Patient Modesty: A More Significant Issue?
Although I shouldn't really be surprised, I am surprised about the relatively large number of comments I received regarding my posting in August 2005 titled Naked.
The posting deals with an article written in the New England Journal of Medicine titled "Naked" by a surgeon in which he describes the inconsistent or better absent guidelines in U.S. medical practice culture regarding how to perform a physical examination in keeping with patient modesty. If the slant of the comments is an indication of general patient feeling, it would seem that there are a lot of unhappy, worried and embarassed patients out there who feel that in many ways physicians and others involved in medical management such as nurses or medical technicians are either unaware or uncaring about their patient's modesty or there are a number of physicians who appear as upright physicians on the outside but sexual perverts on the inside. If these comments to the issue are a reliable reflection of what is the view of U.S. society and not just those who took the time to write to my blog, then I think those who attend to the undressed patient need some enlightenment about what their patients may be concerned about. I want to believe that the physicians and others are simply doing their job, are under pressure of time and may think there are more important issues to be concerned about the patient than their transient modesty problem.
Nevertheless, as state medical board experience will show, there are "bad apple" unprofessional doctors in the profession and they should be dealt with and possibly removed from practice.
My suggestion is that if a patient finds modesty a personal issue at the time of the exam or proceedure, the patient should speak up about their concerns at that time and expect some explanation or response. On my posting, the visitors also raised the issue about those patients who,in surgery, while under anesthesia were "immodestly" exposed. In that case, although, unlike the view of my visitors I think such an occurance is very rare. If some inappropriate and unnecessary exposure of a patient was seen by others, those in attendance should express their concerns to the surgeon or superiors.
As with the complaints by some of the public about physicians asking inappropriate questions in history taking, the concern of the public with regard to modesty may represent a previously considered trivial matter in medical practice that now should be looked at as a more significant issue and therefore more intensively considered by those who teach and practice medicine. ..Maurice.
ADDENDUM: The photographs of bronzes were taken by me 7-5-07 at Huntington Library and Botanic Gardens, San Marino, CA. Left: Male-Unknown French 1780s Right:Female-Unknown Italian Late 17th-Early 18th century. The photograph of the plaster statue of a woman was taken by me on 9-25-07 outside the Boddy House, Descanso Gardens,Flintridge, CA.
WARNING FEB 28 2008: THIS THREAD SEEMS TO BE OVERFILLED WITH COMMENTS AND YOUR FURTHER COMMENTS WILL NOT BE PUBLISHED. PLEASE GO TO "PATIENT MODESTY VOLUME 3" NOW TO CONTINUE COMMENTS ON ISSUES WHICH HAVE APPEARED ON THIS THREAD. DO NOT TRY TO COMMENT ON THIS THREAD--IT WILL NOT BE PUBLISHED!!! HOWEVER, FOR THOSE WHO WANT TO READ ALL THE COMMENTS WHICH ARE MISSING ON THE FIRST PAGE, GO AHEAD AND CLICK "COMMENTS" ON THIS PAGE AND THEN CLICK ON "POST A COMMENT" ON THE NEXT PAGE AND FINALLY ON THE COMMENT WINDOW CLICK ON "NEWER" OR "NEWEST" OR "OLDER" AND SCROLL UP OR DOWN TO READ BUT DON'T WRITE!! ..Maurice.
posted by Maurice Bernstein, M.D. @ 4:02:00 PM
910 comments
910 Comments:
Maurice,
Here is a final thought. I got some of my information from an OR nurse. She said (with out knowing how I feel) that the patient is just layed out naked for the preping. Her husband is a maintence guy at the hospital and he is call in to fix stuff in the OR and sees the same thing. The attitude of the staff does change when the patient is under. I heard this from a nurse with over 25 years of experience. If this is the case who is going to tell?? I also new a student nurse that attended a operation where a man had one of his testicals removed. They waited until he was out and the nurse let the student feel him. To see which one had the cancer. Why not do this when he was awake? She also said he was huge. Even the doctor made a comment. This is what a student was being taught. I did ask my husbands doctor a question about when his foley was put in. It was clear to me she was offended. If I had confessed my true feelings before the surgery. How, with everything else going on in my head how would I have delt with a bad reaction? I was already a mess. I know it may seem as if I have been attacking you but your reaction to me sent me to my knees. Both my husband and I have been through so much. Your blog didn't ask about the other stuff like pain fear of death and so on. It ask about being nude. Now that everything is calming down and he is doing GREAT. The reality of it all sets in. How close I was to loosing him. How scared he must have been. How helpless we both felt a times. And who touched my husbands body.Please don't get me wrong. I will be forever gratefull to those people. I just wish I could have spoke the truth and had everyone involved be ok with it. Please share this with everyone you teach. Look for the signs of those of us that seem very uncomfortable. Go ahead and ask why and DON'T get mad at the answer.
Kim
[To read the history of Kim's concern, return to her comments in the post Naked]
Kim, I certainly will teach what I learned from my visitors on this subject and I am very pleased for you and your husband that he is doing well. Thanks for your comments. You put the issue of concern about modesty in the operating room from a theory to a personalized experience. ..Maurice.
Dr. Maurice:
Thank you for saying what I and what I, Kim, and the members of How Husbands Feel are wanting to hear. That is that you will make new students aware that is is an issue for a lot of paitients even though they may seem alright with it and not speak up.
Why would a paitient not speak up? First is the Dr. paitient imbalance of power. Especialy when it is a female paitient and a male DR. she looks at him as an authority figgure and does not question any thoughts, motives, or actions. Women have been taught from their mothers and grandmothers that the male Dr. is the only male alive that can turn off being male for this brief moment in time during an exam or procedure. This has been relayed to husbands and boyfriends, who from what I have found for the most part choose to suffer in silence than to make an issue of it because of male pride. As men we do not want to admitt that there is a problem that we are having a hard tome handeling.
At every imtimate exam or procedure of a female the DR. in charge should bring up the issue and ask if a female provider would be a perfered choice. This does not happen and the female or couple feel imtimidated into accepting the male provider. Later then the relationship sufferes because of the invasion of the intimate space of the husband and wife. I know first hand of several relationships that have ended because of this, and I'm sure that if the truth was really known many relationships suffer everyday from this. A Dr. should not send a woman home with a clean gyn bill of health but with a side cost of a broken intimate relationship.
On the other issue of getting rid of the bad applen in the medical it is also going to have to be handeled from the inside out just like the issue of medical modesty. It will take DR.s like yourself to stand up and say to each other and the medical board, " we don't want DR.s who practice medical misconduct to get a second chance." Many of the cases we have looked at in the how husbands feel group are Dr.s who are now on their second, third, oand forth round of sexual misconduct and still have their practice.
Again DR. Maurice, I thanks you for taking the time to lisiten to constructive comments, I promise we are not just on a Dr. bashing campain. I formed the how husbands feel group (because I could not find anyone speaking out about this openly)one year ago as therapy to overcome a male gyn exam of my wife that almost destroyed our relationship. In this year I and other members of the group have done countless house of research online and you are the very 1st Dr. that I have came across willing to openly discuss the issue objectivly. Dr.s, and the medical profession in large just does not belive it is an issue worth looking into and certianly does not want to consider changing to meet the request of female paitients and their husbands.
Again I and the HHF group welcomes you to stop by and read for yourself some of the stories and thought of our members. You can read all the post and veiw all the links without membership.
I know that a few of our members would love to ask a real MD. some questions.
The number #1 question of our female members would be. Why is the CA125 blood test for ovarian cancer and the CSA blood test for cevrical cancer not a standard part of every ladies blood workup. We have seen many articles written from different medical groups in the USA and Canada stateing that the pelvic exam is basicly useless at detecting anything other than the size and shape of a uterus. The pap test has been proven to have a high % of false results. Most women and their spouses would prefere a blood test first and then the personal exam if the bloodwork pointed to a real reason for it.
Again here is the link to HHF.
http://health.groups.yahoo.com/group/howhusbandsfeel/
Resoectfully: MIke in Jax. Fla.
Thank You Maurice,
God Bless you and all those you teach. I am going to send this blog to my husbands doctor. She is a teacher to.
Kim
Dr Maurice,
I'm pretty confortable in my own skin. on the occassion where I have been nude in the presence of medical staff, it has never really bothered me. I don't have a perfect body but who has ?
There have however been a couple of instances where I felt there was a subtext to a persons actions. I have spina bifida and I use a wheelchair. On one occassion when I was in hospital,I was left nude on a trolley in a side room for 40 minutes. I had spilled hot coffee in my lap a week before and had to come in for dressings everyday. The nurse in question took me into the room, asked me to undress and then disappeared (it turns out it was a staff meeting !!). After she left I noticed that there was nothing to cover myself with. i didn't know how long she would be gone for so I simply waited. At one point a male nurse did come in for some equipment, he said hello but left before I could asskk him for a gown. To make matters worse he left the damn door ajar. I had to get myself up and over to the door to close it.
The fact that I was naked is not the issue, what annoyed me was the level of disrespect, if I was someone who had huge modesty issues I could have been very trumatised. The nurse obviously did not give any thought to me whatsoever.
How would she feel if the role had been reversed and she was sitting naked in a public place.
Dr. Maurice,
Over and over again you have stated that there is nothing sexual involved in seeing a patient of the opposite sex undressed. How then do you explain that male medical doctors are many times more likely to have committed a sexual offense than the male population at large? In a random gathering of 1000 men, less than 10 of them will have committed a sexual offense. In a group of 1000 doctors, 100 of them will have committed a sexual offense. This is outrageous!
An article in the March 1998 Archives of Family Medicene details a study in which it is found that physicians are less comfortable and less skillful performing "intimate" examinations of patients of the opposite sex: "Conclusions Internal medicine and family practice physicians report significantly less comfort and lower levels of skill when performing sex-related examinations or obtaining a sexual history from patients of the opposite sex." Clearly if the goal is to provide the best quality healthcare, then such examinations should be restricted to providers of the same sex.
In a recent post "BBB" relates having a male doctor repeatedly lift her breast to look at a fully healed bypass scar. Can you offer any valid medical justification for this action?
I can't find BBB's comment but in any event to the question "Can you offer any valid medical justification for this action?", the answer is very difficult for me to give. I know nothing about the details of the examination or the patient's condition. If there was repetitive looking under the breast by the physician which concerned the patient, the patient should have asked for an explanation of this behavior. Physicians should anticipate question when unusual activity is needed during the physical exam. I can give you an example about another activity or "inactivity" a patient notices during a routine examination of the heart. If the patient is unaware of any established heart condition and notices that the doctor is spending "a lot of time" just listening to the heart, patients may asked the doctor "why are you spending so much time listening to my heart. Do you find something wrong?" All heart sounds are not easily identified in every patient with a normal heart and sometimes it takes time to sort out the sounds. I advise my students and follow my own advise by telling the patient if I am listening to the heart for more than 30 seconds or so (about the length of time a patient will tolerate) that I am simply trying to identify sounds but if the sounds are normal reassure the patient their heart is normal but I am simply trying to be thorough. Patients don't realize that doing a proper physical exam on the heart may take more than their expected time limit. ..Maurice.
Dr. Maurice, my comment is 4th or 5th from the bottom on the "Naked" postings. I was in the E.R. for angina and was 2 years post-cardiac by-pass (using the DaVinci robot - thus the much smaller scar). The anonymous poster must be wondering ... as am I ... if there would be any reason to continually check my totally healed scar just because I present with symptoms of angina/MI. At the time the doctor was NOT listening to my heart. I mentioned my cardiac history and he started looking at my scar and didn't stop lifting my breast until he noticed my significant other sitting next to my gurney. I was about to say something about it but he stopped suddenly upon noticing that my significant other could see that he was touching my naked breast. This behavior really made me uncomfortable. Is there any medical reason for his behavior? BBB
Dr. M.,
I find it irksome in your response that you make it incumbent on the patient to inquire about what is apparently a totally unidicated intrusion on her modesty. The physician ought to have told her what he was about to do and why he was doing it, thus giving her the opportunity to decline if she wished.
To the last Anonymous, as I indicated in my last Comment, I think it is the proper professional behavior for a physician to anticipate patient concern and inform a patient when some "unusual activity" is being performed as part of the physical exam. Just as I might have to spend 2 minutes instead of 15 seconds to listen to heart sounds as I described in my last Comment, if a physican has to lift up and look under a breast repeatedly over a short period of time (as BBB described) then that patient-sensitive behavior should also be anticipated and explained by the physician. But if the doctor is so unthinking or unwise to persist without communication, it behooves the patient to take the lead and ask "what exactly are you doing?" The patient has the right to protect his or her own body from unexplained and unwanted intrusion even if it is a doctor's office. I hope I have made my position on this issue clear now. ..Maurice.
Dr. Maurice, If you have been reading the postat HHF you see that there are many different levels of thought within the issue of loss of intimancy in a relationship during personal exams.
With all the internet research that we have done at HHF we have not come across any formal articles written to make medical students aware of this.
Many of the men that have posted comments at HHF and the other 2 big groups that deals with this are still impacted by exams that occured years ago.
Medical students(tomorrows Dr.s) and doctors of today, need to be aware that even though paitents are treated as indivduals when they are married an intimate exam or procedure has the potiential to affect more than just the paitient.
Thanks for lisitening to our opinions with respect
Mike
Here's a male doctor who apparently found something sexual about examining a female patient. I suppose he "should be dealt with and possibly removed from practice."
http://www.tv7-4.com/Global/story.asp?S=4932437&nav=1vrj
To Anonymous of today 5-22-06: If the facts prove that he is guilty of the behavior with which he is accused, of course his license to practice medicine should be permanently revoked. Even one act of sexual assault on a patient should be enough for such punisment in addition to appropriate prison time. It is actions by physicians as is suspected in this Michigan doctor that raise patients concerns about the way physical exams are carried out as discussed on these posts. ..Maurice.
Dr. M.
Here is a link that you might find intresting. Just one of many that we have compiled over at how husbands feel.
http://www.kgw.com/sharedcontent/APStories/stories/D8H60AO81.html
We do need more Dr.s like you that will stand up and insist on the disipline you supported in your last post. Removal of Dr.'s who practice sexual misconduct the first time around.
One of the common things that I noticed when reading acounts from ladies who ws molested by their dr.'s was they all seemed to think that they was the only one. They also thought that since the dr. holds such authority that no one would belive them so they choose to live with this sexual abuse untill someone else with more courage spoke up.
The truth is we are all human and have sex drives. The law of adverages would have to support that if a male is placed in a position to have intimate access to a female, then he would be more likely to have sexual thoughts/impluses/actions than if he did not have this intimate access.
You will never convince me that a male gyn has never looked at or had thoughts of a female patient at some point in his profession as anything other than strickly business.
Have a great day:
Mike moderator @ howhusbandsfeel
In case you missed this one, here's another doctor who apparently was finding something very sexual about his female patients. Being an ob-gyn, according to the conventional medical line, he should have been completely unaffected, having seen so much day in and day out.
http://www.stltoday.com/stltoday/news/stories.nsf/stlouiscitycounty/story/6DC007C6D34CCA828625717900179C80?OpenDocument
"My suggestion is that if a patient finds modesty a personal issue at the time of the exam or proceedure, the patient should speak up about their concerns at that time"
This is exactly it a lot of the time. So many people go into exams expecting/trusting that their modesty will be respected, and come out feeling violated, humiliated, shocked, etc, when it is not.
It's very sad that some providers really do not respect the "private" stuff, and assume that everyone is comfortable in the same situation. Also there are many situations where there is no need to remove things like underwear, but nudity is still enforced for some reason.
I can't speak about surgical procedures since I've never had one, but when it comes to physical (non emergency) types of exams, I think it really is up to the patient to get informed ahead of time and make sure to ask exactly what the doctor is going to do, and what the attire will be.
Some people (like me) have abuse history and a lot of body shame and are not comfortable with nudity. I have a great doctor who is very respectful of my boundaries, but I made sure to do a verbal consult with him first to clarify what would take place, and how, so that I would not be put into a situation of being victimized.
Times have changed, and we are beyond the era of simply doing whatever we are told to in the doctor's office. Perhaps someday we will achieve a greater amount of mutual respect where doctors will ask for consent before performing invasive procedures, instead of just doing them and assuming that the patient is comfortable with it.
Until then, it's up to the patient to be proactive, get informed, and most importantly, always remember that you have the right to say NO to any type of exam. If the doc gets an attitude about it, take your business elsewhere. As patients, we will be treated respectfully as soon as we collectively agree that nothing less is acceptable.
I probably will stir up some commotion on this post by my comment here today. I fully agree with the point made by Mike about the potential "sex drives" of everyone, including physicians, most reasonably of both genders. And physicians have to deal with those drives just as they must deal with other personal conflicts of interest when they assume responsibility for their patient's medical care. Particularly with regard to sexual interest in patients, this conflict of interest will be most damaging to both parties if not held in check. But.. and here is the "stirring" part of my comment..there also has to be control of sexual provocation on the part of the patient! Though truely a rare occurance, there are seductive patients out there to challenge the most professional physician's ability to divest sexuality from the doctor-patient relationship. Seductive patients can be male or female but usually female. Physicians are cautioned and taught in medical school about such patients and about their suggested management. Usually, the motivation for these patients' behavior is one of manipulation and control of the doctor-patient relationship and not for having the doctor engage in sexual activity with them. It would be interesting to read how my visitors would advise a physician to deal with a seductive patient if one should ever come into the office. ..Maurice.
Doc, the bigger problem is the 1 in 10 doctors who are sexual predators. You explain what motivates patients to be seductive, but you offer no insight into what motivates a physician to take advantage of a patient and risk prison, the loss of his practice and family, not to mention the lasting harm done to the patient. If 1 out of 10 of a population were afflicted with a certain disease, you would be looking for ways to prevent it.
Why did the Minnesota Medical Association say the following: "The MMA expresses extreme displeasure with the Board of Medical Practice's practice of publishing the existence of physician sexual misconduct allegations together with the detailed factual account of those allegations"?
There was a patient who woke up following a colonoscopy to find the doctor's semen on her face. In another instance a woman awoke following a hysterectomy to find a doctors penis in her mouth. Another patient had her breasts groped following a c-section. I had no idea that having a colonosocpy, or a hysterectomy, or a c-section delivery were so seductive!
May I make an important suggestion to aid in the intelligent discussion of the issue of sexual misbehavior by physicians? Please give some reference source or link for the basis of the visitor's statement or assertion. For example, in the last two comments, a direct link to the MMA statement would be helpful in order to read the full context of their view. Also, references to the source of alleged physician sexual transgressions would be important for the other visitors to understand the validity of the facts presented. I think examples to substantiate an argument are important but also it is necessary that some reference to documentation is also included. ..Maurice.
"the point made by Mike about the potential "sex drives" of everyone, including physicians,"
Yes, I think most patients understand this and realize it can't be helped. However, this is all the more reason that modesty issues are *extremely important* and need to be given much more precedence. Also, society's attitudes toward sex have changed so much in the last 40-50 years that I'm sure there is much more sexuality read into doctor/patient encounters than there would have been in the past.
"there also has to be control of sexual provocation on the part of the patient!"
I don't know if this is the case, since virtually any profession has pretty strict rules about how you interact with clients/customers. The burden is *always* on the provider of the service, no matter what, he's the one getting paid for the encounter.
Whether you are in retail or medicine or whatever, you are always going to meet provocative people who are going to try to get your attention sexually. (Or just be rude, aggressive, psychotic, etc.) And you have to be the grownup and keep calm and handle it without reciprocating.
"Though truely a rare occurance, there are seductive patients out there to challenge the most professional physician's ability"
Yes, I'm sure there are. (Especially since women tend to be naturally attracted to doctors!) And it's especially difficult to maintain professionalism when there is so much physical contact and exposure happening, moreso than in another type of profession.
So, while these people are annoying and we wish they would keep themselves under control, they are the customer, and they are not getting paid 6 figures a year to be "good" when they see a doctor. When I'm a patient, I am paying $80-$120 for a 20 minute visit, and I do expect service with self control and a smile no matter what. Hell, if I can do it for minimum wage, surely doctors can.
All I can say is that it's a professional courtesy (in any situation) for the client to be polite and act appropriately (what a better world it would be if everybody could do that!), but I wouldn't put it on them as a requirement or obligation.
Anyway it ties nicely into the modesty/naked topic. I think people should not be exposing things unless the doctor is going to have physical contact with that body part specifically. This goes for physical exams (get consent before these areas are exposed) as well as surgery (is underwear *really* going to interfere that much with most surgeries?)
Sorry, I already posted but just wanted to add:
"Doc, the bigger problem is the 1 in 10 doctors who are sexual predators. You explain what motivates patients to be seductive, but you offer no insight into what motivates a physician..."
I have to disagree here. I think a lot of these transgressions are not due to perversion, just misunderstanding or callousness. A lot of doctors really do think they are doing a good job and acting appropriately, but just don't take modesty into account as they should. They get so involved in the physical aspects and "divesting sexuality" from the encounter that they forget that the patient is a whole person with emotional components. To truly empathize with patients, doctors ought to see that all physical encounters ARE going to be viewed as sexual by the patient, at least to some degree.
Again... respecting modesty is the key.
Okay Doc, here you go.
Penis in mouth following hysterectomy and breast "fondled" (I hate that usage here; fondle implies a loving touch):
http://www.stltoday.com/stltoday/news/stories.nsf/stlouiscitycounty/story/6DC007C6D34CCA828625717900179C80?OpenDocument
Gastroenterologist turned on by colonoscopies:
http://www.nbc5i.com/news/4244400/detail.html
and:
http://texaswomenscoalition.org/news/index.php?NewsID=128
Six to 10 percent of physicians admit to sexual contact with patients and the phenomenon is likely under-reported:
http://www.tmb.state.tx.us/news/Spring02/spring02.php
Physician sex abuse under-reported:
http://www.pulsus.com/members/sex/03_03/Pdf/assa_ed.pdf
From a Vanderbilt Unviresity study: "According to the American Medical Association (2001-2002 Edition), 797,634 physicians are actively practicing in the United States. If the survey data are accepted, the potential problem estimates at up to 10 % of the physician population or 79,763 physicians. This is a substantial number and should be considered a priority problem for medical educators, physician leadership groups, and the Federation of State Medical Boards of the United States."
Here's the link to that one:
http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=742
Minnesota Medical Association wanted to cover up physician sex abuse:
http://www.mmaonline.net/policycomp/sectionDisplay.cfm?recNum=100.00
Physician sex predators harm patients:
http://journalsip.astm.org/JOURNALS/FORENSIC/PAGES/3529.htm
http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_ai90.pdf
Thanks to Anonymous for all the references. They can provide all of us with extra background thus enhancing our education on the issues being discussed here on this post. Again, thanks. ..Maurice.
Dr. M:
I think what the last poster was pointing at is the fact that sexual misconduct is not an isolated case that happens once ever year or two and it is much more than A "TUBE" (totaly unnessary breast exam) BTY that is a term used by medical personal themselves. That's who shared the term with me.
My concern is that sexual misconduct is very underreported and when left unchecked the "tube" is no longer enough for the molester so he wades deeper and deeper until he does something like the links above that the past poster showed you. (penis in mouth of paitient) etc.
The above links to articles of bad Dr.'s are in the links section at how husbands feel as well as about 100 more collected in just a few short months. I don't cull them I post them all.
90% are gyn's.
My question to you DR. M.
Why do gyn's comitt sexual misconduct at a higher rate than there counterparts?
Is it just the repeted exposure to intimate exams/procedures or was there a deeper reason why a male DR. choose to be a gyn in the first place?
Studies show that a rape is more about control that sex.
What is more controling than a Male DR. and a naked female paitient.
Your thoughts on this please.
Mike moderator @ HHF
Thanks to the poster who gave all the links about bad doctors. I have a few of them already but a few I did not.
This should be eye opening but most women themselves will dismiss this as " Oh my Dr. would never do this"
My wife herself is an R/N who has heard all the chit chat by doctors themselves about things such as "TUBEING" a female paitient, but when she looks at her own healthcare she blindly accepts whatever comes her way without the thought that her Dr. can have the same thoughts and maybe actions as others. When I point out all these reports and articles she just says. "My Dr. could never be that way"
Dr. M.
Have you ever read the book (Male Practice) by Dr. Robert Mendelsohn? I do agree with much of what he states in this book. Dr.s are looked at above other in society, females do still for the most part look at men above themselves, no naturly women look at male Dr. as men who can do no wrong and do blindly accept whatever is sold to them at face value.
Have a great day all:
Mike tenderhusband, moderator @ HHF
Maurice,
What are doctors taught about patients who have been abused or molested? Do they have signs they look for? If they see something unusual. What are they taught to do for the patient or how to handle them? It sounds like you have diffrent groups you put people in. Is this a group too? What about a patient who is just shy? How do you handle that during an exam?
Kim
Kim, if a physician suspects or finds evidence of abuse, such suspicion or evidence must, by law, be reported to police or other protective services.
A shy patient may acknowledge his or her sensitivity prior to the exam or if not the physician must be aware of the possibility in any patient and through communication discern the issues with the exam that the patient might become upset about. Then, the physician would explain, reassure and monitor the response, but as with any part of the exam if the patient does not agree with what is being done and says "stop!", the physician must stop otherwise further unwanted examination becomes legal battery. ..Maurice.
I'm not saying the doctor is wrong. What are medical students taught to look for and what are they taught to protect both themselves and the patient? Do you look for behavor? My current doctor is a lady and she noticed me being nerves. Somehow she knew. She is the first doctor I have come across like that. I had to have acid reflux surgery a year ago. One of the OR nurses was a wife of a guy that I cut his hair. Anyhow I just ask him to see if she could be in there with me. She did and after she ask me if I was ok. She said she could tell I was really worked up just before I went under. She also could tell I had been through something. It was nice of her to ask. I think for some people the concern medical professionals show can really help. Is there a way to teach this or is it just some People get it and others don't?? Is it something you discuss in medical school? Some people who have been abused in the past may have only emotional symptoms. Is this something you talk about in medical school?? How are you taught to respond to this kind of patient? I know you can't have ESP. Maybe I am asking too much. I was just wondering.
Kim
Oh one more thing. some of the people who treated my husband were very responsive to me and others were very confused. At times it felt like a power struggle and after the stand off they gave in but with resistance. Others treated me as equal and welcomed my help. This is something that if not should be talked about to the medical student. I see it as compassion for the patient and the spouse. I was very thankful for the ones with compassion.
Kim
Dr M,
I don't think that issues of inappropriate behaviour is restricted to those who hold a medical degree.
Although the vast majority of nurses I have encountered have been fantastic I have on one or two ocassions met some who at the very least shown a complete lack of human empathy.
I have Spinda Bifida and asside from yearly medical check ups I've had 5 major operations to help correct a curvature of the spine and some urology problems. In short I have a lot of hospital time on the clock. So it's probably enevitable that I would eventually run across one bad apple.
On one occasion when I was in hospital I had to undress and take a bath while a nurse stood in the room watching me. I'm capable of looking after my own needs and I explained this to her but she insisted that she had to be present for insurance reasons. I didn't question it at the time but now I wonder what was her motivation.
The second incident was much more overt. I was in traction after an operation on my back. I was unable to move and I was naked underneath my blankets. One nurse a catholic nun, treated me as if I was nothing more than a piece of meat. Whenever she was tasked with washing me she would strip off the blankets and leave me totally exposed, once she was called away by a colleague and simply left me naked. An orderly who was bringing me breakfast had the decency to cover me and complained to the ward sister. I never discovered if any action was taken but I'm glad to say I did not encounter that particular nurse agin during my stay. However for all I know she is still working there and doing as she pleases.
More physician sexual misconduct, or were the patients just too seductive?
http://www.thederrick.com/stories/06072006-3004.shtml
Dr.M. One more for the record here. This DR. was given 50 hours of comm. service 3 years after commiting sexual misconduct. He was allowed to plead his case in court just to say he was "only curious" and that is why he fet of this woman's breast. She was not alowed to speak in court, because of the plea arrangment he made with the court. This is a perfect example of what needs to be changed. Dr.s are themselves going to have to take a stand against this. Dr.'s complain about the high cost of medical malprictice insurance but do nothing in the way of taking a stance for change in the status quo.
Since I first posted to this blog about a month ago we have uncovered 20 new cases of sexual misconduct in America involving Dr.s.
Respectfully submitted:
Mike moderator at how husbands feel.
There will always be "bad apples" in the medical profession as elsewhere. These misbehaving physicians should be denied the practice of medicine and be given appropriate punishment if laws are broken. If judges fail to do what society has given them the power to do in such cases, society should identify them and remove them from judicial office. ..Maurice.
Well doc, here's another one:
http://www.wftv.com/news/9343249/detail.html?taf=orlc
You gloss over what is clearly a major problem by saying there will always be bad apples in the medical profession. What you have never even begun to address is why the rate of sex offense among male physisicians is many time greater than the general male population. Wouldn't you be outraged if 1 out of every 10 teachers at your child's school was a sex offender?
To Anonymous of today June 9, 2006: If the statistics are what you describe, I have no explanation. I follow the beginning physician in the first two years of medical school and in my 20 years of experience I haven't seen any student whom I could identify as one who might be a candidate for sexual offense on a patient in his or her future career. To identify such a student would require criteria of observing a unprofessional behavior or unprofessional talk to a patient or by the way the student would talk about sexual issues in our group sessions. Beyond the second year, I personally have no experience. Certainly, as the years progress beyond medical school, the former students will be examining patients on their own and have less direct personal supervision of their behavior by their mentors. It therefore is the responsibility of other physicians, hospital staff and the patients or families themselves to bring any observed unprofessional behavior to the proper authorities for action. How these rotten apples get into medical school in the first place is because we have absolutely no way to weed them all out. Usually, however, just studying to get into med school, affording the great financial expense, years of further study and work to graduate and the physical and mental strain to continue a career in medicine should provide some screening effect on those who apply to med school but are interested only in the opportunity to have sexual fun with patients. I have no further comments to these concerns you and the others present here. Maybe the public has some suggestions of how to prevent this behavior on the part of doctors. ..Maurice.
You said, "Maybe the public has some suggestions of how to prevent this behavior on the part of doctors. ..Maurice."
You could initiate teaching a class on appropriate behaviors on the part of physicians and on ethics to your students. BBB
BBB, at the Keck School of Medicine of the Univ. of Southern California where I teach, we have a course in the first two years of medical training that deals with issues of professionalism (appropriate behaviors) and on ethics. As I have already mentioned, all of this teaching. our "established constructive ethical curriculum", may be deminished in some students by their later experience as part of the "hidden curriculum" taught by,at times,unprofessional superiors and others. Keeping medical students and residents on the ethical "straight and narrow" is not easy and not always successful. What would be helpful would be periodic licensing reviews of each doctor during their years in practice covering not only their medical knowledge and their technical skills but also an investigation through surveys of their patients and review of all malpractice incidents about their ethical and professional behavior. ..Maurice.
Good suggestions Dr. Maurice! The problem would be getting past the resistance of physicians to enforce even the simplest forms of disciplne on another physician. In my own experience, years ago my wife to be was seeing an ENT who was telling his patients that taking Tylenol would relieve their inflammation. I questioned my sweetie's confidence in a doctor who would display such ignorance of basic pharmacopoeia. I even asked my soon to be father in law, who was a pathologist, why this ENT would say such a thing. He gave me all sorts of hemming and hawing, and never did actually say the other physician was in error.
Elsewhere in your own blogs, you have said that when your medical students practice on one another, the males are bare chested and the females wear sports bras. Why is this? Is it because you really feel there is something inappropriate about having a female exposed in this manner? The way to stop the physician sex abuse is the same way the medical boards do when they catch a doctor with his eyes or hands or some other part of his anatomy someplace they shouldn't be, doing something they shouldn't be doing: they restrict them to examining and treating only patients of the same sex.
To Anonymous of today June 10, 2006: Don't be so gloomy about doctors reporting doctors, it isn't unheard of. By the way, there is nothing inappropriate for a physician to order Tylenol to relieve the pain or burning feelings of inflammation in the upper respiratory tract. Some patients are intolerant of aspirin which would also be appropriate. With regard to students examining each other: please remember that these boys and girl med student groups are not strangers to each other and they are not each other's real patients. As teachers of medical students, we are as much concerned about a student's modesty as you would like to have your physicians to be aware about modesty of you or your husband or wife. We don't demand that female students who would be uncomfortable doing so to bare their breasts. The basic techniques can be easily learned with a bra in place. The students will have plenty of experience performing breast examinations with inspection and palpation as they should be performed without a bra on real patients who need their breasts examined. I hope this explanation is clear. ..Maurice.
See Dr. M., you are doing it too! The ENT I referred to was NOT telling the patients to take Tylenol for PAIN, he was telling them to take it for INFLAMMATION!
In some of your other posts you have said:
" a heart exam requires the physician to lay his/her hands on the chest and breast. "
and:
"The doctor may have his/her hand lying on the breast or lifting the left breast and putting a hand beneath the breast to palpate for thrills, lifts and apex impulse."
How are you able to teach these techniques while the females are wearing sports bras?
"With regard to students examining each other: please remember that these boys and girl med student groups are not strangers to each other"
I would think that most patients, after a few visits anway, are not strangers to their doctors!
You said, referring I think to breast exams:
"The basic techniques can be easily learned with a bra in place. The students will have plenty of experience performing breast examinations with inspection and palpation as they should be performed without a bra on real patients who need their breasts examined."
This really makes no sense at all. The point is not that the female med students NEED their breasts examined, the point is that the other doctors need to be taught the proper techniques.
"I hope this explanation is clear."
Not really; so many of the postions you take are equivocal and inconsistent.
Anonymous- I left out that the second year students have a session where they examine the breasts of a standardized patient teacher who gives feedback to the student technique and professional behavior. In any event, all the descriptions I have given you and my visitors on this or other posts regarding teaching physical examination in medical school are really simplistic. There is far more detail which makess up the actual process which is carried on over the two year period. Suffice it to say that all the proper ethical and professional behaviors are demonstrated and stressed to the students over these two years. Hopefully, they will continue these teachings throughout their careers. If they don't then physician's behavior needs more careful scrutiny and actions taken by society to either mitigate bad behavior or relieve physicians of their license to practice. As far as I know, in every U.S. state, the public can and should notify their state medical boards about professional issues regarding specific physician they find wrong and expect a response from those boards. For either the professional colleagues or the public to keep a blind eye to bad behavior will not improve the ongoing problem. I hope that is clear! ..Maurice.
It is easy to see why doctors can't admit a mistake. It opens them up to huge lawsuits. How can we as the public really blame them?? However how can they blame us for wanting them to. When my husband was in the hospital he got an infection on his last surgery. I tried to point it out but only until it got very red and I had an older nurse point it out for me it got no attention. He still got medication in time and it didn't do any damage but it could have and could have been treated earlier. I told his attending and she acted like dhe didn't hear me and I was making hae mad. If I was the teacher I would have ask what happened and find the student who didn't believe me and correct him. After all he needed to learn and he missed an post surgery infection. But again they can't admit fault. It's a catch 22 all the way around. The bigest problem is it is at the expense of the patient. Doctors and nurses are human. In a perfect world it would be nice if we could give them some slack and they in turn could give some to us. It would make for better health care. To all the patients out there. You know your body better than anyone. Don't take no for an answer. Protect yourself and don't think that someone else will take care of it for you. To all the doctors out there we have to trust you. When you are sick you are at the mercy of the people who take care of you what they do and what they think. If you go to medical school you are saying you will do everything you can to take the best care of us that you can. Like I said it's a delicate dance. As for the bad apples... It is up to all of us to get rid of them. There is no easy answer or there would be no war and no crime. Personaly I think most patients don't or won't speek up. Maybe this is something we need to work on.
Kim
Hi Dr. Bernstein. I just wanted to thank you for bringing this topic of modesty up. There aren't many opportunities where people are able to speak with a real doctor anonymously on an issue like this. I am a modest person myself, but ended up with a great doctor, which happens to be male. My original choice was a female doctor because of my shyness issues, but during my pregnancy, the only doc that was willing to work me in for what turned out to be something serious was the youngest male doctor in the practice! LOL I ended up having to see him because he knew most about what was going on with me. Turns out he has been the most kind, understanding, respectful doctor I've ever had. I can now see that male or female, you really just have to have a good feeling about the doctor you are seeing. I agree there are some bad apples out there, but I also think there are a lot of excellent providers, both male and female, who do what they do because they care and want to help people, and those are the doctors I seek out. Anyway, I just wanted to say I appreciate what you are doing and I enjoy reading your posts. This seems to be a very touchy subject! :-) Again, thanks. Your blog is very interesting to read.
I've been reading your blog with great interest. Over the years, I've had several very unfortunate experiences of what amounted to outright abuse at the hands of male physicians, which I will willingly relate at some other time. What I'm angry about right now, however, is something that happened to my husband during a routine screening colonoscopy last week.
First of all, because neither one of us had met with the doctor before hand (he was a referral from my husband's primary care physician) I went in to the procedure room along with my husband in order to at least have some initial contact with the person performing his procedure. We were walked into the exam room by the nurse (female) who was to be assisting the doctor. She was quite resistant to my being there but as I had already been told that it was okay by someone else on the staff, I simpy insisted and followed them down the hall into the room. She was quick to let me know that I was going to have to leave for the actual procedure, which I found to be perfectly acceptable and appropriate. My husband certainly didn't need an audience!
As I'm sitting there she then takes away the gown my husband has been wearing, which leaves him standing with his back to me and to the OPEN door of the exam room naked from the waist down. Then, WITHOUT CLOSING THE DOOR, she rolls up his shirt, which completely exposes his naked backside not only to me to me but to whomever might be walking by! What was it that I said about my husband not needing an audience? I quickly looked to see if there was anyone around (there wasn't) but I felt that this was very insensitive and disrespectful of my husband's modesty and privacy in any case. I didn't say anything at the time because I didn't want to make waves with someone who was going to be a part of my husband's procedure! The doctor finally came in to the procedure room, we discussed what needed discussing and I was summarily ushered out of the room.
I should now preface what I'm about to share by saying that my husband opted to have his colonoscopy without ANY sedation at all so he was completely lucid and aware throughout the procedure...
About half way through his colonoscopy, which was extremely painful because my husband has an unusually shaped colon, with extra turns, someone started to knock on the door of the room, loudly and insistently! It is unclear whether his nurse opened the door or if the person knocking just got tired of waiting and opened the door themselves, but a woman in medical garb appeared in the doorway with the door OPEN to the hall!! Keep in mind that my husband is in pain, not to mention that he is in a very vulnerable position as far as his modesty is concerned, for crying out loud and now has an audience in the form of an unknown woman with an unknown credential demanding that the nurse who is assisting my husband's doctor leave the room to help her with another patient!! SO, the nurse LEAVES the room for several minutes, which puts my husband's colonoscopy on hold! The doctor says absolutely nothing and waits for the nurse to return before proceeding any further.
Needless to say, when my husband told me this I became furious and there are a few letters that have yet to be written...to the doctor, the facility and to whatever professional boards to which they are accountable and which regulate their behavior.
The first indiscretion (of exposing my husband's naked backside to an open doorway where anyone could have been walking by) was completely inappropriate and demonstrated a serious lack of sensitivity to my husband's modesty. When his colonoscopy was interrupted by the female in medical garb (nurse, technician, member of the front office staff??), however, it was a much more serious breach. If she felt her only recourse was to interrupt a procedure that was already in process (in this case my husband's colonoscopy) and demand that it be put on hold until the other patient's need was attended to...what does this imply about the general lack of professionalism and insensitivity of the staff of this facility!? Furthermore, the nurse who left my husband's room had no business leaving and the physician performing his colonoscopy should have insisted that the intruder leave immediately and seek appropriate backup from someone who was not already assisting in a medical procedure!
I believe, sadly, that this kind of thing happens much more often than we are aware. Generally, people are sedated for colonoscopies so the woman knocking on the door probably regarded my husband with no thought whatsoever as to his feelings, his dignity, his modesty or his discomfort, assuming that he was out for the count and wouldn't know the difference anyway. No big deal, right? WRONG! Isn't it bad enough that we, as patients, have normal concerns about the physical discomfort of various medical procedures, issues about modesty, and perhaps concern over the outcome of the procedure, without also having to be concerned about whether or not we're going to be treated with some fundamental level of respect throughout?
Sorry for being so long winded! It is difficult to know that someone who you love has been treated with so little respect or concern for his diginity. Whether or not one is sedated ought NEVER be a reason to be lax in this department. But, it doesn't always take sedation for a doctor to overstep his bounds, as in the case of one internist who felt it was his professional duty to perform a breast exam on me regardless of what my presenting problem happened to be t the time. I was much younger and naive in those days!
I'd appreciate your input.
What can I say? Well.. I think it is up to your husbands doctor and staff to say. And if they don't listen to you and your husband's complaint or if they have nothing to say.. not even an apology, I would say "don't go back to that office". The other step I would take would be to have your husband's primary and referring physician aware of the circumstances. This information along with complaints from other patients referred may have the primary physician change his or her referral practice and that might be a good thing. ..Maurice.
To angery wife,
It depends on how angery you are and how far you want to take it. Things like this won't change until we (the patients) speek up. You can make a written complaint to the hospital or the nursing board in your state or if you are really pissed write to HIPPA or JACO. JACO stands fpr Joint Commission on Accreditation of Healthcare Orgnizations. HIPPA is privacy rights issues. Now in your case you might not be that angery but you should know all your options. It will also mean more if your husband files the complaint because he was the patient. My husbands case manager is a nurse of 40 years. I asked her why some of the staff was very respectful and some not. She said it was about control and power. I'm not sure why you would wan't to abuse your position in that way. After all most patients feel they have no control and are just looking to the staff for comfort. Anyhow it's time to speek up. Try it in a nice way and if that dosen't work be a bitch.
Kim
Whops! If you have read my other comments you might be wondering where my anger is comming from. My husband is in the military. His first 2 surgeries at this hospital. He was tranfered after he got staff infection in his blood. I am in a battle right now to get the hospital to change there policy on letting a family member stay in the room over night with their loved one. The other hospital he had the last 3 surgeries let me stay. They were very nice. I did all of his wound care when we were at home and became very protective of him. The other hospital seemed to understand this. I'm still very angery that they caused his infection and didn't notice it until it was almost too late. They said even if a patient had come back form the war and haden't seen his wife for a year they wouldn't allow her to stay. I hope that makes you as sick as it did me to hear. Anyhow my next step is JACO and our Senator whom I have already spoken to his military aid and the Pentagon. I gave up my business of 10 years to care for my husband and have nothing better to do. I have ended up with PDST from the whole thing and feel better when I am fighting. I want to tell everyone what happened to us.
Kim
Well, Dr. M, I frankly expect a LOT more than an apology from the doctor, the nurses and the staff of the facility where my husband's colonoscopy was performed. Let me assure you that there is no way that either one of us will ever grace the halls of their facility in the future nor will we ever deal with the doctor in question again. We will absolutely inform my husband's primary care physician about what happened (thank you for that suggestion), as well as everyone who might ask us about the procedure in the future. I have a zero tolerance approach to this kind of behavior. I do intend to write every agency possible, as well as those individual involved, and let them know in no uncertain terms that their indiscretions were duly noted, will not be tolerated, and are being reported to regulatory boards and the like.
You know, the doctor involved could have spared himself a lot of grief had he simply spoken up and taken appropriate charge of the situation right then and there. My husband should NEVER have been put in that position and his physician should have reacted accordingly...and maybe even had the decency to apologize to my husband at that very moment. I can only hope that he said something to the other individuals involved after the fact, but I do know that he said nothing to either one of us
As a psychotherapist (I have an MSW and had a private practice for many years), who has some experience with the delicacy of client/patient concerns as well as their rights as established by my profession and the statutes which regulate it, I cannot and will not be silent. If something akin to this had happened in my office, where my client's right to privacy was not respected, I would be in serious trouble right now.
It is so sad to me that the medical PROFESSION has become so much more of a medical BUSINESS, where people are processed through the system with so little regard for their humanity; their wholeness as a person...where they are reduced to just "the colonoscopy in room 3." Well, "the colonoscopy in room 3" was MY husband. He is a brilliant, ivy league educated engineer with advanced degrees. He is also a cellist. He and I have been married for 29 years. He loves anything with garlic and pecorino romano cheese (my influence...I'm Italian). He has the kindest heart going and will willingly give people the shirt off his back (but not necessarily choosing to expose himself at the same time). He skis, snorkels and tends to the needs of his aging parents, and mine, with great love. And I'm only scratching the surface here. But you know, his particular intellect, level of education and/or his general interests are not the issue. The point I'm trying to make is that we, as patients, come from all walks of life and, regardless of what those walks might be, we ALL bring our WHOLE selves to any medical procedure. My husband didn't just show up so his colon could have an experince that was somehow detached from the rest of him.
Would it be so difficult to add even just 5 minutes to the check in procedure so the people involved in a patient's care could have some sense of who they're dealing with and what their personal concerns might be? Maybe then they'd remember what they were (hopefully) taught in medical school...that patients are unique individuals, actual human beings, in point of fact, with feelings as well as a physical body.
As for those physicians who view their profession as a business, here's a heads up. I was originally scheduled for a colonoscopy with that same doctor, at that same facility, two days after my husband's. Needless to say, I cancelled. I'm now having my colonoscopy tomorrow, at a different facilty, with a woman physician, and I called their this morning to make sure that we were all on the same page about what is acceptable to me and what isn't. I don't think I'll be having the same kind of experioence that my husband had. At least, I certainly hope not!
No, a simple apology will not suffice.
way to go Angry Wife: I'm sure that your husband inside is gratefull that your new provider is a female.
It is true, the doctors defense is that he has reduced us down to medical meat. Society tell us that a male DR. who sees naked females under intimate conditions every day only sees them in a medical light. Hre is a link to another thread about a lady who after a colonoscopy woke up with the Dr.'s penis in her mouth. The message thread also has the contact of her attorney listed so I have no doubt that it is real as well as a internet search of his name trurns up many articles on the case.
http://www.doctorandpharmacy.com/members/board/showflat.php/Cat/0/Number/77335/Main/76782
Again, hats off to you for choosing a female DR. for your intimate procedure.
Respectfully:
Mike aka tenderhusband and moderator at how husbands feel
PS. We have close to 100 doct. cases of DR. sexual misconduct listed in our links section.
Maurice, Thank you for initiating this forum. Do you really think, though, that an apology from the physican, facility management and/or staff members involved in my husband's colonoscopy would actually be reason enough for us to consider using their services again? Why would we reinforce their bad behavior, which I consider to be an example of an all too virulent strain of institutional pathology in the medical profession/business in general? Where would be the impetus for them to reconsider the way they provide 'care?'
I have learned over the years to view MD's not as Medical Dieties (an elevated position that they have enjoyed for way too long in our society) but as paid medical consultants whom I hire to perform a service...hopefully on my own terms. I can choose to accept their input or seek another opinion. But, in all cases I DEMAND appropriate, respectful behavior at all times for myself and my loved ones. Unfortunately, my demands sometimes go unheeded as is obvious with what my husband had to endure at the callousness of his providers.
Kim, Thank you for the suggestions about to which agencies I might write to air my grievances! I do understand how helpless one can feel when a loved one is mistreated!
Mike, When we walked in the front door after my husband's colonoscopy I, frankly, burst into tears at what had transpired during his procedure. After what I have experienced personally at the hands of some male physicians it was very difficult to take! I knew that I couldn't/wouldn't have my colonoscopy at the same facility or with the same physician, but it is VERY difficult to find a female gastroenterologist! I did find one in the metro area nearby where I live but she was booked out for months! Well, an hour and a half post procedure, my loving husband took it upon himself to scour the internet and found a woman gastroenterologist who, luckily, had had a cancellation and was able to fit me in! He knew I just couldn't bear the thought of being sedated for such an intimate procedure with a man in the driver seat! If he had thought it might be okay before his colonoscopy, he was certainly of a different opinion afterward! Additionally, I have since done some research on the new doctor and she seems to be well regarded. I guess we'll see how tomorrow goes!
What I hope is that at some point, hopefully very soon, there will be enough professional intolerance on the part of the perpetrators' peers as well as more readily available public disclosure on the part of regulatory boards so that misbehaving medical un-professionals will eventually be weeded out of the system....a sort of societally motivated form of natural selection if you will.
Thanks
Bad apple, innocent victim of seductive patients, or SEX PREDATOR?
http://www.app.com/apps/pbcs.dll/article?AID=/20060620/NEWS03/606200378/1007
Angry Wife writes: “Do you really think, though, that an apology from the physician, facility management and/or staff members involved in my husband's colonoscopy would actually be reason enough for us to consider using their services again?” It is not for me to say. It is up to the patient and family to evaluate a physician’s apology to determine whether the apology is casual and not motivated by personal concern about the harms inflicted on the patient and there is no intention to remedy the situation for that patient, learn from the situation and act to prevent the episode from recurring to any patient. If the apology is not sincere and meaningful in these regards, as evaluated by the patient, I would not be critical of a patient deciding not to return to the physician’s office and act to notify the facts of the occurrence to those in authority to monitor and regulate the behavior of physicians. Unfortunately, either because patients may feel intimidated by physicians or because of an illogical fear of “rocking the boat”, they make keep their consternation and frustration to themselves. Angry Wife, what I do think is that, through legal means (not by slander or libel), the illumination of cases of poor professional behavior, based on facts, should be encouraged and is necessary to improve the medical care system. ..Maurice.
Maurice, how did "slander or libel" enter the mix here? Certainly, fabricating stories and putting them forth as truth, on either end of the spectrum, does nothing to fix an already broken system! Our approach is to meet with the individuals involved face-to-face (if they are willing, that is), write to any appropriate regulatory boards to encourage positive change and/or at least basic compliance with established norms for what constitutes acceptable, professional behavior, and inform my husband's primary care physician about what transpired. Plus, if someone asks my husband about his procedure he will tell them about it. Certainly this is our/his right! Where is the "slander or libel" in that?
I understand that this sort of situation is a sensitive area in ANY profession. The bad apples tend to taint the reputation of the whole, and a certain defensiveness is only natural. Still, it sounds a whole lot like victim blaming to me to throw "slander and libel" into the mix and that just takes us back to square one, doesn't it?
Angry Wife, read what I wrote: "through legal means (not by slander or libel), the illumination of cases of poor professional behavior, based on facts, should be encouraged and is necessary to improve the medical care system." What I am saying is that it is necessary not to hide bad professional behavior but to bring it out into the open. What I was referring as illegal was verbal or written statements by patients to their many friends or on the internet and naming names without the due process given to physicians as would be provided by the medical boards or other authorities. ..Maurice.
I think what Maurice is saying is to tell the people who can do something about it not just your friends. I do both. It seems everyone has a story about the hospital my husband was at. Even the dog catcher. It's my right to tell anyone I want if it is true. The treatment my husband recieved almost killed him. That doctor could have put a hole in your husbands colon with his lack of concern for what he was doing. Tell everyone!!! I am and will until I die. Im angery and will never completely get over it.
Kim
And one more thing...because my husband signed up to protect our country he can't take any legal action. Military can't sue military. It's an act of congress something called the Feres Doctrine. This lets military hospitals operate with no accountability. See why I'm so mad.
Kim
Maurice, what you're saying comes through to me as follows: If someone hires a professional to perform a service for them and they are unhappy with the service they receive they must follow a prescribed grievance protocol (established by whom, I wonder?) and do or say nothing else unless or until such time that the poor performance is somehow verified by an outside source. Only then would it be "legal" for them to disclose to others the experience(s) they had dealing with said professional.
Look, few people deliberately set out to cast dispersions on another person's professional performance whether that professional be a physician, a plumber or a chimney sweep. But it is hardly a matter of "slander or libel," to use your terms, or "casting dispersions" for that matter, if one speaks the truth. Truth is truth; whether or not it is easy to hear it is another story. I'm afraid that what you are proposing just perpetuates the problem.
I'm not saying that I condone taking an ad out in the local newspaper which names the perpetrator and describes the situation in gorey detail, nor do I condone making widespread public statements before large groups. But, if the perpetrator in question were an auto mechanic as opposed to a physician I wonder if you would feel the same way? If you took your car to a mechanic who instead of pulling the engine to install a new head gasket ended up changing out the transmission instead and scratched the paint on the driver's door while he or she was at it and offered no apology or remedy for the situation, would you not warn your good friends or loved ones against using this person based on your own experience? And in doing so, would you not recount to them the details of your experience? And, who would question your motives in doing so?
What you are suggesting smacks of the longstanding notion (myth) that medical professionals are somehow a group set apart and that we, the public, should treat them as such, affording them special dispensation when their behavior is less than honorable. I think ALL professionals should be held to the same high standards and that as consumers we have the right and responsibility to report indiscretions to appropriate review boards as well as to warn our friends and loved ones against dealing with disreputable individuals regardless of their professional credentials...including physicians. It is incumbant upon everyone involved in this process, however, to speak the truth, but that should go without saying. Pun intended.
Good response angry wife! I love to see a doctor squirm!
You touch on Dr. Maurice's implication that people should keep quiet about their dissatisfaction with a doctor. Go back and read the posts from May 28 and check out the link to the Minnesota Medical Association article in which they openly promote that attitude.
Wait a second!! I don't like to see anyone squrim. Patient or Doctor, at least he is asking our opinion. How many doctors do you know that care enough to even ask?
Kim
Thanks for the vote of support, Anonymous, but, I really don't mean to make anyone squirm with my comments. I just hope that Maurice can see the bias implicit in his comments re: slander and libel, and what he apparently perceives as the requirement on the part of the patient to try to work it out with a doctor who has already stepped outside the bounds of appropriate behavior before changing physicians or writing letters to disciplinary boards and the like. Fortunately, as consumers of any professional service we have the right to move on. That's what my husband and I are doing. But, we are also planning to make our displeasure known in a manner that will get the attention of the offending parties, by alerting those who are in a position to levy disciplinary action or at least put them on notice of some kind. At least, I hope that will be the outcome...but I fear that not much will actually transpire due to the fact that members of the medical community tends to protect their own.
Now that I agree with. Good luck.
Kim
I bet lots of people arer squirming over this one:
http://www.kcra.com/news/9401622/detail.html?taf=sac
First, I want to thank everyone, including Angry Wife, for participating on this post. I am sure that it is being read by a number of visitors who are reading but not commenting. But that is exactly what I wanted for this topic and that was to take the acts of improper behavior by the medical profession out of being hidden by physicians or intimidated patients and bring it out into the open. Hopefully, there will also come from my visitors additional suggestions regarding constructive approaches to promote better behavior with regard to patient modesty.
I also want to make clear that I was not critical of any of the responses described here of those who have experienced evidence of improper professional behavior. What I did say was that all responses should be, of course, legal and should not include libel or slander, as legally defined. These acts of libel or slander involve the intent not to be therapeutic but to cause harm of one sort or another to the subject of the act. What I do feel is appropriate is for a patient who has experienced what was felt as improper professional behavior and when specifically asked by a friend or relative for a referral to that physician to feel free to express their own opinion about their experience. That is not slander but free speech. To then progress to tell someone that “I have heard that Dr. X..” did this or that, well this is no longer telling someone about ones own factual experience and would seem to me a bit beyond free and ethical expression. Anyway, a discussion of libel and slander is not the focus of this posting topic and should be put on a law blog.
Again, my thanks to all and as a physician who wants us all to do better I appreciate your comments. ..Maurice.
Maurice, I really do appreciate your willingness to try to move toward a better system for medical consumers and medical providers alike. I also believe that you are sincere. However, you must understand that by introducing legal terms like libel and slander into this discussion you opened a real can of worms, not the least of which being a not so veiled 'threat, ' if you will, that we, as medical consumers, had better be really careful about how we bring our complaints to light. On the one hand we are encouraged to expose inappropriate behavior on the part of physicans and in the next breath we're told to proceed so as to protect those physicians from the consequences of his or her own bad behavior! Either we are either free to speak the truth in the manner we feel is appropriate to effect necessary changes in the system or we are not. You can't have it both ways. I understand your squeamishness in this matter as we're talking about your particular profession, after all, but the same rules should apply in all cases and in all professional disciplines. The medical profession has long enjoyed an elevated status in our society and now that patients/consumers are speaking up and taking more of a stand I'm sure it must feel uncomfortable.
"Either we are either free to speak the truth in the manner we feel is appropriate to effect necessary changes in the system or we are not." Angry Wife, that is my whole point: patient should "speak the truth" in the manner which the patient feels "appropriate" but I only am asking that the "appropriate" approach be legal. Just as members of the medical profession must behave legally, so should their patients. But patients can contribute significantly to get rid of bad doctors by bringing their concerns promptly to the authorities and boards which are responsible for physician supervision and licensure. ..Maurice.
Maurice,
To the best of my knowledge:
1) LIBEL involves the written communication of a FALSE statement, which results in injury to the business or personal reputation of an individual or entity.
2) SLANDER involves the oral communication of a FALSE statement, which results in injury to the business or personal reputation of an individual or entity.
Not being a legal authority I encourage you and others to confirm the above definitions for your own edification and/or for legal purposes.
If, for the purposes of this discussion, however, we can assume that these definitions are correct, why do you state in response to my previous posts: "patient should "speak the truth" in the manner which the patient feels "appropriate" but I only am asking that the "appropriate" approach be legal. Just as members of the medical profession must behave legally, so should their patients."
Okay, we can all agree that both sides should behave legally. But WHERE is the ILLEGALITY, the LIBEL or SLANDER, in communicating FACTUAL INFORMATION in any context? I don't get your drift at all.
I'm not saying that false statements have never been made against a physician and I am not condoning such behavior but I am saying that odds are that many more truthful statments of misbehavior on the part of physicans have been quashed by concerns on the part of patients that by speaking out they will only further compromise their wellbeing and find themselves embroiled in a legal battle to boot; the burden of proof resting with them in a situation where it is generally their word against that of the offending physician's.
How does any of this encourage free speech and foster bringing medical mistreatment into the light of day? And, more to the point, I would appreciate understanding why you are so obcessed with patients speaking the truth in a 'legal manner.' When has it become illegal to speak the truth in ANY manner?
One may speak what that person understands is the "truth" but others might disagree about the conclusion. That is why if one party finds they are harmed by someone writing or speaking to others about their understanding of the truth, the issue goes to court for a resolution. I think we have all detailed our views about this to a sufficient degree.
We all agree that bad medical behavior is bad medicine. I will emphasize the need for more members of the medical profession become aware of the concern many patients (certainly in the United States) find patient modesty an important issue. If the members of the medical profession are unaware of this issue, they are more likely to behave in ways which upset their patients and cause patients to lose trust in them. Continuing medical education courses should emphasize this and other patients' views about how doctors behave. As I have noted previously, I am more aware of this issue now and I plan to do my part to make my medical students more aware of it too. ..Maurice.
Good luck with your blog. I hope it ultimately helps to make physicians more aware of their responsibility to provide an environment, at least in their own practices, in which patient modesty is appropriately respected and upheld.
I also hope that those patients who have been mistreated at the hands of errant physicians will find a suitable forum to express their grievances without fearing that by speaking the truth they will open themselves up to further harm. That remains a key issue, regardless of your desire to be done with it already as far as your blog postings are concerned. Only when a victim of any kind of mistreatment feels safe to report the details of the incident will we be able to truly move toward a climate of zero tolerance.
I hope that day does come. I was recently in A and E. I realise that it is a very difficult place to work but it was overcrowded and chaotic. I could overhear patients medical history being discussed, I had a verry high fever and I was 'parked' in a supply room. I know that I was disoriantated and unsure what was going on but I was treated as a 'difficult' patient. I was undressed and restrained and packed with ice bags. I was left naked and a fan was turned on me.
I was left like this all night.
Dr. Maurice, it appears you, as a medical school instructor, can play a pivotal role in reducing physician misconduct. An article in the New England Journal of Medicene (NEJM 2005 353:2673-82) asserts that doctors who misbehave while at medical school are more likely to be charged with misconduct when they become practicing doctors.
Thanks, but I already posted this finding under the title "Unprofessional Physicians Grow from Unprofessional Medical Students", December 27, 2005. You might want to go back to that posting and read the Comments and add your ideas. My idea is that screening of medical student behavior by their teachers and mentors is an essential function and I certainly am not ignoring the challenge as I deal with my students. ..Maurice.
Dr.M. and others.
Below is a link to the Havard guidlines for pelvic exams as well as a short exert from the exam guidlines.
http://research.bidmc.harvard.edu/VPTutorials/midlife/tutorialShow.asp?setID=10710&sortOrder=1&openChapter=none
(Be sensitive to issues of modesty and vulnerability
Male Trainees: If she is uncomfortable having a male practitioner perform the exam, refer her to a female colleague
Talk with her before she undresses
Invite her to ask questions at any time during the discussion
Let her know in advance that she can ask to have the exam stopped at any time
Let her know that a female chaperone will be present during the exam to assist you and help her be more comfortable
Ask whether she would like to have a friend or family member present during the exam)
If the doctors really want to follow these guidlines then the question should always be ask of the woman. Do you want a female provider? Do you want a family member present.
Because of the imbalance of Dr./ patient power exchange it should not be upon the female paitient to ask. It should be upon the DR. to ask what she is confortable with.
Not too long ago on the how husbands feel board it was brought up that the husband was ask to leave the room for the examination which goes completely against what Havard is spelling out here.
Another comment made that hit home was. "If unwanted male personal (Dr's., nurses, tech's,) is present then is the paitient's needs really being met"
I too hope that this fourm helps to make future Dr.s better at ubderstanding the need for keeping husband/wife intimancy sacard.
Have a great day all:
Mike aka tenderhusband and founder of how husbands feel.
Dr. you said, "My suggestion is that if a patient finds modesty a personal issue at the time of the exam or proceedure, the patient should speak up about their concerns at that time and expect some explanation or response."
Unfortunatly that is completely unavailable to patients, particularly for male patients who's personal issues with modesty and respect are so completely ignored that the majority of men eschew medical treatment to their own detrement. A man coming for surgery will have a long list of female nurses pawing all over his body, and his only alternative choice is to die suffering. There is some recognition of female patients concerns, but in a culture where it is well known that men hate to visit doctors I'm wondering why none in the profession express any concern for the feelings and needs of men?
ok this is my two cents first docs where male and have always had power in society infact early days dictated society and still do to some extent(power not care)now male nurses and aids want that power on the grounds of sex discrimanation lol but want to be left alone with patients, but why ?do not need education to do that family can do it better.
At the end of the day more women docs are coming into med so eventually things will equal and we will have a choice and that is what matters not gender choice.
ps. has anybody herd of females sexually abusing men in the name of care?
well someone said docs do not ask but do (and they should nt )it it up to us to ask though not fare but now we have the internet and books ect it is up to us to take the power away from them and educate ourselves, if you are not comftable with them ditch them simple has that.
enpower yourselves if you are reading this then you have the internet educate yourselves ask questions ect.
yes you are right bob men do have a lot of female nurses helping them and you are right men should if possible have male nurses to care for them,but we have male nurses not many ok but where are they? try female wards or gyne wards.dont blame female nurses blame your fellow males nurses.
Bob ever in hospital again ask for a male nurse as i said you are the customer demand your veiws and wants are met, if you are unable get somebody close to you to do it for you.
Anonymous: You ask if female Dr.'s abuse male paitients. Here is a link done bu Valderbuilt Medical Center. It is a survey in which DR's. themselves admitted to having comitted sexual misconduct.
http://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=742
The study states that roughly 12% male dr's have comitted sexual misconduct, 6% of female dr's. The male dr's were mostly GP's and OB/GYN's. The females were mostly mental health care dr's.
Not only does this suport that medical professionals cannot fully seperate business/pleasure as they would have us always belive. It also renforces the theory that males are more sexualy attracted on a visual attraction and females are attracted on a mental level.
At the how husbands feel group we have over 100 doct. cases of male DR's. who have comitted sexual misconduct. We have yet to come across a nes article where a female halth professional has comitted sexual misconduct. If someone knows of one please post the link. I'm sure that it happens and is unreported. There is a double standard as society sees it. When a woman is sexualy moslested she is a victim, when a man is sexualy molested his is considered lucky. I'm sure that many men who felt that their female nurses might have got their gollies off at his expense has chossen to just keep quite.
Have a great day all:
Respectfully:
Mike aka tenderhusband and moderator at how husbands feel
Dr. M. Please check out the following link.
http://forums.obgyn.net/ob-gyn-l/OBGYNL.0606/0630.html
Here is the direct qoute and signed by Joanne Bully MD.
"Dr. Rudi Ansbacher, an obgyn attending at Univ Of Michigan, at least once told the medical students that if they "did an adequate breast exam, no lubricant is needed for the speculum exam."
Nothing could be further from the truth. As Jamie put it - in the exam room there is one sided vulnerability.
I had a hard time respecting anything else he said during any further months on rotation at the U of Mich.
Joanne "
Now Dr. M. what do you have to say for a teaching MD who would make such a statement. BTY he is still a doctor after saying something as sexist as this in a room full of students.
Dr. M., the attitude of Dr. Ansbacher is exactly why I do not want my wife to be seen by a male gyenoclogist.
Respectfully submitted:
Mike aka tenderhusband and moderator at how husbands feel
ok tenderhusband i 100% understand that(you do not want your wife to see a male after reading some links on this blog) but how does your wife feel about you seeing a female doc(do you have you) nurse, is it different is female modesty different from mens because men are visual women are not is that to blame for mens behaviour in the medical field?
someone quoted this to me
what is the difference between an ameteur and pro?
one does it for fun another does it for fun power and money.
Dr Maurice, I also appreciate your efforts in this area, you are to be commended for your compassion. Anonymous june 28, and several others expressed their thoughts that the issue is completely or mainly a problem for females. As a male I can attest it is not. While I feel the problem is more frequently insensitivity vs malicous, abuse can be defined in many ways. I personally overheard several female nurses in a hospitial commenting and laughing about the large size of a patients penis, one of them said can I take your round I have to see this. While this pales in comparison to physical abuse, it is abuse at least of power and the patient provider relationship. Perhaps one of the biggest barriers to making progress is social condictioning. Several years ago I had to have a ultra sound on my testicles, a female tech performed it, she was excellent, very professional, but I was humiliated and suffered extreme anxiety over the exam. I heard a male tech performing an ultra sound on the other side of the curtain (so much for privacy)so I know it could have been different. I recently discovered another lump. When I was told I was going to need another ultra sound I requested a male tech, not problem they said. A male tech did the procedure and I was so much more comfortable. My point, it is not always anything the provider does or doesn't do, it isn't about them, it is about the patient. We as males (I can't speak for the female experience) have been taught we should just accept it. It is hard for us to request a male, even if we are stressing about it, we were not raised to question. If the medical community would help by simply asking if there is a preference upfront, and if the patients knew they would be asked, so many problems and bad experiences could be avoided. Part of it is provider, the other part is the patient. Until we as patients are confortbale or feel we have the right to ask for same sex providers, and are able to express our own modesty levels, a complete solution will be hard to achieve. I think a very large majority of providers are caring compasionate people, if they would ask and not assume... Your efforts are a very good start that I hope other care givers, male and female, doctors and nurses will follow. Your blog helped me gain the confidence to ask what I deperately wanted. Thanks again As a foot note, I recently read a blog on allnurse, nurses (male and female) discussed the proposed law in Alaska giving patients the right to demand same sex providers, many of the nurses expressed their personal stories of embaressment when they were patients....it was interesting to not hear the we do this all the time when the roles changed. God Bless you for your concern.
anonymos 30 this is what i said
(yes you are right bob men do have a lot of female nurses helping them and you are right men should if possible have male nurses to care for them,but we have male nurses not many ok but where are they? try female wards or gyne wards.dont blame female nurses blame your fellow males nurses.
Bob ever in hospital again ask for a male nurse as i said you are the customer demand your veiws and wants are met, if you are unable get somebody close to you to do it for you.)
i said men should have male nurses.
What you have talked about is embarassment and,modesty yes with intimate care excam everbody feels that with oppsite sex even with the same sex not the same as oppisite sex but still embarassing.
what others on this blog pointed out with web sites was sexual abuse and it just so happens its male meds with female patients(the sites i have read and of other sites i have read howhusbandsfeel.com very rare other way round.
what you talked about with having a female was ambrassment big differance between that and sexual assault.
anyway i am gald you spoke up and asked for a male which is another thing a stated.
ps. i hope you are doing well
If a provider is thinking something sexual while doing an exam you are being sexualy assaulted and you don't even know it. Not only that but people have their own way of doing exams. How do we as the public know what is nesscery and what is over the top?? When I was 16 I had my first pap. The doctor also did a very fast and hard rectal exam. I felt his nuckles hit me. I left in tears and until I got older and realized no one else dose it at a pap. I didn't know I had been violated. So if you ask for a same sex provider unless that person is by or gay I would think you would be safer.
Kim
Marice,
I feel a little re-directed. I went back to the first blog. Why a new posting?? I finally gave this information to my regular doctor. I never did give it to the surgen. To embarrased I guess. I hope my doctor can understand. I don't feel I will ever overcome what my husband went through. The doctor gave me new meds to sleep but I still wake up thinking. It's not all about the naked stuff either. I can't stand the thought of him being cut open. I can't go be a nurse every turn would be just another memory. I keep reaching out to people but it seems there are no answers to make it ok. He's still here. Why isn't that making it all better??
Kim
Kim, I think you should continue to talk this over with a professional to try to treat your emotional upset. Don't give up. ..Maurice.
Thanks Maurice You know it all comes down to control. As a kid I had no control. Medical people should let people at least feel as if they have some control even if it is a lie. I think more than anything that is what has me so upset. When you loose control of what is happening to you or someone you love it is the worst thing I can think of. The lady I am talking to says I should let people know what I am feeling. The problem with this is how do you do that with out being further hurt by what they think of you. My husband had his first obstruction since his last surgery. It turned out ok (no surgery) but I was very nerves and the nurses in the ER were rude. I was trying to ask where I should stand for them to put the NG tube in (so I would be out of there way) and they said in the corner. I was being very polite. My husband wanted me to hold his hand and they were offeded about this. I was out of the way and didn't think emotoinal support was a bad thing. Again they wanted control. Sick people don't need control they need help. Duh!!! How many times will we encounter this? I'm tired. If the next time (hopefuly there isn't one) how do I ask for help without being dismissed as a crazy wife?? I don't feel as if this will ever end. He is now having problems with bowel control. I think it has to do with the gallbladder being removed. If your stools are liquid you can only hold it so long. But here we go with the testing. It feels like round ten. I'm going on and on sorry. thanks for the response.
KIM
I am one of the older docs. One who is old enough to remember stories about the scandal heaped on the first American doctor to do a pelvic in about 1910. He ignored it and women have benefitted greatly every since. Of course modesty is important, but pious preaching and politically "correct" thinking has to be careful. Personally, I have seen far too many women with terminal cancer, who ought to have had a yearly check, who on learning of their disease said, "Oh, I just felt it was more modest not to have exams". The female instructor on breast exams at our local hospital died of breast cancer when a 3 cm mass was deteted by someone else. When I was a kid, women nursed in public, even in church and no one thought anything. Anyone who is actually picking up cancer by exam knows how important a VISUAL inspection is, the tumor blush, orange peel skin, etc are all vital and save lives. We are regressing if we become like women in third world countries who refuse to be examined for some religious scruple. I do not consider myself less religious for trying to do an adequate exam, rather I am saving lives. Embarassment is understandable, but that does not establish that something wrong has taken place with an adequate exam. Before and after the exam, a generous gown is a a courtesy, but during the exam, patients should be encouraged to have regular checkups and correct verbal manner can go a long way toward easing some of the embarassment. The last 135 cancers on mammography were diagnosed by me first by examination. That is a pretty good record, but I could never had done this by slipping past a gown. Cancers pull back on Cooper's ligament creating a sort of indentation and lack of mobility to the breast that is a strong clue, and perhaps as important as looking for a mass. If we wait until a big mass is present we aren't going to be saving many lives. Just my opinion, but I believe my patients are just as comfortable as those fully gowned because I am teaching THEM how to do a proper exam and they appreciate it.
Last week I discovered a mole over my hip which I had not noticed before. I went to my local GP to have it checked out. I explained that I live alone and I'm not in a relationship so I had no idea if there were more I could not visualise. He lifted my shirt and did a cursory check and told me that I was fine. I have to say I did not feel confident that he had done his job properly. He basically rushed me out of the office. I suspect it was because I am a paraplegic and it takes me a little longer to undress.
The next day I booked an appointment at the medical center close to my office. The Dr was a young woman and I told her my concerns and what had happened the previous day. She had no problem helping me strip, she offered a gown, which I declined as I say no reason to wear one when the purpose of the exam was to check my skin. Even when the nurse came in to help administer the electrolisis I simply coverd my privates with my hands and let them do there job. No fuss, no embarresment just two professionals doing there job properly. I know that it sounds like a scene from a porn movie but of course it's not like that at all. I did not get aroused, nor did I think they were getting their jollies from staring at my imperfect body. The mole turned out to be benign and they delt with it. Start to finish the exam took 20 minutes of my lunch hour and I came away feeling reassured and if I need any medical advise I will certainly return to her.
I have noticed that many of the people who post here have some issues regarding their bodies and don't appear to be able to seperate nudity and sex. Perhaps this is an American/anglo Saxon hang up. It's a shame because in certain circumstances it is possible to die of embarressment.
I want to interject here the opinion of a medical student, an angle which has not been offered yet.
First of all, we are taught EXTENSIVELY on the subject of respecting the responsiblity inherent in the patient-doctor relationship. We are taught that while it traditionally is one where the doctor holds more "power," that this paradigm is changing and that a more successful relationship is one where the patient AND THEIR FAMILY are considered a part of the medical team as a whole. The best interest of the patient is undoubtedly the goal of everyone on the team, and everyone's input is considered. Please note, however, that as I understand it this model of care is a relatively newer one, and that most of the older doctors currently in practice NEVER HAD THIS EDUCATION. I'm not excusing them from having the common sense to respect their patients, but you all must understand that their training was different and that things will hopefully change as younger docs with better training take over the profession.
Secondly, consider my own viewpoint--I am a female medical student who also happens to be of a very petite build. I am also in a committed relationship. Because of these things, I have been warned by my instructors that I need to be very cautious of male patients taking advantage of me, and indeed, I have been in situations where my male patients have made me very uncomfortable. Please do not discount Dr. Bernstein's comments about seductive patients, I have met some! I am also in the situation where I am learning to do physical exams on patients, and I challenge the How Husbands Feel group to give me advice on how to convince my boyfriend to feel comfortable about THAT! Just as you are worried about your own spouses, realize that the doctors have spouses too.
Here is my bottom line. Please don't simply attack medical professionals. I understand that many of you have had very bad experiences and I don't doubt that this has caused you to lose faith in healthcare. Please consider, instead, that those of us who are "up and coming" are doing our very best to learn about and address issues like these so that we can better the profession as a whole when we finally get into practice. Please remember that we, too, are facing significant personal challenges in our training that we learn to overcome because we know that down the line we will be able to use that experience to better the lives of our patients.
I think its great to hear from medical students and other providers. You make some great points which I think leads back to earlier comments not only of patients but Dr. Bernstein, that of both sides communicating. It is true it is a relatively new model, one that we as patients are struggling with also, we need to be encouraged to speak out and make our concerns and preferences known rather than suffer through it and complain afterwards. It would help a great deal if providers solicited this information early on rather than one is standing in a open back gown. You must understand going in to this profession, your going to battle historical points of perspective and it will take time to not only change the providers actions and attitudes, but those of your patients. Part of that will be how you as the medical team lead sets expectations. We look at the Physician as the team leader, the example you set will be the one the techs and nurses key off of. If you show an uncompromising respect for your patients emotional well being, including a high value on respecting their modesty, those around you will to. Right or wrong, if you do a good job, but the techs and nurses do not treat your patients modesty as important, thier impression of the whole experience will be effected. Your challenge will be not only to impliment these changes on your and your team's side, but to encourage your patient to take advantage of the new paradigm of power.
As for the challenge you tossed down for the How Husbands Feel, great point. One I imagine very few of us thought about. While it is a bit of a different scenerio it is one we don't think about. Since your the one that keeps your clothes on, we don't see why you would be as uncomfortable or why it would be a problem. I never thought that a spouse my have issues, now I can see it would be. Great point for thought.
And as for patients that intentionally or carelessly make their providers feel uncomfotable, I think they are just as bad as doctors who do the same. There are jerks on both sides of the issue, male and female, patient and provider. I would hope this is a very small minority of patients. And I would hope you can tell them to change the behavior or find a new provider just as patient should do. It needs to be mutual respect. You will face most of the challenge with male patients, I would lay money most will be more intimidated and embarassed by the situation than turned on, some will be idiots, but most will be embarassed whether they can admit it or not. The shortage of male nurses for chapparones will make it even tougher. But as long as you do the best you can, and remember the issue for most of your male patients with you as a female provider, will be the same as female patients and male providers, you done all you can. We were raised to be embaressed by being nude infront of the opposite gender, you being a doctor doesn't erase the years of condictioning. , just do your best to accomidate that and you will be making a contribution to solving the problem. I would hope the "attacks" are aimed at the system and not all medical providers becasue by and large my experience is they are great people who care about thier patients. To a large degree the system is still operating like it always did, people are just now starting to address the emotional side, including modesty. I hope you will encourage your fellow students and providers to join in this blog. It was great insight, good luck with your journey.
To the Med. female student. Mike here from how husbands feel. Please stop by and join the group. You will find us all full of support for making husband wife relationships better and working as a team. Respectfully:
Mike aka tenderhusband and founder of how husbands feel. ps. you will also find us giving thumbs up to Dr.'s who do a good job.
A question to you med students. Do you feel patients treat male or female interns differently when it comes to intimate procedures or exams on oppoiste gender patients? Do you observe any difference when the situation involves techs or nurses? And what do you do to address issues?
Here's a disgusting violation of patient modesty:
http://www.oregonlive.com/newsflash/regional/index.ssf?/base/news-16/1158196458129620.xml&storylist=orlocal
I hope this guy goes to prison for a long, long time.
Here is the link to the news item described in the previous comment. ..Maurice.
hello,
from reading these posts i can see i am not alone. i have problems when my wife has to see a male ob/gyn. i get extremely hostile and feel a lot of anxiety about it, even if i go with her. there was a few negative experiences that we have had, one being the second child we had. we came to the hospital and they basically forced a male medical student on us. i objected about this to the head nurse, but they still did not make him leave. he checked her dialation, had to rub this cream inside her vaginal wall to help her dialate, and i still cant get this image out of my mind. it feels very painful emotionally to me, and sometimes when i try to make love to my wife these images haunt me and i have to stop. i finally got the courage up to talk to my wife about all this (who now is 7 months pregnat) after she described a recent exam she had with her ob doctor that is male, he examed her when no one was in the room, she said that he took an extra long time during the bimanual(using the fingers) and forgot to collect the sample during the papsmear and had to re-insert the speculum to collect it. this went clear through me. now we are trying desperately to find a female doctor to take over and we are having to change offices completely because they do have one female doctor but they have this rotation thing they do. i had to talk to the manager that basically told me that the male doctor had to be the one to do the exams, i asked her why the female doc couldnt do this and she said it was because of their "on call" policy. so i told her that no man was ever going to examine my wife again and she told me to good luck find another doctor office. i called many many offices before i could even get my wife an appointment, and there is no garentee that they will accept her because of how far along she is. but what are we supposed to do when the doctors force their will upon us? sit there and take or try to find someone else? what if we have to wind up using them? she is having a c-section, and the doctors there already know that i have nothing but contempt for them. i think it is very unfair that you cannot choose the doctor you want out of an office full of doctors. they just dont understand that some of us have moral obligations, and basically just dont like it.i have a view of this male doctor female pelvic exam thing as a form of adultry, and i think they should respect that. i know they have seen a million vaginas but so has people that make porno movies. i didnt mean to upset anyone, but i have very few places to vent about this, i have been seriously traumatised and feel a lot of depression and helplessness over this. and the other bad part is what about when we get into the delivery room? will she be draped well if there are male techs, anasthetics in there? who will scrub her and get her ready? will any males participate in that? the shaving of pubic hair and inserting cathadors? it is very stressful to me to think that we will arrive there, they will ask her to undress, and random male healthcare workers will be comeing in and out of the room where my wife lays naked on an operating table. is there any legal recourse to prevent anything like this from happening? can we tell them how wee feel and will they really understand our comfort level? because they have not understood us yet and this is our forth child. i think i am more stressed out over this pregnancy than my wife is.
I don't know what to say that will, without fail, make you feel better. One obvious advice would be to look to your wife for how to react to her exams. If you have trust in her judgments and she is not anxious or upset about it, perhaps you should feel supported by her view and feelings and with that support reject your suspicions and anxiety. This advice is based on the presumption that you are more concerned in the best interest of your wife than your own. If your concern is that of your own interest, your own comfort, then you put yourself and your wife in a difficult situation. While you may feel more comfortable with a female physician examining your wife, maybe you won't and maybe it will never be possible to have needed obstetric or gynecologic procedures performed without your undue concern of those persons participating. Better than my providing my advice to you would be for you to discuss and ventilate your feelings with a professional psychologist. I hope you do that and I send my best wishes to you and your wife. ..Maurice.
Maurice,
You still don't get it!!! Do you realize the guilt you just put on this man? Stop worring about silly things like nudity and think of the wellfair of your wife's health. You are asking about nudity and then dismissing it. He feels the same way I did. Of course he is concerned with getting her the best doctor. Oh and one who is kind and considers the feelings of the patient and the husband. Is this so hard to understand? This causes severe damage to the person who is left with these images to haunt them. Do doctors not consider the emotional health of their patients and spouses? What if this causes problems in their marriage? That will effect both the patient and the spouse even their kids. Why do you even have this blogg if you don't seem to care? Why are you asking?
My advise to the man with the expecting wife. This should be one of the most rewarding experiances of your life. Find a female doctor. Don't not say anything!!! Ask for a full female staff in the OR. You have the right. Tell your doctor your concerns. Be honest. It's nice to see a man who loves his wife this much. It's ok to feel this way you are not alone. What doctors don't want you to know is you have rights as to who will care for your spouse. If THE Patient is forced it is Assault. If you need more help write back I will do what I can.
KIM
One more thing you will need to know. If your wife isn't on board with how you feel you are screwed. She has to take the lead. She is the patient. She has to ask for this. You can ask but it won't be viewed the same. It's all about the patient. Also dont show that you are stressed. This will get you dismissed. I know that is asking alot but try. Be direct and firm but nice. When my husband was in the hospital I felt like I was walking softly yet carring a big stick. If the doctor you find isn't responsive to how you feel as a couple keep looking.
Kim
Kim, since this blog is for open discussion, I don't feel uncomfortable asking you and our other visitors some questions for my own education that might rub some the wrong way. Here they are: 1) Isn't a patient's modesty during a physical exam or other medical procedure something that is personal to that individual patient and should be set by that individual patient? 2) If a patient's modesty is consistent with society's consensus of appropriate modesty under the conditions of a medical exam or treatment, shouldn't that degree of modesty be accepted without question? 3) Shouldn't a spouse of this patient therefore eccept the level of modesty set by the patient? 4) If the spouse disagrees with both the patient and society's consensus, shouldn't we then look at that spouse who finds what is acceptable to the patient and society to be personally unacceptable as holding an aberrent view which may not be in the best interest of the patient and the spouse's relationship to the patient? 5) And shouldn't such a spouse, for his or her best interest, analyze the motivation for that view and reconsider that view with possible professional help? Just asking.. not preaching! ..Maurice.
So is this what you are saying? Those of us that don't fall in the norm need prefessional help? Anyone with a diffrent view is wrong? I will try to answer your questions. From my point of view.
1. Yes
2. No We are all diffrent and should be treated as individuals. I think even NORMAL people are more uncomfortable than you might think.
3. NO If you are married you are a team. You act in a mannor that shows respect for each other. Would you deliberately do something your wife wouldn't like?
4. No What if they agree? We do but the medical community dosen't seem to respect that. If they don't agree they have problems. They need to talk about it and find a comfortable level for both. Marriage is give and take. I found even though my husband agrees with me at times in his illness he didn't have the strenght to protect himself and certanily not me. I was just too scared to say anything.
5. Yes You should know what drives you. But you should allways keep it to yourself. Do you think the people who are writing to you have all been abused and this is the only reason for their reaction? Are all the people with this view that abnormal? Remember I'm a cosmetologist. I talk to lots of people. Even doctors wives. One of wich will not let his wife see a male. I think you would be supprised what people really think.
Kim
Maurice,
Do you think it is ok for a spouse to feel protective of their partner? Expecally when they are vonrable or sick.
You have said you have been a doctor for a long time. When you started patients didn't question the doctor. The doctor was all knowing. Now with more information out there. Us patients question our doctors more than ever. We even question motives.
Kim
Kim, in my almost 50 years of medical practice, I have learned more from the responses to this blog about patient's feelings regarding issues from infant male circumcision to patient modesty and to how doctors practice medicine than from all these years of direct patient communication in the office, hospital or during housecalls. It seems that the benefit of a blog open to discussion by folks, who can remain anonymous if they desire, provides an avenue for the expression of personal beliefs and feelings which they are unable or unwilling to disclose to their own physicians. And then physicians such as myself or others who drop by can learn more about how patients feel about these issues. Thanks to all who have contributed to this 100+ comment thread and welcome those who now visit and might have some different views also to express themselves here. ..Maurice.
Kim
As a person who has watched this thread but has never posted I want to thank you for your response. Many people were thinking the things that you wrote. Thanks again.
kim,
thank you for your response. and you too doctor, however i found kims response a lot more empathetic and helpful to me. my wife has switched to a female doctor, and now we have the hospital to contend with. in all my postings most people want to crucify me for what i believe in. i am a cristian, have studyed the bible extensivly and have found no verse that implies that it is acceptable for a married woman to expose her nakedness to another man other than her husband. i cnat let go of this i really feel like i need to make a strong stand on this. i would like more doctors to be informed of how we feel as patients and spouses and that it does matter. it matters to GOD as i see this practice of male gyn/ob exams as adultry, i have plenty of scripture that supports this stance. and if anyone knows any good resourse for info,legal info, rights, please email me at atdmiller@hotmail.com
once again, thank you kim. i will always be bothered by this procedure, it is written in my heart as a commandment from God to feel this way.
While I understand the emotion of having your spouse exposed to another man, and I compliment you for wanting to protect your wife. I have to agree with Dr. Berntstein. These things really are individual. While the husband and wife relationship is special, and discussions of what is and isn't appropriate in this area should definately be addressed, ultimately it is the patient who should make that call. If the patient has discussed the issue with thier spouse, and still feels the same, the spouse should be able to accept thier decision. Health care is one of the most personal things we will do. It is the patient whose health depends on the care, we need to recognize thier decision of what is and isn't comfortable FOR THEM should be paramont. I have a high degree of concern for my personal modesty, my wife not so much, niether is right or wrong. I respect her right to dictate her care, she mine. While I have been uncomfortable several times when for one reason or another when I was in the room with her (once for a pelvic after a miscarriage and one for a breast exam), my wife requested I be there for support and consultation, it was her call, not mine, she was the one on the table.
hello,
i can respect your opinion that your wife should make the last call about who see's her or not. but let me ask you, did you tell your wife that the pelvic exam made you uncomforatable, or the breast exam? how will she know unless you tell her, and it sounds to me like she is the type that would probably be willing to switch if it made you feel that way. it has taken me a long time just to get over the fact my wife 'used' to see male doctors for this purpose. and if it pops in my mind i still have those imnages that stir up a lot of anger about my experience with males doing intimate exams on my wife. it is difficult to shake off those feelings, and you dont really get a lot of closure for it until time wears it off. i would like to put forth a series of questions for everybody, these are based on a christian perspective:
1. Does God Change?
2. is HE a respector of persons?
3. after adam and eve ate the forbidden fruit, and God was looking for them, what did they do?
4. why did they respond this way?
5. in GOD's eyes, is it OK to tell a lie, even if it seems like its for a good cause(such as keep loved one out of jail, not hurting someones feelings, etc.)?
6. peter and paul in the bible had a debate over jewish law and new christians, what things did they finally decide on what we should abstain from?
7. what is adultery, lascivishness, and fornication?
8. what are the steps in a normal physical exam by an obgyn? including breast and pelvic exams?
9. when you are intimate with your wife, what are possible things you may do before intercourse?
10. what is a speculum? what does it look like? how long is it?
11. what usefull information is gained from a bimanual exam?
12. what are the odds of winning pick 5 lottery jackpot? what are the odds of having an abnormal papsmear? how much do doctors recieve for performing these exams?
how many can they do in one day? what is the most lucrative feild of medicine?
13. if you were the devil, and you had to decieve a lot of people, even the most elect, how would you do it?
14. what do people do at a factory that manufactures goods? how do they become more productive?
15. people claim that doctors never think of sex when giving an exam. i have been repairing electronics for over 20 years, do you suppose that when i watch television i am thinking of whats inside? what would you think if a healthy 18 year old female had her legs spread out in front of you?
16. people say that due to the high number of women doctors see they are de-sensitized to it. do you suppose that people that look at pornography on the internet all the time are de-sensitized because of the volume of women they see?
17. David was the king of isreal after saul, and was the ancestor of JESUS. we are told that he was a man after GOD's own heart. what were the circumstances surrounding the time David commited adultry with Bethsheba? what was David doing at the time he first noticed her? What did GOD do about it? are male ob/gyn more rightous than David?
18. people are saying it is completly up to the woman as to what gender of doctor she chooses, and that the husband's opinion doesnt matter. i was a drunk for over 10 years, and i could see the effect my drinking had on my family. i have been sober for over 5 years now, and my family life is good. do you suppose that my wife should not have been upset over my drinking all the time? that it should have been totally up to me to keep drinking whether my wife liked it or not?
19. what are the marraige vows? who do you say them in front of?
20. why does the bible say women should keep themselves in modest apparel?
21 the bible says that GOD is a jealous GOD. what makes HIM jealous? what analogy does the bible use? is it ok for a man to be jealous over someone touching his wife?(even if it seems like it is for a good cause?) who does the bible say that we are supposed to emmulate?
To Anonymous from yeaterday Novermber 18th: Since this is a discussion blog and not "Twenty Questions", I would like you to discuss what is the significance of the twenty one questions you posted? Is it to explain the basis for patient modesty or the concern and perhaps jealousy of a spouse when the other is examined unclothed? Are you trying to imply that the explantion for these behaviors is based on bible writings? Could there also be some non-biblical explanation? Questioning the visitors is good, but questions must lead to a explanation of views and then a discussion of them. ..Maurice.
Maurice,
Do you and your students discuss this blog in class? If so what do they think?
If Anonymous from today is asking whether my students discuss this entire blog in class, the answer is "no" though they are aware of the URL address and I have encouraged them to read and write if they wish. Because of the importance of patient modesty when the students are learning about performing the physical exam, I have discussed the variety of responses to this thread and to the earlier one titled "Naked". As I previously noted, the students have their own personal experiences as patients being examined by physicians but they do want to learn what is the right and correct behavior by the examining physician. Additionally, I must tell them there is, unfortunately,no strict policies detailing the many issues involved in patient modesty. Perhaps, that is, in part, the origin of the many complaints of the visitors to this thread. ..Maurice.
I can't reply to all the 21 questions, but I can say my wife and I have had discussions on the issue. Both before, and more so after I started reading this blog. It works both ways, I had some minor surgery in the area of my privates, I told her I would feel more comfortable if she would not come back with me before the surgery. I told her the more people back there for the procedure, the more embarassed and uncomfortable I would be. She said she didn't think it was a big deal but if that is how I felt she would leave when I went back and be back before the estimated time the surgery was done. Same with hers, I told her it made me uncomfortable seeing another man, even if it was a doctor, examine her, but I would be there if it made her more comfortable. I am a Christian man, I don't see that religion enters into this. I don't think God sees this as anything other than it is, health care. If so, we males are all in trouble as few have not been in the care of female nurses. If the provider has inpure thoughts, they are the one that has a moral problem and that is between them and God, as we are not privy to thier thoughts.
Dr. Bernstein, I hope you will encourage your students to read and post on this blog, I have sent it to several facilities in the area. One of your students brought up her boyfriend had issues with her examining men....never even thought of that. This appears to be a thing of not understanding the sides, the other person's perspective. Great blog, helpful to us, and it would be beneficial to them to post thier side and read ours.
in my book we are either christians 24/7 or not at all. i agree with the 21 questions posted and feel it is in the best interests of a marraige for both partners to see same sex care givers. if we can avoid ackwardness, jealousy, and even hatred, i think we should all do our part to improve the situation. i dont think i have even been examed by a woman doctor or nurse for that matter, and my wife sees a female (woman) doctor out of respect for me, (also she is more comforatable with that). i have searched the internet for similar blogs and message boards after reading this one, and most of them have animosity towards the male doctor/female pateint relationship, not many address the female nurse/male patient attitudes.
I agree we are either Christians 24/7 or not, I just don't agree ones choice of the gender of a caregiver has anything to do with being a Christian. Further I feel respecting my spouses choice of a caregiver is Christian. Cherishing her and putting her needs before my wants is Christian in my book but this blog isn't about religion. I have the same issues with female nurses as I do female doctors, I am just more uncomfortable with them when it nudity. Nothing against them at all, just condictioning/culture. Unfortunately while our society recognized and took affirmative steps to correct the imbalance in the gender make up of our doctors, they have not done so when it comes to nurses. In spite of the fact that we face an apocolyptic shortage of nurses, and inspite of the fact that while males make up about 50% of the population but less than 11% of the nursing population, our society has done little if anything to bring more males into nursing, so many times we have little choice. I see the indifference to patients modesty as universal throughout the medical community, doctors, nurses, techs, and support staff and make no distinction when it comes to this issue. The only difference I see is individual providers, not classification in making a real effort to respect a patients modesty.
Kelly e-mailed me the following concern and allowed me to post this here for her. My response to her e-mail follows. ..Maurice.
Dear Dr. Bernstein:
Sorry to revisit an old subject, but your (most informative and appreciated!) blog was the only place on the Internet that even came close to touching on what, exactly, goes on in the OR. ("Kim's" postings and concerns about total nudity re: her husband, a surgical patient, popped up and I ended up reading darned near every posting into the wee hours...)
"Wee hours" because, frankly, I've been unable to sleep these past few nights, having just learned that my CHILDREN'S doctor, who's never seen so much as my upper thigh---we live in a very small town, ergo, I see this physician at the market, school functions, semi-socially, etc., and my "own" physician, having been blessed with relatively good health, is limited to an out-of-town gynecologist---was present throughout the surgery. (Apparently he was, by default, the "Referring Physician," though I'd listed my chiropractor first, the clinic where I'd had an MRI performed second, and this virtual country doctor third, as there were three lines on the form. What I didn't know was that the neurologist who performed my surgery made it a practice to have the "referring physician" assist. Indeed, had I just written in "none"---which would have been the truth, as the neurologist was known to me by reputation; I CHOSE to have my MRI sent to him and, for that matter, where I'd go to get the MRI, too---well, no use belaboring that: What truly concerns me is this: My "family doctor" didn't call just to say, "hey, I was there," but to advise me that, during surgery, "...WE noticed an assymetry on your left breast, some prominent blood vessels, etc., and while it might be nothing, WE think it would be worth checking out."
Of course, I quickly scheduled a Pap/breast exam/mammogram with my "regular" physician, but my real concern is:
WHY WAS MY "FRONT" ON DISPLAY WHEN MY BACK THE AREA BEING TREATED? Isn't everything else supposed to be draped? And while I was informed that, once I'd been "put to sleep" they'd be "turning me over," I had no idea this process would be performed in slow motion; i.e., would entail everyone in attendance---and God knows how many were!---standing around saying, "hey, looky there!" WHAT WAS THE REASON FOR THIS? I'd just had an extensive pre-op work-up; all my blood work was free of leucocytes, tip-top WBC, RBC, et al readings; EKG swell; even my chest x-ray came back A-OK on all counts. Furthermore, my MRI showed no tumors, "just" the ruptured disc(s), so why was there this FULL BODY VIEWING?!
Please, I'm rather distraught: if it's my neurologist's/any specialist's and/or surgeon's custom to invite ASSISTANCE, shouldn't said assistance be strictly related to the operation at hand? (Although, and I don't mean to be unkind, I can't imagine my "country" doc's being much more help in an OR than in the passing of scalpels and such.)
Any reply or response will be greatly appreciated! (I know I've lobbed quite a bit at you; all apologies in advance! And if it "helps," I'm long past being able to benefit from some "kindly reassurance." That is, I'm sure nothing unseemly went on---unlike some patient-bloggers, I have no illusions about the naked me being a turn-on!---except, of course, the most unseemly fact that my FRONT was examined when I'd gone in for BACK surgery!)
Many thanks in advance;
Sincerely yours,
Kelly
And my response to her concerns:
I can understand why you are disturbed about finding out that a your children's doctor who had no prior involvement in your diagnosis and care was present and perhaps helping with the surgery. While appropriate visitors (such as medical students or other doctors or nurses in training) may be present as formal observers about which the patient is not usually specifically informed, any surgical assistant who is participating and getting paid should be disclosed to the patient before surgery as part of the informed consent process. I would be also concernied if the assistant was not competent to assist and untrained and unable to take over and manage the surgery if something prevented the neurosurgeon from completing the operation. The co-pilot must be capable of landing the aircraft.
With regard to inspecting your body within the operating room as you are turned and prepared for surgery (either front or back), to me, is not at all unusual, nor does it represent some kind of perversity, deviating from what is considered right or proper or good. Not infrequently when the patient is unclothed, not conscious and the muscles are relaxed and the lighting is excellent, clinical observations of abnormalities of the body not apparent earlier during routine examinations may be discovered. It would be certainly appropriate later to make the patient aware of them if they are clinically important.
I hope all this upset with the event does not affect the results of the surgery about which I send you my best wishes for the best outcome. ..Maurice
I have a suspicion that the concerns of a man or woman about the genitals of their spouse being viewed, even in a clinical situation, may be an example of sexual modesty. Sexual modesty has been a topic of research. I found via Google a reference work from 1922 entitled
The History of Human Marriage by Edward Westermark. Volume 1, Allerton Book Company, New York, 1922. By clicking on the following link, you will be taken to Chapter XII and the topic of Sexual Modesty. What is very interesting are the examples of sexual modesty as observed around the world and the similarities but also marked differences in human behavior. I would be interested in the comments of those who read that chapter and how it might be related to the issues discussed on this thread and on the thread Naked.. ..Maurice.
After reading the chapter I feel it reinforces the thought that this is as much a case of cultural condictioning as it is a medical problem. We are condictioned from our early years that it is wrong to be nude infront of members of the opposite sex. Early on we are taught we need to be clothed in the presence of others. This extends to parents as we get out of infancy and learn it is wrong to bath with, or be present in the bathroom with a parent of the the opposite sex. Our Christian teachings begin with Adam and Eve who became aware of eachothers nakedness and were ashamed. We grow up accepting nudity with members of the same sex in the family as more acceptable and it is reinforced and transferred to arenas such as gym class. We are taught very few execptions to being nude with members of the opposite sex growing up. It is no wonder while we were educated to accept nudity with he opposite gender in the medical field, it is't by choice. As we began to feel there might be options in medical treatment, our acceptance of what we have been taught is embarassing has become more of an issue. We do not, in many cases can not, check the morals and social norms we have learned since infancy at the door of a medical facility. We may learn to deal with them but they are there. While Europeans feel no shame at nude or topless beaches we Americans still struggle with it, they grew up accepting it as normal, we did not. Medical providers are taught from thier side its not a big deal, but feel differently when they are the patient as previous teachings come into play. I do not think there is anything sexual about it to most of us, on either side. Its just that we are condictioned to feel embaressed about it, it is engrained in us. Walk out of a shower infront of someone you didn't know was there, sexual, no, embaressing, definately. I thought the article pointed out how cultural differences play into that issue, and in this case I think the cultural teachings of nudity infront of the opposite sex over rides the concept that medical nudity is not embaressing because that concept comes long later, and less frequently than the fact that it is something to be embaressed about. Take an American to a nude beach, everyone is nude, we still struggle with it the main difference, culture. This combined with the feeling that medical staff should know this, but don't respect it causes a lot of anomosity. We want a choice and respect for that choice.
Pertinent to the discussion of cultural differences and particularly the nudist culture, I would like to hear from those within the "naturalist" or nudist culture about how they feel undressed in the presence of a fully clothed male or female physician as part of a physical examination. ..Maurice.
I'm sorry, Maurice, but I totally disagree with students and other observers being present without the explicit consent of the patient. I am a patient who has a history of abuse, and who also has a history of unnecessay exams by doctors looking in completely the wrong area for what turned out to be crohn's. I have what one might call modesty issues. To me, it is vital that a patient should be asked if they mind extra people being present when they are naked, even if they are asleep. It is my firm belief that the medical profession takes far too many liberties in training the next crop, and that when a patient does assert their right not to have trainees present, the attending or the trainees are often less than pleasant about the situation.
I believe that such 'routine' breaches of patients' modesty are totally unacceptable, and you can be damn sure that the next time I have surgery there will be no consent for any unnecessary person to be present or even observing.
I am also concerned at your response to AngryWife's situation. The idea that an apology could suffice to remedy such a situation is entirely laughable, and in fact I feel that serious disciplinary action should be taken against the staff concerned -- that in fact, they should lose their jobs.
And finally, a friend of mine is in the medical profession, and he comments on a particularly invasive female exam being better for visualisation (despite having a horror of colonoscopies himself). He claims that using another, less invasive method is purely sentimental. This kind of attitude abounds -- that seeing many bodies means that it is somehow okay -- it's not. My body is special to me, and I expect you to respect that. I ask you and every doctor to think nto of yourselves, when you perform any intimate exam (unless, as with my friend, you have a horror of some particular exam, and then you should think of that), but to think of your shyest loved one, and how they would want to be treated, and progress from there -- if a patient is more comfortable being treated with less modesty, fine. However, begin with the path of most concern.
I would like to broadcast here an observation regarding behaviors in operating roooms. I am not a surgeon. As an internist, I have been in operating rooms only occassionly but more often as an instructor with my first or second year medical students. Neither I nor my students have seen any patient naked in the operating room, period. I always observe the nursing staff to repeatedly drape and redrape patients as they are being treansferred to or from the operating table and while they are on the table as necessary to maintain the patient free of unnecessary exposure to any eyes whether the operating medical staff, attendants, faculty or students present. I have always assumed that what I witnessed represented a standard of behavior in all operating rooms. If there are surgeon visitors to this thread who have observed otherwise, let them speak.
With regard to students, either nurses or medical students, observing in the operating room, this is entirely up to the permission by the surgeon and hospital policy. Hospitals which are teaching hospitals have information about the teaching aspects of the hospitalization in their documents for the patient to read and sign. The issue could be whether patients read the fine print. In any event, I am sure that since the presence of these students require the permission of the surgeon, a patient requesting to their surgeon the absence of students during the patient's operation would be generally accommodated.
I am surprised,educated but also disturbed to find that there are patients who worry that the operating room and its participants are involved in some sort of perverse,self-gratifying,patient-humiliating event. I have seen none of that. Operating room activity is a serious occupation with the patient's life literally at stake. While there may be music being played or conversation between participants which are not medically related, all to relieve the tension of the moment,the flowing blood and beeping of the heart monitor keep all fully informed that a patient, though unconscious, is still present. ..Maurice.
Maurice
Unfortunately the operating room is often not as idealistic as you portray. I have heard numerous medical students comment that when they are present for a surgury they inviariable see the patient "buck naked" if the patient is under general anesthesia. This is often followed by an amused comment about whether the patient was attractive. I have also heard of many sexual statements that students have heard spoken by health care professionals.
I agree that these things are very unprofessional, but denying they happen is not the answer. Therefore, please do not blame patients for being concerned about their dignity in medical and surgical situations.
I post here only what I have personally experienced. I am not denying anything. That is why I would appreciate first hand observations posted here by surgeons or OR nurses who observe the same or other behaviors. ..Maurice.
Maurice,
Do you really think a surgeon or an OR nurse will admit to unprofessional behavor? How would the public ever trust them after that? I'm sorry but I tend to believe that they would stick together. How many doctors do you know who have admited to a patient that they have made a mistake let alone something like this?
Kim
hello all,
i also have an issue with modesty, today i had a vasectomy performed. when i had the counciling for this, i was under the impression that the doctor alone would do this simple procedure. when i arrived there today, i took my wife along with me. the doctor got me ready, and then went out the door and said he had to go get a little help. in came a female nurse, i was so humiliated, especially with my wife sitting right there. i havenever felt so much shame in my life as i laid ther with another woman staring at my privates as the doctor done the procedure. they tried to talk to me but all i could do was grunt responses because i was angry she was in ther and i was not informed that a female nurse would be present. i also have issues with my wife being examed by a male doctor. it makes me really uncomforatable, i feel dizzy, my heart races, nausia, and anger. i looked this up, and there is a term for all this called "gymnophobia", or the fear of nudity. when i saw this, i saw that the symptoms mentioned above where described there as well. this is a real condtion, that should be realized much as someone who is afraid of heights. i also would like to add, i have always hated tomatoes, however i think they look like an attractive food, but no matter how many times i have tried to force myself to like them, for no logical reason i can explain, i simply do not like them, and i dont expect to ever like them. the same is true for my condition. i simply dont like it, but what can i do about it, because i feel like we are all force fed by societies view of "what should be acceptable." all i want is to be asked. it is that simple. on the forms you sign it should have a space indicating the gender you feel most comforatable with for intimate treatment. thats all. not everyone likes tomatoes on their hamburgers, and when you get a haircut or such, sometimes people want Mary instead of Kate. is that unreasonable or illogical?
thank you and God bless you all.
people who are watching this blog may also find this one interesting:
http://blog.iblamethepatriarchy.com/2006/02/18/gyno-knows-best/
they are basically talking about men in the ob/gyn field.
you can also check out a lenghthy disscussion here:
http://www.pregnancy-info.net/QA/answers-anxious_and_angered_by_male_doctors_and_scrub_nurses/
For the post on Dec 1. I also had a vasectomy, my doctor completed it by himself without a nurse present. He did the prep. put a drape over me, had the nurse come in and help him glove, then had her leave, he is very careful of his patients modesty. So, this was your doctors choice, not a have to. When I have had issues like this in the past, as a result of reading this blog, I started either calling or writing the facility/doctor and expressing my displeasure. It does two things, makes sure they know so PERHAPS they might treat you or others differently in the future, and it helps get it off your chest. Be sure to point out that having your wife present made it worse, something if you had at a minimum be informed you could have made a choice. Illogical......don't see how personal choice like this is unreasonable, you aren't asking for something that can not be accomodated, or is even hard to accomodate, it just isn't.
As a reader of this blog I would appreciate hearing from other reader/patients. When I read the post by the guy who had the vasectomy, to me it is without qustion insensitive at best. The operation though not dangerous is emotionally stressful for most males. It would seem obvious bringing another female (nurse or not) into the room, much less with his wife present, would only increase that emotional stress and embaressment. So here is the question, when non-medical people read his account, why do you think things like this happen? Is it:
A. The doctor realizes it is stressfule but is only concerned about the physical not the emotional well being of the patient
B. The doctor really does does not recognize that it is a stressful and emotional issue with for the patient.
C. It is a matter of convenience for the doctor, he is more concerned about completing the procedure in a timely fashion than he is worried about the emotional concerns of the patient.
D. The doctor holds the we do this all the time, it doesn't bother us so it should not bother the patient.
E. The doctor felt he had to have the nurse's help so it was proper to compromise the patients modesty?
Obviously only the doctor him/herself knows what thier motivations are. What I would be interested in is how you other patients feel about it.
i feel that there is a correlation bettween gynecological exams and early promiscuity in women. the reason i feel this way is because the doctors office is usually where the barriers of modesty are shed first. lets face it, after a few visits to gyno's office, modesty is thrown out the window, and now this woman/or girl is left de-sensitized to performing in front of strange males. now she will probably go on to have sex sooner than the one that did not recieve the exams, and since we all know there is a link to cervical cancer and being sexually active, the doctors are paradoxing the event by performing the exams in the first place. so, how do we fix that problem, should there be an age restriction on gynecology visits? if you had to rate an exam as you would a movie, what would you rate it? PG-13, R, or maybe X!?
what do you think of that doctor?
Maurice,
Today I had to have a colonoscpy. The doctor allowed my husband to stay in the room with me. We told the doctor about me wanting to be as covered a possible. Everyone was very nice. The procuder went well. It usually takes a lot to sedate me but since I felt good about my husband being there and the kindness of the staff. It didn't take as much. Which is nice because I'm not sleeping all day. It was nice for the staff and the doctor to exept my feelings and to respect them. I think if a man can see you having a baby. What is the diffrence in supporting me in this procuder. It all worked out well and I felt respected.
Kim
I do have a question though. Why do some hospitals have such restrictive policies? I think that was one of the things that make healthare so hard for the patient and the family member. It's not like this in peds. or OB. Just adult care. People of every age need support. Even more when they are sick. If a man can go into the OR to watch a C setion. Why the restrictions for everything elese? With my husband there for my colonoscpy it felt like I would be more respected and I believe I was.
Kim
First of all, I've never posted here before but I just finished reading this ENTIRE blog, and I have a few things to say.
To those people who are so scared about being naked in front of a doctor, you are confusing sexuality with nudity. Do you HONESTLY think that doctors go through YEARS OF SCHOOLING just to look at people naked? If you want to see naked people there are numerous other occupations you could pursue that require a lot less time in school.
It seems like some of you are a little too idealistic. We are all merely human, and just like you will never find a perfect banker, police officer, lawyer, or teacher, you will never find a PERFECT doctor, b/c all doctors are simply humans, just like you!! Would you rather have a robot examine you so you wouldn't be "embarrassed" about taking your clothes off???
I'm shocked that some of you are so ignorant to be afraid to take your clothes off in a medical setting. These people are there to HELP YOU. It's time to grow up and be an adult. If you don't like something that's being done, then SAY SO, but trust that most doctors' very LAST intention is to embarrass you. In fact, they shouldn't even be thinking about it b/c they should be paying attention to your medical problem, not your feelings. They're not therapists, they're highly trained medical professionals. Of course they should be nice and considerate, as should everyone else while on the job. But because everyone is sooo different about feelings of modesty and privacy (some of you are totally crazy), how do you expect them to cater to everyone's personal feelings of nudity when they're seeing hundreds of patients every week?? Do you really think your body is so special that they've never seen anything like it before??? The ignorance here is truly baffling.
Some of you are expecting way to much out of these people. Like I said, they're simply human, give them a break. They're trained and educated, and you should use them to your advantage. Stop criticizing every little thing. Just b/c YOU have a problem with nudity doesn't mean every other patient does. In fact, I'm sure most mature adult patients understand the reasons behind being nude in front of a doctor. It's common sense, and not to sound harsh, but I think you should just grow up get over it.
I fully, thoroughly or some other adverb agree with Anonymous from today Dec. 25th... EXCEPT I want to emphasize here an important point that both I and the other physicians should remember. I suspect, as I think Anonymous does too, that most of the folks writing comments of distress about modesty issues to this blog are really patient outliers if one could determine a statistical analysis of patient views on modesty. Nevertheless, even if this assumption is true, it is essential that all physicians bear in mind that their very next patient will be the one who themselves or their spouses find modesty issues a critical matter in the doctor-patient relationship. Even if they are in the minority, we should not ignore these patients' and their families' views. I am telling my medical students to anticipate this matter and to be prepared to attempt to mitigate the patient's concerns as much as practical and within their duty to perform a thorough and reliable physical examination. Physicians who find modesty issues trivial, antiquated, silly or represent some personality disorder, should shape up their professional knowledge about what is trivial or what is a personality disorder. As Anonymous has noted, physicians are humans but just as patients should realize that their doctor's are not inert robots, physicians should always remember that patient's are not just diseases to be examined and analyzed but are also made of flesh and blood and emotions. ..Maurice.
I find very little in the Anonymous post of Dec. 25 that I agree with. It is a confusing, somewhat irrational rant about a wide range of subjects. Those of us who have posted our concerns here for the benefit of Dr. Bernstein and his students - and hopefully the medical profession at large - are not immature, don't need to be told to grow up,and don't need to be given lessons on modesty. And we don't think that doctors have gone through years of schooling "just" to look at other people's bodies. But we do think that doctors, like all people, somtimes get careless and need reminders. Perhaps in your fury you neglected to read in these posts that surveys have found that between 5 and 10% of doctors admit to committing sexual indiscretions with patients, nearly all of which are male physicians with female patients. The figures for male gynecologist may be twice the highest number - 19%, and it should be noted that these figures are likely on the low side inasmuch as they are self-confessions. Contrary to your assertion, nudity IS sexuality. Always has been and always will be in the human family. The visual sexual urge of males (doctors or not) is well noted in science and ordinary life. Its origins are millions of years old and it doesn't change with a few years of schooling and medical practice. A noted medical textbook from a few decades ago (Sexual Problems in Medical Practices, Renshaw and Lief, 1972) admits the explosive sexual nature of nudity when it cautions and counsels: "The medical student or physician who does experience erotic sensation (while doing a gynecological exam) should recognize that this response is neither unusual or abnormal. Precluded are a physicians exploitative behavior, not his... feeling, which can be controlled." It is indeed odd that the anonymous poster asserts that we are "all merely humans" but then proceeds to advise us that doctors should be trusted as though they are more God-like than human. Strange thinking. The medical profession is concerned about nudity and sexuality and is making concerted attempts to curb male sexual appetites in the medical setting. Readers may be interested in reading an article entitled "Time and Tide" in the Archives of Family Medicine Vol 8, No. 3, May/June, 1999. It is a story by a physician who has erotic thoughts during a gynecological exam and the caution he recieves from a colleague. These are real problems that doctors and patients face and should not be disgarded with a thoughtless wave of the hand.
You have got to be kidding me. Dec. 25th. What is your issue that you spent so much time on christmas day reading this blogg and being so upset about it? I have had almost a year to think what is my real issue with doctors and being nude. Here it is. It's being vulnerable to people who don't think twice about me as a human being. It's about neglect on the part of the staff. I don't want to be just a job to them. I spent over 100 days in the hospital with my husband. I saw what it means for the patient and family member to be respected by the staff and what it means when they don't. When they don't it is not only hurtful but can be deadly. It's about being human and being treated with respect. It starts here. Nudity is the base. If you as a medical professional can't respect the patients feelings about nudity you won't take the time to respect them about what they tell you about their body. My doctor respected my need to have my husband with me during my colonoscpy. I inturn trust him completly with my body and his results of the test. He didn't do what was best for him and his staff. He put me the PATIENT first. For most places it's about the "process" the "staff" and the "needs of the hospital". Do you know that there is no reason you can't have someone you want with you for anything you are having done even surgery. As long as the sterile field is not compromised and the person can handle it. That is why they now let men come in the OR to see their child being born. Here is an example of thoughtlessness on behalf of the hospital staff. I asked to be with my husband befor and after his last surgery. I was told no for HIPPA reasons. There were several patients in one big room lined up like cattle waiting for surgery. OK so you are sitting there IV already in with nothing to do but wait...alone...sared. Nice!! I don't care who you think you are but a stranger in scrubs can not comfort the patient like a loved one. Not to mention how it helps the loved one to be needed. It was for the "needs of the hospital" because if you look hard enough at the HIPPA web sight there is a provision in the law for this. HIPPA realizes that you might over hear doctors comments in a patients double room. It would be the same in the situation in the pre-op room. That shows a lack of concern for the patient and the family members feelings. There for a lack of respect. As a family member I cared most for what happened to my husband the patient. More than one I was able to point out something that wasn't right. Some doctors listened some didn't but I was right most of the time. I kept him out of the OR on the last surgery by pointing out an infection under his skin early enough that medication fixed it. Stuff like this happened over and over. If dotors don't respect you they don't listen if they don't listed they miss stuff...stuff that can kill you. If you don't feel respected by your dotor find another one. If you find a nurse who is disrespctful don't trust her or him. They don't have your best intrest. So shut up and get over it isn't a option.
Kim
I think this intellectual (not sexual ;-) ) intercourse is just great.. but as moderator of this blog may I suggest that those who want to write a comment and remain anonymous please follow Kim's example and end the commentary with a unique pseudonym so that everyone here will know clearly which Anonymous is writing what. ..Maurice.
I agree with Kim. Providers are asking patients to place thier trust in them, we feel very vulnerable. Respecting our modesty is one part of earning that trust. If they don't care enough to respect that, to put forth a minimal effort it would take to accomodate that, why would we trust them to do otherwise in other areas. If the provider really thinks the issue of modesty has to do with what they see and experience everyday, and not what the patient is experiencing in a time of stress in a strange environment....what does that say about them to us. It may be normal to them, but it isn't to us. The relationship between health care provider and patient is like none other, respect and trust are a must. The provider has so much more power in the relationship, if they expect patients to give up control and trust them completly, that trust has to be earned in the basic inception of that relationship. By treating patients modesty which is important to many or most patients, as unimportant the relationship is not based on mututal respect, its based on what they think, not the cornerstone of trust. Trust is earned, not given.
In response to "Anonymous" on Dec. 26, female doctors also have visual sexual urges, this I know first-hand. Whether these result in aggressive action or secretive or inhibited action it makes no difference. Many are affected. Female doctors are still learning the ropes. And they have a much more difficult job of examining male genitalia, which are quite a bit larger than the female. The penis also moves and can change shape during the course of a medical exam. I have seen several medical personnel get embarrassed looking at me naked. A nurse even turned red giving me a shot. But the penultimate moment came when a young female doctor examined my genitals and then turned beet red while shaking hands with me and then leaving the office quickly because of her embarrassment. I agree with Anonymous. Nudity is sexuality. I don't think many female doctors are voyeurs. Females don't look at nudity the same way males do. But some, based on my experience, are "interested." And over time they will toughen themselves to the nude male body and adapt. As of now, they're nowhere near being comfortable looking at and chatting with a nude male patient. It's a bad time for them, the women doctors, and for us, the male patients. But this difficult period must take place to get past it.
I met a new client today. She is a nurse. How come every nurse I come across has a story about putting a foley in a man??? It must be a real moment for them!! You should hear the way they discribe it. I swear they like it.
Kim
Kim, as a physician and since my wife is an RN, I know that inserting a Foley catheter into a man's bladder through the penis is a very common hospital procedure that is carried out by the nurse and only rarely, except for technical difficulties, by the doctor. Each time the nurse attempts this procedure, I suspect, she or he finds it a bit of a potential challenge and carry with it some events which might be remembered. Why? Because the nurse is invading the patient's body with this foreign object after manually sanitizing the tip of the penis. The procedure can involve some pain and discomfort for the patient and a potential for difficulty with insertion, with repeated attempts yielding more pain and discomfort for the patient. And then there is the uncertainty of how the patient is going to respond to the nurse. However, it is all part of the practice of being a registered nurse but non-the-less the procedure is challenging. ..Maurice.
Maurice,
I guess you had to be there. Her story had nothing to do with technical difficulties. It had to do with his age, size and how long she had to hold it. Also the huge grin on her face didn't give me the impresssion she was thinking "thennical". I was wrong in implying that all nurses have this reaction. I'm sure there are good and bad. I wish you would admit that. Sorry if I insulted your wife.
Kim
I think I know what Kim is thinking. I to have been in social situations, as recently as a New Years Party where a couple of nurses in our social group made jokes and told "shop stories". Many times they had to do with procedures involving nude males, one even made a general comment about being prsent during a vasectomy procedure involving one of the guys at the party. Nothing specific or graphic, but it obviously made him uncomfortable to the point where when it wasn't obvious, he left. As Kim, I and other posters have stated, this isn't a thing we feel is universal. But the medical community needs to realize that many of us have been present when this happened. We understand medical people are just being human, which validates our concern that when they say our nudity infront of them is different and we should not be a concern. If you, the providers expect us to accept these incidents as being human, you must also accept our concerns that our being nude is justified as not only us being human, but you also, and therefore deserves consideration and accomidation, not just reassurance. Providing same gender providers, reasonable apparel, privacy, etc should not be something we should not have to ask for. Providers need to understand when you say "its not big deal we see it all the time", not only does it not solve the problem for us because we do not do this all the time, but we know you see it all the time, some of your co-workers have told us that in various social settings. Not to condemn the profession for a few, but perhaps you understand our apprehension and could be a little more aware and accomdiating.
dg
My own experience over the years with the medical profession has been largely postive. However, two incidents occurred that show lack of concern with male nudity. Some years ago I had a vasectomy and during the pre-surgery conference I was told that the male urologist would be doing the operation alone, a fact that was reassuring to me. As the surgery was progressing there was a knock on the door and a female nurse entered the room, walked over the the table where I was lying with my genitals exposed, and casually told the doctor that he had received a telephone call. There was nothing urgent in the message or their voices. She could have waited until he was finished, but instead seemed to take advantage of my vulnerablity to stop in a take a look. I cannot imagine a male nurse barging into an examining room while a female was undergoing a pelvic exam, simply to view the scene. Some years later while undergoing a routine prosate exam, the male urologist said he noticed a lump near my testicle and thought I should have an ultrasound and check it out. My fears of cancer urged me to have the ultrasound, but my sense of modesty caused me to hesitate. Eventually I scheduled the exam, hoping that a male technician would do the scan. I was shocked when a female tech walked into the room, told me to undress below the waist, and she would be doing the scan. When she returned in a few minutes, she abruptly pulled away the covering sheet and told me to hold my penis out of the way. She did not offer me any cover, but left my genitals comletely exposed the entire ten minutes. That was the last time I went to that urologist. As I told my wife when I returned home, it is unimaginable that a male technician would be assigned to perform a mammogram on her, or that during a pelvic exam she would be left completly uncovered throughout the exam. Many men - "good time Charleys" - would have a good laugh over these incidents. But I find them offensive and thoughtless, giving evidence of the medical professions unconcern with male modesty. Incidently, the ultrasound scan was negative. During my annual exam the next years I asked the new urologist about the lump near my testicle. He said such knots are common in men who have had vasectomies. It seems obvious to me that the urologist who suggested the scan knew what he was doing and simply "ran up the bill" on me. The ultrasound was unnecessary.
Gene (I previously posted on Dec. 26 at 3:22)
I have posted nearly the same experiences as Gene. And had the same thoughts, male modesty in society as a whole does not get the same concern as female modesty. While I fully agree with the female posters their modesty is also often taken for granted in the medical community, and they have the additional concern of abuse from a minority of "bad apples" in the medical community, there is a double standard. I have stated both points made by Gene, male mammographers, doubtful, ignore privacy during a pelvic and there will be ramifications, but we expect males to accept it, and we do which is part of the problem. There are medical blogs at allnurses.com addressing the difficulties male nurses face even during training, by other female nurses. I assume it is historical in basis not something sinister, but it is sexist in the same vien as other generalizations imposed on women, and it is just as wrong. Sorry about your experiences Gene, but at least I know it isn't just me.
dg
Dr. Bernstein, accepting the unavoidable instances due to the fact that 85%ish of nurses are female, do you observe a difference in the way modesty is addressed based on the gender of the patient? Do you think caregivers generally view the attitude, and therefore the needs of female and male different in this area?
Anonymous from today Jan 10th wrote: "do you observe a difference in the way modesty is addressed based on the gender of the patient?" Perhaps for this thread it would be more appropriate to ask "do you observe a difference in the way modesty is UNDRESSED based on the gender of the patient?" Seriously, since I have not taken any polls or surveys and I haven't been in other physician's exam rooms or in operating rooms or other procedure rooms routinely, I can only speak for myself and my own philosophy on the matter. I would think that there can be and perhaps should be differences in addressing modesty based on the gender of the physician and the patient. I think that modesty issues are different with men examining men and women examining women as contrasted with one gender examining the opposite gender. With same gender, the issue of exposure and modesty may be of less concern to both parties, certainly for me it has been that way as a physician. Beyond that, I don't know. What I can tell you is that based on reading my threads of Naked and this one, I have obtained much insight into the degree of concerns aome patients have and the surprising lack of concerns some patients have about modesty issues and the behavior of their healthcare providers in this context. As I have mentioned previously, it is this education I have received which I hope to translate into education for my first and second year medical students about what to expect and how to respond as they examine some of their patients. ..Maurice.
To be perfectly honest as a male I have had limited experience with female Physicians, but what I have has been pretty positive. While it is more difficult for me to feel comfortable with a female doctor when exposed, they have been pretty good about doing what the could in dealing with modesty and reassuring me, with the exception that I felt they brought in female nurses when it wasn't absolutely needed. Being exposed to multiple members of the opposite sex is intimidating. My problems have been more with support staff in imaging, nurses, etc that seem to be approaching it in a matter of fact, another day for them attitude. Unfortunately it is part of the whole patient experience and effects not only how we view them, but the Doctors. We look to the Physicians to be the "boss" and protect us. For me, and I think many people, I have less issue with same gender providers, its not as stressful and growing up (locker rooms, etc.) something we have experienced and accepted in our society. I also precieve a difference in how males modesty is approached by the medical community. I think there is the preception men don't care as much so it isn't as big of deal. As the previous posters stated, many times females recieve accomodations for mammograms, pelvic exams, etc.. This is partly society. Remember the big female reporters in professional sports locker rooms battle, female reporters are allowed in male locker rooms after game in the NBA, in the WNBA (womens professional basketball), reporters are not allowed in while the women shower and change after a game....the same double standard seems to be present in health care.
Maurice,
You said your wife was an RN. Can she tell us if she noticed a diffrence and why this might be?
Kim
Maurice,
You have answered two questions on your blog Naked and not mine. Why?
Kim
Kim, I am not trying to ignore your questions. If your question dealt with observing a difference in the way modesty is addressed based on the gender of the patient, I really wasn't sure that an isolated response by my RN wife is of any significance to this discussion. I have no idea whether her view could represent any general consensus amongst other RNs. If so, I felt asking her to express her view for this blog was immaterial. I know by her descriptions of her work at the hospital that she is aware of emotional discomfort of her patients and that she tries to provide the needed ccmfort. I am sure that this concern for comfort would apply to issues of patient modesty irrespective of the patient's gender.
As a physician in over 40 years of practice, I have not heard personally from RNs or have known of RNs spreading "juicey" stories about penile manipulation or Foley insertions. I have heard only about difficulties of insertion of Foley catheters into both men and women. Perhaps you should suggest to your nurse clients that they should keep their unprofessional comments to themselves or if not themselves, limit their descriptions to their psychiatrists. ..Maurice.
Dr. Bernstein, I understand your position, but then most if not all of the posts are individual observations, one could argue the same for all of them. I would be interested in any providers thoughts on this realizing it is just that, thier observations or thoughts. I think Kim's request for your wife's thoughts has value from that point. From personal experience and from what others have posted I think RNs or others joking about intimate procedures are more an indication of the problem we percieve than an indication of perversion. To the provider it is routine, no big deal, they are so used to it they can joke about it without realizing those on the patient side of the conversation find it offensive or intimidating. It builds on that dread we have about going for care. Whether its a self defense reaction of the mind or just desensitizing my personal perception is medical staff see the issue from thier perspective and do not put the same importance on the issue as patients. Humor can be a coping or desensitising mechanism for them so they don't place the same value on it for patients. It isn't THE big issue, its one of the straws on the camels back. You appear to be an exception and seem to understand it can be more than just uncomfortable for patients, it can be a stressful and tramatic and prevent patients from seeking care. Thanks for the blog and being open to back and forth dialouge.
Sorry I forgot something, I understand RN's don't dispense compassion by gender, but something that is a little more concrete, does she observe/percieve a differnce in the approach to modesty by gender, for example there have been some recent legal challenges with male RN's being denied employment opportunities in delivery rooms, obviously becasue of male gender in an intimate female procedure. Is there a deliberate effort to provide females for mammograms but that same gender consideration is not applied in other areas i.e. ultra sounds are assigned by the order come up rather than gender and procedure. dg
OK! OK already! I talked with my wife about Kim, dg and others concerns about a RN's view of patient modesty, gender related. She started out by saying she has heard repeatedly from patients this statement but also a complaint: "when you enter a hospital you can leave your modesty at the front door!" But the issue of modesty for the hospital patient, according to my wife, is not a simple gender issue but it is known by the nurses to be cultural. For example, Hispanic or Armenian families demand to the hospital staff that their female relative NOT be attended by a male nurse. Family representatives of the patient may actually gather in the room during a nursing procedure where modesty issues are involved. My wife states that it is usually a longer and more difficult procedure to insert a Foley catheter into a female because of the more complex anatomy of where the urethral orifice is located. Folds of tissue may hide the opening and therefore more time, closer inspection and more manual manipulation of the genitalia is necessary to reduce the chance for trauma in the female in contrast to the procedure for the male. This could give rise to female patients wondering "what the heck is going on?". With regard to female nurses behavior respecting patient modesty, my wife says there are a lot of thoughtless nurses who when finished with their activities with the patient, male or female, walk away and leave them uncovered, so that other nurses, like my wife, have to enter the room and attend to covering the patient. With regard to the gender issue for mammograms vs other procedures, this is beyond the scope of my eife's experience but she did remark that the last mammogram she had was performed by a female technician who gave her a hematoma. So complications arise even in same gender procedures. In conclusion, maybe all patients, male or female should take a hint from the Hispanic and Armenian culture examples I gave and SPEAK UP if the patients have modesty concerns. I can't predict the results of such speaking up to the hospital staff but I would think the patient might have a much better chance of getting their own personal issue and concern resolved in a timely fashion than simply weeks, months or years later writing about it to a bioethics blog, even mine! I hope with this posting, I have provided some of the answers that my visitors challenged me to provide here. ..Maurice.
Maurice,
Thanks for your answer. I am glad your wife is one of the good ones. Her answer makes me think of a few of the nurses we had. The only problem though is if I as a woman had surgery and ask for an all female staff. It is a good chance I could get away with that. For men that is not really possible since most of the nurses are female. So what do you do? You don't have to answer because their isn't anything that can take it back or make it better. By the way their are more issues at hand here for me. One is the fact that my husband was abused and neglected by the military hospitals staff when I wasn't allowed in the room at night. You would have to listen to hours of explaniation to believe me. I am now terrified to leave him alone in any situation. Even the OR. I don't trust anyone after what we went through. People should never be in the hospital alone.
Kim
I've already posted in the "Naked", but it's clear that in our society men are neither given or expected to desire the levels of modesty or privacy given to females. Conditoning starts in childhood. As recently as the 1970s it wasn't unheard of for YMCAs or schools to require boys to swim nude (though not in the presence of females) or even for colleges to take nude posture photos of freshman as part of a physicals. Even today in secondary schools, a girls lockerroom may have individual shower stalls while the boys have communal showers. On a related note at what point is a minor's desire for privacy or modesty to be respected? Should a physician allow a boy's mother to observe a skin exam or a girl's father to observe a pelvic if the patient objects?
yes hadrin0117 it is conditioning with childhood and with what society accepts. (all ranks of society do that no matter what proffession you do) men can walk around basiclly naked if women do that then they asking for it also now even women ca nt breast feed in public because society and the media have made breasts sexual, mens objects not babies food.
ps.
nice how you made the differ between mother observing your skin which could mean any part of your body but father watching a pelvic excam ?
We are really talking about medical modesty, we have strayed into a related area, cultural conditioning, not sexism. Hadrin was simply presenting examples of procedures a young person may object to the presence of a parent of the opposite gender, pelvic exams are often brought up by females when the subject of medical modesty is discussed. Maybe full skin exams for both genders would have been better but the point was the rights of a minor. On conditioning and double standards, the wrongs against one group do not justify transgressions against another. Hadrin's points were valid, males from a young age are not given the same consideration for privacy as females, does this societal practice carry into the medical arena. I believe it does. Perhaps another question is does what you percieve as a higher standard for women's modesty (acceptable clothing, breast feeding) translate to a higher standard in a medical setting. For instance there have been employment lawsuits regarding hiring male RN's from delivery rooms, are female RN's prohibited from male procedures etc. Does our society have two different standards for male and female modesty in the medical setting. That was the question.
Of course, this whole issue particularly brought up in the last few postings is a particularly pertinent in medical diagnosis and treatment..and not necessarily just from the modesty point of view.. but how about lesser diagnostic awareness and inadequate treatment attended to woman than to men and with potentially detrimental consequences to the women.
I want to apologize to my visitors to this current thread on modesty. I have so many different topics on this blog on medical practice and medical ethics that I just can't always insert appropriate links to direct visitors to other treads for more specific discussion. Such is the situation with the issue of gender differences in medicine. I have a thread started in November 2006 titled "Why Can't a Woman be [Treated]More Like a Man" (a takeoff on the lyrics from "My Fair Lady" musical.} Examples of those detrimental consequences to women are presented and discussed on that thread. Perhaps you want to go there for more insight. ..Maurice.
(We are really talking about medical modesty, we have strayed into a related area, cultural conditioning, not sexism. )
sexism =discrimination on the basis of a persons sex.
which women suffer more from and it is cultral medically and none medically.
i noticed in your naked post hadrino117 that men are told not to be silly well that is also a well know saying said to females so that is not a gender thing looks more the medical persons thing.
Still does not discount hadrino's and others question, is concern for male modesty less than female in the medical setting. Not denying in general women are discriminated against more than men. The question remains, is male modesty approached differently than female in the medical community. dg
"The question remains, is male modesty approached differently than female in the medical community." I think I can simply answer that question and say with confidence an emphatic "yes". This, I suspect, is, of course, the view of male physicians but I also suspect that female physicians would answer the same way. I know that in every way we (and I don't mean just me) teach the medical students the art and science of physical examination, there is more concern about female modesty than with men. Why? Well, perhaps there is more anatomy for women to be modest about than men. Any other reasons? ..Maurice.
Think about this. If you take a man and a woman and have them stand side by side naked. What do you see. With the woman you would see breast and some pubic hair. Not realy any sexual organs. She would have to open her legs for that. With a man there it is. When you put a foley in a woman it goes into the opening of the bladder. Something that dosen't get aroused during sex. With a man it goes through his sexual organ and into the bladder. To me that is a big diffrence. Why then does the medical community treat that with such disregard? It is a big deal. Ive never had a doctor touch my clitoris and would be shocked if they did.
Kim
To expound on Kim's point, using the media as an example, movies showing male or female buttocks or female breast can get a pg-13 or R rating, movies showing gentitles of either are X rated. I think in general exposing ones gentitles is viewed differently by our society than buttocks or though perhaps to a lesser degree female breast. In general being nude in front of the same sex is usually considered more acceptable or less embaressing than the opposite sex. Yet in the medical community that is more of a consideration for some degree for females than than males. Again eliminating situations where due to gender make up of caregivers it can not be accomodated, I would suggest it is just seen as being less important for males and therefore there is less effort to accomodate. Take it a step further, there is a higher degree of concern and accomdation for Muslim patients due to culture. This is just accepted by the medical community which begs the question if it is possible to accomodate specific segments of society, why not just try to do it for all when providers know it is an issue for most, only the degree of concern is different? I think that is the same issue with male patients concerns, they are not seen as a segment in general that has a high degree of need for modesty. Thoughts?
to me solve everything is to have men take care of men women take care of women ok problem solved and i am not religious so please dont reply with that ok
the medical proffession are no different from other men or women so when women can walk around topless from men then we are eaqual(which we are not) if not well women are differ from men and it is you men who created that problem. medical people read books ect learn we can do the same so i say educate yourselfs we have the internet now
I recommend going with this link to Feministing.com and read the discussion of the laws found in the United States and elsewhere which reflect the gender inequality of going topless. Kyra details why these laws are sexist by writing the following: "The law in question, besides serving no real purpose except to impose an outmoded and sexist ideal of morality, arbitrarily discriminates by gender---the only thing that differentiates a bare chest that gets an indecency charge from a bare chest that doesn't, is that one belongs to a woman. Size doesn't matter (fat guys can go topless), bounciness factor doesn't matter (flat-chested women can't), presence of mammary tissue doesn't matter (women who've lost theirs to breast cancer and either replaced them with silicon or left them flat are both restricted by the laws, at least as long as they have nipples, which men are always allowed to display). The one exception is that a female-to-male transgendered person can, while still biologically female, go topless if she has (naturally or surgically) small or nonexistant breasts, AND PRESENTS HERSELF AS A MAN.
Sexism. Plain and simple."
No one here has argued differently as far as I can read. I agree it is sexism but it is a different issue. With the changing dynamics in the gender make up of the legislature perhaps some of these injustices can be corrected. But every issue that is discussed does not revolve around sexism. While I feel male modesty is not given the same concern female modesty is in the medical community, I do not feel it is the result of intentional malicous behavior. I understand sexism does not have to be intentional to effect people. But, if males are treated differently in the medical setting becasue of stereotyping, it is just as wrong as females being held to a different standard when it comes to being topless. Regardless of who is the perpatrator or who is the victim it is wrong. If you justify discrimination against someone else, you justify discrimination against yourself by someone else. But again, this is a blog on medical modesty, not sexism in society unless it is related, and then it should not matter which gender is perpatrator and which is victim to determine whether it is right or wrong. dg
I was told by a nurse that they have power/control issues because of the relationship that they have with doctors and this may get transfered to the patient. A man wrote about some nurses making him shower in plain veiw of nurses with the door open. He was asking if this was normal. I believe the reply was yes this happens in a hospital setting. Why couldn't the lazy nurses shown this man some respect and one of them gone into the room with him shut the door and turned her back for him to shower????
Kim
yes dr Bernstein read that fem site you copied and you pasted a good view point.But is nt modesy built from socially acceptence of what is acceptable from the oposite sex the goverment can rave all it wants about equallity but socially things have not changed socially people choose what is acceptable in society and what they feel no matter what rules are made men and women are still viewed different. so sexism social norms and gender play a big part in modesty other wise we would all be sharing same room in gyms toilets ect
most modesty problems only occurr from reading this site is from someone treating or caring for the oppisite sex
Dear Dr. Bernstein,
Earlier you requested comments from nudists about modesty viz a viz being undressed in a medical setting. I can't speak for everyone, but there is a big difference between being naked on a beach or a club and being in a medical setting -- for one thing, I am always nervous, by definition, if I am being treated or teated for a disease. Also, as far as I'm concerned, there is a greater ease with the opposite sex than with males, I just find it a little more natural to be naked with women than men. My wife, however hasn't got a shred of modesty (one of her most endearing traits) and doesn't care in the least. Anyway, I'd be glad to answer any specific questions you or others may have.
Regards,
CLF
CLF, I'm not doctor Bernstein, but am curious. (1)Do you find your comfort level with nudity different in the medical setting in general other than concern for the medical procedures? (2) Do you percieve any difference in comfort because the providers are all fully clothed (3) Do you feel the level of authority or power dynamics play any role in your comfort? I find it inspiring that nudists seem to have overcome the norms society has imposed in general. I respect you all for being able to do so. I haven't been able to do so, but I respect you for being able to shed what society says and follow what you believe. dg
Dr. Bernstein, I'd be interested in your thoughts about the use of chaperones.
No one questions that male docs need to use chaperones when doing pelvic exams. Despite other rationalizations given, this is mostly for the doctor's protection. Few patients ever request it and the majority of docs would refuse to do it without a chaperone. The chaperone though is always female and modesty is rarely an issue.
There is an increasing use though of chaperones by female physicians when examining male patients. Once again the chaperones are nearly always female and modesty and indeed privacy can be a real issue. As before, the reason to use chaperones is always to protect the doctor, and the patient is rarely given a choice.
I'm aware of no generally accepted US guidelines for the use of chaperones, although I have been able to find them for the UK. Don't you think that chaperones should always be offered when appropriate, but never made mandatory. That means that a male patient should be able to refuse one without prejudice (though obviously the physician can refuse to proceed if they truly feel that one is necessary). I'm also concerned that chaperones are not usually identified as such but disguised as assistants often doing nothing more than standing around and giving the doctor a glove on cue. UK guidelines I saw recommend that chaperones be offered but were voluntary and the chaperone should preferably be the same sex as the patient.
Be greatly interested on your thoughts on this. Is there a medical reference somewhere or perhaps a blog oriented towards physicians?
js md, do you have a reference to the UK guidelines on the use of chaperones in physical exam or procedures? If the UK has such guidelines, why is it that we don't have that here and followed in the United States? ..Maurice.
From a patient perspective, having multiple members of the opposite sex with the paitent being the only member of that sex in the room definately increases the anxiety. I would be really angry if I became aware the that a chaperone had been "disquised as an assistant".
Dr B,
There are actually multiple UK references available online if you google it.
Here's one of the first that popped up.
http://www.telfordpct.nhs.uk/pct_information/policies_&_procedures/pct_wide/chaperone_policy/joint_pct_chaperone_guideline.pdf
I have no idea why there are no US guidelines from the AMA or such. There are some from a few states posted such as New Jersey. If you surf the net (always dangerous and not always reliable) you will come across a depressing amount of credible posts from RNs who talk about how much they enjoy being chaperones in offices and enjoy the available views of nude men in hospitals, even to the extent of sending their friends in to also look. HIPAA doesn't seem to bother them at all.
Dear dg,
To answer your questions, 1- I think that any anxiety I have is from fear of the procedure and/or the test results. 2- The fact that the providers are fully clothed is not a factor, I believe, since there have been many occasions when I have been nude around fully clothed people in a non-medical setting and that doesn't bother me at all. 3- I don't understand this power struggle issue at all, naked or not. Why is there a contest or an adversarial relationship with people whose job is to cure you? Thanks for the compliments, but I don't really deserve them since I was raised this way, and we are raising our kids in this way as well. Sometimes, I just can't fathom the people who equate nudity with sex or power. If you do feel powerless because you are naked, I think the problem is greater than that which can be fixed by putting on your underwear. I hope these answers are adequate.
- CLF
CLF, thanks for the reply, I don't think it is a powerless situation. The concept was presented in this blog. When I read it I thought....maybe. The truth is in my paticular case, I really can't say for sure what it is about the scenerio of being nude infornt of the opposite gender caregiver that makes me so uncomfortable. I always associated it with condictioning as a child, unlike your parents, while I do not recall specifics, I grew up thinking being nude infront of the other gender was cause for embaressment. I took the power dynamic issue expressed here, which I think may have a role, as being the fact that for most of us, being told to remove our clothes by someone and expose our selves to them,is unnatural. Thus someone of precieved power making us do something we find uncomfortable, not something we want to do or would do normally. While I personally attribute my hang-up to cultural condictioning, I can't deny that subconsiously, the power thing may play an unrecognized role. I just don't know why to tell you the truth. Being a nudist, have you had conversations with non-nudist as to why they can't embrace your life style that would shed light on this?
Dr B,
I have a larger question for you. This blog stresses the paramount importance of preserving a patient's modesty which is fine. But clearly modesty is not the most important thing doctors are trying to preserve. Number one is health and safety.
In the US though privacy rights have been subjugated to equal employment opportunity laws. The most notable examples of this are female prison guards and female reporters in locker rooms. But these laws also have a profound impact on health care. Despite what you might think from this blog a patient does not have the 'right' to specify the gender of their health care personnel. You can choose your own doctor, but you really can't tell them the gender of whom they must use as assistants. This is even more true in hospitals. A patient doesn't really have any more right to specify the gender of their health care providers than they would to specify race. Despite this, patients are given wide latitude in expressing preferences. I know at my hospital if a woman doesn't want a male nurse taking care of her, the wish will be granted if possible and it nearly always is possible. Men are always given much less latitude. There are many male nurses, technicians and assistants though, and they have as much right to their jobs as the ladies.
So what's the answer? Where do patient's rights end and equal employment opportunities laws begin? I don't know what the answer is.
There in lies a issue that I read in several postings. There is a double standard in application of equal employment which carries into healthy care. Female reporters and prision gaurds are afforded freedom that their male counterparts are not in reverse situations. Why, to a large degree because society accepts it, why to a large degree becasue males tend to not vocalize their concerns, they take it. Partly becasue of fear o fear of being labeled. Demand rights to a female locker room (WNBA) and you are a perv if your male, a trailblazer if you are female. Demand same gender care your sexist. But if we are to see a change everyone needs to speak up. While we may not have a "right" to same gender, competition in the medical field is really heating up. Ever notice how many advertisements, TV, billboards, etc. you are seeing advertising hospitals, clinics, etc. I think we as patients need to ask, and when we don't feel we got what we should have, complain long and loud to the facility administration, they are the ones trying to drive the bottom line. Let them know not only will you not be back, you are going to tell as many people as you can. If you really want to see change, follow the dollar back to the people incharge. If we don't ask, they won't know, if we don't complain when we don't get what we deserve, it won't change. Realizing the caregiver's first priority is the physical side, and that is where they concentrate, some times its up to us to remind them, it isn't the only thing.
To get an answer to js md's question, I posted his comment on a bioethics listserv and got the following response from an ethicist who provides us with a little unfortunate American history background which parallels the issue that js md brought up. ..Maurice.
Maurice,
In 1838 a "free person of color" contested statute that imposed on persons like
himself a unique vulnerability. If he could not pay fines imposed on him, the
county sheriff had the power to "auction him off" to the highest bidder to work
off his fine. White folks were not vulnerable to this indignity.
The court faced a problem - did this violate the State's equal rights provision
forbidding the imposition of unequal burdens on citizens of the State?
Of course, this raised the vexed question whether free person of color were
citizens and the court answered "yes" but not equal citizens, since women and
children were citizens but not equal to male adults...
Anyhow, and to the point, the court opined that the distinctive provisions
applying to blacks did not offend the constitution [because] blacks were not as
sensitive to degradation as whites.
Seems to me like a similar rationale is used today for asymmetrical privileges.
Here is a question for all of you. When do the rights of others over ride the rights of an individual? When do policies of hospitals violate the personal rights of patients and family? You as healthcare workers are concerned with your rights not the rihgts of the person you are treating. You have a moral obligation to protect your patients. What if you had a patient who had been raped and you said sorry you get a male doctor and you have no right to refuse. Could this cause emotional dammage to that patient that you would be liable for?? Equal empolyment PLEASE Use your head!
Kim
As I understand it the courts have created this same result when it comes to the prison gaurd issue through application of employment standards rather than equal under the law. The rationale in part, at least from what I read was there were many more opportunities for jobs in male correctional facilities than female, so while it could limit female searches by makes by limiting the number of males available, however to apply the same standard would reduce the number of job opportunities for women as limiting them to female facilities reduced the number of positions available. They also ruled pat downs of males by females did not require touching of sensistive areas where pat downs of women was more intimate with the breasts involved, and as indicated they suggested due to societal standards, women were more intimidated by opposite gender searches than men. They did rule male guards had the same rights to inspect showers and female prisoners did not require addtional privacy in the shower areas, from what I read. On the reporter issue, while a big deal was made over letting females into male locker rooms, I don't know that I ever heard of males making the same demand for female locker rooms. Is anyone aware of efforts for access to female locker rooms or was it just accepted when they were denied. Dr. Bernstein, this case was from the late 1800's, since then I would hope that the courts and society have evolved to the point where we believe all citizens are equal. Is your source aware of any recent rulings that carried that ruling forward or any that went counter to it? Society sometimes sets the legal opinion in practice, example in the late 1800's society did not view females and African Americans as equal to while males, something that we have worked to correct, we aren't there yet but we recognize and are working on it. Has there been any recent rulings that reflect this? I know there were cases where male RN's were denied jobs in delivery rooms.
Dear dg,
Are you dg?, the conversations we've had with non-nudists generally revolve around our going to "clothing optional" beaches, where it is mixed between nudists and non-nudists as well as those who are somewhere in between, like women who take off their tops or or people who take off their swimsuits to sunbathe. Anyway, some of our friends have come along with us and declined to be nude -- the reason usually is that they don't feel comfortable being undressed in public but a rational explanation is usually missing, as you said, and I don't know if this reluctance extends to a medical setting. I also don't know if gender has anything to do with it since we have friends of both genders who are and aren't nudists. Actually one of our close friends is a female gastroenterologist, and she rarely takes off her bikini bottom. I'll ask around about the medical thing.
-CLF
Here's my take on gender preferences for health care providers and equal employment laws. I stress this is not the law, but my opinion. I know of no applicable case law, though there could be. The equal employment laws are written to be gender neutral. There are a few exceptions granted and they almost always favor women's right to privacy, but in general they are applied in a gender neutral way.
Chaperones are an instance where there are no health and safety issues, and the major reason for it is to protect the doctor. Should patients have a right to refuse chaperones or request same gender? Absolutely they should. The only real question is the patient's privacy and here it should be paramount. If the doctor doesn't want to proceed like that, he can have the patient sign a release or ultimately refuse to do the exam and send the patient elsewhere. The latter would be rare and only occur if the doctor had major concerns about the individual patient.
On the other hand a few posters here have tried to specify what gender help should be in the operating rooms. Here it becomes a major health and safety issue. OR schedules are important and you wouldn't want e.g. a less experienced nurse or technician substituted for someone because of privacy issues. Yes, if you're having heart surgery the OR techs, nurses, and anesthetists will see your chest, but their gender is unimportant and irrelevant.
I think in general patients should not demand that their caregivers be a specific gender, it's just not relevant. That is not to say though that people with major issues with it like many posters here should not be able to make the request. And certainly everyone with religious reasons for making the request, should have it honored if practical. This does not mean that patient's modesty shouldn't be protected in all instances no matter what genders are involved. But employment rights are here significant.
Dr B., what do you think?
Anonymous of February 23, 2007 8:39:00 AM, there is no real gender inequality in sports locker rooms by law. though there is by custom. All that is required is that male and female reporters have equal access. That can vary from no access to full access. The WNBA, the only pro women's league of significance, allows all reporters in, male and female for 20-30 minutes and then kicks them all out so the women can change in private. The male leagues could do the same but they are more concerned with maximum publicity and don't care about the players privacy for the most part. And most players go along with it. Prisons are different in that the courts have ruled that prisoners have lost a substantial right to their privacy. Every state is different here, but women prisoners have also lost substantial privacy rights. The courts though are correct here in giving greater privacy to women as they are in much more danger of abuse from the male guards than in the reverse situation.
A couple of comments js md, I agree with you in that when it comes to the OR, one has to realize the situation can be life or death and that takes priority, besides with only a limited number of people trained they can't accomodate everyone. The several times I have had operations or procedures in the hospital they have done an excellent job of putting me out or giving annesthesia where I don't know or remember who or what so its not as much an issue for me. I went to sleep in a gown under a blanket, and woke up the same way, nothing exposed until I was out. I do take exception with the comment (or perhaps I misunderstood) that the gender of a caregiver is not relevant. The majority of our interaction with caregivers is not on a life threatening basis. Its ultra sounds, imaging, exams, it's injuries, and illness etc. Mostly general non threatening things, our emotional state effects not only our perception of the treatment, but the link between recovery and emotional state is well supported. The issue here is if a patient feels more comfortable with same gender, why in the world would the providers not seek to provide one so the experience is more positive for the patient. If for no other reason than the patient feels more comfortable, it is relevant to us. It isn't questioning caregivers abilities or intentions, its about our comfort level in an already stressful situation. Caregivers seem to take this personal when the patient requests this, but are gaurded with their own modesty. Do opposite gender caregivers share restrooms, shower or change infront of each other? Of course not and we would not expect them to, but we are to do so no qualms becasue they wear scrubs and went to school? Do providers ever request a same sex caregiver or take advantage of additional covering during procedures that they don't provide patients for intimate exams and procedures?. From this blog, the all-nurse blog, and others we know they guard their own modesty more than they do their paitents.
For employment laws, why do we assume employment law trumps our rights? These things all depend on which side of the gown you are on. Again, I think there is a big difference between required, can't, and just plain don't when it comes to providing the paitent with the modesty they want. Caregivers don't understand why its such a big deal to us, and we don't understand why caregivers can't see it is and accomodate when it would often take so little effort.
On the reporter/prision issues. Don't you think that is reflective of society as a whole. 1. It is assumed men don't care as much, 2. Women need/deserve greater privacy 3. And becasue of past inequities, affirmative action type efforts spill over into the locker room and prisions. While there is no law on the locker room arguement, if we reversed the situation, male & female reporters were allowed in female locker rooms, but not male locker rooms, there would be an uproar demanding the situation be rectified even if it was the same set of circumstances that spawned the current situation. And while there is definately an issue with rape, which is a terrible, terrible, thing and should be prevented at all costs, female guards abusing male inmates in different ways and through abuse of the power they have been given. There is a lot of abuse other than rape, Abu grey? But our society feels it is more acceptable. Equal employment cases for men is relatively new. Thanks for the comments, your respones are very intellegent and well thought out. For a less intellegent, and maybe less truthful look at this go to voyforums and to the title "do women peak" for a conversation on this..not sure if they are real or made up....so take it for what its worth. Thanks again jsmd
Thanks for the kind words Anonymous Friday, February 23, 2007 1:48:00 PM. I could clarify a few points. The sex of the provider is irrelevant to me, but certainly not to everyone and they are fully entitled to their views. As noted we can usually pick the sex of our physicians and this covers most routine and non life threatening situations, but we cannot pick their assistants. You can demand that you be treated with respect and due modesty, but you cannot demand that an assistant or nurse be of a specific gender. You can ask if you want but for the most part you have to accept this or go to another provider who will accommodate you. Since most health care workers are female, men are at a disadvantage if they want men to take care of them (many don't), but you cannot expect providers to have always available assistants of both genders. And yes to me at least the employment rights of the assistants are of concern.
And you generalize too much about providers demanding modesty for themselves. I had surgery at my hospital some years ago. Did I worry about what the staff saw during surgery? Not at all. But I couldn't urinate that evening and had to be catheterized. A nurse did it. I suppose I could have asked for a man, but the thought never occurred to me. Was I embarrassed? Yes I was, but I'm an adult and it's just not a major issue. (I was grateful that I didn't know this particular nurse, though I'm not sure why that's important.) Far more important was the immediate relief I got.
I don't assume that equal employment laws trump privacy, but I think that is a fair interpretation of the way the law functions in this country. (I'm not a lawyer, and haven't made a thorough study of it. I'll be glad to know if I'm wrong.) I personally don't agree with the interpretation of these laws. As far as I'm concerned, if a single athlete objected to women around while he's changing, his wishes should be honored and all reporters kept out. This is not a matter of health or safety. The only issue is how much publicity the team gets. I think privacy is far more important than that. I also don't believe that women should be permitted to strip search men or observe it (and of course vice versa), but it is common. As I stated though, practices vary from state to state and prison to prison. In health care though, the issue is complex and health and safety ARE more important.
Kim, your rape example has some validity. Many hospitals have rape evaluation teams (I know mine does) and most of the members are women. But they cannot be available 24 hours a day and there are times when a man will do the exam. But there would always be women nurses present. It is no different than a doctor's office. You certainly wouldn't encourage a rape victim to confuse a male physician with a rapist I hope.
Anonymous from Friday, February 23, 2007 8:39:00 AM posed the following questions: "Dr. Bernstein, this case was from the late 1800's, since then I would hope that the courts and society have evolved to the point where we believe all citizens are equal. Is your source aware of any recent rulings that carried that ruling forward or any that went counter to it? Society sometimes sets the legal opinion in practice, example in the late 1800's society did not view females and African Americans as equal to while males, something that we have worked to correct, we aren't there yet but we recognize and are working on it. Has there been any recent rulings that reflect this? I know there were cases where male RN's were denied jobs in delivery rooms."
I again posted the questions of my visitor to the bioethics listserv to which I subscribe and got the following response from a different ethicist than I had quoted in my previous posting. I hope his response is helpful.
"Mo,
I think all the recent Supreme Court cases involving civil rights, affirmative action and reverse discrimination address this issue, from Bakke a generation ago to Bollinger. If your poster is serious about this issue, rather than just waving the reverse discrimination flag to support his/her viewpoint, at a minimum s/he should have carefully read:
Plessy v. Ferguson (1896) for a defense of separate but equal.
Brown v. Board of Education of Topeka (1954) to understand when separate is inherently unequal.
Heart of Atlanta Motel, Inc. v. United States (1964) for a definition of "public accommodation" and the limits of autonomy [and maybe Boy Scouts of America v. Dale (2000) for counterpoints learned after 3 decades of grappling with this issue.]
Regents of the University of California v. Bakke (1978) and Grutter v. Bollinger (2003) to address the balance of addressing past wrongs without creating too many new ones.
When it comes to gender, much of Plessy still applies. American society has decided that even if separate is inherently unequal, it won't accept unisex restrooms, even if that does cause some consternation for transsexuals. While [the previous ethicist] pointed out the factual error in the Supreme Court's early 19th century prejudice that "blacks were not as sensitive to degradation as whites," there is a history that women are more vulnerable to abuse and violation than men. Modern revelations of prison rape, the hazing practices of Russian soldiers and American firefighters, and clergy sexual misconduct all show that that vulnerability is not as polarized as previously portrayed. Contrary to Justice O'Connor's Bollinger conjecture that in 25 years affirmative action with regard to race would be unnecessary, I wouldn't expect this issue to die so quickly.
These situations have to balance an individual's autonomy and cultural proclivities with the disparate impact of letting patients specify the sex, race, or sexual orientation of their health care providers.
Answers are not simple. For a reasonably short overview, I would refer your bloggers to
href=http://en.wikipedia.org/wiki/Equal_Protection_Clause
jsmd I think in general we are on pretty much the same page in that I agree that ultimately the patient can not demand gender as much as request. It isn't reasonable to expect providers to have both genders available to assist at all times, cost and just the disparity in gender make up of staff makes it impossible. I think the patient has every right to request and they have two choices, accept or go elsewhere if they feel they need to, not try to force their will. Likewise with your example of your experience with surgery. You are a provider, you are around these type of situations daily, but it was still embaressing, we are hardly ever around this. You have seen both sides, we haven't. As you said you got over it, we do to. I sat on a plane next to a couple of doctors and listened with amusement as one told the other how embaressed he was being exposed to his staff during an emergency appendix removal. I have had a couple surgeries and had no real concern at all as I was out during the "exposure". But as you said it is embaressing when you are awake, sometimes it can't be avoided, sometimes it just isn't. I think the thing that bothers many people is many providers (not just doctors) tend to trivalize patients concerns in this area, and while we understand in the big picture it isn't the highest priority, and compared to what you all deal with, life and death, it can seem totally unimportant. But it is important to us. So when our modesty is compromised when it doesn't have to be, it is a problem. When it has to be, the paitent needs to suck it up and get over it. When a caregiver says "oh this is no big deal I do this all the time, or I've seen thousands of these", they may be just trying to comfort the patient, for the patient its easy to take it as trivalizing our concerns. So I think we are not that far off on expectations. It is more of the issue when I percieve it would be easy to protect modesty and it doesn't happen than an absolute. This goes to Dr. Bersteins post and link, we can not expect patients to casue hardships on health care in general for our special needs. We can ask for reasonable accomidation and accept what can be done in good faith.
I do feel though the societal acceptance of disparity against certain segments of society is a problem that is carried over into the medical community. When the light was shined on the disparity in the gender make up of doctors, affirmative action was taken to balance the gender makeup. Part of the rationale was equal opportunity in employment, but the value to female patients to have same sex providers was also included as a why. I agree with the effort, yet inspite of the fact that we are facing a severe shortage, and the fact that 96% of nurses are female, little to no effort has been made to bring more males into the profession. Tim Hardeways recent hate comments regarding gays was met with distain, but not the uproar or reaction that it would have brought if he had been a white player and used blacks instead of gays as the target of his hateful ridiculous rant. In society we will accept the same transgressions differently depending on the group it was directed at. While this is an extreme example, and hate against any segment based on race, religion, ethinc background, sexual orientation, or other criteria is aweful and unacceptable, I think it gives insight as to why we accept disparity in application of the constitution, law, and practice.
All we can ask the medical community is to truely maintain equal emphesis of preserving the modesty of all of its patients without a preconception of who deserves or desires more or less. This includes offering same gender providers for intimate procedures when available. And we would ask the providers to be proactive in helping their patients express their desires and help change or correct other providers and they institution as a whole to accomidate patients emotional needs in this area. We as patients need to ask, then accept it reasonable effort was made, not stay silent then resent or demand. I see your profession made up of a vast majority of compassionate people who care about their patients, not uncaring of caloused people concerned only with getting the physical part done.
Thanks jsmd & Dr. Bernstein, your comments and observations are very thought provoking. I would imagine from your posts you are very compassionate providers. This thread is a value to people concerned with the subject, Dr. Bernstein you have been pretty successful at keeping this more intellectual and less sensationalistc. Thanks again dg
I guess I just don't like the fact that healthcare people tell me I have no modesty rights when I check into a hospital. It seems very negitive almost crule. We have a Patient Bill of Rights and HIPPA laws. Maybe it shouldn't be about the law as much is it should be about do unto others as you would have them do unto you. Ethics and what is the right thing to do. Treating the person as a whole not just a body. Set aside your own personal agenda and think about the other person for a change. Keep in mind this blog is about how to help patients with modesty issues. It's not about what is more important modesty, life or death. I think we all know life or death trumps modesty. It's also not about healthcare employees rights. It should be about the patient. I'm sorry but to me that is the most important person in the hospital. What it takes to get them well or comfortable. This aslo includes emotional health. So if asking for a same gender provider is what they need to be ok inside. Why would it be such a big deal. The way you MD's both come back with your response is why people don't feel comfortable asking. If you point out we don't have that right. How do you expect us to feel it is ok to ask?
Kim
Is this where hospital staff gets there attitude. Patients and family have no rights. We have all the power. If this is true than would some take advantage? How do you keep a balance? I have never had a real problem with the doctors. Its the nurses and other hospital staff. Do nurses have the legal right to open the bathroom door on a patient who has not called for help and is more than capable of getting around? Do they have the right to make you shower with the door open instead of coming in with you if you need them? Do they have to the right to send in there friends to check out a male patient because they thought he had a nice package? If you take away a patients rights to modesty you leave the door wide open to abuse. This is why they think it is ok to do some of these things. We have rules and laws to keep people in check for a reason. Are hospitals lawless in this area?
Kim
Kim, I believe that you are correct that the patients’ trust is sometimes abused in medicine, and that it is a conflict of interest for the doctors to decide what patients’ rights are. To me one of the largest abuses of trust happens when the educational needs for medical students supersede the patients’ best interests, but that is a different topic. I find it interesting that doctors will use the patients’ best medical interests to justify their need for complete control, but will use that control for purposes other than the patients’ best interest. Sometimes doctors are wrong when they claim that their rights supersede those of the patient. I recall that in England there was a case of a woman who insisted that she not be subjected to pelvic exams by students while she was under general anesthesia for surgery. When the exams were performed anyway, she sued and won. I guess the patient still had rights even though she was in a hospital. It is not clear that the right-to-work arguments made on this thread would hold up in court since the medical situation is very different than the prison and locker room situations. I suspect that the patients’ rights would be given more weight by the courts than they are given by the medical profession.
I agree with Kim and the following 2 posters, few of us argue the issue when it is a nesecity i.e. people brought in an ER from a severe accident. I think several valid points have just been made. When you walk through the door with the basic premisis you have given up your rights to modesty, you can expect to be given little of it and you tend to accept it. For to long people have accepted it without question. Only in the relative recent history have people begun to question the absolute authority of medical personell. We now think we have the right for a second opinion, we used to only go to our local providers, now we look at other facilities. If the starting point was your modesty is important and we will do everything we can to preserve it without compromising your treatment, how would providers look at the tasks at hand. Right now its more like I have a job to do, a schedule to keep, and I have no time to worry about your modesty. When you look at intiatives such as scheduling, why in the workld would providers not automatically give patients same gender providers for intimate exams & care when all it would take was a little attention to scheduling. The answer is becasue they don't have to, they could but (a) they don't want to make the effort and (b) they don't think it is that important, it is as stated, about their agenda, patient modesty takes a back seat. There is a blog called alsnurse, one topic regards males in the delivery room and the proposed law in Alaska that would give patients a legal right to request the gender of the provider. Several nurses indicated, but one guy came right out and said it, he doesn't ask the patient if they want a female nurse becasue they might say yes and he wants to attend the delivery, his agenda is more important than the patients wishes. I think another really important point whas made in the last post. Very few things have been accomplished without a fight or a struggle. For to long we have gone into facilities with the attitude we have given up control. I think it may be time to take some of that control back. We should stand up and make clear what we expect in terms of our modesty, and if it is violated we need to take the issue to the facility director, and if we aren't satisfied, perhaps its time for someone to take it to court. Our basic rights in the country came from a revolution, women, African Americans, and others have had to fight just to be recognized as having equal rights. Perhaps its time to some of these issues to the court. If I say I want to take a shower by myself, or use a same gender provider, and that right is violated, I should have recourse. If I need to sign a waiver to protect the hospital to do so, fine, but as a 50 year old man I should have that right to make that decision, despite what my kids think, I am fully mentally competent. While I am not a big fan of litigation, many of our rights came from the courts, maybe that is what ultimately will happen. Dr. Bernstein, hate to bug your source again. But has anything like this been tried in court, has a patient sued (similar to the pelvic exam case) when medical staff wilfully went against a patients wishes? Think about this, if we walk into McDonalds and don't get the service or the right condiments we are more likely to complain than if we feel our modesty was abused in a medical setting. We forget about the food error in a few minutes, but as indicated by the many posts on transgressions from years ago, we agonize over these for years.
The last poster may find the following link relevant to the question that he posed.
http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1060&context=fac_pubs
Thanks for the URL regarding a discussion on the various factors involved in any litigation of complaints by women who had, without specific consent, pelvic exams by medical students while unconcscious under anesthesia. ..Maurice.
I second it. Nice URL. I can't imagine defending the practice of pelvics done under anesthesia for teaching purposes alone without express signed permission. A general admitting signed form would not be sufficient, teaching hospital or not. Indefensible I would think. Any other views Dr B.?
I note with interest the references to the Alaska bill to permit patients to demand a given gender provider. I assume the bill did not become law as I can't find any follow up. Anyone know the details? Here is a reference to a nurse's website take on the issue with a pretty good discussion both pro and con:
http://www.nursingadvocacy.org/news/2005apr/05_ap.html
My guess is that if the bill had passed it could easily have been challenged in federal court under equal employment opportunity laws. As most laws, it was not gender specific (which would usually be illegal) and would mean that men could demand male nurses, aides etc. Hard to know how that could be practical.
I believe, but am not positive the law was more of a reasonable accomodation basis rather than an absolute. And while men could request-demand a male provider the reality of the situation would not allow that to be possible all the time. It may be more symbolic than substantive, but it would send the message to the medical community that patients have rights in this area. I think many will accomodate if asked, law or no law. But it does send a wake up call to those that don't. What I was wondering was if there had been case law other than the unauthorized pelvic exam where the issue of a patients denying permission for the opposite gender to examine/treat being ignored? The pelvic exam case to me should be a lay down, that is so inheritly wrong I can't believe the people involved did it. But it goes to the mentality that we give up our rights when we come into their domain. A bit of medical arrogancy in some cases.
Dr. Bernstein, jsmd, after reading some of the above responses, I started thinking about an incident that now looks a little different than when it happened. Awhile back I was in the hospital for hemmroid surgery, embaressing enough, but when I was in the prep room and the nurse was having me sign all the releases she handed me one and said this is a release to film the proceedure....she must have read the horrified look on my face as hesitated, she quickly added they rarely film it but sometimes if there is a complication or for review they will. I signed it, but now after reading the above, I am having second thoughts. Is it common practice to record surgeries and why? It kind of creeps me out a little that my rear may be on a website or on classroom screens somewhere for teaching, but I would be absolutely pissed if I found out the rest of me was there where I could be identified. Now I must say the whole experience was much less stressful than I antcipated, the key was they were so considerate of my modesty that they told me upfront, nothing would be done prep wise (other than the IV's) until I was out. They did a really good job on that end (no pun intended)
Anonymous, Monday, February 26, 2007 7:49:00 AM, the release should have specifically said that your identity would be protected. If it didn't I would not have signed it myself. If your face or other identifying marks were shown, a general consent would not be sufficient IMO. HIPAA laws may have something further to say about this, but I don't know.
I think regulations about pictures and videos vary from institution to institution
thanks jsmd, is it normal to video procedures or is this an exception? From your experience what are they used for?
Once again, every hospital is different. Teaching hospitals vary from small private hospitals. Uses vary from teaching purposes to medicolegal documentation.
I have no idea if this was routine at your hospital. The nurse said they only used video infrequently.
I witnessed an orthopedic surgeon videotaping his patient's shoulder surgery with periodic descriptions to the patient as audio of the anatomy of the area in which he was working and what he was trying to accomplish at the moment. The surgeon said he videotaped all of his surgeries to present each patient with a copy for the patient's documentation and of course the copy for the surgeon for the medico-legal documentation that js md noted.
Now I must be truthful in reporting that it seemed to me that the video was being recorded intermittently. Certainly the narrative was being recorded intermittently because when the surgeon was speaking a light turned on and the operating room became quiet.
This surgeon had orthopedic surgeons from around the world studying with him and I am sure he used the videos as teaching tools too. I did not find out what was the content of the document the patient signed for the surgery and what the uses would be for these videos. ..Maurice.
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