https://www.nytimes.com/2017/04/13/w...ency-room.html

"These holes in medical education and training can cost lives. Over 70 percent of transgender people nationwide say they have experienced serious discrimination in a health care setting. A third of transgender people postpone — or completely avoid — seeking health care because of the fear of discrimination. One in five have yet to disclose their transgender status to any medical provider."

This isn't a hole in medical education. This is simply ineffective communication or a larger societal problem depending on your views. If you expect patient centered care then the patient has to play an active role. You can't treat people that don't show up. You can't read their minds either.

Transgender patients account for less than 0.5%(?) of emergency room visits. 100% of a transgender person's ER visits will involve one. The author seems to absolve the patient from any accountability though.

This article is an example of how social commentary starts spreading into things it's not by presenting itself as quasi medicine.

It's a reasonable expectation that a patient be treated with dignity and respect regardless of race, sex, religion, age, etc. It's also a reasonable expectation that a patient give their health care provider accurate information to the best of their knowledge.

The article specifically applying this to emergency medicine is even more off base because it's probably less pertinent in this setting than other fields such as pediatrics/adolescent medicine, other primary care or psychiatry.

What can be ambiguous and an emergency medicine provider specifically needs to know in most cases is probably only:

-Sex
-Surgical history
-Medications

The rest of the stuff about how to address someone, preferred pronoun, being sensitive, etc is just simply about being nice person. It's not about medicine.

Piss off.

F off.

This would be fixed by..... *reads talking points* .... health savings accounts.

Good article. It's not clear to me what your point is. You don't seem to blindly hate trans people, and reading your long post doesn't really clarify your gripe to me.

Like this is an article that says "we don't learn **** about trans people, and maybe that contributes to their negative experience with the healthcare system. Let's take some extra time in med school to learn about how to better treat them and make their experience more positive." Seems like nothing can be less objectionable.

Your read is off.

1. You can pursue this to no end. There is only so much you can cram into 4 years of medical school. Which groups/religions/populations do you place special emphasis on? Why them and not others? If the background emphasis throughout medical education is that all patients deserve to treated with compassion then you don't probably need to spend extra time on this group or that group.

2. What is the objective of medical school? Should the emphasis be placed on "making someone's experience more positive" or diagnosing and treating disease? Are we trying to train doctors or PR spokespeople?

3. No one wants to be treated by an *******. If I had to pick one extreme from the other though, I'd rather have an excellent diagnostician that's socially awkward than someone that makes me feel good as a person as they simultaneously misdiagnose me. I have a problem with issues like this potentially taking away from education time focused on pathophysiology, physical exam skills, clinic time, etc.

4. In my experience, this is not something you can "teach" someone anyways. If someone is an insensitive prick in their early twenties when they get to medical school, you can spend all 4 years on classes about cultural sensitivity and that person will still likely graduate a prick.

5. This would not be at the top of my list of how we can improve medical education or emergency room care. I'm not completely dismissive of it, but I think it's very low yield as compared to many other things. If anything, residency is a more appropriate time to focus on specific populations one may treat. The time spent in medical school is better spent on other topics.

Uh, doesn't this just amount to referring to people in the way that they request? Seems like pretty basic human courtesy.

There is a trend in medicine to treat patients, whenever possible, as autonomous individuals, capable of making informed decisions as to their care. That's a good thing. The surprising part should be that that wasn't always the case.

It probably amounts to an hour's worth of instruction too on how that courtesy interacts with being transgendered.

Is this Dr. Ikes' return?

Oh, I see. We should only train doctors to be nice to cis straight white Christian men, because then they'll be optimal for you.
If you don't think the answer is both, then you know nothing about being a doctor.

Cool? Again, you expect every doctor to be optimal for exactly you, and other people who aren't like you can **** off.

Totally false. Just because sensitivity classes don't work for you doesn't mean they don't work on other people.

It's not low yield. It's low yield for you.

Also this, but "transgender" as an adjective, is the preferred nomenclature.

4. In my experience, this is not something you can "teach" someone anyways. If someone is an insensitive prick in their early twenties when they get to medical school, you can spend all 4 years on classes about cultural sensitivity and that person will still likely graduate a prick.

Well, if you're trying to change their soul, you may be right.

OTOH, since every doctor in any sort of hospital practice is hammered with patient satisfaction survey data, Press-Ganey scores, etc. etc. with significant financial implications (and job security ones as well), behavior in my experience gets modified pretty quickly.

MM MD

There is a trend in medicine to treat patients, whenever possible, as autonomous individuals, capable of making informed decisions as to their care. That's a good thing. The surprising part should be that that wasn't always the case.

Well, sort of.

The whole issue of patient autonomy and informed consent is a very tricky one, and I’m pretty sure the high water mark was when I was in training. We went to workshops, had group discussions about empowering patients, and so forth.

It sounds good, and on the balance I think it’s a good idea, but the reality is a bit different. A couple of years ago I noticed a lump on the right side of my jaw. Figured it was a lymph node, but it didn’t go away, so I saw an ENT and had an MRI which showed a salivary mass. Biopsy was benign (THANK GOD) but it was sitting right on my facial nerve. Followed up with ENT doc,who outlined treatment options but strongly suggested removal.

So I had it out. Because I may be a professor of medicine, but not in ENT, and I’m trusting a professional to do the right thing.

So how informed consent can be isn’t clear. It isn’t (and pretty much can’t be) a discussion based on equal knowledge/information. Sure, I did some reading, but in the final analysis I went with her expert advice. (Probably the smartest thing a patient can do is get a good doc.....)

Where this stuff gets even tougher is in the high risk high reward stuff like acute stroke care. If you suddenly can’t move your right leg and can’t talk, and you’re rushed to my ED I’m going to scan your head, tell you you’re having a stroke and you need Alteplase RIGHT GODDAM NOW. I’ll run over risks and benefits, you’re going to hear and understand about 15% of what I’m telling you because you’re (rightly) scared to death and you’re almost certainly going to consent. How informed that is, and how to improve it I have no idea....

MM MD

ikes was even more obnoxious toward transgendered people. IIRC he delighted in calling them mentally ill.

That was never said. I simply questioned how specific groups are singled outed for extra training and others may not be.

Why not Muslims? Exposure is integral to a physical exam. There are certainly culturally issues with regards to wearing a hijab. Many would prefer another Muslim provide them care. This is not going to happen in your average US ER. Many Muslim females prefer a female provider. This often cannot be accommodated in the emergency room either.

You could go on and on about groups x,y and z and their cultural nuances. I do not agree that there should be significant time spent on this beyond: "Be nice to people."

I think our society's expectations are skewed, not mine. I expect my doctor to be competent and I hope they're also reasonably nice.

It's an ER. The priority is to identify and treat life threatening disease. Wanting to go out for a beer with the doctor that diagnosed your PE or drained your peritonsillar abscess is secondary.


We agree. If you're an angry, hateful person then this may be high yield. For everyone else, it's not.

Being nice is not a cure all, because many people may be ignorant of ways they are not being nice to people unfamiliar to them. Why is an hour's sensitivity training some onerous burden? Which groups besides transgender people feel like their needs are not being met by doctors also should not be the subjects of specific sensitivity training?

It is well known that transgender people face a lot of employment discrimination and are far more likely to be uninsured than cisgender people. That's not their fault, and I know a great way we could fix it. Universal Health Care.

It's not an unreasonable burden but it's not necessary either.

The article is misleading. Most of it's claims are based on nothing more than surveys. I guess I have higher expectations that decisions about medical education actually be evidence based.

Ask Hobbes about what kind of responses you get from people filling out surveys concerning their medical care. They range anywhere from legitimate to completely asinine.

For example, your average female ER physician has probably lost track of how many times a patient has told someone or even filled out a survey complaining about how they never saw a doctor during their visit. This is despite the physician introducing themselves as Dr. X, wearing identification with their title, wearing a white coat, scrubs, having a stethoscope, examining them, ordering tests/medications, explaining findings, discussing follow-up and return precautions, etc.

It's wonderfully ironic how a patient can be oblivious to all of this and assume their female doctor was actually a nurse/phlebotomist/with food services/custodian/whatever and then go on to complain about how they were treated with whatever bias.

Perception may equal reality in many situations. It shouldn't in science. What we see as real is defined by our belief structure. Medicine needs to be more objective than this.

I am very wary/skeptical of articles like this. Why? We're currently dealing with an opioid crisis. In the 90s there was a big initiative to treat pain as "the fifth vital sign." It wasn't based on good evidence. We're now bearing the fruits of this.

More and more decisions about medical care are being based on surveys (fraught with bias) like this article cites. I believe the intentions are good, but medicine is a realm which should remain apolitical.

Ignoring trans people is not apolitical. It is differently political.

You may not like surveys, but your counter is just your gut feels.

**** off

I really don't know what this whole thread is about.

If a patient wants be to addressed by whatever pronoun they desire that should just be common courtesy to do that as a health care provider. Even if you personally think its stupid.

To me it's the same thing as religious beliefs. I'm sure many doctors are atheists, and think religion is stupid, but hospitals have all types of religious provided to pray with patients, give them rites, etc.