Photo Friday: Newest Addition to Health Care – Safe Bathrooms

2017.02.01 Shadowing Kaiser Permanente Kern County, California USA 00323
2017.02.01 Shadowing Kaiser Permanente Kern County, California USA 00323 (View on Flickr.com)

When I had the opportunity to shadow family medicine specialist and Permanente physician Michelle Quiogue, MD (@DrMicheQ) at Kaiser Permanente Kern County recently, I spied this, the first time I have seen the new all gender signage standards in the wild. Prior to this day, I had seen them in the signage standards guide but never in real life.

It was a great an unexpected moment – in Bakersfield, California. Great, almost moving, because I know the feeling of finally being “seen” after being invisible in society – any member of a vulnerable or underrepresented group knows this feeling.

I am reminded by the book “A Fortunate Man,” written in 1967 (!) about a primary care physician in England (see my review of it here, a must read for doctors). In it, the history of medicine and physicians is discussed, and one of the most important roles of physicians in society is to make people feel “comparable to themselves” when it seems they may not be, because of an illness or other condition:

He does more than treat them when they are ill; he is the objective witness of their lives. They seldom refer to him as a witness…that is why I chose the rather humble word clerk: the clerk of their records.

With regard to Bakersfield, usually the most great and unexpected things occur in the places that people don’t think about as much. The same feeling of greatness is true for the family medicine I saw practiced here, except maybe I’d say expectedly great 🙂 . Michelle happens to be the Diversity and Inclusion Leader as well as the Wellness Champion for the Kern County Service Area. And, the incoming President of the California Academy of Family Physicians – hence, the expected and observed greatness.

As of 2017, this type of accessibility for all human beings is required by California State Law (see: OSHPD Issues Guidance on All-Gender Toilet Facilities – California Hospital Association), so these signs should not be an uncommon occurence moving forward. Note that these should not be understood to be restrooms for people who are transgender, nor should the needs of people who are transgender or gender non-conforming be framed around bathroom access. This handy publication helps with that understanding: (see: Just Read: Debunking the “Bathroom Bill” Myth: Accurate Reporting on Nondiscrimination – A Guide for Journalists).

In the meantime, this week’s photograph shows that the world is learning to love better, and the part of the world that should be leading the most, health care, is doing its share.

Thanks to Michelle, her team, and her service area for showing me.

Additional photos from my visit below – can you tell I was very impressed with the innovation here…

Why some people don’t get a thank you for using my photos

Do I really mean thanks when I say thanks?

An esteemed colleague of mine asked me recently,

“When you say ‘thank you’ via social media to someone using your photos, are you truly thanking them?”

The answer is an unequivocal yes!

My photographs are Creative Commons Licensed, and meant to be used to promote the best of the human spirit. I want to give people credit for using the work, and amplify their work at the same time. Here’s an example:

I’ve counted 895 placements so far, and 99.9% of them deserve and receive a thank you.

When is a time I don’t say thanks?

This happens rarely, in cases where my work is used to further un-scientific or unhealthy discourse, especially directed at a group of people. In these cases, that I can count in the single digits over the past several years, I will revoke the license to use the work. Here’s an example of that:

December 21 2016
Ahoy Charisma News!
I see that you’ve used this photo of mine in this post of yours:
http://www.charismanews.com (Direct link removed due to triggering nature of the content)
As it is being used to promote non-scientific and inaccurate health information about #LGBTQ human beings, license to use the photo is revoked. Please remove my photograph from this web page immediately.
I am happy to educate you on the science behind gender at your convenience. Life is good for all humans in the 21st Century, trust me, I’m a doctor :).
All the best for a more informed future for you and the people you humbly serve.
Ted Eytan, MD
USA

In the example above, my work was removed quickly, and another (less interesting) image was put in its place. I appreciated that.

I’m posting this here so that it’s in the ether, and because I may refer people to this post in the future if the license to use my work is revoked. My interest is in the reasoning to be clear and everyone is treated with respect.

Before and with every termination notice, I always offer to educate about why something isn’t factual and not permitted with the use of my work. From this perspective the use of my work offers an opportunity to educate that might not have existed otherwise.

There are a lot of in-between circumstances where license to use is not terminated, and I just leave a comment or add to the conversation in whatever way is appropriate, based on my professional judgement. A Creative Commons license is meant to be used and I respect that as well.

Any questions, feel free to leave them in the comments or contact me via the form above.

Tab Hunter Confidential and Working to Be a Better LGBTQ Ally

Tab Hunter in Washington, DC  09957
Tab Hunter in Washington, DC 09957 (View on Flickr.com)
Tab Hunter

I had the opportunity to see Tab Hunter Confidential, and Tab Hunter (@TabHunterDoc) himself in Washington, DC, along with his partner of 30 years, Allan Glaser.

It’s kind of an amazing story, about a breathtakingly handsome actor (who still has a breathtaking quality), the last of the generation of contracted studio actors, playing top roles, but also hiding the secret of his homosexuality, in the 1950’s, along with many others. Some survived, some didn’t.

Beyond the impact to the person, there’s the impact to the generations of youth denied role models that could have supported their participation in society (or even saved their lives).

It’s never too late tell the story of the system that conspired against so many, and they serve as great role models today. Thank you, it matters.

Allyship in the 20th Century

In the 1950’s, being an ally included protecting someone from the discovery of their authentic selves by others, so that they could survive. As the documentary discusses, once Tab left Warner Brothers, the shield he once had from press scrutiny was no longer there.

Allan Glaser, Tab’s partner, chillingly said: “It may as well be 1928 in Hollywood today. Gay men who are actors are still reluctant to come out in fear of the impact of their career.”

The medical profession, as part of the same society, suffered from the same bias. And the far reaching impact was the same, many patients in the health system were denied empathy (the ones that survived), future physicians or physicians in training were denied role models and opportunity (the ones that survived).

Working to be an ally in 2015: Opportunity and Responsibility

We have great opportunities to do more in the 21st Century. With great opportunity comes responsibility, though.

Following the film I read these two pieces recommended by a mentor of mine, Garrett G, about what it means to work to be an ally (and note the phrase “work to be an ally”), in my case to the LGBTQ community, and specifically for people who are transgender or gender non-conforming.

So yes, it’s all the things working to be an ally suggests, and we can work to be them in a much more helpful way now, plus:

In No More “Allies” – BGD, Mia McKenzie says

It’s not supposed to be a performance. It’s supposed to be a way of living your life that doesn’t reinforce the same oppressive behaviors you’re claiming to be against.

So You Call Yourself an Ally: 10 Things All ‘Allies’ Need to Know — Everyday Feminism is extremely practical and to the point:

Stop Thinking of ‘Ally’ as a Noun: Being an ally isn’t a status.

..and there are 9 other things that I can relate to in my own journey.

And here’s what I’ve learned.

When I speak with Garrett and read and learn more, I realize that working to be an ally is confusing for some. What they might think is helping may not be, and may be attached to their own personal values, at the detriment of the values and needs of the people they’re trying to help. Garrett tells me about some of the behavior of people who identify as allies, and I am a little incredulous. It’s also easy for me to make that judgement from afar.

The reality is that I will never know what it is like to be a transgender person. Just as a heterosexual man will never know what it’s like to be me, and I’ve seen misguided attempts to become our allies, too.

I really like the idea of not using ally as a noun, and so I won’t do it anymore – I only want to be perceived as working to be an ally in the moment, and it’s not my call to make. I’ll always be working at it, which is great, lifelong improvement is what I signed up for.

Hi I'm Ted, Working to be An Ally, old designation 2015 2015-old
Hi I’m Ted, Working to be An Ally, old designation 2015 2015-old (View on Flickr.com)
Hi I'm Ted, I'm an Ally - new designation_ 2015-new
Hi I’m Ted, I’m an Ally – new designation_ 2015-new (View on Flickr.com)

It shouldn’t be easy, but one part of it is

Working to be an ally is hard – you will disappoint the people you are working to be an ally for – maybe because of a retreat into privilege, maybe a poorly thought through action or comment, a lack of humility at the wrong time (or any time).

At the same time, you’ll be the recipient of the bias heaped on the people you are being an ally for.

So? It would be much much harder to watch people, patients, members of my community, denied care, empathy, opportunity based on who they are.

The choice to work to be one is easy then, no complaints, piece of kale, it’s an honor.

There’s some science of relevance here…

Interestingly, I learned recently when studying for my Boards in Family Medicine (hooray!) about the “Developmental Model of Ethnosensitivity,” first written about in 1991.

Seven Stages of a Developmental Model of Ethnosensitivity in Family Practice Training
Seven Stages of a Developmental Model of Ethnosensitivity in Family Practice Training (View on Flickr.com)

When I apply it to the interactions I have, I meet people at all of the stages – lots of Stage 1 when it comes to people who are transgender. And maybe I was there too, a long time ago. Sub, or unconsciously I was/am, I have really noticed this fade in the last few years. You can review my implicit association test result here.

The idea is that we’re all in development, and progressing throughout our lifetime. That’s what the model says, what a coincidence….

The A word: Accountability

Becoming a better trans #ally is good for your health in many dimensions #activetransportation #walkingmentorship 2015-10
Becoming a better trans #ally is good for your health in many dimensions #activetransportation #walkingmentorship 2015-10 (View on Flickr.com)

I am the accountable one for working to be a good ally.

And yet, Garrett has been great for me and to me. He is not obligated to review my work and writing, and he does. He’s not obligated to provide coaching and guidance and he does. He’s not obligated listen to my perspective and he does.

It’s a great, unexpected gift. It’s not required and I value it immensely. It takes a lot of energy to do, and I think only some people are capable/interested in doing it. Maybe this model might spread for the people like Garrett and people like me who want to learn and change.

1928, 1958, 2018, and beyond

As Tab Hunter’s life experience shows, even the most gifted (appearance, wealth, talent, etc) can be denied the opportunity to participate in society, and in their own lives. I’m so glad his story is one with a happy ending, because of the so many that were not (Anthony Perkins, Rock Hudson).

Today there are still people being denied the opportunity to participate in their own lives, at school, in the workplace, in their families. Some take their own lives instead of being who they are.

This is perfectly tuned to what I say about patient empowerment in health care:

1. It’s the doctor’s job to bring the patient story into every conversation
2. Then it’s the doctor’s job to bring the patient into the conversation
3. Then it’s the doctor’s job to have the patient tell they own story and get out of the way

There’s no loss of power or professionalism in this approach, remember, the science above – not minimization, integration.

In this generation, we have the opportunity to do a lot more than protect someone from the visibility of their authentic selves, and I’d like to leverage it, of course, because I and we can 🙂 .

Thanks a ton, again to my mentor/trainer Garrett G. You can read more about our relationship here: WAIT = Why am I Talking? Learning how to be a better Ally

I wish all of this on every doctor and nurse in their lifetime, if not sooner….

Photo Friday: 7th Street, NW Rising, as taken from the beautiful LEED Gold AAMC headquarters, Washington, DC USA

7th Street NW Washington DC USA 08531
Association of American Medical Colleges Headquarters Washington DC USA 08531 (View on Flickr.com)

This week’s photograph was taken from the roof on top of the beautiful, LEED Gold-certified Association of American Medical Colleges (@AAMCtoday) headquarters, situated in historic Mt. Vernon Square, in Washington, DC.

The view itself is a brand new vantage point (since 2014) of a historic street, destroyed once in 1968 following the assassination of Martin Luther King, Jr., and devastated again in the late 1980’s and 1990’s by an uncontrolled drug and murder epidemic, just 1 mile from the White House.

I’ve posted photos of 7th Street and the 1968 damage here: Photo Friday: Progression Place, Washington, DC.

This book, by Ruben Castaneda (@RCastanedaWP) tells the story of 7th Street in the Marion Barry era (see: Just Read: S Street Rising: Crack, Murder, and Redemption in D.C.)

In the upper left is the 7th and O market, where 8 people were shot and 1 killed in 1994, and now houses the largest grocery store in Washington, DC. Catholic University is in the upper right. On the left is the Washington, DC, Convention Center. In the foreground is an area cleared for new development, that can only be appreciated from this vantage point.

I was at the AAMC because I am a member of the Axis Committee, (I said yes: AAMC Advisory Committee on Sexual Orientation, Gender Identity and Sex Development) whose work is getting under way, and holds great promise for a future health system that’s respectful of all.

Thanks Tiffani St. Cloud (@TStCloud) for the tour and for supporting this work. The rest of my photos are below, showing the majestic parts of the city. I always prefer the parts where people learn and grow the most, though 🙂 . Enjoy, comments always welcome, and Washington, DC never stops being beautiful.

You can read more about the headquarters and the AAMC here: AAMC Dedicates New Headquarters, Learning Center for America’s Medical Schools and Teaching Hospitals – News Releases – Newsroom – AAMC

The Stunned Silence in front of the White House in Rainbow Colors

Celebrating a new America #lovewins 58234
Celebrating a new America #lovewins 58234 (View on Flickr)

I wanted to capture the relatively stunned silence of the very large crowd that gathered in front of the White House (@WhiteHouse) as it lit with the colors of the rainbow.

Stunned because of the recognition that a symbol, an institution, that for so long explicitly excluded Americans from the opportunity to achieve their life goals was now in complete opposition to its past, in the most beautiful way.

My community colleague Susannah Fox (@SusannahFox) and I once went on a walking meeting and stopped in front of it during this time period (pre-2008) with this understanding in mind. It was hard to reconcile the respect for the office on the one hand, and its behavior on the other hand.

Now, it’s hard to believe that other White House even existed. It serves best as a distant memory of a past generation.

Institutions are not static. Our generation has the power to change everything. Love always wins 🙂 .

More photographs of the moment are here. All are creative commons licensed, feel free to use.

Photo Friday: Learning Detour, Long Point Light Station, Provincetown, MA, USA

Provincetown MA - Women of Color Weekend 56393
Long Point Light Station (View on Flickr.com)

This week’s photograph is not from DC, as I spent more than a little time away from my favorite place to further my leadership learning @HBSExecEd .

The photo is taken from the top of the Pilgrim Monument, at the tip of cape cod, and shows the Long Point Light Station, an iconic feature of the cape cod seashore.

Provincetown is a beautiful, inclusive, welcoming community, the perfect place to go to remind one’s self about the origins of our country and the diversity of people we get to serve.

More photos below, enjoy.