Over and over I have shown my support for the use of the model. But I think we need to have a long hard look at it and what needs to be done to fix many of the problems that are part of it. For those who might be unaware of what the Gate Keeper Model is please take the time and have a read of the WPATH. Now that you have a starting point let’s take the time and have a chat about some of the issues that reside in it.
The gate keeper model provides a level ground to which proper healthcare can be administered. With the use of knowledgeable medical professionals. Who use a set of agreed upon best practices to guide them.
First of the gate keeper model has two huge problems with it. The medical practitioners are the first of these problems. As with any group of highly educated individuals there is a sense of ego that they know more about what a patient does. Or even more than what doctor’s on the cutting edge do just because they have been stuck in a rut. Refusing to even look at the knowledge that is acceptable and date to ask “what if”. Just because it is “Okay” does not mean that it is the best for the patient.
There second of these problems are the gender clinics that provide healthcare. For a good example in Launceston Tasmania Australia there once was a sexual health clinic that was in a easily accessible location. Which provided needed healthcare for not only sexual based issues but also gender based issues. In the last five years this service has been moved to a location that is not easily accessible and has also changed it’s name that does not link with the services provided (clinic 43). Gone is the service of a qualified mental health professional who is knowledgeable and can assist. We also have seen a refusal to look into updated healthcare practices due to the clinic is publically funded and subject to the whims of politics and ego. Transgender patients are left with no other choice but to accept these practices.
There are a host of minor issues of the gate keeper model. The largest of these is the patient themselves. With many expecting miracles to happen from day one. The lack of the patient to educate themselves about the possible results of the transition process. As well as those who might have unrealistic expectations due to media and rare exceptional results which are backed by money that many in the Transgender community do not have nor can acquire. This also can be resolved by proper healthcare given to the Transgender community by medical professionals. I.E. The things my doctor never told me. (I should make a page on that topic.)
We must also look at the availability of proper services are not always available in the state to which one resides requiring out of state travel and expense. This is also in part due to egos of medical boards and refusing to allow such care for patients. Which must be said is not fully a failure of the Gate Keeper Model. But more a part of Politics that are being played at the expense of the patients.
Last we need to look at the final problem with the gate keeper model. That being of keeping the issue of being transgender out of the light of normal healthcare with the use of regular medical practitioners who can build a healthy conversation with their patient about transition. This issue also creates stigmatism that transgender is not normal. Where medical science has proven otherwise.
Far be it from me to point out problems without looking at the benifits of a gate keeper model and how we can improve upon this system.
As I have stated the view of universal accepted guidelines can provide the best health practices. We need to look at how those can be achieved with better results and a reduction in the ego and political based issues. By regular medical practitioners services taking the time and effort to become certified with the model. We begin to remove the issue of transgender from being one of the back waters to the foreground allowing expansion of a better healthcare for all. Which will also increase awareness and understanding as people will see transgender patients in waiting rooms. Allowing the view to be normalized.
Which will reduce the issue of the 42% suicide rate. Simply due to the fact that the issue is no longer one of unconscious shame. Which is part of the problems of back water clinics like the one I mentioned above. I would like to point out that the professionalism of the above clinics staff is not in question but the attitudes of those who provide funding for that clinic are less than professional. The location of this clinic treats its subject material as something that should not be talked about much less used.
With the use of the gate keeper model there is a reduction of the possibility of detransitioning and possible misdiagnosis. Which also assist in protecting the transgender community from false and misleading information about the rare detransition and misdiagnosis. Also allowing for tracking of these cases to see how healthcare that is provided can be improved.
What I’m not saying is that we need to eliminate all gender clinics but refocus the efforts and money spent on them. Many of these clinics offer a level of expertise that a general practitioner cannot. But the use of general practitioners can reduce the patient load on the services given allowing these services to become more efficient in the end.
What needs to take place for this type of improvement must be driven by patients themselves refusing to accept that the use of off the road clinics like the one listed above is the only choice. Encouraging our general practitioners to have at least basic knowledge of transgender issues. In the end we need to approach the change in attitudes towards the Transgender community by allowing it to be view as normal every day events. We also bring to the forefront of conversations with the medical profession. Expanding on improved healthcare for all of the Transgender Community. We also make sure that our doctors are asking “How’s your mental health going these days?” This is a very important step in also reducing the number of suicides as well. We also need to make sure that the mental health services that our general practitioners use are trained in dealing with the mental health of Transgender patients.
I am going to draw a close to this topic as I hope many of us can look at the above subject and start having conversations with our regular doctors and looking at focusing more on using their services. We must look at how we can provide better healthcare and how we can save more lives. Please take good care of yourself and stay safe.