bye
Not sure if this will be viable, but can you get the letters back and try another surgeon? Perhaps one in Thailand?
There are a lot of good reports about them .
I know Dr Meltzer is a stickler for legalities, as are most medics going to be in the US, re the possibilities of loosing licenses due to any form of potential malpractice...
(So if there's any doubt they'll default to a no go)
But maybe Dr Pierre Brassard in Canada might be less stringent on all the RLT rules re time if the letters and recommendations all stack... ?
If not the only other avenue would be to go to Asia Thailand? However I know that all the half-decent surgeons are more or less busy all the time... so getting a slot or cancellations for this year now is not going to be easy....
You'd have to phone direct me thinks to make any headway....
Emails with these chaps/clinics are notoriously slow!
The U.S. docs are sticklers on the 1 year RLE, for most of them it is a requirement for their malpractice insurance, which they already pay at a higher rate than other plastic surgeons. If they don't follow the rules, they lose their insurance coverage, and no more operating for them unless they can find another carrier to cover them. Don't blame the surgeon, blame the system.
I do not see how the Doc can deny you if you had the two letters. The letters should have been the proof that you have been following the WPATH SOC all this time. Who was this Doctor that has denied you surgery? Or for that matter, how were you able to get two letters without being full time for the required year?
Not sure you are going to be able to get the surgery before 2011, it's less than two months away.
Ok, I'm REALLY REEEAAALLLY not the type to nag. But you really should not take any shortcuts. Rushing things, no matter how sure you are, still sounds like a bad idea to me. I just want to make sure you're going to be safe.
As someone who, a very long time ago broke all the rules, and then went one to live happily and succesfully, ::) I wish more physicians, and indeed patients ::) could get it into their skulls that the standard of care are meant to be GUIDELINES not RULES.
In my personal opinion any doctor or insurance company who treats them as if they were rules, to the detriment of a patient's well being should probably be struck off for effective breach of the whole principle of the Hippocratic oath which starts "First do no harm!" Harm can be done by inappropriate inaction just as much as it can by ill advised action.
I am flipping fed up with with this tendency to want to practice defensive "cover your legal arse" medicine and standardise everything and everyone as if we were all machines with standard maintenance schedules. God help us! People who deal with rules rather than living, and therefore variable, patients, have become lawyers not doctors and would therefore seem to me to be entirely unfit to operate on me for any reason!
Simply put I would find a more competent surgeon because by my personal yardstick this one has just proved himself chronically unfit! (and yes I know a lot of you have had good results and rave about him - but I personally simply could not stomach that attitude however clever a cutter he was. Medicine is about more than technical skill, interpersonal skills and the ability to exercise judgment and not lavishly follow rules also play a part, in my opinion.)
Quote from: rejennyrated on November 10, 2010, 09:48:21 AM
As someone who, a very long time ago broke all the rules, and then went one to live happily and succesfully, ::) I wish more physicians, and indeed patients ::) could get it into their skulls that the standard of care are meant to be GUIDELINES not RULES.
In my personal opinion any doctor or insurance company who treats them as if they were rules, to the detriment of a patient's well being should probably be struck off for effective breach of the whole principle of the Hippocratic oath which starts "First do no harm!" Harm can be done by inappropriate inaction just as much as it can by ill advised action.
I am flipping fed up with with this tendency to want to practice defensive "cover your legal arse" medicine and standardise everything and everyone as if we were all machines with standard maintenance schedules. God help us! People who deal with rules rather than living, and therefore variable, patients, have become lawyers not doctors and would therefore seem to me to be entirely unfit to operate on me for any reason!
Simply put I would find a more competent surgeon because by my personal yardstick this one has just proved himself chronically unfit! (and yes I know a lot of you have had good results and rave about him - but I personally simply could not stomach that attitude however clever a cutter he was. Medicine is about more than technical skill, interpersonal skills and the ability to exercise judgment and not lavishly follow rules also play a part, in my opinion.)
While I agree with you, the Docs can't do anything as they need their insurance and if insurance won't let them do surgeries without the SOC being followed, then there is nothing the Doc can do. Though, I think the two letters should suffice as having followed the SOC and the Doc should perform the surgery just fine.
In my opinion, the SOC is like the Law or the Bible, it is open to interpretation. Both of my therapists are doing this to fit my case into the SOC. Once I get my letters, I am off to surgery where I have been informed I will have no problem getting it.
Don't the standards of care say 2 years of RLE before you can get any letters? If the doctors won't give her the surgery because she doesn't even have 1 year of RLE, how does she have the 2 letters?
From the wiki:
QuoteThe intention of requiring RLE is to reduce the incidence of post-operative regret by giving people more time to come to grips with and reflect upon what exactly they are doing and also to ensure that their plan to transition is in fact what they desire.
I agree completely. Don't bypass the SoC.
Quote from: SamanthaFLA on November 10, 2010, 11:02:44 AM
Don't the standards of care say 2 years of RLE before you can get any letters? If the doctors won't give her the surgery because she doesn't even have 1 year of RLE, how does she have the 2 letters?
From the wiki:
I agree completely. Don't bypass the SoC.
They ARE NOT RULES! As I keep saying they are just guidelines, and suitably qualified doctors and therapists are therefore quite within their rights to exercise their professional judgment.
That
isn't bypassing the soc - it is using it in the proper way, as a starting point! (which the doctor then varies and interprets to fit the individual patient!)
This was what my secondary therapist meant when she said that those in the professional community who are up on gender issues are largely more progressive than the transgender community is itself.
cruelladeville : No, dr Brassard is absolutely strict about requirements. He will not operate without the two letters AND 1 year of RLE. It's sad and hard to understand, but that's the way it is.
Sorry to kind of jump in on the subject? But what is RLE short for?
Real life experience a.k.a. full time.
Quote from: justme19 on November 10, 2010, 03:08:10 PM
Sorry to kind of jump in on the subject? But what is RLE short for?
Generally, wearing clothing that the gatekeprs judge to be gender appropriate.
Presumably they have never actually seen a woman wearing jeans and a sweat shirt. Poor dears.
Quote from: katgirl74 on November 10, 2010, 08:43:44 AM
The U.S. docs are sticklers on the 1 year RLE, for most of them it is a requirement for their malpractice insurance, which they already pay at a higher rate than other plastic surgeons. If they don't follow the rules, they lose their insurance coverage, and no more operating for them unless they can find another carrier to cover them. Don't blame the surgeon, blame the system.
As far as I know, this is true for all US surgeons. They may be willing to be flexible but their insurers are not.
The letters I got from the therapists specified when I started RLE (living as a woman 24/7). I had applied for my name change before then but it didn't come through until later, which was also noted in one of the letters. That didn't seem to make any difference. For me, anyway, my choice of clothing wasn't dictated by the therapists. I wore jeans much of the time just as most women around here do. (They're women's jeans, of course, and fit differently, but they are still jeans.) In my very limited experience, it is between you and your therapist(s) when you started RLE.
I think the only thing to do is to find a surgeon who will accept what you have done. And like Samantha, I want to encourage you to do a full year of RLE (no cheating). It is an important learning experience. (Jenny skipped it because she grew up as a girl - that's different.)
- Kate
hi Sada, how do you do? wish you always fine
I know your feeling as well, I think we must be patient. I would like to have vagina as soon as possible either, but if the time hasn't come yet, we must be patient and never give up.
Sometimes patient will give us better result, indeed :D :D :D
It is a big f---ing deal because there are plenty of trans-women out there who decide to try to get their body straight before getting their mind straight. As demonstrated in another thread about some ass who thinks that trans surgeries should be illegal, there are plenty out there that get the surgery and aren't really ready for it. I know you are seriously pissed off, but be damn thankful you can even have your surgery at the age you are. There are plenty of trans women for whom it wasn't even possible until their '60s! You have it much easier my friend, we are all going through the same issues. I understand your anger, I really do. But it's not going to make things any better to piss and moan about it.
You got your chance to exclaim your frustration, take some deep breaths, and start planning for your next action on what you are going to do to get the vagina you've always dreamed of. You will get there.
if you have your letters and you have been attending school as female that counts as RLE. I would send your letters, that state you're are ready for SRS and a letter to the doctor of your choice and go from there. Keep trying.
Keep calm and carry on....
When dealing with Meltzer, we came to blows.... and he rejected me as a patient....saying we were not a good fit....So it looked like I'd thrown good money, flights and months of prep down the drain....
However, after getting the elusive good doctor to actually talk with me.... we managed to move on... and finally get something scheduled...
I think all too many Medics fail to realise that we (gender dysphoric types) are always under a great deal of stress/pressure and tend to come to the table used to eating a barrel full of sh#t.....
We also have to oft self-fund these highly costly procedures, (burning many hours) of blood, sweat and tears along the tricky way......while juggling complex private lives....and trying to hold down relationships and careers....
So Sada, do I think this 'dynamic' is likely to change....nope.....defo not!
Is it best to always smile sweetly and focus on fluffy kittens.... (absolutely).....but keep a secret steely eyed grip on where you wanna go girl...
And I assure you, you'll make it there babe....
Oh.... and I almost forgot to add this...
One moment of patience may ward off great disaster...
One moment of impatience may ruin a whole life.... [Chinese Proverb]
I am going to disagree with my good friend Cruella - but it won't be the first time that we have been of different opinion, and we are friends so we are allowed to differ :laugh:
Personally I think that there are plenty of other good (maybe even better) surgeons out there who will take a more reasonable view of things. It sounds to me like you are up against the sort of rule driven doctor that I had in my first gender shrink. My response was (eventually) to find another doctor, one who could see past the letter of the law and follow the spirit of it.
With all due respect to the Meltzer fans, there are a lot of good SRS surgeons. He simply isn't the only one who can produce a decent result or we would all go to him, and we don't! As part of the deal is having a good doctor patient relationship I think if I were so at sixes and sevens with a man I would not want him operating on me.
I think you should look carefully at other options, however, personally I think going to Thailand may not be the smartest thing to do. There are doctors in the US and indeed the UK who will take in account the time in school and will thus deem you eligible. Dr Nguyen in Oregon was, I gather, trained by Meltzer and is a good surgeon. Dr Harold Reed has some very impressive results on his web-site and is also pretty good value. Mcginn and Bowers need no introduction, and there are others in the Us too, not to mention Thomas and Bellringer in the UK. Before you give up you should look at all of these. I'm sure at least one of them will take you.
Get those letters back - or get some fresh copies from the therapists. Be more careful how you represent the time in school - if you are enroled as a female - then you are full time! Don't tell doctors little picky details they don't need to know which will only cause them trouble.
Finally remember under the SOC it is for the therapist and not the surgeon to determine when you have fulfilled the criteria to be technically eligible for SRS. Sadly that does not mean that a doctor is obliged to accept you after a consultation.
You need to establish the ground rules before you see the next doctor. Send them copies of the letters in advance and get them to confirm IN WRITING that subject to a satisfactory consultation they are happy to accept you for surgery. It sounds to me as if Meltzer was being way way WAY to literal in his interpretation of full time. His loss need not be yours.
I am glad that it has happened for you. And welcome to the class of 2011. ;D
I have no idea who you are but i can't help feeling very happy for you ;D
Great news. :)
So who will be your surgeon now - if I may be so impertinent as to ask? Or has Dr Meltzer relented as Cruella thought that he would?
Perseverance wins through - well done missy....
And good luck with it all when you finally are there on the day, sometime next year!