Shuster Stef M
Appalachian State University, Boone, NC, USA
J Health Soc Behav. 2016 Sep;57(3):319-32. doi: 10.1177/0022146516660343.
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.
为了缓解跨性别医学专业领域的不确定性，心理和身体保健提供者在临床指南中引入了循证医学（EBM）的理念，以辅助医疗决策。然而，目前尚无诊断测试来评估跨性别医疗干预的有效性，也没有科学证据支持这些指南。通过对23名医疗保健提供者进行有目的抽样的深入访谈，我发现提供者采用了两种应对指南的策略。一些人运用循证医学的理念，严格遵循临床指南以控制不确定性。另一些人则灵活解读指南以接纳不确定性。这些发现引发了关于循证医学和指南在医疗决策中有效性的问题。虽然跨性别医学涉及的是一种身份认同而非生物医学疾病，但提供者在应对不确定性时采用的策略与其他医疗领域可能相同。
