I'm a double amputee, and I can confirm I feel so sorry for my doctors and nurses having to deal with this stuff 😂 the systems are so hard to negotiate with.
and for that matter, if someone gets a double amputation, are we supposed to enter a new height? because that's really going to affect their BMI. And also trigger a nutritionist consult.
The fun part is that even if you have a hysterectomy on your medical chart it still asks the period question every time AND forces you to get pregnancy tests for certain medications 🎉
Another issue these record issues like this cause is that doctors who read them later on think the patient is someone who.lies and makes things up. The damage from EMR issues is real
Absolutely. I went to the doctor just for a medicine refill. Just a basic appointment, and since the doctor didn't really do much but refill my meds, they just copied and pasted from the last visit. Fast forward to my next visit. I was in pain that was worse than my chronic pain. It was mentioned that I never mentioned pain in my last visit. I didn't mention it because it was not brought up and my appointment t was not for pain. So it makes me look like I am lying when I am not.
something I’ve actually seen in the context of trans patients are practitioners who find out a patient is trans and just put “sex change operation” without much of any idea of what that could be or whether it’s true. Like what do you think happened that made your trans man patient grow a lumberjack beard do you think those are implanted subdermally
As I often say to people "please don't try to pigeonhole me - I am not a pigeon". In other words I don't fit neatly into anyone's little tickboxes - never have done, never will do. As an example, I'm both a wheelchair user, and until his passing was my husband's main carer. You could not be registered with my family doctor at that time as both a person with a disability, and as one with a caring role. It was more important to me to be registered with my doctor as a carer, so I did so. That then caused an issue when I needed transport to hospital appointments in a wheelchair accessible vehicle. I was not eligible for my local scheme, because I was not registered with my family doctor as a wheelchair user!
Wow, that's seriously stupid. I would've thought that would be a common enough occurrence to have an option for it, especially considering elderly couples who are both in poor health due to age.
This is so real on just a level of not even being transgender and trying to fit everything into a questionnaire...... So easy to forget why you're even there or what your chief concerns are while you're spending half an hour on questions that don't really capture the problems. I put off a lot of important doctor visits just because it's such an ordeal and I often do not feel like anything gets addressed really .....
I use the same program on my phone for shopping lists to list what I need to talk to my doctor about. It helps keep things on track and me to not forget that, oh, yeah, my leg has shooting pains, doc, and that's a bit more of a problem right now than my slightly elevated blood sugar.
I have no family medical history (adopted as a baby and bio parents gave no medical info) and the amount of time's it's cause a problem in the computer system of a doctor's office isn't even funny. Honestly I don't know why for every question there isn't an "other- explanation" option.
And then once you finally get past all that BS and the thousand other random questions the Dr has to ask while never looking up from their computer screen . . . They tell you there’s only a max of 3 medical problems/concerns/question they can help you with that day. Any more you have to reschedule for next earliest appointment in 17 months 🙄🤬
I ask if I can fill them in online in advance or with a nurse. My favorite is "birth control method." For some reason "my partner was sterilized 20 years ago" isn't an option.
I am just wondering how did this electronic medical record system even went into doctor offices when it does not account for such cases. There should have been an N/A option at a minimum.
it is medical, that's why most medical docs ask for sex and not gender because of the genetic differences between biological males and females. Even when taking in account hormone therapy a trans-female has MUCH higher testosterone then most females.
@@PUM_Productions A trans woman on hormone therapy generally has *less* testosterone than a cis woman actually, because cis women produce small but significant amounts of testosterone and don't take hormone blockers
Because just like medical insurance, the people making all the decisions have zero medical education and have never before even talked to a patient or someone that works directly with patients.
This is a real thing I've run into in almost every EMR system apart from Seattle children's. It took a downright stupid amount of time to separate the "sex" and "gender identity" boxes but you bet you ass the Catholic hospitals all had a "religious preference" box.
Yes! I hate when i'm doing intakes and thetes not an other or n/a option! Digital charts can make life easier but also cause problems like this 😅 I actually just had this issue on a job app where you had to select a major for your masters degree and they didn't have mine!
Even before fully digital charts, it was such a pain. A standard admission or clinic intake form needed to be applicable to pretty much everything and everyone, and then you get where I worked: Endocrinology. Endo specialises in people who don't fit inside the box. The standard intake for a large portion of the patients wasn't applicable so endo made their own. Medical Records did NOT like that, but they just about ran screaming when we proposed an additional section to the standard intake, because of how complex it needed to be and how many additions of N/A would have been needed in the standard form.
@@stansman5461 The entire point of the video is that, unless your EMR understands trans folks, it *won't* be able to understand their *current* biology and recommend the correct interventions or screenings.
As a cis woman in a relationship with another cis woman for 13 years, the "are you sexually active" followed by "what kind of birth control do you use" questions have always been tricky to answer. I sometimes lied to get to the truthful statement that no, I cannot be pregnant, no really, I'm very sure. It was almost a relief when I developed a fibroid and my doctor prescribed me birth control as part of the treatment. "Lesbianism" isn't an option for birth control on those intakes, but oral contraceptives are!
You could also just tell your doc you’re lesbian if you wanted lol. Also we will still pregnancy test you if it really matters because if you somehow were pregnant a potential med / procedure could harm the baby. Can’t take people just based off their word in the medical field sadly
If youre transmasc and don't get a period anymore, there is *also* no option for that. My doc ended up having to put in that im not menstruating due to "birth control".
@@Luubelaar Saaame! My last clinic would diagnose trans women with "agenesis of the cervix" (NOT TECHNICALLY INCORRECT!) to get the EMR to stop recommending pap smears.
It's awesome that they're trying to get creative, but as a trans man who is also a clinician, I'm torn with these things. Because, sure, now they won't ask questions about periods, but also... They might be less inclined to discuss potential for pregnancy, which can still happen while we are on T and some of our younger guys don't know that. Having the EMR make assumptions and prompt us is great, because we have too much to keep in our heads and not enough time with patients so could forget something, but it's also frustrating because the programming doesn't take into consideration the enormous diversity of our species. I don't have a solution here; just agreeing with how frustrating it is for all parties involved.
I want to laugh, but as a trans masculine person (female to male is probably the easiest description) who had a baby 6 months ago and I got asked all sorts of stupid questions and treated like crap, I can definitely empathize with this. Seriously it doesn't matter if you're transmasculine, transfeminine, or androgynous/non-binary, or even if you're intersex, the healthcare field just isn't really willing to deal with us. And it's not fair and it results in a lot of Us ending up with health problems that we don't need.
I used to work admin in endocrinology. The standard intake for a large portion of the patients wasn't applicable so endo made their own. Medical Records did NOT like that, but they just about ran screaming when we proposed an additional section to the standard intake, because of how complex it needed to be and how many additions of N/A would have been needed in the standard form.
I just don’t understand people getting into medicine and learning about the complexities and “messiness” of biological systems. Only to throw all that out the window when faced with something they don’t like or understand. Is the person human? Yes? Then treat them like one and check your prejudice and ignorance at the door.
In the UK we are having a big issue where trans people end up being called for the wrong screenings. like men not getting pap smears and women not getting prostate exams.
I truly wish I wasn't making this up but I had similar problems with a doctor, but it wasn't the computer making her say it, she just appeared to be exceptionally dense. I'd had hysteroscopic sterilisation followed by endometrial ablation by saline balloon about 9 years previously, so no periods for that 9 years. Then I had a total hysterectomy & oophorectomy. A couple of months after that, I had pain and blood in urine and suspected a urinary tract infection, so went to my GP. me: I think I might need antibiotics for a bladder infection. (I'd already brought in a sample as requested) GP: are you on your period? Me: no, I had a hysterectomy. GP: when was your last period? Me: um? Dunno? About 9 years ago? GP: is there any chance you could be pregnant? Me: no, I had a hysterectomy. GP: are you SURE you're not on your period? Me: ... GP: ? Me: I LACK THE NECCESARY EQUIPMENT. She left the room for about 15 minutes. She came back, she looked at the computer for several minutes. GP: so I think you have a bladder infection, you'll need some antibiotics. Me: (desperately trying not to scream or headdesk)
@@tscimb apparently so. I think at one point I also used the wording "I do not have a uterus" when she didn't seem to comprehend the hysterectomy bit, but I distinctly remember finishing with the rather strained, slowly enunciated "I LACK THE NECCESARY EQUIPMENT!" Because by that point I was struggling to know what other combination of words was going to get the concept through to her, and seriously wondering if she was perhaps the cleaning lady who wandered in and wanted to play at being a doctor for the day.
@@MiceAndMinecraft - I kept getting asked to have a Pap smear test - but I had had a total hysterectomy years before... Dr : it’s very important, you keep missing your smear test, it could save your life Me : I don’t have a cervix Dr : you do, all females have one Me : no, I lost mine Dr : you can’t just lose your cervix Me : I had it surgically removed Dr : that’s not an operation that’s performed Me : it wasn’t just my cervix, I had everything removed, no cervix, no uterus, no ovaries, no Fallopian tubes, all gone Dr : what country did you have it done in Me : this one, at the hospital across the road Dr : when Me : about five years ago when I stopped getting the smears done 🙄
It’s true. EPIC sucks. You can’t move past it until all the fields are filled and then - at least in my institution - you wouldn’t get the ‘green check mark’ ✅ indicating that your work was done and complete. And the rather significant details - like Doc Schmidt just demonstrated - really don’t matter. Just ‘Did you get the green check mark?’ ✅ Ah, no. Sorry, not sorry.
We use Athena and it took several years to get them to add a chosen name field. Considering we are an LGBTQ agency, this was causing a lot of harm on a regular basis. So frustrating to hear it's not just Athena and is actually most of the EMRs, though not even a little surprising, honestly.
If you are in Epic click their gender to open the form and put that they were male at birth and identify as female. It will say they are female in the chart but it will stop asking random gyn questions.
Also, Catholic based health insurances, like Christus Santa Rosa, will not pay for any medical or psychiatric visits if gender dysphoria is anywhere on the diagnosis list Edit: spelling
I don't work in healthcare, but I'm nonbinary and AFAB. I never got a period, and now, I'm on testosterone so will never get one. I have also never dated a person who could get me pregnant. All of my intake appointments start this way. 😂 "What do you mean you've never had a period? Do you mean you don't get periods because you're on testosterone?" "Both." "There isn't a box for that!"
Nothing seems to confuse the NHS quite like not having a functional uterus. The look of confusion you get sometimes when you say "I don't have periods" 🤣🤦🏻
Huh, I never thought of that from the trans fem side before. I’m trans masc, so despite being masc, I still get asked these questions for safety reasons. Never thought abt it the other way around. Med rec needs to change, and my heart goes out to all my trans fem friends out there ❤
As a trans gender man this is too relatable, the systems are always confused because according to them I shouldn’t have a uterus. I know of a couple (a trans man and a cis woman) who wanted to do IVF and the rules state that straight couples need to try on their own for a year before they can get it done, and both them and the doctor were like alright this is awkward… they ended up going to Denmark instead.
I'm an AMAB non-binary guy.. Once I switched my medical profile from male to non-binary very helpfully I started getting notices about needing screenings for cervical cancer.. I did manage to get that marked as not needed, but it'll be interesting, err annoying, to see if it comes up again. The other dumbass thing is MyChart in at least the few installations I've seen, won't allow you to change your login name on your own, so if it includes part of your deadname you're stuck with it..
I read something about the login names thing on Reddit. Apparently while you can't change your own login name, it's pretty easy for the tech support people to do for you, so you can call the tech support number and ask, and they'll usually change it for you.
@@diablominero TBH, the thing is this shouldn't require a tech support call. Its something many many other places allow you to do online. Requiring a phone call to do this means its just another way that those who change their names, which especially includes trans people, aren't thought of when designing systems. Honestly, I prefer bypassing the whole thing and just making login names email addresses.
@@NickCBax My email address is derived from my birthname. And now that I'm thinking of switching to a different name, I find myself regretting my lack of foresight at age 6.
@@diablominero Lol.. Yeah, but email addresses can be changed, and you can forward emails from one address to another. Besides, you can have a lot of email addresses.. At last check I had 2,330 of them... And by last check I mean just now, because I got curious. Although, most of them filter their way back to the same email box. (I'm serious, and yeah, I have a kinda unique system..)
Retired EMR analyst here: It’s important to report these things to the support team for your EMR; hopefully there’s someone on the team with clinical experience who can help with these issues. They should be able to add choices such as n/a that allow you to bypass a question (and any subsequent rules that automatically add more questions). The weight change rule after amputation might be tricky, since hopefully that doesn’t happen to the same patient very often; it might make sense to propose the orders triggered by the large weight change and allow the provider to accept or decline them. They should also be able to get responses added to allow for LGBTQIA folks since there are some different assessments & responses required.
TBH, shouldn't there be some thought about these things when the system is being designed? The roll it out and fix it once it has reached actual humans isn't really a good way to design software, especially when it is know that there are dramatic variations in people.
One of my long term closest friends is tg f to m...It never occurred to me that some of his history might trip up your softwaire in some way,even though he had the same Dr. who helped him transition..And that whole process was often entertaining,but that's another story. Good video.
Sounds more like the EHR isn't inclusive of the LGBTQ+ community. Not the program's fault, the hospital that bought it should have demanded it be inclusive of all of their patients.
I think it's important to recognize that it's not *just* about inclusion -- you can ask all the SOGI questions you want in the demographics section, but if the actual clinical workflows don't understand the consequences of those answers, we still won't be getting the appropriate medical care.
So many biological sex section to trigger subsequent questions and social gender section. This is so interesting. I do read medical charts for a living and I have encountered it but never thought of the nightmare of just making the computer happy by answering the questions.
@@goldensunrayspone "N/A" would let us fall through the cracks. We need a system that understands anatomy and hormones better, not one that shrugs and says "ehhh, it's probably fine" when we show up.
It's not a matter of not being "up to date" but simply not being inclusive. We've had modern medical transition for a century now, long before computerized medical records. Culturally, we've had multiple genders and transition for thousands of years. It's much closer to how medicine is extremely white. It's not a matter of not being up to date with the fact that many people are not white. Pulse oximeters that give false data because they are only calibrated to the whitest people led to unnecessary intubation and deaths during Covid. They kept calling it "happy hypoxia" instead of "bad data" and were literally kicking people off their phones to intubate them because they cared more about the incorrect reading than what was obvious. Poor understanding about what skin lesions and hypoxia look like on darker skin tones, lead to significantly worse outcomes for Black people. There's still a lot of bias but ignorance is rampant. It's a choice not to reflect humans as they are but instead to focus on cishet non-disabled white men as the "normal human."
I get questions about whether I smoke. I don't deliberately expose my lungs to burnt plant, but I do use nicotine lozenges. So... I've been answering "no" but worrying that they might miss something because I give them bad information. Aren't forms the best?
Hello Dr. Schmidt. I don't know if you can answer this question. If not, that's okay. I went to the ER yesterday. During check-in the nurse asked me what year it was, who is the Vice President and where I was. I answered the questions and should have asked why they were asking me these things but I did not. However, today it is really bothering me. Is this something new hospitals are doing? They have never done that before. Also, the hospital never had a guard at the entrance before who had to check your purse and bags and make you walk through a metal detector before you checked in. If you can answer this I would appreciate it. Thank you.
Do you have a primary doctor? I would ask your primary if you have one. Probably any doctor you see might be able to answer your question. There could be many reasons for the question and one if your healthcare providers could answer that better than anyone here could. Hope this helps ☮️
I'm not a doctor, but this seems like one of those test that they often give to confirm that you're aware and lucid. Basically its a quick check of your brain function.
Me coming in for bladder pain and incontinence and having to submit a pregnancy test before we could move forward…. But I can’t pee on command bc of the whole bladder thing. And I’m asexual + not sexually active. (Stares at the ceiling) and it wasn’t an option to skip it for some reason. I was mad.
At least the patient did disclose they are transgender to avoid investigation complications. I get it is not something you want to be reminded of but when it comes to clinical stuff knowing what your body is made of and what stuff you got going on inside obviously is very important.
@@isidoooora some equivalent of that is what's usually done when possible (EMRs don't universally have a gender field, some only have sex assigned at birth) but for someone who's been on HRT a long time it's easier to put in the patients affirmed gender for their sex so the reference ranges on all the labs are correct
@@isidoooora There should yet but its the whole complicated thing of identifying as or actually having clinical transitional surgery stuff. And people not using labels.
depends on institutional policy. Some list sex assigned at birth, some list affirmed sex (which makes some things more convenient, eg you get the correct reference ranges for labs that way), some EMRs have an intersex option and clinicians then chart "Jane Doe, xx year old female (AMAB, on estradiol since xx/xx/xxxx, status post SRS xx/xx/xxxx) is here for such and such," and some institutions just have no idea what to do because "we don't treat people like that"
i know in the UK you can update your file by just asking, according to PCSE regulations. whether or not you'll have to correct your GP on what the PCSE guidelines are and then have to escalate it to a complaint because the GP has decided theyre above the official guidance is a whole other story (it fucking sucks ass lmao)
These electronic medical records should be illegal. This is just one of many many problems I've seen with them. Just let the doctors chart what they need or want to .
If she's transgender you have to put in 'male' first and ask those set of questions. She'll need to be screened for male conditions like prostate cancer and the CrCl needs to be calculated for the birth gender. We've come across this at my hospital more in recent years.
Prostate cancer treatment is often based on lowering your T level as much as possible (because prostate gland is an androgenic tissue). So she's probably already getting treated for prostate cancer whether or not she has it.
Maybe the electronic record isn't wrong after all. You should've referred that patient with (Gender Dysphoria) to a psychiatrist to receive adequate medical attention.
The consensus among medical professionals is that the best treatment for gender dysphoria is hormone replacement therapy and socially interacting with the patient like someone of the gender they identify as. The specialist to administer that treatment, if you're not competent to do it yourself, is an endocrinologist, not a psychiatrist.
after 12 months of regularly and correct hormone dosing a trans person's blood is unrecognisable from a cis person of the same gender, and they're at the same risk of the diseases of that gender (yknow how men are at a higher risk of heart disease and strokes? trans men on T will have that same higher risk). the actual physical sex is far less important than the hormones present in the body when it comes to general medical health, essentially. if it's a sex specific issue then it's a matter of the person clarifying. plus, at least for some doctors surgeries in the UK, the gender on record has to match the title used by the person. so if a trans man wants to be addressed as Mr on all automatic letters, prescriptions, etc, his file has to be male. If the file isn't update the only non gender specific title available is "Mx" TBF it's up to the trans person themself whether or not they update their NHS file, some people choose not to it's a massive faff, medical records can be lost if the GP forgets to transfer something over (mine lost all my vaccine records), sometimes GPs just straight up lie and say they can't do it "it's impossible" --i had to quote the PCSE guidelines and GDPR Article 16 in complaint before my GP finally caved!! and on the other hand some folks don't mind. personally i didn't feel the need to update mine until i moved and my new GP refused to refer to me as Mr Bob, they kept insisting I was Miss Bob, which was insane. i went to the pharmacy and the lady issuing my prescription starting asking about whether i was trans, which wasn't a thing i really wanted to talk about. Then i went to hospital for a broken arm and was asked about being trans because, again, my file was Bob, Female. after those incidents/issues it made more sense to update my file to say male. if my genitals are relevant i'd bring it up, but 99.99% they aren't 😅 it's just the occasional "oh no i don't need a ball cancer exam thanks" or "yes i do need that swab test", but my personal GP knows i'm trans so it's chill. just don't need the receptionist, pharmacy, and post man delivering mail from the doctor's knowing i'm trans!
also the genitals change on hormones. for trans women taking oestrogen the penis and balls shrink and they lose the ability to stay hard without taking dysfunction pills. i remember reading a trans woman's account of when she panicked because she thought her balls had fallen off, but they'd just shrunk in on true selves. for trans men the clit can grow up to 3 inches and maintain an erection. so even before surgerical changes to the genitals, trans people's genitals can be wildly different to what is expected, and the binary idea of penis and vagina get slightly confusing
Alot of times, your sex has to be based on your legal gender for epic. And while I have seen some patients flagged as like "ftm" for the purposes of genital cultures and such, I don't think that cancels the questioning or corrects gender-based results like CBC. Plus, i think most ppl have no idea how to set that flag.
If only it were that simple! Let's say a doctor is treating a trans woman who has taken hormones long enough to grow breasts, and who has had a vaginoplasty. From a prostate cancer risk perspective, they do have that "male anatomy". If they're getting pulmonary function tests done, it's likely their torso's skeletal structure is what's typical for "male anatomy", so it's more appropriate to use "male" norms for things like forced vital capacity than the "female" ones. But they've got far more breast tissue than they did before hormones, so from a breast cancer risk perspective, they're somewhere between the "male" and "female" statistics. And they've now got a shorter urethral tract, so from a UTI risk perspective, they're probably way closer to the "female" statistics than the "male" ones. These aren't hypothetical! Half of them are from my own healthcare experiences. So no, documenting them as "male" will just cause the EMR to make *different* bad decisions.
This does point out that gender isn't a helpful description in medical contexts outside of psychiatry. Use biological sex instead!! Though obviously other and N/A are always important. What if she was just born without a uterus??
Biological sex doesn't capture it either, such a system would for instance assume a much lower probability of blood clots then is actually the case (since physiology that is attached to hormone therapy matches up with what hormones you currently have, including which ones you're taking, not what chromosomes you have). The core problem is a rigid system that doesn't allow flexibility for the fact that people have different experiences that result in medical differences, and while transgender people are an example of that they are a long way from the only example.
@@bosstowndynamics5488 Yeah, I'm constantly flagged for polycythemia because the medical record only reflects my sex at birth. And flagged for having high testosterone 🤭
It doesn't though, because loads of transgender people are on hormone therapy, and many have had surgeries, that mean they aren't the same as their assigned sex at birth might imply (a trans woman on hormone therapy has much of the same physiology as a cis woman). The real problem here is a software engineer making a rigid system that's not able to account for differences in humans, differences that exist in cisgender and transgender people in many domains.
@@bosstowndynamics5488 - and a further problem is that human differences are vast, and there will almost always be someone who doesn't fit neatly into this box or that box for a questionnaire.
Nah, you need that inclusivity. Between HRT, surgery, and intersex conditions, there are a *lot* of configurations of human bodies besides the common two.
@@juliethecyborg True intersex is very rare. Most cases classified as intersex just involve a micropenis, hypospadias, or a larger than average clit. HRT doesn’t change your insides. Hence why it’s unnecessary to include. Your cancer risks don’t change. Your genetics don’t change.
@@bosstowndynamics5488 A transwoman even after surgery does not have the same physiology as a ciswoman. By claiming to be female, you’re putting yourself at risk of things like prostate cancer because now there’s no screenings available to you.
Transgenderism DOES exist in nature. There are certain species of fish and frogs that apparently transgender, automatically, naturally without choice. ...but, It does not occur in humans. Humans are not fish or frogs.
You would not have these problems if you just wrote male in the form and, for the sake of completeness, added GID to the mental conditions section. Truth is always simpler.
In addition, simply being transgender is not a mental illness. Gender dysphoria is not the same as simply being transgender. You can look it up in the DSM if you’d like to learn more.
@@Doc_Schmidt That is why I used the old term, Gender Identity Disorder, which does simply describe an individual's belief that his gender is in contrast with his sex. Furthermore, as your skit perfectly demonstrated, for medical records, it makes much more sense to identify people by sex, rather than gender as it is more relevant for treatment and diagnosis.
@@Mishterius Gender Identity Disorder is the old term for what became known as Gender Dysphoria. GID was removed because being transgender is not a mental illness, just like how homosexuality was removed from the diagnosis list prior to that. The medical record struggles to function for cis people as well, because there are plenty of circumstances where a person who was assigned female at birth could not have periods or even not have a uterus without having had surgery. Additionally, trans women with breasts require mammograms to screen for cancer, which the EMR would probably ALSO struggle with letting you do if you put her in as "male", but it's care she needs.
@@gracklepopp Allow me to address the points you made in order. I do not use the term mental illness as it has strong emotional associations. Instead, I said mental condition, meaning something of clinical significance going on in the mind. You would not deny that a transgender self-identification fits both of these criteria. Due to the prevalence of a wide range of psychological comorbidities, such as depression or suicidal ideation, it is undeniable that such a self-identification has great psychological significance, and therefore removing it from the DSM-5 was an error. It is true that some women also do not have uteruses, however, in them it is a medical issue, while for people identifying as trans women it is merely the natural state of their anatomy. As to the last point, requiring mammograms is tied to the long-term reception of estrogen shots, not with any inherent property of identifying as transgender. Seeing as some people identifying as trans do not receive estrogen shots, basing screening recommendations on gender identity is logically unsound.
Honestly just put male, and in any other option just add identifies as transgender. Mentally they can be whatever they want but biologically they are male, or female only.
No, that doesn't work. A transgender person may have had surgeries and/or is on hormones. Saying the person is the sex they were assigned at birth misses all that. Trans women are more prone to breast cancer than men, cis or trans, are. And they do have monthly cramps despite never having a uterus. Trans men probably have special problems too, but I haven't had that conversation with a trans man yet, so I don't know what they might be. They need to be marked in medical systems as trans men or trans women and they need questions aimed at their population. You can't wish them away just because you don't like the idea.
@@letshavepie how is that wishing them away? They are still what they where before transition, the surgery and the hormone therapy can be easily added on the surgery section and on the medication section.
That isn't how it works. After about a year on HRT then the medical care you need is much more in line with your transitioned gender, and that is important for the medical record to know so that you can be screening for the right things.
@@gracklepopp i never understood how you guys work at USA. Here we only use male and female, if you are trans we treat you based on you being trans, the hormone therapy should be followed by endocrinology, not by any doctor. Also, those hormones change your body, but it doesnt change the fact that is a male body being modified with drugs. if you want a mammogram you can get it even if you are male.
Even then, it's complicated. Trans people on hrt, trans people not on hrt, and post-op ppl all have different medical needs and testing reference ranges.
So as a cs student I think I'll leave an explanation out there for everyone, why we can't have N/A on all forms. Tldr: It creates too many choices. Just put them down as a man instead of woman. First of all, database will have to accept blank or N/A as an answer. This breaks multiple constraints on the database, in other words, devs normally have to tell the database this can't be empty, because this answer is needed to decide about something later on. If it's left empty then everything will break. So they have to rewrite all the rules of the database to allow N/A. But wait that's not all. The webpages need to change so the form allows N/A as an answer, which is relatively simple thing to do. But depending on how many input fields there are, it will get tedious but doable easily. Next part, the generation of "if this do that". Like if they had an operation recently then do a post op checkup. I can kind of guess as to how it's working but that entire system will have to be redone, to accept N/A responses. And generate proper questions. Once that's done. Congratulations! You have successfully made a system that is on the cusp of burning down a hospital. Now that so many open ends are allowed, there are so many states unaccounted for. To go through and test every single thing, to make sure it's working correctly and in the way we want it to, it will take years. The correct thing to do for the system is you should have entered them as a man. Yes I know that it's not respecting trans people, but people need to understand what they were born with won't go away. That their biological gender is more important to receive proper healthcare. If anything making a simple button that says the person is trans and just flip the genders internally would allow the system to work properly much better than allowing N/A everywhere. Because that's an indeterministic nightmare hell hole I wish upon no soul to test. What I mean is, you will constantly go, "why wasn't this tested?!" Or "stupid technology!" As I've seen countless times...
Yeah, you can't just "flip the genders internally". To fix this *right*, you need to understand a patient's anatomy and hormones instead of inferring them. Between hormones and surgery, your guesses will always be wrong some of the time -- and that's before you realize intersex people exist.
If you're a programmer, please read the classic 2010 blog post "Falsehoods Programmers Believe about Names." That and this are perfect examples of what happens when you try to make an expert system or even a database without a fundamental understanding of the field.
Oh, I missed this gem the first time through: "people need to understand what they're born with won't go away" Putting trans surgery aside for a moment, I was born with a gallbladder and vitreous humour in both eyes. I now have no gallbladder and vitreous humour in my right but not left eye. The former is important information during an abdominal ultrasound, and the latter is important information for future cataract risk. *You* (and the folks who write and configure EMRs) need to understand that what we're born with *can* go away. When that happens, our future medical care needs to account for it.
Patient came in for above knee amputation. Computer flagged a dramatic change in weight and automatically submitted a dietitian referral.
🤦
I'm a double amputee, and I can confirm I feel so sorry for my doctors and nurses having to deal with this stuff 😂 the systems are so hard to negotiate with.
the BMI calculator also gives some really goofy results when people have had limbs removed.
and for that matter, if someone gets a double amputation, are we supposed to enter a new height? because that's really going to affect their BMI. And also trigger a nutritionist consult.
OH MY GOD 🤣🤣
The fun part is that even if you have a hysterectomy on your medical chart it still asks the period question every time AND forces you to get pregnancy tests for certain medications 🎉
Another issue these record issues like this cause is that doctors who read them later on think the patient is someone who.lies and makes things up. The damage from EMR issues is real
Absolutely. I went to the doctor just for a medicine refill. Just a basic appointment, and since the doctor didn't really do much but refill my meds, they just copied and pasted from the last visit. Fast forward to my next visit. I was in pain that was worse than my chronic pain. It was mentioned that I never mentioned pain in my last visit. I didn't mention it because it was not brought up and my appointment t was not for pain. So it makes me look like I am lying when I am not.
They think that anyway. Doctors, overall, consider patients to be horrible people there to annoy and take advantage of them
@@mellie4174 I've stumbled on some good ones, but some of the stuff doctors say on Reddit when they don't think patients will see is *shameful*.
something I’ve actually seen in the context of trans patients are practitioners who find out a patient is trans and just put “sex change operation” without much of any idea of what that could be or whether it’s true. Like what do you think happened that made your trans man patient grow a lumberjack beard do you think those are implanted subdermally
@@juliethecyborg you should hear what they say when speaking to other doctors.
As I often say to people "please don't try to pigeonhole me - I am not a pigeon". In other words I don't fit neatly into anyone's little tickboxes - never have done, never will do.
As an example, I'm both a wheelchair user, and until his passing was my husband's main carer. You could not be registered with my family doctor at that time as both a person with a disability, and as one with a caring role. It was more important to me to be registered with my doctor as a carer, so I did so. That then caused an issue when I needed transport to hospital appointments in a wheelchair accessible vehicle. I was not eligible for my local scheme, because I was not registered with my family doctor as a wheelchair user!
...wow, that's an incredibly silly limitation.
FFS 🤦♀
Wow, that's seriously stupid. I would've thought that would be a common enough occurrence to have an option for it, especially considering elderly couples who are both in poor health due to age.
“Any problems with the surgical site?” OMG!
This is so real on just a level of not even being transgender and trying to fit everything into a questionnaire...... So easy to forget why you're even there or what your chief concerns are while you're spending half an hour on questions that don't really capture the problems. I put off a lot of important doctor visits just because it's such an ordeal and I often do not feel like anything gets addressed really .....
Exactly!! Like, how are we still such a fcking mystery to the medical system??
I use the same program on my phone for shopping lists to list what I need to talk to my doctor about. It helps keep things on track and me to not forget that, oh, yeah, my leg has shooting pains, doc, and that's a bit more of a problem right now than my slightly elevated blood sugar.
I have no family medical history (adopted as a baby and bio parents gave no medical info) and the amount of time's it's cause a problem in the computer system of a doctor's office isn't even funny. Honestly I don't know why for every question there isn't an "other- explanation" option.
And then once you finally get past all that BS and the thousand other random questions the Dr has to ask while never looking up from their computer screen . . . They tell you there’s only a max of 3 medical problems/concerns/question they can help you with that day. Any more you have to reschedule for next earliest appointment in 17 months 🙄🤬
I ask if I can fill them in online in advance or with a nurse.
My favorite is "birth control method." For some reason "my partner was sterilized 20 years ago" isn't an option.
Electronic Records arent that great.
Over 30 yrs I still have to tell everyone no Sulfa drugs.
20 yrs ago it was a bright sticker
I am just wondering how did this electronic medical record system even went into doctor offices when it does not account for such cases. There should have been an N/A option at a minimum.
It's because they are using systems so old, that it was prior to people accepting non-binary states of being.
it is medical, that's why most medical docs ask for sex and not gender because of the genetic differences between biological males and females. Even when taking in account hormone therapy a trans-female has MUCH higher testosterone then most females.
@@PUM_Productions A trans woman on hormone therapy generally has *less* testosterone than a cis woman actually, because cis women produce small but significant amounts of testosterone and don't take hormone blockers
@PUM interesting. Still, I think it is a glaring issue.
Because just like medical insurance, the people making all the decisions have zero medical education and have never before even talked to a patient or someone that works directly with patients.
This is a real thing I've run into in almost every EMR system apart from Seattle children's. It took a downright stupid amount of time to separate the "sex" and "gender identity" boxes but you bet you ass the Catholic hospitals all had a "religious preference" box.
Patient with Turner syndrome had the exact same issue!!! :( (Hypothetically)
Yes! I hate when i'm doing intakes and thetes not an other or n/a option! Digital charts can make life easier but also cause problems like this 😅 I actually just had this issue on a job app where you had to select a major for your masters degree and they didn't have mine!
Even before fully digital charts, it was such a pain. A standard admission or clinic intake form needed to be applicable to pretty much everything and everyone, and then you get where I worked: Endocrinology. Endo specialises in people who don't fit inside the box. The standard intake for a large portion of the patients wasn't applicable so endo made their own. Medical Records did NOT like that, but they just about ran screaming when we proposed an additional section to the standard intake, because of how complex it needed to be and how many additions of N/A would have been needed in the standard form.
N/A should be an option on all forms.
Hard stops in the EMR make everything "safer"
Or you know, you can fill these forms out according to biology since that's the goal of intervention.
Alright mister na na na. What seems to be the problem?
@@stansman5461 The entire point of the video is that, unless your EMR understands trans folks, it *won't* be able to understand their *current* biology and recommend the correct interventions or screenings.
@@juliethecyborg What current biology? The magical uterus showing up cause they wished hard enough?
As a cis woman in a relationship with another cis woman for 13 years, the "are you sexually active" followed by "what kind of birth control do you use" questions have always been tricky to answer. I sometimes lied to get to the truthful statement that no, I cannot be pregnant, no really, I'm very sure. It was almost a relief when I developed a fibroid and my doctor prescribed me birth control as part of the treatment. "Lesbianism" isn't an option for birth control on those intakes, but oral contraceptives are!
Just put down no for sexually active?
@@prateekkarn9277 Answering "no" would overlook potential STI risks.
You're just a woman with another woman, don't feed into this "cis" labeling crap.
There is no cis woman.
Its either a woman or a man.
You could also just tell your doc you’re lesbian if you wanted lol. Also we will still pregnancy test you if it really matters because if you somehow were pregnant a potential med / procedure could harm the baby. Can’t take people just based off their word in the medical field sadly
If youre transmasc and don't get a period anymore, there is *also* no option for that. My doc ended up having to put in that im not menstruating due to "birth control".
Technically true. I like it when doctors get creative with how they answer a question like that.
@@Luubelaar Saaame! My last clinic would diagnose trans women with "agenesis of the cervix" (NOT TECHNICALLY INCORRECT!) to get the EMR to stop recommending pap smears.
It's awesome that they're trying to get creative, but as a trans man who is also a clinician, I'm torn with these things. Because, sure, now they won't ask questions about periods, but also... They might be less inclined to discuss potential for pregnancy, which can still happen while we are on T and some of our younger guys don't know that. Having the EMR make assumptions and prompt us is great, because we have too much to keep in our heads and not enough time with patients so could forget something, but it's also frustrating because the programming doesn't take into consideration the enormous diversity of our species. I don't have a solution here; just agreeing with how frustrating it is for all parties involved.
T is a hormonal medicine that can reduce fertility. So... technically the truth?
When you get that M on your ID and tell someone you have had a hysterectomy they are just like… uh I don’t have a button for that 😂
My favourite
"Did the patient suffer cardiac arrest during treatment?"
FFS! I'm just wrapping up a sprained ankle......
OH SHIT!
I want to laugh, but as a trans masculine person (female to male is probably the easiest description) who had a baby 6 months ago and I got asked all sorts of stupid questions and treated like crap, I can definitely empathize with this. Seriously it doesn't matter if you're transmasculine, transfeminine, or androgynous/non-binary, or even if you're intersex, the healthcare field just isn't really willing to deal with us. And it's not fair and it results in a lot of Us ending up with health problems that we don't need.
I used to work admin in endocrinology. The standard intake for a large portion of the patients wasn't applicable so endo made their own. Medical Records did NOT like that, but they just about ran screaming when we proposed an additional section to the standard intake, because of how complex it needed to be and how many additions of N/A would have been needed in the standard form.
I just don’t understand people getting into medicine and learning about the complexities and “messiness” of biological systems. Only to throw all that out the window when faced with something they don’t like or understand.
Is the person human? Yes? Then treat them like one and check your prejudice and ignorance at the door.
Oof, I can only imagine the ways that went sideways. I hope you and the kid are doing alright.
You're right. It is unfair and results in big barriers to accessing healthcare. I hope you and your baby are doing well.
In the UK we are having a big issue where trans people end up being called for the wrong screenings. like men not getting pap smears and women not getting prostate exams.
I truly wish I wasn't making this up but I had similar problems with a doctor, but it wasn't the computer making her say it, she just appeared to be exceptionally dense. I'd had hysteroscopic sterilisation followed by endometrial ablation by saline balloon about 9 years previously, so no periods for that 9 years. Then I had a total hysterectomy & oophorectomy. A couple of months after that, I had pain and blood in urine and suspected a urinary tract infection, so went to my GP.
me: I think I might need antibiotics for a bladder infection. (I'd already brought in a sample as requested)
GP: are you on your period?
Me: no, I had a hysterectomy.
GP: when was your last period?
Me: um? Dunno? About 9 years ago?
GP: is there any chance you could be pregnant?
Me: no, I had a hysterectomy.
GP: are you SURE you're not on your period?
Me: ...
GP: ?
Me: I LACK THE NECCESARY EQUIPMENT.
She left the room for about 15 minutes. She came back, she looked at the computer for several minutes.
GP: so I think you have a bladder infection, you'll need some antibiotics.
Me: (desperately trying not to scream or headdesk)
I would also want to scream! 😱😱😱
So true, exactly my own experience with some really dense "doctors ".
Did a DOCTOR forget what a hysterectomy is??
@@tscimb apparently so. I think at one point I also used the wording "I do not have a uterus" when she didn't seem to comprehend the hysterectomy bit, but I distinctly remember finishing with the rather strained, slowly enunciated "I LACK THE NECCESARY EQUIPMENT!" Because by that point I was struggling to know what other combination of words was going to get the concept through to her, and seriously wondering if she was perhaps the cleaning lady who wandered in and wanted to play at being a doctor for the day.
@@MiceAndMinecraft - I kept getting asked to have a Pap smear test - but I had had a total hysterectomy years before...
Dr : it’s very important, you keep missing your smear test, it could save your life
Me : I don’t have a cervix
Dr : you do, all females have one
Me : no, I lost mine
Dr : you can’t just lose your cervix
Me : I had it surgically removed
Dr : that’s not an operation that’s performed
Me : it wasn’t just my cervix, I had everything removed, no cervix, no uterus, no ovaries, no Fallopian tubes, all gone
Dr : what country did you have it done in
Me : this one, at the hospital across the road
Dr : when
Me : about five years ago when I stopped getting the smears done 🙄
It’s true. EPIC sucks. You can’t move past it until all the fields are filled and then - at least in my institution - you wouldn’t get the ‘green check mark’ ✅ indicating that your work was done and complete. And the rather significant details - like Doc Schmidt just demonstrated - really don’t matter. Just ‘Did you get the green check mark?’ ✅ Ah, no. Sorry, not sorry.
Epic might not be perfect, but compared to other EMRs...oh boy
Tell your builders to do Epic’s SGN project. It gives you an organ inventory to trigger these questions from and is much more inclusive!
We use Athena and it took several years to get them to add a chosen name field. Considering we are an LGBTQ agency, this was causing a lot of harm on a regular basis. So frustrating to hear it's not just Athena and is actually most of the EMRs, though not even a little surprising, honestly.
If you are in Epic click their gender to open the form and put that they were male at birth and identify as female. It will say they are female in the chart but it will stop asking random gyn questions.
I hope a lot of medical staff read this 🙏🏼 you are a great human, thank you
Our OB admission on the EMR had a question about prostate issues.
As someone who writes questionnaires for a living, medical questionnaires never fail to drive me up the wall.
The bean counter EMR format clashes frequently with real life for sure!
Also, Catholic based health insurances, like Christus Santa Rosa, will not pay for any medical or psychiatric visits if gender dysphoria is anywhere on the diagnosis list
Edit: spelling
gross :(
I don't work in healthcare, but I'm nonbinary and AFAB. I never got a period, and now, I'm on testosterone so will never get one. I have also never dated a person who could get me pregnant. All of my intake appointments start this way. 😂
"What do you mean you've never had a period? Do you mean you don't get periods because you're on testosterone?"
"Both."
"There isn't a box for that!"
Nothing seems to confuse the NHS quite like not having a functional uterus. The look of confusion you get sometimes when you say "I don't have periods" 🤣🤦🏻
It's nice seeing a short with a trans woman character that's trans positive! Trans rights!
I’m so glad that Epic is finally doing an organ inventory that will intelligently trigger those questions. 🎉
WAIT IT IS?! Can you link me more info?
Huh, I never thought of that from the trans fem side before. I’m trans masc, so despite being masc, I still get asked these questions for safety reasons. Never thought abt it the other way around. Med rec needs to change, and my heart goes out to all my trans fem friends out there ❤
💜
The hysterectomy was during fetal development. Duh! 😂
Gotta love being trans at the doctor's. This is painfully real.
As a trans guy, it's so great to see casual trans representation! Thank you!
Exactly, this is how you make tasteful trans jokes, not whatever attack-helicopter nonsense the Internet seems to come up with on the reg.
Trans woman here -- this is absolutely accurate. I just had a mammogram and had to lie on a couple questions in EPIC to finish the intake form.
And if it is at the ER and they admit you, you have to go through it ALL again.
Hahaha. This legit had me LOL! Great video Doc. Wish I worked with more Drs. Like you.
As a trans gender man this is too relatable, the systems are always confused because according to them I shouldn’t have a uterus. I know of a couple (a trans man and a cis woman) who wanted to do IVF and the rules state that straight couples need to try on their own for a year before they can get it done, and both them and the doctor were like alright this is awkward… they ended up going to Denmark instead.
It’s pretty obvious that electronic medical records haven’t kept up with everything…
I'm an AMAB non-binary guy.. Once I switched my medical profile from male to non-binary very helpfully I started getting notices about needing screenings for cervical cancer.. I did manage to get that marked as not needed, but it'll be interesting, err annoying, to see if it comes up again.
The other dumbass thing is MyChart in at least the few installations I've seen, won't allow you to change your login name on your own, so if it includes part of your deadname you're stuck with it..
I read something about the login names thing on Reddit. Apparently while you can't change your own login name, it's pretty easy for the tech support people to do for you, so you can call the tech support number and ask, and they'll usually change it for you.
@@diablominero TBH, the thing is this shouldn't require a tech support call. Its something many many other places allow you to do online. Requiring a phone call to do this means its just another way that those who change their names, which especially includes trans people, aren't thought of when designing systems.
Honestly, I prefer bypassing the whole thing and just making login names email addresses.
@@NickCBax My email address is derived from my birthname. And now that I'm thinking of switching to a different name, I find myself regretting my lack of foresight at age 6.
@@diablominero Lol.. Yeah, but email addresses can be changed, and you can forward emails from one address to another.
Besides, you can have a lot of email addresses.. At last check I had 2,330 of them... And by last check I mean just now, because I got curious. Although, most of them filter their way back to the same email box. (I'm serious, and yeah, I have a kinda unique system..)
Retired EMR analyst here: It’s important to report these things to the support team for your EMR; hopefully there’s someone on the team with clinical experience who can help with these issues. They should be able to add choices such as n/a that allow you to bypass a question (and any subsequent rules that automatically add more questions). The weight change rule after amputation might be tricky, since hopefully that doesn’t happen to the same patient very often; it might make sense to propose the orders triggered by the large weight change and allow the provider to accept or decline them. They should also be able to get responses added to allow for LGBTQIA folks since there are some different assessments & responses required.
TBH, shouldn't there be some thought about these things when the system is being designed? The roll it out and fix it once it has reached actual humans isn't really a good way to design software, especially when it is know that there are dramatic variations in people.
Oh my God this just described my life so hard
One of my long term closest friends is tg f to m...It never occurred to me that some of his history might trip up your softwaire in some way,even though he had the same Dr. who helped him transition..And that whole process was often entertaining,but that's another story.
Good video.
This is so spot on!!! 🤦🏻♀️
Sounds more like the EHR isn't inclusive of the LGBTQ+ community. Not the program's fault, the hospital that bought it should have demanded it be inclusive of all of their patients.
I think it's important to recognize that it's not *just* about inclusion -- you can ask all the SOGI questions you want in the demographics section, but if the actual clinical workflows don't understand the consequences of those answers, we still won't be getting the appropriate medical care.
thankfully no EMR I've ever seen is *actually* this obtuse but man dose it sure feel like it some days.....
Valant is.
Some installations of EPIC are absolutely configured to be this obtuse.
So many biological sex section to trigger subsequent questions and social gender section.
This is so interesting. I do read medical charts for a living and I have encountered it but never thought of the nightmare of just making the computer happy by answering the questions.
That is on you. You ask the questions you don't know the answer to, not all of them.
So true, so true 😂
My gyn couldn't put "vasectomy" as my current birth control method because of a similar electronic flaw.
Please tell me that the computers in that hospital have been updated so transgender people can be charted correctly now.
This is too familiar... Technically, you could put down uterine agenesis. That is accurate.
The joys of medical questionnaires mot quite being up to date for trans/non-binary people
they really should just have an "other" or "n/a" option for all inputs, it would be future proof, it's stupid that they don't honestly
@@goldensunrayspone "N/A" would let us fall through the cracks. We need a system that understands anatomy and hormones better, not one that shrugs and says "ehhh, it's probably fine" when we show up.
It's not a matter of not being "up to date" but simply not being inclusive. We've had modern medical transition for a century now, long before computerized medical records. Culturally, we've had multiple genders and transition for thousands of years.
It's much closer to how medicine is extremely white. It's not a matter of not being up to date with the fact that many people are not white. Pulse oximeters that give false data because they are only calibrated to the whitest people led to unnecessary intubation and deaths during Covid. They kept calling it "happy hypoxia" instead of "bad data" and were literally kicking people off their phones to intubate them because they cared more about the incorrect reading than what was obvious. Poor understanding about what skin lesions and hypoxia look like on darker skin tones, lead to significantly worse outcomes for Black people. There's still a lot of bias but ignorance is rampant.
It's a choice not to reflect humans as they are but instead to focus on cishet non-disabled white men as the "normal human."
@Tamara Roberson if they were otherwise clinically stable wouldn't they have done an abg before intubation??
Those things are so awful. If you don't fit their norm, you are in deep dodo.
Protip doc, put greater than 5 years and list estrogen as the birth control method!
If they're actually on estrogen since that conveniently lines up as not-misinformation, or just in general?
Brilliant!
I get questions about whether I smoke. I don't deliberately expose my lungs to burnt plant, but I do use nicotine lozenges. So... I've been answering "no" but worrying that they might miss something because I give them bad information.
Aren't forms the best?
As a transwoman, this is😅
As a transwoman--stay out of woman's space. The world doesn't revolve around you.
How awkward haha
Organ inventories are a better system for this stuff
I love it!!! So funny!!!
Hello Dr. Schmidt. I don't know if you can answer this question. If not, that's okay. I went to the ER yesterday. During check-in the nurse asked me what year it was, who is the Vice President and where I was. I answered the questions and should have asked why they were asking me these things but I did not. However, today it is really bothering me. Is this something new hospitals are doing? They have never done that before. Also, the hospital never had a guard at the entrance before who had to check your purse and bags and make you walk through a metal detector before you checked in. If you can answer this I would appreciate it. Thank you.
Do you have a primary doctor? I would ask your primary if you have one. Probably any doctor you see might be able to answer your question. There could be many reasons for the question and one if your healthcare providers could answer that better than anyone here could.
Hope this helps ☮️
I'm not a doctor, but this seems like one of those test that they often give to confirm that you're aware and lucid. Basically its a quick check of your brain function.
Thanks to Judith Faulkner
Oh goodness!
Some cis women also develop no uterus. You would think they’d have options for rare developmental abnormalities since they exist.
Me coming in for bladder pain and incontinence and having to submit a pregnancy test before we could move forward…. But I can’t pee on command bc of the whole bladder thing. And I’m asexual + not sexually active. (Stares at the ceiling) and it wasn’t an option to skip it for some reason. I was mad.
Bro in epic the chart can reflect they are transgender and not prompt these questions. 😂
You say that like anyone configures EPIC properly. 🙃
Epic is an epic fail.
First problem is this is not a woman. EMR has a lot of issues, but that’s not the fault of the EMR.
Lol that's why you stick to the biological sex when charting
I guess young girls simply can’t have a medical record either 😂😂
At least the patient did disclose they are transgender to avoid investigation complications. I get it is not something you want to be reminded of but when it comes to clinical stuff knowing what your body is made of and what stuff you got going on inside obviously is very important.
shouldn't then the file say that the sex is male and *gender* is female? that way it automatically skips over all the ob&gin questions
@@isidoooora some equivalent of that is what's usually done when possible (EMRs don't universally have a gender field, some only have sex assigned at birth) but for someone who's been on HRT a long time it's easier to put in the patients affirmed gender for their sex so the reference ranges on all the labs are correct
@@isidoooora There should yet but its the whole complicated thing of identifying as or actually having clinical transitional surgery stuff. And people not using labels.
Serious question... Do you still put sex as male if she was born biologically male?
depends on institutional policy. Some list sex assigned at birth, some list affirmed sex (which makes some things more convenient, eg you get the correct reference ranges for labs that way), some EMRs have an intersex option and clinicians then chart "Jane Doe, xx year old female (AMAB, on estradiol since xx/xx/xxxx, status post SRS xx/xx/xxxx) is here for such and such," and some institutions just have no idea what to do because "we don't treat people like that"
i know in the UK you can update your file by just asking, according to PCSE regulations. whether or not you'll have to correct your GP on what the PCSE guidelines are and then have to escalate it to a complaint because the GP has decided theyre above the official guidance is a whole other story (it fucking sucks ass lmao)
Once again, trying to eliminate the Doctor of Medicine doesn't work. But AI is coming fast.
These electronic medical records should be illegal. This is just one of many many problems I've seen with them. Just let the doctors chart what they need or want to .
If she's transgender you have to put in 'male' first and ask those set of questions. She'll need to be screened for male conditions like prostate cancer and the CrCl needs to be calculated for the birth gender. We've come across this at my hospital more in recent years.
Prostate cancer treatment is often based on lowering your T level as much as possible (because prostate gland is an androgenic tissue). So she's probably already getting treated for prostate cancer whether or not she has it.
@@diablominero but you know what I mean... screen for diseases that are possible for that person.
Yep, electronic medical charts doing their job ))
Which job is that?
Maybe the electronic record isn't wrong after all. You should've referred that patient with (Gender Dysphoria) to a psychiatrist to receive adequate medical attention.
I agree
😂😂😂😂😂😂 💯
Okay, that's cute, but they still need whatever care they showed up for, and the EMR is getting in the way of that.
Lmao
The consensus among medical professionals is that the best treatment for gender dysphoria is hormone replacement therapy and socially interacting with the patient like someone of the gender they identify as. The specialist to administer that treatment, if you're not competent to do it yourself, is an endocrinologist, not a psychiatrist.
Looool
Hey, but being politically correct.
genuine question, why don't just put that the sex is male and gender is female? it is more medically important that they have male anatomy
after 12 months of regularly and correct hormone dosing a trans person's blood is unrecognisable from a cis person of the same gender, and they're at the same risk of the diseases of that gender (yknow how men are at a higher risk of heart disease and strokes? trans men on T will have that same higher risk). the actual physical sex is far less important than the hormones present in the body when it comes to general medical health, essentially. if it's a sex specific issue then it's a matter of the person clarifying.
plus, at least for some doctors surgeries in the UK, the gender on record has to match the title used by the person. so if a trans man wants to be addressed as Mr on all automatic letters, prescriptions, etc, his file has to be male. If the file isn't update the only non gender specific title available is "Mx"
TBF it's up to the trans person themself whether or not they update their NHS file, some people choose not to
it's a massive faff, medical records can be lost if the GP forgets to transfer something over (mine lost all my vaccine records), sometimes GPs just straight up lie and say they can't do it "it's impossible" --i had to quote the PCSE guidelines and GDPR Article 16 in complaint before my GP finally caved!!
and on the other hand some folks don't mind. personally i didn't feel the need to update mine until i moved and my new GP refused to refer to me as Mr Bob, they kept insisting I was Miss Bob, which was insane. i went to the pharmacy and the lady issuing my prescription starting asking about whether i was trans, which wasn't a thing i really wanted to talk about. Then i went to hospital for a broken arm and was asked about being trans because, again, my file was Bob, Female. after those incidents/issues it made more sense to update my file to say male.
if my genitals are relevant i'd bring it up, but 99.99% they aren't 😅 it's just the occasional "oh no i don't need a ball cancer exam thanks" or "yes i do need that swab test", but my personal GP knows i'm trans so it's chill. just don't need the receptionist, pharmacy, and post man delivering mail from the doctor's knowing i'm trans!
also the genitals change on hormones. for trans women taking oestrogen the penis and balls shrink and they lose the ability to stay hard without taking dysfunction pills. i remember reading a trans woman's account of when she panicked because she thought her balls had fallen off, but they'd just shrunk in on true selves.
for trans men the clit can grow up to 3 inches and maintain an erection. so even before surgerical changes to the genitals, trans people's genitals can be wildly different to what is expected, and the binary idea of penis and vagina get slightly confusing
Alot of times, your sex has to be based on your legal gender for epic. And while I have seen some patients flagged as like "ftm" for the purposes of genital cultures and such, I don't think that cancels the questioning or corrects gender-based results like CBC. Plus, i think most ppl have no idea how to set that flag.
If only it were that simple!
Let's say a doctor is treating a trans woman who has taken hormones long enough to grow breasts, and who has had a vaginoplasty.
From a prostate cancer risk perspective, they do have that "male anatomy".
If they're getting pulmonary function tests done, it's likely their torso's skeletal structure is what's typical for "male anatomy", so it's more appropriate to use "male" norms for things like forced vital capacity than the "female" ones.
But they've got far more breast tissue than they did before hormones, so from a breast cancer risk perspective, they're somewhere between the "male" and "female" statistics.
And they've now got a shorter urethral tract, so from a UTI risk perspective, they're probably way closer to the "female" statistics than the "male" ones.
These aren't hypothetical! Half of them are from my own healthcare experiences.
So no, documenting them as "male" will just cause the EMR to make *different* bad decisions.
This does point out that gender isn't a helpful description in medical contexts outside of psychiatry. Use biological sex instead!! Though obviously other and N/A are always important. What if she was just born without a uterus??
Biological sex doesn't capture it either, such a system would for instance assume a much lower probability of blood clots then is actually the case (since physiology that is attached to hormone therapy matches up with what hormones you currently have, including which ones you're taking, not what chromosomes you have). The core problem is a rigid system that doesn't allow flexibility for the fact that people have different experiences that result in medical differences, and while transgender people are an example of that they are a long way from the only example.
@@bosstowndynamics5488 Yeah, I'm constantly flagged for polycythemia because the medical record only reflects my sex at birth. And flagged for having high testosterone 🤭
If you use just biological sex for trans women, you'll miss things like blood clot and breast cancer risk.
Cis women can also be born without a uterus.
So mark that he’s a guy 🤷🏾♀️
“Trans” women are guys, not women
Or just put down sex as male but transgender. Makes all the problems go away.
This is why being too inclusive is bad.
It doesn't though, because loads of transgender people are on hormone therapy, and many have had surgeries, that mean they aren't the same as their assigned sex at birth might imply (a trans woman on hormone therapy has much of the same physiology as a cis woman).
The real problem here is a software engineer making a rigid system that's not able to account for differences in humans, differences that exist in cisgender and transgender people in many domains.
@@bosstowndynamics5488 - and a further problem is that human differences are vast, and there will almost always be someone who doesn't fit neatly into this box or that box for a questionnaire.
Nah, you need that inclusivity. Between HRT, surgery, and intersex conditions, there are a *lot* of configurations of human bodies besides the common two.
@@juliethecyborg True intersex is very rare. Most cases classified as intersex just involve a micropenis, hypospadias, or a larger than average clit. HRT doesn’t change your insides. Hence why it’s unnecessary to include. Your cancer risks don’t change. Your genetics don’t change.
@@bosstowndynamics5488 A transwoman even after surgery does not have the same physiology as a ciswoman. By claiming to be female, you’re putting yourself at risk of things like prostate cancer because now there’s no screenings available to you.
More like when humanity GOES wrong
Bro shut up cis people have the same problems with the EMR
Transgenderism DOES exist in nature.
There are certain species of fish and frogs that apparently transgender, automatically, naturally without choice.
...but,
It does not occur in humans.
Humans are not fish or frogs.
*intersex people have entered the chat*
You're mistaking sequential hermaphroditism for transgenderism and bigotry for biology.
@@juliethecyborg you can't change sex. Why do you think you can? You're mistaking narcism disguised as political activism for biology, genius.
You would not have these problems if you just wrote male in the form and, for the sake of completeness, added GID to the mental conditions section. Truth is always simpler.
The point is that things aren’t that simple anymore and therefore our computer systems need to be updated accordingly
In addition, simply being transgender is not a mental illness. Gender dysphoria is not the same as simply being transgender. You can look it up in the DSM if you’d like to learn more.
@@Doc_Schmidt That is why I used the old term, Gender Identity Disorder, which does simply describe an individual's belief that his gender is in contrast with his sex. Furthermore, as your skit perfectly demonstrated, for medical records, it makes much more sense to identify people by sex, rather than gender as it is more relevant for treatment and diagnosis.
@@Mishterius Gender Identity Disorder is the old term for what became known as Gender Dysphoria. GID was removed because being transgender is not a mental illness, just like how homosexuality was removed from the diagnosis list prior to that.
The medical record struggles to function for cis people as well, because there are plenty of circumstances where a person who was assigned female at birth could not have periods or even not have a uterus without having had surgery. Additionally, trans women with breasts require mammograms to screen for cancer, which the EMR would probably ALSO struggle with letting you do if you put her in as "male", but it's care she needs.
@@gracklepopp Allow me to address the points you made in order. I do not use the term mental illness as it has strong emotional associations. Instead, I said mental condition, meaning something of clinical significance going on in the mind. You would not deny that a transgender self-identification fits both of these criteria. Due to the prevalence of a wide range of psychological comorbidities, such as depression or suicidal ideation, it is undeniable that such a self-identification has great psychological significance, and therefore removing it from the DSM-5 was an error.
It is true that some women also do not have uteruses, however, in them it is a medical issue, while for people identifying as trans women it is merely the natural state of their anatomy. As to the last point, requiring mammograms is tied to the long-term reception of estrogen shots, not with any inherent property of identifying as transgender. Seeing as some people identifying as trans do not receive estrogen shots, basing screening recommendations on gender identity is logically unsound.
Honestly just put male, and in any other option just add identifies as transgender. Mentally they can be whatever they want but biologically they are male, or female only.
Trans women's breasts and intersex people's existence would like a word with you.
No, that doesn't work. A transgender person may have had surgeries and/or is on hormones. Saying the person is the sex they were assigned at birth misses all that. Trans women are more prone to breast cancer than men, cis or trans, are. And they do have monthly cramps despite never having a uterus. Trans men probably have special problems too, but I haven't had that conversation with a trans man yet, so I don't know what they might be. They need to be marked in medical systems as trans men or trans women and they need questions aimed at their population. You can't wish them away just because you don't like the idea.
@@letshavepie how is that wishing them away? They are still what they where before transition, the surgery and the hormone therapy can be easily added on the surgery section and on the medication section.
That isn't how it works. After about a year on HRT then the medical care you need is much more in line with your transitioned gender, and that is important for the medical record to know so that you can be screening for the right things.
@@gracklepopp i never understood how you guys work at USA. Here we only use male and female, if you are trans we treat you based on you being trans, the hormone therapy should be followed by endocrinology, not by any doctor. Also, those hormones change your body, but it doesnt change the fact that is a male body being modified with drugs. if you want a mammogram you can get it even if you are male.
Simple:
They just need to invent a new form for "women" who are not female.
And for "men" who are.
Even then, it's complicated. Trans people on hrt, trans people not on hrt, and post-op ppl all have different medical needs and testing reference ranges.
Thanks for your "useful" contribution to this conversation.
Well there's no such thing as transgender, so...
*vanishes in a puff of illogic*
I’m confused. There are literally thousands of transgender people.
@@Doc_Schmidt can't wait until people sue physicians for malpractice. Being spineless will have a price.
So as a cs student I think I'll leave an explanation out there for everyone, why we can't have N/A on all forms.
Tldr: It creates too many choices. Just put them down as a man instead of woman.
First of all, database will have to accept blank or N/A as an answer. This breaks multiple constraints on the database, in other words, devs normally have to tell the database this can't be empty, because this answer is needed to decide about something later on. If it's left empty then everything will break.
So they have to rewrite all the rules of the database to allow N/A. But wait that's not all.
The webpages need to change so the form allows N/A as an answer, which is relatively simple thing to do. But depending on how many input fields there are, it will get tedious but doable easily.
Next part, the generation of "if this do that". Like if they had an operation recently then do a post op checkup. I can kind of guess as to how it's working but that entire system will have to be redone, to accept N/A responses. And generate proper questions.
Once that's done. Congratulations! You have successfully made a system that is on the cusp of burning down a hospital. Now that so many open ends are allowed, there are so many states unaccounted for. To go through and test every single thing, to make sure it's working correctly and in the way we want it to, it will take years.
The correct thing to do for the system is you should have entered them as a man. Yes I know that it's not respecting trans people, but people need to understand what they were born with won't go away. That their biological gender is more important to receive proper healthcare.
If anything making a simple button that says the person is trans and just flip the genders internally would allow the system to work properly much better than allowing N/A everywhere. Because that's an indeterministic nightmare hell hole I wish upon no soul to test. What I mean is, you will constantly go, "why wasn't this tested?!" Or "stupid technology!" As I've seen countless times...
Yeah, you can't just "flip the genders internally".
To fix this *right*, you need to understand a patient's anatomy and hormones instead of inferring them.
Between hormones and surgery, your guesses will always be wrong some of the time -- and that's before you realize intersex people exist.
If you're a programmer, please read the classic 2010 blog post "Falsehoods Programmers Believe about Names."
That and this are perfect examples of what happens when you try to make an expert system or even a database without a fundamental understanding of the field.
Seconding@@asongfromunderthefloorboards 's recommendation for that blog post. It is excellent.
Oh, I missed this gem the first time through:
"people need to understand what they're born with won't go away"
Putting trans surgery aside for a moment, I was born with a gallbladder and vitreous humour in both eyes. I now have no gallbladder and vitreous humour in my right but not left eye.
The former is important information during an abdominal ultrasound, and the latter is important information for future cataract risk.
*You* (and the folks who write and configure EMRs) need to understand that what we're born with *can* go away. When that happens, our future medical care needs to account for it.
There is no such thing as "biological gender". You're referring to biological sex. A person's gender is what they say it is.