America, party of 2

[Cwoods]

Welp. There will be a new President soon...He has promised to "repeal and replace" Obamacare.

The real question is (as someone who will be out of school and in practice soon) what will happen with our profession? I know with Obamacare, folks were saying NPs will be in high demand. Don't get me wrong, I know NPs will still be in demand, but what do you think it will look like?

[RunNP]

I try to see the other side of an issue and form some type of understanding of another's point of view, but there are just some ideas in this topic that make me sad.

Some areas I do not understand such as gender reassignment and I cannot walk a mile in their shoes or relate to the pain these individuals endure nor do I feel qualified to dismiss their pain as unreasonable. This a gray area where I admit I do not have enough information nor should I expose my ignorance on the topic to belittle others.

The same respect I apply to those who believe in a deity. I do not share their beliefs nor do I every want to dissuade those people from their beliefs, but in the same respect I do not want those beliefs forced on me in the form of laws or missionaries showing up on my door step.

What worries me about the Trump and his followers is that there seems to be a lack of respect for the dignity of others. Our country is the great melting pot and it is the diversity that makes us strong. muslims love their children enjoy their families and worship as they see fit - just like Mexicans, people from India and Americans of color and all deserve to be treated with respect and hopefully a bit of compassion. not as NP but as human beings and the lack of respect and compassion shown is sickening.

[Corey Narry, MSN, RN, NP]

Which by the koran is "striking at the neck."

Beheading.

This is precisely why I have personally decided that religion is poison and that my belief in a supreme being doesn't have to conform to a set of beliefs imposed by others. Wars have been waged in the name of religion for centuries, people have been oppressed in the name of religion throughout history. The pilgrims who came to this country escaped religious persecution and in the end they also became the persecutors of others who came later. Christians are just as responsible for the ills of the world.

[PG2018]

I try to see the other side of an issue and form some type of understanding of another's point of view, but there are just some ideas in this topic that make me sad.

Some areas I do not understand such as gender reassignment and I cannot walk a mile in their shoes or relate to the pain these individuals endure nor do I feel qualified to dismiss their pain as unreasonable. This a gray area where I admit I do not have enough information nor should I expose my ignorance on the topic to belittle others.

The same respect I apply to those who believe in a deity. I do not share their beliefs nor do I every want to dissuade those people from their beliefs, but in the same respect I do not want those beliefs forced on me in the form of laws or missionaries showing up on my door step.

What worries me about the Trump and his followers is that there seems to be a lack of respect for the dignity of others. Our country is the great melting pot and it is the diversity that makes us strong. muslims love their children enjoy their families and worship as they see fit - just like Mexicans, people from India and Americans of color and all deserve to be treated with respect and hopefully a bit of compassion. not as NP but as human beings and the lack of respect and compassion shown is sickening.

It's not about how they worship. Islam, collectively, does not endorse our freedoms and non Muslim beliefs. The entirety of the Middle East and East Asia present too great a number of Muslims such that preventing the unrestricted immigration of Muslims is like failing to quarantine a case of smallpox. Maybe no problem but a problem nonetheless and potentially of pandemic magnitude.

It's not a lack of respect for the dignity of others. It's not an intolerance. It's merely a boundary, and by working in the line of work I do it's glaringly apparent modern society has no ability to set boundaries. Not everyone can have or should have their way. There's nothing wrong with boundaries. We don't have to accept another's lifestyle when it negatively affects us.

Or effects. The correct word has always been my nemesis.

[PG2018]

I don't know man, you're the one working in Psychiatry, don't you guys have to do some kind of assessment that it's not a choice they will regret later? Lol. I don't know the answer to that other than I'm a man perfectly satisfied with being a man, on the other hand, I will never claim to understand what internal struggles these people face day to day. Should we have to shoulder the cost of that surgery? I think the answer lies in whether we accept that this is a disorder that is treatable by the surgery.

But I have to agree that we may have gone too far. Does a person with a burning desire to alter their appearance by seeking plastic surgery have a disorder? maybe, but yet insurance will not cover these types of surgery. In the end, I agree with you that sex reassignment should not be covered. I work at a facility that successfully performs these surgeries. I think we should continue to have these surgeries as an option lest these people go overseas and end up with substandard care.

There's supposed to be an evaluation. I wouldn't provide it because it's too ambiguous of a problem. Fact: Ive seen a patient who started out man, went woman, lost his genitalia, decided he really was a man, and tried to make a go of life until he developed blood clots purportedly blamed on hormone therapy followed by a MI, CVA, and loss of a leg. What the heck transpired in his psychological evaluation?

[Jules A, MSN]

And the degrees are FREE at community colleges, and now that we have a president vested in the economy I am sure they will be even more needed. Hell, i know people banking 100k in those fields.

I actually worked while in school, paid for my CC degree, relatively inexpensive, and with that ADN made over $80,000 a year.

[Jules A, MSN]

I don't know the answer to that other than I'm a man perfectly satisfied with being a man, on the other hand, I will never claim to understand what internal struggles these people face day to day. Should we have to shoulder the cost of that surgery? I think the answer lies in whether we accept that this is a disorder that is treatable by the surgery.

But I have to agree that we may have gone too far. Does a person with a burning desire to alter their appearance by seeking plastic surgery have a disorder? maybe, but yet insurance will not cover these types of surgery. In the end, I agree with you that sex reassignment should not be covered. I work at a facility that successfully performs these surgeries. I think we should continue to have these surgeries as an option lest these people go overseas and end up with substandard care.

So Gents, definitely veering off a bit but curious to know since you aren't in favor of this type of surgery being covered what about other expensive items that are presently covered and yet in some's opinion aren't a necessity such as fertility treatments? or VIAGRA????? Now we're talking, lol. How do we even attempt to sort through these ethical questions as to what is a necessity to someone else?

[Corey Narry, MSN, RN, NP]

So Gents, definitely veering off a bit but curious to know since you aren't in favor of this type of surgery being covered what about other expensive items that are presently covered and yet in some's opinion aren't a necessity such as fertility treatments? or VIAGRA????? Now we're talking, lol. How do we even attempt to sort through these ethical questions as to what is a necessity to someone else?

Actually, male patients complain that phosphodiesterase inhibitors such as Viagra are typically Tier 3 medications that require high co-pay. They are not cheap. We prescribe Revatio (basically sildenafil under a different name) to patients with pulmonary HTN. I know of one female patient with methamphetamine induced pulmonary HTN who never got control of her condition because she sells her sildenafil to make money.

For the record, I'm in favor of the surgery and personally know people that had them. I just agree that insurance shouldn't cover them. Trust me, I am in liberal land and the City and County of San Francisco allows access to these surgeries to the uninsured via Healthy San Francisco - the County's free health insurance program that all city residents pay their taxes to.

My issue is with the same scenario that PsychGuy stated - how do you know this is really going to solve their issues? But there are battles worth fighting somewhere else.

[Corey Narry, MSN, RN, NP]

Not to give Viagra a spotlight but a Urologist I spoke to said to me that we may see sildenafil being sold over the counter soon. There is a push to do that - I don't know from whom, the "male rights" lobby? lol

[Corey Narry, MSN, RN, NP]

We should look at data when approving procedures and treatments for insurance purposes. Are the procedures and treatments successful enough to produce the intended results. I'm not sure about the data for fertility drugs but we know phosphodiesterase inhibitors work when used correctly. Gender reassignment surgery has mixed results with the little data available because they are not widely available and there aren't many surgeons in the US who will do them.

Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

Satisfaction With Male-to-Female Gender Reassignment Surgery

[Jules A, MSN]

juan de la cruz said:

Not to give Viagra a spotlight but a Urologist I spoke to said to me that we may see sildenafil being sold over the counter soon. There is a push to do that - I don't know from whom, the "male rights" lobby? LOL

I'm guessing this isn't too far out. My impression, no data so don't ask, is that when there is a member involved things seem to be approved, developed etc. with more gusto than female things but again just my impression. 🙂

juan de la cruz said:

We should look at data when approving procedures and treatments for insurance purposes. Are the procedures and treatments successful enough to produce the intended results.

I think this is definitely one component but what if someone's opinion is that they don't care if Viagra is successful and produces the intended results they view it as not medically necessary condition/treatment so why is it ever covered by insurance?

I guess my point is so much of this decision is a matter of opinion and yet we all pay for it to a certain extent. Although I actually think all three should be paid out of pocket if I had to pick one I'd rather insurance cover someone having a gender reassignment surgery than fertility treatments or pills.

[traumaRUs, MSN, APRN]

Okay - gonna interject here: There is a political forum on AN. If you wish to cont this POLITICAL discussion, please take it there.

Otherwise, back to the topic at hand. Thanks.

[Salter444]

So Gents, definitely veering off a bit but curious to know since you aren't in favor of this type of surgery being covered what about other expensive items that are presently covered and yet in some's opinion aren't a necessity such as fertility treatments? or VIAGRA????? Now we're talking, lol. How do we even attempt to sort through these ethical questions as to what is a necessity to someone else?

If we start pulling at strings here (LOL) and deciding what we should be paying for and it impacts us. I have to share the cost for people having children and sending those rugrats to school. I do not have kids and never do I want them but still am taxed and assessed for the little snotgobbers. So, those of you who bemoan the transgender folks remember many of the benefits you enjoy are by those who are paying for some of your lifestyle, whether they approve or not. Plus, I thought religion taught is to judge not lest ye be judged.

I use to care for prisoners and I made it a point not to want to know what they were being incarcerated for as I did not want to let that shade of judgement creep into my head. Bottom line it was NOT my place and not my call. So, I made every effort to treat them like actual people. It was not always easy and sometimes I did know their offense and sometimes I did judge, but I fought against it and I am only human and full of faults.