i've talked about hidden gems on steam before, and i've talked about hidden rocks. i'm struggling to come up with a name for the third category. perhaps hidden horses - things that are neither good nor bad, i'm just baffled as to how and why they ended up in this mineshaft. there isn't a lot of trans rep in gaming, obviously, so i'm sure you can understand that it didn't take a tonne of searching for me to stumble upon Teaching Gender Affirming Care. still, the question remains: why the fuck is an educational resource for doctors free on steam and made with ren'py?
Teaching Gender Affirming Care is a visual novel in which you play as a doctor at a queer-inclusive health clinic, navigating situations with various transgender patients and trying to help them as best you can. the target audience is very explicitly doctors as per the advertising, and it is specifically designed to teach real-world doctors how to handle real-world patients, to the point of having "learning goals" before each session. i do understand the benefits of learning via gaming, but i also can't help but imagine some poor 60-year-old doctor out there is saying "I want all my patients to feel welcome, but I just don't understand this transgender thing!" and then suddenly finding himself being instructed on how to make a Steam account.
i'm not a doctor, obviously. i'm a game reviewer and a trans person and i'm not particularly good at either of those. while i will allow myself to freely speculate on how this approach may or may not facilitate medical providers to learn real-world skills, the fact is that i really don't know what's best for doctors or how they learn. this game may be advertised and designed as an education tool but once you put something on the steam store, you inevitably open yourself up to people treating it like a game - there's some obvious value in this game for the patients just as much as the doctors, it doesn't exactly seem like most of the game's 17 official reviews are from medical professionals. i will be primarily reviewing TGAC as a game.
and as a game, it's... fine. it's not Deck Verified, but it works just okay on the deck. it had some lag, more lag than i ever really see in a visual novel, which seemed to get progressively worse throughout my playthrough as more data piled up. half of the steam achievements are broken. there's no feature to skip dialogue you've already seen, which is particularly frustrating because (1) that's a built-in ren'py feature that someone must have chosen to remove and (2) you're explicitly encouraged to replay sessions until you answer every question correctly.
there are a lot of quiz/question sections in this game, and while some are just about the most compassionate or helpful course of action and relies on emotional intelligence over medical knowledge, some are just straight-up medical questions about the effects of medication - which makes sense for the target audience but feels unfair for those of us that never went to med school. normally in this situation i would just google the answers, but online information about trans medicine is so unreliable and so full of contradicting claims that i don't really expect to find anything. in fact, i don't even really expect the devs of this game or the doctors treating the patients to know any of these answers for certain - this shit is underresearched as fuck, different doctors say different things without much of a clear consensus, and of course, absolutely everyone is pushing some kind of an agenda.
since this is more of a visual novel than a game, i'm primarily judging it for the story. which is ... again, just fine. you follow a couple of trans patients as they work through their issues and get the care they need. they become more confident as they have a doctor they can trust and then they find a therapist that works for them and a loving partner and achieve all their goals outside of transition (even the really lofty goals like becoming a famous movie director and actor) and they all live happily ever after. it's... sickly-sweet.
the tone of this game is the thing that stuck out to me the most while playing. it's so positive that i can't ignore it. every line of dialogue is written with an insane degree of self-awareness and honesty about both physical and mental health problems - everyone talks like they've been to 500 seminars about communication. the doctors are kind and nurturing and explain everything perfectly. the questions are phrased like "is it okay if i ask you about these symptoms?" and the patient responds with affirmative consent for the question before they describe their symptoms. they know exactly what is medically relevant and they hesitate with none of it, they gush constantly about how the clinic is so good for them and they're so grateful, and even when the game specifically has to guide you on how to handle a situation where another doctor misgenders or mistreats a patient they are always simply uninformed rather than actively transphobic.
it's downright jarring when you factor in the obvious reason why this game was made, which is acknowledged by characters in the game: healthcare for trans people fucking sucks. it's an uphill battle to find someone who's even willing to do the most performative respect of names and pronouns, let alone someone who knows enough Trans 101 to actually provide you healthcare on anything relevant to your gender. the game tries to acknowledge this - characters talk about their own previous offscreen bad experiences, about offscreen characters not having good experiences, about the statistical fact that the vast majority of trans people are not having this perfect wholesome doctor experience - but it comes across as a massive violation of "show don't tell".
even when the game tries to show this in practice, it fails. the in-game meter of how well you're doing in each session is labeled as a measure of how much the patient trusts you and how stressed they are. saying things that are insensitive or factually incorrect will decrease the patient's trust score... because, of course, the patient knows more than you and is able to immediately flag it as incorrect. there's no risk of realistic consequences from being given wrong information by an expert who you trust - the patients don't follow your bad advice and end up in a bad situation, they just reveal that they knew the answer to the question they asked all along, and you calmly apologise and re-check your information and correct yourself.
the most jarring part to me, i think, is that the patients don't really respond to a decreased trust in you. if you make them uncomfortable or give them wrong information, they don't, like... stop expecting you to give correct information, stop self-advocating because it seems pointless, stop asking questions, try to end the session as quickly as possible, stop coming back. they just argue with you, briefly and gently, and then forgive you. providing healthcare to vulnerable traumatised individuals really is as simple as not fucking up every single fact you try to state.
the obvious defense for this is that the game isn't supposed to be realistic, it's supposed to train doctors, but, well, i can't help but wonder. wouldn't it be better if the doctors were trained for real patients? not for a hypothetical extremely-self-aware trans person who describes all of their problems perfectly and with no hesitation, but for real messy people with real messy problems who don't know exactly what to say for the doctor to understand them? do doctors not need training on helping patients who, instead of describing physical pain/discomfort in the exact way the textbook does, say "idk it feels weird" 5 times and struggle to give more information? on helping patients who don't see the point in talking about issues that they don't expect to successfully get help with, and need prompting or support to talk about stigmatised health issues?
i don't actually... like to get into my Dark Backstory on the game review blog. but in this case it does genuinely feel relevant to say exactly when the game found me, so here's the cliffnotes version: i gave up on the idea of medical transition a few years ago, when it seemed like the risks and the hardships outweighed the benefits. then things happened to make me question if that was a rational decision, and i had to start grappling with a thousand variations on the impossible question of "do i actually not want this, or do i just feel like pretending i don't want it is less painful than admitting i can't have it?". someone in the steam reviews said "This game is especially good If you want to know what to expect from a doctor visit discussing gender affirming care or are curious about hormone therapy". it seemed like the right time.
it... would have been really cool if i could say something in this review like "the game lags like hell and the dialogue is insufferable, but it caused me to get lifesaving medical care so i have to give it 5 stars". unfortunately i suspect that's an unrealistic expectation to place on a video game, and i really don't feel any less uncertain about medical transition than i did before playing. i definitely don't feel like it's helped me "know what to expect" from a doctor's appointment, because everything about the doctors depicted in this game is so far removed from my lived experience that it reads as blatantly unrealistic.
my best friend, more optimistic than i, has made a valiant attempt at telling me that it's not unrealistic, just... uncommon or something? i'm pretty sure the gist of what they said was "some doctors genuinely are like this, you just haven't met them". i guess i get the idea.
realistic or not, i do see the appeal of games like this, where all the evils of the world happen offscreen and all the important characters seem to live in a trans healthcare utopia. i don't usually like anything in the "wish fulfilment" genre and i sometimes try to get on a high horse about "um actually if this story isnt realistic about Trans Experiences then i can call it transphobic for that" but this game ended up being an exception for me in a weird way. even as i told myself that it was a stupid game/education concept that wouldn't help anyone, and the writing was bad and the whole thing was unrealistic... i couldn't stop playing.
sometimes playing this game, imagining a world where everyone is perfect and accepting and safe and it's just okay to be trans in a doctor's waiting room, feels like healing. other times it kind of feels like it's making fun of me. the constant therapyspeak just takes it over the edge from "hopeful goal to work toward in real life" to "unrealistic utopia with no relation to real life" for me, and i hate that something that could have been so hopeful and healing is so full of jarring reminders of "by the way, none of this is real!". the perfect doctors from this game might really exist in some lucky queer-focused clinic, but i really think the perfect patients probably don't, and if they do then i'm not one of them.
i... don't know, man. i understand why the trans community needs stories like this - we need to be able to see examples of people like us succeeding and finding joy. i just feel like the tone of this one is so obnoxiously, jarringly wholesome that i can't see any of myself in it. i mean i thought the One Night, Hot Springs game series was a bit Fluffy and Wholesome for my taste and that had way more realistic tackling of Trans Issues compared to this.
ultimately: do i think this game achieves its intended purpose as a training tool for medical professionals? well, probably - there's a lot of things that i would have designed differently if i was the one calling the shots on what doctors need to learn, but that's probably why i'm not writing med school curriculums. do i think this game has unintentional value for trans gamers? sure, in the way a lot of lighthearted wish-fulfilment-esque trans stories are. if you find it healing or comforting to see stories like this, absolutely check this one out. i just have a hard time swallowing it.
there's something oddly healing about a lot of the wholesome casual trans-friendly dialogue, but the most meaningful part of the whole story for me was an offscreen character, River, who is one of the patient's friends. in one of the obligatory "this clinic is so meaningful and helpful to me" scenes, which is supposed to educate medical professionals about the positive impacts of trans-friendly healthcare but in a video game context just comes across as player shilling, Liv mentions wanting to recommend the clinic to others because of a friend who had a bad experience with doctors. in the next appointment with liv, during the mental health screening, they mention that their friend committed suicide recently. a damn heavy-handed and oversimplified way to get across the concept of "bad healthcare experiences affect patient mental health", sure, but it was the only point in the game where i really felt like my character was doing meaningful work and like giving the best care i could was important.
but, of course, we never get to meet River, and we certainly never get the chance to accidentally drive a character to suicide. that would be beyond inappropriate for a training exercise - a lot of my criticisms, i'm aware, can easily be parried with a simple "it's meant as an education tool for doctors, you can't expect it to tackle everything". i can stand here and argue till the cows freeze over about why i think maybe doctors should be educated less optimistically about what their trans patients go throug. but really, i think it's only natural that as a trans person i'll look at a resource like this that necessarily cuts so much of what could be meaningful to me in order to be school-appropriate, and think, why can't we ever be the target audience instead of the subject?
spicy 3 stars. should i just play celeste? i feel like now that i'm doing this whole "try to heal my internalised tranpshobia with my steam deck" thing i might just benefit more from playing celeste. i mean that one's actually deck verified and everything