Just Read: A Transgender Military Internist’s Perspective – #WhatADoctorLooksLike

This article, published in JAMA Internal Medicine describes the personal journey of a physician who is now serving as their authentic self:

…today I serve as a female physician in every respect within the Department of Defense. Last month, I graduated the Army Medical Department’s Advanced Course with honors, and now I look forward to the sec- ond half of my military career being treated like any other capable military physician.

The commentary, by Jamie Henry, MD (@MAJ_JLee_MD), concerns another paper in the journal

Schvey NA, Blubaugh I, Morettini A, Klein DA, KL M, G B. Military Family Physicians’ Readiness for Treating Patients With Gender Dysphoria. JAMA Intern Med [Internet]. 2017 Mar 13 [cited 2017 Mar 16];104(7):e5–6.

which, sadly, shows an important part of our profession unprepared, and in some cases, unwilling to provide care to their patients in need.

Depending on how full your glass is, the figure that 76% say they can provide “non-judgemental care” is either good or bad.

  • Good, because 24% admit that they have bias. To not admit bias leads to more harm and errors, multiple studies show this.
  • Bad, because 24% of physicians will provide care in a biased fashion, which is harmful
  • Good or bad: The 76% who say they can provide “non-judgemental care” may have hidden biases. The literature here is also helpful – there is the “illusion of objectivity” which describes the idea that people who believe they are not biased can be the most biased in their behavior (see these posts on my blog about this).

As Dr. Henry states, there is still a long way to go.

At the same time, how incredible is it that a person can have this aspiration, and fulfill it, because the only prerequisite is that they are human.

I went to medical school for a number of reasons, but primarily I wanted to heal—myself and others.

  • heal society too, which is what will happen, as we change forever #WhatADoctorLooksLike

Also noting the work of Jesse Ehrenfeld, MD – @DoctorJesseMD – working to be an ally for the LGBTQ community.

Love this century 🙂 .

Photo Friday: Networking the soldier – innovation around every corner on #walkingmeetings

This photograph is from the Ted archive, however it has not been posted until now. It shows Kaiser Permanente colleague and innovator Alex Lowenthal ( @Alex_inPDX ) being shown new technology at the AUSA Conference, held in Washington, DC, in October, 2011.

How did we end up here? Well, Alex was visiting from Kasier Permanente Northwest ( @KPNorthwest ) and when we went on a walking meeting, we happened on the conference and went in. I took some photographs (with permission) about many of the innovations that we saw:

  1. Weapons systems that seem tailored for the Facebook generation – you tag targets, and then eliminate them
  2. Huge investment in mobile technology
  3. Electronic noise filters that separate targets from the background
  4. Workforce planning – thinking about networked workers, planning for a good career AND a good life

Of course, we saw many analogies to the health care industry, and felt that maybe we are not thinking as much about the next generation of our workforce (and our patients) as we should. The rest of my photographs are below, see if you agree.

This week’s photograph also tells the story of an innovator like Alex, who’s open to new experiences, and curious to learn what he doesn’t know from teachers around every corner.

Don’t Ask Don’t Tell repeal is a big deal for the medical profession : The end of “if”

Did your family doctor/pedatrician ask you when you were a kid, “what do you want to be when you grow up?”

When you told her/him the answer did he/she say,”I’m sorry, you can only be a policeman/fireman/teacher/brigadier general ‘if’.”

I’m sure they didn’t – they were asking, like I would ask any patient, to tempt you with your future potential and begin a lifelong healing relationship, to be available to you as your parents would be, to help you achieve your life goals. The doctor patient relationship should be the last place where constraints are placed on a person’s achievement in health or in life.

The repeal of Don’t Ask Don’t Tell brings us closer to the end of “if,” as in “you can realize your life’s potential ‘if’ you are a…”  man/white/heterosexual/etc etc.

The medical school class after mine was the first one that had more women than men in it. No one knew how many lesbian, gay, bisexual, or transgender students there were, they didn’t ask.

The American Medical Association took a strong stand against Don’t Ask Don’t Tell. It called for a full repeal in November, 2009, and these letters were sent to Congress in support. I applaud their efforts.

This piece was published in the New England Journal of Medicine, written by Kenneth Katz, and discusses the health hazards of the policy, which harms the therapeutic relationship between patient and physician. (It’s behind a paywall, but you can find a blog post by the author here)

This change is great, both for the makeup of the medical profession, and the way we are able to support the people we serve. Health care is healthier, communities are better off, when more of a person can be brought into interaction. This applies not only to diversity but all kinds of participation.

One of the coolest, I’ll say touching bordering on tearful, experiences I had in November, 2008, was when I was shadowing in a medical office:

A mother was there with her child, a boy aged about 5. I asked him what he wanted to be when he grew up. He said, “The president!” I don’t know who said what came next, but it was said:  “and now you can be.” This was an African American family. 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 15664
  • 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
  • Boy Scout Memorial 19242
  • 2013 Rally for Transgender Equality 21169
  • SCOTUS  26251
  • March on Washington 2013 29383