Friday, September 16, 2016

The Doctor Will See You Now… Maybe

For many trans people they are afraid of going to the doctors and they have legitimate reasons. In the 2011 survey “Injustice At Every Turn” they found that 19% of us have been refused medical care and 50% of us reported that they had to training their doctors.

So this will not be a surprise for us…
Transgender patients face fear and stigma in the doctor's office
By Daniel Trotta
September 15, 2016

Tanya Walker had lung cancer and was coughing up blood, but she says her emergency room doctor kept asking about her genitals.

"It seemed like they weren't going to treat me unless I told them what genitals I had," Walker, a 53-year-old transgender woman, activist and advocate, said about her 2013 experience in a U.S. Department of Veterans Affairs hospital in New York. "I felt cornered."

She experienced a stigma shared by many transgender people. The same rejection they confront at home and in society can often await them in the doctor's office, where many report being harassed, ridiculed or even assaulted.
Walker said the doctor who was distracted by her sex organs misdiagnosed her lung ailment as tuberculosis. He gave her antibiotics and sent her home. Three months later she discovered she had lung cancer, Walker said, though she is now cancer-free.

Some doctors acknowledge their profession is woefully out of date.

"We have a lot to apologize for in the medical community. Our treatment of transgender people has been abhorrent," said Dr. Aron Janssen, founder and director of the gender and sexuality service at New York University Langone Medical Center.
What will happen if I was in a traffic accident? What if I was down south and something happen? Would I get the best treatment or will they just fluff me off?

Someone I know here in Connecticut slipped and fell on some ice and when the emergency room staff found out she was trans they sent her home and told her to see her doctor in the morning. Her doctor found out that she had fractures in her spine and hip.
Private insurers are also at the vanguard, changing record-keeping systems so that, for example, a transgender man who has legally changed his identity documents but is still capable of getting pregnant will not be denied obstetrics and gynecology care.

There are still a lot of insurance companies that try to wiggle out of it anyway they can. I have a hard time getting my prostrate test paid for during my annual physical and Medicare has a special code for us,
B. Policy: For Part A claims processing, institutional providers shall report condition code 45 (Ambiguous Gender Category) on any outpatient claim related to transgender or hermaphrodite issues. This claim level condition code should be used by providers to identify these unique claims and also allows the sex related edits to be by-passed. The CWF [Common Working File] shall override any gender specific edits when condition code 45 is present and allow the service to continue normal processing.

For Part B claims processing, the KX modifier shall be billed on the detail line with any procedure code(s) that are gender specific. The definition of the KX modifier is: Requirements specified in the medical policy have been met. Use of the KX modifier will alert the MAC [Medicare Administrative Contractors] that the physician/practitioner is performing a service on a patient for whom gender specific editing may apply, but should have such editing by-passed for the beneficiary. The CWF shall override any gender specific edits for procedure codes billed with the KX modifier and allow the service to continue normal processing.
So if you are a trans man and you need a Pap Smear it should be covered and for us PSA should be covered. These codes all the doctors to treat the body, not the gender.

UCSF Center of Excellent for Transgender Health says this about Prostrate exams,
Prostate cancer
Documented cases of prostate cancer in trans women with a variety of hormone use and surgical histories have been reported.[1-3] Most cases of prostate cancer in trans women have been in individuals who started hormones after age 50; such cases may actually represent occult neoplasms, which existed prior to initiation of hormone therapy.[4] In a cohort of 320 transgender women in Belgium who had undergone vaginoplasty, PSAs along with transvaginal ultrasound and digital vaginal examination of the prostate revealed lower PSA and prostate volume than what would be expected in a non-transgender men of corresponding age.[5] Some anti-androgens, such as 5-alpha reductase inhibitors have also been documented to decrease the PSA result.[6] Removal of gonads in addition to estrogen exposure likely reduces risk for prostate cancer and benign prostatic hypertrophy.[4,5]

Regardless, primary care providers should remain aware of the possibility of prostate cancer in transgender women, even those who have undergone gonadectomy. The decision to perform screening for prostate cancer in transgender women should be made based on guidelines for non-transgender men. If a prostate exam is indicated, both rectal and neovaginal approaches may be considered. Transgender women who have undergone vaginoplasty have a prostate anterior to the vaginal wall, and a digital neovaginal exam examination may be more effective.[5] It should be noted that when PSA testing is performed in transgender women with low testosterone levels, it may be appropriate to reduce the upper limit of normal to 1.0 ng/ml.[4]
Some trans women believe they don’t need a Prostrate exam, fine. It is your life and if you want to gamble with it go right ahead. For me, I rather have a moment of discomfort for a year of protection.

1 comment:

Janet said...

This happened to me after I was involved in a automobile rollover in central NH in November, 2014. After I was brought in by ambulance, once the staff found out I was pre-op, they left me in a room off the emergency room for 11 hours, focusing solely and repeatedly on "Who is going to come get you?" and ignoring the fact that I was starting to go into shock.

After four hours of increasing abdominal pain and inability to pass any urine, I insisted that they perform an ultrasound on my sole kidney (I'm a cancer survivor). They grudgingly performed the ultrasound, and after ignoring my reporting that an ultrasound performed just 7 days prior had shown the kidney to be of normal size and shape, told me that the reason my kidney was swollen to twice its normal size and grossly distorted from its normal shape because I probably had kidney cancer, and I should make an appointment with an oncologist, and that there was nothing they could do for me.

They ignored my request to speak to a doctor, or a kidney specialist, or anyone with knowledge of either cancer or urology, and refused to either admit me or treat me. I was pushed out the door with a voucher for a taxi ride to a hotel (which I paid for out of my own pocket). Mind you, I'm covered by Tricare, since I'm retired military, so it wasn't that the hospital wasn't going to get paid if they treated me. It was bad enough that I insisted that I be transported to the nearest VA hospital, because I told the patient care representative (who wandered in to see me 10 hours after I was brought in) that I knew that I wasn't receiving the proper care at her hospital. The hospital refused to even notify the VA.

Three days later, when I went to see my own doctor, I was immediately hospitalized for eleven days because my kidney had shut down completely and had to undergo repeated sessions of dialysis before the kidney resumed functioning. My doctor was absolutely -bullshit- about the way I was treated, maldiagnosed, and shoved out the door.

Consider the fact that my sister-in-law has worked for this same hospital for over fifteen years. When my brother was brought in to them with cancer later the same month, all they did was transfer him to a hospice. Where he died shortly thereafter.

If you are ever in NH, do not allow yourself to be taken to the hospital in Manchester. Go anywhere else. Your life depends upon it, whether you're transgender or not. If they treat family members of their own employees this way, imagine how you will be treated as someone with absolutely no connection to them.

All of this contrasts with the care I received in the hospitals in Gloucester, MA, where my doctor practices, and Burlington, MA, where I was taken because they have a unit specializing in treating kidney problems. It didn't matter to them that I had male plumbing and presented as a female; I was treated with respect and concern by every member of the staff I came into contact with. All of the followup visits were conducted in a professional manner, and in April, 2015 I was cleared medically just a week before my GRS in Montreal.