Doctor Power, Chronic Illness & Transsexual Medical Theory

Quite a few people, seishonagon and rm among them, have pointed out interesting things about this letter from a doctor to patients dealing with chronic illnesses.

I wanted to more widely spread an idea which I had talked about earlier in someone else's friends-locked post, because I think it bears thinking about:

A lot of people are angry, and I think rightfully so, about some assumptions made in the letter: namely, the idea that patients with chronic illness may make doctors and the medical system uncomfortable for a number of reasons, but that the patient should try and make the doctor comfortable, even if that process makes the patient uncomfortable, so they can get better treatment.

I think that this idea--so often hidden in discussions of chronic mental or physical illness--comes right out into the open when discussing the Benjamin Standards of Care for transsexual persons seeking gender-confirming surgeries and/or hormone therapy.

I think it's interesting to see that the often-unspoken systematic methods that therapists, doctors and hospital systems may use to deal with persons with chronic illness dovetail so neatly, and so nearly, with the explicitly written-out standards and systematic methods that therapists, doctors, and hospital systems may, and in fact must often, use to deal with transsexual people.

I'm not trying to conflate transsexuality with sufferers of chronic illnesses, or vice versa. But I do think that:
a.) persons with chronic illness may find discussions of how transsexual people have navigated an explicit doctor/patient power imbalance (one where the patient is the one expected to make the doctor comfortable, often at expense of patient comfort, in order to receive proper treatment) instructive and/or useful in
navigating a much less explicit or articulated, yet similar, doctor/patient power imbalance paradigm.

b.) Transsexual people may find discussions of how those with chronic illnesses deal with the un-codifed nature of the doctor/patient power imbalance interesting and useful: I know there are a lot of dicussions on whether the Standards of Care are necessary or useful, or harmful; there is a lot of anger and constant calls for repeal and revision. I have found that those discussions tend to center around a few things: how much explicitly codified standards help and/or harm those seeking GTS, how much explicitly codified standards help and/or harm those in the medical professions, how much those explicitly codified standards ultimately rest on personal judgement calls made by medical professionals, and how those medical professionals act as gateways to treatment or bars from treatment, depending on how comfortable the transsexual person in question makes them.

c.) Those persons who are both transsexual and have chronic illnesses would, I hope, also find said discussions useful.

d.) Allies of transsexual people and of those with chronic illness should not use one as a metaphor for the other--doing that is both inaccurate and inconsiderate. But thinking about the different ways in which the medical establishment hides its uncomfortability with difference by telling the patient that it is their job to make the doctor more comfortable in order to get better care hopefully will help allies be better and more understanding allies, especially when/if interacting with medical professionals at a friend's request or on their behalf.

e.) All morning I have been thinking, "especially when it comes to the medical profession and the medical system, it looks like a lot of people treat transsexual identity explicitly like an illness; it also looks like those with chronic illness have doctor/patient power dynamics/expectations of the idea that the patient should make the doctor comfortable in order to get treatment placed upon them in some of the same ways that transsexual people do, without the benefit/drawback of those power dynamics being explicitly written and encoded. I don't see other people writing about this, so I bet I should."