Southern Comfort
March 3, 2009 9:17 PM Subscribe
Southern Comfort is a 2001 documentary film about the final year in the life of Robert Eads, a female-to-male transsexual. Eads, diagnosed with ovarian cancer, was turned down for treatment by two dozen doctors out of fear that treating such a patient would hurt their reputation. You can watch the film here, part 1 through 10.
Hippocratic oath or hypocritical oath AMIRITE?
posted by Effigy2000 at 9:28 PM on March 3, 2009
posted by Effigy2000 at 9:28 PM on March 3, 2009
Yes this doesn't sound breathtakingly depressing at all.
posted by turgid dahlia at 9:34 PM on March 3, 2009
posted by turgid dahlia at 9:34 PM on March 3, 2009
treating such a patient would hurt their reputation
Because patient confidentiality would not have applied in this case why?
posted by padraigin at 9:41 PM on March 3, 2009 [1 favorite]
Because patient confidentiality would not have applied in this case why?
posted by padraigin at 9:41 PM on March 3, 2009 [1 favorite]
Without actually watching the entire documentary I find it really really hard to believe that two dozen doctors turned this, eh, guy, down simply because they didn't want to ruin their reputations. I hate doctors as much as the next guy (or maybe not as much as the next guy) but to think they are so evil that 24 of them refused to save someone's life smells like someone stretching the truth. It seems like it's probably one of those situations where the surgery is so complicated and risky that noone will take it, or maybe it's not, I haven't seen the documentary and really don't feel like watching it. If someone watches it and finds out the real story that'd be interesting, if these 24 doctors really are a bunch of assholes than that's quite a story.
posted by BrnP84 at 10:13 PM on March 3, 2009
posted by BrnP84 at 10:13 PM on March 3, 2009
Yes, this is a great documentary and love story. I'm delighted to see it online. Despite the subject matter, I and my sweetie took away an overriding feeling not of depression, but rather admiration for Robert and his spouse and friends. Lots of gratitude for our own love and ease of access to medical care, too. My spouse had been uncomfortable with the T part of LGBT, but this documentary really made him think about it. It was a major turning point in helping him shift from viewing trans people as, you know, people.
padraigin, it takes place in Georgia. IIRC, Robert talks about sticking out painfully in the waiting room of an OB-GYN with lots of cis-women patients who quite obviously were wondering WTF this man was doing there. A non-judgmental doctor would have ignored the whispers and gossip and disapproval, but the problem was finding one.
posted by cybercoitus interruptus at 10:23 PM on March 3, 2009
padraigin, it takes place in Georgia. IIRC, Robert talks about sticking out painfully in the waiting room of an OB-GYN with lots of cis-women patients who quite obviously were wondering WTF this man was doing there. A non-judgmental doctor would have ignored the whispers and gossip and disapproval, but the problem was finding one.
posted by cybercoitus interruptus at 10:23 PM on March 3, 2009
I realize it takes place in Georgia, but Georgia's not a portal to the past and there are major universities there with hospitals, so I have trouble getting my head around the idea of being unable to find a doctor that would not be willing to work around a patient's special needs (haven't watched the documentary yet, will absolutely do so when I get the time to sit and give it full attention).
I have no doubt that I'm spoiled by living in a LGBT friendly region. But christ, there are always guys sitting around in the waiting room at my OB's office and wandering in and out of the back. It doesn't ever occur to me to wonder what their purpose is, whether they're there to support a partner or if they're there because my OB happens to be a primary care doctor as well and maybe it's just easier for a family if the guy sees the same dude who delivered all his kids or if they're biologically XX and have a medical need to see a doctor who specializes in gynecological treatment.
Even without seeing the documentary I'm grateful for the access I have to care without judgment and the freedom I have from passing judgment on others.
posted by padraigin at 10:32 PM on March 3, 2009
I have no doubt that I'm spoiled by living in a LGBT friendly region. But christ, there are always guys sitting around in the waiting room at my OB's office and wandering in and out of the back. It doesn't ever occur to me to wonder what their purpose is, whether they're there to support a partner or if they're there because my OB happens to be a primary care doctor as well and maybe it's just easier for a family if the guy sees the same dude who delivered all his kids or if they're biologically XX and have a medical need to see a doctor who specializes in gynecological treatment.
Even without seeing the documentary I'm grateful for the access I have to care without judgment and the freedom I have from passing judgment on others.
posted by padraigin at 10:32 PM on March 3, 2009
I vaguely remember watching this documentary in late one night in college. Yes, it was depressing, but the way his chosen family gathered around him was also uplifting and heartwarming. I don't remember anything sketchy about about the presentation in regards to refusal of treatment, but perhaps I just missed that possibility. Like I said -- late night, freshman year. :)
On preview, what cybercoitus interruptus said. I'll be watching it again -- it's definitely worth seeing.
posted by natabat at 10:35 PM on March 3, 2009
On preview, what cybercoitus interruptus said. I'll be watching it again -- it's definitely worth seeing.
posted by natabat at 10:35 PM on March 3, 2009
Robert talks about sticking out painfully in the waiting room of an OB-GYN with lots of cis-women patients who quite obviously were wondering WTF this man was doing there.
Not that it's any of anyone else's business, but doesn't it seem to anyone else that the obvious assumption a gossip would draw, if a man is in the waiting room of an OB-GYN, is that he's there with, or on behalf of, a woman patient of the doctor? In this case it's the incorrect assumption, but no less obvious for it.
posted by aeschenkarnos at 10:35 PM on March 3, 2009
Not that it's any of anyone else's business, but doesn't it seem to anyone else that the obvious assumption a gossip would draw, if a man is in the waiting room of an OB-GYN, is that he's there with, or on behalf of, a woman patient of the doctor? In this case it's the incorrect assumption, but no less obvious for it.
posted by aeschenkarnos at 10:35 PM on March 3, 2009
shift from viewing trans people as freaks to viewing them as people, I mean. Hurts to write "freaks" but yeah, he did, until he was exposed to what trans people had to say. Books like As Nature Made Him and Trans-Sister Radio helped, too.
posted by cybercoitus interruptus at 10:36 PM on March 3, 2009
posted by cybercoitus interruptus at 10:36 PM on March 3, 2009
is that he's there with, or on behalf of, a woman patient of the doctor?
Yes, and I can't remember enough to address this. Possibly his (female) birth name is what the nurse would have called out, and then he'd have to get up in response, or something. I hope somebody who has a better memory or a more recent viewing pops in to explain.
posted by cybercoitus interruptus at 10:39 PM on March 3, 2009
Yes, and I can't remember enough to address this. Possibly his (female) birth name is what the nurse would have called out, and then he'd have to get up in response, or something. I hope somebody who has a better memory or a more recent viewing pops in to explain.
posted by cybercoitus interruptus at 10:39 PM on March 3, 2009
but doesn't it seem to anyone else that the obvious assumption a gossip would draw, if a man is in the waiting room of an OB-GYN, is that he's there with, or on behalf of, a woman patient of the doctor?
agreed, the story seems kinda like it's got some kind of agenda against something (southern ideals, bad doctors, IDK) and is telling us a skewed version of the truth. I have enough faith in humanity to believe that two dozen doctors would not refuse a patient strictly for reputation.
posted by BrnP84 at 10:40 PM on March 3, 2009
agreed, the story seems kinda like it's got some kind of agenda against something (southern ideals, bad doctors, IDK) and is telling us a skewed version of the truth. I have enough faith in humanity to believe that two dozen doctors would not refuse a patient strictly for reputation.
posted by BrnP84 at 10:40 PM on March 3, 2009
I have enough faith in humanity to believe that two dozen doctors would not refuse a patient strictly for reputation.
Even if I believed all doctors were self-righteous jerks, and I definitely don't, I have enough faith in human ego to believe at least one doctor in a hundred would take on such a patient primarily for the sake of reputation.
posted by aeschenkarnos at 10:44 PM on March 3, 2009
Even if I believed all doctors were self-righteous jerks, and I definitely don't, I have enough faith in human ego to believe at least one doctor in a hundred would take on such a patient primarily for the sake of reputation.
posted by aeschenkarnos at 10:44 PM on March 3, 2009
telling us a skewed version of the truth. I have enough faith in humanity to believe that two dozen doctors would not refuse a patient strictly for reputation.
would you believe 2 dozen refusing a patient because they secretly believe that he's a freak who deserves what he's gotten?
Never mind. Why don't you watch the documentary before concluding things about it?
posted by cybercoitus interruptus at 11:15 PM on March 3, 2009 [1 favorite]
would you believe 2 dozen refusing a patient because they secretly believe that he's a freak who deserves what he's gotten?
Never mind. Why don't you watch the documentary before concluding things about it?
posted by cybercoitus interruptus at 11:15 PM on March 3, 2009 [1 favorite]
I have enough faith in humanity to believe that two dozen doctors would not refuse a patient strictly for reputation.
Compare this to the story of Thomas Beatie and his infertile wife's desire to have children. (Beatie gave birth last year and is expecting again). Many doctors refused to treat the couple and they had to resort to buying donated sperm and doing the insemination themselves at home.
That was in the liberal Pacific Northwest.
It's more than likely that in a place like Georgia, you find a lot more discrimination against transgender people.
posted by cmgonzalez at 11:18 PM on March 3, 2009
Compare this to the story of Thomas Beatie and his infertile wife's desire to have children. (Beatie gave birth last year and is expecting again). Many doctors refused to treat the couple and they had to resort to buying donated sperm and doing the insemination themselves at home.
That was in the liberal Pacific Northwest.
It's more than likely that in a place like Georgia, you find a lot more discrimination against transgender people.
posted by cmgonzalez at 11:18 PM on March 3, 2009
So I had this class in college my senior year that I had to take. I guess I didn't have to take it, but it fulfilled so many of my requirements that it would save me taking two other classes in its place. Unfortunately, I realized that I needed all these other requirements about a week into the semester, so I begged and pleaded with the teacher (Barbara, not her real name) to give me authorization to register for the class late. She replied amicably and just said I had to get about halfway into a book in about a days time, and that if I was up to it I was more than welcome to join them. This seemed like no problem at all, so I read the book and showed up for class on Monday.
I had never been to this class that all these other kids had been going to for a week, so I walked to the opposite end of the room from the door and took a seat at the back. A couple minutes late and after everybody had taken their seat, a man with a wispy goatee enters the room and sets down his briefcase on the table in the front of the class. Fuck. This was not my professor. I came into the wrong classroom. And sat at the far end of the class. And this was already the second week of school. If this was the first week of school I would have sucked it up and been the asshole that came into the wrong class and walked out after class had started, but no, it was already the second week when people know where the hell their classes are. If I was next to the door I probably would've slipped out easily and undetected, but no, I had to march to the far side of the classroom. I slumped back into my seat and prepared to sit through a lecture that was totally irrelevant to me and formulated excuses to feed the professor whose class I missed.
As the lecture progresses I notice a lot of mention and highlighting of the homosexual character in the novel we had been assigned. I also notice a lot of tangential discussion relating to queer interaction with mainstream society. I also notice that this professor is a bit wide in the hip for even a stocky dude. Then it hits me like a ton of bricks. I am not in the wrong class, the person teaching the class is Barbara, a female to male transgender who actually goes by Benny (who doesn't actually go by Benny), and I've signed up for a "Queer space and time: LGBT English Literature" course. I felt a wave of both confusion and relief come over me.
Anyway, we watched the documentary sometime later in the class. It was pretty refreshing insight into queer culture, as up to that point the majority of queer culture seemed to be obnoxiously and deliberately provocative material designed to "shake up" the mainstream, but is ultimately ignored due to its extreme nature. The point that Robert couldn't find a physician isn't really played up too much in the movie. While we did have a guest speaker, a very angry butch lady, come in and hurf and blurf about "systemic prejudice" and reference that movie, I felt the movie's take on it was more of, "healthcare is hard, and it sure is harder with one more hurdle like this." The movie seemed more to focus on just how normal transgendered people were, but also how it was difficult to interact with a society that insisted on a sexual binary. Due to this it mostly shows their interactions with each other, with Robert taking on a nurturing role to his other transgendered friends, and a loving role to his transgendered..wife? Girlfriend? I forget.
A funny point in the movie is when Robert is smoking his pipe and telling a story of him smoking his pipe outside a store. A few "good ol' boys" approach him and say that he looks like quite the "good ol' boy" himself, and ask if he would like to be a part of their secret "klan." That's about as exciting as he gets, I think. Robert's just a regular, ordinary guy.
posted by GooseOnTheLoose at 11:22 PM on March 3, 2009 [3 favorites]
I had never been to this class that all these other kids had been going to for a week, so I walked to the opposite end of the room from the door and took a seat at the back. A couple minutes late and after everybody had taken their seat, a man with a wispy goatee enters the room and sets down his briefcase on the table in the front of the class. Fuck. This was not my professor. I came into the wrong classroom. And sat at the far end of the class. And this was already the second week of school. If this was the first week of school I would have sucked it up and been the asshole that came into the wrong class and walked out after class had started, but no, it was already the second week when people know where the hell their classes are. If I was next to the door I probably would've slipped out easily and undetected, but no, I had to march to the far side of the classroom. I slumped back into my seat and prepared to sit through a lecture that was totally irrelevant to me and formulated excuses to feed the professor whose class I missed.
As the lecture progresses I notice a lot of mention and highlighting of the homosexual character in the novel we had been assigned. I also notice a lot of tangential discussion relating to queer interaction with mainstream society. I also notice that this professor is a bit wide in the hip for even a stocky dude. Then it hits me like a ton of bricks. I am not in the wrong class, the person teaching the class is Barbara, a female to male transgender who actually goes by Benny (who doesn't actually go by Benny), and I've signed up for a "Queer space and time: LGBT English Literature" course. I felt a wave of both confusion and relief come over me.
Anyway, we watched the documentary sometime later in the class. It was pretty refreshing insight into queer culture, as up to that point the majority of queer culture seemed to be obnoxiously and deliberately provocative material designed to "shake up" the mainstream, but is ultimately ignored due to its extreme nature. The point that Robert couldn't find a physician isn't really played up too much in the movie. While we did have a guest speaker, a very angry butch lady, come in and hurf and blurf about "systemic prejudice" and reference that movie, I felt the movie's take on it was more of, "healthcare is hard, and it sure is harder with one more hurdle like this." The movie seemed more to focus on just how normal transgendered people were, but also how it was difficult to interact with a society that insisted on a sexual binary. Due to this it mostly shows their interactions with each other, with Robert taking on a nurturing role to his other transgendered friends, and a loving role to his transgendered..wife? Girlfriend? I forget.
A funny point in the movie is when Robert is smoking his pipe and telling a story of him smoking his pipe outside a store. A few "good ol' boys" approach him and say that he looks like quite the "good ol' boy" himself, and ask if he would like to be a part of their secret "klan." That's about as exciting as he gets, I think. Robert's just a regular, ordinary guy.
posted by GooseOnTheLoose at 11:22 PM on March 3, 2009 [3 favorites]
would you believe 2 dozen refusing a patient because they secretly believe that he's a freak who deserves what he's gotten?
Never mind. Why don't you watch the documentary before concluding things about it?
If I did watch the documentary is it going to show indepth interviews with all 24 doctors and their exact reasons for refusing care? From the surface this seems like a "hey we should feel really sorry for this guy b/c these doctors are all scum of the earth people" and not that I don't feel sympathy for Eads but that's not the point. What exactly are you trying to convince me of? That humans ARE so evil that they would not treat a terminally ill patient strictly b/c it would look bad? I'm sure there are a few that would refuse care, not 24 in a row.
posted by BrnP84 at 11:36 PM on March 3, 2009 [1 favorite]
BrnP84, are those the only options? I dunno, sounds so, binary.
posted by iamkimiam at 12:06 AM on March 4, 2009 [1 favorite]
posted by iamkimiam at 12:06 AM on March 4, 2009 [1 favorite]
What exactly are you trying to convince me of? That humans ARE so evil that they would not treat a terminally ill patient strictly b/c it would look bad?
I just watched the whole documentary and I have to agree with an above commenter that that's hardly what the documentary is about. The time spent discussing the medical condition is a tiny, tiny portion of the documentary. I suspect there's probably no one here who could give you the kind of evidence you want, but it's MeFi so maybe I'm wrong. Either way, it's not the point of the documentary and I don't quite understand your monomania about it.
You can either watch it and appreciate it for what it is, or you can just keep repeating that you don't believe such a thing would happen and keep yourself from watching it in fear that it might foist some view on you. While I understand some skepticism, the latter doesn't seem productive.
posted by Nattie at 12:14 AM on March 4, 2009 [1 favorite]
I just watched the whole documentary and I have to agree with an above commenter that that's hardly what the documentary is about. The time spent discussing the medical condition is a tiny, tiny portion of the documentary. I suspect there's probably no one here who could give you the kind of evidence you want, but it's MeFi so maybe I'm wrong. Either way, it's not the point of the documentary and I don't quite understand your monomania about it.
You can either watch it and appreciate it for what it is, or you can just keep repeating that you don't believe such a thing would happen and keep yourself from watching it in fear that it might foist some view on you. While I understand some skepticism, the latter doesn't seem productive.
posted by Nattie at 12:14 AM on March 4, 2009 [1 favorite]
I have enough faith in humanity to believe that two dozen doctors would not refuse a patient strictly for reputation.
I have enough faith in humanity to believe that whole tribes and nations wouldn't try to systematically eradicate various minorities due to prejudice, and if I put my fingers in my ears and shout loud enough, sometimes I can even convince myself that the holocaust didn't happen.
posted by PeterMcDermott at 12:20 AM on March 4, 2009 [5 favorites]
I have enough faith in humanity to believe that whole tribes and nations wouldn't try to systematically eradicate various minorities due to prejudice, and if I put my fingers in my ears and shout loud enough, sometimes I can even convince myself that the holocaust didn't happen.
posted by PeterMcDermott at 12:20 AM on March 4, 2009 [5 favorites]
BrnP84, are those the only options? I dunno, sounds so, binary.
That's kinda my point. This thread has turned into "these doctors are evil people b/c they refused care based on reputation", hell that's pretty much the title of the post. What I'm saying is no, we aren't seeing the whole picture here and that's not even what Eads story should be about. The focus has been taken away from Eads and his story and shifted to "here's a chance to give doctors a bad name." Honestly, if this really went down like the title implies it would've have become a national shit storm. I'm saying that these ARE NOT the only options, these doctors must have had more reasons to refuse care other than him being transgender or at the least I truly hope that to be the case. It seems like people are trying to convince me that doctors truly are huge pieces of shit.
posted by BrnP84 at 12:21 AM on March 4, 2009
Is it possible that Robert wasn't willing to give up testosterone injections during the course of his ovarian cancer treatment, and that was a complicating factor that made at least some of the 24 doctors shy away from the case?
I don't deny that discrimination exists, but reality check: when a specialist focused on a long run of successful outcomes (instead of looking for the occasional, groundbreaking challenge) has a hammer, s/he is often only willing to take cases that look like nails. Robert might also have piss poor insurance as well.
posted by availablelight at 2:24 AM on March 4, 2009 [2 favorites]
I don't deny that discrimination exists, but reality check: when a specialist focused on a long run of successful outcomes (instead of looking for the occasional, groundbreaking challenge) has a hammer, s/he is often only willing to take cases that look like nails. Robert might also have piss poor insurance as well.
posted by availablelight at 2:24 AM on March 4, 2009 [2 favorites]
What thread are you reading, BrnP84? The one I just read had a lot of thoughtful responses and anecdotes, and in it, you were the only one who had a chip on your shoulder. You gave yourself away in your first post:
I find it really really hard to believe that two dozen doctors turned this, eh, guy, down simply because they didn't want to ruin their reputations. (bold mine)
Learn to live with it. It's not going away and it doesn't threaten your masculinity. (Or does it?)
Sorry for being rude. Dude's rubbing me the wrong way this morning.
On preview, there is no excuse, especially not a lack of insurance, for a doctor not treating someone who is terminally ill. I have no idea whether it was discrimination because of Ead's transgender status, and I really don't care. It just sucks when someone dies in this country for lack of treatment, and it happens every day.
(Doctors also do wonderful, mind-blowing things everyday, like save my dear friend with no insurance from his brain tumor, and for this, I am eternally grateful. I do not hate doctors in any way.)
posted by nosila at 5:55 AM on March 4, 2009 [3 favorites]
I find it really really hard to believe that two dozen doctors turned this, eh, guy, down simply because they didn't want to ruin their reputations. (bold mine)
Learn to live with it. It's not going away and it doesn't threaten your masculinity. (Or does it?)
Sorry for being rude. Dude's rubbing me the wrong way this morning.
On preview, there is no excuse, especially not a lack of insurance, for a doctor not treating someone who is terminally ill. I have no idea whether it was discrimination because of Ead's transgender status, and I really don't care. It just sucks when someone dies in this country for lack of treatment, and it happens every day.
(Doctors also do wonderful, mind-blowing things everyday, like save my dear friend with no insurance from his brain tumor, and for this, I am eternally grateful. I do not hate doctors in any way.)
posted by nosila at 5:55 AM on March 4, 2009 [3 favorites]
I viewed the documentary years ago, and was very moved by Robert's plight. When I read this FPP, I looked at the Wikipedia bio to learn more about the allegations that 24 doctors refused to care for him.
On December 23, 2005, an anonymous Wikipedia user first wrote that Eads "was refused treatment." ["He had ovarian cancer and was refused treatment."] The user, who appears only to have contributed to Eads' article and no other Wikipedia entries, then came back later that day and added "Diagnosed with ovarian cancer, then turned away by more than two dozen doctors who feared that taking him on as a patient might harm their practice, Robert had [[ovarian cancer]] and was refused treatment."]
The anonymous user, who only contributed to Eads' article on December 23, 2005, and seemingly never again to Wikipedia, gave no source/attribution for this statement, which has remained in the biography for three years. It is a provocative assertion posted anonymously, without attribution, and so, at the least, should be questioned.
posted by terranova at 8:03 AM on March 4, 2009 [2 favorites]
On December 23, 2005, an anonymous Wikipedia user first wrote that Eads "was refused treatment." ["He had ovarian cancer and was refused treatment."] The user, who appears only to have contributed to Eads' article and no other Wikipedia entries, then came back later that day and added "Diagnosed with ovarian cancer, then turned away by more than two dozen doctors who feared that taking him on as a patient might harm their practice, Robert had [[ovarian cancer]] and was refused treatment."]
The anonymous user, who only contributed to Eads' article on December 23, 2005, and seemingly never again to Wikipedia, gave no source/attribution for this statement, which has remained in the biography for three years. It is a provocative assertion posted anonymously, without attribution, and so, at the least, should be questioned.
posted by terranova at 8:03 AM on March 4, 2009 [2 favorites]
On preview, there is no excuse, especially not a lack of insurance, for a doctor not treating someone who is terminally ill.
I agree. I also live in the United States of America, where this kind of thing happens not infrequently to cis-gendered folk-- try even getting an appointment at a private specialist without having the receptionist man the gate with the all-important question: "What kind of insurance do you have?"
posted by availablelight at 8:56 AM on March 4, 2009
I agree. I also live in the United States of America, where this kind of thing happens not infrequently to cis-gendered folk-- try even getting an appointment at a private specialist without having the receptionist man the gate with the all-important question: "What kind of insurance do you have?"
posted by availablelight at 8:56 AM on March 4, 2009
ok, Episode 1 at 11:30, Robert and his friends talking about how beautifully MDs can do beautiful post-mastectomy breast reconstructions these days and why can't they do phalloplasties that look real too
13:27, Robert starts telling of discovering that he had cancer of the cervix, ovaries, uterus
14:00 [rough transcription]
Robert: "It took 3 weeks of calling dr after dr after dr. I kept getting turned down by drs. They would not treat me.
friend: "What Ob-Gyn doesn't know how to treat female organs? That is a lame excuse."
Robert: "There was 2 or 3 of the drs that were at least honest enough to just say point blank "I'm sorry but it would be too much of an embarrassment to my other patients to have you in here. They were afraid of losing business. . . . Finally one Sunday morning I woke up in a pool of blood so I told my friends Tom and [Deddy? Debbie?]. I was staying with them at the time."
friend [Deddy/Debbie?] "One hospital that was down in another town that was real close... told 'em he didn't have insurance, told 'em not to worry about it we would pay the bill. Told em what was going on and that he'd been seen at the other hospital and we had no problem with that and I said, "Here's the next thing. He's a transsexual."
""Well maybe you'd better go to downtown." Downtown. Hung up from there, called another one. I think by the time that day was over we had over 20 doctors and I don't know how many hospitals that refused to treat him."
posted by cybercoitus interruptus at 10:03 AM on March 4, 2009
13:27, Robert starts telling of discovering that he had cancer of the cervix, ovaries, uterus
14:00 [rough transcription]
Robert: "It took 3 weeks of calling dr after dr after dr. I kept getting turned down by drs. They would not treat me.
friend: "What Ob-Gyn doesn't know how to treat female organs? That is a lame excuse."
Robert: "There was 2 or 3 of the drs that were at least honest enough to just say point blank "I'm sorry but it would be too much of an embarrassment to my other patients to have you in here. They were afraid of losing business. . . . Finally one Sunday morning I woke up in a pool of blood so I told my friends Tom and [Deddy? Debbie?]. I was staying with them at the time."
friend [Deddy/Debbie?] "One hospital that was down in another town that was real close... told 'em he didn't have insurance, told 'em not to worry about it we would pay the bill. Told em what was going on and that he'd been seen at the other hospital and we had no problem with that and I said, "Here's the next thing. He's a transsexual."
""Well maybe you'd better go to downtown." Downtown. Hung up from there, called another one. I think by the time that day was over we had over 20 doctors and I don't know how many hospitals that refused to treat him."
posted by cybercoitus interruptus at 10:03 AM on March 4, 2009
I've come to believe that just about everything in the world would be improved if folks would learn more about the things they criticize before they start criticizing them.
posted by serazin at 10:03 AM on March 4, 2009
posted by serazin at 10:03 AM on March 4, 2009
I've not seen the documentary yet, but based on the comments and cybercoitus' transcription above, it is rather likely that he was refused because of having no insurance for a likely incredibly expensive surgery, with major complications (i.e. non-typical anatomy) with nothing other than "we'll pay for it" as assurance.
Plus, most doctors rather enjoy seeing patients and making money. Surgeons especially are famous for being willing to take a spleen out on a cafeteria table so long as they are going to get paid for it.
Further, docs routinely do unusual, embarrassing, uncomfortable things on a daily basis.
Of all the reasons, it is very unlikely that the MAIN cause was "because this is weird". The MAIN cause was likely related to insurance and/or malpractice liability.
I have to admit I'm a bit surprised that a female to male transsexual did not have a complete hysterectomy before the sex change operation. The chance for a complication like this seems exceedingly high, and seems like it could easily be avoided.
With all that said, yes there are lots of doctors who are also bigots, but Atlanta is in Georgia, and Emory is a world class medical teaching institution. They would have probably treated him for free just for the gain in teaching opportunity.
*Disclaimer: I am a healthcare executive, therefore my opinion is quite likely biased.
posted by Ynoxas at 10:25 AM on March 4, 2009 [4 favorites]
Plus, most doctors rather enjoy seeing patients and making money. Surgeons especially are famous for being willing to take a spleen out on a cafeteria table so long as they are going to get paid for it.
Further, docs routinely do unusual, embarrassing, uncomfortable things on a daily basis.
Of all the reasons, it is very unlikely that the MAIN cause was "because this is weird". The MAIN cause was likely related to insurance and/or malpractice liability.
I have to admit I'm a bit surprised that a female to male transsexual did not have a complete hysterectomy before the sex change operation. The chance for a complication like this seems exceedingly high, and seems like it could easily be avoided.
With all that said, yes there are lots of doctors who are also bigots, but Atlanta is in Georgia, and Emory is a world class medical teaching institution. They would have probably treated him for free just for the gain in teaching opportunity.
*Disclaimer: I am a healthcare executive, therefore my opinion is quite likely biased.
posted by Ynoxas at 10:25 AM on March 4, 2009 [4 favorites]
The movie takes place in Toccoa and Toccoa is COUNTRY. He does make a couple of trips into Atlanta and his girlfriend (Lola, was it?) does end up helping a lot, but overall I got the impression that Robert was as stymied by the medical profession by his socioeconomic class and location as his gender.
You also have to think about how incredibly far we've come (even realizing there's still a long way to go) with respect to LGBT awareness and rights in this country in the last decade. I feel fairly strongly, as someone who was living in Tennessee at the time and has lived in Georgia for the last six years, that in Toccoa in the late 90s, Robert would have had a VERY difficult time finding adequate healthcare when A. uninsured and B. transgendered.
I worked with a MTF on a university campus (and this was a state university, not a private religious college) in Tennessee in the 90s and the women in the building kicked up a fuss about that individual wanting to use the womens' restrooms in the building during the transition year before surgery. Can you imagine how those women would have felt if Robert had been in their OB/GYN's waiting room?
All that aside, the documentary is beautiful and heartbreaking and one I've recommended to many, many people since I first saw it.
The irony of a person living as a man and dying of ovarian cancer is probably the reason the movie got funding. The beauty of the movie is how it chronicles life, love, and death in the last year of a person who is terminally ill.
posted by 100watts at 10:47 AM on March 4, 2009
You also have to think about how incredibly far we've come (even realizing there's still a long way to go) with respect to LGBT awareness and rights in this country in the last decade. I feel fairly strongly, as someone who was living in Tennessee at the time and has lived in Georgia for the last six years, that in Toccoa in the late 90s, Robert would have had a VERY difficult time finding adequate healthcare when A. uninsured and B. transgendered.
I worked with a MTF on a university campus (and this was a state university, not a private religious college) in Tennessee in the 90s and the women in the building kicked up a fuss about that individual wanting to use the womens' restrooms in the building during the transition year before surgery. Can you imagine how those women would have felt if Robert had been in their OB/GYN's waiting room?
All that aside, the documentary is beautiful and heartbreaking and one I've recommended to many, many people since I first saw it.
The irony of a person living as a man and dying of ovarian cancer is probably the reason the movie got funding. The beauty of the movie is how it chronicles life, love, and death in the last year of a person who is terminally ill.
posted by 100watts at 10:47 AM on March 4, 2009
Of all the reasons, it is very unlikely that the MAIN cause was "because this is weird". The MAIN cause was likely related to insurance and/or malpractice liability.
"One hospital that was down in another town that was real close... told 'em he didn't have insurance, told 'em not to worry about it we would pay the bill. Told em what was going on and that he'd been seen at the other hospital and we had no problem with that and I said, "Here's the next thing. He's a transsexual."
""Well maybe you'd better go to downtown."
fyi, first bolded part above could be transcribed as "told 'im" [hospital told Robert he didn't have insurance]. (Doesn't change anything in our respective positions, but I should have mentioned the ambiguity of the pronoun.)
"we had no problem with that" I interpreted as "The hospital had no problem with that." Which makes the hospital's reaction to "He's a transsexual" strongly indicative of prejudice.
But reading your take, Ynoxas, I can see that "we" could be interpreted as meaning only that Robert's friends had no problem with Robert having been seen at the other hospital and paying for whatever treatment he needed. Taken with the rest of the documentary I still think my original interpretation is probably correct, but if you ever get around to watching it I'd be interested in whether it modifies or confirms your analysis.
posted by cybercoitus interruptus at 10:50 AM on March 4, 2009 [1 favorite]
"One hospital that was down in another town that was real close... told 'em he didn't have insurance, told 'em not to worry about it we would pay the bill. Told em what was going on and that he'd been seen at the other hospital and we had no problem with that and I said, "Here's the next thing. He's a transsexual."
""Well maybe you'd better go to downtown."
fyi, first bolded part above could be transcribed as "told 'im" [hospital told Robert he didn't have insurance]. (Doesn't change anything in our respective positions, but I should have mentioned the ambiguity of the pronoun.)
"we had no problem with that" I interpreted as "The hospital had no problem with that." Which makes the hospital's reaction to "He's a transsexual" strongly indicative of prejudice.
But reading your take, Ynoxas, I can see that "we" could be interpreted as meaning only that Robert's friends had no problem with Robert having been seen at the other hospital and paying for whatever treatment he needed. Taken with the rest of the documentary I still think my original interpretation is probably correct, but if you ever get around to watching it I'd be interested in whether it modifies or confirms your analysis.
posted by cybercoitus interruptus at 10:50 AM on March 4, 2009 [1 favorite]
Possibly a person who is completely aware of the breadth of the health-care system, knows how to ask questions, when to ask questions, when to escalate, and who has not previously been subjected to poor treatment may have managed to navigate himself into better cancer treatment earlier. That's a pretty high bar for getting medical attention for late-stage ovarian cancer.
Many FTM transsexuals do not get a hysterectomy because it is, after all, major abdominal surgery with its own possible complications. Why undergo major surgery when it's rendered moot by hormones? Not to mention the staggering expense of elective complete hysterectomy. Even if Eads had been receiving completely compassionate, competent, consistent care, do you think that there are analyses comparing both risk and treatment cost of ovarian cancer versus risk and cost of hysterectomy to help him make this decision? Of course, he was uninsured, so this sort of level of care is a fantasy.
Ynoxas, you're kindly focusing on what surgeons would be willing to do, but there are one hell of a lot of gatekeepers between a patient and a surgeon -- usually for good reason, but not when transphobia is preventing medical care. You're putting forth theories that would be completely reasonable...if not for the fact that transsexuals seem to confound and completely short-circuit recognition of basic human decency for a lot of people.
posted by desuetude at 11:41 AM on March 4, 2009 [2 favorites]
Many FTM transsexuals do not get a hysterectomy because it is, after all, major abdominal surgery with its own possible complications. Why undergo major surgery when it's rendered moot by hormones? Not to mention the staggering expense of elective complete hysterectomy. Even if Eads had been receiving completely compassionate, competent, consistent care, do you think that there are analyses comparing both risk and treatment cost of ovarian cancer versus risk and cost of hysterectomy to help him make this decision? Of course, he was uninsured, so this sort of level of care is a fantasy.
Ynoxas, you're kindly focusing on what surgeons would be willing to do, but there are one hell of a lot of gatekeepers between a patient and a surgeon -- usually for good reason, but not when transphobia is preventing medical care. You're putting forth theories that would be completely reasonable...if not for the fact that transsexuals seem to confound and completely short-circuit recognition of basic human decency for a lot of people.
posted by desuetude at 11:41 AM on March 4, 2009 [2 favorites]
Without actually watching the entire documentary I find it really really hard to believe that two dozen doctors turned this, eh, guy, down simply because they didn't want to ruin their reputations.
Without reading all of your comment, I can tell you already you probably should watch the film first.
posted by chairface at 12:40 PM on March 4, 2009 [4 favorites]
Without reading all of your comment, I can tell you already you probably should watch the film first.
posted by chairface at 12:40 PM on March 4, 2009 [4 favorites]
Naïve much, BrnP84?
posted by five fresh fish at 5:18 PM on March 4, 2009
posted by five fresh fish at 5:18 PM on March 4, 2009
I've not seen the documentary yet, but based on the comments and cybercoitus' transcription above, it is rather likely that he was refused because of having no insurance for a likely incredibly expensive surgery, with major complications (i.e. non-typical anatomy) with nothing other than "we'll pay for it" as assurance.
What a bizarre "healthcare" system. The guy needs a life-saving operation. And can be refused that operation. I see no health, nor care, in that system.
posted by five fresh fish at 5:26 PM on March 4, 2009 [1 favorite]
What a bizarre "healthcare" system. The guy needs a life-saving operation. And can be refused that operation. I see no health, nor care, in that system.
posted by five fresh fish at 5:26 PM on March 4, 2009 [1 favorite]
...Emory is a world class medical teaching institution. They would have probably treated him for free just for the gain in teaching opportunity...
With all due respect for Emory (I would agree that they are top notch and have done a lot of good for people) there are other academic medical centers in GA, including my employer. In fact, according to the Wikipedia bio of Mr. Eads, we were actually the hospital that ended up treating him. I was working there at the time and do not recall him as a patient, but believe it or not a man with ovarian cancer is not by any means the strangest thing we have seen in our OR.
As has been mentioned above, he lived in a rural area of the state (but not without its claims to fame), but even (perhaps especially) then, the docs in GA are more than happy to refer cases that are too complex, politically charged, confusing, or just plain too expensive to MCG. I almost wonder if some of the physicians he called blew him off because they thought it was a prank/joke. That is no excuse, but I agree with those who wonder if the film presents a viewpoint that is skewed to some degree.
In an interesting coincidence, while we were operating on a baby from the neonatal ICU this afternoon, one of the surgeons related the story of one of his best friends from college. They had played football together, chased women, gotten in fights, and all sorts of macho things. His friend was a monster in the gym, too. They were even in each others weddings. But several years ago the surgeon got a call: Doc, I need to tell you; I'm transgendered. The surgeon then related a lot of details of the process culminating in the fact that his buddy had completed the process down to the last detail. There were a few snarky comments (even from the guy telling the story), but by the end of the tale, everyone accepted his friends new identity. The turning point seemed to be when his transgendered friend kept calling him at work using her new, feminine name. After a few snide comments about "Carla"(made up name) calling for him again and again he told the staff that Carla was his old buddy Carl, and not someone he was fooling around with (I have known him for years and would be floored if he was unfaithful to his wife). After the explanation the staff were all cool with Carla's phone calls and the surgeon and Carla remain friends to this day.
I relate this because I have lived in Georgia most of my life, and while there is certainly a lot of ignorance and prejudice here, there are also a lot of people who are more open-minded than they themselves realize. I hope Mr. Eads's family and friends temper their sense of loss with the realization that he did more than his part to get people to reconsider their prejudices.
posted by TedW at 6:56 PM on March 4, 2009 [1 favorite]
With all due respect for Emory (I would agree that they are top notch and have done a lot of good for people) there are other academic medical centers in GA, including my employer. In fact, according to the Wikipedia bio of Mr. Eads, we were actually the hospital that ended up treating him. I was working there at the time and do not recall him as a patient, but believe it or not a man with ovarian cancer is not by any means the strangest thing we have seen in our OR.
As has been mentioned above, he lived in a rural area of the state (but not without its claims to fame), but even (perhaps especially) then, the docs in GA are more than happy to refer cases that are too complex, politically charged, confusing, or just plain too expensive to MCG. I almost wonder if some of the physicians he called blew him off because they thought it was a prank/joke. That is no excuse, but I agree with those who wonder if the film presents a viewpoint that is skewed to some degree.
In an interesting coincidence, while we were operating on a baby from the neonatal ICU this afternoon, one of the surgeons related the story of one of his best friends from college. They had played football together, chased women, gotten in fights, and all sorts of macho things. His friend was a monster in the gym, too. They were even in each others weddings. But several years ago the surgeon got a call: Doc, I need to tell you; I'm transgendered. The surgeon then related a lot of details of the process culminating in the fact that his buddy had completed the process down to the last detail. There were a few snarky comments (even from the guy telling the story), but by the end of the tale, everyone accepted his friends new identity. The turning point seemed to be when his transgendered friend kept calling him at work using her new, feminine name. After a few snide comments about "Carla"(made up name) calling for him again and again he told the staff that Carla was his old buddy Carl, and not someone he was fooling around with (I have known him for years and would be floored if he was unfaithful to his wife). After the explanation the staff were all cool with Carla's phone calls and the surgeon and Carla remain friends to this day.
I relate this because I have lived in Georgia most of my life, and while there is certainly a lot of ignorance and prejudice here, there are also a lot of people who are more open-minded than they themselves realize. I hope Mr. Eads's family and friends temper their sense of loss with the realization that he did more than his part to get people to reconsider their prejudices.
posted by TedW at 6:56 PM on March 4, 2009 [1 favorite]
I have to admit I'm a bit surprised that a female to male transsexual did not have a complete hysterectomy before the sex change operation
Ynoxas - this statement invalidated the rest of your comment (if it hadn't already been invalidated by your admission that you haven't seen the film). Most trans guys never get hysterectomies. Most trans guys also don't get "sex change operations" in the sense you seem to be imagining. Again, I think a lot of people would be less offended if before you discounted someone's experience, you got to know a little tiny bit about that experience.
posted by serazin at 8:59 PM on March 4, 2009
Ynoxas - this statement invalidated the rest of your comment (if it hadn't already been invalidated by your admission that you haven't seen the film). Most trans guys never get hysterectomies. Most trans guys also don't get "sex change operations" in the sense you seem to be imagining. Again, I think a lot of people would be less offended if before you discounted someone's experience, you got to know a little tiny bit about that experience.
posted by serazin at 8:59 PM on March 4, 2009
Well, at least he wasn't chased through the bayou by murderous Cajuns.
Still, this is probably worse. Not so long ago they wouldn't give black men transfusions. While this doesn't surprise me, it still kind of does. In a bad way.
I don't get how an educated individual wouldn't treat someone with cancer. That just doesn't register with me. I know it happens. I know anyone can be prejudiced. I don't know how, being a doctor, knowing the body is just flesh, they're not immune to it.
I know some things about the body, I know a bit about animals. I know enough to know it's pretty much just guts, blood and other fluids and for the most part our only real differences are simple plumbing, a difference in muscle mass and fat content, and some routing of neurons that don't amount to much of a difference when it comes down to it.
If I'm dying and Eads is my blood type - doesn't matter at all if he's a she or vice versa, the right type is going to save my life and that's all that really matters. Doesn't really matter how rich I am if I'm leaking blood like a sieve and there's nothing to replace it.
My reputation isn't going to save me. The car I drive, my friends, there's not a damned thing except the right blood that will save my life. You'd think all doctors would understand that concrete reality of it.
...except apparently not.
posted by Smedleyman at 9:12 PM on March 4, 2009
Still, this is probably worse. Not so long ago they wouldn't give black men transfusions. While this doesn't surprise me, it still kind of does. In a bad way.
I don't get how an educated individual wouldn't treat someone with cancer. That just doesn't register with me. I know it happens. I know anyone can be prejudiced. I don't know how, being a doctor, knowing the body is just flesh, they're not immune to it.
I know some things about the body, I know a bit about animals. I know enough to know it's pretty much just guts, blood and other fluids and for the most part our only real differences are simple plumbing, a difference in muscle mass and fat content, and some routing of neurons that don't amount to much of a difference when it comes down to it.
If I'm dying and Eads is my blood type - doesn't matter at all if he's a she or vice versa, the right type is going to save my life and that's all that really matters. Doesn't really matter how rich I am if I'm leaking blood like a sieve and there's nothing to replace it.
My reputation isn't going to save me. The car I drive, my friends, there's not a damned thing except the right blood that will save my life. You'd think all doctors would understand that concrete reality of it.
...except apparently not.
posted by Smedleyman at 9:12 PM on March 4, 2009
An interesting and important point is that a lot of insurance policies specifically exclude anything related to transsexuality from being covered. Go check your own policy, if you have one -- there's a good chance that there's a paragraph in there that says you're not covered for anything related to transsexuality. And what counts as related? Pretty much whatever the doctor decides, from what I've seen. A lot of trans folks live in fear that, even when they do have insurance, doctors will decide that random malady X, which has nothing to do with being trans, will not be covered because of that stupid paragraph.Some doctors are nice and take a narrow view of that exclusion, but far too many are not.
It's also important to note that it's completely legal to discriminate against trans people in most of the US. Fire us, refuse to hire us, refuse us housing, refuse to treat us... we don't have protections against that stuff most of the time.
posted by jiawen at 11:05 PM on March 4, 2009 [1 favorite]
It's also important to note that it's completely legal to discriminate against trans people in most of the US. Fire us, refuse to hire us, refuse us housing, refuse to treat us... we don't have protections against that stuff most of the time.
posted by jiawen at 11:05 PM on March 4, 2009 [1 favorite]
I hadn't planned to make time to re-watch Southern Comfort today, but I wanted to find that scene, so I ended up at least listening to a lot of it. BrnP84, I really have to thank you, sincerely, because I'm glad I made the time to do it. (Thanks to nola, too.) Two scenes in particular, where the dialogue drew me back to the video because the emotions were so strong:
1. where Maxwell's gf is reading the letter she wrote to Max's mom asking his [estranged] mom to just please give Max one call because the daughter named Peggy Sue had turned into such a fine man and it would mean so much to him, and then Max's reaction, listening to the message his mom left
2. where Robert and Lola have moved in together because he needs round the clock care, and he's teasing her about being able to make her blush and how beautifully she's blossoming in confidence and not hiding her brains, and oh, the way they're looking at each other. Just gorgeous. Everybody should be so lucky to have such love at least once in their lives. Very wabi-sabi, that scene.
posted by cybercoitus interruptus at 11:58 PM on March 4, 2009
1. where Maxwell's gf is reading the letter she wrote to Max's mom asking his [estranged] mom to just please give Max one call because the daughter named Peggy Sue had turned into such a fine man and it would mean so much to him, and then Max's reaction, listening to the message his mom left
2. where Robert and Lola have moved in together because he needs round the clock care, and he's teasing her about being able to make her blush and how beautifully she's blossoming in confidence and not hiding her brains, and oh, the way they're looking at each other. Just gorgeous. Everybody should be so lucky to have such love at least once in their lives. Very wabi-sabi, that scene.
posted by cybercoitus interruptus at 11:58 PM on March 4, 2009
I still believe this MAINLY to be a problem with the uninsured in America, not the transsexual in America. Individual bigotry could very well explain some of the problem, but not the entire situation.
cybercoitus: I definitely read that as his friends having no problem with paying for the bill. I will try to watch the video this weekend. If the hospital initially said "no problem" then balked at the word transsexual, then I agree this was deplorable action by the facility. Of course, the way around this is to show up at the ER, where they have no choice but to treat you, or ship you to a facility that will.
serazin: I know for a fact that hysterectomies are sometimes performed on FTM transsexuals. I honestly do not know how to find out if "most" receive this or not. Unless you can prove to me that it is unheard of for a FTM transsexual to receive this, I stand by my statement. The OVERWHELMING number of hysterectomies in America are performed for treatment of benign afflictions. Given the situation, I would consider "preventative" hysterectomy to be a reasonable procedure, not some off-the-wall process that you seem to be implying. Or course, I am not a physician, I do not know if you are or not. But neither of us is his physician.
fff: What a bizarre "healthcare" system.
I would agree completely. Even though I'm "part of the system", I am an advocate for a complete and total revamping of the medical delivery system in America, starting with the way it is paid for. America has the greatest doctors and the greatest technology in the world, without question, but yet we do not top the categories in any measurable health matrix worldwide. America's healthcare system is BROKEN. To use a medical metaphor, it requires not a band-aid, but radical surgery to save it.
desuetude: you're kindly focusing on what surgeons would be willing to do, but there are one hell of a lot of gatekeepers between a patient and a surgeon
I agree with you, and it is actually a recognized problem in healthcare. I believe that was probably a great deal of what was going on here. I imagine out of the 20 "doctors" they spoke to, it was quite likely only a handful of doctors they spoke to, and the rest were staff members. In particular, the statements about "it might embarrass our other patients", even though attributed to doctors, seems much more like something a staff member would say. Gatekeepers are there for a reason, but they very often overstep their bounds, and one reason is that the bounds are so ill-defined.
For instance, some of the offices that I run, the physician has stated that they do not want to accept any more new patients that are on governmental assistance, such as Medicaid. So, if a person calls the office and has Medicaid, then they are refused by the receptionist, the physician is never consulted. I think that is unfortunate, because there could be special circumstances that might implore that physician to consider a special case, but you have to dismiss the special case with the other 95% of Medicaid patients, just for no other reason than practicality.
For all that is right with healthcare in America, just as much is wrong.
Collecting money from "self-pay" patients for major medical expenses is very challenging. Most hospitals and doctors have huge discounts for self-pay patients in the hope of receiving at least some recompense for the service. Very few individuals can pay for a $35,000 surgery. So, if you discount it to $6,000, and give the person a multi-year payment plan, then MAYBE you will get something.
However, make no mistake, most physicians realize it is that self-pay patients CAN'T pay, not WON'T pay. I have not yet in my professional career met a doctor who truly had no compassion towards his or her patients.
The "war on medicine" would be much cheaper, and reap many more magnitudes of return, than the "war on terror".
Obama says "we have done more in 30 days to revamp healthcare in this country than has happened in the last 10 years", and that is actually true in many regards.
Here's hoping that America is finally ready for real, substantive changes to the health delivery system. Everyone will be better off, except for the insurance companies, and I couldn't could care less for their welfare.
posted by Ynoxas at 8:02 AM on March 5, 2009
cybercoitus: I definitely read that as his friends having no problem with paying for the bill. I will try to watch the video this weekend. If the hospital initially said "no problem" then balked at the word transsexual, then I agree this was deplorable action by the facility. Of course, the way around this is to show up at the ER, where they have no choice but to treat you, or ship you to a facility that will.
serazin: I know for a fact that hysterectomies are sometimes performed on FTM transsexuals. I honestly do not know how to find out if "most" receive this or not. Unless you can prove to me that it is unheard of for a FTM transsexual to receive this, I stand by my statement. The OVERWHELMING number of hysterectomies in America are performed for treatment of benign afflictions. Given the situation, I would consider "preventative" hysterectomy to be a reasonable procedure, not some off-the-wall process that you seem to be implying. Or course, I am not a physician, I do not know if you are or not. But neither of us is his physician.
fff: What a bizarre "healthcare" system.
I would agree completely. Even though I'm "part of the system", I am an advocate for a complete and total revamping of the medical delivery system in America, starting with the way it is paid for. America has the greatest doctors and the greatest technology in the world, without question, but yet we do not top the categories in any measurable health matrix worldwide. America's healthcare system is BROKEN. To use a medical metaphor, it requires not a band-aid, but radical surgery to save it.
desuetude: you're kindly focusing on what surgeons would be willing to do, but there are one hell of a lot of gatekeepers between a patient and a surgeon
I agree with you, and it is actually a recognized problem in healthcare. I believe that was probably a great deal of what was going on here. I imagine out of the 20 "doctors" they spoke to, it was quite likely only a handful of doctors they spoke to, and the rest were staff members. In particular, the statements about "it might embarrass our other patients", even though attributed to doctors, seems much more like something a staff member would say. Gatekeepers are there for a reason, but they very often overstep their bounds, and one reason is that the bounds are so ill-defined.
For instance, some of the offices that I run, the physician has stated that they do not want to accept any more new patients that are on governmental assistance, such as Medicaid. So, if a person calls the office and has Medicaid, then they are refused by the receptionist, the physician is never consulted. I think that is unfortunate, because there could be special circumstances that might implore that physician to consider a special case, but you have to dismiss the special case with the other 95% of Medicaid patients, just for no other reason than practicality.
For all that is right with healthcare in America, just as much is wrong.
Collecting money from "self-pay" patients for major medical expenses is very challenging. Most hospitals and doctors have huge discounts for self-pay patients in the hope of receiving at least some recompense for the service. Very few individuals can pay for a $35,000 surgery. So, if you discount it to $6,000, and give the person a multi-year payment plan, then MAYBE you will get something.
However, make no mistake, most physicians realize it is that self-pay patients CAN'T pay, not WON'T pay. I have not yet in my professional career met a doctor who truly had no compassion towards his or her patients.
The "war on medicine" would be much cheaper, and reap many more magnitudes of return, than the "war on terror".
Obama says "we have done more in 30 days to revamp healthcare in this country than has happened in the last 10 years", and that is actually true in many regards.
Here's hoping that America is finally ready for real, substantive changes to the health delivery system. Everyone will be better off, except for the insurance companies, and I couldn't could care less for their welfare.
posted by Ynoxas at 8:02 AM on March 5, 2009
Collecting money from "self-pay" patients for major medical expenses is very challenging. Most hospitals and doctors have huge discounts for self-pay patients in the hope of receiving at least some recompense for the service. Very few individuals can pay for a $35,000 surgery.
Most of what Ynoxas says is right on the money, but the usual practice is for hospitals to give deep discounts to insurance companies and HMO's to get the managed care contracts, and then charge uninsured patients (known as self-pay patients in industry jargon) the full price. The difference can be quite significant; this article suggests uninsured patients pay 2-3 times what insurance companies pay and that is what I have seen as well.
posted by TedW at 8:25 AM on March 5, 2009
Most of what Ynoxas says is right on the money, but the usual practice is for hospitals to give deep discounts to insurance companies and HMO's to get the managed care contracts, and then charge uninsured patients (known as self-pay patients in industry jargon) the full price. The difference can be quite significant; this article suggests uninsured patients pay 2-3 times what insurance companies pay and that is what I have seen as well.
posted by TedW at 8:25 AM on March 5, 2009
America has the greatest doctors and the greatest technology in the world, without question
Such hubris! Anyone with bucks can buy the technology. And there are great doctors in every sizable country. Surely you do not really believe what you wrote; it's just mindless rah-rahism, right?
posted by five fresh fish at 9:14 AM on March 5, 2009 [1 favorite]
Such hubris! Anyone with bucks can buy the technology. And there are great doctors in every sizable country. Surely you do not really believe what you wrote; it's just mindless rah-rahism, right?
posted by five fresh fish at 9:14 AM on March 5, 2009 [1 favorite]
fff: No, I believe, on the whole, American trained physicians to be superior to foreign trained physicians. Of course there are great doctors everywhere, and there are quacks from every medical school in every country (I've personally met a quack from Harvard), but we are talking general populations here.
I believe American trained physicians have better access to superior technologies and superior facilities, both during training and during practice. I believe American facilities to have a higher utilization rate of advanced technologies than other countries. It is one of the reasons healthcare in America, person for person, is so expensive.
There is a reason that the overwhelming majority of new treatments and surgical techniques are developed in America. There is a reason that foreign-born candidates compete to attend American medical schools, but there are no large competing populations of Americans vying to attend medical school in foreign countries. Those are usually relegated to candidates who cannot get into American medical schools. Also, the overwhelming majority of foreign-born candidates that come to America for medical school, which almost by definition are their countries' best and brightest, stay in America to practice. It's brain-drain, pure and simple. I don't consider that to be a politically incorrect thing to say.
This is typical in most industries, not just healthcare. I'm surprised you would take umbrage at this, as to me it is self-evident.
TedW: I think we may be talking about the same thing, but different perspectives.
Insurance companies indeed get contracts with heavily discounted charges. These are called "fee schedules" in the business. What this means is that the insurance is actually charged a lower rate for services, with the expectation that they will pay at these discounted rates.
Self-Pays are charged full rate, but then usually offered substantial discounts on the back end when payment is due.
All of the facilities I have ever worked for have always offered steep discounts to self-pay patients. The hospital that serves my current market offers an immediate discount to self-pay patients.
At my former employer, I was responsible for instituting a self-pay program that offered discounts as high as 60% for payment at the time of service. Payments made over time were discounted less, out to about 90-120 days.
We routinely offer discounts up to 25% or more for timely payment of patient balances, even if they are already discounted via the insurance contract. In other words, if you had a $10,000 bill, and your insurance was an 80/20 plan, you would be responsible for $2000 of that payment. We would typically offer you a discount of 25% if you were to pay the entire bill immediately. If you went on a payment plan, that would reduce the amount of the discount.
At all the places I have worked, payment plans were offered at 0% interest.
I would be rather surprised if your institution actually forced self-pays to remit 100% of charges.
posted by Ynoxas at 10:23 AM on March 5, 2009
I believe American trained physicians have better access to superior technologies and superior facilities, both during training and during practice. I believe American facilities to have a higher utilization rate of advanced technologies than other countries. It is one of the reasons healthcare in America, person for person, is so expensive.
There is a reason that the overwhelming majority of new treatments and surgical techniques are developed in America. There is a reason that foreign-born candidates compete to attend American medical schools, but there are no large competing populations of Americans vying to attend medical school in foreign countries. Those are usually relegated to candidates who cannot get into American medical schools. Also, the overwhelming majority of foreign-born candidates that come to America for medical school, which almost by definition are their countries' best and brightest, stay in America to practice. It's brain-drain, pure and simple. I don't consider that to be a politically incorrect thing to say.
This is typical in most industries, not just healthcare. I'm surprised you would take umbrage at this, as to me it is self-evident.
TedW: I think we may be talking about the same thing, but different perspectives.
Insurance companies indeed get contracts with heavily discounted charges. These are called "fee schedules" in the business. What this means is that the insurance is actually charged a lower rate for services, with the expectation that they will pay at these discounted rates.
Self-Pays are charged full rate, but then usually offered substantial discounts on the back end when payment is due.
All of the facilities I have ever worked for have always offered steep discounts to self-pay patients. The hospital that serves my current market offers an immediate discount to self-pay patients.
At my former employer, I was responsible for instituting a self-pay program that offered discounts as high as 60% for payment at the time of service. Payments made over time were discounted less, out to about 90-120 days.
We routinely offer discounts up to 25% or more for timely payment of patient balances, even if they are already discounted via the insurance contract. In other words, if you had a $10,000 bill, and your insurance was an 80/20 plan, you would be responsible for $2000 of that payment. We would typically offer you a discount of 25% if you were to pay the entire bill immediately. If you went on a payment plan, that would reduce the amount of the discount.
At all the places I have worked, payment plans were offered at 0% interest.
I would be rather surprised if your institution actually forced self-pays to remit 100% of charges.
posted by Ynoxas at 10:23 AM on March 5, 2009
I know for a fact that hysterectomies are sometimes performed on FTM transsexuals. I honestly do not know how to find out if "most" receive this or not. Unless you can prove to me that it is unheard of for a FTM transsexual to receive this, I stand by my statement. The OVERWHELMING number of hysterectomies in America are performed for treatment of benign afflictions. Given the situation, I would consider "preventative" hysterectomy to be a reasonable procedure, not some off-the-wall process that you seem to be implying. Or course, I am not a physician, I do not know if you are or not. But neither of us is his physician.
No-one said that it was unheard of for a FTM transsexual to get a hysterectomy, but it's not de rigeur. I don't understand why you think that someone would pay out of pocket for unnecessary major surgery. Even if someone IS insured, procedures related to transitioning are often not covered.
You might be shocked to find out that most people have absolutely no idea that their hospital bills are negotiable beyond the amount which would be billed to insurance. Payment plans, discounts...this is not common knowledge. At all. And when you've already been treated unkindly, going back to convince some staff person to let you negotiate...it's an intimidating and soul-sucking prospect. Again, a lot of things are possible if you have the temerity and knowledge to navigate the system, but the bar is too high for ordinary people to know how to do this.
posted by desuetude at 6:31 AM on March 6, 2009
No-one said that it was unheard of for a FTM transsexual to get a hysterectomy, but it's not de rigeur. I don't understand why you think that someone would pay out of pocket for unnecessary major surgery. Even if someone IS insured, procedures related to transitioning are often not covered.
You might be shocked to find out that most people have absolutely no idea that their hospital bills are negotiable beyond the amount which would be billed to insurance. Payment plans, discounts...this is not common knowledge. At all. And when you've already been treated unkindly, going back to convince some staff person to let you negotiate...it's an intimidating and soul-sucking prospect. Again, a lot of things are possible if you have the temerity and knowledge to navigate the system, but the bar is too high for ordinary people to know how to do this.
posted by desuetude at 6:31 AM on March 6, 2009
desuetude: I was responding to serazin's rather rude comment implying that I have no idea what I'm talking about. I do not portray myself as an expert on transsexual procedures, but I am an expert on healthcare in general, and I am aware that hysterectomies are sometimes performed on FTM transsexuals. Relying on memory without a source, something like 30-40% of women end up having a hysterectomy during their lifetime.
So, with all things considered, that a woman has a 1/3 chance or greater of needing a hysterectomy sometime in life, and considering the already considerable challenges before during and after a sex change, then to me it is not crazy talk to say that getting a hysterectomy during this process would be reasonable. I would go so far as to say advisable, for reasons exactly like this situation. But again, I'm not a doctor, I just babysit them on a daily basis. For anyone considering a sex change operation, they should consult with their physician, not an internet forum.
As for the rest of your comment, no, I am not shocked at all. I again admit this is yet another failing of the current healthcare system in America.
There are lots of people such as myself who have tried to improve the situation, but we are simply sticking our fingers in a crumbling dam. There are tens of millions who need assistance, and the number of people I have helped in my career is a tiny drop in a very large bucket.
As I said earlier, we need radical, fundamental change. America hasn't had the stomach for it before, and I'm not sure we do even now, but I agree with our President that the time has come.
Consider this: we are about to enter a period of unprecedented demand for healthcare in this country due to the demographics. We are also experiencing a shortage of providers, with a current nursing shortage about to turn into a nursing crisis in the next few years, and a looming doctor shortage, ESPECIALLY in primary care (i.e. your "family doctor" or internist).
For the last several years, physician reimbursement has been falling.
Medicare is scheduled to have massive cuts in reimbursement, which have already been forestalled several times. This is because the program will not be able to pay for itself once the boomers hit.
So the boomers are not only going to need more medical care, they also make up a substantial portion of the provider population, and will be retiring out of the system.
Therefore, you have an industry with increasing demand, declining supply, and dwindling profit. Regular economics goes out the window.
Massive, sweeping change is required. It will be lobbied very hard against by insurance companies and large corporate healthcare providers, such as hospital corporations. It will also be lobbied very hard against by many individual physicians. Many of them have been convinced by the large corporate concerns that any sort of change to the healthcare system by the government, such as universal coverage or single-payer systems, would destroy them financially.
I do not believe this to be true. And I think opinions are slowly changing inside healthcare.
I feel that both universal coverage and single-payer systems are not only advantageous, they are also at this point inevitable.
Instead of standing against the tide, I think everyone, the public and the providers, the hospitals and the government, will benefit from total healthcare reform.
Again, the big losers are insurance companies, and they know this. They will spend billions of dollars fighting this on all fronts, since they would be quite literally fighting for their lives.
I've got alot more to say about this but it'll have to wait for another day. It's already taken me 2 hours to write this in-between phone calls.
Suffice to say, we're in for a rocky road ahead even under the best of conditions. Holding on with white knuckles to an outdated and obviously failing model will just make things worse.
Another way of putting it is, considering how things are about to get, how could it possibly hurt to try something new?
posted by Ynoxas at 8:38 AM on March 6, 2009 [1 favorite]
So, with all things considered, that a woman has a 1/3 chance or greater of needing a hysterectomy sometime in life, and considering the already considerable challenges before during and after a sex change, then to me it is not crazy talk to say that getting a hysterectomy during this process would be reasonable. I would go so far as to say advisable, for reasons exactly like this situation. But again, I'm not a doctor, I just babysit them on a daily basis. For anyone considering a sex change operation, they should consult with their physician, not an internet forum.
As for the rest of your comment, no, I am not shocked at all. I again admit this is yet another failing of the current healthcare system in America.
There are lots of people such as myself who have tried to improve the situation, but we are simply sticking our fingers in a crumbling dam. There are tens of millions who need assistance, and the number of people I have helped in my career is a tiny drop in a very large bucket.
As I said earlier, we need radical, fundamental change. America hasn't had the stomach for it before, and I'm not sure we do even now, but I agree with our President that the time has come.
Consider this: we are about to enter a period of unprecedented demand for healthcare in this country due to the demographics. We are also experiencing a shortage of providers, with a current nursing shortage about to turn into a nursing crisis in the next few years, and a looming doctor shortage, ESPECIALLY in primary care (i.e. your "family doctor" or internist).
For the last several years, physician reimbursement has been falling.
Medicare is scheduled to have massive cuts in reimbursement, which have already been forestalled several times. This is because the program will not be able to pay for itself once the boomers hit.
So the boomers are not only going to need more medical care, they also make up a substantial portion of the provider population, and will be retiring out of the system.
Therefore, you have an industry with increasing demand, declining supply, and dwindling profit. Regular economics goes out the window.
Massive, sweeping change is required. It will be lobbied very hard against by insurance companies and large corporate healthcare providers, such as hospital corporations. It will also be lobbied very hard against by many individual physicians. Many of them have been convinced by the large corporate concerns that any sort of change to the healthcare system by the government, such as universal coverage or single-payer systems, would destroy them financially.
I do not believe this to be true. And I think opinions are slowly changing inside healthcare.
I feel that both universal coverage and single-payer systems are not only advantageous, they are also at this point inevitable.
Instead of standing against the tide, I think everyone, the public and the providers, the hospitals and the government, will benefit from total healthcare reform.
Again, the big losers are insurance companies, and they know this. They will spend billions of dollars fighting this on all fronts, since they would be quite literally fighting for their lives.
I've got alot more to say about this but it'll have to wait for another day. It's already taken me 2 hours to write this in-between phone calls.
Suffice to say, we're in for a rocky road ahead even under the best of conditions. Holding on with white knuckles to an outdated and obviously failing model will just make things worse.
Another way of putting it is, considering how things are about to get, how could it possibly hurt to try something new?
posted by Ynoxas at 8:38 AM on March 6, 2009 [1 favorite]
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posted by jonmc at 9:25 PM on March 3, 2009