Bioethics Discussion Blog

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Saturday, July 13, 2019

Patient Dignity (Formerly:Patient Modesty):Volume 102

The last Volume of this thread stressed the patient carries with him or her the ethical power of autonomy, self -final decision-making. And I have a concern that a number of patients don't display that power in decision-making because they are not familiar with issues related to their suspected condition or disease in terms of medical principles, diagnosis or treatment and often the healthcare provider may make assumptions overestimating their patient's medical knowledge or just be too busy to teach. Yet without that knowledge, the power of autonomy cannot be fully expressed in the best interest of the holder of that power.  The solution may be self-education in medical matters before the need to express the patient's ethical power.

 We call for patients to feel free to "speak up" to their attending medical professionals regarding matters that concern them. But understanding general medical principles beforehand which may apply to the patient's symptoms or diagnosis or treatment is worthy and may be obtained from books and now the more easily obtainable  reliable medical internet resources.  Sometimes even talking over the fence with a next door neighbor might be of help in the patient's education but be cautious since their experiences and views and philosophy  may be different from what you need for your own decisions.

In conclusion, pre-educate yourself  in general medical principles for the time you wield the power to express to your healthcare providers your power of autonomy. ..Maurice.

Graphic: From Google Images

Sunday, June 23, 2019

Patient Dignity (Formerly:Patient Modesty):Volume 101






Is the image above, the way patients, especially male patients, as extensively discussed here, are expected to look at and accept nurses and their behavior? Or should we disregard the published
exceptions and  look at a nurse this way:




It is the nurse who manages the day to day and hour to hour care of patients after being diagnosed and treated by physicians.  The discussions concluding Volume 100 of this thread specifically deal with nursing behavior which enter into the sexual misbehavior or worse realm.  Should this smear on the nursing profession be considered as characteristic of the profession, perhaps more apparent in our current era  and more active means be carried out to rid the profession of those who continue "sexual misbehavior or worse"?  ..Maurice.

Graphic: From Google Images.


NOTICE: NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME.
FURTHER COMMENTS CAN BE WRITTEN TO VOLUME 102.

Friday, May 31, 2019

Patient Dignity (Formerly:Patient Modesty):Volume 100








Should we all look at this blog thread as an elevator where a small group of patients or potential patients are gathered together, floor by floor, to talk about the issues that disturb us within the current medical system? As we stop at a floor, others may look in and even join us in conversation to move along to another floor.  But, beyond our conversations, the only way to make change is to step out of this elevator and walk into the governmental, legal and medical business world and carry out the declarations and approaches which has been repeatedly discussed during the elevator ride.
How is that for an analogy to Patient Dignity (Formerly Patient Modesty) as we have moved up to the 100th floor in our little elevator?  ..Maurice.

                                                                                                      Graphic: From Google Images.
AS OF JUNE 23 2019 THERE WILL BE NO FURTHER COMMENTS POSTED ON THIS VOLUME. COMMENTS CAN NOW CONTINUE ON VOLUME 101.

Monday, May 13, 2019

Patient Dignity (Formerly:Patient Modesty):Volume 99






















Does  the above animation tell us anything about the
patient-doctor relationships which has been amply described
and detailed on this blog thread?  Could any of the patient
reactions to the actions of the physician or the medical system
simply be a natural reflex to some actions by the profession which
were not intended to be traumatic? Could some actions of the
professionals be well intended (in this example to test for neurologic
reflex impairment) and  yet turn out to appear that it was not fully
 considered?

In this analogy, by working together, could the patient have reminded
the physician, based on the patient's previous experience that the doctor
may be sitting too close for the test?  Usually, patients know more about
themselves and their reactions (both emotional and physical) and the
physician deserves to be informed in advance. So..the message again
to the patient: "Speak up".
 ..Maurice.


Graphic: From https://gifimage.net/interrogatorio-medico-gif-3/
via Google Images


NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 99.
NEW COMMENTS CAN NOW BE WRITTEN TO VOLUME 100.

Sunday, April 28, 2019

Patient Dignity (Formerly:Patient Modesty):Volume 98






So the "Rules of the Road" is a worthy presentation to each patient who comes to the physician for help but what is often missing is that the doctor needs to understand the "Rules of the Road" as taught by each patient.  As you walk into the doctor's office you get a Welcome document from the doctor. What is missing often is the doctor doesn't get a "Its about me" instruction paper from the patient to educate the doctor regarding his or her rules as they both go down the same road with upcoming Stop signs, turnoffs and speed limits.  One major issue within  such a driving analogy is WHO FOLLOWS WHO? (physician paternalism vs patient autonomy).   Can any of my visitors add to this road analogy? ..Maurice

Graphic: From ZNX Health via Google Images and modified by me.

AS OF MAY 13 2019, THERE WILL BE NO FURTHER COMMENTS POSTED ON THIS
VOLUME 98. YOU CAN CONTINUE POSTING ON VOLUME 99.

Wednesday, April 10, 2019

Patient Dignity (Formerly:Patient Modesty): Volume 97



"Not OK" and who decides it's "OK" or "not OK" in a medical professional-patient relationship? Should the final decision be made by the patient (autonomy) or by the medical professional (paternalism).  My view and practice as a physician is that patient informed but autonomous decisions (or informed decisions made by the patient's surrogate, if necessary) should be the determinant state in all patient-medical profession relationships from onset to final actions.  So this view applies to clinical interaction in all stages of medical practice.  In non-clinical relationships (as briefly discussed in Volume 96) the final decisions are more complicated if a clinical relationship had previously been present.

From the onset of this thread topic,  the views presented have clearly held, with examples of patient hurtful contrary professional behavior, that it is the patient who should "be in charge".   What is my opinion is that simply mumbling and grumbling  on this blog thread as to what is "not OK", I fully agree with the attempts by some of our visitors to "move on" to publicize their view for a need for a changes within the medical system to attend to the needs of patients to maintain their dignity beyond maintaining their health and that there are many examples of professional behaviors which are simply "not OK"with them.  ..Maurice.

GRAPHIC: Created by me utilizing the Microsoft Paint Program

NOTICE: BEGINNING APRIL 29 2019 NO FURTHER COMMENTS WILL BE PUBLISHED ON  THIS VOLUME. COMMENTS CAN BE WRITTEN TO VOLUME 98.

Thursday, March 21, 2019

Patient Dignity (Formerly:Patient Modesty): Volume 96

Isn't this is what is facing patients who want to express their "concerns, desires and wants" and is amply exemplified by the
Comments already and to be written to this blog thread topic?
..Maurice.
Graphic:  From FamMedVitalSigns.com and excellent article on our subject by Kyle Bradford Jones.



BEGINNING APRIL 10 2019, NO FURTHER COMMENTS WILL BE PUBLISHED IN THIS VOLUME 96.  COMMENTS CAN CONTINUE IN VOLUME 97

Thursday, February 14, 2019

Patient Dignity (Formerly: Patient Modesty): Volume 95






Ray B. said in Volume 94:

If you believe Steven Miles, M.D. (“Oath Betrayed: Torture, Medical Complicity and the War of Terror”) the answer is, “All of them.” That’s hardly evidence of outliers. At the same time, however, there is reason to believe, from Milgram’s study, that the people who commit evil acts may, in fact, be outliers – it depends on the situation. 

And so where are we, as patients and our dignity, within the medical system? ..Maurice.

Graphic: From Google Images and modified by me with Art Rage.
As of March 21 2019, no further Comments will be published on
this Volume. Comments will continue on Volume 96.



Sunday, January 06, 2019

Patient Dignity (Formerly: Patient Modesty): Volume 94



Entering the "dirty pond" or "down the drain", these expressions along with accompanying graphics are amongst a host of verbal expressions with their visual analogies which I have used over many Volumes to describe the status of the medical system as brought out in the views presented by the contributors to this blog thread over the years. And now with Volume 94 comes another: the medical system utilizing the conveyor belt image within the process of diagnosis and treating of its patients.  This analogy is spelled out in a "Perspective" description of a clinical event in the January 3, 2019 issue of the New England Journal of Medicine with the title of "Walking Away from Conveyor Belt Medicine".
The story begins and the conveyor belt first starts moving when a community hospital notifies a major medical-surgical hospital that it found in a 70 year old demented patient who spends  his life simply "walking" that his previously surgically stabilized aortic aneurism is enlarging compared to his previous checkup and he was felt to be in need of immediate surgical repair to prevent rupture.  He was on his way by ambulance "and the conveyor belt started moving" in the major hospital to carry out all the preparations involved in what was to happen on the patient's arrival. On arrival "the conveyor belt is speeding up".  Then the "belt was moving fast" as all the many components which were needed to prepare and carry out this risky surgery were proceeding and being accomplished.  And, if continued to the anticipated end-point, the patient, elderly and demented would be dropped off onto the operating room table for the start of this  surgery and..and.. but, fortunately the conveyor belt stopped running when time was taken for communication between surgeons and the family who arrived and that communication changed everything and it was decided that the risks of surgery was too great for this particular patient.  So the patient was sent home with a pair of slippers for his walking and was alive 6 months later and carrying out his life as before his immediate life was governed by that medical system "conveyor belt".


What impressed me about this article is  a suggestion, which some may consider, that the medical system may have a tendency to be employing a "conveyor belt" mentality in its approach toward virtually all patients.  And this uniformity of belief and action may be contributing to a loss of dignity to each individual patient involved in the system.  "It's always done in this way and so that is how we will do it."  That is, hopefully, until the patient or family intervenes  and "speaks up".  What do you think about this analogy?  Do you see that you have been sitting on that fast moving "conveyor belt" within the medical system as a patient?  ..Maurice.

GRAPHIC: From Google Images and modified by me with ArtRage Studio Pro

AS OF FEBRUARY 14, 2019 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON THIS VOLUME. CONTINUE COMMENTARY ON 
VOLUME 95.

Thursday, November 22, 2018

Patient Dignity (Formerly: Patient Modesty): Volume 93







This graphic is my repeat presentation to this thread.  It first appeared here 5 years ago as the graphic on Volume 56 of "Patient Modesty". (Photograph  from U.C.L.A. library website  obtained through Google Images.  )

Now that we are focusing on patient dignity, it would be of interest to compare dignity vs modesty as applied to a patient fully asleep under anesthesia within the operating room.  

Might I suggest that modesty is no longer a matter of ethical concern when the patients body is uncovered but the issue becomes the preservation of dignity. Modesty requires awareness .  Anyone want to discuss this conclusion related to the unconscious but exposed patient? ..Maurice.

AS OF JANUARY 6 2019 VOLUME 93 WILL BE CLOSE FOR FURTHER COMMENTS.  GO TO https://bioethicsdiscussion.blogspot.com/2019/01/patient-dignity-formerly-patient.html FOR MAKING COMMENTS.

Thursday, October 11, 2018

Patient Dignity (Formerly: Patient Modesty): Volume 92






"Modesty is Not About Hiding Your Body. It's About Revealing Your Dignity"

What I wrote in Volume 91 detailing  this expression:


In other words "hiding your body" is a component of "dignity", a concept that is worthy of reminding those in the medical profession who simply consider physical modesty as a matter of personal "shame" for which the goal of correct diagnosis and treatment should trump. How's that??  


And now..let the discussion continue with the goal of how we all, patients as well as members of the medical profession (who one day will be patients) rehabilitate and change the medical system to be the supporters of patient dignity in all of its various contents and expressions.    ..Maurice.


Graphic: From Google Images and Pinterest.com https://www.pinterest.com/

BEGINNING NOVEMBER 22 2018 NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 92. COMMENTS CAN CONTINUE ON VOLUME 93.

Saturday, September 08, 2018

Patient Modesty: Volume 91







There currently is discussion as to exactly or inexactly what is the topic of this thread which has been published Volume after Volume for 13 years.  And whether there is a need to make the title of this thread more appropriate to the content that actually has been already published here. As Moderator, I agree that the discussions and documentations here are far more broad in terms of the patient-medical system relationship than the simple "Patient Modesty" title represents.  The problem is deciding how to express the title of content most appropriately, particularly for the new visitors to this bioethics thread.

I think it is of value to reproduce here the view of a faithful contributor to the blog and this thread whose identification is "Banterings" and my response as presented at the end of Volume 90.  I think it is then important to continue the discussion of the meaning of this thread and the consensus of the contents and ethics meaning of the many posting contributions over the years here.  Banterings last posting follows after my published suggestion for a title.

---------



How about:
"Patient Modesty, Dignity and Expected Respect by Medicine:Volume 91"

???
Isn't this precisely what is the theme presented over and over here?  
..Maurice.
===================================================================

Maurice,

Again you are making it look like the patient is (now) asking for 2 things they are not entitled to. Not only are they too modest, now they are "expecting respect."

...how dare you expect to be treated with respect? If you come to a teaching hospital, it is understood that you will be treated like a warm cadaver. Students will line up to practice their "probing" skills on you...

This is "victim blaming," plain and simple. In this era of the #MeToo movement, the last thing that one would want to do is victim blaming.

If we want to be brutally honest, then title the thread exactly what it is: 


Medicine's Lack of Respect for Human Dignity and Patient Modesty



-- Banterings


===============================================================================================

And now the discussion of a new title continues followed hopefully by further dissection of the status of medical care behavior towards their patients.  ..Maurice.

Graphic: Google Images.


AS OF OCTOBER 11 2018, NO FURTHER COMMENTS  WILL BE ACCEPTED ON THIS VOLUME.  YOU MAY CONTINUE THE DISCUSSION ON THE BLOG THREAD NOW
TITLED: "PATIENT DIGNITY (FORMERLY "PATIENT MODESTY") VOLUME 92"




Saturday, August 04, 2018

Patient Modesty: Volume 90









The animated GIF picture for Volume 90 (thanks to matthen.com via Google images) is my graphic
impression of what has been one of the primary concerns of patients writing here: unwanted, unnecessary or even non-permitted  bodily visual inspection during medical or surgical procedures.  Of course, other unprofessional acts by the "professionals" have also been described but unnecessary and patient unwanted inspection, looking or "peeking" is a common behavior presented. 
However, the graphic should also represent the eye movements and "attention" by patient's themselves, looking out, keeping their eyes open to professional misbehavior coming from any direction.

I think this graphic should emphasize the need for such attention and if unwanted "gazing" other "unprofessional" behavior is found, patients should feel free to "speak up" and contribute to making the medical profession truly "professional" toward a goal directed solely to  patient beneficence and not some other goal set solely for "the system person" or the system itself.  Is there anything further to add describing any relationship of this graphic to the issues brought up in these 90 Volumes?  ..Maurice.
AS OF SEPTEMBER 8 2018, NO FURTHER COMMENTS WILL BE PUBLISHED ON
VOLUME 90. THE DISCUSSION WILL BE CONTINUED ON VOLUME 91

Monday, July 30, 2018

Pharmacist:: Just Filling Prescriptions or Should They Also Diagnose?









      There may be some confusion about the full role of the professional pharmacist in medical care. The patient, with
prescription from a physician in hand may consider the 
diagnostic phase completed and comes to the pharmacist for
the prescribed medication to take for their physician identified
illness.  On the other hand, pharmacists after their studies and

But, "Changes to modernize traditional medical education and care delivery are, in fact, currently being introduced, with interdisciplinary health professional teams emerging as a core element of new models. Before graduates of different health programs are assigned practice responsibilities, however, many questions still need to be answered: What are the core functions and responsibilities of practitioners in each profession? What is the minimum education and training needed for someone to attain the core competencies required to perform these functions well and safely? Where do the different professions intersect and where could the public benefit from services offered by more than one provider? How can interprofessional learning and practice environments foster and support collaboration? How can we prevent turf battles and encourage true collaborative, patient-centred, complementary care?"

So, the question to my blog readers is whether, as a patient, you would think that pharmacists should taught further to play the bigger role as diagnostician beyond screening and packing medication already prescribed by the examining physician? Are you satisfied with the relationship you have with your licensed pharmacist? Would you want your pharmacist to learn and carry out more clinical responsibility?  Physicians in the past and occasionally now have dispensed medication to their office patients after making a diagnosis. Should pharmacists take on a bit of the responsibility of making a diagnosis based on their more limited pharmacy school and hospital internship experiences? How do you want your pharmacist to be interacting with you as a patient? ..Maurice. 


 Graphic: From Google Images and NIDDK Image Library.





Sunday, July 01, 2018

Patient Modesty: Volume 89





I took the above photograph of a "dirty" pond this morning (Descanso Gardens, Southern California) because it struck me as analogous with what is currently being written on this thread about the medical system which we are all experiencing.  Each fragment of  "dirt" was actually part of adjacent beautiful and organized plantings but each fragment going their own way ended up in this pond no one would want to enter..  Is this analogy consistent with the current medical care system? Worthy parts from the past and elsewhere but now just a "dirty pond" ..Maurice.

AS OF AUGUST 4 2018, NO FURTHER COMMENTS TO THIS VOLUME WILL BE ACCEPTED.  COMMENTS CAN CONTINUE ON :"PATIENT MODESTY: VOLUME 90".

Friday, June 01, 2018

Patient Modesty: Volume 88



So.. based on what has been written in all the previous Volumes of this thread, it appears that a consensus is that the medical system just going "down the drain".  And if so..whose fault? Who should we blame?  And if this analogy is realistic, what is the solution since seems obvious that we (all of us) need trained humans to diagnose and treat us for many of  our illnesses?  Should we have folks not trained in medicine or business to actually run the medical system? Should they be "voted into office" and that by public vote
decisions in medical-surgical practice be made? What is your opinion? Got one? If so, then Comment.  ..Maurice.

As of July 1 2018, Volume 88 will be closed for further Comments.
However, Comments can continue on Volume 89.

Graphic: From Google Images and modified by me with ArtRage 3.


Sunday, May 06, 2018

Patient Modesty: Volume 87









EO, a visitor writing in the Comment section of Volume 86 of this thread title has set the stage for further discussion-- particularly the way male patients are treated within the medical system. I thought his narrative would be appropriate to start this Volume. ..Maurice.
Graphic: My composition using ArtRage and appearing as the graphic on the thread "Order vs Chaos in Medical Practice"

Though I am encouraged that many of the contributors to this blog have become activists as regards affording male clients (patients) the same rights as female clients when it comes to modesty/dignity, I see little hope that the system will change in any broad or meaningful manner. There has been some discussion regarding the corrupt corporate takeover of the make’emsick (medical) industry and how this relates to discriminating against male clients, but until the collusion between Big Pharma, private insurers, federal and state governments, and healthcare providers is truly revealed and 100% amended, there will be no real change on the industry’s part as regards the discrimination against male clients. Like the current swamp in D.C., the make’emsick swamp is just too powerful and entrenched to be brought to justice.

Wow! Thanks, PT, for bringing that incident to our attention, wherein a female hag made fun of a male urology patient’s pain level after a prostatectomy (I can only imagine that type of pain such as having a hysterectomy), called him a wuss, made fun of his career as a marine and other commentating hags told the student nurse to get used to because you’ll be gossiping about your patients like we do! Like you said, patient privacy suffers even more because “it’s attributable to what I call the hate factor, devoid of caring, devoid of advocating.” Most people go into the make’emsick industry for the money (and they think the prestige, but man are they fooling themselves here!). I’m sure hags are making ugly comments about clients about a zillion times a day!

That men would even have to think this way as one contributor has written, BESPEAKS VOLUMES about the abusive foundations of Western medicine: “Men will be afraid to come forward and take their case to its conclusion through the courts of public opinion and the criminal justice system out of fear of seaming weak in front of the world and out of fear of retribution from caregivers against those men currently in treatment.” Wow, that ill male clients are afraid (and justly so!) that caregivers will retaliate is abominable! How can a society accept such sordid scenarios? From the little I’ve had to read, female caregivers, especially the nursing hags, retaliate in many and vicious ways! Here’s just one little, minor example: A hospitalized male client refused the nursing hag’s “offer” of shower help (he was totally ambulatory) and angry she could not attend that peep show, she canceled his dinner! Nice, huh! One male has described hospitals as “humiliation factories” where males are “treated like farm animals.” This is a pretty apt analogy!

Banterings, my friend who was abused just wants to forget – he won’t file anything, and we’ve caught the physician in Medicare fraud – charging thousands for a program he did not attend. As you mentioned, he could file for “conspiracy or obstruction of justice… a criminal complaint,” but he won’t do it. This is a typical scimmer-scammer type of physician who opens tons of offices and stocks them with – I love your terms, PT – PAs (Physician Actors) and NPs ( Nurse Quacktitioners). I’ve done what I can with anonymous reports which I’m sure will go nowhere. Time for other avenues… As one contributor pointed out – that good men do nothing that evil prosper.

Maurice, you ask “WHAT IS IT ABOUT PATIENT MODESTY that has attracted so much interest by visitors and writers for this blog? There are so many other life and death topics throughout this blog and yet with them the number of responses from visitors is relatively trivial (though, to me, they are also important and worthy of responding to) but WHY PATIENT MODESTY leads the way and continues to do so?’ Banterings mentioned “social justice” as a reason, and others have indicated the damage that is rendered to male clients re modesty concerns as an assault on one’s very soul, etc. I must concur with both. However, to the make’emsick industry ( I can no longer even call it the sickcare industry since this past year two friends have suffered terribly at the hands of inept surgeons, one losing permanent vision in one eye and the other losing a leg!) male modesty is of trivial concern at the most. Thus, we must ask – why is this so? It is pure common sense that dictates that same sex or gender concordant care (something about the term is rather a put off – just call it what is in plain speech) should be not even questioned, but rather same sex teams should be automatically assigned to clients and if they wish, then opposite sex or mixed gender teams would be arranged. Others here have written of this. This automatic assignment of same gender would put an end to many modesty violations, and as others have written should be codified into federal law that all facilities, whether hospitals or private clinics (if they accept Medicare/Medicaid payments and who doesn’t!) then Title VII dictates that same gender providers for intimate care is ALWAYS PROVIDED. Man, will the nursing hags be disappointed when they can’t run around to peep at whomever they choose!

So, we’ve seen that all the meaningless platitudes of “we’re all professionals,” “standard of care,” “patient dignity is respected,” – the “fake core ethics” as PT noted - and etc. can be seen as nudging/bullying. Recall the stats on colonoscopies and that scam! Well, I’d like to introduce a term that is bandied about as an excuse for whatever the provider wants to do – EBM (evidence based medicine). It is this term that the make’emsick industry shoves down our throats. TALK ABOUT NUDGING! It was probably John Ioaniddis’ 2005 article in PLOS, “Why Most Published Research Findings Are False,” that really brought the false narratives of EBM into the public arena: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124.

Here’s a quick overall read: https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

I encourage people to read the latest reports of Big Pharma’s fraud, there’s plenty to read out there, and you’ll wonder why people would take any pharmaceutical after educating yourself of their deceptive practices. One of my “favorites” is the bogus medical journal they created in Australia, which promoted certain new drugs. And, be sure to read about the Rockefellers and how they helped to create the AMA and how many safe and USEFUL alternative therapies and practitioners were run to ground/banned. Rockefeller saw a HUGH opportunity to profit from the pharmaceutical poison model, and not so coincidentally this ugly monopolization occurred at the same time he was monopolizing the oil industry.

And here we are today, the richest nation on the planet with (outside of hellholes such as Syria and others) the worst health outcomes. Hmmmm, why could this be?

One of my major points is that the current foundation of the make’emsick industry is based on giving dangerous poisons (pharma drugs) to supposedly “manage” chronic conditions (all “evidence based” yippy!), and conducts significantly more tests (often harmful!) but look at how low US “health” care ranks among developed nations –one of the lowest in terms of infant mortality, life expectancy, emotional and physical health, etc. and is headed lower! We had been discussing the useless DRE (and PSA) tests and how Albin regards the PSA test. Let’s look a little closer at this example of nudging. One expert cited by Ablin says perhaps half of the urologists in the United States would go bankrupt without the gold rush of prostate-removal surgery that followed the PSA discovery. “When a 50-year-old man went for his yearly physical,” explains Ablin, “he routinely had a PSA test, quite often without his knowledge. The level of his PSA could propel him into the prostate cancer industry . . . the prostate gland is at the epicenter of a worldwide trillion-dollar industry and the PSA test as its kingpin. Think of PSA as oil. If the test were made irrelevant, an industry would crumble. You don’t have to be a conspiracy theorist to grasp what the stakeholders will do to keep this industry booming.” Guys, you may wish to read his book: The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster" by Richard J. Ablin and Ronald Piana. Here’s where I found mention of it: https://nypost.com/2014/03/01/why-the-prostate-cancer-test-is-useless/

So, how to reform a Frankenstein-like industry ruled by Big Pharma whose private, monetary interests are sanctioned and ENFORCED by the state (via the make’emsick industry) and in some arenas are not subject to any usual redress via the legal system? How many men abused by nursing hags have sought justice in a court of law? Not too many, as we have witnessed time and time again, and of course the events that make it to the news most likely reflect 1/10 of 1% of such events. As it appears that most morons go into the make’emsick for the income (and yes we must include female hags that go into it for the viewing of naked males), we return to REL’s line of reasoning, that is, we must attack their money/income just as they attack vulnerable, ill male clients. We see that it is VERY effective to boycott certain companies for needed changes. I must disagree, Maurice, that the abusive events are rare – they are most certainly not! If they were, this blog would not exist! Now this is from some 6 months ago, but here’s a team in Bolivar dancing about mocking a naked male patient on the operating table, here’s one of the links: https://www.mirror.co.uk/news/world-news/doctors-nurses-fired-after-outrageous-10112888

It seems Western “medicine” (vomit) is conducive to patient abuse, no matter the geographical area. And perhaps we must come to the conclusion that the make’emsick industry is but a reflection of a society in steep decline. I do ask this: What is it about Western medicine (as opposed to other systems of medicine) that so objectives clients and is overrun with degenerates, whether nursing hags sexually abusing male clients, doctors’ semen ending up on female colonoscopy patients, or hags stealing hospitalized clients pain meds, etc. etc. ad infinitum?

Now, male clients that value their modesty and want to have the same consideration as female clients have been referred to as outliers. I don’t believe this is true, but the make’emsick industry certainly promotes this incorrect idea. That it does so actually tells us that this industry is well aware of this issue, but desires to hide it by distorting the facts. Besides the obvious sexual urges of many workers, especially the female nurses (humiliation of a male client does make for some great convo in the break room!), that many females in managerial positions responsible for their nursing brigades and the hiring, protect the female nurse and discriminate in yet another way against males by not hiring male nurses - this discrimination is against male clients as well as male nurses. And, that physicians allow their office managers to hire almost all if not all female MAs, techs, etc. informs us that they don’t care about the modesty/dignity of their male clients.

I disagree that modesty violations are not sexual abuse – they certainly are! Like the hags telling a male patient to take off all clothes for an EKG and then being terrible disappointed when they flung open the gown to not being able to peep as underwear were still on or the hag threatening a hospitalized client with having a guard perform a rectal swab – these are sexual abuse incidents! They should be treated as such! One writer mentioned having non-medical groups that serve as watchdogs and this is surely needed!

And PT, thanks for the detailed info on just how non-sterile/filthy operating rooms are. I didn’t even think of the cigarette chemicals invading open wounds and until recently thought that the make’emsick industry was really trying for clean ORs. Call me naïve but I thought the surgical teams changed scrubs between surgeries but instead track everything from the last (perhaps infected) surgical client to germs from the cafeteria and cigarette chemicals and the effluvia from a flushing toilet to the next surgical victim (client)!

Sorry, but I think I am extremely disappointed (yeah, okay, angry) that so many male clients won’t speak up for themselves, but will accept this situation. However, a recent poll by Anthem shows at least 60% of males will not return to a female provider after seeing one for the first time. I was skimming some blog (maybe Allnurses) last week that had female providers discussing how to retract the foreskins of male children and adults. Why would they think that this is just fine and dandy when so many young men are humiliated and mortified by these kinds of (usually unnecessary!) exams, and this leads to not only avoiding the make’emsick industry altogether (actually, most people will be healthier by avoiding the industry), but leaves many with lifelong emotional scars? Hmmm…. And until recently, these medical morons in the US, especially the females, didn’t know it could harm a male child or teenager to have his foreskin prematurely retracted – that is – ripped down! Stupid is as stupid does…

Perhaps I (and others I know) are the true outliers. I have absolutely zero trust in the make’emsick industry and its workers, wherever they are on the scale, from physicians to NAs/MAs. As I have 30-60 IQ points on the average physician (I come from a long line of physicists and philosopher/poets and the two arenas are not as different as they may seem as they both permit for highly critical thinking abilities), why would I trust someone who is hopelessly corrupted by a false medical model? I would only consult an MD (would never accept a PA or NP) in extremis, armed with a protector (advocate) and my attorney’s number on speed dial! And though I may need a diagnosis, for the most part there is nothing these physicians could offer me outside their regime of dangerous pharmaceuticals and many times equally as dangerous surgery. I won’t go into detail as this is a blog for male dignity, but suffice to say I have lifelong health issues due to individual providers’ malpractice as well as the industry’s widespread practices that are making so many of us, especially our children, damaged for life. And, many decades ago, I was abused on several occasions. I remember hitting one male doctor and he wheeled around and scurried out of the exam room like the dirty little rat he was! I was just a young thing at the time, and tried to forget it, but the awful feelings are still with me decades later. So, I have some personal experience in this area as well.

Now, the fact that medical “care” (can one scream and vomit at the same time?) is seen as the third leading cause of death in the US is old hat – some 2 decades years outdated. The true fact of the matter is the make’emsick industry is the LEADING CAUSE OF DEATH and everyone from Big Pharma, individual providers, and hospitals are fighting not to have the Codes updated so as to truly reflect actual causes of harm and death. (Look it up –the real stats are out there for those that wish to take the time to research.) Their facilities would be almost empty! I can tell ya, folks, people like me just don’t go! A yearly physical exam is out of the question! As regards nudging I call it bullying/propaganda, and if any medico tried to convince me that a certain drug, vaccine, or procedure is considered “standard of care” (The Exorcist vomit!) depending on the provider’s attitude I might very well consider this bullying and would respond appropriately. And here’s the point: Using useless and meaningless terms such as “evidence based medicine,” “standard of care,” “we’re all professionals,” “patient dignity is respected” etc. is nudging/bullying, more, it is lying.

I’ll briefly mention one more example of the lies of EBM, that of enhanced MRIs. Talk about a euphemism! The EU has restricted/banned many GBCAs as yes gadolinium is deposited in the brain, bodily organs, and bones, and has harmed untold numbers but now people are waking up to this particular scam and are suing: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Gadolinium-containing_contrast_agents/human_referral_prac_000056.jsp&

But of course the good ole’ FDA though it admits GBCA are deposited in the brain finds no evidence that heavy metals in the brain (and other areas of the human body) are damaging! Like radiation, heavy metals are incredibly damaging and yep I’ve got another friend permanently damaged by multiple “enhanced” MRIs. That PAs and NPs as well as PCPs are ordering these dangerous tests leads us back to the lies of EBM and of course, good old fashioned greed. Physicians admit to ordering over a million unneeded tests per annum for the kickbacks but we know this figure is much higher. This does not occur in other medical systems where kickbacks are not allowed.

So, we have a false medical model, an industry that does significantly more harm than good, and mostly female medical workers doing their best to peep on male clients, all topped off with a huge dose of greed! What’s not to trust?

Thanks for listening…
EO

BEGINNING JUNE 1 2018 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON VOLUME 87 BUT COMMENTS CAN BE CONTINUED ON VOLUME 88.

Tuesday, April 10, 2018

Patient Modesty: Volume 86



The above graphic for this Volume really shows distinctly a major discussion point which has continued on our blog thread, literally for years: the requirement for the patient undergoing surgery with general anesthesia to have his underwear removed, in this case for his arthroscopic knee surgery. The story is told by an onion farmer in his blog "Mucking It Up in Muckville"

I hope my visitors here go to the above link and first read the patient's story.  Then, come back and  continue, reading the experience and view of an anethesiologist-ethicist Dr. Alyssa Burgart.  I have been given her permission to reproduce her presentation here but besides writing your Comments to my blog thread, you should go re-read the text and write your comments directly on her own blog "Medicine, Ethics and More" and therefore to her own readers.  I am pleased to be able to get Dr. Burgart's experience and knowledge in both her areas of experience.
Her blog address: http://www.alyssaburgart.com/blog/2018/04/11/underwear-for-surgery/ and here is what she wrote:




Why was I asked to take off my underwear for surgery?









It can feel weird to be asked to take off your knickers… Underwear makes us feel proper, protected, clothed. Even though I get that those are concerns, there are several reasons why you may be asked to remove underwear:
Number One and Number Two
Under general anesthesia, patients sometimes pee and/or poop. It’s not pretty, it’s not always easy to know when this will happen, and we usually ask patients to use the restroom before surgery by means of prevention. If a surgery will be very short, the risk is lower. It is completely irrelevant which body part being operated on when the whole body is anesthetized and unfortunately, this can be a messy situation. The nice, clean skivvies the patient wore to the hospital are going to be peeled off and put in a biohazard bag. Patients do not necessarily bring extra underwear with them and don’t have any to wear home. Removing the garments before surgery means the patient can put those clean undies on when they wake up. We usually still have patients lie on an absorbent towel/pad, just in case. Undies or no, the nurses in the OR are going to make sure the skin is cleaned before the patient wakes up.
Time
If a surgery is long, a Foley catheter is typically placed to drain, collect, and measure urine. Placing the catheter requires sterile prep of the genital area and underwear are going to be in the way. They won’t fit properly and can apply unwanted pressure to the catheter once placed. This can even cause a pressure injury to the skin.
Spic and Span
Some people (not you, I’m sure) wear undies that are not very clean. It’s a gross over-generalization to apply that concern to everyone, but for practical reasons, it can be easier to just have everyone take them off.  If you’re having a belly surgery, your skin will usually need to be cleaned as low as your pubic bone. Knee surgery? To clean the whole knee, it has to be lifted up and the prep drips down the thigh. Those undies can get saturated with cleaning solution. They might get stained with the dye in the soap, which is rude on our part. They may not dry very quickly– and this can increase the risk of a fire during surgery (yeah – we have to worry about your pants on fire!). Realistically, the only procedures that underwear don’t get in the way are those on the chest and above.
While You Were Sleeping, We Got Back Pain
Is it more awkward to ask a patient to take off their panties or, if they absolutely have to come off, to take them off when they’re under anesthesia? Personally, I think it’s weird to wait until someone is anesthetized to take off their tighty whities. Then the patient wakes up having lost their underoos. If they need to come off for any number of reasons, I prefer the patient does it themselves. I think it’s weird to take them off in the operating room. Plus, it can take multiple people to get them off and we genuinely risk workplace injuries (back pain anyone?) to do so.
That’s nice, but maybe you still don’t want to ditch your briefs.
There may be hospital staff that get their panties in a bunch about your underpants. If you’re an adult, no one can MAKE YOU take off your clothes. If you refuse to do it, you can take your chances that your underwear will be on your body and be clean. But they may need to come off emergently (or because they interfere with the procedure you showed up to get) and that may mean they get cut off. There is dignity in controlling the removal of your own clothes, as I would personally find it more of an affront to emerge from anesthesia with clothing inexplicably missing. But that’s me. Maybe you don’t mind. There are perfectly uncomfortable mesh underwear that hospitals are likely to have on hand – meant to hold absorbent pads for post-partum or menstruating patients, or who have other reasons to need them. (To the above points, those will be promptly cut off if they are in the way, or of the patient urinates.)
When teens and adults are concerned about removing their underpants, I ask them why and offer to explain the reasons why it is called for in their particular case. Generally, I think the whole underwear things gets patients bend out of shape when they don’t feel they are being heard. Coming in for surgery is stressful, and maybe taking your tighty whities off based on the demands of a pre-op nurse is the last straw. When it comes down to it, patients are usually certain that they are just being asked to do something ridiculous, with not reasoning behind it. Secondly, they are concerned that their body will not be respected while they’re anesthetized and that it will be exposed for no good reason. By staff taking the question seriously, a dialog can form where the patient hears that they are respected, and staff have a chance to explain that this isn’t a thoughtless, nonsensical request to diminish inherent human dignity.
We have bet bter things to do all day than play power mind games with our patients. I can’t speak for every operating room out there, but I have yet to be in an OR where patients were left exposed for no good reason. First and foremost, we respect patients’ dignity and modesty. We have lots of sheets and blankets and use them to cover whatever we can. On a practical matter, it’s really important to keep patients warm, and leaving them uncovered is super counter productive.
On the surface, most of these reasons might seem like they are solely for the benefit of the healthcare people involved, but I think they are rooted in an effort to prevent patient inconvenience from dirty, damaged, wet, stained undies and loss of dignity from being given a biohazard bag full of soiled unmentionables, and to ensure that, above all, the patient gets safe care. If you disagree and refuse to take em off, staff should listen to your concerns to find an acceptable solution.
There will be no further Comments published on this Volume 86 as of May 6 2018. Continue the Comments on Volume 87,

Tuesday, March 06, 2018

Patient Modesty: Volume 85


I think this Volume's graphic really defines the basis for the ongoing modesty discussions which continues to focus on the behavior of some females in the healthcare profession with regard to their male patients but also importantly seemingly often the inability of male patients to express their distress or, in fact, change the system to male demands for the system to attend to their modesty as the system offers to female patients. The men seeming just have to stand for this inequality. Isn't this "the Problem"? ..Maurice.

Graphic: From Google Images and modified by me with ArtRage.

Beginning TODAY  April 10 2018, no further Comments will be posted on Volume 85 but the
discussion can continue on Volume 86.  



Monday, February 05, 2018

President Trump:Diagnosis and, if Necessary Therapy: Doing it Ethically









An excellent article written by physician-ethicist  Joseph J. Fins in Harvard Medical  School Bioethics Journal  and it is my reading that he suggests when it comes to the psychiatric fitness of Donald Trump to be the United States President, it should not be a psychiatric diagnosis (such as "sociopathy")  from afar but should be the education of the public in a clinical non-partisan fashion  by the psychiatrists of the symptoms of disease and it will be the public and their government to prescribe and carry out the appropriate treatment. 


In Dr. Fin's words:


In the context of the president’s personality, it is not an outright diagnosis that is needed per se but a public appreciation of what sociopathy is that can help inform a response. Medical diagnosis demands a high evidentiary standard. In the public sphere, mere knowledge of what sociopathy entails may enable the requisite scientific literacy for the citizenry to decide if observed behaviors fit a discernable pattern of psychiatric diagnosis that has a bearing on an ability to govern. This knowledge is especially important in sociopathy, which by its nature can obscure and seduce the observer. Human nature is drawn to sociopathy and vulnerable to its charm. Public awareness of sociopathy’s existence and nature is thus vital to deliberative democracy. This knowledge becomes a component of basic scientific literacy for deliberative democracy. Having said this, this knowledge need not require understanding at the level of clinical nosology. It may constitute essential knowledge like the germ theory of disease: even if they can not diagnostically distinguish an errant gastroenteritis caused by E. Coli or Salmonella, the public knows enough to engage in personal hygiene and perhaps avoid potato salads simmering in the sun at a summer picnic. Public knowledge about sociopathy has a similar utility: it can help guide behaviors and inform responses by our political leaders and journalists in the Fourth Estate as they do their work. 



So read the entire but brief article  and return with your idea of the role, if any, for the psychiatrists in relation to the American public with regard to President Trump.  Remember, this thread is not about presidential policies but about how to make a psychiatric diagnosis and who should be supervising any treatment.  ..Maurice.

GRAPHIC: From Google Images

Sunday, February 04, 2018

Patient Modesty: Volume 84





Currently on a bioethics listserv to which I read and contribute there is a discussion about policies within the healthcare system which attempt to protect the participants of the medical institution from demands of patients with regard to race and ethnic background.  One response by a physician was that his hospital institution had a policy to
"employ people on the basis of their skills and competence and without regard to gender, skin color, religion, etc. and when patients or families make discriminatory requests they must be evaluated in light of this commitment.  Some seemingly discriminatory requests may be accommodated if there are good reasons to believe they have good psychological or medical validity and if doing so can be accomplished without compromising patient care pr staff safety (e.g., a teenage girl requesting a female physician for a pelvic exam).  In our experience, the overwhelming majority of these incidents occur with nursing staff and allied health personnel (like phlebotomists or ECG techs). Most never percolate up the chain so that senior folks hear about them and they are usually handled locally by juggling staff assignments."

I responded with : It ain't just a "teenage  girl requesting " a gender selection of a physician or more often that of nursing and allied staff (including scribes!) performing or presence when genitals are being exposed.  And in my 13 year ongoing Bioethics Discussion Blog thread on "Patient Modesty" it is mainly men who are demanding but very often not receiving their gender "discrimination" requests and are left either avoiding necessary medical care or leaving "care" emotionally upset.  Although my blog thread is titled "modesty" there  has  been "no...none" racial or country origin demands ever mentioned or exampled. 

Well, another listserv participant followed up with: "Maurice, maybe that is because discriminatory requests based on race or national origin are not necessarily associated with the heading of 'modesty' ?"  

And so to start off this new Volume,  yes, the title of this thread is "modesty" but is it true as the participant wrote it is inappropriate for me to infer that beyond this issue the writers here are free from racial or ethnic bias or any of the other issues of social inequality because of this thread's directed subject matter?  Or are gender issues lengthily covered here may be or are  related to other medical treatment concerns which could be described as attached to other aspects of social equality or inequality such as race and ethnic origin which also bothers my visitors? Repeating: Is the medical profession not offering all that it should be offering to patient desires to those writing here in terms of social quality, beyond poor attention to modesty.  ..Maurice.

Graphic: From Google Images and modified by me with ArtRage 3.  

THERE WILL BE NO FURTHER POSTING OF COMMENTS ON VOLUME 84.
THE POSTING OF COMMENTS WILL RESUME ON VOLUME 85.



Saturday, January 20, 2018

Difficult Patient vs Difficult Doctor

One cannot ignore the potential for conflictive behavior as a potential in medical patient-physician relationships (and indeed associated with other individuals in the medical system interacting with patients and patients interacting with them.) This behavior can be disruptive to attain important professional relationships and effective diagnosis and treatment. 

The following is a brief analysis of the dynamics associated with such behavior and hopefully toward resolution as researched and written by a first year medical student.  The obvious goal, hopefully, is resolution of potential conflicts to promote a therapeutically effective doctor-patient relationship.  My visitors' views on this issue are welcome.  ...Maurice.

                   DIFFICULT PATIENT VS DIFFICULT DOCTOR
                                                           
                                           Surabhi Reddy
                                   First Year Medical Student

A doctor’s worst nightmare? A patient that is impatient, inattentive, rude, and demanding. A patient’s worst nightmare? A doctor that is impatient, inattentive, rude, and demanding. A so-called “difficult patient” or “difficult doctor” represent two sides of the same coin, with similar behavioral and communicative factors causing conflict. Occasionally, the difficult relationship may culminate in a
messy outburst – as recently seen in a violent altercation between a Gainesville doctor and patient.1  The duality of the patient-physician relationship allows us to examine (from both perspectives) what underlying actions and issues initiate the conflict – and eventually focus on mediation and resolution. Addressing the “difficult” nature of these parties is a vital first step towards creating positive patient-physician relationships and health outcomes.

You may hear the phrase “difficult patient” offhandedly thrown around in a physician’s lounge – a blanket term like “problem child” or “one of those” that draws universal understanding but little clarity on the specifics of the interaction. Physicians characterize 15-20% of all patients as “difficult.”2,3 Such encounters point to a strong association between the “difficult” characterization and patient mental disorder – namely, depression, panic disorder, and anxiety.2,3 Doctors note these patients are either 1) not interested in a medical opinion whatsoever, or 2) have repetitive, non-specific complaints. However, it was also noted that difficult patients are hard to describe and characterize as a group.4 Mental health does not preclude a difficult interaction. In a series of interviews, physicians described “difficult” as conversational issues such as patients being “violent, demanding, aggressive, rude and [seeking] secondary gain.”5 Physicians describe their primary motivations as the desire to solve medical problems and help others – and anything that stymies this process sadly draws the label “difficult.”

The onus is not completely on the patient, however. One study points out that the difficulty may stem from the doctor’s work style, belief system, and/or cultural barriers.5 The more experienced a family medicine physician is, the less likely he/she is to characterize a patient as “difficult” – suggesting that there is a burden on the doctor to develop the interpersonal skills to handle the interaction. Collectively, physicians that report high frustration with patients are those that are younger, work longer hours, and have symptoms of depression, anxiety, and stress.6 While physicians often characterize patients as difficult, patients are less likely to describe their physician as so. In most studies, patients are evaluated for their “satisfaction,” which includes many aspects of their medical care, including perceived expectations, the underlying medical condition, and other members of the healthcare team. This may also reflect the power dynamic between patient and physician. Patient complaints may be dismissed, once again, as the patient being “difficult” - leaving the physician immune to criticism.

The difficult patient-physician relationship involves both behavioral (mental disorders, stress) and communicative (rude and aggressive language) factors from both parties. Ultimately, cooperative relationships stem from respect, empathy, and patience. As one physician stated in his interview, “First of all, what I have learned with the years is being empathetic toward [patients].” Taking the time to understand another’s perspective can go a long way in making the difficult into easy.5



Sources
1.       Bever, Lindsey. (2017). A doctor shouted at a sick mother to 'get the hell out.' Now he's under criminal investigation. Washington Post.
2.       Hahn, S. R., Kroenke, K., Spitzer, R. L., Brody, D., Williams, J. B., Linzer, M., & Verloin deGruy, F. (1996). The difficult patient. Journal of general internal medicine, 11(1), 1-8.
3.       Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069-1075.
4.       Koekkoek, B., van Meijel, B., & Hutschemaekers, G. (2006). " Difficult patients" in mental health care: a review. Psychiatric Services, 57(6), 795-802.
5.       Steinmetz, D., & Tabenkin, H. (2001). The ‘difficult patient' as perceived by family physicians. Family practice, 18(5), 495-500.

6.       Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC health services research, 6(1), 128. 


 GRAPHIC: From Google Images.