by hilzoy
Queen Emily, who is guestblogging at Feministe,
hates forms. Why? Because while "my birth certificate says I am male, my gender presentation is female.
They do not match. Until I can afford expensive genital surgery, I cannot change the marker on my birth certificate." If you've never had to think about exactly how much trouble this can cause, consider yourself lucky:
"A small example: Imagine you went to the hospital, with stroke-like symptoms (it was later found to be "complicated migraines"). Because you want to actually be treated, you do not out yourself as transsexual. When the triage nurse filled in the forms, he puts female, and you leave it there. (...)
Fast forward to a week later, and I'm (sorry, you) at a neurology department to see a specialist to organize an MRI, when one of the reception people comes out to see you and starts screaming that you're a GODDAMN LIAR because your forms say I'm female but some quirk of the computer system has found your birthdate and surname and pinged up an old treatment from when you were six. Because of this, they decide that your name isn't real either, and it takes three trips to different departments with your changed birth certificate (changed in name but not in sex). In the end, they put a post-it on your file, with your name, your legal bloody name, in quotation marks like it’s a f*cking nickname. And these are the people who are supposed to help you.
Now imagine what happens in an emergency situation.
Imagine you're me, six months before this, and you're young and naive and full of stupid, figuring that putting M will help them you treat you better (ha!), checking yourself in to see a doctor because you’re struggling to breathe. And the dude takes one look at your forms and your barely passing self, and refuses to enter the room. He just stands there at the edge, asking you to holler symptoms at him, and you sit there knowing that if you collapse, this man will pause and debate whether to save you or not."
Read the rest. It gets worse. There are customs lines, and traffic stops, at any one of which someone could look at you, look at your driver's license, and decide that you're a fraud, or a freak, or whatever their minds might come up with to explain the anomaly of someone who presents as one gender carrying a driver's license or birth certificate that says something different.
In comments, someone
wrote that the local public transportation system requires little M or F stickers on their monthly passes, and that "an acquaintance of mine (a trans woman) was *arrested* because a bus driver, convinced that she was "male" (she had an "F" sticker), called the police."
I'm trying to think of a reason why any bus or subway system needs to specify gender on its monthly passes. I can't think of a single one.
And it's not as though there are ways of avoiding this situation. Even assuming that you live in a state that lets you legally change your gender, that requires gender reassignment surgery, and gender reassignment surgery normally requires, among other things, living as the gender you identify with, completely, for a year. That's a year during which traffic stops, doctor's visits, and the like will be very problematic.
The reason I write about trans issues is that I really can't see how any of this will change until non-trans people really stop and think about things like this. once you do stop to think about it, it's barbaric that doctors and hospitals would be unprepared to deal with trans people, or that whenever you have to tick a little box that says M or F, there's a real possibility that someone will realize that your gender presentation and your ID don't match, and freak out about that. It's even worse that mollifying them, if it's possible at all, will require divulging a whole lot more about the state of your genitalia and the details of your personal life than anyone should ever have to explain to, say, a bus driver or a traffic cop.
I'm just hoping that maybe that doctor or traffic cop might read Queen Emily's post, and think again.
It would seem at the very least that forms should allow for "Transgender", and people who have to deal with IDs should be trained to deal with results for people who check the "T" box instead of the either "M" or "F" box. This especially includes doctors who should be able to treat a medical problem in such a context with professionalism and dignity.
On the other hand, I think it is unreasonable to expect to be identified with a preferred gender that doesn't match your chromosomal gender in a medical context, especially during an emergency. A doctor should know exactly what they face, whether that means that the person who appears to be a woman is actually has Y-chromosomes and is taking female hormones, or the reverse. The clear exception being when transsexual people go for minor visits for things where gender wouldn't play a role in reaching a proper diagnosis (like the flu, I guess).
I do agree that it is a minefield for trans people interacting under the conventional assumptions. Would adding a "T" box for adult IDs help alleviate the situation at all? I imagine it would desensitize most people (bus drivers, doctors, etc) to the "novelty" of encountering trans people, and might encourage them to do their jobs more professionally. Does this seem like a reasonable hypothesis?
Posted by: J.J.E. | July 06, 2009 at 03:34 AM
"I'm trying to think of a reason why any bus or subway system needs to specify gender on its monthly passes. I can't think of a single one."
I'm uncertain of the specifics, but I believe that some nations (such as Japan) have instituted gender-segregated public transport as a response to sexual harassment in mixed transport cars.
Posted by: TheShipBeSinking | July 06, 2009 at 03:43 AM
J.J.E.: On the other hand, I think it is unreasonable to expect to be identified with a preferred gender that doesn't match your chromosomal gender in a medical context, especially during an emergency.
There are perfectly valid reasons why a doctor or other medical personnel will need to know all of a patient's medical history, including that she's been taking hormone tablets for many years, or that he regularly injects himself with testosterone, or that she's recently had major surgery, or that he's pregnant.
There is no valid reason at all why any medical personnel, emergency or not, can't refer to their patients by the name and the gender of their choice. That includes ER doctors and nurses and ambulance paramedics - it may be an emergency, but that doesn't excuse acting out transphobic hostility or outright rudeness.
I do agree that it is a minefield for trans people interacting under the conventional assumptions. Would adding a "T" box for adult IDs help alleviate the situation at all?
Not much.
You can have three boxes "F", "M", and "Other", with a field to allow anyone who wants to add additional details to do so. But there's no reason why a trans woman should have to identify herself as "T" on her adult ID - she should just be able to tick "F". Her private medical history is not the concern of any random person to whom she shows her adult ID.
Social change on this matters, of course, but legislative protection matters just as much.
Posted by: Jesurgislac | July 06, 2009 at 03:57 AM
I do agree that it is a minefield for trans people interacting under the conventional assumptions.
Posted by: haber | July 06, 2009 at 04:36 AM
"I'm trying to think of a reason why any bus or subway system needs to specify gender on its monthly passes. I can't think of a single one."
Well, it depends on whether "needs" requires a compelling reason, but SEPTA, Philadelphia's transit agency, does this in an attempt to limit pass-sharing (such as a husband and a wife using the same pass; passes are supposed to be non-transferable). There's been at least one recent suit against them by folks whose gender identity isn't immediately obvious and who have gotten grief, or worse, for having a pass with the "wrong" sticker.
I don't think the suits have been resolved yet. SEPTA is working on a new fare system that I've heard will use other ways of identifying the holder of the pass, and I suspect that they're hoping to hold off any changes until the new system is in place.
Posted by: John Mark Ockerbloom | July 06, 2009 at 07:05 AM
Prior medical history is a rather significant issue at a hospital. So is billing.
Are you saying that you can't understand why they may need to ensure that the person in front of them is who they say they are, and not either lying or goofed up in the system? That an obvious gender discrepancy might throw up a red flag, indicating a possible undocumented allergy or medical condition?
Of course, that is no reason to be rude, and most certainly no reason to deny medical care. I really don't see how medical professionals wanting to be sure of who they are dealing with is in any way unreasonable, however.
And you can't see why a traffic cop would need to know that you are the same person as the ID you present? Seriously?
Posted by: Andrew | July 06, 2009 at 07:58 AM
Am I weird in that my initial outrage wasn't over the trans issue? It was over the fact that forms should stop anyone, irrespective of reason from seeing a doctor. The reason just made things worse.
Posted by: Francis D | July 06, 2009 at 08:25 AM
As to pass sharing, what if people of the same sex try to share the pass?
As to the cop, the person wants the sex on the id to match her gender presentation. Would this mean a traffic cop would not know who you are?
Posted by: Joe | July 06, 2009 at 08:29 AM
Andrew: Are you saying that you can't understand why they may need to ensure that the person in front of them is who they say they are, and not either lying or goofed up in the system? That an obvious gender discrepancy might throw up a red flag, indicating a possible undocumented allergy or medical condition?
Well, this is a key advantage of a socialized medical system which the piecemeal crappy US system lacks - centralised medical records attached to the patient, not the practice or the insurance company.
But, that aside: as I noted in my comment, yes, a doctor may well need to know that the woman who has a bad case of the flu is on a regimen of hormone tablets and has recently had major surgery. Which means the doctor needs to make a public and serious committment to never disrespect the gender of the patients and to treat all past medical history as strictly confidential. Legislative change to make it illegal for the doctor to discriminate against or abuse the patient: social change to make it clear to all that it's inappropriate.
And you can't see why a traffic cop would need to know that you are the same person as the ID you present? Seriously?
Absolutely! How else would the traffic cop know for sure he was targeting a black man for "driving while black"? These things are important!
Posted by: Jesurgislac | July 06, 2009 at 08:56 AM
My local transit system tried to have people put "M" or "F" as well as their names on passes to keep people from using each other's passes for a while. Fortunately, for once they realized what a stupid idea that was, and gave up trying to prevent people from sharing passes altogether.
As far as forms go - I do think that it's understandable that doctors would require a complete medical history, and that would include hormone therapy and so on. However, that's a wealth of information that is not going to be available simply from a person who was born biologically male but identifying and presenting as female ticking off the "F" box. In other words, I'm entirely with Jesurgislac on this one.
Posted by: tariqata | July 06, 2009 at 09:02 AM
The existence of discrimination does not obviate the need for police officers and medical professionals to be able to positively identify the persons with whom they deal.
Posted by: Andrew | July 06, 2009 at 09:04 AM
Andrew: The existence of discrimination does not obviate the need for police officers and medical professionals to be able to positively identify the persons with whom they deal.
You haven't yet explained how they're going to be able to do that, or be prevented from doing that, just by having someone check "M" or "F" on the form or the license.
Posted by: Jesurgislac | July 06, 2009 at 09:14 AM
You haven't yet explained how they're going to be able to do that, or be prevented from doing that, just by having someone check "M" or "F" on the form or the license.
I'm not sure if you are just messing with me.
How do you identify a person? Look at your driver's license: height, weight, age, sex, eye color, and maybe hair color.
If one of those features is noticeably different than what it says on the ID, you are probably going to be asked about it.
How would you propose they identify people? Carry around optical scanners? That is somehow less invasive than referencing the standard features humans have been using to identify one another since time immemorial?
Posted by: Andrew | July 06, 2009 at 09:23 AM
I have a hard time getting worked up about this.
I don't see why she can't just tell the doctor (or anyone else) she's trans. If there is a problem being treated for that reason (as is implied) let's enforce the right to be afforded medical care without discrimination, but there's no right to have your special need treated as if it doesn't exist. Sorry you wound up trans. It makes things hard, one of which is the M/F question. I'm sure the guy without a right hand feels the same way about how cars are designed in this country. But the solution isn't to design all cars so that they accommodate everyone including the one handed man. It's to acommodate the one handed man in the best way possible wherever possible.
The problem is that she does not fit in the M or F box, but she wants to be treated as if she does fit into one of them. Most of the time that doesn't matter, but often it does, and it's not an irrational way to identify most people.
Posted by: G | July 06, 2009 at 09:57 AM
Drivers licenses are photo IDs. If a picture alone is not enough to identify a person's gender, then their gender is ambiguous enough that it's not very useful at identifying people. (And obviously, gender provides a positively tiny amount of information, since it divides the population exactly in half.)
Also, it's probably worth noting that weight is really an odd thing to use to identify people too. Transsexuality is one thing, but far far more people lose significant amounts of weight than have sex changes.
Posted by: Anonymous | July 06, 2009 at 10:10 AM
I don't see why she can't just tell the doctor (or anyone else) she's trans.
Because there isn't a spot on the form for that. So she has to tell them she's trans after they've already started shouting at her.
Posted by: Francis D | July 06, 2009 at 10:21 AM
Drivers licenses are photo IDs. If a picture alone is not enough to identify a person's gender, then their gender is ambiguous enough that it's not very useful at identifying people.
Well, one way of faking a driver's license is adding your photo to an existing license. So checking the data on the card against the person in front of you is important.
At any rate, when the person is in front of you, treating the photo as somehow more dispositive of a person's appearance seems strange to me.
Posted by: Scott P. | July 06, 2009 at 10:21 AM
To me, the issue in hilzoy's stories is the rudeness displayed by the medical professioonals, not their need to know for certain the identity of the patient. I get why the biling clerk and others have to be sure that the person they are treating is the person their driver's license says they are. And I do think that simply telling the clerk "I'm a trans" before the shouting starts is a better tactic then not telling anyone until later when they find the discrepency on their own and start thinking they are being scammed, perhaps by someone trying to use someone else's insurance,
But there is no excuse fot te doctor who wouldn't come into the room with the patient. OF all the professions, medical people should have the knowledge that would lead to sensitivity about transgender issues.
Posted by: wonkie | July 06, 2009 at 10:40 AM
I don't think changing forms is needed as much as presenting doctors with some basic training regarding unique cases.
Your doctor should be familiar with your genetic sex, as certain conditions may manifest themselves differently in men vs. women and that information is pertinent. It might not be the sex you identify with psychologically, but it is still your genetic sex and might affect the diagnosis.
Posted by: Comrade Dread | July 06, 2009 at 10:44 AM
Are the driving licences there still paper with clipped-on photo? Otherwise I can't see how changing the photo is easier than changing other data on the thing. And how will the cop check exact height, weight etc.? Even hair-colour is no indicator since many people change it often. I also assume that there is no requirement to have ID's updated in case of significant changes.
Looks again like living in the totalitarian police state of Germany has its advantages ;-).
Posted by: Hartmut | July 06, 2009 at 10:48 AM
"Because you want to actually be treated, you do not out yourself as transsexual"
This statement is confusing. Many places have no need to know, but this seems someplace that the facts would be important.
On the other hand, this is a subject that makes many of my most open minded acquaintences uncomfortable. So maybe it just becomes a reaction to protect onesself.
Posted by: Marty | July 06, 2009 at 11:21 AM
wonkie: "To me, the issue in hilzoy's stories is the rudeness displayed by the medical professioonals, not their need to know for certain the identity of the patient."
Yes, exactly. I completely see why doctors and hospitals would need to know one's biological sex. But bear in mind the episode that's described later, but occurred before letting the 'F' slide, in which Queen Emily told all, for that very reason, only to have the doctor not want to be in the same room.
Transportation agencies are another matter. (This one is in Philadelphia, so I don't think that cultural requirements for gender segregation are the issue.) Once you think about it, there would have to be any number of identifiers that don't put trans people in this box. But that's kind of the point: non-trans people don't have to think about it.
(Nb: there has recently been a big fight about the use of the term 'cisgender' to mean 'not transgender'. I didn't use that term, but it's not that I'm not OK with it; just that I didn't want to detour into explaining it.)
Posted by: hilzoy | July 06, 2009 at 11:25 AM
Andrew: I'm not sure if you are just messing with me.
No, serious question: what makes you think that "M" or "F" are such magical little talismans?
How do you identify a person? Look at your driver's license: height, weight, age, sex, eye color, and maybe hair color.
I don't have a driving license, but I do have a passport. My passport has a photograph with my hair differently styled from how I wear it now, looking darker than it does in reality except at the depths of midwinter, different style of glasses from the ones I wear now... er, even the shape of my face is a bit different, since I lost weight since that photo was taken back in 2001. It gives my date of birth, but I look younger than I am. I somehow don't think the single letter "F" on it is a magical talisman that's going to make sure people can tell I have the right to this passport.
If one of those features is noticeably different than what it says on the ID, you are probably going to be asked about it.
I've never been asked to explain why I've had my hair cut, changed my glasses, or lost weight. Never, ever, ever. At least, not by complete strangers looking at my passport.
How would you propose they identify people?
In practical matter of fact, Andrew, when I've needed an identity check, what's generally called for isn't a gender check, but multiple forms of ID all with the same name on it - I can show a couple of bank cards, a zoo membership card, a credit card, and a sports club card: when more is required, it's usually one or two recent utility bills with my address on them. No one asks me to prove that I'm really the "F" on my passport. How often do people ask you to show your dick to "prove" you're really the "M" on your drivers licence?
That is somehow less invasive than referencing the standard features humans have been using to identify one another since time immemorial?
If you're suggesting a gender check is less invasive than being asked to show your bank card or a utility bill, you must really like whipping out your dick... ;-)
G: I don't see why she can't just tell the doctor (or anyone else) she's trans.
Because, as illustrated in the story above, medical personnel are not immune from reacting to trans people with hostility and bewilderment or refusing to treat them...
Posted by: Jesurgislac | July 06, 2009 at 11:27 AM
Holy crap, driver's licenses still have eye color and hair color and weight on them in some places?
In Massachusetts they don't. I assumed this was because they're totally stupid pieces of data to use for identification, a throwback to pre-photo days.
But look, if this were just about making sure people are who they say they are, we'd have equally horrible stories about people who use their middle name as a first name occasionally getting arrested on buses, screamed at by doctors, and so on-- is there really any question why trans people are treated differently?
(Sure, nicknames are more common than changes of gender. But I'll eat my hat if the people acting horribly in those anecdotes had never heard of trans people, even if it was 20 years ago and so they were "transexuals", or it was on a talk show and so they think the term is "she-male", etc.)
Posted by: Cavity Lee | July 06, 2009 at 11:33 AM
People change their hair dos all the time. People do not change their genders that often. It is not unreasonable for someone who is looking at at person who appears to be one gender and an ID that indicates another, to be confused. IT doen't seem unreasonable to me for them to wonder is the ID actually matches the person.
However, a professional--cops, or doctor or whoever, ought to be able to handle the situation politely and should not get all nasty about transgender issues.
Posted by: wonkie | July 06, 2009 at 11:38 AM
Wonkie nails it, I think. For all sorts of reasons the doctor's staff, and especially the doctor, need to know what's going on. I'd be a bit more sympathetic if she had explained matters during the initial visit.
That doesn't excuse rude and unprofessional behavior, of course.
Posted by: Bernard Yomtov | July 06, 2009 at 11:48 AM
Bernard: I'd be a bit more sympathetic if she had explained matters during the initial visit.
That doesn't excuse rude and unprofessional behavior, of course.
Huh. You don't quite appear to get that the reason why she didn't explain matters during the initial visit was because she correctly anticipated rude and unprofessional behavior if the medical staff found out, and wanted to avoid it.
I take it you'd have no sympathy for a Jew in an anti-Semitic environment who tried to avoid disclosing their religion, either.
Posted by: Jesurgislac | July 06, 2009 at 12:01 PM
This serves to highlight yet another group of citizens possibly disenfranchised by the various voter-ID/voter suppression bills being pushed by the GOP across the country.
Posted by: capitol dave | July 06, 2009 at 12:02 PM
"The existence of discrimination does not obviate the need for police officers and medical professionals to be able to positively identify the persons with whom they deal."
Why not list "race"? Interestingly, I still have old ID cards from Colorado and New York State, and neither have that as an entry. My current North Carolina card does, which I declined to give an answer to.
If people really want an identifier on their card, why not fingerprint everyone? Better, how about we scan everyone for DNA and all biometrics when they get their card, and put and RFID chip on the card? And make it national? And have a national database for everyone's info, including combining all their banking info, credit history, credit/debit card spending history, and all the other info the FBI, NSA and all other government and private agencies collect on you?
Then we'd really be safe and identified.
What could possibly go wrong?
Posted by: Gary Farber | July 06, 2009 at 12:41 PM
Jes,
She anticipated rude behavior during the first visit. Was this accurate? I don't know. The rudeness described came in a later visit, from a clerk, and in part as a consequence of the misinformation.
The treatment six months earlier was inexcusable, of course, and probably justified a formal ethical complaint, but to generalize from that to all physicians, as both she and you are doing, is unfair also.
Posted by: Bernard Yomtov | July 06, 2009 at 12:43 PM
Bernard: She anticipated rude behavior during the first visit. Was this accurate?
Well, clearly, she herself wasn't a good judge - after all, (a) she just happened to be the person on the spot at the time, and (b) it's not as if a doctor at that same hospital had refused to enter the examination room or give her treatment (c) or as if a clerk at that same hospital didn't react to discovering past records of her male identity as if the clerk had never heard of anyone being transgendered but thought the appropriate reaction was to scream "GODDAM LIAR!" at a patient waiting for treatment.
Obviously you, a cisgendered man who has never entered that hospital nor tried to obtain treatment as a trans person, are a much better judge than she could be of whether she was right to try to avoid the issue on a second visit. Thanks for clearing that up, Bernard: I would get in touch with her directly to let her know you'll use your extraordinary ability to predict accurately whether she'll be treated rudely in any given situation if she's open about being transgendered.
Posted by: Jesurgislac | July 06, 2009 at 01:05 PM
"People do not change their genders that often."
They change their race rather less often. Perhaps you should have to identify yourself by race on every form or piece of ID, too? After all, it's very important that it can be verified that you are who you say you are, and what better way than through race? Nothing could possibly go wrong from this that idea, right?
Posted by: Jacob Davies | July 06, 2009 at 01:17 PM
And - sarcasm apart - maybe this is just another difference between the standards I expect from NHS staff and the standards Americans put up with from your crappy health-care system, but the idea that the clerk's behavior ("one of the reception people comes out to see you and starts screaming that you're a GODDAMN LIAR") could in any way be described as a "consequence" of this woman failing to disclose her transgender history, just appals me, exactly as much as the doctor's behavior in the earlier incident appals me.
I mean, for godsake: sure we all complain about rude NHS receptionists, and my trans friends have horror stories to tell about medical and non-medical staff in the NHS. It's only in the past ten years that trans people in the UK have had legal rights to complain about discrimination.
But the kind of rudeness they complain about is reception staff deliberately/accidentally getting their names wrong, or apparently exchanging comments and giggling about them, or even making comments in open disbelief "You're a GUY! You're here to have your CERVIX looked at??"
Not a receptionist coming out to see them and screaming at them that they're a goddamn liar. That is unprofessional behavior. The fact that Americans apparently feel they have to put up with this kind of thing from hospital staff because that's how your health insurance works, is really as big an indictment of your health care system as it is of transphobic prejudice. It's not the receptionist's job in an NHS hospital to decide if a patient "deserves" treatment: it's their job to make sure the patient gets in to see the doctor without more waiting than necessary.
Posted by: Jesurgislac | July 06, 2009 at 01:18 PM
Jesurg: Because, as illustrated in the story above, medical personnel are not immune from reacting to trans people with hostility and bewilderment or refusing to treat them...
Exactly. So the problem is not with the fact that IDs and other forms generally have a M/F box that is meaningful and not confusing for 99+% of the population, but with educating people about trans issues. Until awareness is more widespread, who better to do so than the person affected? Yes, it's annoying, but there's no constitutional right not to be annoyed.
Posted by: G | July 06, 2009 at 01:26 PM
There are all kinds of professionals who do not need to know the gender of their clients.
Doctors are not among them. It really is not reasonable to go to the doctor on the expectation that the doctor does not need to know one's gender. Gender effects all kinds of medical decsions from diagnosis to treatment. NOt every decision and not the necessarily the controlling factor in a decision, but still a factor to be considered along with age, general health, etc.
Heck, gender was a (minor) factor in the diagnosis of my detached retina! I do not think that it is a good idea to go to the doctor in with the expectation of being able to avoid the issue of one's gender even if previous experiences were bad. It just isn't realistic.
The problem here is not that doctors expect to learn the gender of their clients. The problem it that medical professionals ought to be professional in their conduct and show some sensitivity to their patients. The transgender person has a right to be treated resectfully and supportively as an openly transgender person.
ANd that isn't going to happen, sadly, until a lot of transgender individuals have gone through the painful experience of fighting for the courteous treatment which ought to be given freely.
But the goal shouldn't be to let a person get medical treatment wihtout revealing their gender. The goal should be to let everybody get supportive, professionoal treatment regardless of gender issues.
Posted by: wonkie | July 06, 2009 at 01:28 PM
Let's review what I've learned from the comments: methods of identifying individuals are not perfectly specific, so they should be eliminated altogether. Also, as these same methods are dangerously specific or will inevitably lead to ever-more dangerously specific methods, they should be eliminated altogether. Let us not forget that people in authority have abused these methods, so we should probably eliminate them altogether. And finally, if a utility bill is good enough to get me a library card, I don't see why a hospital or customs agent would get bent out of shape over what seems to be a very obvious discrepancy between my documentation and my appearance.
The suffering described in the anecdotes (both original article and various comments) is entirely sufficient reason to review current policies to determine whether the utility we get out of gender-identifying forms and IDs is sufficient to justify their existence in various cases, and whether better alternatives exist. But it doesn't advance the argument to simply continue pointing out the flaws in the existing systems in increasingly shrill ways.
The example of including race/skin color on state IDs is a good one, I think. It is a useful (though imperfect) metric for identifying individuals. But the massive and obvious potential for widespread abuse outweighs that usefulness in pretty much all cases. Does the same apply to gender; and if so, in which situations?
Posted by: Raka | July 06, 2009 at 01:36 PM
Jes,
I have not defended the behavior of anyone involved. I have said that it is unfair to generalize, as you are doing, from the experience of one individual at one hospital, with one clerk and one physician, to the entire American medical system. Further, whatever the system's faults, and it has many, I'm not aware that it treats transgender people worse than anyone else.
To the extent individuals permit their biases to affect their treatment of patients, that is deplorable, unethical in fact. That such behavior is more common in American hospitals than in the UK, or other countries, is not something that, so far as I am aware, there is evidence for.
So I think you could stand to tone it down a little.
Posted by: Bernard Yomtov | July 06, 2009 at 01:40 PM
"Why not list "race"? Interestingly, I still have old ID cards from Colorado and New York State, and neither have that as an entry. My current North Carolina card does, which I declined to give an answer to.
If people really want an identifier on their card, why not fingerprint everyone? Better, how about we scan everyone for DNA and all biometrics when they get their card, and put and RFID chip on the card? And make it national? And have a national database for everyone's info, including combining all their banking info, credit history, credit/debit card spending history, and all the other info the FBI, NSA and all other government and private agencies collect on you?
Then we'd really be safe and identified.
What could possibly go wrong?"
Great idea. Without complete identification someone might mistake you for a reasonable man.
Posted by: Marty | July 06, 2009 at 01:56 PM
Bernard: I have said that it is unfair to generalize, as you are doing, from the experience of one individual at one hospital, with one clerk and one physician, to the entire American medical system.
Given that your response to a reception clerk screaming abuse at a patient is that this is just a "consequence" of her omitting to put "trans" on her forms, I don't see how I'm over-generalizing: if you take that kind of abuse of patients by hospital staff as a normal consequence of a records error, then patently, there's something very wrong with your expectations of a health care system.
That such behavior is more common in American hospitals than in the UK, or other countries, is not something that, so far as I am aware, there is evidence for.
Well, for one thing, Bernard, in the UK it would be unlawful. For another, as noted above, in the UK we evidently have much higher standards of politeness from NHS receptionists to patients - since you dismiss abuse as just a "consequence" for which the patient is partially responsible...
Posted by: Jesurgislac | July 06, 2009 at 01:57 PM
FWIW, when my parents got married they combined their last names, so my last name is hyphenated. I tend to go by the latter of the two names whenever I can, just out of preference, but I haven't legally changed it. (When it would have been relatively easy to change my name it was also easy to go by the preferred form even without changing it, so I put it off. Today it would be hard to change my name and also hard to go by my preferred form. It figures.) This results in hassles pretty much any time I could have to pay for something. I have to have hotel reservation desks look me up under one name and then the other, etc. And yet, I can't recall ever being called a "goddamn liar," even in some instances where the confusion really was my fault and a more-than-trivial problem. I wonder why that is?
I have said that it is unfair to generalize, as you are doing, from the experience of one individual at one hospital, with one clerk and one physician, to the entire American medical system.
I would say it's Pollyannaish to imagine that what happened to this one individual is a fluke anomaly. (And maybe you aren't imagining that, I can't read your mind, but if not then what is your point?)
This serves to highlight yet another group of citizens possibly disenfranchised by the various voter-ID/voter suppression bills being pushed by the GOP across the country.
How bizarre. One might almost be crazy enough to connect the dots, call it a trend, and observe that modern American conservatives think it should be harder for minorities to vote than for everyone else. But that would be unfair.
Posted by: Cyrus | July 06, 2009 at 02:18 PM
Jes,
Do you know what the word "over-generalizing" means?
I did not describe the behavior as "normal." I said it arose partly as a consequence of misinformation on the form. That is certainly true. That doesn't mean I expect or condone the clerk's behavior. (And while we're questioning assumptions, are we sure the clerk was not just an all-purpose a**hole?) Further, I plainly described the earlier physician's actions as unethical. Nor do I think either behavior is common. If you have evidence that it is, other than a misinterpretation of my comments, please present it.
Otherwise, as I said, tone it down. The personal attacks and distortions are getting tiresome.
Posted by: Bernard Yomtov | July 06, 2009 at 02:21 PM
Bernard and others, do you really think the 'rudeness' (hardly the word for it) is just a result of the 'misinformation'? (Which is not really misinformation, because if Emily had checked the other box, she wold have had the same problem. Which was the whole point of the post.) Do you really think that the clerk, a**hole or otherwise, would have yelled 'liar' at someone who put down the wrong address or phone number? Do you really think this treatment by the clerk, and the doctor six months ago (and lots of other examples in the comments on the original post) are just a coincidence? Really?
Posted by: lt | July 06, 2009 at 02:41 PM
I didn't put policy prescriptions in the post, but for what it's worth, I think it would make a difference if: (a) M/F was not used where it doesn't need to be, e.g. on bus passes. It's just an invitation to trouble for trans people, and there are lots of other ways of identifying people. (b) in cases where there is an obvious need (e.g., medical stuff), train people better. I really don't think there's any excuse for the doctor's reaction when she gave her biological sex, or for the receptionist's not having been told about the existence of trans people, and how to treat them with respect.
I mean, to me, this is like those stories from the Bad Old Days about doctors refusing to give blood transfusions to blacks. It's just barbaric, and the fact that people who deal with patients don't seem to have either any basic education about trans issues or basic human decency can only, I think, reflect the fact that it's easy to ignore trans people if you don't know any.
Or, as we say, cis privilege.
Posted by: hilzoy | July 06, 2009 at 02:53 PM
"Bernard and others, do you really think the 'rudeness' (hardly the word for it) is just a result of the 'misinformation'? (Which is not really misinformation, because if Emily had checked the other box, she wold have had the same problem. Which was the whole point of the post.) Do you really think that the clerk, a**hole or otherwise, would have yelled 'liar' at someone who put down the wrong address or phone number? Do you really think this treatment by the clerk, and the doctor six months ago (and lots of other examples in the comments on the original post) are just a coincidence? Really?"
As "others", I think that the tone of this set of back and forth discussion is exactly the challenge we have in these discussions. Emotion overwhelms reason. I don't believe the "error" explains the reaction, nor do I think that the American health care system is full of people who would react that way.
Each injustice is abhorrent on its own. Broad awareness of the obvious discrimination will be slow, the numbers of transgender people are small and, I believe, the nature of the reaction is more common than we would like to believe.
I think the details are less important than the general point, perhaps posting this makes some people less likely to react negatively.
Posted by: Marty | July 06, 2009 at 03:13 PM
lt,
I read through the comments on the original post and didn't see "lots" of examples. I saw a few.
You want me to concede that there are those who dislike transsexuals? Fine. I concede it. I never denied it. What I object to is the broad brush attack on the medical system on this issue.
Posted by: Bernard Yomtov | July 06, 2009 at 03:21 PM
Don't be silly, Bernard. Extrapolating from a sample size of one in order condemn a couple of millions is common practice on blogs.
Posted by: novakant | July 06, 2009 at 03:31 PM
> shrill
I think that arguments you don't want to hear are shrill, even if they're right. Or wrong. Whatever. Generally it isn't effective political strategy to stop being what someone calls shrill; even if for some reason you're making a false argument, making people hear what they don't want to hear is the soul of successful activism.
> Further, whatever the system's
> faults, and it has many,
> I'm not aware that it treats
> transgender people worse than
> anyone else.
Well, it's good to know that you're not aware of anything like that. As far as I'm aware, it doesn't not treat transgendered people worse than anyone else. Except possibly, and I'm just making this up, Dr. Doom. If he came into a hospital it would probably treat him pretty badly; that's why they stuck him in that mask even though his facial burns healed a long time ago. (Or whatever it is he had.) The only way we can resolve this cosmic clash of awarenesses is PHILOSOPHICAL BATTLE: WHOSE QUALIA REIGNS SUPREME?
Posted by: Jenna | July 06, 2009 at 03:37 PM
Usually such activities are the domain of aerodynamics engineers.
You see, they know what the slope is, already, so extrapolation from a single datum is a piece of cake.
Posted by: Slartibartfast | July 06, 2009 at 04:15 PM
"The example of including race/skin color on state IDs is a good one, I think. It is a useful (though imperfect) metric for identifying individuals."
Really? How many skin colors do people come in? How many "races" of human beings do you suggest there are? Cite to science on that, please?
Posted by: Gary Farber | July 06, 2009 at 04:20 PM
"Great idea. Without complete identification someone might mistake you for a reasonable man."
That's your entire comment.
Posting Rules.
Posted by: Gary Farber | July 06, 2009 at 04:21 PM
"If he came into a hospital it would probably treat him pretty badly; that's why they stuck him in that mask even though his facial burns healed a long time ago."
He created the mask himself.
And most of the more recent writings about him have suggested that in fact the scar in question is so insignificant no one else would find it noticeable; it's his own psyche that found it so hideous.
I know everyone wanted to know this crucial and completely non-geeky and relevant information.
"You see, they know what the slope is, already, so extrapolation from a single datum is a piece of cake.
Indeed.
Posted by: Gary Farber | July 06, 2009 at 04:27 PM
"Great idea. Without complete identification someone might mistake you for a reasonable man."
That's your entire comment."
In context (see below) I felt it was all that was necessary to make the point. The antecedent was so unreasonable there wasn't much to do except point it out.
""Why not list "race"? Interestingly, I still have old ID cards from Colorado and New York State, and neither have that as an entry. My current North Carolina card does, which I declined to give an answer to.
If people really want an identifier on their card, why not fingerprint everyone? Better, how about we scan everyone for DNA and all biometrics when they get their card, and put and RFID chip on the card? And make it national? And have a national database for everyone's info, including combining all their banking info, credit history, credit/debit card spending history, and all the other info the FBI, NSA and all other government and private agencies collect on you?
Then we'd really be safe and identified.
What could possibly go wrong?"
Great idea. Without complete identification someone might mistake you for a reasonable man."
Posted by: Marty | July 06, 2009 at 04:44 PM
> I know everyone wanted to know
> this crucial and completely
> non-geeky and relevant information.
. . .
That's the last time I use Dr. Doom as a counterexample to the culture of victimization argument metacluster. *^_^*;;
Posted by: Jenna | July 06, 2009 at 04:56 PM
Bernard -
The point isn't whether some doctors *like* transsexuals. It's whether our society is sufficiently accepting of transsexuals that they're likely to be treated with respect. If you live in the same society I do, knowing what the general image of this group is, it seems a bit much to then dismiss the experiences of an extremely marginalized group because it's not a double-blind peer reviewed study or some such.
Posted by: lt | July 06, 2009 at 05:13 PM
Society has some way to go before transsexuals are totally accepted, partly because the concept is still somewhat unusual and novel. On the other hand "rudeness" and discrimination against obese people abounds. Obese people constitute a large portion of the population. I'm not sure why entire blog posts and comments aren't devoted to outrage about discrimination against obese people. Or, for that matter, ugly people. There are so many categories of people who are unfairly treated that it's difficult to even list them here. What's the point of an i.d. anyway, and to what extent should we be exempt from dealing with facts about ourselves that we're uncomfortable with? If I hate the fact that I'm 68, and have had a facelift and look 45, should I be required to reveal my birth date?
Posted by: Sapient | July 06, 2009 at 06:07 PM
I'm curious about the relative populations of transgender and if this has an impact on these practices. Japanese TV gives me the impression that it is very common in Thailand (though I'm not sure if I trust them), and I'm wondering if bureaucratic procedures are therefore more flexible.
Posted by: liberal japonicus | July 06, 2009 at 06:16 PM
by 'them' in 'I'm not sure if I trust them', I am referring to Japanese TV.
Posted by: liberal japonicus | July 06, 2009 at 06:17 PM
Bernard: The rudeness described came in a later visit, from a clerk, and in part as a consequence of the misinformation.
No. The clerk screaming "GODDAMNED LIAR!" at her was not a "consequence" of any "misinformation" she provided. Your assertion that it was - that she herself was even "in part" to blame for being the recipient of such abuse, simply because she failed to notify the hospital that she was transgendered, either says something about your attitude towards transgendered people, or your expectations of proper behavior from hospital employees towards patients. Or both.
Posted by: Jesurgislac | July 06, 2009 at 06:29 PM
"I'm not sure why entire blog posts and comments aren't devoted to outrage about discrimination against obese people. Or, for that matter, ugly people."
I've read quite a few such posts at various blogs. Especially about discrimination against obese people.
Posted by: Gary Farber | July 06, 2009 at 06:32 PM
Gary, true, as usual. I should be more specific in my complaint. Someone's birth certificate describes the state of affairs at someone's birth. Things change during the course of a lifetime, including sometimes: weight, gender, residence, etc. "Matching" shouldn't be an issue, therefore change of gender, height, weight, etc., shouldn't be an issue. I guess the question should be: how should society record entry into the world? I think it's fair to record physical data into a birth record. How should society identify people? That's a different question since everyone occupies space within the dimension of time. Do I have brown hair (of my birth), grey hair or blond hair (of possible subsequent artificial or natural choice alterations)? ID's are difficult in that they can't possibly keep track of the essential "us".
Posted by: Sapient | July 06, 2009 at 06:45 PM
"I think it's fair to record physical data into a birth record."
Few elements of physical data that will remain the same from birth throughout life, so far as I know: DNA; fingerprints; retinas; probably a biolgist could name some others. But none of those are, so far as I know, listed on either birth certificates or State IDs.
"Things change during the course of a lifetime, including sometimes: weight, gender, residence, etc."
I'd also just like to note that, even setting aside handles on the internet, and immense number of people change or do not commonly use the name on their birth certificate.
"How should society identify people?"
That's a good question.
"ID's are difficult in that they can't possibly keep track of the essential 'us'."
Yes. In so many ways, we humans are mutable.
Digressively, I'm reminded of how constantly all the lawmakers involved in the creation of the Social Security system and the SS system assured the public, over and over and over, that the Social Security number would never be used as any sort of identification number for any other reason.
Posted by: Gary Farber | July 06, 2009 at 06:52 PM
Jes,
My final comment to you is that you don't know me, and have no basis for concluding or saying anything about my attitude toward transgendered people, or anyone else, from a comment the meaning of which you wilfully distort.
Harangue all you want. I'm done.
lt,
I repeat what I said above. I suppose by "dislike" I meant, "treat badly." That would have been clearer. Still, claiming that medical personnel in general do that is not exactly respectful of individuals either.
Posted by: Bernard Yomtov | July 06, 2009 at 07:58 PM
Bernard: My final comment to you is that you don't know me, and have no basis for concluding or saying anything about my attitude toward transgendered people, or anyone else, from a comment the meaning of which you wilfully distort.
Actually, from several comments, which all seemed quite clear: however, if you now regret making them and are trying to backtrack and claim you didn't intend to express such disrespect, that's nice.
Posted by: Jesurgislac | July 06, 2009 at 08:14 PM
While I sympathise with Queen Emily's predicament, concealing her biological gender while seeking medical treatment is clearly the wrong course of action. Apart from establishing that a patient is a human rather than a dog or a cat, biological gender has to be the most important and fundamental piece of information for a doctor to know. Apart from jeopardising the quality of the care you receive, it seems unlikely that you would succeed in concealing your biological gender for very long anyway. Maybe I'm wrong about this, but even if Queen Emily had had the necessary surgery, surely her original biological gender would still be vital information for any doctor?
By the way, according to her blog, she lives in Australia. Maybe she moved, but if not then some people are disparaging the US medical system unfairly (at least in this instance...)
Posted by: byrningman | July 06, 2009 at 08:18 PM
"While I sympathise with Queen Emily's predicament, concealing her biological gender while seeking medical treatment is clearly the wrong course of action."
YM "XX chromosomes," rather than "biological gender." That biological gender is mutable and not binary is an elemental part of this discussion.
Posted by: Gary Farber | July 06, 2009 at 08:28 PM
Maybe she could make her "gender presentation" (whatever that means) match her genitals when she has medical treatment????
Posted by: tde | July 06, 2009 at 08:32 PM
I'll chime in with at least a 2nd data point. I'm trans, but I still can look "boy" if I want. Went to a new doctor to get my meds renewed. He wouldn't do it. I've been in therapy (want to make your body match your mind: crazy!) for the required length of time. I've been on estrogen for about 18 months. This doc said I needed to have a battery of tests done, and to consult with an endocrinologist before he would approve my estrogen prescription. And he looked so uncomfortable to be near me at all.
*shrug* I went home, and asked on a trans chat board for a recommendation. Went to that doc, and no problem - more medicine. For what it's worth, the "gender" box at the 2nd doctor had 4 choices.
Posted by: BethanyAnne | July 06, 2009 at 08:33 PM
To give the medical personnel in this story the benefit of the doubt:
a) as in any situation, maybe the narrator's perceptions are misleading. For example, she says the doctor stood away from her and barked instructions, but she is clearly very uneasy going into medical facilities, and maybe the doctor was giving space to an evidently uneasy patient. Or maybe the doctor's just got a bad bedside manner, or was having a bad day, and it is nothing at all to do with what she has or hasn't got in her trousers.
b) medical personnel have good cause to be snappy with anyone who seems to be intentionally deceiving them: first it wastes their very valuable time, secondly it creates the risk of flawed treatment (and also lawsuits).
c) more than most people, medical personnel in my experience are extremely professional, hard to shock, and empathetic. Surely if she calmly explained her situation from the outset whenever she sought medical attention, she would more often than not be treated in an appropriate manner. I'm sure it sucks to have to do that, but those are the cards she's been dealt. Even if she was to have the relevant surgery, any doctor still needs to know that she was born a man.
Posted by: byrningman | July 06, 2009 at 08:33 PM
Reading what she says about the clerk who called her a liar, it seems rather plain that he did not call her that because he realized she was transgendered--on the contrary, he called her that because he did not realize she was transgendered, and thought he'd caught her red-handed engaging in identity theft. That's not to say there isn't a lot of prejudice against the transgendered, but this isn't a very good examle of it.
Posted by: rea | July 06, 2009 at 08:37 PM
That biological gender is mutable and not binary is an elemental part of this discussion.
That's nonsense. Surgery and hormones are crude and superficial modifications compared to DNA. One's original biological gender informs the doctor what conditions you might be susceptible to, or how you might respond differently to certain medications and treatments.
Moreover, the surgery and hormones in themselves have ramifications for treatment.
You conceal something that basic from your doctors, you risk your health. It's that simple.
Posted by: byrningman | July 06, 2009 at 08:39 PM
Reading what she says about the clerk who called her a liar, it seems rather plain that he did not call her that because he realized she was transgendered--on the contrary, he called her that because he did not realize she was transgendered, and thought he'd caught her red-handed engaging in identity theft.
Do you really think the same clerk would have called her a liar if he discovered a discrepancy in her given name rather than her gender? My wife uses a different given name than her official paperwork and runs into clerical confusion all the time, but no one has ever screamed at her or called her a liar.
Posted by: Turbulence | July 06, 2009 at 08:42 PM
Um, did any of you who are faulting her for not revealing her gender at birth read the post? There were only two boxes on the form. She had tried checking the male one in the past and had been treated terribly, in a way that possibly could have lead to her death. It's the truest kind of no-win situation.
Byrningman, I'm glad that had been your experience with doctors. However, this is most likely to be the case if you are affluent, straight, thin, have insurance, and are cisgendered. Most people who aren't all these things deal with this in the way you describe. But we also ask that people be educated to serve all of us better, as the oath of their profession calls for. That doesn't seem too much to ask.
Would you tell African-Americans being harassed by police "That sucks but those are the cards you were dealt?"
Posted by: lt | July 06, 2009 at 08:43 PM
> Apart from establishing that
> a patient is a human
> rather than a dog or a cat,
> biological gender has
> to be the most important
> and fundamental piece of
> information for a doctor
> to know.
That's an overly romantic notion; major allergies are more important than species and asthma seems like it'd be more important than gender most of the time.
Which isn't to say you're crazy; if a doctor happens to know that some medicine works poorly on . . . XY biochemistry? or something? . . . and I assume there is stuff like that? then heck yeah, the doctor needs to know, and there's no way for either the doctor or patient to know that that's relevant without the transgendered patient saying. Then again, that also applies to, say, not having had measles, or whatever. The real point is, modern medicine isn't about doctors correctly carving the patient's image out of a block that is primeval Form, beginning naturally with human, then as God in Genesis did dividing the sexes, then perhaps the ambiguous strains of humanity that we call races, then filleting off the rare cases, here checking with the sculptor's scalpel for an extra chromosome, there removing the cases where the lungs work poorly, bit by bit the base genetics before carving into the history of the patient's life, and finally seeing with that great piercing insight the truth of all things and how the patient's yin-yang conditions may be redressed. It's more like standard procedural responses to signs and symptoms backed by a little bit of great piercing insight if the doctor has some to spare that day.
I mean . . . yeah. Not letting your doctor know these things = not good. But it's not like jumping into the cockpit of a plane and not telling anybody you don't know how to fly. It's more like trying to cook Mexican food when you can't remember which bottle of peppers is the really hot ones. I'm gonna concede that that's not the best way to cook Mexican, but I'm not gonna say it's a sin, y'know?
Posted by: Jenna | July 06, 2009 at 08:45 PM
(And I should probably even extend my analogy to assume that one is living, for some reason, in a world where sometimes people just don't have a realistic choice about whether they're going to cook Mexican food or not, and the only question is whether to trust their pepper instinct or make the whole thing suspiciously mild.
Analogies are hard.)
Posted by: Jenna | July 06, 2009 at 08:51 PM
byrningman: generally, in cases in which it's important to draw the distinction, 'sex' refers to your biological male/femaleness, and 'gender' to how you identify, present yourself, etc. I suspect that's where you and Gary are disagreeing: sex, while not wholly binary, is largely so at the level of chromosomes (not genitalia, where there are intersex conditions to be dealt with). Gender, on the other hand, is much more complicated, and less obviously relevant to medical practice.
Posted by: hilzoy | July 06, 2009 at 08:52 PM
major allergies are more important than species
????
Go see the vet next time you've got an ache then...
Posted by: byrningman | July 06, 2009 at 08:53 PM
dumb italics
Posted by: byrningman | July 06, 2009 at 08:54 PM
UGH speaking of rude - a lot of the comments here are just as disrespectful as the reactions from the clerks and doctors in the original post. Hilzoy brought this issue up as a teachable moment - its a time to reflect on the privileges that come with being cisgender--and the ability to fit easily into the gender dichotomy of male and female. It's not about judging whether her story is a justifiable case of discrimination. It's not about her "personal failings" in the doctor's office.
This comment thread COULD be a space to reconsider the categories that define us, instead of trying to shove everyone back into a box. Identity is not a "yes or no" answer; it's complex, fluid, ambiguous and NEVER what the government or medical community wants it to be. The categories are for standardization. Sex, gender, and sexuality are not easily standardized. For some people, this constant need to standardize means death or pain. Doesn't anyone recognize the link between these seemingly "objective" categories, dehumanization, and oppression??
Posted by: meg | July 06, 2009 at 08:58 PM
"One's original biological gender informs the doctor what conditions you might be susceptible to, or how you might respond differently to certain medications and treatments."
I take it that despite my link, you know nothing of intersexuality, since you persist in referring to gender as if there are only two distinct genders (or "sexes," if you prefer Hilzoy's usage and that of some others; I have no dog in that fight). This is simply ignorant. I won't bother repeating my link since you couldn't be bothered to read it and respond in the first place. But you might give it a try.
Posted by: Gary Farber | July 06, 2009 at 08:58 PM
eep, italics monster. hmm, wonder if a close bracket would help?
Posted by: BethanyAnne | July 06, 2009 at 09:02 PM
Hilzoy, I perfectly understand the concepts involved. It just seems to me, that if someone is born male but gender identifies female, but hasn't undergone any sort of medical procedures like surgery or hormones, then medically speaking, her gender identification might not be much more relevant than her religious beliefs (both might have some sort of psychosomatic relevance, but maybe that's it?).
Medically speaking, the correct box for that person to tick is clearly male. Even if she has undergone gender-realigning procedures, that is still all terribly relevant medical history and information -- she simply does not have the medical profile of a woman who was born a woman and never had any serious medical treatment.
I'm fully sympathetic with how uncomfortable that might be, and certainly deplore any abuse she is receiving from doctors, bus drivers or whoever, but it just seems like for the sake of her own health, she has to take that into account. (no, I don't think it's the bus driver's business under any circumstances).
Posted by: byrningman | July 06, 2009 at 09:02 PM
I take it that despite my link, you know nothing of intersexuality, since you persist in referring to gender as if there are only two distinct genders
Gary, what are you talking about? Queen Emily is not intersexual.
Posted by: byrningman | July 06, 2009 at 09:04 PM
From another of her blog postings:
Things you need to know about me: I’m a white able-bodied trans woman from Australia, currently in Louisiana with my lovely girlfriend and our four cats....
Un-gendering. Trans people are the genders they say they are. A story about a trans woman means female pronouns, and male pronouns for one about a trans man. Don’t use third gender pronouns (eg “ze” and “hir”) on a binary identified person.
She's quite emphatically a trans woman, Gary, not intergendered.
Incidentally, she is in the US after all, so everyone feel free to resume griping about the US health care system.
Posted by: byrningman | July 06, 2009 at 09:11 PM
@ Jenna, who says "Not letting your doctor know these things = not good."
Okay so patients should actively vocalize their medical histories. Fine.
This still doesn't solve the systematic problem - which is that medicine does not allow for gender variation; that doctors still freak out in many cases; that the medical establishment forces gender ambiguous infants into "male" or "female" without the parent's consent (let alone the child's); that the entire medical categorization system in the DSM-IV is a living, breathing document of trans- and homo-phobia that marks trans people as deviant or sick; that health insurance refuses to pay for sex changes or hormone therapy; that we who are cisgender are also oppressed by a sex/gender system that allows for tiny variations in the biological/performative/psychological aspects of sex/gender; and i could go on...but you've probably stopped reading by now.
Why is it always on the burden of the patient to change all of this? Why is it always the patient's fault if they just. don't. feel. like. playing. along. with. the system. for once.
Posted by: meg | July 06, 2009 at 09:11 PM
But if Dr. Doom tried cooking his Mexican food Latverian style... oh, never mind. :-)
Posted by: Gary Farber | July 06, 2009 at 09:13 PM
"Gary, what are you talking about? Queen Emily is not intersexual."
I'm referring to the statement I quoted: "One's original biological gender informs the doctor what conditions you might be susceptible to, or how you might respond differently to certain medications and treatments."
I quoted it because it was the statement I responded to. You wrote of "original biological gender" as if there's are only two, and they're perfectly distinct. This is not always the case. That was my point. As usual, if I'd have wanted to make some other point, I'd have made it. I didn't say anything about Queen Emily at any time, did I? If I'd wanted to address that specific case, I'd have said so.
Posted by: Gary Farber | July 06, 2009 at 09:18 PM
Bryingman, again, did you read the post? She tried checking male and the doctor would not enter the room to treat her.
Posted by: lt | July 06, 2009 at 09:18 PM
Whatever, gary...
Posted by: byrningman | July 06, 2009 at 09:28 PM
Bryingman, again, did you read the post? She tried checking male and the doctor would not enter the room to treat her.
I'm not really sure how that's my fault?
Posted by: byrningman | July 06, 2009 at 09:31 PM
"This comment thread COULD be a space to reconsider the categories that define us"
It could be, but if you (the general you, not you in particular) accuse people of prejudice when they try and grapple with the ramifications, you shrink that space quite a bit.
I find the fact that it may have been in Australia very interesting (though comment 64 in the thread suggests that it is in the US). Oz society has some wonderful aspects to it, but it could be (at least 20 years ago when I experienced it) a place where sexist assumptions ran pretty deep. Not saying that they are worse than other places, but macho seems to be a deeply abiding trait in the culture.
Here in Japan, there are a large number of transexual 'talents' (people who appear on TV in various capacities, most often as talk show guests), not to mention manga and Takarazuka which seems to show a cultural framing that I don't understand. I find a lot of problems with sexism in Japanese culture, but it seems that when the divide between a man's world and a woman's world is very clear cut, changing from one to the other is easier than cultures where the boundaries are less defined.
Posted by: liberal japonicus | July 06, 2009 at 09:33 PM
Ugh, it's a hard one. Really.
I'm a dyke, female-identified, yet on a regular basis I get called Sir (I actually respond to it, not even bothering correcting them. They usually do themselves, certainly not always), I get re-directed to the men's room (or while exiting the women's room, seeing me, other women will automatically go to the men's room. Then freak out. Kinda funny, but sometimes it just gets to me.)
I've been kicked out of women's bathrooms (mind you if I'd wear a bra, it'd be a size DDD, waaaay bigger than anyone who kicks me out!!) I've had security called on me while going to the bathroom.
The security women though, as should medical professionals, soon recognize me as being a woman and there's no problem.
I'm not Trans. I don't know how it is to feel like, say M, but be a F. Especially in the F-to-M cases, surgery is extremely hard and extremely non-realistic. M-to-F surgery is much more achievable it seems.
The way to reduce/remove the need to identify people of course is to have nationalized insurance. If EVERYONE has insurance, who cares who comes in??? That way, the records will be accurate at all times.
The main obsticacle is discrimination and the so-called 'Ick-factor'.
I think ALL medical personnel should be thoroughly educated on ALL facets of society. Period. And treat them. Period.
Posted by: AL | July 06, 2009 at 09:38 PM
Ahhh, Louisiana. Coming from next door, I think that there are going to be problems from the get-go. Which doesn't absolve the rest of the states, but Louisiana is this pastry that has a protestant Baptist crust with a creamy catholic center. Or maybe some religious turducken.
Posted by: liberal japonicus | July 06, 2009 at 09:38 PM
Is that turducken better Cajun or Creole?
Posted by: Gary Farber | July 06, 2009 at 09:58 PM
AL: I haven't had people confused about my gender recently in person, though people always used to assume I was a guy on blogs. However ...
Once upon a time, I was working for Let's Go, and I was in Mexico. (NW Mexico, which I am told is worse than most of the rest.) I got a *lot* of harassment, and there was very little I could do about it, since part of writing a travel guide is that you have to go to e.g. restaurants, night clubs, etc. And in my case, it was of course alone, since there wasn't anyone else. I had been in other countries with serious harassment, e.g. Egypt, but somehow it was uglier this time: in Egypt, a lot of the guys would (after I turned them down and they realized I meant it) have this "heck, can't blame a guy for trying" attitude, whereas for whatever reason, that summer in Mexico, it was more "screw you."
One fine day, a guy grabbed my breasts, and when I got away, started screaming "F*cking bitch! F*cking American whore!", and I thought: really, I have had enough of this. My first thought was to get a nun's habit, but I didn't know where to get one, and besides, it was July, in Mexico. My second thought was to cut off all my hair, which I did. (As in, it was less than 1/4" long.) And it worked! As I had hoped, in the split second during which someone walked by me, he was generally too busy asking himself "what on earth is that?" to bother me. Yay!
But a couple of times, people really did mistake me for a guy. (I am not very guylike. I was in T-shirts.) The first time it happened, I was writing in a restaurant, and this guy struck up a conversation with me, and it was normal, a kind of normal conversation I hadn't had for weeks -- movies, soccer, etc. I was so happy -- not having any normal conversations for weeks is pretty lousy -- and then, maybe half an hour into this, a friend of his walked up, and he introduced me as "un norteamericano", and my inward jaw hit the floor.
Completely surreal.
Posted by: hilzoy | July 06, 2009 at 10:09 PM
Incidentally, Hilzoy, this thread has been all italic (in Firefox) since 08:53 PM, if maybe you could fix, pliz? Thanks!
Posted by: Gary Farber | July 06, 2009 at 10:22 PM
Hilzoy: It sounds indeed surreal, and I'd label you as insane to go alone to a Latin country. Sexism is off the charts there.
My GF (at the time) and I were almost raped while hitch-hiking in Spain. We had to physically fight the guy off. Successfully though. (And, stranded in the middle-of-who-knew-where-in-Spain, we found a barn to sleep in and had the best sex there, but that's besides the point. I think.)
I used to live in Paris, the 9th arrondissement, nearby Place Pigalle. I was into wearing army pants/jackets at the time, and the guys tried to pull me into the whorehouses all the time. Not figuring out I was a woman. I almost got into fist fights with them. I think I would've won too, but that may have been wishful thinking.
People thinking you're a different sex has it's pros and cons. Either way.
BEING transgendered, pfff, I don't even know what that's like.
Medically, as I said before, classes should be given in MedSchool, but still, one single class in school won't change the mind of a bigot.
Universal healthcare (you treat whoever comes to you for treatment. Period.) is the answer as far as I'm concerned. If, as a doctor, you don't want to treat 'certain people' (a violation of your oath!!) go work for some religious organization.
I'm just so so sick of crap like this.
Personally, almost 46, I have no insurance. I got laid off almost exactly a year ago. I was going to sign up with my DM for health insurance, alas, she got laid off before open enrollment.
Two women unemployed, 2 dogs, 4 cats, 5 turtles, countless fish. Imagine THIS family moving in case of foreclosure!!???!!
NOT gonna happen.
Things are bleak. All over, no matter what gender you are, race, sexual orientation.
Obama is disappointing A LOT of people.
Not just economically (Bush' recession, after all) but not giving us all the dignity he promised us. Yeah, I'm mad.
Posted by: AL | July 06, 2009 at 10:33 PM
Hey - I shouldn't have said 'whorehouses'.
They were strip clubs.
My bad, and my apologies to the professional women!
Posted by: AL | July 06, 2009 at 10:34 PM
Byringman, my point was that your comment that she should identify herself as male to doctors was more than a little blinkered in light of her earlier experience.
Posted by: lt | July 06, 2009 at 10:41 PM
Um, making sure the hospital knows your biological sex, even if it's not your psychological sex, is awfully important. I don't think I need to explain why.
Posted by: anonymous | July 06, 2009 at 10:44 PM
Um, anon, if you read the original post, the many comments, and the many comments here, you'll see that Emily and others outraged of her treatment are aware of that issue. In fact, she tried doing just that, and that's when she was given the worst treatment of all.
In fact, I'd hazard a guess that Emily has given a hell of a lot more thought to all aspects of this question than you have. I mean, seriously, the willingness of folks to lecture one of the most marginalized groups in our society about their own situation is really mind-boggling.
Posted by: lt | July 07, 2009 at 12:03 AM