More Fun With Health Care Professionals

Back in May, I wrote about a visit to the dentist’s office where my coming out six months prior resulted in my being on display like a monkey in the zoo. Little did I know that I would encounter similar experiences this summer in other health care arenas.

The next came in June after I had a nasty run-in with some Toxicodendron radicans while weeding the raspberry patch and I ended up at the doctor’s office.

I have never been to the doctor to take care of a case of poison ivy, but I also had never had it this bad before. Despite protecting my skin with pants and a long-sleeved shirt, the offending blisters ran from my legs, up the right side of my abdomen and chest, down my right arm and over my right shoulder, marking the trail where the noxious plant oil must have rubbed off of my clothing when I disrobed.  The back of my neck was particularly encrusted, probably from swatting a mosquito with the colorless, odorless ivy oil on my hand.  When I woke up on the third day with a swollen eyelid and blisters under my left eye, I decided that going to the doctor for treatment might be the best option.

The doctor wasn’t available, however, and I was scheduled to meet with a nurse practitioner I had seen in the past.  I had been out as trans to my doctor and the clinic’s office staff for over a year, but I hadn’t seen this particular nurse practitioner within that time frame.

When she began the exam, I explained to her where I had the blisters, gesturing in a line from my legs up the right side of my body.  She looked at the affected areas on my right arm, face and back of my neck and then said, “I’ll need to see all of it.”

“All of it?” I asked in surprise since she had just seen the worst areas.

“Yes,” she replied, “I need to make sure it isn’t infected.”

“It’s not infected,” I assured her.

“I need to make sure,” she insisted.

Because this was the first time I’d ever gone for medical treatment of poison ivy, I wasn’t sure whether checking every spot for infection was standard procedure, but I accepted what she said and raised my shirt.  She quickly examined the blisters on my abdomen and neck and then pointed at my legs.

“I’ll need to see the rest,” she said.

“It looks just like everything else,” I countered.

“I need to see it anyway,” she replied.

As I unbuckled my belt, I started to experience some doubts about her reasons for the “completeness” of this exam.  It was when I unfastened the fly of my jeans and bent slightly to drop them when her next question turned my doubts into annoyance.

“Is it on your genitals?” she asked.

I froze and turned my eyes up toward hers, but she wasn’t looking at my face. She was looking down at my crotch that was still covered by the, ahem, men’s undergarment I was wearing beneath my jeans.

Now, I had already explained to her where the blisters were, and nothing on the list I had provided included my genitals.  I have had the unfortunate experience of poison ivy blisters erupting on my nether-regions when I chose the absolute wrong place to take a leak in the woods once when I was a young adult.  Believe me, if I had been in that predicament this time, I would have stated as much quite clearly to improve my chances of getting effective treatment for it.  (And if that situation doesn’t induce a person to learn what poison ivy plants look like, nothing will.)

And so similar to the visit to the dentist’s office the month before, I was in a situation where I wondered what my response should be.

I considered the retort, “Oh, you’d like that, wouldn’t you?  To see the transsexual’s genitals!” but I held my tongue.

I quickly considered my options.

I didn’t want to continue to stand there holding my unfastened jeans, and I did want to have the poison ivy blisters treated, so rather than inflame the situation, I dropped my pants the rest of the way and simply answered, “No, there isn’t any on my genitals.”

She only glanced at the blisters on my legs — apparently, the transsexual show at the doctor’s office was over — and turned to write a prescription for prednisone.  (And I am pleased to report that the treatment did indeed clear up the problem.)

One month later, it was the optometrist’s turn.

I walked up to the receptionist’s desk to check in and said, “I’ve changed my name,” as I handed her my new insurance card.

“Oh, okay,” she replied.  “What was your old name? I’ll look it up and then we’ll just change it in the system.”

I told her my former name, which she typed into her computer, and she looked at the card I had just handed her.

Then she looked at it again.

Then she looked up at me and down again at the card.  She slowly said, “Ohhhhhhhhh,” as though several realizations came to her, one at a time, the “oh” extending over each one.

And then, she was all business.  “Okay,” she said crisply.  “I’ll just enter that in with the old name.”

“What does that mean?” I asked, not wanting to have my old name in the system and raise the chances of someone using it accidentally.  She seemed to pick up on my discomfort with this and explained, “The old records can’t be changed, so we need to keep both names in the system so the new records are connected to the old ones.”

That seemed to make sense so I didn’t question it further.

I was soon called from the waiting room by a young assistant who, as she led me back into a large pre-exam room, seemed to make a point to use my first name several times as we walked.  She gestured toward an apparatus on the table and asked me to take a seat in front of it while she sat down on the other side.

I leaned forward and set my chin on the little cup, placing my forehead against the cushion so the assistant could  measure the curvature of my corneas.  It didn’t take long, maybe a minute or so.

When she was finished, I sat back and was surprised to see another assistant standing next to us.

So surprised, in fact, that I jumped.

Then she jumped.

“Did I startle you?” she asked.

“Well, you weren’t standing there when I sat down,” I replied.  I hadn’t heard her walk up, so it was as if she had just appeared out of nowhere.

I couldn’t figure why she was there and I expected her to walk away, but she didn’t.  She just stood there looking at me.

So I looked at her.

And she looked at me some more.

Suddenly, I realized what was happening.  Word had gotten out that there was a transsexual in the office and she had come to gawk.

That realization might have hardened the look on my face, or maybe she simply snapped out of whatever trance she seemed to have fallen into, because finally, she stopped staring at me and blinked.  She looked around the room briefly, as though she had forgotten where she was, smiled at me awkwardly and walked out.

Sigh.  When people do this sort of thing, why do they have to be so obvious about it?

Once the woman had left, the first assistant led me to one of the small exam rooms where she completed the eye tests and left to call in the optometrist, who had obviously been informed about my name change.  He walked in and offered me a firm handshake, heartily saying my “new” name as though we were good friends.  That’s where the pleasantries ended.

He used a contraption to look at my retinas (my pupils had been dilated by the assistant) and after that, he couldn’t get out of there fast enough.  He sat at the desk, his back somewhat turned toward me.  He regarded my records, including the results of the exam, wrote down a few things, and without turning around, asked me if I had any questions.  Then he scooped up my file and abruptly stood up.  He turned to shake my hand, saying, “Glad to hear that you’re doing so well,” opened the door to the exam room, stepped out to indicate the direction I should go to get back to the reception desk, and strode away.

I’m not even sure he was in the room for five minutes.  I’m also not sure how the hell he could have known whether I was doing “well” since he hadn’t even bothered to talk to me.

It all happened so quickly, it took a little while for me to realize that he hadn’t told me whether my eyesight had changed since last year or how my eyes were doing since the lasik surgery I’d had in 2007, which is the conversation we usually have during my annual eye exam.

Interestingly, the reactions at the optometrist’s office were polar opposites:  the gawking woman didn’t know when to bug off and the optometrist couldn’t seem to leave my presence quickly enough.  (At least neither of them asked to see my genitals.)

I know that there are trans people who have experienced far worse at the hands of health care “professionals” than I have, but I am still annoyed with it all.  Next time, maybe I should just raise my hands, wiggle my fingers, waggle my tongue, jump up and down and say, “BOO!”  At least that would be behavior which would actually warrant a stare or running away, because my acting just like any other human being that walks into their offices certainly doesn’t, nor does it justify a request to inspect my genitals.

That’s my opinion, anyway.

–ATM

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11 Responses to More Fun With Health Care Professionals

  1. maddox says:

    I always think that maybe I’m paranoid about people staring, but it’s true, they do stare, especially in bathrooms, when shopping for clothes, and kids. I guess if you come out to them, the more reason to think that.

    This reminds me of my recent trip(s) to the optometrist, where I put my chosen name. Despite having my insurance information, they used the one I wrote down, except they couldn’t pronounce it or place a gender on it (which is great, it means it’s working!). The only other doctor I’ve been to recently is the trans clinic, so I guess that doesn’t count as a “regular experience” 😛

    • Hey Maddox.
      Glad to hear that your optometrist used the correct name. I think that in general, healthcare professionals are trying to get things right with trans clients. Some of them just may not know how to go about doing that the best way.

  2. Tracy says:

    To be honest, reading about your experiences (and others like them) absolutely petrify me. I’ve recently begun to take T and have top surgery scheduled, and the next time I see various people (dentist, eye doc, etc.), I will definitely be post-op and the T will have started making physical changes visible. So far my current doctor has been great, but I’m quite worried and nervous about other doctors who don’t know about my transition. Given these have been your experiences, any advice to share with us newbies about how to maybe handle situations like this in the least uncomfortable manner? (Other than giving them the big middle finger, of course) 🙂

    • Thanks Tracy for your comment. I am sorry to hear that my posts are scaring you (and maybe others?) — that’s not my intention, but I should be sensitive to that possibility, so I am glad to know this.

      Congratulations on the start of your medical transition. I’m glad to hear that your regular doctor has been great. Mine has as well — I didn’t write about that, although given your reaction, maybe I should.

      As for my giving advice to “newbies,” I’m basically a newbie myself, having socially transitioned a little less than a year ago. (I think that still makes me a rookie.) As everyone’s comfort level is different, my advice would be based on my own comfort level and might not be helpful or appropriate for someone else who has a different threshold. I think my best advice would be to hop on over to Matt Kailey’s blog (www.tranifesto.com) and ask him what he thinks. He has a lot of experience and knowledge around issues that people in our community must face. Maybe he’ll see our comment thread here and offer a suggestion.

      • Tracy says:

        Well, I’m not REALLY scared…it’s just more of me being incredibly privileged and living in an all-accepting bubble. I know there’s plenty of prejudice and discrimination out there, I’ve just yet to experience it, so it’s almost like I’m just waiting until something happens.

        And thanks for the tip, I’ll definitely check him out!

        • Hey brother, that’s not being “privileged” — living in an “all accepting bubble” is the way it’s supposed to be!

          I have not really experienced overt prejudice and discrimination because I am trans, other than some crap from a couple “friends” that I don’t talk to any more and the annoying business with the health care professionals. So you might not experience anything worse than a few stares or inappropriate questions (and there are non-trans people who are experience those things as well) and once you have been on T for a while, those instances might even stop.

    • Matt Kailey says:

      It has been a while since I have been over here to read this great blog. I’m still trying to adjust to my new gig teaching college and getting prepared for my classes. That seems to take up about all of my time.

      In my experience, most doctors have been clumsily benign when I come out as trans. In the case of medical stuff, I don’t come out unless I have to (stuff going on with my netherparts) or unless I think it’s important to let a doctor know that I’m on testosterone (because I’m getting some prescription). It was different in ATM’s case, because he had to change his paperwork with these doctors. I have not had to do that with anyone in years.

      When I know that I will have to take off my clothes for a doctor and I know that he/she will either examine or notice my non-standard genitalia, I always say something ahead of time, and what I normally say is “I just want you to know that you will find something different than what you’re expecting when you examine me. I have female genitalia.”

      Now, some people would disagree with me saying that I have female genitalia. The reality is that I have transsexual genitalia, in that I am a transsexual who has not had genital surgery. But I find that this is the best way to get this across. I have never had a problem. One doctor said to me, “Don’t worry. I’ve seen everything.” Another doctor could not figure out which “direction” I was going and kept asking about my prostate. But I find that the best way is straightforwardness.

      Also, there is something to be said for writing it on the intake form when you see a new doc. That way, they have time to digest it and the nurses have time to whisper and gossip before anyone actually has to deal with you.

  3. sirgarreth says:

    I’m sorry you’ve had such bad luck with medical professionals. I hope your doctors get their acts together, and that you don’t have to deal with any new instances if there are more docs to come out to. I am fortunate enough that I have had pretty good experiences with my doctors, with a little awkwardness and fumbling of pronouns being the worst of it. But it is still one of the more harrowing areas as the place where sex vs. gender seems to become so much less important (compared to getting necessary medical treatment) and so much more important as people examine you so closely.

    • Thanks man.
      Perhaps I should write about the good experiences I’ve had with health care professionals, of which there have been just as many, if not more than the not-so-good ones.
      Glad to hear that your experiences have been good ones.

  4. NP from New England says:

    I am a nurse practitioner and do pre-employment physicals. Recently I had a patient who appeared to be a male who had transitioned to female. In the process of our conversation about past medical history, at no time did the patient state that she was transgender. This physical exam does not require examination of the genitals or breasts, just strictly heart, lungs, vision, muscle strength, etc. Should I have come out and asked about it? Is it rude? It’s wasn’t technically necessary in my opinion, because if the person is physically capable of doing their job, transgender status doesn’t matter. I would love some guidance!

    PS- I apologize if I’m getting the terminology wrong or it appears offensive, I mean no disrespect!

    • Hello NP from New England and thank you for your question. Thank you also for being concerned about terminology — it can be tricky.

      Before I answer your question, I would suggest to you and all health care providers to take advantage of a relatively new resource from The Center of Excellence for Transgender Health. Click to see the Primary Care Protocol for Transgender Patient Care. However, I am not sure that your questions are directly answered in this protocol so I will give you my opinion – thank you for asking.

      So first, regarding your comment that this person that she “appeared” to be a male-to-female transgender person. As a nurse practitioner, you have likely seen people with many different body types, and so you know that there are women in the world who have bodies that have more masculine characteristics than other women, but that does not mean they are MTF trans women. This woman might have been a natal woman who had physical attributes that were part of the normative human variation. Or she might have been intersex, which is different than being transgender (although some intersex people also identify as trans, but that’s another discussion.) What I’m getting at is that there are stereotypes as to how transgender people look, and if someone is perceived to fit those stereotypes, that doesn’t mean they are trans. There are all kinds of different characteristics of the human body – it’s normal biological variation.

      In addition, had you examined her breasts and genitals, you still may not have gained any information as to whether she was transgender. A trans woman who has had estrogen hormone replacement therapy can have breast growth that is no different than that of natal women (with all the associated variation in size, shape, etc.) and sex reassignment surgery, if she had had it as part of her transition, would have provided her with normative-appearing genitalia, offering no clues to her trans status.

      But the bottom line here is your question “Should I have come out and asked about it?” Actually, you sort of answered your own question when you wrote, “It’s wasn’t technically necessary in my opinion, because if the person is physically capable of doing their job, transgender status doesn’t matter.” With that in mind, what would then be the motivation behind asking her whether she is transgender if there was no medical reason to do so?

      Let’s put this another way. If you had patient who you suspected was a lesbian based on the way she presented herself, would you think it proper to ask her about her sexual orientation? Asking someone if they are trans, if there is no medical reason to do so, is no different than asking someone if they are gay, or any of a long list of personal questions that we generally do not ask people out of politeness and respect.

      I think you probably have answered your other question, “Is it rude?” Based on your comments and questions, you refrained from asking this woman what would have been an unnecessary personal question. If you have read my blog posts about my experiences with health care professionals, you have seen how people can indeed be rude, intrusive and disrespectful toward trans people (or people suspected of being trans). Based on your description of the situation, you were not rude, intrusive or disrespectful, so kudos to you for giving this woman the sensitivity and thoughtfulness you would have extended toward any other person. There are other health care professionals who do not act so professionally – you’d be surprised at how awful some of them can be to people in the trans community. Click here for a news report about an example of this that happened in Indiana last year.

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