“He was REALLY a…”

Okay, time for a little rant about Dr. Elitism. Dr. Elitism is a physician who lives inside all doctors, just waiting to pop out and say something great. Here’s one of my personal favorite lines:

“(S)He (thought/seemed/appeared) (s)he was X, but really (s)he was Y.”

Dr. E loves this phrase because it gives Dr. E the opportunity to show someone hir “real” self. Dr. E went into medicine because Dr. E loves diagnosing people, which to Dr. E means telling people what’s wrong with them and what to do about it. Dr. E seriously gets off on discovering “the truth.”

Sometimes, that drive is important. For example, it’s nice to inform a patient whom you’ve just discovered is insulin-resistant about hir condition and what might help hir manage it. This is not what Dr. E does. Dr. E doesn’t help patients manage their health, Dr. E tells patients what they should and should not be doing. I know that can be a difficult distinction to imagine, but those concepts are definitely different.

So, what brings me to Dr. Elitism today? One of Dr. Elitism’s favorite topics is Trans people. Why does Dr. E love transgender folks so much? Because they give Dr. E a chance to use this phrase:

“The patient appeared female, but was (biologically male/actually a man/had a penis/wasn’t really a woman.)”

“But MA!” You say to me, “isn’t that true? Isn’t a pre-operative transwoman biologically male?”

Yes and no, I say. Unfortunately, medical definitions of biological sex remain quite stringent and unreasonable. One of my personal favorite (non-medical) takes on this issue is Not Your Mom’s Trans 101 by Asher Bauer. Profanity aside, Bauer makes some excellent points that the medical community could wise up to, especially this one:

Sex is no more an immutable binary than is gender. There are intersex people who are born with non-binary genitalia, as I have already mentioned. There are people with hormonal anomalies. In fact, hormone levels vary wildly within the categories of cis male and cis female. Chromosomes, too, vary. If you thought “XX” and “XY” were the only two possible combinations, you have some serious googling to do. In addition to variations like XXY, XXYY, or X, sometimes cis people find out that they are genetically the “opposite” of what they though they were– that is, a ‘typical’ cis man can be XX, a ‘normal’ cis woman can be XY.

So what standards are we actually using to define biological sex? This is a topic that I will return to many times, I’m sure. Certainly, though, the penis/vagina binary is no good, and other secondary sex characteristics are similarly variable. I’m leaning towards believing that medical histories need to be much more complete in terms of sex characteristics, and much less “I wrote female which thereby means the patient has this, that and the other thing in her body.”

How does this relate to Dr. Elitism? Well, Dr. E, language is very important. Instead of the above statement, Dr. Inclusive would have said,

“My patient was a #-year-old female with (body parts, etc). She complained of (something which is relevant to her body parts.)”

Need a more specific example?

“My patient was a 55-year old transgender* female. Her medical history is notable for vaginoplasty, breast augmentation and 25 years of estrogen supplementation. She came to the clinic for a pelvic exam. Upon examination, I found a dark patch on the wall of her vagina, and subsequent testing revealed this to be a melanoma. Surgery was able to achieve clear margins without significant damage to the vaginal wall. I have recommended her for follow-up pelvic exams to monitor her for subsequent neoplasms.”

Well, I think it sounds pretty good. See yah, Dr. Elitist!

*There is debate as to whether to describe this patient as “transgender female” or “female with transgender history.” What do you think? Comment in the comments!

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3 Responses to “He was REALLY a…”

  1. Steph says:

    i think in “dr. inclusive’s” history should read “transgendered female.” Not as a dig or an insult, just to give a clear picture to any other medical personnel that might need the record (who aren’t as open minded.) If he writes “transgendered female,” then anyone else picking up the record knows that though she is now female (and identifies as such, and maybe always has) she was born with other parts and had them at some time in her life which may still be pertinent to her health (like a prostate!)

    Sorry, i think of all the “cover your ass” things that could be a big deal if you don’t document them. Me? I’m a lesbian that’s currently partnered with a man. Go figure.

    fyi- did i tell you about the hermaphroditic pug we tried to “spay”? Ok so Daisy the female pug comes in to be fixed, so we do the usual. Shave, scrub, and make an incision on her abdomen. The doctor digs around for a while and CAN.NOT.FIND a uterus or ovaries. IT’s just not there. But he DOES find these two weird roundish things that kind of look like undescended testicles. In the place where undecsended testicles would be. So he removes them and sends them out for pathology.

    It took a couple days for the path to come back, but they were testicles! In the meantime, we were examining her – and her vulva (which looked like a very normal dog vulva) and there was a very small PENIS that you could push out of it- very much the way a boydog keeps his penis in the sheath most of the time. WHAAAA??? Daisy the pug was a hermaphrodite!

    Her owners (which were an elderly couple) were a little thrown by it all- but daisy is still happy and healthy as far as i know (and yes they kept the name and still identify her as female.) But still- does she have a prostate? is she at risk for prostate cancer? we don’t know. If she gets bladder stones someday is she at risk for an obstruction? maybe, moreso than an average textbook female dog. Either way, it was a neat case to be a part of. I may never see anything like that again. I love explaining that one to other techs.

    However we’ll never know if daisy really identifies as male. Maybe she’s really not into her pink collar…

    • Steph, you make an excellent point. I still have yet to decide for myself if Dr. I needs to include “transgender female” as part of hir patient history. Is it necessary for patient care? That probably makes the biggest difference. In this case, it’s probably relevant. I certainly wouldn’t call say Dr. Inclusive is no longer inclusive for using the word “transgender” when appropriate!

      Great story on Daisy the pug! I find it interesting that we have such trouble with gender that even in other species we require Daisy wear certain color collars. I hope they find out what Daisy’s health concerns are so their dog stays as healthy as possible!
      ~M.A.

      • Steph says:

        I know- weird huh? even MY new girldog has a pink collar. WTF? That’s it, now i gotta go out and get her a tough spikey one… My dogs don’t have gender roles, maybe that’s why i like animals so much. But it is fun to joke about. Daisy the hermaphropug has a long life ahead of her, no issues yet that i know of, but when she’s older and develops something it will be of interest, i am sure…
        *********
        I mean, if the patient is trans and is in the ER for stitches, no big deal. If the patient is having some systemic disease (in this case cancer) it is totally relevant- because the prostate could totally be involved. Testosterone could play a part. Etc. History is SO important…

        (i am just hyper aware of this. write EVERYTHING down. Something insignificant could become significant. Cover your ass.)

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