Why I’m going to Capital TransPride this weekend


1comment

Open Doors, by @ReginaHolliday

Short answer: because I and my fellow physicians went into medicine to support the ability of every human being to achieve their life goals.*

*see my note at the bottom of this post about the physician role

Capital Transpride is May 18, 2013, in Washington, DC.

Kaiser Permanente is a Gold Sponsor for the first time, this year. As of 2013, Kaiser Permanente covers and provides medically necessary care for its employees who are trans, earning it a 100% rating on the Human Rights Campaign Corporate Equality Index.  Every member is covered for hormone treatment and behavioral health services. Not every member is covered yet for surgery, however, because not every employer purchases a supplemental insurance rider for this coverage.

There are also clinical facts about this care, and an increasing trend of coverage across the United States, which I have written about in several posts on this blog, since November, 2012.

Since then, I have been having dialogues with others in this area, some friendly, some extremely hostile.

I’ll answer some of the questions I have actually been asked, here. I have reworded a few and not answered a few because they were asked too insensitively to post in their original format – it’s okay, we’re on a learning journey :) .

Q: This is a small population of people, why should they be advocated for?

That’s what people asked in 1993 about persons with HIV/AIDS.

Today, we look back in horror at the way the medical profession carried itself during that era.

To learn more about that, check out Regina Holliday (@ReginaHolliday) and my TEDx Talk, Embracing Failure.

I’m relatively certain the medical profession will be horrified by its treatment of trans people when it looks back as well. I’m going to TransPride to help shorten and end the horror.

Q: Isn’t this care way too expensive? Why should I have to pay for it? 

That’s what people asked in 1993 about persons with HIV/AIDS.

A few additional points:

  • Trans persons who are insured and have so-called “exclusion clauses” for their care are paying for everyone else’s care, including care that has been deemed unnecessary and wasteful. Hormones, sex affirmation surgery, and behavioral health, when medically supervised are necessary and effective. Treating this rare condition (the way I refer to it with medical colleagues, understanding that every person doesn’t see it as a “condition”, it is an identity) using established guidelines promotes other positive health outcomes, and supports the achievement of life goals, which is what the health care system is for.
  • Most insurance plans that won’t cover surgery or hormones cover the complications of surgery or hormones. In other words, if a trans person obtains surgery and has an infection or other complications, or complications from non-prescribed hormones (heart attacks, clots, strokes) you will pay for their care. This doesn’t even touch on lost productivity, behavioral health issues, and suicide. Gender dysphoria is not a mental illness – much of the mental illness that is associated with gender dysphoria is caused by bias in society that the health care system promotes. Medically supervised care is likely to be less costly in the long run.

Q: Isn’t sex affirmation surgery cosmetic? 

No, it is not. I’ll state it again for the search engines out there: Sex affirmation surgery is not cosmetic.

The below is from American Medical Association Resolution 122 (A-08), 2008

Whereas, Health experts in GID, including WPATH, have rejected the myth that such treatments are “cosmetic” or “experimental” and have recognized that these treatments can provide safe and effective treatment for a serious health condition; and

Whereas, The denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient’s gender identity; and

Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression, and 12 substance abuse problems, which further endanger patients’ health and strain the health care system; therefore be it

RESOLVED, That the AMA support public and private health insurance coverage for treatment of gender identity disorder (Directive to Take Action); and be it further

RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician (Directive to Take Action). Fiscal Note: No significant fiscal impact.

If hormones and behavioral health are covered and performed, but not surgery, is this discrimination?

Yes. Medically necessary care includes all three components, appropriately prescribed in consultation between a patient and physician. Not every patient needs all three components. Disallowing any of the components represents discrimination based on a person’s gender identity.

See above.

Weren’t you attacked recently on the Yale Daily News website when you commented about their decision to cover sex affirmation surgery?

I was. By 3 or 4 people.

By the way, Yale University is in the group of 37 universities who now cover this care for their students.

Once the attacks became ad hominem in nature, I went away. I just checked back in, an lo and behold, and comments like this  popped up:

 I admire Dr. Eytan’s remarkable patience and forbearance in responding to the comments on this thread. Even when respondents have turned to devaluation and ad hominem attacks, he has maintained a respectful stance toward all.

And then an email like this arrived in my box, from 15-year Yale Alumnus, Rachel See, JD:

Just wanted to drop you a note to thank you for your accurate and even-handed comments to the Yale Daily News story on Yale’s extension of health benefits (including surgery) to transgender students. This trans Yale alumna who graduated some 15+ years ago from Yale College was deeply gratified to see an accurate, and compassionate voice of reason in the comments.

In many trans*-related discussions in the popular media, I often see a tagline of, “…and as always, don’t read the comments.” I routinely ignore that advice, but its presence reflects an unwelcome reality that there can be a lot of rancor (and plain old fashioned ugliness) in online comments.

In a totally different context (blogging about ichthyosis), my wife and I have asserted that a calm, rational and respectful voice can act as a humanizing buffer against the propagation of some of the uglier trolls. But we’ve also noticed that those (lone) voices often go unrecognized.

So — thanks. :)

These messages cancel out 10,000 attempts at devaluing other human beings, because they show that the world is learning to love better.

If more attacks come in any venue I’ll just get one or two more of these messages that will cancel out 10,000 more.

The lesson is the same here – un-love can’t win – so great to see that affirmed, again.

Ted, are you transgender?

Feel free to select the answer that will allow you to have the greatest empathy.

The truth is:

  • I am not transgender

I am also not

But I have met or seen the stories of people who are/were.

We didn’t go into medicine to un-care for people, and in 2013, we don’t have to. More and more clinicians are practicing the medicine of inclusion every day, and we’re going to change everything.

If I missed any questions above, feel free to ask more in the comments.

See you there. Oh yes, and love always wins :) .

Civil Rights Protesters, Washington DC
Let Freedom and Love Ring
Please!
Chris and Hampton
Prop 8 ruling outside Federal court in San Francisco 4
Washington DC Demonstration for Equality November 15 2008
reason to celebrate
The Death of DADT - 352/365
Standing on the Side of Love with LGBT People Everywhere!
Marriage Equality Celebration by The Stonewall
CA Day of Decision
Civil Marriage Protection Act 2012 Signing Ceremony
SCOTUS - DOMA 20991
2013 Rally for Transgender Equality 21169


*A note about the physician role. There are a lot more people than physicians working in this area, and they have been doing it for a very long time. Our role is to bring the patient story into every conversation, and help the people and communities we serve take control of their destiny. With that in mind, I acknowledge many dedicated people and organizations, including Casa Ruby , @casarubyDC , the DC Center @TheDCCenter and those who I have not met or worked with, yet. See you tomorrow as well.

Similar Posts:

ILN13: MIT Media Lab Safari


2comments

@medialab – photos by @veenu_a (View on Flickr.com)

This Innovation Learning Network (@healthcareILN) I tried something new – I brought a second camera and gave it to a colleague, to allow me to be in two places at once.

While I was learning about food insecurity and demonstration kitchens at Boston University School of Medicine (the social determinants of health thing), my colleague Veenu Aulakh (@veenu_a) was learning about the future of the future at the MIT Media Lab (@medialab). Here are her photographs, enjoy.

(She has a good eye!)

Photos of/from ILN13

Similar Posts:

Now Reading: Don’t hand the keys over, collaborate with Gen Y


2comments

Nayar, Vineet: "Handing the Keys to Gen Y," Harvard Business Review, May, 2013

On the one hand, this post is way overdue. On the other hand, it’s right on time.

Overdue because I was supposed to write a half-way summary of my co-mentorship relationship with Katie Rovere (@katierovere) , who’s on the board of GenKP, the Generation Y Employee Resource Group of Kaiser Permanente.

Right on Time because we’re almost at the conclusion of our one year co-mentorship relationship. It’s concluding in the most awesome way, with Katie front of room, leading a workshop at our annual innovation retreat.

First, on the subject of the post – handing over the keys:

I see and hear so much commentary, including this article, around the concept of “get out of the way of Generation Y,” and I think it’s misguided. The articles seem to focus excessively on GenY’s ability to leverage technology:

What’s more, Gen Y workers raised on social media have special skills in pulling together solutions, and they know how to mobilize their networks. In today’s world, this ability to quickly collect and make sense of information and respond in real time often trumps experience.

To that I say, don’t be dazzled by something just because you don’t understand it. If you understand technology, you understand its limitations.

In many articles, I see Generation Y referred to as something of an invading force coming to take over with their different values. Are the values that different?

If you read an article about Generation X written 10 years ago, a lot of the themes are the same – self sufficiency, leveraging new communication, etc.

The suggestions people make about managing Generation Y to my eyes are about being more human and respectful in the workplace.

GenX wanted that too when we were starting our careers. Same goes for transparency.  I witnessed the most amazing devastation at the hands of a medical profession obsessed with paternalism and secrecy (as laid out in my TEDx talk with Regina Holliday) which makes me as interested in transparency as any GenY person might be. A lot of the desires of this generation are felt by other generations, too.

My year-long mentorship relationship – collaboration is the key, not handing keys over

When I encourage people to mentor, they sometimes say to me (I’m paraphrasing), “I should mentor a Generation Y staff member because they know a lot more than I do.”

To that I say, (1) yes you should and (2) that’s a fallacy.

My assessment above comes after a wonderful year co-mentoring Katie. We’ve been in the same space physically just twice in the last 12 months, and have been having regular semi-structured interactions by phone otherwise. Kaiser Permanente has a really nice matchmaking site for mentoring; that’s how we found each other. The joke between us is that we are always on the hunt for a mobile phone / land line combination that allows us to hear each other clearly :) . That’s a good sign for both of us, we are intensely interested in what the other person is saying.

In our time together, Katie has brought real, tangible insights about what it’s like to be starting a career in a large organization. None of them have struck me as the rant of the spoiled or the entitled. They highlight important limitations that I don’t see in my every day life. I don’t see them because I am farther along, I am a physician ( It doesn’t matter that I tell people to call me by my first name, there is a difference ) , and part of me has stopped noticing the every day hurdles. 

We need to validate, empower, reflect, and support Katie and her colleagues to connect their desires to the mission and values of the organization. We learn a lot during this process, of course!

It’s a great thing to provide the support that I was offered when I was in her shoes. It seems only natural that I want her to benefit from whatever I got, x 10.

A good mentor in my opinion does not intervene or choose the path for a mentee. As Lao Tsu said:

“The Sage is self-effacing and scanty of words. When his task is accomplished and things have been completed, all the people say, ‘We ourselves have achieved it!

From spreadsheets to cathedrals: Left to Right: David Nwangwu, Jessica Johnson, Bernard Tyson, Incoming Chairman and Chief Executive Officer, Kaiser Permanente,Katie Rovere, (GenKP Board)

A good mentor does do things like mention to Katie that her name was on a spreadsheet connected to planning an event (like the national Diversity Conference), and it was her decision to decide to follow-up on that. When life throws your name on a cell in a spreadsheet…

In the case of the National Diversity Conference, Katie did follow up, and literally showed attendees the difference between laying bricks and building cathedrals, on site. She herself and her colleagues achieved it.

So now Katie has ended up on another spreadsheet, and she and I will both spend some time on stage at our innovation retreat. I’ll be doing what I love, bringing the member voice forward (in a multigenerational panel – Gen B, X, Y, and Z!) She’ll be doing what she loves, bringing the voice of her generation forward.

We’re collaborating, because we love what we do and we want each other to succeed.

Utilize rather than surrender

The founders of my specialty, family medicine, said this about the relationship that family doctors should have with specialists:

Her/His aim is to broaden her/his concern, to widen her/his skill; s/he seeks to accept responsibility; not merely to pass it along. S/He utilizes specialists, rather than surrendering to them

I think this is a good analogy. Our patients don’t want anyone to surrender to anyone, they want us to leverage each other’s talents to create a much more beautiful cathedral (i.e. the achievement of their life goals through optimal health) for them. No one is laying bricks around here.

Here’s a video of the imaginarium that the GenKP group were a part of last year. Tomorrow I’ll post about Katie’s commentary on a few articles I asked her to read.


Similar Posts:

Link

What Makes a Mother? Suffering – NYTimes.com.

Thanks to Kayt Havens, MD, for sending this to me. As she mentioned to me, it is a sweet article, about the transition of a dad to a mom.

It makes me think, changing the medical profession is at times nothing but grief, too. People should try it more often. We are.

Similar Posts:

Innovation Learning Network 2013 Day 1-2 , Boston University and CIMIT


1comment

View ILN13 24051 on Flickr.com

This Innovation Learning Network (@healthcareILN) was one of the ones where we spent most of the time doing open space networking so I’m not going to be able to create a summary that will reflect anyone’s experience but my own, which is fine because this is my RSS Feed :) .

I like the ILN. It’s a combination of exposure to people like me who need each other for various reasons, because life is not always dancing with prince charming at the ball (see my Teds2ndJacket story for more), a little bit of rebooting of the brain, and a few nuances and tidbits to help my passions become a little more refined and organized.

There’s also a component built in of “it feels good to be bad” 

ILN13 23934

Guest photographers with firefighters (View on Flickr.com)

Only to a point, until Chris reels you back in. Until then, though, there’s nothing wrong with celebrating the protectors of your community, or taking a moment to remember those who were not protected enough.

Photos of/from Copley Square

I innovated a little myself this time, by bringing a second camera, and inviting guest photographers to use it to take great photos. This time, they were Margaret Laws (@margaretlaws) and Veenu Aulakh (@veenu_a). As a result there are a lot of photos, so I’ll let the pictures do the talking.

Photos of/from ILN

Photos of/from ILN

Similar Posts:

dys4ia – A game for the health system, to heal itself


4comments

Dys4ia – a game

From the author:

dys4ia is an autobiographical game about the period in my life when i started hormone replacement therapy. it’s a story about me, and is certainly not meant to represent the experience of every trans person.

When people talk about games for health they often talk about games to impact the health of an individual person. This is a game about the health of a health care system, that sometimes isn’t caring:

A recent non-peer reviewed report on transgender discrimination showed some 28% of respondents had experienced harassment in a clinic setting and that 2% had been subject to physical abuse.

The game is flash based, use the arrow keys to play, and see things from the perspective of a person as they interact with the health system. Go through all the four levels. You’ll see that just a little more listening and caring, which sadly is not the norm for this population, can go a really long way.

When I posted this on Facebook, Robin Deane said:

Anything that engages someone in a more open-minded format helps! …and, for me, highlighting the challenge of the psych gatekeepers and a supposedly like-minded community stood out! In the end, my trauma was ‘relieved’ through my association with similarly situated individuals…they really get the credit for launching me like a rocket!! :) )

That’s the job of physicians in this generation, to launch rockets. Holding people back is the domain of 20th Century medicine.

Make sure you get to the ending, there’s something valuable and worthwhile in helping people become who they are; everyone deserves the opportunity.

Similar Posts:

Now Reading: Integrating Patient- and Family-Centered Care With Health Policy


1comment

DiGioia AMIII, Fann MN, Lou F, Greenhouse PK. Integrating Patient- and Family-Centered Care With Health Policy: Four Proposed Policy Approaches. Quality Management in Healthcare. 2013;22(2).

As Regina Holliday (@ReginaHolliday) and I discussed in our TEDx Talk (“Embrace of Failure” – Henry Ford Innovation Institute), health care is addicted to not involving patients and families in the design of the system that’s built for their benefit. Multiple reasons, including fear, lack of self-confidence, and also not knowing how to do it. That’s where Tony DiGioia, MD’s (@PFCC_) work comes in. It’s not that hard and it’s possible in every specialty of medicine, every one of the health professions – Tony’s an accomplished orthopedic surgeon at one of the most prestigious institutions in the United States.

This paper includes tidbits including a description of the first mention of the term “patient-centered care”:

Balint introduced the term in 1969, referring to the need for physicians to build a physician-patient relationship by seeing each patient as having a unique experience of illness.

Isn’t it interesting that 1969 is also the birth year of the specialty of family medicine – a lot of innovation was going on in the 1969.

I digress, though. Tony and I think very much the same way when it comes to involving patients and families in the design of the health system. This paper takes that passion and applies it to requirements of the Accountable Care Act and vice versa, connecting what should be done to what needs to be done. Easy!

Actually, the easy part is that Tony’s methodology doesn’t take a lot of resources, just the ability and interest in listening and observing. He discusses the limitations of data (I am also in agreement, when I talk about data versus facts – Getting the Facts about patient and family experience: Shadowing (presentation) | Ted Eytan, MD).

When patient satisfaction benchmarks are exceeded, we tout the results; when they are not, we variously (1) attribute the results to comparing “apples to oranges”; (2) are frustrated by the fact that the data is necessarily dated because of the time it takes to distribute, collect, collate, and disseminate it; (3) are frustrated by the difficulty of identifying root causes for both positive and negative patient satisfaction data, and (4) redouble and reprioritize our efforts to achieve better outcomes and scores despite the inevitable shortcomings of the data.

One great aspect of the PFCC methodology is that Tony’s view of what the care team is is much broader – innovation and caring comes from everyone on the team:

The PFCC M/P defines caregivers broadly, as any person within the health care setting whose work touches a patient’s or family’s experience (eg, doctors, nurses, therapists, technicians, appointment schedulers, parking attendants, medical records clerks, etc).

He involves all of them in the process to produce a healthy, cost-effective, high quality care experience. Want to practice how it’s done and you’re close to Washington, DC? Come to VisionQuest on May 10, 2013 at The Center for Total Health (@kptotalhealth). We’re hosting this with Tony because we want to build a base in Washington, DC for this approach as a norm rather than an exception in health care here. There are a limited number of scholarships available – contact me in the comments or tweet me @tedeytan and we’ll set you up. If every health system did this there would be a lot less unnecessary un-health.

Similar Posts: