Transgender London

The Trans Healthcare Shortage

It is no secret that the LGBT population of Ontario is grossly underserviced by the Healthcare system. This is particularly so within the transgender population. It is also no secret that in many cases, the reasons are no different from the discrimination most of us experience every day. Still, there are plenty of physicians who are willing to work with the transgender community albeit for one reason; they don’t know how to treat us.

Okay, I can understand that there are “extenuating” circumstances but also, basic healthcare needs also need to be addressed. So, let’s start with the “extenuating” circumstances first since they are probably the most difficult.

A transwoman undergoing transition is on hormones. So, what does that mean to the general practitioner? Let’s start with blood tests. The body chemistry is changed so some tests have to be treated as female because of it. Now, if the patient hasn’t gone through all the legalities of name and sex identification (M or F) change then the problem with getting these tests done properly is an issue. Similarly how would a lab do a prostate test on a legal female? Of course in Ontario, this is not covered by OHIP but the point is still made. As soon as insurance of any kind is involved the restrictions are applied because you can’t do female tests on a male and vice versa.

So, is it the physician, the lab or insurer who is to blame; or is it a combination. I would state that the root of this is the insurer. They simply are not flexible in any way shape or form. It is all black and white with them. So, they won’t cover it. Now, let’s go to the lab. You present your healthcard and it says M but you need a test for a female blood chemistry. Back to the insurer again, because OHIP (who are the policy administrators), can’t cover it for the reasons above. So, what to do?

Well, you either pay for it out of pocket or find a physician who has their own lab. While this is an uncommon situation, it is not unheard of. Why would a physician have his or her own lab? Because they need the tests done cheaper than the outside (private corporation) labs charge, they have a high enough volume of business to justify the expense of the lab, they can get the tests done that need to be done the way they need them done and all of this in a timely manner where the control of the process is assured. So, what is the solution?

How about if the labs were invoice the physicians who can then bill the health system for tests. Yes, this will add to the doctor’s operating costs, but a small extra charge for the service will be worth it to any of us. Of course then comes the issue of an audit of the doctor. It is a Catch-22. Now the doctor is putting his or her practice at risk for doing the right thing, the necessary thing. That simply isn’t fair to anyone. So, who pays the ultimate price? Why we as patients do.

Now, let’s look at more mundane things.

The physician needs to get over their prejudices. Let’s start with something as simple as teaching a transwoman how to do basic breast self-examination. Why should this be an issue? Is this not a basic healthcare need? Okay. Let’s move on. Basic routine healthcare is largely unaffected by any of this. This is what a GP is supposed to do. So, why are they excusing themselves because someone is trans and they don’t know how to treat a transgender patient? That is simply nonsense.

As I said, some blood tests can be skewed, BUT if that is the case, the endocrinologist can get what is needed. All the GP needs to do is contact them or better yet, the endocrinologist could order these tests on a regular basis and send a copy of the results to the GP. Wouldn’t that be easy?

Now to more sensitive areas. Yes a transwoman who has had SRS needs an internal too. The OB/GYN can educate themselves on the surgical process and expected results within a couple of hours, and after that it is business as usual. Look for signs of cancer or STD’s. This isn’t rocket science is it? But again; “Oh, I don’t know how to treat a transwoman”. My reply again is; that excuse is BS.

Is it any different for the transman? Of course not; why should it be? They have the same problems the transwoman does; access to the healthcare system.

Now, what about mental health? This is an even more difficult area to work in since only psychiatrists (because they are MD’s) are OHIP funded. So, the net result is that they are grossly unavailable to the trans population. Why? First, most won’t treat transgender because they don’t know anything about it. That is the real problem; they don’t realize you can’t treat transgender. They see transgender as a problem and forget that the patient is suffering anxiety and depression because of their perceptions of society. It isn’t about transgender, it is about the person. WHY DON’T THEY GET IT? The answer is simple; because nobody told them.

Their psych classes, if they did anything on transgender at all, were based on out-dated or inaccurate information. Again, this information often treats transgender as a pathology instead of being a normative. So, they are unprepared in their own minds. Instead of treating the person, again, they see their job as to treat transgender. They have no experience and thus, pass on the treatment.

Now, if the psychologists were covered by OHIP, there could be a lot more mental healthcare available, but again, we are facing the same scenarios as above. So, why aren’t they covered? It comes down to funding, transfer payments and Canadian government definitions, rules and regulations for coverage.

Okay, so now to the BIG one. Why won’t a doctor recommend a patient for SRS? Because in Ontario, the gatekeepers of the mysterious provincial funding for SRS lies with CAMH. That of course is a great cop out. “I can send the patient to CAMH and I don’t have to accept any responsibility for my own treatment protocols.” That is, by any definition, passing the buck.

First, after a period of time, the doctor will know with a great deal of certainty whether a patient is a candidate for SRS. That is a fact. If they don’t, they should give up their license to practice. That too is a fact. There is nothing preventing them from expressing that opinion on a letter. The problem is that they think their recommendation is divine. It isn’t. Ultimately, it is the patient’s decision. The doctor is only expressing an opinion based upon their treatment of the patient as a mental healthcare professional. That is it. If a mistake is made, it is ultimately the mistake of the patient, not the doctor. If a mistake is made, it is an extremely rare case.

Okay, so even if the doctor believes their diagnosis of “Gender Dysphoria” or “Gender Incongruence” is correct, their recommendation will carry zero weight in getting provincial funding for SRS. Only CAMH can give that letter and that is highly unlikely because they can only issue a very limited number of letters per year. So, in effect, a patient can go through all of this then wait for a decade or more to actually be able to get the funding for his or her SRS. That is a sick, sick system. The cure for the problem has to wait for an undetermined length of time.

Imagine needing a kidney transplant only to be told you have to go on a wait list because the province will only pay for 10 a year. Oh right, I forgot; SRS isn’t treating a life threatening condition. Want to bet? The suicide rates in the trans population are staggering. Still think it isn’t lifesaving surgery? Oh, I get it, so someone who commits suicide because they can’t get a kidney transplant is excused; right? If you believe that, you need to give your head a shake; there might be a few loose brain cells rattling around.

None of this is fair to anyone.

The patient is being denied healthcare. Those are increasing social support costs exponentially. The fact is that it is more cost effective to treat the transperson than to ignore the problem. The long term costs are only going to increase without having the necessary care. That is a fact.

So, what is the problem with Ontario’s: government, physicians, mental health professionals, surgeons, politicians, and social workers just to name a few? If you get an answer, please tell me; I would dearly love to know. But then, I already know what they don’t and aren’t willing to learn or acknowledge because keeping your head in the sand is easier than facing a growing problem.

For information on providers in your area, go to Rainbow Health Ontario. (Now this is an eye opener if you want to see who is providing trans healthcare.)

http://www.rainbowhealthontario.ca

This site was last updated 03/01/11