Kaiser Permanente Center for Total Health May Technology Focus : Vital Connect – YouTube

Kaiser Permanente Center for Total Health May Technology Focus : Vital Connect – YouTube

Our very first Total Health Technology Focus – filmed in HD. Special thanks to producer/director Keith Montgomery, The Kaiser Permanente Educational Theatre Program, and Vital Connect the first technology featured in the series.

We slightly miscalculated the amount of time it would take to run through the scenarios, so my recollection is of Keith coming into the room advising us to stretch out the time … fortunately I think there were plenty of inquisitive minds in the room and online.

See what you think. The next Tech Focus will likely be Google Glass, happening in July, 2013. Watch for it!

Kaiser Permanente to Pursue Minimum of LEED Gold for all New Major Projects | Kaiser Permanente News Center

Kaiser Permanente to Pursue Minimum of LEED Gold for all New Major Projects | Kaiser Permanente News Center – As part of its ongoing commitment to create healthy communities, Kaiser Permanente today announced it will seek Leadership in Energy and Environmental Design (LEED) Gold certification for new construction of hospitals, large medical offices and other major projects.

Now Reading: Care of Transsexual Persons — NEJM, in the era of inclusion

Care of Transsexual Persons — NEJM

I’m not going to summarize this article because many of its recommendations are now outdated, even though it was published in 2011. You can access WPATH guidelines for the most accurate information. See: Now Reading: Choosing Wisely : Standards of Care for the Health of Trans People | Ted Eytan, MD

I am posting this because of what it says about the era of inclusion by the medical profession. It’s arrived.

I learned about this article while at this weekend’s first ever Kaiser Permanente Symposium for LGBT Health (post coming on that next), and now that I read it, I can understand what an impact it has had.

Impact, not because of what the article says, because of what is not said.

There’s a letter to the editor about the fact that the guidelines stated are not the most up to date (see: Care of Transsexual Persons — NEJM (letter)), and the correspondence back and forth is so – polite.

There’s also a blog post about the article on @NEJM and same thing, a description of the article and zero comments on that post (maybe I should add one of support…I think I’ll do that). What a contrast to the relative disaster that is the discourse sponsored on the MedPageToday site about the care of these fellow human beings (see: Asking about sex affirmation surgery – a review of the numbers | Ted Eytan, MD)

Inclusion. The whole thing is remarkable, isn’t it.

The real clinical problem is bias, not biology

One thing that made me chuckle a little is this introduction to the piece, that I think goes on the top of all articles of this kind in the Journal:

This Journal feature begins with a case vignette highlighting a common clinical problem.

Actually, the issue of gender dysphoria is not a common clinical problem at all. The clinical problem is one created by the health care system, not by biology – it’s the bias and inability to deliver sensitive, accurate care to trans people. That clinical problem results in unnecessary harm and death.

If you read carefully about treatments that should not be administered to trans people, such as Ethinyl Estradiol (causes clots, death from cardiovascular disease in doses needed to be effective), know that trans people without coverage or access to competent, judgement-free medical care may end up obtaining this form of estrogen without a prescription.

This nature of the clinical problem is not discussed in the piece, so I’ll help by pointing it out here :). That clinical problem is 100% curable. This paper helps with that treatment.

The irony / sadness is that while safer, medically supervised therapies are often not covered by health insurance, the treatment of complications and harm from unsafe, non-medically supervised therapies, are usually covered by that same insurance. Our generation is going to change that situation, though.

California Bans Insurance Discrimination Against Transgender Patients | Transgender Law Center

In a groundbreaking directive to health plans, the DMHC confirmed that California’s Insurance Non-Discrimination Act of 2006, authored by former Assemblymember Paul Koretz, guarantees all people the right to access coverage for medically necessary care regardless of their gender identity or gender expression.

via California Bans Insurance Discrimination Against Transgender Patients | Transgender Law Center.

MedEdPortal – Call for Submissions – to improve LGBT / DSD curricula in Medical Schools

When I was at the AAMC Joint Meeting of the … (see: Dialogue about #hcsm at the 2013 #AAMCJtMtg – Academic Medicine and Social Media | Ted Eytan, MD), I was of course talking about the future, and that includes a more inclusive medical school curriculum around issues related to people who are LGBT (including, not excluding, T) and Disorders of Sex-Development-affected.

I learned there about the Lesbian, Gay, Bisexual, Transgender and/or Disorders of Sex Development-affected Patient Care Project, which is being hosted at Association of American Medical Colleges’ MedEdPortal (@MedEdPortal) , which I also learned about:

MedEdPORTAL Publications promotes educational scholarship and collaboration by facilitating the open exchange of peer-reviewed health education teaching and assessment resources.

The project, which states the obvious, in the most polite, understated way:

Strong evidence demonstrates that LGBT people and people who are affected by DSD are disadvantaged by our current healthcare system.

Is announcing a call for submissions to improve upon this situation, starting with medical schools:

The Association of American Medical Colleges announces a call for submissions for competency-based educational and assessment resources, as well as effective (or best) practices, policies and guidelines, that address the health of lesbian, gay, bisexual, and/or transgender (LGBT) individuals, gender nonconforming and/or discordant children and adolescents, and those affected by disorders of sex development (DSD).

The are some resources/educational programs on the portal already. On the positive, it’s nice to be able to have a look into what medical schools might be teaching students in this field.  Also on the positive, there are some resources already on the portal, and some of them are inclusive of trans and gender identity issues. On the not-as-positive side, there isn’t that much for this population, some of it is focused on LGB only. That’s why the call for submissions is timely and filling an important need. Here’s a video of the presentation made about the call for submissions.

I’m not a medical school educator, or a trans person, however I think both should be involved in improving the knowledge of our doctors-to-be about listening, and being there for all of the patients/communities/societies they will serve in their lifetime.

I’m thinking back to the LGBT curriculum I experienced in medical school – it was mixed. The actual teaching about taking sexual histories was modern for its time. The actual real-life discussion of sexual minorities was a disaster (which I later fixed when I was a lecturer at University of Washington – if you don’t like the news, go out and make your own). There was no discussion whatsoever about transgender health issues or DSD-affected people. The thing is that these experiences, good or bad, can affect a physician for their entire career, not to mention the reinforcement that may unintentionally happen on hospital wards / in the medical offices where they rotate (see a description of my wards experience in this writeup).

There’s more background on this AAMC (@AAMCtoday) initiative below. The intent is to make sure it gets better, and gets better inclusively for trans and DSD-affected people. Even if you are not a curriculum developer, search around and feel free to add comments to any of the 3-4 pieces that are currently up there, it will help medical school faculty help save lives.

Lesbian, Gay, Bisexual, Transgender and/or Disorders of Sex Development-affected Patient Care Project – Diversity Portfolios – Diversity and Inclusion – Initiatives – AAMC

I’m glad I found this work by the AAMC. There are more and more examples of health professionals understanding the huge gap in transgender health and why it is time for a change. I’m not imagining things, and I sense that I am just scratching the surface. That’s good, there’s a lot of depth to cover :).

Asking about sex affirmation surgery – a review of the numbers

Survey – should medicare pay for sex-change (italics by me) surgery – In one of the responses there’s an enlightening back of the napkin calculation of the potential costs of sex affirmation surgery, which point out important numbers about the prevalence of this rare condition. Much lower than the amount of emotion attached to the non-fact-based responses to the question.

Using the numbers quoted in the WPATH guidelines, I came up with this potential number of trans people in the US, based on 2011 census data:

MTF: 2495 – 9437 people over 18

FTM: 595 – 3911 people over 18

That’s for the entire United States. Some may require psychotheraphy, some may require hormones, some may require surgery, some may require none of these treatments, some may require all.

See: Now Reading: Choosing Wisely : Standards of Care for the Health of Trans People | Ted Eytan, MD

Now let’s discuss the question asked by Medpage today, especially in the context of this determination:

In June 2008, the American Medical Association (AMA) House of Delegates stated that the denial to patients with gender identity disorder of otherwise covered benefits represents discrimination, and that the AMA supports “public and private health insurance coverage for treatment for gender identity disorder as recommended by the patient’s physician.”[link]

The question that should have been asked is

“Given that sex affirmation surgery is recognized as medically necessary by every major medical organization and denial of coverage represents discrimination, should medicare refuse to cover this procedure when recommended by a physician?”

If you don’t ask a question with context, especially with regard to a population that is openly discriminated against in society, you are essentially asking respondents if they like the population or not.

It’s not much different than asking people in 1942 if African Americans should be admitted to white hospitals, or in 1993 if persons with HIV should be treated with modern medications. Going this route ultimately reveals more about the bias of those creating the survey than those answering it.

I wasn’t around in 1942, but I was in 1993. In 2013, we look back in horror at the way the medical profession treated other humans during that period.

I believe we will do the same when we reflect on how trans people are being treated today.

#nhssm : the RCGP’s Patient Online: The Road Map

#nhssm : the RCGP’s Patient Online: The Road Map
Recently the Royal College of GPs (RCGP) launched their Patient Online: The Road Map document which sets out how patients and GPs will be able to interact online over the next few years. I wondered how many patients actually knew that Patient Online existed.

Currently only 1% actually have access to any of the facilities, why? The answer is simple; the functionality has not been enabled by the practice. In fact only 37% of GP practices have actually enabled the functionality. As a patient I find that staggering. 42 million people have taken the time to register to say they wish to use the facility yet the “on” button hasn’t yet been pressed.

Washington, DC 2013 Sheroes of the Movement, Leadership

The Office of GLBT Affairs 2013 Sheroes of the Movement Award Winners – Lately I have been meeting people who have what I call I high “humility/experience” ratio. This is a compliment, it means someone who is approachable, and human, and has at the same time accomplished so much that it’s expected that they wouldn’t be.

Diana Bruce, Julie Ost, Reverend Dyan Abena McCray, Ruby Corado, and Ellen Kahn – View 2013 Sheroes of the Movement Award Recipients for Washington, DC on Flickr

Last evening I got to attend the Washington, DC government Office of GLBT Affairs (@GLBTAffairsDC) second annual Sheroes of the Movement Awards, which honor “five lesbian, bisexual and transgender women who have made a significant contribution to the GLBT movement and community in the District.”

A few things I learned just during this time together:

  • The average age when a child comes out as LGBT is now 12 years old. They need more support than ever in our schools and in their communities.
  • Transgender health support is inappropriately inadequate, I am not alone in feeling this, and specifically behind that for lesbian, gay, bisexual persons (and they’re behind the rest of society).

These women are years if not decades ahead of their time in changing society. And with all that comes with being a change agent, they are still open to all. As it says on the Casa Ruby web site:

Today, after 20+ years of precious life experiences with my LGBT family, Latinos and otherwise, I have the opportunity to continue to be the voice of those who can’t speak for themselves, I have the honor to continue to be in their life and tirelessly work to make their lives better.

Casa Ruby, is a Multicultural Latino LGBT Community Center, A Resource Center A Recreation Center, A Place You Can Call Home.

EVERYONE IS WELCOME

No matter where you are in your life, if you have nothing or maybe have all the material things but something is lacking, We Want You Here.

Leadership versus Followship

It’s wonderful in 2013 that so many other public officials are saying that they’ve changed their mind about equality – this bodes well for our society (and proves that love always wins). The reason they’ve changed their minds, though, is because of the work of the 2013 Sheroes of the Movement, who are the ones receiving awards. This is the difference between leadership and what I call “followship” – leaders are the people who say “this is the right thing to do, so we just did it.” Who would you rather follow….

Thank you Washington, DC Office of GLBT Affairs for introducing me to these women and for the powerful leadership lesson during 2013’s National LGBT Health Awareness Week.

Oh, and also, thanks Fathom Creative (@fathomcreative) and all of the other local businesses who supported the event. I’m used to coming to this space for monthly WordPress meetups, nice to know that community is created around many topics here :).