“Were the doctors in attendance saying how they felt so sick inside,
Or was it just the scalpel blade that lied?”
– “Tower of Babel”, Elton John/Bernie Taupin
Years ago when a third year resident, the first breast exam I was directed to perform was on a man, semi-balding, beard, hairy chested, and former female impersonator. In his working days, he had gotten estrogen shots (his story) in his breasts to make them grow, and now he was worried about a lump. Not how I thought the day was gonna go, but any of us former med students have had similar surprises. Later in residency, I was assigned an HIV-positive “married couple”, one of whom was an egregious cross-dresser, both very male. Oh well, professional decorum, stick to the problem list, do your best, try not to be overtly judgmental, and treat the patients the best way you can.
Perusing the American Medical Association’s website, I chanced a look at their current topics page, which confirmed yet again that the AMA is ever the refuge of the dull-witted and easily led. Consecutive topics included their efforts to create a list of LGBT groups in organized medicine (Earlier this year, the AMA wrote that “the only effective treatment of [gender dysphoria] is medical care to support the person’s ability to live fully consistent with one’s gender identity.”) and announcing that another state is covering “gender reassignment” surgery for employees.
Maryland has become the third state, following California and Oregon, to offer such coverage that includes hormone and surgical therapies. Now that the newly released DSM-5 has decided to de-stigmatize this sad affliction, their criteria of “must exhibit a strong and persistent cross-gender identification…” will surely encourage more takers. The Obama Administration has already weighed in with an executive order extending new protective emphasis to the transgendered in federal employment.
We should all be sincerely, and truthfully compassionate toward these unfortunates. But that does not include lying, either to patients or to ourselves. We can’t pretend that there is an easy answer to this problem, and it is the height of dishonesty to pretend that buckets of hormones and surgical mutilation affords such an avenue. The L, G, and B demographics as a subject of public policy, psychiatric consideration, diversity celebrations, or societal acceptance are one thing; externally altering someone and assuring them that they are what they wish to be simply because they wish it will only add new conflicts to their already serious inner turmoil. Now that both governments and the AMA are bowing to media-fed political pressures, more physicians will be called upon to accept and perpetuate these deceptions. Is it now a doctor’s ethical duty to refer a would-be transgender to a psycho-endo-surgical team offering corrective therapies? Will a physician refusing to do so be subject to legal sanction or board of medicine scrutiny, with the AMA policy used as evidence? Authentic medicine means compassion and looking for answers. It means trying to be kind to those who seem strange, different, uncomfortable with themselves, or even creep the hell out of you. It also means admitting when you are unequal to a problem, and not selling a lie as a substitute. Policy that endorses someone’s psychopathology is neither good medicine, nor authentic.