Thanks for the comments on the previous post! I’m going to write this one first, and then hopefully a longer, trans-health focused post next.
As I’ve made clear in almost all of my posts, I work in a community clinic. 90% of our patients are covered by Medicaid, Medicare or are uninsured. I’m pretty sure that my transgender patients make up a good chunk of that remaining 10% with private insurance. Ha, kidding–sorta. Most of our privately insured patients are those who live in the area but are lucky enough to have found full-time, gainful employment with one of the few large local employers. A few are my transgender patients who commute in to see me.
Unlike a lot of blogs I’ve read, I don’t mind taking care of Medicaid patients. In fact, I love my patients. Here are some reasons why:
- First and foremost, my patients are survivors. Yes, they may have poor coping skills. Yes, some of them may try to solve their problems with violence. But my patients are scrappy, streetwise and tenacious, and I love that about them. If I had been raised alongside my patients, I have no doubt that I would also have some maladaptive coping skills, but I can only hope that I would have as much sass and will to survive.
- Every so often, I get to see some truly awesome fashion. One of my patients recently came in for an appointment in a tight tank top that read, in huge letters, “ONE CLASSY BITCH.” I was like, yeah, you own it!
- Even if I wanted to, I couldn’t sell out to the pharmaceutical companies. Most of my patients’ plans will only cover generic/older treatments, and I have to go through an enormously burdensome authorization process to get newer/more expensive drugs. When a patient really needs something that’s not covered, it’s a pisser. But 9 times out of 10, we can manage their illness using a cheaper drug. So…in your face, fancy packaging and every-so-slightly different “new” drugs! You get no money out of me.
- Because most of my patients have limited computer access, I very rarely have to deal with someone who comes in with a print-out from Dr Google, asking me for expensive tests to diagnose something that they read about online. The majority of my patients are not entitled in the same way that wealthier patients can be. Yes, my patients demand “a scan” for their tension headaches. Yes, they want “a blood test to make sure that I don’t have cancer.” And occasionally they’ll ask me to “test me for everything, like every possible disease. Like cancer and stuff.” But you know what that means? It’s a chance for me to do a little health education. It’s not an unpleasant exchange where someone questions my competence or demands to see a supervisor. Please note that I’m not saying that all upper class patients are assholes–just that they can be difficult in a whole other way.
- The majority of my patients have behavioral health issues. Mostly this is garden-variety depression and PTSD, but sometimes it is schizophrenia, or bipolar, or some undiagnosed kind of crazy. This can be really challenging to work with, but it’s also pretty rewarding. I like it when I can come up with interventions that are tailored to people’s particular needs. It also means that if I spent half of my visit providing supportive listening, I’m actually doing an important intervention. So many of my patient’s feel unheard and unwanted that my 20 minutes of undivided attention can make a big difference. (documentation tip: “Supportive listening” is what I use in notes instead of saying “Didn’t really do much but listen to the patient talk about their problems for 15 minutes”)