Documentation and Coding For the Protection of Targeted Communities
Dec 19, 2024I want to start by acknowledging the incredible dedication of everyone in this community. We are all navigating the complexities of providing affirming care amidst rising systemic threats, fascist policies, and personal stressors. This work is not easy, but it is essential.
I also want to acknowledge that everything I say here is because I sit at the feet and stand on the shoulders of my trancestors and all the activists who have taught me the importance of anti-racism and bodily autonomy:
“There is no such thing as a single-issue struggle because we do not live single-issue lives.” Audre Lorde
Medical Documentation: We Were Trained by Our Oppressors
We were trained to believe that thorough documentation protects patients and ourselves—reducing fraud risks, avoiding malpractice liability, and aiding patients’ navigation of care systems. But this belief assumes systems rooted in equity and safety—a luxury not afforded to systemically undervalued groups, including transgender and gender diverse (TGD) people.
Today, medical documentation is increasingly weaponized against TGD patients and providers. Texas and Florida have misused medical records to target TGD youth, their families, and clinicians. Over-compliance by providers and institutions has only worsened this harm, surrendering records unnecessarily to law enforcement or state actors. We must confront this reality: our training and instincts cannot be trusted in a system built to oppress.
A Call for Discernment
These attacks demand we rethink everything we document. "Less is more" is now a critical guiding principle. Minimal, thoughtful documentation can obstruct the misuse of records while remaining clinically appropriate.
I urge everyone to engage with resources like Interrupting Criminalization and Beyond Do No Harm to understand how documentation and mandatory reporting are tools to make us agents of the state. The stakes are clear: every detail we chart has the potential to harm, not protect.
Charting Practices: A Call to Action
For years, many of us have used alternative diagnoses instead of gender-related codes. This practice is consistent with national standards of care and does not compromise care quality. While no single action is a perfect shield, this “swiss cheese model” approach adds essential layers of protection. This is medical activism in practice.
Our Ethical Obligation
The AMA Code of Ethics preamble is unambiguous: our ethical duties surpass our legal obligations when they conflict. And they are in conflict now. Trans youth are dying—not just because of hateful legislation, but because of the silence and inaction of providers unwilling to offer medically necessary, life-saving care.
Let’s be clear: there is a right and wrong side to this issue. If we as healthcare providers collectively rose up and said, “I will not participate in these unethical, unscientific, unconstitutional bans,” we could fundamentally shift the narrative. History has shown us the power of unified resistance: Dutch physicians in Nazi-occupied Netherlands refused to comply with directives that contravened their medical ethics, despite the grave personal and professional risks. Resistance is possible, and resistance is necessary. Together, we can expose the disinformation and misinformation poisoning public discourse about gender affirming healthcare.
Join the Fight Together
Community, connection, and joint action are essential to sustaining this work. If you feel alone, please reach out to me—none of us has to do this in isolation- GLMA, PACT, A4TE, Campaign for Southern Equality, and more are connecting us. Together, we are stronger.
If we stand together, we can save lives. We can resist. We must refuse to be complicit in the criminalization of trans lives.
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