For the medical community treating or considering treating transgender patients
Evaluations (Grades and Comments):
→ Dr. Sherman Leis: (A) – An excellent surgeon who stays current and cares about the transgender community. In general, he’s a caring individual with a very good bedside manner. He trains other surgeons. On a couple of occasions, I didn’t grasp what he was telling me on the first go round, but I have had this problem with others in the medical profession as well. Part of it may be due to the fact that I have had little interaction with the medical profession until I started to transition, so I don’t always know what to ask. Part of the problem (which I also have to be aware of when I provide tax preparation services) is that there can be a disconnect between professional lingo and everyday speech.
→ Pain Level: (A+) – Dr. Leis states that he doesn’t believe in patients having pain. Most of the time in recovery, my pain level was between 0 and 1 (with 10 being the worst) and it never got above a 2. My biggest problems in the hospital were a cramp in my lower back and some discomfort from the IV lines. Dr. Leis told me that I have an excellent profile as far as not having a lot of pain (don’t drink alcohol, don’t smoke, not diabetic, no hypertension, good BMI). And people tell me I must have a high pain threshold. Maybe so, but believe me I felt a lot of pain after my oral surgery. I believe a lot of credit needs to be given to Dr. Leis for his technique and post-operative protocols. For one thing, the patient resumes walking more gradually than I have heard for most GRS surgeons, and walking immediately after surgery seems to be a very painful activity for most GRS patients. (The only downside is that I have heard that the walking provided an opportunity to meet other transgender patients. I didn’t get that opportunity. But I’ll sacrifice that to have less pain.)
→ In General: (A-) – Top notch, discreet office staff; nicely appointed, secluded offices in a safe neighborhood with a range of services nearby. Traffic can be difficult at times and public transportation is a bit lacking. The walk up to the top floor can be inconvenient and was a challenge (and can be very difficult for some patients) three days after GRS and with a Foley catheter still inserted.
→ Communications: (B-) – The staff is very efficient in sending out necessary e-mails and making phone calls to patients, other physicians and insurance companies. There was some information lacking and a slip up or two in terms of handouts to the patient. Some information communicated verbally was missing on handouts. A handout on what is available in the kitchens would have been helpful. The notice to not put things on the floor was on a counter where I didn’t (and wasn’t likely to) see it when I came in the day before surgery.
→ Amenities: (C-) – The recovery rooms for the patients and caregivers were comfortable, spacious, and attractive. The cable TV with a plethora of channels was a plus and the shared kitchen was very good. The other recovery room with which I shared the kitchen and bathroom was empty for most of my time there, but a shared bathroom when one is recovering from surgery with four other people present (my caregiver, another patient and their two caregivers) potentially could pose a problem. (I came close one time.) The person who was supposed to provide me with a relaxing experience was a big negative for me, but I didn’t mark down as much as I might have because I understand that other patients are happy with the experience. All I can say is that with all the people I dealt with, whether in Dr. Leis’s office, the hospital or at my primary care physician’s office, this person was the only one who I felt didn’t treat me with respect.
→ Follow up Care: (A) – Thorough and accommodating. Dr. Leis and the staff were readily available by e-mail, phone and in person during appointments. This is very important. Not only should your surgeon recommend follow up visits, you are likely to have questions along the way and problems of various orders of magnitude are likely to develop, especially in the first few months after GRS.
→ Websites: (A) – Informative and excellent at communicating the type of work that the center provides without hyperbole. My caregivers who looked at Dr. Leis’s website were as impressed as I was. It is an accurate reflection on the nature of the practice and the type of work done there.
Lower Bucks Hospital (www.lowerbuckshosp.com): (A-) – The nurses and certified nursing assistants (CNA’s) were excellent. They were professional, caring, knowledgeable, pleasant and patient. I could not have been in better hands during my three days there. The television by the bed instead of on the opposite wall is a very good idea. Since I was not mobile during my stay, I didn’t get much use of my room, but it was spacious. The windows were large. The décor was typical hospital, as was the food (including the three daily meals jammed together between 8 AM and 5 PM). The intake and release procedures were efficient and the registration staff did a good job. The only significant negatives were that my personal belongings never made it to my room until a few minutes before my release and that the IV monitors were prone to beeping for no apparent reason.
Joy Vanderberg (www.derma-lase.com): (A) – I could not have found a more caring and cooperative person to do my genital hair removal. She had done my facial hair removal as well with laser. She was cooperative and more than respectful: she was a cheerleader in my process. And I would find it hard to believe that there is anyone more knowledgeable about hair and hair removal (especially lasers and the pros and cons about lasers versus electrolysis). I have recommended two other transgender patients to her and they are very happy with her as well. I hope she will advertise her services more to transgender clients. And I wish it wasn’t such an ordeal for her to deal with the insurance company for reimbursement. I helped her as much as I could.
Dr. Carolyn Wolf-Gould (https://physicians.bassett.org/details/568/carolyn-wolf-gould-family_medicine-oneonta): (A) – While not officially part of my surgical process, I could not have successfully made it through GRS without her. She was the doctor that I was so fortunate to find when Obamacare became law and I had to find a doctor knowledgeable in transgender medical care who is in New York State. She was the doctor who brought my hormone protocol into the 21st century, taking me off of Premarin and sticking with me as we tried different estrogen delivery methods. She was the one who told me that Governor Cuomo’s executive order for GRS coverage included Medicaid. She was the one who eventually found Dr. Leis and recommended him to be my surgeon. She used her connections in the industry so I wouldn’t need to start over with another surgeon and further delay surgery when a surgeon who performed GRS in NYC began accepting Medicaid. She was there to help me when my EKG came back with some irregularities and I needed to get a sonogram and stress test a few days before surgery. And she was there just a few days ago when I was feeling overwhelmed by blood clot issues, dilation issues and mouth issues. She is a knowledgeable doctor and a caring individual in the unlikely location of a small upstate NY college town. She listens, she is proactive, and she is there when I need a hug, a pat on the back or a little shove in the right direction. A practice that features transgender medicine is being set up in my county and maybe when they get some experience under their belt, I will switch to a local doctor. But for now, as long as I can manage the long, pleasant drives into an area similar to where I went to college at Cornell (and much of the drive covers the same route), it is worth it to me to take those 2½-3 hour drives each way to see Dr. Carolyn and some of her other staff members who I have come to know over the years, as well as some new ones I have just met.
Insurance [Fidelis Managed Medicaid] (www.fideliscare.org): (B) – When I had to choose a Medicaid provider at the New York State Marketplace website, I asked Dr. Carolyn and her staff for a recommendation as to who they worked with best. Their first choice did not cover my county. Fidelis was their second choice. They felt that their first choice did better with medication requests, but that Fidelis did better with the surgery procedure. One of the best things about Fidelis is that they provide each patient with an actual caseworker who is also an RN. Susan Wolfe did a good job and is a caring individual. The drawbacks with Fidelis was that I sensed that Ms. Wolfe had a much too big caseload, there were restrictions put on her access to information about my case that somehow customer service reps could access, and that there was some negativity towards transgender patients creeping into other departments at Fidelis as well as some overly complicated bureaucratic procedures for some steps. In three different instances, I ran into problems. Ms. Wolfe went to bat for me each time (and was understanding and tolerant of my impatience) and each one was eventually resolved favorably. With her help, my persistence and some outside help from Dr. Carolyn in one case and a NY State Senator’s office in another, difficult employees became ex-employees for whatever reason and troublesome policies were changed for the better.
Recommendations to Medical Personnel and Organizations providing GRS services:
These recommendations, in conjunction with the evaluations I gave earlier in this post, can be used by those who provided me with services and any others who are either currently providing similar services or are looking to do so.
To Dr. Leis in particular: you have trained other surgeons who have gone on to start their own practices. That is commendable as you recognize that there is plenty of demand for transgender related surgeries. My hope is that for patients who will come in the future is that you will train a surgeon to join you in your practice who has the potential to become as skilled as you, the ethics and curiosity to stay current with technique, and the heart to treat patients with the same level of care and concern as you do. It would be a shame if the practice you have built so well does not remain and continue in the same vein after you are no longer able to perform surgery.
To surgeons in general: there is a template contained in my evaluations and recommendations on what it would take to be a top surgeon in general and a surgeon for a transgender practice in particular. Every patient receiving any kind of medical service deserves the utmost in respect, and that includes the ability to deal tactfully at times when misunderstandings arise with patients. But the need for respect is especially true for transgender patients. As a group, we have been denigrated by sizable segments of our society and even been mistreated by an unconscionable segment of the medical community. Many transgender patients report having been refused routine medical care and there are so many physicians who are prone to blame every malady we experience on the fact that we are transgender a sarcastic name was coined for it: “trans broken arm syndrome.” http://www.pinknews.co.uk/2015/07/09/feature-the-dangers-of-trans-broken-arm-syndrome/
To the next generation of surgeons: I make a shocking recommendation. Put yourselves out of a job! Or rather, follow the progress of the use of adult stem cells and research in these areas and adapt your practice as bioengineered stem cells taken from the bodies of your patients can be used in many ways as a less invasive alternative to surgery. Currently MTF bottom surgery has limitations and FTM bottom surgery is even less adequate. Uterine transplants have a high risk of rejection (the same thing that probably killed Lili Elbe). But we are also seeing bioengineered adult stem cells grow new knee cartilage instead of a knee replacement operation and they are also being used to grow new ears. In time, maybe 25-50 years, it is conceivable that similar use of stem cells will be able to transform endocrine systems and genitalia for transgender and intersex patients.
Gender related surgical and medical offices: As the doctors lead, so the office staff should be expected to follow. It made a world of difference that Dr. Leis has hired efficient, effective and caring office personnel. Carole and Jenna deal with needy (and sometimes verbose!) patients, insurance bureaucracies, and schedules that occasionally get blown apart by weather or people running late (whether the doctor or the patients). And they get the job done. The one thing I can’t stress the importance of enough is clear communications, especially when it comes to procedures: whether it is the patient’s schedule from arrival to hospitalization to recovery to release, or what is available and permissible in the recovery rooms including kitchen and bathroom, or post-surgical schedules, techniques and procedures. Avoid only conveying some of the important information orally when related information has been conveyed in writing. There is a danger in overwhelming a patient with too much information. Therefore it needs to be in a format that is easily digested. Even those of us from my generation have become used to the sound bite culture. I have changed my blog posts and my communications with my clients to make them easier to read as much as possible.
Amenities: I would have preferred a professional “Mom” than the person who was provided for my benefit in the middle of my recovery. Why a Mom? A Mom is someone who is there when you arrive and is glad to see you. She is there to make sure you are comfortable and that everything goes well while you are visiting. In particular, she would tell you all about the TV remote and cable stations, the beds, the closets and dressers, what’s in the bathroom and in the kitchen and that some of the food left by other patients has been there a while. She’ll let you know about the nearest grocery stores and pharmacies and other things that you and your caregivers might need to know. She’ll also be there as you prepare to leave to make sure you get off on your journey well. Like a Mom making sure a child in winter has their mittens and warm clothing, she’ll make sure you have all the things you are supposed to leave with (paperwork and supplies) and when the surgeon is coming to give you your final checkup before being released. She’s not a caregiver. She gives the caregivers the information they need to take better care of the patient. And she would take a lot of the burden off the office staff.
Seest thou a man diligent in his business? he shall stand before kings; he shall not stand before mean men. – Proverbs 22:29