The stakes are high, and the morale is low. There was a time kids were hospitalized to have their tonsils removed at astonishing rates. A British journalist at the Daily Express in 1927 wrote that tonsillectomies were routinely performed on at least 80,000 schoolchildren annually. In the 1970s, public discourse claimed it was a practice that did not have the child’s best interest at heart. (Dwyer-Hemmings, 2018).
In 2019, a study focused on improvements in care delivery and recommended education for clinicians and patients with actionable goals to optimize the tonsillectomy management of children pre and post-operatively, emphasizing reducing inappropriate or unnecessary operative procedures or variations in care (Mitchell, Archer, Ishman, et al. 2019).
Take the eustachian tube debate among scholars and physicians. Once again, affecting the pediatric population, any child with frequent ear infections who does not respond to traditional treatment might be a candidate for eustachian tube dilation. A child who responds to traditional treatment most likely is not a candidate. Eustachian tube dilation procedure is guaranteed to minimize the risk of hearing loss caused by ear infections (Tisch, Maier, Sudhoff, 2017).
What about cesarean sections? Most commonly performed worldwide, mainly in the United States. Can we say C-sections are classified as major surgery and a risk to the birthing parent and the infant?
A Harvard Chan podcast at the School for Public Health held by two OB gynecologists agree that risks correlate to hospital labor and delivery units’ management. (Shah & Leavitt, 2017).
The trends are not just about tonsillectomy, eustachian tube dilations, or C-section narratives; puberty blockers for prepubescent children allow a child time to decide.
Prepubescent children are not receiving gender-affirming surgeries. Prepubescent children are receiving plastic surgery who present with rare diseases or are born with cleft palates, and congenital anomalies.
Debates about prepubescent blockers will probably continue for decades, turning the discussions into a political platform and a public health concern. In an interview with pediatrician, Dr. Raoul Sanchez, M.D., puberty blockers have been well-studied for years, given that the intersex population consists of individuals who don’t reach puberty until much later. Some present with Androgen Insensitivity, Congenital Adrenal Hyperplasia, and Kleinfelter’s, but not all are the same. Still, unlike the other examples, gender-affirming care does not receive the same consideration.
For the tonsillectomies, Dwyer-Hemming’s arguments point to the shifts concerning social determinants that have lasted over a century and remain in discourse among medical providers. To date, tonsillectomies continue.
Reducing risks for birthers and infants hinges on how hospital labor and delivery units manage care (Shah & Leavitt, 2017).
Despite reported deaths in tonsillectomies and C-sections, the clinics weren’t cut off or shut down. Funds weren’t slashed. Doctors weren’t threatened with felonies, and people weren’t left without any care. There might have been some malpractice suits, but overall, the government did not step in and shut down access to care.
We could improve pediatric medical and mental health practices addressing gender-affirming care by tracking public health trends and studies focusing on three areas; the number of individuals receiving informed consent and counseling unhurriedly and competent medical care compared to those rushed through all three modalities.
A study was done on the reasons why individuals chose to reverse their transition.
Fenway Institute and Massachusetts General Hospital (Harvard Medical School) published one of the first rigorous studies that showed 82.5% of people who reversed their transition did so because of family pressure, lack of affirming environments, sexual assault, and violence. (LGBT Health 2021).
We must be open to all conversations, including detransitioners who detransitioned for various reasons. Not everyone detransitions because of regret. We have a public health crisis identified in the Fenway and Harvard study.
Some who have braved coming forward to talk about having detransitioned did so at a risk only to end up blamed by the trans community, who fear that these stories will end gender-affirming care. The fear is displaced, however. The rise in political sociocultural blind spotting originates from economics, religion, and political interests as opposed to the small percentage of detransitioners who have come forward to report alongside medical providers and parents concerned with a lack of medical and mental health due diligence.
We are responsible for improving the informed consent process as a continuum instead of a rushed one. We also must remember that what makes a pediatrician good at their job is when they take the time to address the child, the parents, and the family in an unrushed fashion. The fashion of medical delivery has turned shabby because it is primarily rushed in a standardized way throughout most clinical settings. The hospital industry, by design, is all about money, time, and reputation. This is a bad combination because when time is money, the usual outcome will affect reputation at the end of the day. Someone will not feel adequately cared for or pleased with their care or how they were treated.
Budget slashes usually come at the cost of training, employing less-skilled individuals, and rushed consent processes and procedures to save time and money at the risk of medical errors.
Addressing social determinants in healthcare that potentially could result in delays in treatment requires changing the dynamics of social, cultural and economic policies at the political level.