The New Yorker Documentary
For a long time, U.S. healthcare was guided by the attitude of “doctor knows best”. Finally, in the nineteen-sixties, that plan began to decline, as the concept of individual-centered attention, which sought to stage power differences between patients and doctors, emerged. Within individual-centered treatment, doctors prioritize informed acceptance, offer known risks and benefits, and motivate the people they’re treating to make decisions about their well-being.
That sounds easy, but barriers to this type of treatment persist—in situations when a doctor experiences uncertainty about how to identify a patient, has limited training, or lacks clarity in what indicators to use to determine a patient’s decision-making ability. Transgender treatments, a field that also started to emerge in the 1950s, has these characteristics of skilled haziness as marks. Most doctors at the time believed that trans people were delusional when seeking health care, so they had the sole discretion to decide whether or not a trans person may receive care.
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The variables that were used to prevent transgender people from getting hormones were social factors like the potential risks to one’s physical well-being as opposed to medical ones, such as the ability to adhere to gender norms. White, mid-course, employed female trans women and muscular trans men had an easier time obtaining hormones. Additionally, when selecting “ideal” patients, doctors looked for a certain type of story and presentation and identified with the “opposite” gender from a young age and identified with the “opposite” gender. These patients expressed a persistent discomfort with one’s body and genitals. The transnormative narrative is now known as it. Patients who failed to uphold these expectations were frequently denied care.
Many of the explicit restrictions that trans people face today have fallen out of favor. However, the transnormative narrative persists, as does ambiguity regarding when a doctor can refuse care and what a “good” medical encounter might look like between doctors who still have a lot of power and trans people who have historically been marginalized within medicine.
How doctors and patients navigate this troubled relationship is rarely covered in trans-media and rarely covered in academic circles. The Script, a new short film from Noah Schamus and Brit Fryer, introduces viewers to the intimate setting of a doctor and a transgender person seeking gender-affirming care. By utilizing re-creations, this hybrid film removes the veil from such encounters by displaying representations of how doctors might get things wrong and what getting it right might look like. Inventive and playful, serious and heartbreaking, “The Script” offers viewers a nuanced depiction of trans care.
Doctors have gotten more comfortable providing hormone access for trans women and trans men over time. However, for nonbinary people, medical paternalism may still be a problem because the standard of care used in trans medicine since the 1950s implicitly assumes that being trans means converting from one binary gender to the other. According to Schamus, “we want people to feel like they don’t need to be as immediately legible in these regimented ways that have been established through our understanding of binary gender.” It’s a transformative concept in medicine for doctors to have a more inclusive perspective on who can legitimately access gender-affirming medicine and for authority to rest with the patient.
The Script offers an alternative perspective on how medical interactions might feel and look for both doctors and patients, which is what makes it stand out from the competition. Trans and nonbinary people are the main subjects of the movie, but the documentary also serves as a reminder that the wider tensions in medicine exist between trans people and their doctors. As Fryer shared, “We think of the film as an invitation to trans folks, but it’s also an invitation to everyone, to think about the dynamic that we want between provider and patient. What do we really want that to look like, exactly?
“The Script” is an invitation for more complexity in conversations about gender. Additionally, it is a plea for doctors to do better for all of their patients by putting aside rigid criteria for categorizing patients and paying more attention to their own listening.
