in the dark while a loved one might be dying is a bit too metaphorically apt. I kept mentioning it to ED staff and securit, but nothing happened until I e-mailed my supervisor, who e-mailed the nurse manager of the ED. Now there are working lamps in the room: hurrah!)

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  5. Susan:

    I've also posted my thoughts about this subject on my blog, and I've provided a link to your post for my readers.

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  6. I appreciate your efforts to raise consciousness around the issue. I hope it helps.

    My doctor is transgendered. Last year, and for a long time before that, my doctor was a man, and that was just great. (Well, it was great for me. I later learned that he was not happy about it.) He sent letters to all his patients, saying that for profoundly personal reasons, he was going to go on leave for a month and return as a woman. He said he had considered moving to a different place, where nobody would know him, but he was so attatched to this community, this practice, he wanted to stay and hoped we would understand. He enclosed some articles about gender change, and made himself available for questions.

    It was strange that the articles he pointed to, about gender change and medicine, were all about how a doctor should deal with a patient who had changed gender (or was considering it.) There was nothing about medical professionals changing gender. I don't know if it's too unusual to have anything written about it, or not considered noteworthy at all.

    I have transgender acquaintances, who I encounter in social and artistic situations. It's easy for me not to be shocked. It's harder for me not to worry that this experience will change my doctor's attitudes towards surgery, making her more likely to consider it a cure-all. It's harder for me not to worry that other medical professionals will think my doctor is some kind of flake and not take her seriously if they know about the sex change. And sometimes they notice the name change and ask if I have a new doctor...what I say determines my credibility, my doctor's credibility, and affects how they treat me.

    Maybe it's just my inadequate sense of humor, but I don't see jokes about Rocky Horror as indicating helpfulness or sensitivity about gender issues. My doc used to dress like a totally non-flamboyant man, and now she dresses like a totally non-flamboyant woman. She looks like my old doc's sister.

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  7. MJ: Thanks for the link; by now, you've probably read my response to your post!

    Adrian: Thank you for that thoughtful and moving comment. I think your doctor must be very brave, although I can also imagine that she might respond, "It's not courage. What choice did I have?" (That's what my mother always says, in exasperation, about people who said she was "brave" for coping with cancer treatment.) Do you still have that list of articles about gender change? Info designed specifically for medical providers is exactly what I'm looking for!

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  8. Anonymous6:38 AM

    At my nursing school in MA we got a 1-hour optional seminar talk by a transgender doctor talking about a whole host of transgender issues. I went because I've been involved with and part of the GLBT community for a while now and am sensitized to the issues; but the room was packed. I'm sure the folks who were most uncomfortable didn't come, but I was heartened to see so many of my fellow students taking time out from precious study-time to come learn how to be more culturally sensitive to transgender issues.
    - Kate

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  9. Kate -- That's heartening news! Do you remember the name of the doctor who gave the presentation?

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  10. marachne9:45 AM

    Sorry for the cross post (I just left this over at Nurse Ratched's) In terms of training, I am involved with one project called "Removing the Barriers" that was designed by the Mautner Project (http://www.mautnerproject.org/home/index.cfm)

    That was specifically aimed at myths related to treating lesbians, bisexual, and transgender women who partner with women, and their families. I just went to their site and see they've teamed up with Gay and Lesbian Medical Association (GLMA) and the Human Rights Campaign to create a "simple two sided tool designed to help GLBT people be more open and improve communications with their health care providers" I looked at the tool and it's one side for consumers, one side for providers. There are also a couple of free videos to watch. So there is stuff out there that is designed to reach medical providers.

    As I said over there, the issues are not going to go away. The LGBT community has made some progress, but one of the things I worry about is the fact that we have a cohort of TG people aging who have been on hormones for 20, 30+ years -- we have no idea of the long-term effects of these meds. And then the next generation is coming up and transitioning younger and younger: late teens, early twenties. If they live a normal life-span, what are the health consequences?

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  11. Marachne, thanks so much for the information! Reading across blogs, I've now heard enough stories about training and education on these issues that I'm feeling much more hopeful about the whole subject.

    Yes, I've wondered about the health effects of the hormones, too. My mother got breast cancer when she was on hormone replacement therapy (this was in 1987, when I think dosages were much different), and as a result, I'm very leery of hormones -- although the timing of her illness could just have been coincidence. (She's now 81, and has also survived a stroke and lung cancer . . . tough lady!)

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  12. marachne10:09 AM

    OK, here's a couple more things from GLMA:

    specifically about transgender issues:

    http://www.glma.org/index.cfm?fuseaction=Page.viewPage&PageID=664&CFID=11643671&CFTOKEN=51523061

    General resources for providers:

    http://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageId=534

    One thing about this that I find really striking is the assumption that both parties -- consumers and providers need to take some responsibility. Makes sense to me.

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  13. I didn't save the medical references. I really did not think they were appropriate for the doctor-patient relationship, any more than it would be appropriate for another doctor to send his patients details of how his new blood pressure medication worked. (I see that as being on a different level from telling patients, "I have high blood pressure, and I am working with other doctors to treat it.")

    I think my doctor *is* being brave, by choosing to stay in the same home, the same practice, the same community, while going through gender transition. She may feel she doesn't have a choice about becoming a woman. But she could have moved to California and become a woman where she didn't know anybody. Maybe not extraordinarily brave...this is Massachusetts, which has a certain reputation for being socially liberal. But we also have a lot of social conservatives, so there is still a lot of temptation to hide in a closet.

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  14. Marachne: You rock! This is exactly the kind of thing I've been looking for. Thank you so much!

    Adrian: I suspect your doctor was trying to do some public education around a little-understood topic. And, yes: brave. I just wonder how she'd respond to that word.

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  15. marachne1:10 PM

    OK, I have to add just one more story: When I was in my undergrad RN program, and we were talking about gender and sexuality the professor showed a couple of slides that provided food for thought. They were of a couple of heavily pierced genitalia -- the female had about 10 rings through labia, clit, etc. The penis had studs going up the shaft, through the testicles as well as a "Prince Albert" through the glans.

    Her point was two fold: 1) You WILL meet people like this, and you can't respond with a negative reaction and maintain a professional relationship. 2) This IS a medical issue beyond such things as infections and possible Hep C - we have no idea what the long-term effects of this sort of piercing has on soft tissue, etc.

    In other words: "there are people out there who are different from you -- deal!

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  16. Marachne: Good for your nursing professor! Also, I've now included one of the links you provided in the short handout I'll be trying to get distributed in my ED (Jen Burke has approved the wording, and I'm now running it past Kim; I'll probably post it here when I have a final version). So thanks again!

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