Sunday, May 06, 2018

I’m Not A Big Fan Of Telemedcine

Somehow I am more comfortable sitting in the doctor’s office than sitting in front of a computer screen.
Telemedicine Takes Transgender Care Beyond The City
NPR
By Keren Landman
May 5, 2018

At an outpatient lab in Tifton, Ga., where Karen Williams gets her blood drawn, a clerk looked from her computer screen to Williams' printed lab order, then back again.
"This is not right," the clerk said, squinting at the lab order. There, the birthdate and address matched the ones on the screen, but the name displayed was a male one.
A transgender woman, Williams lived as a man for nearly 50 years before beginning to make physical changes several years ago. She's grown out her hair and has gotten most of an old goatee lasered off. One of the things that hasn't changed, however, is her legal name – so in most health care situations, she usually uses her old name and driver's license.
[…]
For many transgender people, moments like this, when a health care worker first becomes aware of their gender identity, are often fraught with fear and anxiety.
This is always hard for us, coming out to healthcare* providers; many of us avoid going to healthcare providers because of our tangled identity documents. Our driver license might show a different name or gender than our medical records and even when the documents are in agreement we have to out ourselves to make sure we get proper medical coverage.

But then we still need to find doctors who will treat a trans patient.
Williams has a primary care doctor at a family practice in town, where framed Bible verses hang on the wall and Christian music plays in the waiting area. When she felt ready to begin taking hormones for gender transition, she didn't bother asking her local doctor. Instead, she made an appointment with Dr. Izzy Lowell, a family practitioner who specializes in caring for transgender and gender non-conforming people. But Lowell is based in Atlanta, a three-hour drive away.
And now thanks to the current administration healthcare providers can legally refuse to treat us, and it may even override state non-discrimination laws.
It's those patients Lowell had in mind when she opened QMed in the late summer of 2017. The practice offers care exclusively to transgender and gender nonconforming patients in the southeastern United States. Lowell's intent was to lower the barrier to access for adults and adolescents living in rural parts of the region. In less than a year, she's been able to do that, with only occasional hiccups.
[...]
In a study of rural sexual and gender minorities, 14 percent of transgender people reported traveling more than an hour to see their primary care provider – not necessarily the doctor who provided gender-related care. And in a 2017 survey by the Center for American Progress, 30 percent of transgender people living outside metro areas said it would be very difficult or impossible to find an alternative to their existing provider.
Okay as I said I am not a big fan of telemedicine, I feel there’s a great advantage to being there in person rather than a remote location. Body language tells a doctor a lot about how you are feeling, you might say everything is great but your body language says otherwise.

One other concern that I have is licensing…  I know there has been talk on WPATH elist and also in NASW about licensing of providers who are telehealth providers with patients not in their state where they are licensed. Questions arise about the need to be licensed in the state where the patient resides, telehealth are raising some questions that need answers. If you are in a state with minimal licensing requirements and your patient is in a state with stricter standards which state takes precedent?

But I have to admit that for patients who do not have access to a trans friendly healthcare provider this can be a blessing.

*I use the term “healthcare providers” because more and more of us are seeing not just MDs but also APRNs and Pas, RNs, therapist, and we also see a large number of lab techs and other specialists who are not doctors.

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