Clinical Innovators: Advocating for Equal Treatment | An Interview with Rebecca Allison, MD

Rebecca Allison, MD, FACC, is a practicing cardiologist at the Heart and Vascular Center of Arizona and an active transgender advocate. She received her medical degree Magna Cum Laude at the University of Mississippi School of Medicine, and residency in medicine at the University of Mississippi Medical Center Jackson, MS. Dr. Allison practiced small-town primary care before completing her cardiology fellowship at The University of Mississippi. She practiced invasive cardiology for 17 years with Cigna Medical Group of Arizona, serving as the Cigna Cardiology Section Head, before joining the Heart and Vascular Center of Arizona, Phoenix, in 2012. After completing gender transition in 1994, Dr. Allison became a prominent activist to address the medical, legal, and spiritual needs of transgender people. She served as President of GLMA: Health Professionals Advancing LGBT Equality, as a Board member of the World Professional Association for Transgender Health, and as chair of the American Medical Association’s Advisory Committee on Gay, Lesbian, Bisexual, and Transgender Issues. Dr. Allison has frequently been named one of the “Top Doctors” in Phoenix and was the recipient of the Human Rights Campaign Individual Equality Award in 2012.

How did you become interested in cardiology?

During my years of Internal Medicine practice, I came to realize that the part of my practice I loved the most was taking care of heart patients. Even back in the 80s it was possible to see their lives improve so much. Then I started to read about Andreas Gruentzig, MD, and the development of coronary angioplasty. I said to myself, “I can do this—and I really want to make it my practice.” I was fortunate enough to be accepted for fellowship at my alma mater. Cardiology has been a perfect fit for me.

What is your practice like at the Heart and Vascular Center?

I love the balance of hospital and office cardiology. After 31 years in the cardiac cath lab, I am beginning to turn to my younger colleagues for the interventional procedures, but still maintain a lighter invasive practice. In the office, I find my practice reminds me of my early career in internal medicine. I can spend time with my patients, many of whom I have treated for decades. It is so rewarding emotionally - for me and, I trust, for them.

What was your experience like transitioning in the early 1990s? How was your decision received by the medical community?

Going back even further, to early childhood, I cannot remember a time when I was not aware of a difference between my body and my mind—my sense of self. It was never a “choice.” Long before I had any understanding of sexuality, I knew I was on the “wrong side of the playground.” But this was the South in the 1950s, and there were absolutely no resources or information. My culture told me that I could be “healed” of whatever-this-was if I prayed sincerely enough. So I tried and I prayed for years and years. I give this background because none of my peers, including my medical colleagues, shared this life experience. While I gradually became aware that the only way to resolve it was through transition, they saw me as making an unfortunate “lifestyle choice.” My practice in Mississippi shrunk as my referral sources turned elsewhere, and I knew I could not survive professionally unless I moved away. I spent some time in Atlanta completing my transition, and after surgery I settled in Phoenix and the practice at Cigna.

How did you become involved in advocacy work for the LGBT community?

I might not have been involved in activism at all, if not for my partner, Margaux Schaffer. Margaux has been advocating for transgender/transsexual rights since the 1980s. Around 1990, she was the first transgender person named to the Atlanta mayor’s LGBT Task Force. Some of her contributions - planning the annual Southern Comfort transgender conference, creating the design for a transgender flag - have been carried forward by others, but the inspiration came from her.

On a local level, I assisted Margaux for many years in producing the annual Arizona Transgender Day of Remembrance. The event, which was held at the Arizona State Capitol, called attention to those transgender persons who were murdered during the past year. It was both a memorial service and a call for equal protection. I also spoke before the Phoenix City Council, supporting the rights of transgender people in public facilities, years before the current “bathroom bill” non-issue spun out of control.

Margaux encouraged me to begin my advocacy efforts with the “drbecky” website, which led to my involvement with the Gay and Lesbian Medical Association, now known as GLMA. In 2004 I was honored with the GLMA Achievement Award and joined the GLMA Board of Directors.

Please tell us about your blog, drbecky.com.

I began the “drbecky” website in 1996 with the assistance of Margaux, who was then an Art Director for an Internet Service Provider. We wanted to create a resource for persons who were beginning transition or contemplating it. At first we developed basic services such as a director of therapists and a state-by-state guide for changing the gender on the birth certificate. Over the following months our site traffic increased as word spread and other sites linked to drbecky. I included a few efforts at personal blogging, and a series of essays on transgender spirituality. The site has been unchanged for a while, as work has taken priority, but we still get a large number of “hits” and email. The responses that mean the most are from persons who say that my writing has inspired them to keep going, to make their lives succeed.

You have been involved in advocacy work within the American Medical Association (AMA) and American Psychiatric Association (APA). Could you tell us about your involvement with these organizations?

In 2005, I was named to the AMA’s Advisory Committee on LGBT Issues. In that role in 2007, I testified before the AMA delegates urging AMA support of insurance coverage for medical and surgical transition expenses. This resolution passed and has been cited numerous times in support of expanded health coverage. In 2009, I was invited to participate in a panel of the APA on the subject “Aligning Bodies with Minds,” advocating medical and surgical treatment as appropriate for gender dysphoria rather than reparative types of therapy. This outcome happened in 2013 with the DSM-5, when the APA removed “gender identity disorder” and replaced it with “gender dysphoria,” which connotes the reaction to external stress which we experience during and after transition. Now it can no longer be said that transgender people have a diagnosis of “mental disorder.”

You have written and spoken about the importance of medical terminology and the language we use as health care professionals when addressing transgender patients. What should clinicians be aware of to ensure that they address their patients respectfully?

Fair treatment begins with the health record. If the patient’s preferred name and gender can be noted, the record will be a source of relief rather than a source of stress and anxiety. All front office staff, medical assistants, technicians and nurses would use the correct name and pronouns. If you aren’t sure which pronoun to use, ask! The patient will be glad to know you care. Treat the transgender patient just as you would treat any other patient. Transgender people aren’t “icky,” and they aren’t contagious. The “first do no harm” compassion that we bring to every patient encounter should be shared with transgender patients.

What goals do you have for the future of your advocacy efforts?

A personal goal for me has been to support LGBT persons who continue in their faith. Many progressive groups, Christian, Jewish, or other, are welcoming to all, and share a message of love rather than rejection. My own denomination, the United Church of Christ, is a welcoming home for those who have been banished by their former churches. Perhaps this is the cause I will continue to support after I slow down in my other efforts.

How have attitudes towards transgender patients evolved over the last 20 years in the medical community? Where do you see things heading in the next decade?

Most health professionals understand that gender dysphoria is a medical condition, and that appropriate medical treatment brings good outcomes. The next step is to learn what “appropriate medical treatment” means. In the next decade, I see transgender health (along with general LGBT health) included in the curricula of all health professional schools and postgraduate training. The path to mainstream inclusion of transgender people and transgender health is not always smooth, as we can see from the backlash evident in some state legislatures. But I believe that within a few years, transgender health will be included in the general curricula of health professional schools, and beginning students will have no memory of a time when it was not so.

Read the full July issue of CardioSource WorldNews at ACC.org/CSWN

Keywords: CardioSource WorldNews, American Medical Association, Human Rights, Transgendered Persons


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