Paging Dr. Lysenko

The Pronoun and Gender Police Enter the Telemedicine Space

About the Author: Board-certified in Emergency Medicine. Father. Believer. Concerned about the takeover of rational thought by DEI and it’s associated devilish brethren. Pseudonymous for the present for reasons you may read below.

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We want you to write it down--to camouflage it. Only for the present, of course. Once the thing gets going we shan't have to bother about the great heart of the British public. We'll make the great heart what we want it to be. But in the meantime, it does make a difference how things are put. For instance, if it were even whispered that the N.I.C.E. wanted powers to experiment on criminals, you'd have all the old women of both sexes up in arms and yapping about humanity. Call it re-education of the maladjusted, and you have them all slobbering with delight that the brutal era of retributive punishment has at last come to and end. Odd thing it is--the word 'experiment' is unpopular, but not the word 'experimental.' You mustn't experiment on children; but offer the dear little kiddies free education in an experimental school attached to the N.I.C.E. and it's all correct!

C.S. Lewis, That Hideous Strength (The Space Trilogy, #3)

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My career in medicine is now in its third decade. My training and much of my practice has been in Emergency Medicine though now I am exclusively in injury care. My education and training were strict, unforgiving, and excellent. 

For a decade or more now I have supplemented my income with telemedicine. My initial skepticism about practicing medicine without vital signs and a physical exam proved largely unfounded, but only if one keeps the scope of practice very narrow. 

Telemedicine is very handy for those on vacation who left their blood pressure medicine at home, for the patient with  poison ivy, for advice, and for a few other things. Telemedicine (in various forms) has been around for decades, but is now usually included with most insurance plans for the general public.

Remote medical care, of any sort, relies heavily on exact and specific information about each patient being available to the consulting physician. More and more, this falls to me and my colleagues. 

The folks who sign patients up for our service often miss important information. Medication lists are flawed and inaccurate. Surgical history is usually missing. Often, medical conditions are missing and, worst of all, allergy history is often missing or incorrect. Correcting this lengthens my time per consult and decreases my meager reimbursement. In my ten years working for this company they have had huge success and are now listed on the NASDAQ. Physician reimbursement has never increased.

Consults that I do can last from five to thirty minutes. The longer ones are usually because I have to do the job that my company should do up front. 

With these inherent limitations of telemedicine extant my particular company recently rolled out a Diversity, Equity, and Inclusion (DEI) initiative. Now I am also tasked with making sure the patient has listed their ‘preferred pronouns’ and ‘sex assigned at birth’. Madness. 

When this initiative was announced I emailed the corporate team. I called the initiative ‘trash’ and said it produced ‘garbage data’. I argued that this made a hard job harder, and provided no useful information on the consultant end. Also, it adds a potential source of conflict, quite separate from the medical issue, to the consult.

The response was a glorious example of progressive gobbledegook…  “…we are committed to promoting a diverse and inclusive environment for both our patients and employees. We firmly believe that recognizing and respecting individual differences contributes to a more compassionate and effective healthcare experience.” 

‘We firmly believe…’ the language of the Borg. Do normal adults not ‘recognize and respect individual differences’? That’s medicine 101. Compassion is nice but truth is more important.

Finally followed a veiled threat that if I would not follow policy that I could work elsewhere. Ten years of excellent work and production for this company… ten years… about to end over ‘pronouns’.

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Last week I took a consult on a transgender patient ‘assigned male sex at birth’. He was taking cross-sex hormones. This should, immediately, disqualify him from telemedicine treatment. Cross-sex hormone treatment is neither ‘simple’ nor ‘routine’. It’s the province of a few ‘specialists’ and many grifters. This followed directly on the heels of the company’s new DEI direction. Welcome to American Lysenkoism.

The ‘magical thinking’ of the progressive DEI movement has real and immediate impact. It’s anti-science and anti-reality. Fight it. But as I say this I also find that, in my particular case, ‘fighting it’ may well cause me to lose a job that I have come to rely on. Unfortunately, it has come to this in medicine, and if it has not come yet to you, it will.