Bioethics Discussion Blog: Patient Modesty: Volume 2

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Friday, December 14, 2007

Patient Modesty: Volume 2




















With over 700 Comments written to the thread "Patient Modesty: A More Significant Issue?"started on May 11 2006, one of my visitors, js md, suggested that I start another volume on the topic to promote easier access to the comments for reading and writing. This posting here is to follow up on that suggestion which I thought was appropriate.


NOW..ON TO A NEW ISSUE OF THE PATIENT MODESTY DISCUSSION--
All the discussion regarding patient modesty had to do with issues of the modesty of adults in the medical environment. No visitor, none, have discussed at what age a patient's modesty must be considered and whether all this discussion of modesty applies to infants, small children or up to what age. And, if modesty applies to infants and children WHOSE modesty does the concern represent? Is it the modesty of the parents? If so, is this one of the responsibilites of parenthood? And if so, from what are the parents protecting the child? Is it fair for the parents to project their biases on the healthcare of their children? Is modesty purely an issue for those humans who have passed through the period of puberty or does modesty have nothing to do with the development of secondary sex characteristics or the maturing of emotional sexuality in the developing human of either gender? I think answers to these questions would help develop more of an understanding of the whole issue of patient modesty. Any ideas? Remember, post this new discussion HERE. ..Maurice.

ADDENDUM: Graphic-Photograph of Apollo, presumably as a child: National Museum of Antiquities of Tajikistan Southern Tajikistan, Sculpture of clay 3C-2C BC. Photograph altered by me in the interest of modesty! ..Maurice.

ADDENDUM (1-14-2008):ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice.

ADDENDUM (3-1-2008) THE THREAD NOTED ABOVE "Patient Modesty: A More Significant Issue?" IS NOT FUNCTIONING PROPERLY AND IS NOT POSTING COMMENTS. PLEASE DO NOT ATTEMPT TO WRITE COMMENTS TO THAT THREAD. ..Maurice.

ADDENDUM (4-17-2008) THE THREAD "Naked" is NOT FUNCTIONING PROPERLY AND IS NOT POSTING COMMENTS. PLEASE DO NOT ATTEMPT TO WRITE COMMENTS TO THAT THREAD. ..Maurice.






ADDENDUM (5-23-2008) WARNING! SINCE MAY 14 2008, NONE OF THE COMMENTS SUBMITTED AND APPROVED BY ME FOR POSTING HAVE ACTUALLY BEEN POSTED ON THE COMMENT PAGE. AGAIN, THIS APPEARS TO BE A QUIRK OF THE BLOGGER.COM SYSTEM. ALL THE POSTINGS CAN BE VIEWED HERE BY CLICKING ON "NEWEST" ON THE POSTING PAGE BUT NONE ARE PUBLISHED ON THE COMMENT PAGE. IT APPEARS TIME TO START A NEW VOLUME. I WILL BEGIN "PATIENT MODESTY VOLUME 3" AT ONCE AND INCLUDE ALL THOSE POSTINGS WHICH DID NOT PUBLISH ON THIS THREAD.

DO NOT TRY TO POST ANY MORE ON THIS THREAD SINCE IT WILL NOT BE PUBLISHED. PLEASE GO TO "PATIENT MODESTY VOLUME 3" ..Maurice.

209 Comments:

At Saturday, December 15, 2007 7:27:00 AM, Anonymous js md said...

I have already expressed some opinions on the issue. Modesty is something children are taught. It is not intrinsic. Some societies practice none at all. However it is not fully in a parent's control, as there is much that is shaped by early grade school experiences and interactions with playmates.
But there is a difference between medical modesty and modesty elsewhere. I believe that exaggerated medical modesty serves no useful purpose and is only a source of pain. I previously recommended that children purposely be exposed to providers of both sexes so that they see it as normal. Indeed many patients who are very modest in general, have no problem in medical situations. It is unlikely that anyone can live in our society without having to be exposed to providers of both sexes at some point in their lives.

 
At Saturday, December 15, 2007 6:57:00 PM, Blogger Maurice Bernstein, M.D. said...

I suspect that modesty may be expressed in medical situations when feelings of lack of control in an examination or treatment, a lack of power, an inequality with the healthcare provider seems apparent to the patient. When this feeling is missing in other situations such as in school gym activities, nude modeling or nudist activities, modesty is not definitely an issue. Thus, I think that this is why with children, as you imply, they are free of modesty until taught by their parents or by experience. Again, a child's feelings of inequality with other children, by taunting regarding genitals or other physical or behavioral characteristics could lead to the development of significant modesty.

I would think that it would be non-constructive and not in the child's best interest to teach a child to be uncomfortable with physicians of either gender based on a parents own fears. Let a child make his or her own decision regarding acceptance of and comfort with a physician. ..Maurice.

 
At Monday, December 17, 2007 10:27:00 AM, Anonymous js md said...

Mike said from the first blog:
"you stated that pelvic exam in the OR should only be given "to feel the pre-op abnormalities better" I say humbug to this prictice as well. In most surgery situatitions the paitient has had an examination before she enters the OR and the surgon knows exactly what is wrong with her. Besides after he or she brings out the knife everything will be exposed.

Well my comment was based on what I was taught in my surgery rotations decades ago. I have no current competence in the matter. A surgeon would have to comment. But I don't think you're correct. Not all pelvic exams are adequate, and surgical techniques nowadays often feature much less exposure than they did decades ago.

 
At Tuesday, December 18, 2007 6:25:00 AM, Anonymous Anonymous said...

js md, Should you have not posted you reply on the other blog page? I thought that ws the idea, to keep all thoes post together and start off with a new train of thought on patient modesty-2 with child modesty.

Mike

 
At Tuesday, December 18, 2007 6:38:00 AM, Anonymous Anonymous said...

This does not deal with child modesty but in the intrest of starting a new train of thought.
Should a patiant be allowed to have a advocate witness present for procedures whith require anesthesia?

Mike

 
At Tuesday, December 18, 2007 7:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Mike, thanks for recognizing the slip up on both js md and my part to keep the topics distinct on each thread.

With regard to an advocate witness in the operating room, there is current talk about such a person in relation to the removal and repair of the potentially lethal faulty leads of certain cardiac defibrillators. Such a person would be the patient's lawyer who would see that all the evidence that might be used in an upcoming court action was properly identified and preserved.

Otherwise, I am not aware of the patient advocate generally allowed to attend an operation except I suppose that a husband attending his wife's delivery could be termed a patient advocate witness.

..Maurice.

 
At Tuesday, December 18, 2007 8:18:00 AM, Anonymous MIke said...

Dr. M., My idea was more addressed to the issue of patient modesty protection. Example, the practice of doing unneeded pelvic exams, or did an orderly lift her gown and fondle her breast while she was in the recovey room, or in the elevator back to her room.
This advocate would be a person who would be her/his defender and later give her/him information about what happened while they were out. This could be a family or a paid non hospitle employee.

One true example, my wife is an R/N who has worked in the past in both L&D and surgery. During a surgery she told me that she was standing beside the surgon who abruptly took hold of her wrist and placed her hand deeply into a ladies chest and looked at her and said "how does it feel to have your hand on a beating heart" Now tell me how did this serve the lady having the surgery? The attending MD should be the patiants advocate but in this case he was not or when the patiant is out of sight of the MD?

Mike
Mike

 
At Wednesday, December 19, 2007 9:06:00 AM, Blogger Maurice Bernstein, M.D. said...

If the motivation for the action of the surgeon was not to teach your wife regarding the detection by palpation of the apical impulse (which is what we teach our medical students learning examination of the heart on awake patients or themselves) then I would say the surgeon was at the least inconsiderate of the patient's right for control of her own body. ..Maurice.

 
At Wednesday, December 19, 2007 9:24:00 AM, Blogger Maurice Bernstein, M.D. said...

Now, back to the topic of physical modesty in children. I put the question, by e-mail, to a pediatrician I know who wrote back the following:

"I've noticed my current hospital making a big deal of this recently and giving gowns for kids who may only have their shirts off. My training (wrong half the time after 20 years) was that physical modesty in most children developed around age 8-9. Certainly most toddlers 1-3 yo seem willing to run around outside naked. Most 3-5 year olds will play doctor, though toward 5 yo they begin to sense that adults think something is wrong with that. However, these are generalizations. A minority of children may feel uncomfortable at earlier ages. Medical practice needs to accommodate the minority as well as the majority. But modestly may be mostly a cultural thing.


Based on my recent reading, I would agree that physical modesty in children could well be a "cultural thing". Cultural, not only in the large population sense but also culural in terms of the individual household. Parents, seen or never seen by children,walking around nude or having sexual or toilet activity, may be affected in their own attitudes and behaviors toward modesty. Therefore, modesty concerns (or lack of concern) as brought up by patients regarding medical practice may well be related, in part, to childhood exposures and training. Any comments? ..Maurice.

 
At Wednesday, December 19, 2007 3:13:00 PM, Anonymous js md said...

I certainly wouldn't claim to be an expert on the subject, but I believe that most children start developing modesty when they start school, use separate bathrooms, and are exposed to older children on buses and at school. Of course parents also have an influence.
I have seen it commented on and believe that modesty is actually more pronounced in today's society than it was 50+ years ago. Back then homes were smaller and kids routinely shared bathrooms and bedrooms. If the family was large, as was often the case, some exposure was inevitable. Nowadays many families live in large houses and kids often have their own bedroom and even their own bathrooms. Plus many school physical education programs don't mandate showering anymore, so some kids can get through high school without ever having been exposed to anyone. It's quite a contrast from my upbringing when male nudity at least was taken for granted.
Strange that as society has become more modest, its standards of sexual morality have considerably loosened.
I briefly tried to get references on the subject, but didn't come up with much. Anyone have any?

 
At Wednesday, December 26, 2007 5:10:00 AM, Anonymous jbe said...

Sadly, increased modesty in children has partially grown out of natural protective intent. Some very few members of our society have preyed upon children. This can cause devastating emotional damage to a person. In "the old days" such things occurred, but were not typically the subject to the media attention it is now. In some ways all adult males, and increasingly adult females are seen as potential predators. The patient often refers to this as "trust issues". Teaching modesty at an early age is a way parents have of feeling that they are helping prevent their child's becoming a victim. I also agree with js that family size and sleeping arrangements are a major factor.
My thoughts about modesty (and whose modesty) in children are: which ever individual has the greater modesty, parent or child, that should be respected. Parents are the advocates for their children, and until the child can express for herself or himself, the parents set the level.

 
At Wednesday, December 26, 2007 10:17:00 AM, Anonymous Anonymous said...

This is an interesting question and it’s one that I’ve actually asked myself. Before I started posting on the other blogs, I spent a few months just trying to figure out at what point in my life did modesty become such an issue with me? I was hoping, by reading others experiences, I could get some answers for myself. I have since given up on that approach, my conclusion is that God has given me these concerns/feelings for a reason and it’s not for me or anyone else to change them.

One experience stands out to me more than anything and it happened when I was 8 years old. I was in 1st grade and the highlight of any 1st graders day was to take the lunch money to the office (you left the room and went across the playground and turned in the lunch money). When I was finally picked, boy was I happy. I took that money and raced out the door as fast as anything you could imagine, unfortunately there was a street that the buses parked on that you had to cross become getting to the office. This street was supposed to only be used by the buses but as I ran across I didn’t see the oncoming car. He hit me and I was under the car before I knew what happened. He wasn’t going that fast and stopped before rolling completely over me so I simply slid out the side and just went about my business like nothing happened. I really wasn’t that hurt, just sore. I returned to the classroom as normal and a few minutes later my parents arrived at the school with some police officers. They took me out of the classroom and took me straight to the hospital. I was nervous enough with the officer asking me all the questions about what had happened but when they got me to the ER, the nurses practically threw me on a bed and started asking me questions about where or if I hurt anywhere. I kept telling everyone that I was fine and to just leave me alone but no one would listen, I got upset and they strapped me to the bed around my knees and chest. For whatever reason, one of the nurses pulled my pants down to my knees. When the doctor finally came in, he just observed me and flicked my penis around a few times? He checked the area where the car hit, which was in my rib area and all I had was a small bruise.

I’m sure that this experience attributed to my feelings on modesty today. Since that event, I’ve never went to a female doctor nor have I had to disrobe in front of a nurse. There have been times that I was asked, only to refuse or ask her to leave. I played sports in both middle and high school but went to my choice of physician when it was time for a physical, the other players normally had theirs done by a female nurse all at the same time. So to answer, I do fully agree that it does start at your early ages but I don’t really think you can place it on a specific age group. For me, it was a specific event that seems to have been permanently engrained in my head. I wouldn't think that it would be an issue during the infant years, I nor anyone I know can remember anything from those years. JMO

JK

 
At Wednesday, December 26, 2007 10:29:00 AM, Blogger Maurice Bernstein, M.D. said...

jbe, certainly you have made a reasonable point there in relating parental education of their children in terms of physical modesty to the need to attempt to protect them from those adults who desire to take sexual advantage of them.

However, I intentionally want to be argumentative here: My question is whether it would be beneficent for the child and fair for any doctor for the parents, if that is what is really happening, to lump physicians into the category of potential pedophiles and encourage their children to also be hesitant to be examined properly because of fear of sexual abuse? Is this what has happened during the childhood and adolescence of my visitors who are now, in these threads, expressing their great concern about their own modesty and the anticipated behavior of doctors and others in healthcare related to examination and treatment?

These questions should get some of my visitors juices flowing! ..Maurice.

 
At Wednesday, December 26, 2007 11:01:00 AM, Blogger Maurice Bernstein, M.D. said...

JK, of course I don't know what really happened when you were being examined for any potential injury and the doctor "flicked my penis". However, a thorough examination of a trauma patient hit and thrown under a car beyond that of the chest where the bruise appeared would include also the pelvis and examination of the pubic bone area, to rule out fracture, and could include some manipulation at the base of the penis. In retrospect, it would have been beneficial for you if the doctor explained (even to an 8 year old) what he or she was doing and for what reason.

Talking and explaining to the patient during the examination itself is what we teach our first and second year medical students as a very important activity. An example, which I think I have already mentioned somewhere on this blog, is about a student or doctor listening to the heart of a patient with a stethoscope. If for a number of benign technical reasons, one has to listen for more than a minute, it is wise to tell the patient what is happening since many patients will at one minute of listening begin to assume that something is wrong with their heart.

Talking and explaining can relieve a lot of anxiety and doubt and in your case may have deminished your modesty concerns in later years. Again, I don't know what happened but it all may have been part of a thorough exam. ..Maurice.

 
At Wednesday, December 26, 2007 12:01:00 PM, Anonymous Anonymous said...

Dr.Bernstein

Thanks for the response, that does make sense to me know. What was traumatizing to me was the fact that no one listened to me at the time, I would've known even then if something was wrong. After all that, I left that ER with a small bruise and a lifetime scar in a way.

I don't teach my kids to treat any physician as a potential pedophiles, quite the opposite. If my child feels uncomfortable being undressed in front of the opposite sex, I'm going to protect him from that, that's me being a good parent. I'm not going to feed him the line that it's okay in a medical situation, that's being a hypocrite. My son is only six but he is already as modest as I. He won't undress around is own grandmother and she actually had the nerve to tell me that I need to change his attitude toward being viewed by the opposite sex? I don't agree with that approach and feel it may hurt him more long-term if I force that on him. It's up to the parents to make that decision based on how their child feels. Any good parent should know if something is uncomfortable for their child.

If anything, my experience taught me to be more thoughtful toward my children. What I feel is missing in our children’s upbringings is the fact that they were never taught that there are other options, if your not comfortable with this situation we can do it this way. They to have choices and we shouldn't punish them for our past generations mistakes. My children will know that they have choices and they won't be forced into any situation that uncomfortable to them.

JK

 
At Wednesday, December 26, 2007 6:02:00 PM, Anonymous js md said...

JBE's point is one I have pondered. Our increasing fear of pedophilia has caused much distortion in our society. Male teachers, especially grammar school teachers, seem to be automatically suspect (see an article in Time magazine about 4-6 months ago) and this is spreading to increased incidents with female teachers, at least charges are now being made public and prosecuted. Certainly one way to combat this is by teaching children not to expose themselves to anyone. I wish there were reliable statistics about whether this strategy has reduced the incidence of child abuse. Hard to know as there was gross under reporting decades ago, whereas now we often seem to lean in the opposite direction.
Still and all I think it is possible to teach children the difference between appropriate exposures in medical situations and other situations, such as locker rooms. It astounds me to see the number of young men at my local Y who won't undress, even to the extent of taking showers with their shorts on or changing under towels like Europeans on an open beach. I grew up in a different era, but guys who did that when I was a kid would have been heavily teased.

 
At Thursday, December 27, 2007 3:18:00 AM, Anonymous Anonymous said...

To your earlier comment Dr Bernstein, I would hope parents would not teach their childeren that their Dr's are potential pedaphiles. If so there are going to be a lot of sick people as they avoid Dr's out of fear. I think it is important however for parents to teach thier children they have the right to question anything that makes them uncomfortable, regardless of who makes them feel that way. I also feel teaching them to challenge things that they aren't comfortable with could lead to change or perhaps a reversal of the trend away from disregard for patient modesty. As a child I was not given a choice when I had to have medical care, I got it, I did the same with my daughters, but I also requested a female tech when she was having bladder infections and had to have a voiding test. I made sure to tell them infront of her, IF a female was available we wanted her as she would be more comfortable, but I never told her she had an option not to have it done.... I would hope we don't intentionally make our children afraid of providers...that is a recipe for disaster. JD

 
At Saturday, December 29, 2007 6:37:00 PM, Anonymous jbe said...

I think Maurice is correct in his assessment that modesty is at least partially a function of control. JS reminds us that exaggerated medical modesty serves no useful purpose. When providers arrange their practice so that patients feel they have a maximum amount of control, while upholding the necessary components of good medical practice, the patient will not need to grasp for control anyplace she or he can find it.
I would like to offer a bit of clarification regarding my previous comment. I am not saying that pedophiles, or any other sexual deviant is overrepresented in the ranks of medical providers. I suspect that the numbers are roughly the same percentages, perhaps a bit less, as in the general population. The comments regarding antics of a few in the OR are examples of this. We do need to acknowledge that such individuals exist and deal with them appropriately and publicly. To handle such matters in private allows the behavior to continue since these behaviors are by nature secretive.
One final thought on this (for now). For some victims of past abuse, exaggerated modesty may be a way of feeling that they have greater control over their lives. Ideally, these persons will be able to one day feel comfortable with a more normative level of modesty since that shows that they are overcoming their trauma. Until they can, lets be compassionate.

 
At Monday, January 14, 2008 9:24:00 AM, Anonymous Anonymous said...

I hate when males are made to feel sexist when they are modest. Many males could of been abused as kids (by females) or had an incident to make them highly uncomfortable with female doctors.
For example one of my friends overheard his female physician discussing (with laughter) an incident regarding his sex orgran with her female colleagues. This made him feel very sexually humiliated and caused him great psychological harm.
I personally find these events (sexual humiliation) a form of sexual assualt. If women doctors are going to complain about males being "sexist" than they should at least be subjected to the same sex laws as males. What would happen to a male doctor if he was joking around about a patient's vagina with his male coworkers? The greatest sexism in the industry is the lack of equality in the enforcement of sex laws.

 
At Monday, January 14, 2008 10:39:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today January 14 2008: I agree. The male gender has as much right for privacy and modesty consideration by others as do females. Why do you think men are treated differently with regard to modesty issues. Do you think that males are more tolerant regarding these issues of other males than females are of males? I don't want to start a gender war here but I am curious about what happens and why.

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

 
At Thursday, January 17, 2008 2:33:00 PM, Anonymous js md said...

Anonymous of Jan 14, 9:24AM, I don't think most men who refuse female caregivers are accused of being sexist, but it certainly happens. The example of Dr Keagirl is perhaps the most blatant I've seen. You're also right that at least some men have been abused by women and prefer male providers (though I think that being abused by another man is more common). My blog has one horrendous example of that off allnurses where a man became infertile after being struck by a nurse. I believe it is under personal stories.
But it's certainly true that many men are made to feel as if it's their fault if they want same gender care, and they're not given the same respect with these requests are women are. In order for it to change, you have to keep on protesting though. Otherwise it's always assumed you don't care. The same is true for women who are distressed about their treatment; they have to speak up too.

 
At Friday, January 18, 2008 7:16:00 AM, Anonymous Anonymous said...

js md
I would have to agree with you, my experience has been providers act surprised, while I have never had a confrontation as I ususally try to be reasonable (ie I have never asked for an all male OR staff) I have inquired and recieved accomodation on scheduling an ultra sound etc. But each time it is treated as a surprise, you can tell in their voice. It makes me wonder, do they really not know, are do they know and they just surprised someone spoke up and asked, or is it they know there is an issue but act surprised to put you on the defense. Anyone have an opinion? JD

 
At Saturday, January 19, 2008 12:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Today Jan 19 2008 9:59 AM, GEPDAR posted the following comment:


Dr. Berstein,
What do you think?
I know all the facts are not in the story but WOW! I did read a similar story and it said the plaintiff spent 3 days in jail.
I have read all the post and actually posted one myself. NO MEANS NO! I feel other steps could have been taken instead of the DRE. if the pattent refused that part of the exam for whatever reason. I also know your not a lawyer but I feel if the NY State Supreme court thinks this case has merit it could slowly change some laws on how we are examined. I would love to hear how you feel on this case being a doctor. Thank-You very much for your incredible public support of people and there feelings reguarding the Medical World.


A link to the case was noted in the comment but I have found a more direct link to the original New York Times article dated January 16, 2008. ..Maurice.

 
At Saturday, January 19, 2008 12:49:00 PM, Blogger Maurice Bernstein, M.D. said...

The motivation of the patient and patient's response against a rectal exam may have had nothing to do with patient modesty but anticipating being uncomfortable by the procedure or simply disgust. The issue may not be that of preserving modesty but whether the patient had the capacity to make the decision after hearing the explanation of the procedure. If the patient did not have the capacity, then in an emergency room, without surrogates available to make such decisions for the patient, the assumption is made that a competent patient would agree to the procedure. If the patient was shown to be indeed competent and have the capacity to make his own medical decisions, then the manner he was treated by the ER staff and police would be unethical and possibly illegal. When a patient is so forced to have a procedure performed against his wishes, I would suspect he has the right to physically resist and defend himself in any practical manner. ..Maurice.

 
At Saturday, January 26, 2008 8:47:00 PM, Anonymous Anonymous said...

re: 1/14/08 Maurice

I think one reason there is a difference in treatment is because of the difference in consequences legally. A male doctor would be more likely to get arrested/prosecuted/expelled etc. than a female doctor would. The only way I can explain this is to compare another industry that got heavily feminized. In the education industry it took DECADES for female teachers abusing male or female students to get the hard time behind prison and social stigma associated with it as the male teacher would have. The treatment of female doctors has not matched that male doctors (the largest sexism IMO)
But keep in mind it is not a male doctor that cries sexist when a female patient rejects him for whatever reason it is usually a female doctor who states this.
As for turning this into a gender issue, it will ironically be women who push to stop this rather large injustice. Just like in Education where the mothers of abused boys starting demanding justice, the wives of patients are starting to complain as well. It turns out that that wives don't like their husbands being needlessly probbed, humilated, or chaperoned etc.

TS

 
At Saturday, January 26, 2008 9:27:00 PM, Anonymous Anonymous said...

re JS MD 1//08
I’m glad MDs like you and Maurice are paying attention and thank you for it. I agree that more people of both sexes need to speak out. Part of the problem modest males have in speaking out IS the fact that being labeled a sexist has a social consequence that is larger than a male’s embarrassment. In fact the tone of voice and mannerisms of the doctor’s office manager makes it difficult to do so. Especially if they are using techniques like ‘reverse psychology’ or making plays on the patient’s maturity level.

Re: stories

One story in Allnurses that stuck out to me was the one where a group of nurses in California needlessly went to view a teen male’s oversized genitals. Very little was done but just imagine a group of males in medicine going to needlessly view a teen girls vagina. You can bet heads and lawsuits would fly.

I don't think anyone epitomized the double standards and hypocrisy as well as Dr.K does in her blogs. I recall that thread vividly and found it rather hypocritical on MANY levels. How can she on the one hand BRAG about patients coming to her " *because* " she is female but call those who don't "sexist at its best". Aren't her patients coming to her because she is female also sexist?
Then there is the hypocrisy that she herself would never see an opposite sex doctor DESPITE the fact her specialty (Urology) has a large amount of male intimate examinations to be performed. As far as I'm concerned if you have issues with doctors of the opposite sex examining you, you yourself should not be doing so because those same reasons, whatever they may be. I personally think its a power thing but I digress...
All this because a male who may have had a serious reason not to be examined by her (like previous bad experience with female Dr., previous sexual abuse, religious, etc).
I also find words like "do you have a problem with that[me being female]" highly offensive. It is a form of reverse psychology to guilt a male patient into accepting her as a doctor. I consider this a form of sexual harassment in itself. What would happen to male doc who tried a technique like that.

But I have to wonder, after reading that thread Maurice had about a Urologist professor using his own body to test his students. Considering Dr. K would rather pass her own kidney stone before letting a male see her "privates", I have to wonder if she would consider herself sexist if she didn't do like the male professor did and have her students perform on her body for testing purposes....not that's sexism at its best.



TS

 
At Saturday, January 26, 2008 10:52:00 PM, Blogger Maurice Bernstein, M.D. said...

TS, I just don't remember writing anything about a urology professor "using his own body to test his students". But with 520 or so different threads, I could be excused for being forgetful. TS, could you refer me to which thread you recall. However and by the way, it is not unusual for any of us who teach first or second year medical students the art of physical examination to have students examine us too, in addition to students practicing each other. No genital, rectal or breast exams on the regular instructors, however. One can get an up close and personal evaluation of how a medical student performs both in skill and relationship behavior between the student and the "patient" by being the "patient" for the student. And as I have mentioned elsewhere previously, for genital (both male and female) and breast exams,skilled specialized teachers in this area of physical examination are used for instruction and practice subjects. Incidentally, there is no gender selection since both male and female students practice on both male and female teachers. What happens later in the students careers I guess is what is being discussed on this thread. ..Maurice.

 
At Sunday, January 27, 2008 8:39:00 AM, Anonymous Anonymous said...

I did some quick searches on your blog and couldn't find it so I must of read it off a different forum or blog (apologies).

But my point was that the S-BOMB (sexism) should not be used by a doc who doesn't let males docs examing her still stands.
In fact, modest male patients confronted with hostility towards wanting a male doc could say something like "I want a male doctor examining me the EXACT SAME WAY many female doctors want female doctors."

TS

 
At Sunday, February 03, 2008 11:07:00 PM, Blogger Maurice Bernstein, M.D. said...

On this Modesty Volume 2 thread, I would like to bring up a topic which has not really been discussed specifically on any of the patient modesty threads. I was wondering if there might be a relationship between patient modesty and a life history of social shyness. Do those visitors who write to these threads about their experiences with modesty issues have also a history of shyness in various interpersonal relationships throughout their lives? I haven't as yet investigated any literature on the subject since just recently the thought came to my mind that such a relationship might exist. What I wonder, if such a relationship exists between social shyness and patient modesty, perhaps approaches to reduce the anxieties associated with shyness might be of benefit regarding those who are concerned about their modesty in medical situations. Any thoughts? ..Maurice.

 
At Monday, February 04, 2008 3:39:00 AM, Anonymous JAKE said...

No Shyness would not be my case I am very out going even in a medical setting I have had several nurses even say I was one of their favorite patients.
I actually understand that exsposure is part of the system to getting healthy, today and for a few years I have several female doctors they have seen every inch of me several times over. I do have have a problem with extra people in the exam room like nurses but I am working on that issue. My problem is when nurses and doctors do not tell you up front that nudity is going to be involved like shaviving your groin, also today I understand that shaving and maybe a foley may haved to be used. A perfect time for a nurse to tell you is when you are on the hospital floor and the nurse is doing your intake, great time, because that would erase any mystery that the nurses and doctors forget because they are busy.
It has taken me years to work out some modesty issues and maybe mine fall into control issues (not knowing) but if they spring something on you and do not tell you it leaves in your mind that they were wrong and not me.
I see what you are saying and maybe counsling should be involved in this subject for people to find out if there is a real issue or did health care proffesional do something they could have done different. I do understand most men just go through the process and not say a word or understand they did have an option. I even read on these boardfs where patients spouse have a huge problem with their other half being exsposed. Are they jealous? Is it really and issue they have or they really proctecting there sposue? Again, maybe some counsling in this area would help everyone maybe get to the bottom of some issues. I also do understand many things could be done different in hospital and exams and procedures that only take a second to explain to a patient. I do not think everyone needs counsleing but if something did happen early on in life and you are walking around with it maybe counsling could help.

 
At Monday, February 04, 2008 10:56:00 PM, Anonymous Anonymous said...

I’m not sure I quite understand your question so I’ll answer based on what I think your wanting know.

Growing up, I didn’t consider myself shy at all, if anything, I went to great lengths to make sure or try to run with the ‘it’ crowd. I played sports through high school so I was exposed to changing in front of other guys and showering, it never bothered me. I can say that I’m very private in my thoughts and feelings (as far as sharing them with others besides my wife). I go by the rule of only answering when appropriate or asked. I don’t engage in any conversation that I have strong feelings on and try to keep my private life, private. I don’t consider myself outgoing but being married to a hospital CFO, I find myself in many parties, ribbon cuttings, and other events of that nature. I always put on my fake smile and go with the flow. I’m not sure if all that falls in the social shyness category, but I do know that I don’t need any couseling to help me. Jimmy

 
At Tuesday, February 05, 2008 1:28:00 PM, Anonymous Anonymous said...

There's a difference between shyness of the individual and
the unnecessary and thoughtless humiliation of patients. In my
case, I don't want to impower
clothed female staff by being
naked with them when they are
not necessary or because their
presence in health care hasn't
been controlled by affirmative
action quotas, the way the numbers
of female gender doctors has.
And I'm sick of female medical staff members telling me they can't or won't help in accomodating males in this area when they go out of there way to
see that females (their sisterhood) are not subject to
humiliation by their male staff
co-workers. This is total double-standard BS !!!
-- CHUCK McP

 
At Tuesday, February 05, 2008 3:09:00 PM, Anonymous Anonymous said...

I am very modest and very outgoing. I can strike up a conversation with anyone and am very social. I think my "issues" or reistance are more with being in control, feeling taken advantage of, not given proper respect for my wishes, the double standard....and perhaps the personality triat that comes into play on my part has more to do with insecurity than shyness. One can be outgoing and insecure at the same time....I think that is more to the point. But thats just me as I see it....jd

 
At Saturday, February 23, 2008 8:39:00 AM, Blogger Maurice Bernstein, M.D. said...

For those interested in reading and writing about physician modesty in terms of behavior and appearance, I created a new thread on the subject titled: Being A Modest Doctor a Virtue and a Benefit for Their Patients? ..Maurice.

 
At Monday, February 25, 2008 11:13:00 AM, Blogger James said...

I have Spina Bifida, I've lost count of the number of medical professionals who have seen me nude over almost 4 decades of hospital exams, surgery etc.

Today on my lunch break I went to my local medical center to see the district nurse to get my weight monitored and a skin exam to check for pressure soars or breaks in my skin.
I generally get this done evey 2 or 3 months. I have done for the past year after getting both a pressure soar on my hip and loosing 5 kilos in weight.
I realise that I'm a little hypersesitive about the problem and today she asked my why I wanted it done. It's a reasonable question I guess but I wanted it done for peace of mind. She was very reassuring once I explained my reasoning.
The exam and weighing took 15 minutes I was nude during the exam and it was done professionally.

Perhaps this is off topic but my question is this.

1) Was my request unreasonable
2) Was the possibility I was doing this for kicks prompting her question ?

 
At Thursday, February 28, 2008 9:59:00 PM, Anonymous Anonymous said...

Why were you completely nude for the exam and weighing versus boxers or a gown? Do you request to be nude or is that what they try and make all patients do in the office?

There is nothing unreasonable about wanting to get weighed or have sores checked. I would think given your condition the why would be obvious.

-law

 
At Friday, February 29, 2008 3:22:00 PM, Blogger Maurice Bernstein, M.D. said...

FOR THOSE WHO WANT TO READ ALL THE COMMENTS WHICH ARE MISSING ON THE FIRST PAGE OF "PATIENT MODESTY: A MORE SIGNIFICANT ISSUE?", GO AHEAD AND CLICK "COMMENTS" ON THAT FIRST 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!!

 
At Friday, February 29, 2008 4:46:00 PM, Anonymous Anonymous said...

This is a great loss! Can be get all the missing comments (since
Feb. 26, 2007) to reappear?
-- CHUCK McP

 
At Friday, February 29, 2008 4:50:00 PM, Anonymous Anonymous said...

I didn't request to be nude and I can't speak for other patients. I requested the skin exam, I was asked to undress. I did so, including underwear. I suppose that there was a mutual understanding that full nudity was required. No gown was offered and I didn't ask of one. The weighing was conducted after the skin exam. The entire exam was no more than 15 minutes and professional.

 
At Friday, February 29, 2008 5:48:00 PM, Blogger Maurice Bernstein, M.D. said...

To Chuck McP: I agree it is a loss and inconvenience. I suspect it is some "large number of comments" glitch in the otherwise quite functional Blogger.com program. I will see what I can do to mitigate the problem. If the thread site can't be returned to its previous state, I'll see if I can copy the missing postings to this site. If you or any other visitor has suggestions or knowledge about what happened, please write here or on my 500 thread feedback site. I am checking with Blogger.com too. ..Maurice.

 
At Friday, February 29, 2008 6:42:00 PM, Anonymous Anonymous said...

Dr. Bernstein:
I don't have an answer to why a year's worth of blog entries suddenly disappeared but I do
think it is significant that some
time on 2/27/08, all entries since
2/26/07, disappeared. It would
seem to be a calendar issue -- exactly one back year of postings
going phantom ??? Good luck with
the blogger.com investigation.
-- CHUCK McP

 
At Saturday, March 01, 2008 5:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is a posting from today on the malfunctioning "Patient Modesty: A More Significant Issue?"
PLEASE DON'T POST THERE..POST YOUR COMMENTS ON THIS THREAD!! ..Maurice.


Anonymous said...
I read with interst the Univ of MD piece about pelvics done under anesthesia. Very interesting and disturbing at the same time.

I had surgery and after obtaining my surgical/medical records of the procedure I found that in small print on a consent form I was handed to sign by a nurse in the OR holding area had that I was consenting to other people to stand in and also to photos, video taping etc. I was appalled and extremely angry. I did not have my glasses at the time and it was prior to when they allowed my wife to join me before going into the OR suite. I was told the form was to allow a blood transfusion if it was necessary. This is another case of the arrogance and insanity that goes on daily. Would they want to be treated this way?

JS

Saturday, March 01, 2008 12:25:00 PM

 
At Saturday, March 01, 2008 8:59:00 PM, Anonymous Anonymous said...

JS,

Next time tell them you aren't signing anything until they get your glasses so you can read the forms. Also, call the hospital a few days before your surgery if it isn't an emergency and arrange to pick up the consent forms in advance. This will give you time to read, review, and make a list of questions.

Did the medical records indicate photos or video were taken? Chances are neither were done. It's not very often that they do. I hope that brings you some comfort.

-law

 
At Sunday, March 02, 2008 5:09:00 AM, Anonymous Anonymous said...

law--
Yes, your advice about obtaining the consent forms in advance (for elective surgery) is EXCELLENT and is what I concluded myself after my ordeal. I learned a great deal from this horrid experience. It is unfortunate that people must learn the HARD WAY. The surgical centers performing elective surgery should send the consent forms to a patient in advance. Something as important as surgery should not be signed while you are lying in a bed, mostly naked, in a stressful mindset, waiting to be rolled into an OR suite. Why is that too much to ask of a healthcare facility? I blame them for this type of conduct. It is their business and it is poor administration to the paying consumer.

This wasn't the all that was wrong either. The surgeon put a full history and physical in my record that he never did-- the nurses in recovery charted 4 or 5 things they never did and charted things that were fraudulent -- The nurse discharging me was very rude to my wife -- the surgeon left me on the OR table for 35 min on general anesthesia and had his RNFA employee (she was not employeed by the surgicenter) finish the procedure while he left the place and went back to his office 2 blocks away.

I was not informed ahead of time that he would not be doing the entire procedure or that significant surgical tasks would be performed by another person.

To me this kind of care is pathetic. I plan to never experience something like this again and I'd have to be mighty sick to ever step foot in a surgicenter again. I have lost all respect for the system.

JS

 
At Monday, March 03, 2008 12:27:00 PM, Anonymous Anonymous said...

law, to continue the discussion on the original Patient Modesty thread:

Your assumption that my husband must not be "as upset" as I am is of no concern to me.

Overlooking that rather arrogant comment, I want to point out that I am concerned with what is ethical, not with what is legal. If the law allows unethical behavior to take place that could easily be avoided, then the law needs to change.

You stated in one post that "Most people do consent. That could be because not everyone reads the form in its entirety." You point out in a separate post that procedures including shave, scrub, cath, breathing tube, new gown, etc. are not spelled out in the surgery consent form. You then say that doctors and nurses are perfectly within their rights to then expose and handle a patient's genitals while they're under anesthesia.

So let me get this straight. Not only do you want patients to read the consent form in its entirety (fair enough), but you also expect them to read the doctor's mind about procedures being performed that any reasonable person would consider an invasion of privacy. So, even though my husband has little knowledge of how surgery works, was warned of the breathing tube insertion ahead of time (a rather benign procedure), and then allowed to keep his underwear on the entire time up until being put under without so much as a comment by the OR staff, he was just supposed to assume that, obviously, his penis would be pulled out and handled by a nurse?

I don't think so.

- Dismayed Wife

 
At Monday, March 03, 2008 3:53:00 PM, Anonymous Anonymous said...

JS,

I'm glad you will change your policy in regards to consent forms in the future. My mother had surgery not too long ago and they requested she pick up the consent forms in advance when she called to verify her surgery. I was impressed by that.

I also didn't know much about the RNFA role before having a career in this field. The RNFA doing the close isn't unusual. Not all surgeons use a RNFA to do this, but quite a few do. The RNFA cab be an employee of a hospital, surgicial center, or the actual surgeon(s). Many also don't realize that the surgeon is the last one in the room and the first to leave. They are long gone by the time the patient is undraped, cleaned up, and out of anesthesia.

I would switch doctors not so much due to the RNFA, but because of the documents that you feel were falsified. That would be my biggest concern if I were the patient. I hope things go better for you in the future.

-law

 
At Monday, March 03, 2008 8:38:00 PM, Blogger Maurice Bernstein, M.D. said...

CLW, I rejected your posting because the link to the California Medical Board could not provide any documentation regarding the physician you identified. Perhaps, without naming names, you could descibe that physician's alleged behavior that concerned you. ..Maurice.

 
At Tuesday, March 04, 2008 2:12:00 AM, Anonymous Anonymous said...

Dr. Bernstein,

How is your wife doing? I pray she's doing well.

-law

 
At Tuesday, March 04, 2008 9:21:00 AM, Blogger Maurice Bernstein, M.D. said...

law, unfortunately after a few days out of the hospital, she had to be rehospitalized for a complication in the post-operative period. She is still in the hospital but is recovering. Again, her and our concerns was not at all about any personal modesty issues related to the healthcare providers. In fact, I was surprised how doctors and nurses listening to her chest with a stethoscope did so listening through the gown and not on her bare skin. I have instructed my medical students not to listen through coverings. I suspect the doctors and nurses were either in a hurry or have their own concerns about patient modesty. ..Maurice.

 
At Tuesday, March 04, 2008 11:48:00 AM, Anonymous Anonymous said...

To All,

I’m not sure how many (if any) have took a look at Dr.Sherman’s (JSMD) blog but we have recently opened a new topic that I’d like to encourage you all to review and submit comments/suggestions. The topic is called “Organize for Patient Modesty/Privacy.” Along with this topic, there are many others that have been broken down into individual discussions; all have a great amount of information in them.

After reading all the issues and concerns brought forward on this board and all the links contained within, one thing keeps coming to mind that would help solve all of this and that is just allowing the patient a choice of how they are to be treated. It should be your choice if you’re to be filmed, photographed, examined while under anesthesia; having other non-essential personnel in the room, gender of chaperone, better understanding of consent form…I think you all get the point. It’s easy for all of us to vent on this blog and I think we can all agree that there are issues that need to be addressed but if it’s been ignored this long, just writing on these blogs isn’t going to change anything. If anything is going to change, we’ll need to do it together so that’s why I’m inviting you all to this topic. You’ll find an email account that I’ve created that you can send your support, I’ll keep up with the responses myself. If we get enough support, this could be that first step in being heard so I’ll leave it up to all of you whether you’d like to offer support/suggestions or just continue to write and vent of Dr.Bernstein’s blog. Thank you all for your time. Jimmy

Link to board…. http://patientprivacy.blogspot.com/2008/02/organize-for-patient-modestyprivacy.html

 
At Tuesday, March 04, 2008 5:09:00 PM, Anonymous Anonymous said...

Speaking of photography under anesthesia, do you think this is what these patients expected from their anesthesiologist when they signed the consent forms? Quoting from a California medical board discipline report:

"Respondent's digital camera, found in his home during a search conducted on November 2, 2001, contained several sexually explicit images of female patients in an operating room, apparently under anesthesia. There were several pictures of one female patient who had been anesthetized with a tube through the nose, which is a rare method of administering anesthesia. There also were pictures of two other female patients who had been anesthetized through a tube in their mouths.

"Two pictures show an exposed penis located near the patient's face or shoulder.

"Five pictures show one of the female patients with her breasts fully exposed. In three of those photos, a man's hand is either touching the woman's nipple or grasping a breast.

"Three pictures show another female patient with her breasts fully exposed.

"Personnel at the facility where the pictures were taken recognized the operating room and equipment, and indicated under normal procedures, anesthesiologists are not alone with a patient. Usually there is a scrub technician and circulating nurse in the room with the anesthesiologist and patient, except in rare emergency circumstances. It is not normal procedure for an anesthesiologist to carry a camera and take photographs of anesthetized patients. There is no medical reason for an anesthesiologist to photograph a patient's breasts.

"During an earlier search of Respondent's home conducted on or about August 9, 2001, FBI agents also found on Respondent's desktop computer an Internet instant messaging communication dated October 23, 200, between Respondent ...[and a person}...who described herself as 19 years of age. Respondent discussed his profession as a doctor, described getting sexually aroused during gynecological exams of women while he was an intern, and discussed other medical exams in sexually explicit terms.

"FBI agents also found on Respondent's home computer an e-mail dated May 4, 2001....in which Respondent described himself as a middle-aged man who has molested dozens and dozens of women, probably hundreds, over the last 15 years, by fondling their breasts while they were unconscious, as well as by digitally penetrating several of them."

CLW

 
At Tuesday, March 04, 2008 8:19:00 PM, Blogger Maurice Bernstein, M.D. said...

CLW, I don't know to make of this relatively isolated case, except that it is an anomaly. What I mean is that one cannot generalize this criminal behavior to other anesthesiologists or the operating room system in general. It is like a policeman killing his wife, as in the recent publicized case. Should we extrapolate this to police in general or the police department system of operation or selection of police candidates?
This is my first impression of your posting. Does it provide any other support to the concept of a need for patient modesty to be attended to in the operating room?

I think that the modesty practices within the operating room which protect the patient from unnecessary viewing is not so much out of concern about that unconscious patient, but has more to do with the personal feelings of the operating room staff about how they themselves would want to be treated. In fact, much of how physicians and nurses behave to the benefit of the patient is more out of the heathcare providers' own personal desires. Remember "Do onto others as you would have others do onto you".. I think this does go through doctors' and nurses' minds. It does for me when I am caring for a patient. ..Maurice.

 
At Wednesday, March 05, 2008 12:07:00 AM, Anonymous Anonymous said...

D. Bernstein,

I'm sorry to read had to be hospitalized again, but glad that she is getting the care that she needs. She will be in my prayers.

I've never had my heart listened to through a gown either. Usually they stick the stethoscope down the front or I don't have a shirt on at all.


-law

 
At Wednesday, March 05, 2008 8:36:00 AM, Anonymous js md said...

As I threatened on the original modesty blog last month in response to 'RN -retired', I have opened a thread, on equal employment laws, gender preferences, and 'bona fide occupational qualifications.'
Please feel free to comment or disagree.

 
At Thursday, March 06, 2008 8:20:00 AM, Anonymous Anonymous said...

CLW, Dr. Bernstein,

While this kind of outright molestation is probably rare, three things occur to me:

1) Lesser molestation, such as unnecessarily viewing or handling a patient's breasts (or other private parts) even in front of others, no doubt takes place on a much larger scale. This is clear just from anecdotal evidence.

2) The situation of having a patient under anesthesia is one that puts the patient in an unusually vulnerable position. The patient is not only defenseless, but is unaware of what is going on. Therefore, even if deviants are rare, the risk to an anesthetized patient of being molested is much higher.

3) Unlike keeping 24/7 surveillance on police officers who might behave badly, the way to protect anesthetized patients is easy, and therefore it is unconscionable to provide the patient this protection. Simply allow the spouse, parent, or other representative of the patient to be present at ALL times, or at least watching through an OR window. If that's not possible, then have a same-gender chaperone at all times.

Dr. Bernstein, I appreciate that most medical professionals will respect the patient's modesty for the sake of their own feelings. Nevertheless, can we argue that "no harm was done" to the female patients in CLW's example, based on the fact that the anesthesiologist was clearly comfortable with the situation? Of course not. It all goes back to this: It is about what the patient is comfortable with. The anesthetized patient is in a vulnerable position, and the patient needs protection.

- Dismayed Wife

 
At Thursday, March 06, 2008 11:58:00 AM, Anonymous Anonymous said...

law,

I fully agree with the bloggers on this site when stating that patients become very offended with OR nurses of the opposite gender doing personal genital procedures when the patient is NOT informed in advance or mislead.

I understand from your previous post about the consent forms not listing everything that goes on in an OR. I don't think people are concerned about IV tubing or solutions or extraneous items; I do think many patients are concerned when they find out afterwards they have had their genitals handled by an opposite sex nurse. And, by handled I mean a lengthy bit of time. Preps take more than a minute. It is unreasonable and ethically wrong for healthcare facilities to assume that all patients are unaffected by this.

Even though this has been the routine for many years, that does not make it RIGHT. Why can't this be addressed with a patient prior to surgery? There certainly is time for a short question.

A doctor/nurse may see a thousand patients ----but a patient does not see a thousand doctors/or nurses. This may be routine for a nurse/doctor but it is NOT at all routine for a patient. That isn't too hard to understand and it should be a primary focus in dealing with surgical patients. Don't OR clinicians understand this offends some people? And do they even care?

JS

 
At Monday, March 10, 2008 3:57:00 AM, Anonymous gve said...

people may find the website

http://www.stmichaelshospital.com/programs/imaging/ultrasound/exams.php

very interesting!

The tide is already starting to turn.

 
At Monday, March 10, 2008 4:00:00 PM, Anonymous Anonymous said...

gve..
that should be stated at all facilities, but isn't this hospital in Canada?

An OR nurse stated to my wife on a blog that "most men prefer being handled by a female. She had seen more male nurses rejected by male patients than female nurses. Men don't want another man touching them. Male patients that prefer same sex nurses doing genital procedures and treatments are the exception."

What are the comments on this?

JS

 
At Monday, March 10, 2008 7:37:00 PM, Anonymous js md said...

Well that's too simple JS. Figures are hard to come by but my impression is that most men prefer male doctors for intimate exams, but maybe up to a third would prefer women. It’s probably less than that. With adolescents the number is much lower. If you were right there would be far more female urologists than there are (under 10%) and they would be overwhelmed by male patients.
My thread, on chaperones has some applicable data on this though chaperones are not providers. The only data come from the British.

 
At Tuesday, March 11, 2008 6:40:00 AM, Anonymous Anonymous said...

js md,
This claim was made regarding men having a female vs male nurse doing intimate genital procedures in the OR. Like the shaving of pubic hair, surgical cleanse, cath, etc. It was not directed at a male going to see a male vs. a female physician.

The tone and attitude of female OR nurses is smug that they think they are much preferred by male patients therefore, they don't discuss this issue (among other reasons supposedly--eg. limited male staff, it's just a job, part of the routine for them--all views on their part and not the patient's feelings or the patients' rights of giving informed consent of such a treatment).

I think most men do prefer to go to a male physician but the fact is once a male walks through the door of a surgical floor they are handled by women whether they like it or not. That should be addressed differently than what has been the status quo.

JS

 
At Tuesday, March 11, 2008 3:49:00 PM, Anonymous js md said...

I agree JS that gender preferences for providers is not the same as for nurses. For the latter, homophobia plays a large role, especially in this country.
It almost never happens though that patients are given a choice as to who preps them prior to the OR. As there are many OR male technicians, it could be either gender.

 
At Wednesday, March 12, 2008 7:55:00 AM, Anonymous Anonymous said...

I know many will argue this, but a section needs to be added to consent forms that explains the prep of procedures. It's so obvious that hospitals/providers are hiding alot of important information from patients, otherwise there would be so many questions like these. I agree that patients aren't given a choice of the prep nurse, but I also feel many don't ask because they are just clueless, providers don't discuss this in detail if at all. I do feel if you make your preference known, they'll try to address it but it's up to you to make it a priority. Say and do nothing, it will stay the same status quo. Jimmy

 
At Wednesday, March 12, 2008 9:11:00 AM, Anonymous Anonymous said...

js md,
A patient is not clued in on the person or the extensive prep prior and I feel this is not treating a patient with respect. It should absolutely be discussed.
A patient has every right to know and approve of such.

JS

 
At Wednesday, March 12, 2008 11:26:00 AM, Anonymous Anonymous said...

Jimmy,
I absolutely agree with your comments [Wed Mar 12 7:55 am].

I do not understand why this is not discussed. The OR evidently feels that this is so routine for them that it is a non-issue. I concur that people going into the OR are completely clueless regarding P & P [policy and procedures]. I contend that if the patient were given the information there would be a good deal of opposition.

Would the normal person have a clue that for heart surgery the whole body is cleansed including their genitals?

My wife had surgery years ago and now is realizing that a male did a prep. She had no idea then and to learn about it later made her sick to her stomach. People have every right to know who is going to be handling them while they are "out."

JS

 
At Wednesday, March 12, 2008 5:38:00 PM, Anonymous gve said...

If the OR prepping is such a "Non issue", and posters in here are in such a minority (as OR staff would have you believe), why is it that such issues are never spoken of?

Is it because they know they have the informed consent of every patient?

Or is the reality that they don't ever want you to ask questions about what will happpen to you when you are out?

The assumption is that because patients are not complaining, they must be happy......

If that is logical and well argued, I see no point in any debate on anything ever.

When will medical staff wise up and treat patients as equals, not as people to be kept in the dark?

If everyone would be happy with what happens, why is it not in block capitals on the consent form?

 
At Thursday, March 13, 2008 8:18:00 AM, Anonymous Anonymous said...

JS, Jimmy, gve, it's good to see we're on the same page with this. It would make me sick to my stomach too, if I were to be prepped by a male stranger without my knowledge or consent only to find out after the fact. It makes me sick that this happened to my husband, only with the genders reversed. How medical providers convince themselves that keeping their mouths shut on the issue leads to "informed consent" is beyond me.

I recently sent a letter to the hospital where my husband's procedure was performed. I took the time to create a generic consent form for genital procedures that would alert the patient to these procedures as well as give them a place to provide privacy requests in writing. To make the doctors happy, I worded it such that the patient would understand that the requests would be honored if possible, subject to staffing limitations. An option is also included to allow the patient to seek other options if their requests cannot be honored and they are not willing to sacrifice their privacy. All this, on a simple one-page form with the words "genital/private procedures" in large capital bold letters at the top. I recommended to the hospital that they make it standard procedure to include this form with the other consent forms and make it a point to bring up the issue with surgery patients. Frankly, I wish every hospital would respect their patients enough to do this.

I'll try to keep you guys posted on whether the hospital responds to my letter.

- Dismayed Wife

 
At Thursday, March 13, 2008 3:39:00 PM, Anonymous gve said...

dismayed wife, dont hold your breath, they will igonore you, that is their idea of dialogue

 
At Monday, March 17, 2008 5:47:00 PM, Anonymous Anonymous said...

dismayed wife and others...
I think the OR clinicians use the excuse that both genders are in the OR with the patient naked. "They" don't see any difference in the fact that a patient is viewed and/or "handled."They have been trained to this mind-set. The mind-set is that they were trained as a circulating nurse, scrub nurse, OR tech, etc. to do "this job". Therefore, in their mind that is "just what they are doing and getting paid to do." The patients' feelings are not part of the equation. Most come out with the words, "oh, is that a problem?"

We complained heavily about this to the surgicenter and ...bottom line about all you get is: "Gee, sorry you had a bad experience."

Nearly all patients go into surgery and don't know what to ask. The facilities cover themselves by saying that it is up to the patient to ask. They will only discuss it and answer questions if the patient asks.

Complaints are not registered by patients therefore this has been continued practice. People in general don't take the time, effort or persistence to make formal complaints [in general regarding anything]. Most patients are never aware of this before, during or after the surgical experience.

JS

 
At Wednesday, March 19, 2008 2:20:00 PM, Anonymous Anonymous said...

Well, guys,

I'm pleased to report that I received a response letter from the hospital. They didn't say that they would implement the consent form I provided, but they did apologize and say that they were reviewing the consent process. They thanked me for my input and mentioned by name two of the hospital managers who were looking into the matter. By the detail they included, I could tell that they had looked up my husband's records before responding.

I hope they really do take it seriously and decide to make a real change in their consent policy regarding privacy-invasive procedures. At least I didn't get totally brushed off. When I have time, I may send a similar recommendation to the other hospital in the area. I may also send a follow-up in a few months to see if anything came of it.

- Dismayed Wife

 
At Wednesday, March 19, 2008 3:19:00 PM, Anonymous Anonymous said...

--dismayed wife,
Good to hear you got a response.
If I may ask-- what state or geographic area are you in?

Did you and your husband ever confront or discuss this experience with the surgeon? If not --you should have.

Your husband must have had a post-operative evaluation after his appendectomy--right? You and your husband could have discussed this issue then. Although, the surgeon I went to did not see his patients; they were put off to a nurse. Another embarrassing situation, having a female office nurse remove a dressing in a groin area. I refused the appointment and had my wife take care of it.

The surgeon is referred to as the "captain of the ship." He/She is the one who brings a patient in to a facility for business. That is why the facilities cater to physicians and give them bennies such as free cafeteria food, etc.

JS

 
At Friday, March 21, 2008 7:47:00 AM, Anonymous Anonymous said...

JS,

We're in Florida, USA. He did have a follow-up appointment, which I attended with him to help "protect" him from being pressured into exposing himself to a female nurse. (He is very shy about speaking up to defend himself in this kind of situation.) Fortunately, it was not an issue at the appointment. I was relieved (and he was more so).

I wanted to mention the issue to the surgeon, but my husband gave me the impression that he would be embarrassed to have his modesty needs brought up to the (male) surgeon. I kept my mouth shut to make him more comfortable. I can see why men aren't given as much consideration as women in this matter; there seem to be some pride or masculinity issues attached to it, so they probably don't bring it up as often.

I know that the surgeon is the "captain of the ship," but if hospital policy is to require express consent for genital procedures, how can they get around it? Maybe I've had a greater effect by contacting the hospital. Besides, this surgeon didn't bring us to the facility -- we brought him there. The surgery was not pre-planned.

I say good for you for refusing to let a female nurse remove a dressing from the groin area. I think some medical staff are way too keen on doing "private" stuff that could be handled by a wife or husband.

- Dismayed Wife

 
At Monday, March 24, 2008 7:16:00 AM, Anonymous Anonymous said...

Dr. Berstein --
Recently a family member had a colonoscopy. The gastro was male, the nurse anesthetist was male, the assistant or nurse was male. The patient was a young female. Soooo...in the closed procedure room were three males and the female patient was fully sedated (out) with Propofol. This does not appear ethically proper. Especially with the patient "out" for about 15 min or more.

What is your opinion on this?

JS

 
At Monday, March 24, 2008 8:23:00 AM, Blogger Maurice Bernstein, M.D. said...

JS, I am surprised that three indivuiduals were necessary, since usually it is only the physician and a nurse are necessary. Conscious sedation is usually provided and is necessary because it is of procedural importance that the patient can report any "discomfort". The patient may later, however, have total amnesia of the event.

Though I truely doubt a felony was being committed behind "closed doors", the patient would clearly have had an opportunity before sedated to request a female provider present. Also, it would be quite acceptable for the patient's chaperone to be sitting somewhere in the room.

By the way, ethics are really not involved in your example. However, ethics and law would be involved if the physician went ahead with the procedure against the request and consent of the patient by not having a female in attendance. ..Maurice.

 
At Monday, March 24, 2008 11:33:00 AM, Anonymous Anonymous said...

Dr. Berstein,
Thank you for your comment on the colonoscopy situation. Many people in my family and extended family have had colonscopies within the last several years. The GI groups now have opened their own "procedure" suites and employ an Anestesiology Group to administer medications. It seems now that there are three people in the room during a colonoscopy. Two in the room if a sigmoid is done --w/o any sedation. What you described is what I experienced in '02. The GI doc and a female nurse. The doc put the versed in my IV line. Now they apparantly widely using Propofol. It is an amesia sedative, quick acting and you wake easily w/o grogginess. But they are using anesthesiologists for administration and monitoring. I think the GI docs are trying to argue the "law" standpoint to get away from having to use an anesthesiologist for administering the drug.

Whether this was or was no an ethics issue, I think personally they should have had a female in the room. Yes, the patient could have spoken up....the process usually moves very quickly--rolling you in the room and BAM the drug hits your vein and you are instantly--OUT. Patients don't always have a lot of time to process what is happening and think about it later. They should ask, is this okay with you?

JS

 
At Monday, March 24, 2008 11:36:00 AM, Anonymous Anonymous said...

Dr. B,
As a post note to my last comment, they do not allow any family member or chaperone beyond the doors of the patient "area." They would not let my spouse to even be in the area before the procedure of after. My spouse ask--and were denied. They usually state for "other patients' privacy."

JS

 
At Monday, March 24, 2008 11:45:00 AM, Anonymous Anonymous said...

I had a colonoscopy with similar situation other than my primary provider is male. I had a female CNPA do the sedatives, and two female nurses assisted the two of them at least in the begining as I know there were three females in the room when they told me to turn on my side and put a pillow between my knees, then the lights went out so I don't know who stayed. I was expecting one person plus my Dr. By the time I hit the room and knew there were going to be three people plus my Dr. I was looped and couldn't say anything and then the lights went out. I was not a huge deal for me, but I would have preferred as few as people in attendance as possible. One thing I did have issue with was the facility used the curtains in the prep room, I could hear what they were saying to other patients...must have been colonoscopy day as the other two were there for the same thing...I knew who they were etc. before it was over so I assume the same was true about me. Then when they wheeled be out of the curtain toward the room there was a group of 5-6 nurses (all female) standing outside and I was rolled through them gauntlet style. Probably nothing to them, but to me it added to the stress of the procedure. It is a small town hospital and I knew several of the nurses.........nothing I felt unethical, other than possible hippa issues with the lack of privacy during prep on the legal front, however, not exactly a high degree of concern for paitent emotional well being. The secernio of all or extremely lopsided gender during these things is something us guys experience all the time...I did write the facility about it got a response, limited building budget, professionals, will look at alternatives.....yada yada yada...when I needed to have hemmroid surgery discovered in the colonoscopy I went out of town to a larger facility and it was much more private...which was surprising to me.......JD

 
At Monday, March 24, 2008 12:50:00 PM, Blogger amr said...

Third person was probably the anesthesiologist (use of Propofol) – When I had mine, there were 4 people in attendance. Male ane, male assistant, female nurse, and male doc. They would not allow my wife in the room, I asked. These are things that must be talked about well before as has been noted here before. Maybe even talking to the director of the facility before hand. For my wife it was a male doc and a female nurse – use of verced and demorol. I had propofol because of the endoscopy that I also had. So Dr. B, I think there is variation in drugs used.

And in keeping with this topic, what does the blog think about this article: Colonoscopy for Women.

Apparently there is a demand for all female providers to make women feel more comfortable. Hmmmm? Maybe this privacy / modesty thing is more important that doctors have heretofore wished to consider (when a pt is out). (This had nothing to do with necessary exposure. But I repeat myself.)

-- amr

 
At Tuesday, March 25, 2008 2:03:00 PM, Anonymous Anonymous said...

The usual double-standard bullcrap. Woman can get an all-female clinic for colonoscopies.
Where is the all-male facility for men?
Would a male doctor dare to take this approach?
--CHUCK McP

 
At Tuesday, March 25, 2008 4:32:00 PM, Anonymous Anonymous said...

I like the idea of clinics just for women and staffed only by women. And while I have heard of this sort of thing in the area of ob/gyn, this is the first example I've seen in another specialty. I think it's great!

CLW

 
At Tuesday, March 25, 2008 4:38:00 PM, Anonymous Anonymous said...

amr

There must have been an obvious need in this area for anyone to start a clinic like this. I find nothing wrong with this. If that's what it takes for them to get the women in this area to have this test, good for them and they'll probably make some money doing it as well. Fact is, for this to ever be an option for a man, we have to start complaining and STOP having these test done or demand same gender care. If everyone continues to have the test and say nothing, nothing will change. You'll get their attention once you hurt their pockets, you can bank on that. Jimmy

 
At Tuesday, March 25, 2008 5:59:00 PM, Anonymous Anonymous said...

Jimmy, I think it has less to do with the lack of males complaining and more to do with the fact that
there are no male doctors out there willing to take the flack for what would be deemed sexist hiring practices if it is for the benefit of men. As I said, it's typical double-standard tactics.
A female doctor can get away with this. First in the ob/gyn theatre then in colonoscopies.
-- CHUCK McP

 
At Tuesday, March 25, 2008 7:30:00 PM, Anonymous Anonymous said...

Chuck

I do agree that this is a double-standard but let's focus on this statement.

'Recent medical studies have determined this may be due to fear of embarrassment associated with seeing a male doctor.'

When I read this I assume that they've asked a group of women why they haven't had the test done so obviously enough have spoke up for them to try something different and more comfortable. Do I agree with this? No. But if enough men do the same, I'd bet some doctor would be willing to try this but we remain silent? We continue to have the test done and say nothing? If there's a market for this, a doctor would be willing to do it. Jimmy

 
At Wednesday, March 26, 2008 6:09:00 AM, Anonymous Anonymous said...

Women will always protect other women in a medical setting. Men are just a patient if less in the medicsl community.
ROB.

 
At Wednesday, March 26, 2008 11:10:00 AM, Anonymous Anonymous said...

I think this goes on due to the fact-- most men don't complain about being viewed or handled by a female healthcare worker ---female healthcare workers are and have been dominant ----males are perceived as being less sensitive about nudity ----but..the biggest factor I feel is that MEN don't speak up and voice objection. When and if facitlites and physicians start hearing MEN complain..nothing will change.

Men seem to accept that they must keep their mouth shut and accept female clinicians doing personal procedures.

JS

 
At Wednesday, March 26, 2008 4:56:00 PM, Anonymous gve said...

I think most men feelk almost powerless to make progress against a female dominated health care system.

The reality is that unless we make enought trouble for health care providers, they will see silence as compliance and acceptance.

In NO other walk of life is such inequality tolerated, why is it ok for men to be discriminated against?

 
At Wednesday, March 26, 2008 6:45:00 PM, Anonymous Anonymous said...

All,

There's nothing that you've said that I can disagree with. These concerns are the reason I recently opened a new topic on JSMD's blog because I do realize that one person alone cannot change anything, it's going to take a collective group effort to get our message out to the providers so please stop by and post suggestions and give support. The link is below.

http://patientprivacy.blogspot.com/2008/02/organize-for-patient-modestyprivacy.html

Thanks
Jimmy

 
At Wednesday, March 26, 2008 7:08:00 PM, Blogger Maurice Bernstein, M.D. said...

As all my visitors to these threads on modesty should know that I have repeatedly advised that it will only be through the development of a formal and ACTIVE activist group that modesty and gender issues can be brought to the consciousness of the various medical institutions and something positive accomplished to mitigate those issues. Though I personally have not taken a side in these issues, nevertheless, I personally encourage such group activism as the best approach to accomplish that goal. ..Maurice.

 
At Thursday, April 03, 2008 11:56:00 AM, Anonymous gve said...

I think the issue of patient modesty is perceived of as an inconvenience by the medical profession. Instead of recognising that we are all different and have differing needs and expectations.
I am very pleased for people who have no concerns whatsoever, good luck to them. What I find intolerable is the way that despite most medical professionals knowing that the gender of the provider WILL be an issue for many, they NEVER acknowledge this by simply OFFERING same gender care for even the most intrusive, embarrassing and personal care. I have no care about who looks at my ingrwoing toe nail, my finger that needs sutures, my broken leg etc etc etc. What i do take issue with is all female care in circumstances like male only procedures such as transrectal ultrasound, or when a male is to receive a cystocopy or an testicular ultrasound. The providers MUST know that gender will be an issue for the patienst but simply ignore it. I am certain many men do nothing about prostate symptoms until too late for just that reason. It is not rocket science, it is not something unreasonable, providers would have you believe same gender care is a major burden, it need not be.

 
At Thursday, April 03, 2008 2:18:00 PM, Blogger Maurice Bernstein, M.D. said...

I have to be very frank with my visitors to this thread. Believe it or not, in my entire career (50 years) I have never heard a discussion by colleague physicians about patient gender concerns regarding the physician or the assistants in relation to diagnostic or therapeutic procedures. Gender of the patient has really been of no concern to physicians when considering and preparing for an procedure. Yes, there is concern that the procedure is the right one and will be the most appropriate diagnostic or therapeutic, that the patient's medical conditions (no liver disease, renal disease, high BP or drug allergies) will allow the procedure to be carried out without complications. Efficacy and safety those are truely the essentials. Gender..no.
To the physician these procedures do not represent a game or contest or some social interaction between the doctor and the patient. In the doctor's mind, the procedure is a serious matter. It's like landing an aircraft sucessfully and safely with the help of the control tower. What pilot cares whether he or she is guided in by a male or female? The pilot wants accurate information and guidance. I realize that modesty is the difference in this comparison. But I can tell you that gender is of no import and probably why it is difficult to have available specific gender physicians or assistants is because that is the attitude of the profession.

I am not saying that physicians should continue to maintain that attitude toward the gender issue. What I am trying to explain is the reason why gender differences are not considered the most imporant element in managing procedures. With that, if desired, it is time to change the mindset of physicians-- yes it will be an addition to their already major concerns of efficacy and safety but if that is what the patients want..then so be it. ..Maurice.

 
At Thursday, April 03, 2008 2:28:00 PM, Anonymous Anonymous said...

I am sorry the doctor is not even present 3/4 of the times with a patient, nor are they around for 90% of the test they order. So it is not really like landing a plane. A pilot is always on the plane with the passengers unlike a doctor with a patient.

 
At Thursday, April 03, 2008 3:09:00 PM, Anonymous Anonymous said...

Annonymous of April 3 2:28-- So true and well stated. Dr. B makes a valid point with his comments of what doctors themselves deem important---with that said as it was stated the physician --surgeon is not around so much of the time. In surgery they come in after all of the intrusive, personal prepping is done. I would have rather had a female surgeon and male nurses/techs work on me than a male surgeon and female nurses. Males go into the offices of male surgeons/physicians and then get FEMALES to do all the really personal stuff....Absurd!!!!

JS

 
At Thursday, April 03, 2008 3:42:00 PM, Anonymous gve said...

Dr B, either deliberately to create discussion or out of genuine ignorance you continue to pretend gender is never an issue.

If I asked the nurses to attend to me in the same state of undress as I am expected to endure for some treatments, I would probably be considered a pervert- WHY SO if being clothed is so trivial?

If medical parctitioners are so positive that patients in general are happy with the status quo, asking if a patient would prefer same gender care would have no impications at all, so why not ASK

 
At Thursday, April 03, 2008 5:02:00 PM, Blogger Maurice Bernstein, M.D. said...

gve, I am not saying that "gender is never an issue"..it obviously IS an issue for some (?many) patients-- but it is NOT an issue for doctors. Since the doctor-patient relationship is still a two-way street in terms of the performance of a procedure, if a gender issue for the patient arises and is made known to the physician, as I implied in my previous post, it should not be ignored and it may be necessary for the physician to add it to the burden of providing and assuring, as I already mentioned, efficacy (value, benefit)to the procedure as well as procedure safety. Again, what I am writing is not what doctors may or should now consider but trying to tell my visitors what doctors actually do consider. By the way, in truth, doctors DO consider a gender issue in one aspect of any doctor-patient relationship and that is to be protected against being accused of unprofessional behavior in the performance of a pelvic exam of a woman. In that regard, most physicians will see that a female attendant is present as a chaperone. However, I know the attendant is present, in the final analsis, for the legal protection of the physician and not for the emotional support of the patient since most physicians know that the patient has nothing to fear with regard that the physician will act unprofessionally. Of interest, physicians are not as readily compelled to have an attendent present for the breast examination of a female. I didn't require one prsent but one was and is always present during a pelvic exam.

Finally, and as I have repeatedly stated on these threads, in view of the comments on these threads I am expressing your concerns directly to my first and second year medical students and emphasizing the need for them to become aware that some patients they will attend will have these very concerns and may not express them to the student or physician. ..Maurice.

 
At Friday, April 04, 2008 4:45:00 AM, Anonymous Anonymous said...

It would seem then that we are relegating Dr.'s to the role of human mechanics, focusing on the task at hand much like a mechanic makes sure he gets the right fuel injector replaced. That is of course overstated. There was an interesting movie called the Doctor. It details the enlightenment of an arrogant Doctor as he becomes a patient and experiences indignities he so easily inflicted and took for granted when he treated his patients. I sat next to a Doctor on a flight and listened with amusement as he detailed the humiliation of having to be exposed during an emergency appendectomy in his hospital. I think there is awareness of the issue by Dr.'s when it is them...I turely feel 75% of the issue is shear convenience and economics for providers, the balance is devided between just numb to it and to a very very small degree in some cases malicious. JD

 
At Friday, April 04, 2008 5:15:00 AM, Anonymous Anonymous said...

Dr. B,
I had an article some time ago that was entitled, "What Doctors' Fear" in which it described a doctor becoming a patient. Of pertinence to this blog was the fact that it stated that "most" doctors prefer to admit themselves to other hospital facilties for procedures due to privacy reasons. This of course follows this discussion of the doctors being uncomfortable and unwilling to be viewed and prepped by nurses they would be working beside on a daily basis. So when the tables turn...and the doctor is a patient...a different approach is taken by a doctor. Nudity then becomes an issue for them. It all depends on who is standing clothed and who is laying on a table naked!

JS

 
At Friday, April 04, 2008 7:57:00 AM, Blogger Maurice Bernstein, M.D. said...

I have been a patient twice in the hospital at which I was on staff with serious illnesses and my main fear was that the medical staff would treat me as some VIP and NOT treat me like a regular patient. I also had some concern about others beyond my attending physicians reviewing my chart. I suppose my long history of viewing the human body in various stages of undress, has made me less sensitive or modest when I appear to the healthcare providers in various stages of undress too.

By the way, I sincerely wish that a number of physicians would come to my blog and write their understanding and response to patient modesty and about their own modesty issues. I seem to be almost the sole representative of physicians (except for js md) and I would like to see whether my life experience is an anomaly or is representative of the experience of other physicians especially those who, as part of their profession, are exposed to the unclothed human body. ..Maurice.

 
At Friday, April 04, 2008 12:12:00 PM, Anonymous Anonymous said...

Here's an interesting tidbit. I recently took a tour of the hospital where I am planning to deliver my child (the same one where my husband had his appendectomy). I asked, "Is it usually possible to get all female nurses during the delivery?" The answer was that only female nurses worked on that floor, not only because of deliveries, but also because of mothers who might be breastfeeding.

That was comforting. Nevertheless, I can't help but see the glaring double standard that so many on this blog have pointed out. A lot of breastfeeding women seem to have less modesty than other women about their breasts being seen even in public, yet the hospital cares enough to make sure that they are not exposed to males, just in case. At the same time, male patients in the OR are not only exposed, but handled by female nurses on a regular basis, and they are subjected to this while under anesthesia and never having been informed that it would happen.

- Dismayed Wife

 
At Friday, April 04, 2008 5:33:00 PM, Anonymous Anonymous said...

Dr. Bernstein --
I've noticed that whenever postings are running a little slow on this blog you manage to stir things up by posting comments like this --

"...I can tell you that gender is
of no import and probably why it is difficult to have available specific gender physicians or assistants is because that is the attitude of the profession."

First off, this is totally inaccurate because it only pertains to the care of males. Where females are concerned modesty is always taken into consideration
as a couple of your responses have so accurately pointed out.
Your focus would be better directed to attacking the old double-standard in this regard.
-- ALVIN

 
At Saturday, April 05, 2008 2:56:00 PM, Anonymous Anonymous said...

I concur with Alvin's comment. Somehow it is perceived MEN are not concerned about modesty, nudity and being cared for by the opposite sex.

When this issue is raised, the response is that "the only reason a female is doing these personal procedures (on males) is that they are the ones who work in that area (eg OR). That is the PAT answer when the question is raised.

THEY need to address the nudity, modesty issue just as they seem to address things---gender neutral. Both sexes have the concern. Men are deserving the same as women-- of the same respect.

Men need to voice their concerns and speak up. Only then will change come about.

More men need to be in nursing and the healthcare fields.
Ultrasounds techs and nurses make a great salary and yet for some odd reason most are female. Strange?

Another point...males in nursing originated in the military.

JS

 
At Saturday, April 05, 2008 6:33:00 PM, Anonymous Anonymous said...

Dr. B,
Regarding your post of when you were admitted as a patient and you did not want to be treated as a VIP, I might add that from personal knowledge most times DOCTORS are given a little more respect, dignity, privacy, etc. I have had several doctor friends and when they were patients male nurses were assigned to them and privacy was afforded. Even in the OR this was the case. Strange how these things can be accommodated and there is an awareness of respect by the workers. Even the father-in-law of an attending doctor was given such respect.

Nurses on the other hand are sometimes treated differently by other nurses. Once they know you are a nurse, staff nurses on duty tend to stay away from you.

JS

 
At Sunday, April 06, 2008 9:56:00 PM, Anonymous Anonymous said...

I recall reading a post by a male nurse (I think it may have been on Voy.com) in which he was able to get an all male team for his surgery. I to have heard of doctors given this privacy as well as their spouces in our small local hospital. The excuse that I've heard is "it's only this one doctor or it's no burden for this one case." I guess that's some of the perks at practicing at hospitals? Funny how they respect these wishes but don't give that option to everyone. I feel it's the dignified thing to do for all.

Dismayed Wife: You wrote a while back that you added a section on the hospitals consent form for genital preps, would you mind posting it on JSMD's blog? I've yet to find a hospital website where you can download a copy of their consent form online (atleast in my are). If you read my last post on March 26th you can find a link. Thanks
Jimmy

 
At Friday, April 11, 2008 2:24:00 PM, Anonymous Anonymous said...

Jimmy,

I didn't see how to attach a file to a post on the blog, so I emailed the form to your medical privacy address instead. The hospital never said they would implement the form, but I wish they would implement it or something similar. That would resolve my main concerns. Of course, it still doesn't change the wrong that has already been done.

- Dismayed Wife

 
At Sunday, April 13, 2008 12:19:00 PM, Anonymous Anonymous said...

-Dismayed Wife,
Your efforts of devising a consent form for genital procedures I can almost without doubt say are in vain.

The healthcare field thinks what they are doing and have been doing IS okay. The consent forms prepared by attorneys cover them legally. The form they use simply encompasses the generality in totality of a surgical procedure. The consents also use language that "others" (gender neutral) are assisting the surgeon.

They have legally protected themselves. In most hospital "Bill of Rights" it specifically states that upon request this infomration will be given. Simply stated a "Patient Must Ask." This relieves the hosptial of having to discuss this issue with a patient.

I suppose they feel, in their own selfish way, that this does not bother them so why should it bother a patient, especially when the patient is sedated or anesthetized and are unaware.

I totally disagree with the way in which this is handled and feel it is very wrong and unfair to a patient. It is poor business.

Retired RN--

 
At Monday, April 14, 2008 12:18:00 AM, Anonymous Anonymous said...

I recently did a google search on the double-standard for men in medicine. The first article read "The New Double Standard." I recently posted the link on JSMD's website, please stop by and take a look. Jimmy

http://patientprivacy.blogspot.com/2008/02/organize-for-patient-modestyprivacy.html

 
At Monday, April 14, 2008 11:34:00 PM, Anonymous Anonymous said...

Retired RN,

Since hospitals are legally required to obtain "informed consent" from a patient for a surgical procedure, I am hopeful that there is a chink in their legal armor with the current generic consent forms. Correct me if I'm wrong, but I think there are certain aspects about surgery that a doctor is required to address regardless of whether a patient asks.

When a patient is flat-out uninformed or wrongly informed (in your husband's case) about pre-op procedures, in particular those that any normal human being would find embarassing, intimidating, or offensive if done by a stranger of the opposite sex, then there is no informed consent for that pre-op procedure. I wish that hospitals and physicians would step up and address this problem themselves. If they don't, I wouldn't be surprised if someday, a good lawyer comes along and wins a landmark case against a hospital that does this.

One problem currently is that most people simply don't realize what is involved in pre-op. My husband and I certainly didn't. He would never even have known that his penis was handled by a stranger, had he not experienced discomfort urinating afterward and asked about it! Those patients who do realize it usually don't say anything for one reason or another. Eventually, though, some patient, perhaps a woman who has been previously traumatized by being raped or molested after having a man slip a date-rape drug into her drink, is going to experience this mistreatment and then buck the system. They will press criminal charges for this re-enactment of their trauma, and they will win. The practice of keeping patients in the dark about this will be exposed and fall into disfavor. If I had been the one to experience this, I might very well be pressing criminal charges myself. Whether I won or not, it would expose this unethical practice to more people, and send a message to the healthcare system that this is not okay.

- Dismayed Wife

 
At Wednesday, April 16, 2008 2:03:00 PM, Anonymous Anonymous said...

Dismayed Wife
You claim to be so angry but your going back to the same hospital for delivery of your baby. You and your husband saw the surgeon who operated on your husband and eithier one of you said a word to the surgeon.
Retired Nurse- You just sound like a jealous wife, you of all people know the Double Standard that men endure in all healthcare and you got zapped this time.

 
At Friday, April 18, 2008 4:15:00 AM, Anonymous Anonymous said...

Here's something to think about.

"For example, when few women are in a lucrative profession, for instance, computer science or engineering, most universities and large employers install reverse discrimination policies to avoid organizations such as NOW tarring them with the dreaded epithet, “sexist!” Yet, where is NOW’s and the media’s outrage when women are overrepresented in a desirable career such as pharmacist? Where’s the outrage over the fact that only men must register for the draft, the obligation to risk getting one’s head blown off?"

I've often wondered how our government allowed women to occupy 90% + of all nursing jobs? I'm not sure about the rest of you, but the company I work for has to have a certain amount of women working in each department. Even in my administrative role, our last hire had to be a women based on our department size and head count (male vs female). Don't give me any BS about the profession, I had to go to school and get certified to do what I do. I think it's high time to put quotas on the number of females entering the field. If that happens, that may just be the motivation needed for more men to enter the field. Jimmy

 
At Friday, April 18, 2008 12:51:00 PM, Anonymous Anonymous said...

April 16 Annonymous--
As a retired nurse of more than 25 years from a "hospital setting" ---precluded me from the knowledge of the P & P of an OR and the prepping of a surgical patient. I never worked as an OR nurse nor did I ever witness an OR prep.

Just because this was my area of occupation please don't personally blame "me" for the "double standard." I take offense to your comments.

The dissatisfaction of my husbands' surgical experience was not based on jealously. My husband specifically asked prior to the procedure and was lied to regarding the prep. He was extremely offended with what was done and was very upset and angry with the lie by the medical director of all people.

This was a ethical violation of privacy on the facilites part.

A formal complaint was attached to their file with the Joint Commission and stayed for 3 years.

Retired RN-

 
At Saturday, April 19, 2008 11:05:00 AM, Anonymous Anonymous said...

Dismayed Wife --
Regarding your message of Monday, April 14, 2008--

It is the legal responsibilty of the surgeon to obtain the informed consent. This includes, but is not limited to, the risks, benefits, complications, expected outcome, etc. of the proposed surgical procedure(s).

It is the duty of the nurse to ascertain, confirm and verify that the patient has been given informed consent by the surgeon and that they fully understand.

It is the duty of the nurse to explain other facets of the surgical procedure.

If a surgical shave prep or catherization is necessary the nurse has a duty to discuss this with the patient. For example, who will be doing the shave prep, when will it be done and where, how extensive will the prep be, etc.

If the patient seeks information from anyone on the OR clinician involved in their case, they have a duty to see to it that all questions the patient may have are fully and truthfully answered prior to the patient being transferred to the OR suite. The procedure should abort until the patient is satisfactorily informed and all of their questions answered. That is the law.

The root of the problem is that patient education by nursing staff is altogether lacking or simply inadequate.

Anger occurs when expectations are violated.

An attorney would not take a case as this on a contingency basis. We were told by an attorney that in general malpractice suits are difficult to win; a "privacy violation" case in the legal system would be very difficult. It would be up to a patient as to how much money they would be willing to expend to fight this "wrong."

Retired RN-

 
At Tuesday, April 22, 2008 12:07:00 PM, Anonymous Anonymous said...

Jimmy,
Your post is interesting food for thought as to how to get more men in nursing. I suppose the biggest problem is recruitment into nursing schools. Facilities can't hire men unless they are trained and licensed as an RN. So they only have the pool of qualified candidates to hire from. Maybe when the war ends and all these men and women return to civilian jobs here in the states, the male nurses that are currently in the military will be available and willing to serve in our hospitals and surgicenters. That'll be a plus.

Retired RN-

 
At Tuesday, April 22, 2008 4:27:00 PM, Anonymous Anonymous said...

The vast majority of nurses are female, take it or leave it, thats how it is, if you dont like it, tough!

 
At Tuesday, April 22, 2008 5:08:00 PM, Blogger Maurice Bernstein, M.D. said...

Even though I don't usually take one side or another as moderator of this thread, I would disagree with the Anonymous from today. Even if the "vast majority of nurses are female", I don't think that there is any civil, educated, practical, scientific, legal or ethical reason why folks should simply "take it or leave it". Even the force that kept humans on planet earth,planetary gravity, has been overcome to go up into space and the moon. Yes, and if some people "don't like it" and would find society functioning better with more men in the profession of nursing then people should try to make a change in that "vast majority" of female nurses. Yes, it may be "tough" but as with extending human experience beyond the field of earth's gravity, as I have previously noted on this thread, with a little energetic activism applied to the appropriate institutions, I think it can be accomplished. ..Maurice.

 
At Wednesday, April 23, 2008 8:56:00 AM, Anonymous Anonymous said...

Dr. B,
I totally agree with your comments regarding the post of 4-22-08 Annonymous.

I hate to say it but it sounds like one of the "angry" type female nurses that are regulars to the "allnurses.com" website.

This is the attitude that is spewing from their posts. I think it is sad that that type of angry sounding dialogue is uttered by anyone especially in the field of healthcare. It shows a complete lack of compassion for "others." and their feelings. Nursing is really a profession that is about "caring."

Retired RN-

 
At Wednesday, April 23, 2008 12:52:00 PM, Anonymous Anonymous said...

It's been well established on this blog and in real life that the majority of nurses are female but there was a time to that the majority of doctors were male and that time as noted on this blog as started to pass. It just takes time and effort. Can't really say that I have anything to say about the 'take it or leave it' option. I can say that if a nurse told me that, I would leave then pay a personal visit to her supervisor and try my best to get her removed. Don't think that comment or attitude would fly in any hospital. Jimmy

 
At Wednesday, April 23, 2008 1:54:00 PM, Blogger Maurice Bernstein, M.D. said...

And, by the way, the value or benefit to the patient of that "caring" should not be defined by the gender of the provider. ..Maurice.

 
At Wednesday, April 23, 2008 2:06:00 PM, Anonymous Anonymous said...

Dr. B,
Absolutely! Whether you are a male or female physician; a male or female nurse---you should have the compassion to respect every patient no matter what their personal viewpoints and preferences are. It is rude, callous and unprofessional to do otherwise.

Retired RN--

 
At Wednesday, April 23, 2008 5:26:00 PM, Anonymous Anonymous said...

Jimmy,
Your point is well stated. I join you in the opinion that a hospitals' administration would accept or would condon that sentiment from nursing staff. Legally they cannot. Nurses with that attitude need to have inservice on the "Patient Bill of Rights." Go to any hospitals website and type on the search bar- "patients rights".

All patients, male and female, have the same rights. Preference and privacy are specifically included in these rights.

Retired RN-

 
At Wednesday, April 23, 2008 8:55:00 PM, Anonymous Anonymous said...

I've noticed that whenever a debate gets going on allnurse.com regarding the double-standard in modesty treatment the thread is eventually "shut down" by the female nurse administrator. It's quit obvious that female nursing is a sacred cow and that any attempts to change that are going to be resisted. The medical profession needs affirmative action coupled with BFOQ enforcement to lower the number of women in nursing and med-tech fields. They can not (by factor of gender) offer equal modesty consideration to both male and female patients. CHUCK McP

 
At Thursday, April 24, 2008 10:38:00 AM, Anonymous js md said...

I'm not sure it makes any difference Chuck McP, but the administrator/originator of allnurses is Brian and I doubt very much that he is a female nurse administrator. I've had some brief communication with him.

 
At Thursday, April 24, 2008 1:11:00 PM, Anonymous Anonymous said...

JSMD. Brian Short, the founder/
administrator of allnurse.com
doesn't monitor everything on the site.
The two patient modesty
threads that were "shut down" as
"Rants" were killed by a
"staff administrator" handled,
TRAUMA RU. I believe this person
is a female. Brian Short's
web handle, BRIAN, Admin./Founder
usually has a green ball suffix
where he choses to identify himself as "male".
If he's strong enough to do this, I don't think
he's behind shutting down threads
that pressure female nursing over
its double-standard modesty treatment of male patients or theissue of patient modesty in general.
-- CHUCK McP

 
At Saturday, April 26, 2008 9:25:00 AM, Anonymous Anonymous said...

The threads seem to be shut down when they become to emotional or confrontational which I think sheds a little light on just how charged this issue is, not just with patients. It also cuts across several related topics. You will find female RN's defending patients rights as well as challenging them. Many seem to understand male patients reservations and say if they can't put them at ease will get a male to perform the proceedure when they can. One even called a RN who goes under Witchy...something out and suggested she is in the wrong field if a patients concerns are an issue with her. There are several threads on allnurse that go down this road...cone of silence, there is one where several nurses were invited in to view an unconcsious and well endowed young man.. The issue got hot with the posters over ethics and whether the nurses should be reported, the double standard was pointed out by a female nurse who stated, if this was a group of male nurses and female patient would we be arguing about this, they would have been reported immediately. So while I agree it is a real issue and one that does not look like it will be resolved in the near future...it is atleast one that the medical community is now debating with some zeal as the site showed. On another subject on what we can do, I would love to see an activist group, but I am not sure who could have the tools to do it, it would take some money and co-ordination...every challenge ie civil rights faced the same, but I am afraid the liability issue of today would scare a lot of people out, so on my part I am personally challenging my personal care, and I have encouraged several young men to go into nursing with some financial help and through speaking to kids at school through Junior Achievement and other opportunities....its not the impact of an activist group which I would gladly suppport...but its something...JD

 
At Saturday, April 26, 2008 11:23:00 AM, Blogger Maurice Bernstein, M.D. said...

If I may make a suggestion: Perhaps the easiest way to get going on the issues of patient modesty and gender inequality as decribed on this thread would be for those interested to contact established patient advocacy groups and see what suggestions and direct assistance could be obtained from them rather than starting from "scratch". I don't have the time to do all the research myself (though I was looking around Google with the words "patient advocacy" and there are many groups specialized toward specific diseases or more general HMO issues.) I suspect information can be obtained from some of these groups which would a valuable "start up" for those on my blog who want to get something rolling. ..Maurice.

 
At Saturday, April 26, 2008 5:57:00 PM, Anonymous Anonymous said...

I've spent a good amount of time looking to see if there is an already established activist group for these issues we've discussed. The closest group I've found is the 'National Organization for Men' and they seem to be stuck in start-up mode. They only have a comment board at this time. I to hate to start from scratch but what other choice is there? I've searched patient advocacy myself and only found that they only specialize toward diseases and other medical issues (just as Dr.Bernstein mentioned). Perhaps someone would be willing to assist me in searching and getting names? I to have a full time job and I'm expecting another addition to my family any day now so time is something I don't have alot of right now. We could use the thread that JSMD created to coordinate those type activities. That's only a suggestion. I'm going to continue to search and post because this issue is that important to me. Jimmy

 
At Tuesday, April 29, 2008 11:11:00 PM, Anonymous Anonymous said...

I'm a male and I've worked in health care for 30+ years. Yes
there is a double standard. I
was a patient 5 times and each
time my privacy was violated. On
two occasions I believe the nurses
were unprofessional to me. I was
young then and didn't really know
any better. I'll tell you right
now it will NEVER EVER happen
again cause they will be sorry
they ever saw me as a patient.
I know for a fact that female
nurses live to violate a mans
privacy. I believe they get
their kicks out of doing it.
If you bring it up on a forum
they (female nurses) will
quickly ban you. Personally, I
hate all female nurses and I
think they're all perverted. The
things I've seen in the 30 years
I've worked in health care. There
is not enough room in cyber space
to describe it. P.S. On allnurses
.com the thread whoa..inappropriate
was closed. I wonder why!

 
At Wednesday, April 30, 2008 2:51:00 PM, Anonymous Anonymous said...

The Double Standard starts early in life for men.
1)physical in school with a female doctor and female nurse both watching the men pull down there underwear for a hernia check and the girls never have to pull down there underwear.
2) Most uroligist are males but there whole staff are females.
3) When you go for an ultrasound and the same place they ask your wife if they would like a female to perform the procedure and they never ask the men and when you speak up they say sorry no male staff is available.
4) when yoiu get shaved 3 times by all female staff and never once was asked if I was okay with it.
5) When one female nurse helps you in the shower and another one helps you out, (how many different females have to see you naked for one shower)?
6) when you got to the dermatologist and a female nurse stays for an entire skin exam.
I agree most female nurses act like they are never part of the DOUBLE STANDARD but we sure have to hear how there husabands were treated.

 
At Wednesday, April 30, 2008 3:33:00 PM, Anonymous Anonymous said...

I'm not one to just post and whine.
I am going to do something about it. Awareness is part of the key.I'm not a modest person per se.
I just expect the same respect and treatment that any other patients
get. If they don't respect your
privacy which by the way is the first step of being an advocate
for the patient then how can you
as a patient trust them for any
other care! There won't be a next
time. Trust me!

 
At Thursday, May 01, 2008 5:21:00 AM, Anonymous Anonymous said...

comments on the last couple of blogs referring to how the double standard applies in the field of healthcare towards men--
First step is getting males to enter the various fields for patient care. How many male lab techs do you see, how many male dental hygenists do you see, how many male ultrasound techs do you see?
Second step--the majority of people do not have training or repeated experiences being a patient. Most people have not had repeated experiences with a surgical intervention, therefore, they are not familiar with the process. Once they are equipped with the knowledge, they can speak up and be their own advocate regarding privacy.
Thirdly, if there is a concern about privacy and the double standard--the patient should immediately speak up. For an ultrasound--a male can call around and find a hospital that staffs a male tech before scheduling the procedure. That what I did. Many times there is a choice. You just have to pursue it and demand it.
I think there are female nurses out there that are not guilty of what is being stated here.
JS

 
At Thursday, May 01, 2008 6:05:00 AM, Anonymous Anonymous said...

Well stated JS, I have been encouraging males in the Junior Achievement class I teach to join the field and have tried to break down that gender connotation that nurses are women and am trying to make contact with any Male Nurse Assoc. in my state to see what I can do to help. I have also talked to my state senator about implimenting a program like Oregon did (Are you man enough to be a nurse),
To the second point you are right on, on my 1st testicular ultrasound I had a female, which is how I ended up here, on a follow up I took charge of scheduling my own, asked and recieved a male. I have been successful in some instances, not all, but even when they have not been able to accomodate (OR), they are more congnicent of my concern and I felt better afterward. As JS stated, I didn't know what to expect the 1st time, got a little more knowledge and its been better. Dr. Bernstein has indicated, and rightly so that the best way to effect change is through an untied activist association. That takes a leader and a lot of effort to organize and we don't seem to be making much progress in that, but we can individually stand up and not only impact our experience, but possibly encourage others to do the same and might cause some change. As JS has indicated speak up, recently during my exam when it came time to drop my shorts, I simply turned to the nurse and said would you please step out for this, she looked and the Dr. he nodded and she stepped out, no big deal....we just need to get by the self imposed intimidation that we have no say or control of the situation...we do have a say, it is our body, our right to have input just as it is their right as providers to say no, but its in their best financial interest to accompdate if they can...we leave, no revenue

 
At Thursday, May 01, 2008 10:23:00 AM, Anonymous Anonymous said...

I forgot to comment on JS's last comment. I am in complete agreement there is a double standard and there is an issue that needs addressed. I agree that it is both the institution and providers that are the problem. However my personal experience is a vast majority of providers have been kind and compassionate. Most deal with modesty from their side and concentrate on making you more comfortable with where they could put more effort in avoiding it, and rely on you to speak up when they could ask....but by and large the ones I have had expierience with as a patient and visitor has been very positive. No doubt there are some that are bad, the WitchyRN on allnures is someone I hope I never meet..she thinks health care is all about providers not patients........but all and all I have to say my experience has been positive. I would be interested in hearing from others, over all, nurses negative or positive experience...same with MD's

 
At Thursday, May 01, 2008 11:31:00 AM, Anonymous Anonymous said...

Recruiting more men into healthcare
will certaining help. I don't think
it's going to change attitudes though. In all my experiences as
a patient I saw and experienced
this double standard firsthand.
From privacy violations to
unethical behavior from female nurses. That's one aspect about
this forum that no ones will change
my mind adout. I think all female
nurses are like that!

 
At Friday, May 02, 2008 4:50:00 AM, Anonymous Anonymous said...

Witchy RN on allnurses.com has a definite attitude problem.

The attitude of female nurses and the healthcare field in general is such, I feel, due to the fact that only females [sic majority] are employeed and trained. I don't think there are many male or female patients that complain, make an issue of this, or refuse treatment, therefore status quo continues. When a complaint is made, it is so rare, that it is mostly treated as an abberrant behavior. Therefore, nothing is done to change the policies.

Until more men speak up and refuse personal care by a female, nothing will change. Female seem to speak up, so should males that feel privacy is an issue. MOST men seem to prefer (or not care) to have women working on them, I don't know. But you don't see most men complaining or things would have changed by now if they did voice a strong opinion.

Only females are employed in doctors' offices.
I am changing derm doctors due to the privacy issue. A female assistant enters the room with the male doc and stays the entire time, supposedly to take notes of the skin check findings on a computer. In spite of the fact I have stated I only want the doc in the room, they still come in and sit behind the curtain. The doc seems to think the assistant speeds up their patient/time process by being in there and taking the notes.

JS

 
At Friday, May 02, 2008 4:52:00 AM, Anonymous Anonymous said...

JS said it very well There is no doubt the 1st step and most important part is to change attitudes. As Dr. Bernstein has stated before the most effective would be a activist group. However there are things we can do individually. As js stated once you have been through it a couple times you are now a little more educated in how it works and what to expect. We have to over come what is often self imposed intimidation and make our wishes known. That simple step will help, instead we often sit in silence, take what is handed to us and come to blogs to complain. They in turn think we are ok with it becasue we don't say anything to them. If we can't organize we need to at least individually speak up. The other point JS made, take charge, it isn't a prison, we have rights, my 1st testicular ultra sound was very stressful with a female tech, I told my urologist I would schedule the follow up instead of letting them do it, requested and received a male tech........little steps JD

 
At Friday, May 02, 2008 7:18:00 PM, Anonymous Anonymous said...

I have have been reading the issue on the Double Standard here and thought I would throw my two sense in.

I understand it is what men have to do is shop around for privacy.-I think that is absoutley unfair, My insurance and myself are paying the same price as a female patient. Why should men have to shop around and ask all of these privacy questions. Is privacy and dignity not something taught to doctors in med school? I could just go on and on.
I feel all present nurses and techs are not to blame for the Double Standard but I would put alot of money down on the table and say they have not done a whole lot to bring the subject to light wherever they work or haved worked. If feamale nurses push for more males in the field that would mean they might not have that job one day because a male may fill it. If male and female patient were treated the same and Male nurses took care of there daughters the way female nurses take care of male patients, you would here alot more protest about oppisite sex caregivers. I feel most female garegivers just like to pretend there has not and still is not a Double Standard, just look away blind at the subject. I am not saying privacy is always my first issue but if it was I THINK I DESERVE THE SAME RESPECT AS A FEMALE PATIENT, (i just want the choice).

I read an article not to long ago where a male nurse at the hospital he worked at was required to have a female chaparone present with him and a female patient, but the female nurses needed no chaparone for treating male patients. He sued the hospital for a number of charges and won every cent he asked for. I am not all about law suits but if that case does not sum up the fact how THE DOUBLE STANDARD switches from the patient role to the proffesional role.
What is even sadder about the Double Standard and females dominating the feild as caregivers is the LAW proctecting the female patient (or the fear of the law), male patients just get a double whammy where privacy is concered.

Justin- actually a not so modest patient just angry about the playing field. I have been sadly conditioned to have female caregivers.

 
At Friday, May 02, 2008 9:49:00 PM, Blogger amr said...

Regarding the "double standard", least we forget the venerable practice of non-consensual pelvic exams in the OR? Given the massive presence of females as nurses in the OR, clearly "they" have been a part of the "practice".

-- amr

 
At Saturday, May 03, 2008 5:30:00 AM, Anonymous Anonymous said...

JD,
Why didn't you simply refuse the female ultrasound tech for the testicular exam? It is yet another example how men go along with the program and endure the unpleasantries and violations of dignity and respect.

I can't say it enough, if men spoke up and refused...things would change.

If I wanted a female auto mechanic I would have to look long and hard and wouldn't have my car fixed. That is about what it is in healthcare. I don't think it is an issue of men taking over nursing positions and putting women out of work. There are plenty of jobs to go around. It is reported that there are huge nursing shortages and the problem will continue to grow over the next 20 years if more recruitment does not take place. One issue in training more nurses is the lack of nursing instructors and nursing school slots available.

Many male nurses start in clinical fields but advance and are promoted to administration or supervisory positiions taking them away from direct bedside patient care.

The idea of a chaperonne for a male provider and a female patient is also for the protection of the male provider. He does not want to be falsely accused of inappropriate touching and legally challenged.

In the case of a male patient and a female provider I guess it has always been viewed that men aren't raped by women. Men can physically fend for themselves if there is untoward inappropriate behavior from a female provider.

JS

 
At Saturday, May 03, 2008 6:34:00 AM, Anonymous Anonymous said...

amr-Regarding the "double standard", least we forget the venerable practice of non-consensual pelvic exams in the OR? Given the massive presence of females as nurses in the OR, clearly "they" have been a part of the "practice".


No that is not part of the Double Standard, that is just beyond poor behavior.
Justin...

 
At Saturday, May 03, 2008 3:42:00 PM, Anonymous Anonymous said...

Justin I liked alot of what you said and your passion you need to get more involved to help change the pratice of a lack of privacy for males in the healtcare system. If I could add to one thing to your post is the huge increase of women doctors. My first dermatoligist was a female doctor and she had a female nurse present for my full-body-skin-exam, before I knew it I was buck naked infront of two female health prof. it was extremely humilating and I seached high and low for a new doctor. Most females on this board do not understand what it is like for male patients or even understand what the double standard is.

 
At Saturday, May 03, 2008 6:28:00 PM, Anonymous Anonymous said...

Annonymous of May 3, 3:42pm
There are many male dermatologists available. Most tell you to leave your underwear on and put on a gown. You could have requested or demanded the assistant to step out, especially at a sensitive point of the exam.
No one had a gun to your head, did they?

I dont' quite understand that if this type of thing is SO upsetting why do people go along with the program. You are paying for this service, therefore, it should be up to you of what you'll accept. It is an elective doctor appointment not an emergency, you should have made an appointment with a male doctor.

 
At Saturday, May 03, 2008 8:50:00 PM, Anonymous Anonymous said...

Annonymous of May 3, 3:42pm
There are many male dermatologists available. Most tell you to leave your underwear on and put on a gown. You could have requested or demanded the assistant to step out, especially at a sensitive point of the exam.
No one had a gun to your head, did they?------------------------------------

I dont' quite understand that if this type of thing is SO upsetting why do people go along with the program. You are paying for this service, therefore, it should be up to you of what you'll accept. It is an elective doctor appointment not an emergency, you should have made an appointment with a male doctor.

LOOK IF YOU YOU READ MY POST I SAID IT WAS MY FIRST VISIT TO A DERMATOLOGIST!!!!
AND I WAS ONLY TWENTYONE YRS. OLD, AND MY PRIMARY PHYSICIAN RECOMENDED I GO DUE TO BEING A LIFEGUARD FOR 6 YRS. AND HE SAW SOMETHING ON MY BACK. I KNEW NOTHING OF WHAT THE APPT. WAS GOING TO BE LIKE AND MY PRIMARY RECOMENDED THIS OFFICE!!!!! Yes when the underwear came off and i was naked it was hard not to be seen. PLEASE DO NOT JUDGE ME WHEN YOU KNOW NOTHING ABOUT ME, AND I WOULD SUGGEST GOING FORWARD YOU SHOULD READ PEOPLE POST BEFORE COMMENTING ON THEM!!!!!!

 
At Saturday, May 03, 2008 8:53:00 PM, Anonymous Anonymous said...

P.S. I was not paying for this service my father was with his insurance... I was a full-time college student not a full time patient like you. I did not no what questioned to ask.

 
At Saturday, May 03, 2008 10:33:00 PM, Anonymous Anonymous said...

Please can everyone sign off in some way so we know who is replying and who to reply to.Come on you didnt just all of a sudden end up naked in front of 2 females. You should have said something. Nothing will change if you allow this to happen, RMc

 
At Sunday, May 04, 2008 4:38:00 AM, Anonymous Anonymous said...

JS,
I read article on female doctors, I do not remember prcents or anything but I do remember it was low. The article basically said that some female doctors are actually nervous being with a first time male patient (partially disrobed) so many times they bring in a nurse or someone, it also said usually the same doctors will by-pass the wittness after a few visit with the same patient.

I personally have no problem with female doctors I just do not want an office party in my exam room. LOL.
For me I just want a great doctor with a great staff and the rest will fall into place.

Eric S.

 
At Sunday, May 04, 2008 4:53:00 AM, Anonymous Anonymous said...

Annon- Sat May 3 8:53 pm
The service was being paid for, period. You were over 18, an adult.
None of us are full time patients, I don't think. Yes, after going through something that is not acceptable, you and others change.

Things is though we all need to speak up. That is what women demand and ask for, men should take their lead.

 
At Sunday, May 04, 2008 11:00:00 AM, Anonymous gve said...

Saturday, May 03, 2008 6:28:00 PM, Anonymous, People go along with these things because once the are in that position they feel vulnerable, powerless and don't want to make a fuss. I have posted a few times on this blog and recently underwent an aspirarion of my infected hip, despite having been VERY vocal in here, I was conpliant at having 9 (yes NINE) staff in the OR while I was treated. I Had stood up for myself in advance and insisted I be allowed to wear my own underwear (and keep them on), I pulled the underwear to one side for the procedure. Can you imagine WHY a provider would even begin to think it was ok for me to have been naked in such a situation? I stood my ground about the nakedness, but then went along with there being so many spectators, I was furious with myself afterwards. I call it the "stuck in the headlamps" syndrome, where a patient is unhappy but suddenly loses the ability to articulate what they are feeling.

 
At Sunday, May 04, 2008 12:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Please, please all those visitors who sign on as "Anonymous", please end your commentary with a consistent pseudonym or some initials for all of us to follow the continuity of the discussion.

IMPORTANT: We are up to over 140 postings and I haven't counted the number of words or characters but I have a feeling that it may be necessary, in view of the history of how this blogger.com works and seems to suddenly stop printing comments, to start a Volume 3 on patient modesty. Remember, if I do that then we will all have to stop attempting to post here so that important function of "continuity in discussion" is not lost. Any comments about this? ..Maurice.

 
At Sunday, May 04, 2008 8:01:00 PM, Blogger amr said...

Justin,

Per se, non-con is not female nurses relationship to male patients. What I was trying to point out is that we are dealing with a continuum of "poor behavior". Reactions of pts can be anywhere from oblivious to PTSD.

Also, I am concerned about comments made recently as absolutes. I don't believe that ALL nurses are bad. In fact, I have witnessed where that is simply not the case. I believe rather that there is small but significant percentage of that gives the profession a black eye. I bring up the non-con issue because it is still practiced today, and even the CA law prohibiting it, to my read, does not spell out penalties if it is violated.

Dr. B -

1. I would take backups by copy/paste to a doc file from time to time.
2. Maybe 500 entries is a good cutoff
3. Email google with a ? regarding this problem.

-- amr

 
At Sunday, May 04, 2008 8:10:00 PM, Blogger Maurice Bernstein, M.D. said...

amr, I have tried to e-mail Google but I have not received a reply. I suspect there is some cutoff in posting to a thread when it reaches a certain size. Does anyone who has a blogger.com blog know the limits? With regard to the doc. file, where would I place it to be accessed? Perhaps, keeping the number of postings smaller on each "volume" would make for easier reading (??). ..Maurice.

 
At Sunday, May 04, 2008 9:52:00 PM, Blogger amr said...

Dr. B,

You can copy the entire blog to a doc file. This would be a backup to you and the community. You could publish the doc file as a single entry (such that you have done herein - with your intro and all our comments to the intro). This could be done should another glitch occur as long as you keep your doc file "current" ie copy/paste each new entry that you review to the end of the doc file.

Also, the idea of splitting volumes could help - say a volume for every 6 months?

Another subject: Angie's List. This is a website that has been devoted to consumer reviews regarding home services. They have recently started a new section on the medical profession. This might be an interesting forum to review doctors and institutions with respect to the matters covered herein. This could be the place to begin the advocacy that Dr. B has mentioned.

--amr

 
At Monday, May 05, 2008 8:50:00 AM, Anonymous Anonymous said...

JS

As you stated in an early post, my testicular ultra sound, while I was about 50, was my 1st actual experience with something of this nature. I was uninformed, had no idea what was to come, and assumed that I didn't have a choice. After the event, I found this blog, picked up some information and courage and now take a much more active role. The deer in the headlight analogy is pretty representative. I also agree most providers I have met have been great. The problem I feel, on top of a few bad apples is a system that focus's more on profits through efficiency than patients comfort. When it doesn't cost money they will provide...and efficency is a money issue, doing more for less. Rather than try to schedule for patient comfort by gender, they would rather try to teach providers how to deal with it and reduce the anxiety instead of eliminate it through giving the patient the choice which could complicate scheduling. Gender nuetral is a concept for the benefit of the provider...not the patient. Now that I know...I no longer just take it when I can plan ahead or have time to think it through..I have asked a NP in training who was shadowing my PP to step out for the Hernia & Prostrate exam during my last physical...to a large part becasue of what I picked up on this blog...knowledge is very enabling, now I know I am not a freak asking for something unreasonable, I have the right.

 
At Monday, May 05, 2008 3:56:00 PM, Anonymous Anonymous said...

There is a huge double standard in
health care as far as male patients are concerned. I blame all
of it on female caregivers. That
includes female physicians,nurses
er techs and cna's. Trust me, they
live to violate your privacy.They
actually get their sexual kicks doing it. There is substantial
proof on the internet about it.
On allnurses.com there is a
thread called "ever have a male
patient comment on his size".
The perverted female nurse actually states that she evaluates
all male genetalia! If I were
some kind of a male caregiver and
said that I evaluate all of my
female patients what would people
think of me! Then there is on
allnurses.com whoa..inappropriate
the smoking gun which the site
locked. It involves female nurses
going into a comatose male patients
room and lifting the sheet to look
at his penis. These nurses were
not even assigned to him. Even the
charge nurse was involved. I have
had my privacy violated 5 times
as a male patient. Never again will
I allow that. If you are a female
nurse listen up. Be very very
careful around me. Until that time
comes for some personal procedure
I'll request a male nurse. Or an
all male nurse team. I'll get it
as I HAVE A RIGHT AS TO WHO IS
INVOLVED IN DELIVERING MY HEALTH
CARE. I AM THE BOSS,IT'S NOT ABOUT
YOU.IT'S ALL ABOUT ME. I'M PAYING
FOR IT. IF YOU LIKE TO GET YOUR
SEXUAL MASTURBATION KICKS GO TO
A SLEAZE BAR OR BECOME A WHORE!
NOT AT MY EXPENSE. I HAVE SUCH
A GREAT DISTRUST FOR FEMALE NURSES.

 
At Monday, May 05, 2008 5:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous of 3:56pm today:
ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT.

Also

I am not sure that it is wise to select single postings from allnurses.com or even necessarily from this very blog here to make generalizations. What folks write there and even write here, especially if anonymous of their real identity (including those with only pseudonyms)cannot be used as data to prove any common behavior. Unfortunately, as hopefully we all know, anyone can write anything on these blogs. We shouldn't extrapolate to all nurses, male or female, all behaviors simply because someone wrote on a blog as though they existed. Maybe the behaviors did exist but out of the need to make generalizations meaningful and significant something more than repetition of an isolated expression from a unknown author is needed. ..Maurice.

 
At Monday, May 05, 2008 8:59:00 PM, Anonymous Anonymous said...

Annon- Sat May 3 8:53 pm
The service was being paid for, period. You were over 18, an adult.
None of us are full time patients, I don't think. Yes, after going through something that is not acceptable, you and others change.

Things is though we all need to speak up. That is what women demand and ask for, men should take their lead.

I sorry you being a retired nurse I 'am sure you have no idea what it is like being a male patient in any kind of health situation.
As for for a female patient your demands have been much easier to deal with 94% of the caregivers being female.
Quick Question?- Have you ever been lying in a hospital bed and a male employee walks in your room and says "he is here to shave your groin area for your operations"?
I highly doubt you were ever even put in that situation, so until you have please do not put other people down. EACH PERSON ON THIS EARTH GROWS AT A DIFFERENT RATE.
Thank You and Bless You.
Marty

 
At Monday, May 05, 2008 10:08:00 PM, Anonymous Anonymous said...

Marty, if your last comment was directed at me RMc Sat 10.33 open your eyes I'm not the same person as RN. Nor do you know my gender or what i have been through.RMc

 
At Tuesday, May 06, 2008 5:10:00 AM, Anonymous Anonymous said...

Sorry Dr. Bernstein, I keep forgetting, my last post was Mon 5th, 8:50. I would say we are pretty universal in that there is a Double Standard, that there is need for improvement, that improvement has to come from each of us speaking up unless we can form an activist group. I could not agree with you more that we can't put a label on all providers based on one persons experience or posts such as allnurses. As Marty pointed out we are all different. What I got out of the Whoa post was a disappointment they did not hold the nurses involved accountable for their actions, but I also recall on this and other threads there were many nurses who objected to the behavior. The other thing we must all keep in mind....we are all different...we have to let them know what we are thinking. I am very modest, but I don't have a lot of problem with exposure in the OR after I am out, when the procedure calls for it. I think exposure for a shoulder operation is ridiculous and could be easily eliminated by providing surgery shorts (they do exist), others may not care at all, and still others may object to opposite gender being present under any circumstances. I read somewhere a guy was angry his Dermotologist had a nurse present to record as he dictated the exam, she was seated behind a curtain to keep her from observing the patient during the exam. The patient was really mad she was there, I on the other hand thought the Dr. was being very considerate in striking a compromise that considered his need for efficency and time, and the patients desire for privacy.......that is part of my education from these blogs, the definition of modesty and accomodation varies greatly among us. As such while we need to get providers to ask and consider the issue, we also need to understand what we want is so diverse, we have to speak up prior to procedures....and we have that right. JD

 
At Tuesday, May 06, 2008 9:02:00 AM, Anonymous Anonymous said...

To RMc-
if you noticed on my last post I copy/paste the entire post I was referecing including day and time, it was clearly not the post you are talking about.
Thank You
Marty

 
At Tuesday, May 06, 2008 3:52:00 PM, Anonymous Anonymous said...

Regarding the thread on allnurses
whoa..inappropriate sure there were a lot of nurses objecting to what happened,however, I'm willing to bet you that they wish they were there enjoying the sights. It's easy for them to type something in to make them look good.One nurse, I believe it was "tri" obviously a very disgusting nurse stated that
"lighten up, this happens all the
time in hospitals". It actually
does. Take a look at this site
http://topofmyhead.blog-city.com
/examples_of_unprofessional_nursing.htm

Pt

 
At Wednesday, May 07, 2008 3:38:00 AM, Anonymous Anonymous said...

I read the web site and page regarding unprofessional care by nurses. It is disgusting no question, however, you must take into consideration the fact that the employees are also CNA's. They have about 6 weeks of training. Probably employees at McDonalds' get more training. They are not licensed but certified.
The pill dropping on the floor? My dentist dropped my cap on the floor as he was attempting to put it in my mouth! He picked it up off the dirty floor and put it in my mouth. I was stunned, but with my mouth open and his hands there I could not talk. This is life unfortunately. These people working in nursing homes, hospitals, etc. are just that PEOPLE. No different than the general popultation. Supervisory positions need to oversee the people.

One day people can be a beautician, a receptionist, an accountant, a car mechanic, etc. then go through some training and wala, now they are a healthcare worker.

bm

 
At Wednesday, May 07, 2008 9:16:00 AM, Anonymous Anonymous said...

bm

So your saying "its ok, we are professinals here" doesn't bring you a lot of comfort? Its often used to try to difuse resistance. And that is one of the problems from the whoa thread at allnurse, even those that condemned the behavior, did not recomend reporting or pushing the incident....can't judge them all from the blogs, but when you look at it as a whole, I think validates our concerns.

jd

 
At Wednesday, May 07, 2008 1:46:00 PM, Anonymous Anonymous said...

If the story is true I blame the hospital for allowing group lesson on how to give a bed bath. What that poor guy must have felt like. Second, if that story is true there will be a special place in HELL for that CNA.
Third, if that story is true the students did report that CNA and in my eyes that means so muuch to me, granted she did get away with it but the supervisiors did know about it in the long run.
I think for everyones sanity we must remember there are good eggs and bad eggs in every proffin out there. As Dr. B has stated and also in my opinion we can not get lost in these kinds of stories, if they are true or not and we will problay will never know. I also think allnurses.com now knows they have a much larger public audience and I am sure everyone posting on there is not a real nurse and pulling peoples legs with the smug postings. What we can do as we go forward trying to gather advocay support is to ask hospitals how they decide if an employee of any level is burned out and how they would handle it?
Eric S.

 
At Wednesday, May 07, 2008 2:41:00 PM, Blogger Maurice Bernstein, M.D. said...

Eric S., well said. Folks trying to use "stories" told anonymously on the web as documentation are unreaslistic and the documentation is truely of doubtful value. Those who have personally suffered and who want changes in the system should leave the undocumented stories behind and go on to an activistic approach and instead of presenting to institutions or doctors offices commentary from the blogs, go in hand with legal testamony in which there is notarized identification of the compainant and names are named. That's the only way I see one can get the attention needed to change systems. Otherwise, you can expect only a "ho humm.."..Maurice.

 
At Wednesday, May 07, 2008 2:59:00 PM, Anonymous gve said...

DR B,
you have "hit the nail on the head", and stated the reason such bad behaviour will continue.

The so called "professionals" will close ranks, deny everything, proof is required of the vulnerable patient.

How can a sole individual prove anything against a group of friends?

Why should individuass have to prove anything, surely the fact that a male feels uncomfortable with females present when they are naked is sufficient to cause carers to show compassion?

The should be no need for proof, rational argument or anything else, just compassion and consideration.

 
At Wednesday, May 07, 2008 3:39:00 PM, Blogger Maurice Bernstein, M.D. said...

As I have repeated many times on these threads on modesty, you just have to believe that physicians just have not given much thought to patient modesty issues. Even I, though for years have included the importance of patient modesty as I taught second year med students to do physical exams, I didn't really appreciate the degree of upset of some patients until I read the comments on these threads. Those doctors who don't come to my blog or others where modesty issues are brought out will also remain ignorant---and that is why, yes, patients will need some "proof" to show the doctors that this is not an isolated concern. ..Maurice.

 
At Wednesday, May 07, 2008 3:54:00 PM, Anonymous gve said...

Dr B,

so in your opinion, would it be sufficient for a man to say "I would prefer an all male team as I will feel less uncomfortable and embarrassed that way" or would i need to prove i felt that way?

However, most men will feel too shy to say this, as has been said dozens of times in this blog, why can't providers simply ASK?

I have delayed having a transrectal ultrasound biopsy for over a year because i can't find a team who are willing to help. Most make vague promises like "we will see what we can do", i Know that means, turn up and we will pressure you to accept the status quo and make you feel stupid if you resist, that is how I, as a male feel!

 
At Wednesday, May 07, 2008 6:02:00 PM, Blogger Maurice Bernstein, M.D. said...

gve, depending on your age, race and family history for prostate cancer and level and change in the PSA test and the findings by palpation of your prostate gland, don't put off getting the transrectal ultrasound biopsy. Unless you live on a desert isle, you should find a male urologist who will help you meet your request regarding the gender of the urologist's helper. It shouldn't take you a year to find one. If most of the factors above are suggestive of a high risk of treatable prostate cancer and undergoing treatment will be of value in terms of statistically preventing unnecessary debility or mortality (both situations must apply), it is wrong to delay. ..Maurice.

 
At Wednesday, May 07, 2008 6:16:00 PM, Anonymous Anonymous said...

Many urologists are male so finding one really shouldn't be an issue. Some bigger urologist's offices also do much of their testing right on site. I would look for one in your area that does as having everything done in one setting as that might be less stressful for you.

If men don't speak up how will anyone know? If men are afraid to say anything they are accountable not the doctors, etc. The doctors won't kow if they are dealing with someone with modesty issues unless told. And when there is no emergency involved you can still get up and walk out.

If you want an all male surgicial team I would discuss it with your surgeon. Ask him if it is a request that can be met. Some hospitals can do it easily but many can't. They might put you in touch with someone who can help your request along.

I also would urge anyone who needs a medical test to get it done. Time can be of the essence where some testing is concerned. If there is no male to do the test ask if you can bring someone in the room with you. That can help ease the discomfort. Also tell the person performing the test of your discomfort. Ask to be covered as much as possible, be sure door is closed, no students, etc. Might not be ideal but it can help.

-law

 
At Wednesday, May 07, 2008 7:13:00 PM, Anonymous Anonymous said...

GVE. I had a similar situation with basic scrotal ultrasound and the male urologists in my health plan only having female sonographers. I called the plan
and asked them to find me a male
sonographer as they had not covered for the possibility that a male patient might want same gender. First, they told me they couldn't refer me outside the plan. I then put my request in writing to the doctor
in charge of the plan's approvals. I told him I would consider them responsible for all health complications that might come as a result of this delay.

Two things happened in short order.
One: They found me a male ultrasound tech and paid for the exam in system.
Two: They then informed me that one of their plan doctors would be hiring a male tech and sharing this person with two other plan urologists that were all contractors in the same medical building. In effect, among them these urologists now had male and female sonographers to offer their patients.

If I hadn't insisted and raised
the possibility for a medical lawsuit, I don't think anything would have happened. I'm not suggesting this will always work or that it will work with full OR teams but here and there we can get the system to change if we hold our ground and document in a threatening fashion. Afterall, this is how woman managed to win all the special considerations they now enjoy in medical modesty.(Many of these coming at the direct expense of male patient needs.)
- CHUCK McP

 
At Wednesday, May 07, 2008 9:50:00 PM, Anonymous Anonymous said...

Chuck, can you please explain your last sentence. What do you mean by at the expense of male patient needs? RMc

 
At Thursday, May 08, 2008 1:23:00 PM, Anonymous Anonymous said...

RMc.
The fact that male doctors require female chaperones to meet the needs of female patients and that they also hire female techs so that these in turn will not have to chaperoned during intimate
procedures has helped to keep the
number of males in support staffs
low to non-existent at many facilities.
So female requirements cut into any fairness
for males in this regard.

Why did I have to explain this...?
I think its very obvious.
-- CHUCK McP

 
At Thursday, May 08, 2008 1:31:00 PM, Blogger Maurice Bernstein, M.D. said...

An Anonymous visitor attempted posting the following on the now inactive "Patient Modesty:A More Significant Issue?" so I am posting it here. ..Maurice.

I recently had a mastectomy and bilateral oophorectomy I requested females, and strongly expressed my opposition to male care while undergoing such proceedures. Then after I was under anesthesia they brought in males to prep, male surgeons, and male students, to do practice exams, procedures, and surgery. After I begged them not to do it again during a colonoscopy, again they did anyway. I was also left in the care of men while under anesthesia. This is in OR where I read here and have been told by others that they leave you naked in front of anyone. I now have Herpes 2, my husband does not, and I did not a year ago. So, what do you think happened?
BTW while hurt is not the problem. He had much more trust in men than I, who had enough experience as a female patient to know better.

 
At Thursday, May 08, 2008 10:12:00 PM, Blogger Maurice Bernstein, M.D. said...

I had to reject publishing one visitor's response to CHUCK McP because the commentary was leading to become an unproductive angry discourse. It would be better, if those who want their view to be accepted provide some formal documentation to support a contention. This can be a reference to a resource or can be a step-wise logical explanation which leads one to a conclusion. This is much more constructive and civil than back and forth anger. ..Maurice.

 
At Friday, May 09, 2008 5:07:00 AM, Anonymous Anonymous said...

The situation men face in a male urologist office is that there are only female assistants employeed in offices. Many urologist now have extensive services in office. These include the prostate biopsies, ultrasounds of the pelvic region, cystoscopies, etc. There is exposure when these are done and by female office assistants. I had a biopsy proposed by a male urologist and I asked if my wife could be in the room during the procedure. The doctor was very hesitant and stated that he normally does not have the spouse in the room during these types of procedures. When I pushed he finally said that she could be there but stand at the head of the bed. (!) What is all of this about?

 
At Friday, May 09, 2008 9:45:00 AM, Blogger amr said...

Dr. B,

It is a shame what that the lady who posted in the closed blog might never know that her entry was made here. I wonder if there is some way to post an entry in the blog telling her and others to come here - with a link.

I would love to know more about how she found out what had happened to her and how it was that it happened again. Was it the same hospital? What formal complaint path has she followed? Did she put her wishes in writing to the Dr. so that there was a record of her request? The implication that she was raped is appalling. This might be the exception case, but it is the same boggie-man scenario that brought me to this blog. Perhaps she could join Angie's list and right a review.

Regarding "unproductive angry discourse". I would submit that it is that very anger and feelings of violation that is the cornerstone of concern that has come out herein. To censor it might be similar to what allnurses does. On the other hand, civil discourse is important to get the message across. Perhaps you could publish a thesis statement of the visitors position and invite the visitor to come back and join the conversation. Sometimes, people are so hurt and angry, that hearing that visceral response is important to getting the message across.

Regarding your May 7th entry regarding how the medical community has not given much thought about patient modesty, I respect what you are saying. However, I believe there is a segment of the profession that has in fact studiously side-stepped the issue for the institutions self interest.

More often or not, a ritual of keeping the patient covered and carefully placing heart monitors on the patient with minimal exposure is what is taught. It is taught not to expose the patient until after they are asleep. My conclusion is that the profession knows that modesty is important.

Cameras / video in the OR: Argument most often given in the literature is patient safety from SSI - fewer people in the OR - but more students can witness the surgery. This is done as a condition of treatment. Pandemic in the profession is this coercive invasion of privacy which given the internet is getting worse not better.

In keeping with your reasonable request to provide documentation to support my argument, submitted for our review is a link to the Stanford University Schools of Medicine, Department of Obstetrics and Gynecology, 2006 Gynecology Resident Preop Manual.

Not only does this give us a really good idea of the preop process, but it also documents (same as UCLA) that the patient may not alter the consent form. Thus they must accept the fact that pictures may / will be taken of them as a condition of treatment (as well as students participation in their care). On page 43 is the consent form for surgery which notifies the patient that they must agree to pictures being taken. On page 37, it clearly states that: "Note that the hospital does not allow the patient to in any way modify this form; if she insists, surgery cannot be performed." The purpose of these photos are clearly stated in the consent form and clearly are for the institutions benefit.

Since this is pandemic and has been going on forever, and new Drs are inculcated in the medical culture, I would submit that the "modesty" issue has been taught to be "ignored" as a matter of institutional self interest. It is the same mentality that allows cameras in the ED department or in the ambulance, or for that matter teaches med students in OB rotation that getting informed consent to do a pelvic exam when the patient is asleep is not important.

So, I believe that the issue of patient modesty is not "thought about" by doctors (as you say) is in fact "taught" through the culturization of the student not to be considered. It is insidious, and it takes a very special person (like Dr. B) to take a giant step back. I remain thankful that this blog (which is unique) exists.

Also, it just occurred to me that maybe the reason we see sometimes some very militant views expressed by the profession justifying their actions in this regard, may in fact be a need to justify actions they take that they know are wrong. As in: "The lady doth protest too much."

-amr

 
At Friday, May 09, 2008 3:29:00 PM, Anonymous Anonymous said...

If you don't want students present or filming to take place I would suggest crossing it out and then initialing it. Point out the changes to the person who gave you the forms at hospital. If someone states that you can't alter the consent form you need to ask to speak to hospital counsel or the compliance officer immediatey to rectify the situation.

-law

 
At Friday, May 09, 2008 4:23:00 PM, Anonymous Anonymous said...

I don't see the problem with spouses staying in the room during a standard exam as long as it is the actual patient making the request. Asking spouse to stay at head of bed was probably to give the patient some privacy while allowing emotional support to be in the room as well. That would be my guess.

-law

 
At Friday, May 09, 2008 6:48:00 PM, Anonymous Anonymous said...

-law,
That is amusing. The female assistant looking at private parts of the male patient allows for patient privacy wherein the spouse is requested to not look thus giving "privacy" to their husband?

I think things are twisted here.
I find that reverse thinking and ridiculous in nature.

 
At Sunday, May 11, 2008 12:26:00 AM, Anonymous Anonymous said...

I don't see physicians as being the
problem in healthcare. It is the
female nurses who are the problem.

They are the ones depriving people of their privacy. For example,they
always seem to be standing around
when there are some kind of exams
that men need.Ever notice that. Do
you see a crowd of men standing
around when women get a gyn exam?

If you are a female patient and
you seek out male physicians for
care and sexual impropriety occurs
then are you not part of the blame.

As male patients, we don't per se
go to a gyn. That experience usually occurs when we are patients
at a hospital. Odd that they never
ask us would you like a male nurse
to do this procedure, despite the
fact that there are male nurses
available.

Do you think that a female nurse
can leave her gender at the door
of the exam room.

 
At Sunday, May 11, 2008 4:10:00 AM, Anonymous Anonymous said...

Mr Law,
How can you state a patient is provided privacy during a procedure such as what a urologist would do, with a female assistant peering at him and HIS wife out of sight? Your statement seems to be contradictory.

 
At Sunday, May 11, 2008 3:08:00 PM, Anonymous Anonymous said...

I don't know if a female assistant was even in the room during biopsy. The poster doesn't mention having a problem with a female assistant in room so either one wasn't there or they didn't care of one was.

Forumer states he asked for his wife to be present and doctor asked for wife to be at head of bed. They seem to be upset by this. I don't know what the doctor's response would have been had he asked if wife could watch the procedure. If he wanted his wife to watch he should have made the request. If he was told no the patient could then decide whether he wanted to proceed or seek out another doctor. Complaining here doesn't rectify the problem. Speak out and ask questions at the office.

As far as a female staff aiding a doctor sometimes a doctor does need assistance during certain procedures whether the patient is male or female. If the patient is uncomfortable they need to speak up. They could request same gender care or if the office doesn't provide it they could seek out a provider who does. How easy that would be to accomodate I don't know as females do make up the vast majority of the nursing world. It makes it harder for modest men. There's no doubt about that.

If a nurse is present for an exam that is at the doctor's request. If the doctor didn't want them there they would be dismissed. If more doctors were willing to do routine exams without them it wouldn't be such an issue. We have seen many complaints about dermatologists using assistants in this thread and that is one area where they could be avoided if doctors were willing to chart things themselves. Speak up.

-law

 
At Sunday, May 11, 2008 3:22:00 PM, Anonymous gve said...

When i saw my urologist about my enlarged prostate, he looked amazed when i asked for his nurse to step out of the room while I discussed my symptoms and had the DRE.

He then felt it acceptable to write to my own physician telling him (and all the administrative staff in between) that I had been "bashful". How condescending and patronising is that?

 
At Sunday, May 11, 2008 3:27:00 PM, Anonymous Anonymous said...

I originally thought an ultrasound was being done but noticed when reading it again that it was a biopsy. I bet your spouse was asked to stay at top of bed because of how that is done. That can be very hard for a spouse to watch. I would have asked for clarification as to why anyway if it bothered me.

 
At Sunday, May 11, 2008 3:29:00 PM, Anonymous Anonymous said...

Sorry Dr. B. Last comment was made by law. I was stating it would be hard to watch a biopsy. If you can add my initials that would be great.

 
At Sunday, May 11, 2008 4:13:00 PM, Anonymous Anonymous said...

gve-5-11-08 3:22 pm
You are absolutely right. It is condescending and unprofessional. There is absolutely no reason for a female assistant to be in an exam room while you are discussing personal information with a physician. It is inappropriate for an assistant to be during a DRE.
I would immidately seek another physician along with writing a letter explaining my reasons for making a change in caregivers.
JS

 
At Sunday, May 11, 2008 5:27:00 PM, Anonymous Anonymous said...

gve,

How did you become aware of letter? Did your general physician bring this up to you in a future exam? How do you know all the staff was made aware as well? Was it something mentioned to you verbally or did you request your records and see the letter? And did the letter include any other info i.e. a diagnosis, test results, etc.

Glad you asked nurse to leave as I know you are a modest man. Sorry this experience has left you upset.

-law

 
At Monday, May 12, 2008 6:16:00 AM, Anonymous Anonymous said...

law,
When a patient sees a specialist it is customary for a letter to be sent to the Primary. Office staff have complete access to most correspondence [unless marked "PERSONAL & CONFIDENTIAL] as they open mail and file to the patients' chart.

Your comment stating you are glad that "gve" ask the nurse to leave the exam room because you know he is a modest man is absurd.

What has modesty got to do with this? A nurse has NO business to be present for a private discussion or a personal exam, PERIOD!

What I find odd with this entire healthcare scenario that is being actively debated on this forum is that when a person goes to see an attorney, a CPA, a financial planner or any other professional in which you are discussing personal information, there is NEVER another person in the room. Complete privacy is given. Seeing a physician demands the same or even more respect.

JS

 
At Monday, May 12, 2008 8:17:00 AM, Anonymous gve said...

I asked to see my notes because I did not feel i was being fully informed. Clearly, the letter was never expected to be seen by me, it has been! I have written to the Urologist to give him the opportunity to apologise, I am NOT holding my breath. I still cannot believe that anyone could be so umprofessional arrogant, condescending and patronising. I live in a small town, letters are typed by secretarial staff, opened by secretarial staff etc, it is OBVIOUS that others will have seen this insulting letter.

 
At Monday, May 12, 2008 1:51:00 PM, Anonymous Anonymous said...

I love the way a male patient
who expects his privacy is "bashful" but a female in the same position is "assertive".

Their are many hospital corridors
in L&D in this country that have
signs that say, "NO MALE STAFF
BEYOND THIS POINT". Guess there
are a great number of female charts that have "Bashful" penciled in the notes.

I hope you rip your urologist
a new one for being such a BIG
ONE!
- CHUCK McP

 
At Monday, May 12, 2008 10:37:00 PM, Anonymous Anonymous said...

I would have wrote a letter to the
state medical board. If anything it
gets their attention. Personally, I
think female nurses seek out these
jobs at urologists offices just to
see how many penis's they can see.

PT

 
At Tuesday, May 13, 2008 3:23:00 AM, Anonymous Anonymous said...

With the discussion of female assistants in offices whether it be urology or otherwise, a statement was made a short time back to the effect, "nurses are always hanging around..." Another comment just made was stating nurses take a urology office job to see penis'. I must say that it truly is the physician and his practice. It is he/she [the physician] that creates the office policy of when the assistant is in the room. The female assistant does not make the policy. The assistant doesn't say to the doctor, "Can I be in the room?" No, it is the doctor that sets the standard, sets the policy, asks for an assistant to be at his/her disposal, or asks for her to be present. The real complaint lies with the "BOSS" not the employee.

 
At Tuesday, May 13, 2008 9:36:00 AM, Anonymous Anonymous said...

Well said, while there are certain violations that nurses/tech's should be held accountable for, the Dr. does control the setting in Dr. Offices. I had a vasectomy and the Dr. did it by himself no one in the room but us. My friend had one, the Dr. had his nurse in there the whole time. That said, I have seen the other side in an imaging center where the female staff-nurse and receptionist-made a point of asking a female patient if she wanted to wait for a female tech right after a female tech had done a skrotal ultra sound on me...when it comes right down to it, we are still the boss...we can have complete control over our situation, now we may have to pay the price for that in terms of compromising our care, but ultimately in most routine cases, a large portion of the blame falls on us (males) for not making ourselves heard or being willing to assert our rights when they are not respected.
On an earlier post someone challenged the contention that Dr.'s don't think about modesty, the point was made that they do make efforts in certain area's ie waiting until a patient is out, female staff on mammograms, restricted access to OB'floors, etc. That was well stated, I think it is recognized by Dr.s and providers, it is (a) not a priority compared to the procedure and results so it gets completely discounted rather than prioritized and (b) it is much easier to ignore it than accomodate it so its sort of a don't ask don't tell (the patient) if it's a problem......JD

 
At Tuesday, May 13, 2008 12:21:00 PM, Anonymous Anonymous said...

Most doctors are in groups now and between the group of doctors and the office manager they make the rules. Nurses usually have the run of the office.
I have had a CYSTOPY in two different states in very large cities and both times I had the nurse (female) in the room from the begining of the procedure to the end. Not only did she see me with no pants or underpants she handled my penis, She cleaned the area and put some numbing gel in my penis. Then she left and came back before the doctor even came in the first time. She stayed for the entire procedure and then watched me urinate to wittness the flow. I know female patients think they have it so stuff being the patient.
Yes I have learned my lesson of the Double Standard, never again.

 
At Tuesday, May 13, 2008 1:14:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today 12:21 PM: Why did you accept the presence of the female nurse at the time of your second cystoscopy, if your experience with the first study was so uncomfortable for your modesty concerns?

I think that if anything which can be carried away as a conclusion of all these personal stories on this thread it is: unless the procedure is time critical and any delay will affect your chances of recovery, you should make your modesty issue known to the doctor and nursing staff and office staff and refuse the procedure if it can't be accommodated. You are the individual who is authorizing the procedure (it can't be done without your informed consent.) Part of the consent is to accept all those who intend to participate in the procedure. To come to this blog later and moan and groan may be therapeutic emotional ventilation but certainly does not prevent what has already happened to you. Hopefully, with your next cystoscopy, if you need one, you will have learned what to do! Best wishes. ..Maurice.

p.s.- Again, to all, please all Anonymous writers, please end your commens with a consistent pseudonym or initials.

 
At Tuesday, May 13, 2008 3:37:00 PM, Anonymous Anonymous said...

I can't say why this poster went
through two cystoscopies under
similar privacy violations but
I know that I went through three
such moments before I made a move
to take control of modesty issues.

After the first time, I was just
angry and dreading a second visit. After the second visit proved even more immodest, I went
online looking for help. That's how I found your blog, Dr. Bernstein... and Dr. Sherman's blog, and allnurse.com... and everything else that has turned me into an advocate for this cause.

I read 700 or more entries here and came away fortified that I could have things my way in most of these situations. I started to check on facility staffing, making gender requests, etc. Then when the first occasion arose where I had been patronizingly lied to, I unleashed HELL.

I'm sure it says more than "bashful patient" in my reports. I believe it now says: "Quick, look for a male
nurse, get drapes, close doors, no visitors, explain all
procedures and states of undress, smile at all times, and duck if you make a mistake."

I am no longer a quiet victim.
- WJB

 
At Tuesday, May 13, 2008 5:44:00 PM, Anonymous Anonymous said...

* I don't agree with the poster that office managers' and doctors' office female assistants make the rulles.
* It is the physicians' practice, license and reputation, therefore the physician sets the protocol [who is in the room] for patient exams and procedures.
* True patient modesty is not a priorty, OBVIOUSLY, it is easier to ignore and act as though patients don't care about it.
* It must not be an issue with most of the male population going into female staff dominated offices because it goes on everyday with thousands of male patients across the country. Most males don't care or it would not be the standard.
* A nurse on website stated that the "exception" is a male that prefers male staff to touch their genitals. She stated more male nurses have been rejected by men in the OR than female nurses rejected. She stated that most men prefer a female nurse. That evidently is how female healthcare workers feel; they think this is what men want.

 
At Tuesday, May 13, 2008 7:14:00 PM, Anonymous Anonymous said...

I don't agree with the poster that office managers' and doctors' office female assistants make the rulles.
* It is the physicians' practice, license and reputation, therefore the physician sets the protocol [who is in the room] for patient exams and procedures.
* True patient modesty is not a priorty, OBVIOUSLY, it is easier to ignore and act as though patients don't care about it.
* It must not be an issue with most of the male population going into female staff dominated offices because it goes on everyday with thousands of male patients across the country. Most males don't care or it would not be the standard.
* A nurse on website stated that the "exception" is a male that prefers male staff to touch their genitals. She stated more male nurses have been rejected by men in the OR than female nurses rejected. She stated that most men prefer a female nurse. That evidently is how female healthcare workers feel; they think this is what men want.
-----------------------------------

I DO NOT AGREE WITH YOU!!!!!!
Please as for this male patient do not tell my how I should feel having anyone touch my penis or see me undress or be present when I am discussing private issues with a doctor.
As for quoting "nursing" websites do us all a favor and not quote them because they can be as wrong as you. HOW DARE YOU!

A MALE PATIENT

 
At Tuesday, May 13, 2008 7:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Please, let's keep discussion here civil. And I would agree with A MALE PATIENT, if that was his intent, that writers to this thread should not make any generalizations based on a specific comment on another blog or even from this Bioethics Discussion Blog. Remember, to make generalizations one has to know the quality of the references and the magnitude of agreement. Anonymity with the absence of any documented facts regarding the source or the conditions cannot be the basis of generalizations. The discussion no longer becomes civil and educated discussion but undocumented harangue. Whatever the importance of the topic, this is not the way we should set our discussions here. ..Maurice.

 
At Wednesday, May 14, 2008 6:32:00 AM, Anonymous Anonymous said...

A MALE PATIENT:
You are sounding way too defensive and taking comments here the wrong way in my opinion. No one stated that you are wrong, don't have a right to be angry or feel "as you do." Others on this site feel the same way for the most part.

I read those comments you reacted to in a different way. Why is this going on in doctors' offices? Doctors' make their own decisions as to how to run their practice.

Men are not objecting, in mass, to having female assistants in offices and OR's where the majority if not all of the workers are female and participating in doing genital procedures. That is why this practice continues. The majority of men accept what they do. If every man that walked into a doctors office for a cystoscopy refused female staff in the room, how long do you think urologists would continue to hire only female staff for their offices?

Try doing your own research. Make some calls to urology offices, to OR desks, etc. and ask about female staff vs male staff for genital based procedures. You'll get a sense of "how many men" request same gender care and the tone and other comments will come directly from those that work in those fields.
Things should change, but only female staff will be eliminated by men refusing. From my viewpoint that is the only way it will change. It will effect the bottom line and then and only then will doctors' see the light, when it hits them in the wallet.

I am also an irrate male patient from past experience. I fully agree with you and others it is NOT right that men should have to endure this situation.

 
At Wednesday, May 14, 2008 9:36:00 AM, Blogger Maurice Bernstein, M.D. said...

I want to explain myself about generalizations with regard to views and concerns regarding patient modesty. Generalizations, for example proving that a number of patients have these views and concerns is really not necessary when talking about the doctor-patient relationship. Notice, I didn't write doctor-patientS relationship. It is a one on one relationship and as with the individual stories of illness each patient provides, each patient has their own individual views and concerns or lack of concerns about patient modesty. It shouldn't be necessary and it wouldn't be professional for a doctor to take a poll to determine how he or she should behave with any individual patient. It is through individual communication with each patient that the doctor understands the patient's symptoms, needs and desires and no generalizations of what others think or believe is necessary. This is what I teach my first year medical students when they are learning how to relate to patients.

Therefore, in the discussions here on this thread, comments should be restricted to the feelings and concerns of individual visitors and how best to achieve their own particular needs when they are under medical care. This doesn't mean, if widespread systemic changes in medical practice are desired, that groups of like-minded patients shouldn't come together in an activistic process to attempt to accomplish their goal. But, with regard to the individual patient communicating with the individual physician, the patient should deal with his or her own concerns and the physician should attend to those concerns of that patient. ..Maurice.

 
At Wednesday, May 14, 2008 10:24:00 AM, Anonymous Anonymous said...

I understand and agree with Dr. Bernstein in the one on one interaction. This is something we have to do to change our situation, however what options we have are going to be determined by getting enough men to express their concerns in large enough numbers to effect change in the options available. If there are no male assistants it isn't an option. That will not change over night. We can achieve two things by making our concerns known, 1st we will improve our experience, and two we will begin the process of making the issue a higher priorty much as women have done. The optimal would be a larger organization to attack it but that doesn't appear likely soon, it takes time if it happens. On the other hand if we as individuals encourage other males we know to stand up...the mathematics of progressive multiplication come into play. If I do it and say nothing I am one, if I tell 4 men and 2 do something it is three, and they could become 6 etc.

Several of the comments above are part of the problem we face. Just becasue men don't complain, doesn't mean they agree. Men are/have met with several reactions to requests...surprise indicating your not normal....or condemnation as being sexist. We have few options, we have been condictioned to accept it which has resulted in the lack of concern for our modesty being expanded. A person who thinks they have no options or control appears to accept or agree with situations they may actually really struggle with. I did until this and other sites opened my eyes that I do have options and I do have some control over the situation. I apolgize, but a gentleman that used to post here that I don't recall his name, presented the exact opposite to the opinion that men prefer female providers when exposure is required. While his data was limited, it was at least imperical in approach and not the observation or opinion of a single provider who had a vested interest in the issue........sorry about the length, but one thought I had and I am going to toss out here and on JS MD's site. There is a lot of concern and risk on a webb site of stating problems with specific facilities or providers. However, if someone with a lot high technical ability than me would do a link or site where patients could list by state facility or providers that had indeed accomodated or made a special effort to respect modesty, perhaps it would provide a guide or resource to patients, give some examples of what the poster did to achieve this if anything, and provide someone trying to work with a provider and example of providers who are doing something which would raise the bar for competitive reasons....not the same liablity of saying this person did this wrong and making accusations against some one.......thoughts...JD

 
At Wednesday, May 14, 2008 10:59:00 AM, Anonymous Anonymous said...

I agree with your statements, Dr. Berstein, about one on one, patient/phsysician interaction, but the point being is that if a urologist had 6 cysto's scheduled in one day and 4 cancelled or refused to have a female assistant in the room while the man was exposed, HOW fast do you think that would change.

That was my point. MONEY talks in every profession. Medicine is no different.

 
At Wednesday, May 14, 2008 1:39:00 PM, Anonymous Anonymous said...

Yes, there is the financial reality and
the lopsided staffing situation.

A third of men don't care.
A third of men are homophobic
and want females.
A third of men want same gender.

The doctor needs females for his
own protection when working with
females and women tend to want
same gender. Add the fact that
we have a 92/8% imbalance in
female to male staffing and you've
got one big problem for modest
men.

I believe the ultimate goal has to be
fairness. If medicine can't
accomodate men and women's modesty
request equally, then no one
should be allowed to make any requests.
Now, I understand with
the staff imbalance the way it is
this would still leave modest men
the losers by a great percentage
but this could be balanced and a
great point made if the 8% male
staff total was asigned to OB/GYN
and L&D. Then, at least, females
would begin to get a taste of what
one third of the male population
feels. Let's see if they like
that brand of fair, as indeed it
would be.

That's the bottomline issue of
this great debate.
- CHUCK McP

 

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