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Abstract
To alleviate uncertainty in the specialized field of transgender medicine, mental and physical healthcare providers have introduced the rhetoric of evidence-based medicine (EBM) in clinical guidelines to help inform medical decision making. However there are no diagnostic tests to assess the effectiveness of transgender medical interventions and no scientific evidence to support the guidelines. Using in-depth interviews with a purposive sample of 23 healthcare providers, I found that providers invoked two strategies for negotiating the guidelines. Some used the rhetoric of EBM and closely followed clinical guidelines to contain uncertainty. Others flexibly interpreted the guidelines to embrace uncertainty. These findings raise questions about the effectiveness of EBM and guidelines in medical decision making. While trans medicine involves an identity and not a biomedical illness, providers use the same strategies to respond to uncertainty as they may in other medical arenas.
References
|
Abbott, Andrew . 1988. The System of Professions. Chicago: University of Chicago Press. Google Scholar | Crossref | |
|
Atkinson, Paul . 1984. “Training for Certainty.” Social Science & Medicine 19(9):949–56. Google Scholar | Crossref | Medline | ISI | |
|
Bosk, Charles. [1979] 2003. Forgive and Remember: Managing Medical Failure. Chicago: University of Chicago Press. Google Scholar | |
|
Brookes-Howell, Lucy Claires . 2006. “Living without Labels: The Interactional Management of Diagnostic Uncertainty in the Genetic Counseling Clinic.” Social Science & Medicine 63:3080–91. Google Scholar | Crossref | Medline | ISI | |
|
Browner, Carole H., Preloran, H. Mabel. 2010. Neurogenetic Diagnoses: The Power of Hope and the Limits of Today’s Medicine. New York: Routledge. Google Scholar | |
|
Charmaz, Kathy . 2006. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Thousand Oaks, CA: Sage. Google Scholar | |
|
Eli, Coleman, Bockting, Walter, Botzer, Marsha, Cohen-Kettenis, Peggy, DeCuypere, Griet, Feldman, Jamie, Fraser, Lin. 2012. “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, version 7.” International Journal of Transgenderism 13(4):165–232. Google Scholar | |
|
Denzin, Norman K. 2009. “The Elephant in the Living Room: Or Extending the Conversation about the Politics of Evidence.” Qualitative Research 9(2):139–60. Google Scholar | SAGE Journals | ISI | |
|
Espeland, Wendy Nelson, Sauder, Michael. 2007. “Rankings and Reactivity: How Public Measures Recreate Social Worlds.” American Journal of Sociology 113(1):1–40. Google Scholar | Crossref | ISI | |
|
Freidson, Eliot . 1971. The Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Dodd, Mead. Google Scholar | |
|
Gerrity, Martha S., Earp, Jo Anne L., DeVellis, Robert F., Light, Donald W. 1992. “Uncertainty and Professional Work: Perceptions of Physicians in Clinical Practice.” American Journal of Sociology 97:1022–51. Google Scholar | Crossref | ISI | |
|
Hembree, Wylie, Cohen-Kettenis, Peggy, Delemarre-van de Waal, Henriette, Gooren, Louis J., Myer, Walter, Spack, Norman, Tangpricha, Vin, Montori, Victor M. 2009. “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guidelines.” Journal of Clinical Endocrinology and Metabolism 94:3132–54. Google Scholar | Crossref | Medline | ISI | |
|
Henry, Michael S. 2006. “Uncertainty, Responsibility, and the Evolution of the Physician/Patient Relationship.” Journal of Medical Ethics 32(6):321–3. Google Scholar | Crossref | Medline | ISI | |
|
Karkazis, Katrina . 2008. Fixing Sex: Intersex, Medical Authority, and Lived Experience. Durham, NC: Duke University Press. Google Scholar | Crossref | |
|
Lambert, Helen, Gordon, Elisa J., Bogdan-Lovis, Elizabeth A. 2006. “Introduction: Gift Horse or Trojan Horse? Social Science Perspectives on Evidence-based Healthcare.” Social Science & Medicine 62(11):2613–20. Google Scholar | Crossref | Medline | ISI | |
|
Landsman, Gail H. 2006. “What Evidence, Whose Evidence? Physical Therapy in New York State’s Clinical Practice Guideline and in the Lives of Mothers and Disabled Children.” Social Science & Medicine 62:2670–80. Google Scholar | Crossref | Medline | ISI | |
|
Light, Donald W. 1979. “Uncertainty and Control in Professional Training.” Journal of Health and Social Behavior 20(4):310–22. Google Scholar | Crossref | Medline | ISI | |
|
Lofland, John, Snow, David, Anderson, Leon, Lofland, Lyn H. 2006. Analyzing Social Settings: A Guide to Qualitative Observations and Analysis. 4th ed. Belmont, CA: Wadsworth. Google Scholar | |
|
Mayes, Rick, Rafalovich, Adam. 2007. “Suffer the Restless Children: The Evolution of ADHD and Pediatric Stimulant Use, 1900–90.” History of Psychiatry 18(4):435–57. Google Scholar | SAGE Journals | ISI | |
|
Meyerowitz, Joanne . 2002. How Sex Changed: A History of Transexuality. Cambridge, MA: Harvard University Press. Google Scholar | |
|
Money, John, Ehrhardt, Anke E. 1996. Man & Woman, Boy & Girl: Gender Identity from Conception to Maturity. Northvale, NJ: Jason Aronson. Google Scholar | |
|
Mykhalovskiy, Eric, Weir, Lorna. 2004. “The Problem of Evidence-based Medicine: Directions for Social Science.” Social Science & Medicine 59(5):1059–69. Google Scholar | Crossref | Medline | ISI | |
|
Sackett, David L., Rosenberg, William M. C., Gray, J. A., Haynes, Brian R., Richardson, W. Scott. 1996. “Evidence Based Medicine: What It Is and What It Isn’t.” British Medical Journal 312:71–2. Google Scholar | Crossref | Medline | |
|
Sanders, Caroline, Rogers, Anne. 2011. “Bodies in Context: Potential Avenues of Inquiry for the Sociology of Chronic Illness and Disability within a New Policy Era.” Pp. 483–504 in Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century, edited by Pescosolido, B., Martin, J., McLeod, J., Rogers, A. New York: Springer. Google Scholar | Crossref | |
|
Schilt, Kristen . 2010. Just One of the Guys? Transgender Men and the Persistence of Gender Inequality. Chicago: University of Chicago Press. Google Scholar | Crossref | |
|
Timmermans, Stefan, Angell, Alison. 2001. “Evidence-based Medicine, Clinical Uncertainty, and Learning to Doctor.” Journal of Health and Social Behavior 42(4):342–59. Google Scholar | Crossref | Medline | ISI | |
|
Timmermans, Stefan, Berg, Marc. 2003. The Gold Standard: The Challenge of Evidence-based Medicine and Standardization in Healthcare. Philadelphia, PA: Temple University Press. Google Scholar | |
|
Villanueva-Russell, Yvonne . 2005. “Evidence-based Medicine and Its Implications for the Profession of Chiropractic.” Social Science & Medicine 60(3):545–61. Google Scholar | Crossref | Medline | ISI | |
|
Westbrook, Laurel, Schilt, Kristen. 2014. “Doing Gender, Determining Gender: Transgender People, Gender Panics, and the Maintenance of the Sex/Gender/Sexuality System.” Gender & Society 28(1):32–57. Google Scholar | SAGE Journals | ISI | |
|
Winnick, Terri A. 2005. “From Quackery to ‘Complemen-tary’ Medicine: The American Medical Profession Confronts Alternative Therapies.” Social Problems 52(1):38–61. Google Scholar | Crossref | ISI |
