Thursday, January 11, 2018

The Doctor Is In

But is “in” for us? Or do we still need to go find a trans friendly healthcare provider?

Healthcare and insurance have been a big thorn in our sides and with the current administration it could get even worst.
The Future of Transgender Healthcare Is Online
Transgender patients often travel long distances and pay more for less-than-competent medical care. But as doctors embrace virtual treatment models, those problems may soon be obsolete.
By Keren Landman
January 10, 2018

M, who is non-binary and transgender, first sought care for gender dysphoria at their local Planned Parenthood clinic in South Carolina. (Because M has not disclosed their transgender status at work, they requested anonymity for this story.) The staff there was very caring, they said, but the clinic was underfunded and understaffed, with a long waiting list for follow-up appointments. "It was almost like musical chairs," said M, "with more people than seats." When M began taking hormone therapy for gender transition, delays in care led to month-long lapses in hormone prescriptions, resulting in an emotional and physical roller coaster.
The demand for affirming, competent transgender care far outsrips what’s available, and in rural areas, physicians able to provide that care are often few and far between. By bringing doctors as close to patients as their nearest high-speed internet connection, telehealth offers a potential solution to that gap.
And it is going to get worst with Planned Parenthood possibly being cut from the federal budget. Planned Parenthood is one of the biggest healthcare providers in the nation for trans people. Maybe in the cities and on the coast finding healthcare for is not as bad as that in the rural areas but it is still hard to find competent providers; I can’t imagine what it is like in rural West Virginia.
As a result of all of these factors, transgender people living in rural and exurban areas are often faced with a vacuum of physicians willing to perform the bread-and-butter work of transition-related care: prescribing and adjusting hormone replacement therapy and related medication, ordering and reviewing laboratory results, responding to concerns about medication side effects, and monitoring patients' overall health within the context of transition. And while medical educators are beginning to catch up with the demand for trans-competent doctors, there’s still a long way to go.
So more trans people are turning to online medical providers…
The technology essentially removes the geographic barrier to specialty health care for marginalized populations, said Yadin David, a biomedical engineering consultant and founder of the Center for Telemedicine and e-Health Law. "[For people] who think, 'I'd never be able to make it to the medical center, it's too far, it's too expensive, I don't have a car, I cannot leave the home,'" he said, telehealth offers an opportunity to get better, more appropriate and faster care.
But as the article points out there still are major hurdles to jump through, namely licensures.

I remember sitting in on a National Association of Social Workers (NASW) talk about having online patients and about the ethics involved and whether you need to be licensed in the state where you client is located. Another consideration was insurance, do you need to have insurance in the state where you client is located. The same discussion was on the WPATH listserver.

It seems like this will be destined for the courts to settle. Right now the country is a hodgepodge of laws and interpretation of those laws.

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