Bioethics Discussion Blog: Patient Modesty: Volume 4

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Thursday, June 26, 2008

Patient Modesty: Volume 4


WE ARE CONTINUING THE DISCUSSIONS OF PATIENT MODESTY HERE FROM VOLUME 3. PLEASE DO NOT ATTEMPT TO POST FURTHER ON VOLUME 3. ..Maurice.

Graphic: Courtesy of Wikipedia modified by me.

101 Comments:

At Thursday, June 26, 2008 10:12:00 PM, Anonymous Anonymous said...

MER is absolutely correct. As
I've been posting here for over a year, nothing is going to change until the issue of a double-standard in modesty considerations for males ends up in court as a
class action test of DISCRIMINATION Law-- unequal treatment by gender. We have had BFOQ provisions in law which manditate that health insitutions use them to protect the patient modesty(read privacy) of ALL patients, regardless of gender.

The right to privacy and modesty were linked in BFOQ legislation to include what would be viewed as intimate pelvic care.

Everything that is currently status quo is outside the law and it will change if it is challenged because it can not be upheld within the existing law.
Female nurses, male doctors, HMOs
all have a vested interest in
maintain high levels of female
staff. They will stonewall to
their advantage at every turn
until a judge rules in class-action that males must be treated equally with females or BFOQ be
removed from law. If that were to happen, then all female patient modesty requests would also be
ignored and male staff could rushed into OB/GYN and L&D, etc. What's good for the goose is
good for the gander.

I'm not a lawyer but I know you
can not discriminate against
either sex in a straight forward
manner. To respond "you are
not a woman" is all an American
Civil Liberties attorney would need to make something out of this. Have any of those posting here, who are being denied equal rights to medical privacy/modesty, attempted to do this? MER, have you sent highlights of your extensive and well organized research to any legal body for an evaluation?

Final note: Dr. Bernstein, as we start Patient Modesty, Volume 4, is there anyway you can get back
the hundreds of missing comments
lost when Volume 1 went under?
It would be great if these might
be set up as Volume 1B, 1C, 1D, etc. and fitted in between Volume 1 and 2,3,4. It would be wonderful to google the words, "Patient Modesty", and see a long list of volumes. As this issue reaches
out, the ability to look like more than a fringe movement would be very beneficial.
(avram)

 
At Thursday, June 26, 2008 10:53:00 PM, Blogger Maurice Bernstein, M.D. said...

Avram, I do have the missing postings from the "Patient Modesty: A More Significant Issue?"
and I'll try to put them up in two or three pages in sequence.

By the way, here is a posting I received from cm which was attempted to be posted on Volume 3 after I already closed it. ..Maurice.


You are talking to the wrong people. You need to speak directly to the doctor who is performing the procedure. The doctor not the nurse sets the standard as to who is in the room. Perhaps your doctor would be willing to do the procedure alone. If it something he can do solo I bet he would accomodate you. If he needs an assistant and no male is available in the office ask if another male doctor can assist instead. If it's being done in a hospital they might be able to pull a male nurse or tech from another area to assist the doctor.


-cm

 
At Friday, June 27, 2008 12:58:00 PM, Anonymous Anonymous said...

I agree with you that a wholesale change may need a court challenge, but I believe the BFOQ applies to discrimination in hiring and allows a employer to discriminate in hiring if it can demonstrate a Bonafide Occupational Qualificaion need, it does not require them to provide equality in their offering. I am sure there may be some cases that could present support for that position relating to the civil rights movements of the 1960's with the seperate but equal positions etc....but I think patient rights and employment rights are two seperate issues in the eyes of the court. None the less, if we as patients do end up filing court cases it can drive change even if they do not succeed. The same thing can be said of challenging the status quo, as the numbers increase so will the attention it gets, after its all said and done, medicine is still a business. As a result of this sie and some of the posts on all nurse I sent a letter to a hospital I had issues with,(contacted them before) this time I sent it from the point of view of you have two female and two male imaging tech's, you have an untapped advantage over you compeitors who can not offer or advertise the accomodation for both genders and I was wondering why you don't advertise it and use it to your advantage....while before I got form type responses, I actually became involved in an online exchange with the admin. asking some questions and her final was basically they had never really thought of it as a competitive advantage and were investigating some possiblities.....doesn't mean it will happen, but if I would take the time to get some other people to join in.....might get something done, not for the reason we would prefer, but the end result could be the same...

Just a side note, did anyone catch the series premier of "Hopkins" a documentary type show on John Hopkins Hospital, the followed 3 doctors...and here is a surprise, one was a female Urologist (the 1st or only female urology surgeon at Hopkins). They showed a male getting a prostrate exam from her, a vas reversal, etc. There were comments from her about having to act like it was no big deal she did it all the time to hide her nervousness etc. Kind of interesting, no doubt it was a focus as a rating getter, and more acceptale than a male gyn esp. to females, but I wonder what the thought of viewers was, providers vs the general public, female vs male...its on abc ...JD

 
At Friday, June 27, 2008 3:25:00 PM, Anonymous Anonymous said...

JD, you're wrong and the position you take is a popular misconception of BFOQ law.

BFOQ originated in the anti-discrimination acts of the 1960s. In fact, it was absolutely necessary in order to have the bills pass Congress.

BFOQ has to do with the right to
hire with gender as a primary requirement. BUT WHERE DOES GENDER AS A REQUIREMENT COME
FROM!!!??? IT COMES FROM THE
REQUEST OF THE PATIENT. IT CAN'T
BE INITIATED WITHOUT A PATIENT
REQUEST.

This was what was being debated when BFOQ was attached to anti-discrimination. It allowed medical facilities, hospitals, nursing homes, schools, etc.
to DISCRIMINATE in employment so as not to violate the privacy/modesty(both were linked as intimate pelvic care)of patients who REQUESTED same gender assistance. Since then, the law has simply been ignored as it regards hiring male personel to cover male requests. We know it is terribly
difficult to give men an option
even though that option is already
covered for in existing law...
AND WE NO LONGER CARE ABOUT THIS
SO CALLED REALITY

The bottomline is a need for a court challenge at the level of class-action which demands affirmative action be taken, immediately, to recruit more males into the required medical professions and create employment-pools of circulating male staff to offer men some options if they can schedule for them. This is
far less than all women are offered, today. But it is a first step and it puts the issue on radar.

PLEASE, LETS GET THE EXISTING LAW
STRAIGHT ON THIS. IT IS THE MOST IMPORTANT OF FACTS IN THE DOUBLE STANDARD DEBATE REGARDING MALE PATIENT MODESTY/PRIVACY REQUESTS.
- avram

 
At Friday, June 27, 2008 4:15:00 PM, Blogger Maurice Bernstein, M.D. said...

For those still interested in reviewing the missing comments from the thread titled "Patient Modesty: A More Significant Issue?", I divided the numerous comments into two parts A and B and published them here yesterday.

 
At Friday, June 27, 2008 4:53:00 PM, Anonymous Anonymous said...

Dr. Bernstein, happy to see the missing
comments are back. However, can you PLEASE rename the A and B comments under the original name
of -- Patient Modesty: A More Significant Issue - Additional Comments "A" (and) "B".
This allows the grouping to appear as a block on a google search.

Actually, if the following
"Volumes" were also labeled the
same way -- Patient Modesty: A
More Significant Issue - Volume 2,
etc. (then) all your Patient Modesty blog chapters would appear as several continuous pages
when googled. I think this is important as I see more and more people referring to your
modesty blogs on other health and
medical sites. I'd like to see
that a phalanx of information hits anyone who comes looking for facts on this issue.

So how about it? Thanks.
- avram

 
At Friday, June 27, 2008 7:26:00 PM, Blogger Maurice Bernstein, M.D. said...

avram, let's go to the feedback thread to discuss your worthy suggestions. ..Maurice.

 
At Friday, June 27, 2008 9:51:00 PM, Blogger MER said...

I finally figured something out. I refer you all to an article in the School of Law Faculty Publications for Pace University (2004) written by Emily Gold Waldman. It’s title is The Case of the Male OB-GYNI: A Proposal for Expansion of the Privacy BFOQ in the Healthcare Context.” I think you can access it on line by typing in the title and author.

It’s a great overview of the whole BFOQ law, but here’s a very interesting case I discovered in this brief. It’s the case called Fesel v. Masonic Home of Delaware, Inc. I won’t go into detail, but this small nursing home had 8 women and 22 men. The female patients objected to having men do personal care, so the court ruled that being female was a BFOQ for the position – meaning the home could discriminate and hire just female nurses. The courts usually look at two issues in these cases. The first is called “the essence of business,” that meaning that having male nurses would undermine the “essence of business” for the home – meaning their clients would use them unless they had female nurses. Meaning they'd go out of business. Follow the money. The second test for the courts – the business must demonstrate that “due to the nature of the operation of the business, it would not be feasible to assign job responsibilities in a selective manner so as to avoid collision with the privacy rights of customers.”

Basically the court is saying that the business has an obligation to try to schedule things so that both men and women can have same gender intimate care. I’m not sure how this home demonstrated why they couldn’t do that. I would think a business would have a difficult time with this, especially large hospitals and clinics.

In it’s ruling, the court wrote:

“The Home has the responsibility of providing twenty-four hour supervision and care of its elderly guests. Fulfillment of that responsibility necessitates intimate personal care including dressing, bathing, toilet assistance, geriatric pad changes and catheter care. Each of these functions involves a personal touching as to which each guest is privileged by law to discriminate on any basis. Because our tort and criminal laws recognize these personal privacy interests, the Home cannot legally force its female guests to accept personal care from males. Since it is clear that a substantial portion of the female guests will not consent to such care, it follows that the sex of the nurse’s aides at the Home is crucial to successful job performance.”

Now, read that again, closely. The basic idea of privacy applies to both males and females – but the KEY here is that the females “will not consent to such care” and that under our law “cannot be legally” forced to. That’s the KEY.

As I said before, until more males complain and actually refuse treatment and make that part of the record, there will be no data or evidence for the courts to use to say that a substantial portion of men feel this way.

And here’s another insight I gained from reading this article. Hospital managers and administrators know the basics of this law. They probably have many workshops and classes. This, I believe, is one possible reason why hospitals (even clinics) seem to have a policy of not asking men their preference. If they ask, and the men prefer male nurses, they’ve actually started to collect data and evidence that can be used in courts to enforce the BFOQ laws. Now, I’m not saying every nurse knows this. But you can be sure their managers and supervisors do. And I wouldn’t be surprised if there were unwritten policies that said nurses were not supposed to ask men their preference. Why make a case against yourself? I’m not claiming there’s a big conspiracy, but I do think this is a factor in why men are not offered choices and women are.

I used to think that the law wasn’t the way to go with this. But the more I research this, the more I believe it’s the only way to go. We should still try to communicate with our doctors and nurses, but we need to realize that there are bigger issues that the managers and administrators are controlling. Follow the money. There are too many vested interests in keeping the status quo. We need to go to the courts.

 
At Saturday, June 28, 2008 6:25:00 AM, Anonymous Anonymous said...

I stand corrected. I would be interested in hear the response of an administrator if approached with this information. JD

 
At Sunday, June 29, 2008 5:36:00 AM, Anonymous Anonymous said...

"cm" comment from 6-26-08 was to ask the doctor not nursing staff about same gender care. I did that of a male surgeon who uses only females to assist him for male herina surgery. His reply was that he did not have the time to train anyone else and he was uncooperative to make any changes whereas the hospital he uses for his procedures do have males in the OR and thus it was the doctor not nursing who was unwilling to accommodate the patient. This seems odd and a real affront to patient satisfaction. It must be that not enough men make this request or this surgeon would change his attitude.

 
At Sunday, June 29, 2008 3:02:00 PM, Blogger MER said...

The last comment is exactly what I'm talking about. There's no reason for these doctors to change the status quo if enough men aren't making their preferences known loudly and strongly. In a way, you can't blame the doctors. Why change if they don't need to? Why spend the time training males if they have enough females?

They won't change until it affects the bottom line -- the concept of "essence of business" that the courts use is important.

What usually starts the legal process going is the fact that a nursing home or clinic or hospital decides it will lose money or go out of business because patients won't put up with opposite gender intimate care. They'll find other places to go.

Most of the cases I've found involve women complaining, but there are some cases involving men.

So...they lay off one gender and hire the other gender. They claim that this discrimination is okay under the BFOQ exception. The gender being discriminated against files a lawsuit. The court considers BFOP exceptions and looks at the "essence" of business and the "scheduling" criteria and makes a decision. But the courts need quantitive evidence, written complaints, testimony, affadivits to back up the fact that a specific gender won't use the business if forced to undergo opposite gender intimate care.

Men can't complain about this situation on the one hand and not stand up for themselves on the other hand by complaining in writing, officially, and publically. At first there may be some ridicule, intimidation and resistance. But eventually, if enough men complain, spread the word among other men, make the issue public, and refuse to go to these "businesses," -this "essence of business" idea will kick into play and the ball will start rolling.

Once it gets to court, I can't see how men can lose, assuming they have enough evidence that a significant number of men refuse to accept this treatment. The legal principles seem to back up each gender equally.

 
At Sunday, June 29, 2008 5:09:00 PM, Anonymous Anonymous said...

Upon contacting the HR person at a major hospital close to me the comment was " We will do our best to accomodate you...but if you want a male all of the time you need to find them for the hospital..they would love to hire them"
leemacaz

 
At Sunday, June 29, 2008 8:08:00 PM, Blogger MER said...

It's possible some HR people actually believe that men are not interested in nursing. Because they're not walking in off the street, they assume men don't want those kinds of jobs. Don't you recall hearing the following comments many years ago:

"We can't get women to fly jets. They don't want to, anyway. And even if they did, they're just not up to it."

"Women don't want to run heavy equipment. Plus, they just don't have the skills."

"We'll never find enough women to fill construction jobs. They don't like that kind of work."

It's amazing what happened once affirmative action and quotas kicked in -- when recruitment started and incentives appeared.

 
At Sunday, June 29, 2008 9:50:00 PM, Anonymous Anonymous said...

Anonymous 6/29-If you know for a fact this OR has male nurses I would call the hospital directly to see if they can accomodate you. It might not be a guarantee but it will get your request heard and on record at the hospital. They make the actual schedule. I would then follow up in writing to your doctor and the hospital that you would like to see male nurses trained in this area. It couldn't hurt any.

-cm

 
At Wednesday, July 02, 2008 7:47:00 AM, Anonymous Anonymous said...

MER-
I could not agree with you more.

Lee- as for calling a hospital HR person they are only going to tell you they are trying. Calling a HR manager is not going to change the situation, if you really want change get you pen or keyboard ready and write to every person you can think of from congress to the local news to your personal primary doctor. Then when you get a letter back from them saying "they are trying" write them another letter. I see alot of people really saying they are so fed up but I get the feeling that some people in these rooms just think the problem is going to fix itself and as history tells us that does not work. TAKE A TRUE STAND ON THIS ISSUE IF IT BOTHERS YOU THE WAY YOU SAY!
Tommy

 
At Saturday, July 05, 2008 7:46:00 PM, Anonymous Anonymous said...

Not sure where this discussion fits but recently I refused a procedure that I felt wasn’t going to be any benefit to me. I did explain to the scheduling nurse that if no problem is found with the three other alternative tests, I’d revisit my decision. When she first called me and wanted to schedule the procedures, she was very polite and accommodating; after I refused she became quite rude and just didn’t want to talk to me any further. That happened in March and it took until this week to get that first alternate test scheduled. They never returned any of my calls and the few times that I tried to schedule a test, they took my information and just never followed through. They even sent me a letter that said that they had been trying to reach me to schedule some test and that I haven’t responded even though they never left a voice message on my home or cell phones? I called them last week and threatened to not only change doctors, but turn their office in to our nurses here at work and give them bad feedback on our consumerism tool. Our IS department built this database to rate all the facilities on our plan, we also compare prices for procedures at different locations so we can help our company save money (to bad all employers don’t have this tool). There is also a feedback section for doctors on our plan as well. I then spoke to a different scheduling nurse and she got the test scheduled. She also asked why I refused this test and didn’t like the response I gave her. I guess my question here is ‘do these professionals have a good understanding of our patient bill of rights?’ This is what is stated:

A patient has the right to refuse any drugs, treatment or procedure offered by the facility, to the extent permitted by law, and
a physician shall inform the patient of his right to refuse any drugs, treatment or procedures and of the medical consequences
of the patient's refusal of any drugs, treatment or procedure.


I think more time needs to be spent on this subject with all healthcare workers because I don’t believe any of them know or care about our rights. The physician also never followed up with me, I had a five minute consultation that involved just history taking and giving me some samples (no physical or anything) and the next thing I know they want to put me under and do at least one useless test without going with the less invasive tests first? Very frustrating to get that attitude when it’s your body and your right to refuse.

Jimmy

 
At Saturday, July 05, 2008 9:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Jimmy, what appears to have been missing was informed consent with the information being provided by the physician. Significant tests, particularly invasive ones, are explained by the physician to the patient and not a scheduling nurse. Once the patient understands the basis for the examination, the benefits, the risks and alternative approaches all provided by the physician and then agrees, it is then the scheduling nurse may appear and schedule the test. ..Maurice.

 
At Monday, July 07, 2008 4:58:00 AM, Anonymous Anonymous said...

Yes, Jimmy, what Dr. Berstein states was exactly what was deficient. Your physician should have done his/her job by spending appropriate time with you as a patient and fully explained what they were proposing as a diagnostic procedure. Time enough for you to ask questions and get the full picture. Ancilliary personnel are minimially trained (if at all) and act many times arrogant toward a patient. Personally, I feel that any time a patient asks questions, doubts, hesitates with a decision, researches options, seeks alternatives, etc. the entire system is defensive. The employees and many times physicians seem to like the dutiful, non-questioning patient that just goes along. The typical parent/child type relationship. Plus, many of the tests and procedures suggested are income producing for the physician. And one can only wonder how much does that play into the equation. The bottom line is always in the mix.

 
At Monday, July 07, 2008 10:23:00 AM, Anonymous Anonymous said...

In order to do as you suggest, Tommy, I need to also include valid examples of why legislative and or court action is teh only remedy available to me and all other males who wish to have greater protection of our modesty and aknowledgement of our rights.
My calls are only to be able to provide a basis for my request for intervention by authority as I can't get anything but a smart alec answer from providers...(who is going to be able to get an complete entourage of medical staff to accompany them to a hospital or doctor? Who could afford this if they could find willing medical personnelSo far I have recieved NO responses to any letter to congressmen or anyone else....It would be nice to get one..even a refusal....But either no one wants to recognise a real problem and injustice..or they just do not want to deal with it.
I agree that a stand must be taken..but ya gotta show 1) there is a problem...2) that there is no other remedy to the problem..that the ones who could make change voluntarily are not going to do so. I think most if not all writers to this blog have a demonstrable reason that status quo is unjust and want a change.
leemacaz

 
At Tuesday, July 08, 2008 8:44:00 AM, Blogger Maurice Bernstein, M.D. said...

I just wanted all the visitors to this thread to be aware that I am in the process of contributing my experience with the threads on patient modesty and professional gender selection in the form of a 700 word column to a newspaper which has distribution to a couple hundred thousand physicians. It will be published in a couple of months. I have already submitted a draft of the article. I have taken an impartial view in my presentation but since most of my experience with these threads are based on comments by those who find problems in terms of patient modesty with the medical system, that is obviously what I wrote about and expressed those views. A non-impartial point I did take was to urge the physicians to recognize, if they were unaware, that such concerns may be in part of their patient population and physicians should take time to listen to their patients and seriously consider their concerns.

Since, I still have about a month to edit what was written I look forward toward any further input my visitors can provide. I really can't disclose anything further about the article but obviously I will write about it here once it is published. ..Maurice.

 
At Tuesday, July 08, 2008 9:31:00 AM, Anonymous Anonymous said...

I thankyou, Dr Bernstein, for taking an action that will at least alert physicians who probably have no clue as to the concerns expressed here. It has probably not even crossed many of their minds...And as doctors set procedure in their offices and clinics and often have influence with other medical institutions their awareness and understanding will make a great difference in how males are viewed as patients..and how they are treated.
I hope you get a lot of positive feedback from them.
lemacaz

 
At Wednesday, July 09, 2008 5:06:00 AM, Anonymous Anonymous said...

I applaud you doctor for making an attempt in bringing this area to the attention of physicians. When we made a formal complaint to the corporate center of a surgical center we received an appology but the caveat is that it was followed with the cliche of "the female nurses are trained to do this." That is an ignorant response in our opinion. Male nurses are "trained" to do the same. This is a cop out excuse and response. I suppose it is the only response they can come up with after they have given no thought to the fact that "some" people are not pleased with this opposite gender care.

 
At Wednesday, July 09, 2008 10:00:00 AM, Anonymous James, UK said...

Dr, M.
I recently had an exam (I live in the UK) and was a little taken aback by the thoroughness.

We'd just moved house and I thought I strained something lifting in my groin, so I arranged an appointment with my GP.

I've seen her for a few years so I am usually ok with her. Anyway, she asked me to lower my trousers and underwear and she proceded to check around my groin area. She checked my testicles and even held my penis in different positions while checking for pain and swelling. She even checked along my penis shaft with her thumbs and forefingers underneath (cue rather embarrassing involuntary erection).

I wondered if this degree of thoroughness was normal in an early 40's male. The good thing was I was only diagnosed with a minor strain, but it did seem a rather personal exam to give that diagnosis. Maybe I am just thinking that because my Doctor is female, I don't know.

 
At Wednesday, July 09, 2008 10:18:00 AM, Blogger Maurice Bernstein, M.D. said...

James UK, from your description it sounds like your doctor gave you the proper and thorough genital exam for a symptom of "groin pain". I presume she also pushed her little finger up into the scrotum to the external inguinal canal and had you cough to discover whether your pain was due to an inguinal hernia.

What I think is missing from your description is her running commentary describing why (for what clinical reason) she was doing what she was doing. In other words, telling you what she was looking for. It is important that patients hear this as the exam proceeds and particularly so in genitalia exams. In fact, this important communication during the exams is one of the main teaching points for medical students as told to them by their subject-teachers as they are learning how to perform the exams.

James, if that communication was missing, that is the only fault I can find with your description of the examination. ..Maurice.

 
At Thursday, July 10, 2008 10:54:00 PM, Anonymous Anonymous said...

I am not sure if this is the right blog page for this...
I saw on one of the entries in this series on this subject..the advice to look on student doctor . net.
If I had any doubt that anything short of court decisions...and expansion of laws was needed to get
males any real consideration about their modesty issues...those doctors on that site dispelled it completely....
I found the arrogance and disrespect those docs displayed for their patients to be more damning than anything any contributor to this blog has said.
Their discussions can't be called someone faking an injustice or maltreatment...They flatly think they are entitled..their mockery of patients rights astounded me...They want respect...yet in their own words ..they show they are not to be trusted...
Dr Bernstein..have you ever surfed that site?
leemacaz

 
At Friday, July 11, 2008 1:47:00 PM, Anonymous Anonymous said...

Don't post a comment like this and then leave out the address for the site. What is it, please?
Do you have to be a doctor to post on it?

CHUCK McP

 
At Friday, July 11, 2008 2:49:00 PM, Blogger Maurice Bernstein, M.D. said...

Chuck, leemacaz actually did present the URL of the site: studentdoctor.net
I went there but I didn't know where to look on the site for the remarks that leemacaz noted. I don't know how many comments that I did read are actually from medical students, doctors or others. Everyone please remember that views of many different aspects of patients and medical care may be quite different between a medical students views and that of a physician in practice. In fact, the views are different between first and second year students as compared with a graduating fourth year student. . ..Maurice.

 
At Friday, July 11, 2008 3:08:00 PM, Anonymous Anonymous said...

If you will use the search on studentdoctor.net and search for catheterisation or tatoos you will find the posts I found the most offensive. (I do not have any tatoos) I have no idea just how far along the posters were, but some seemed to be residents at least... The statements were something I might expect from early teenagers. I don't think the patient in question had his modesty violated nearly as much as his privacy and the "what is known to a doctor is not to be spread around" so much for confidentiality. Especially as I know that yu have to sign a release to give one the right to tell another about you..even when they have refered you to him/her.
The hospital fired the doctor..the responses are what really jared me.
I can only say that any release I might sign for surgery would have a whole list of items restricting what goes on..including NO cell phones or other cameras in the
operating room
leemacaz

 
At Friday, July 11, 2008 3:56:00 PM, Anonymous Anonymous said...

I could not find any particular blogs as referenced by "leemacaz". I did read through one blog that was quite interesting. Students were discussing physical exams. Again, different year med students were responding. Of interesting note was that there was a wide variance of thoughts, feelings, attitudes and opinions from the medical students on how they "personally" felt disrobing (not even completely as a patient must do) and being touched by fellow students and the issue of doing exams on same gender/opposite gender peer students. Some responses were "cold" and stated, "get over it!!" Studendid have issues with modesty and not being comfortable with it. Plus, it sounded like from school to school routine varied as to what was done.

 
At Friday, July 11, 2008 10:52:00 PM, Anonymous Anonymous said...

Dr.Bernstein

Thank you for the time that you’ve spent not just on the article that your working on, but the time you’ve spent responding and listening to everyone here. That is what I feel is the main problem, just LISTENING. Many doctors/offices follow their own rules without regard to the patients concerns or feelings? Be honest and most importantly give the patient all the information. Through all of the procedures that I’ve had, no one has ever gone in detail about the prep or states of undress? I don’t get, I’d hate to wake up to find out that another women (other than my wife of course) handled or touched my genitals. It has nothing to do with the system or the doctor involved, it’s about me having that choice like I do in any other thing in my life. At the end of the day it’s still a service we have to pay for, and we should get the service that we want since it’s our body and money. When this service is free, then there can be an argument…

On a side note: Do you plan on posting the article once it’s published?

Jimmy

 
At Friday, July 11, 2008 11:34:00 PM, Blogger Maurice Bernstein, M.D. said...

Jimmy, to answer your question: "Do you plan on posting the article once it’s published?" Yes, if I have permission by the newspaper or at least a URL link.

I should make some comment on the significance of the word "service" in medical practice. Service is something which although the patient (and/or the insurance company) pays for it, "service" is not the same in medicine as in other services that are available to purchase. That is, patients cannot request a service and expect that the physician will agree to perform the service. An common example would be if a patient requests a CAT scan which is not clinically indicated but is desired by the patient for the patients own concerns. Another would be that the patient requests an abortion but that service is against the morals of a particular physician and the physician refuses. In addition, some services are just logistically impossible to provide. So even though the patient is willing to pay for a service, that service may not be available. The important takeaway message from this is that all patients who desire a service should feel free to speak to their doctor and ask for it. The doctor should then explain to the patient the reason the service cannot be provided and if a doctor-patient relationship has already been formally developed and the patient is not satisfied with the explanation, the physician,in order not to ethically or legally abandon the patient, may have to make a reasonable effort to assist the patient finding another physician who will provide the service. Again, to emphasize, the fact that money is to be paid for a service does not guarantee that the service will be available. ..Maurice.

 
At Saturday, July 12, 2008 5:21:00 AM, Anonymous Anonymous said...

I think what Jimmy was trying to say is that patients see a professional and for their service there is an exchange of money just like other services so therefore a patient should have some say-so.

I have heard many times in todays' world of medicine that physicians will no say "no" and will grant a test if a patient "asks" for it because of the current litigious nature of our medical system. Physicians are bending over backwards to protect themselves.

Most times situations are voluntary and patients have every right to expectations under non-emergency situations where there is plenty of time to properly inform a patient.

 
At Saturday, July 12, 2008 6:55:00 AM, Blogger Maurice Bernstein, M.D. said...

The doctor saying "No" determined by evidence based standards of practice and yet finally ordering the test motivated by legal worries or in the case of end-of-life care procedures or other aggressive treatments, the inability to accept that the patient is dying on his or her watch is much of what is raising medical care costs.. but that is a different topic for a different thread. ..Maurice.

 
At Saturday, July 12, 2008 9:11:00 AM, Anonymous James, UK said...

Dr M,
Thanks for your prompt response. I just wanted to add that my Dr did give a commentary of sorts all through the exam when she was examining me.

The only bit she didn't really talk through was when she said she needed to check along the shaft of my penis. I didn't really know if this was related to the groin pain or just standard procedure in a male of my age (early 40s)?

 
At Saturday, July 12, 2008 12:30:00 PM, Anonymous Anonymous said...

In June, Dan Walter posted a discussion blog on www.nursing.advanceweb.com detailing his wife's medical experience. He asked for comments from professionals in the field of medicine. Not one comment has been posted. Very interesting!

 
At Saturday, July 12, 2008 4:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Palpating the shaft of the penis is standard procedure for every male genital exam. It is to detect early benign fibrous plaque of the shaft of the penis (Peyronie's Disease),penile cancer lesion, inflammatory condition as with infection which can cause pain referred to the groin amongst other conditions. Inflammation or cancer could cause painful and tender inguinal lymph nodes secondarily.
Penile shaft exam is a "must do" portion of the genital exam and the doctor should nevertheless explain why the shaft is being examined when the patient attributes no symptoms to it.

As I have noted elsewhere on this blog, the patient developing an erection while the penis is being palpated should be no big deal if the physician explains why this is happening, that it is normal and indeed shows the doctor and the patient that the nerve and blood vessel supply to the penis is normal and thus intact. This is a valuable observation when examining a patient with diabetes, cirrhosis or various neurologic or vascular disorders.

James UK, I hope this answers your questions. ..Maurice.

 
At Sunday, July 13, 2008 10:33:00 AM, Anonymous gve said...

James UK epitomises the difference between the feelings of patients.

He chose to see a female practitioner for a very personal examination. Most men would not.

Unfortunately once we become hospitalised or require hospital based tests in the UK, choice disappears.

I have conducted a little research of my own as I am likely to undergo Urodynamic tests in order to try and establish the root cause of prostate problems.

My findings are simple; if you are female, no problems, most hospitals even advertise the fact that the tests will be done by a female nurse.

If you are male, forget it, the nurses who routinely do the tests take great offence to any requests for an all male team, suddenly it becomes essential to have at least 2 nurses in the room (probably 3 or 4 when the decide to impose students on you). The nurses concerned demonstrated absolutely no empathy or compassion, being clearly more concerned with not setting a precedent of allowing a man any dignity, perish the thought, others might follow suit.

I was told;
"don't be so silly", "that is not possible, take it or leave it", "nurses do Urodynamics here, what is the problem".

The main defence mechanism against providing me with the test in a way i would find more comfortable, were attempts to ridicule me.

The face of todays modern nursing.

 
At Monday, July 14, 2008 12:14:00 AM, Blogger MER said...

To gve:

Hospitals sometimes need to be reminded of their mission statements and/or their core values. As an example, here are two of the core values for the Providence Hospital systems:

"Respect
All people have been created in the image of God
Genesis 1:27

We welcome the uniqueness and honor the dignity of every person
We communicate openly and we act with integrity
We develop the talents and abilities of one another

Compassion
Jesus taught and healed with compassion for all
Matthew 4:24

We reach out to people in need and give comfort as Jesus did
We nurture the spiritual, physical and emotional well-being of one another and those we serve
We embrace those who are suffering"

I'm just using Providence as an example. I'm not suggesting they don't follow these. But go to the websites of the hospitals you're looking into and find their core values. If you then run into problems like the one you describe above, ask them:
1. What does it mean to "honor the dignity of every peson." How do you impliment that on a daily basis, especially when it comes to same or opposite gender intimate care?
Now they may answer that they do respect the dignity of each person. Then, you need to ask them that whose definition of dignity are they using, theirs or the patients. Remind them, they don't get to define the patient's dignity. The patient gets to define his or her own dignity.

2. What does it mean to "nurture the spiritual, physical and emotional well-being of one another and those we serve?" Does the patient's concern with modesty affect his or her physical, spiritual and emotional well-being?

Now, my experience (and it's not extensive, but I've had some) is that in most cases the hospitals won't engage in discussion with you in any depth about this. It's easy to gather a committee of ethics experts and philosophers and come up with core values. It's more difficult and a real challenge to determine how to turn those core values into policies that affect every day behavior toward patients. From my experience, most hospitals haven't done that with the issues we're discussing on this blog. Especially with men. There's a tremendous disconnect between their core values and how they impliment them on these issues.

 
At Monday, July 14, 2008 8:34:00 PM, Anonymous Anonymous said...

re: not enough male nurses

I find it harder to to believe these days that males would not want to go into the nursing field given how many industries have collapsed or had hard times in recent decades. Nursing pays well and is not as prone to outsourcing.

I'm sure it varies by jurisdiction but somehow I doubt many medical institutions and governments aggressively tried to get males to enter the nursing field as they did females in the fields of Engineering, Sciences and Medicine. I have to wonder if the people at places like allnurses aren't as receptive to male modesty as it could directly lead to more males entering their field.

re: Maurice's paper in process of being written.

Please mention a common pet peeve of mine for this issue about the fact that female practitioners themselves would be irate if male practitioners examined them intimately.
Oh the hypocrisy!



TS

 
At Monday, July 14, 2008 9:30:00 PM, Blogger Maurice Bernstein, M.D. said...

TS, what I have written is a summary of the personal views by visitors to these modesty threads that I have read. What I can't write about is the "fact that female practitioners themselves would be irate if male practitioners examined them intimately." How do I know that this is a fact (not an assumption) and that it is a common enough reaction to use this as a support for the gender selection views of my visitors? I don't. ..Maurice.

 
At Tuesday, July 15, 2008 9:08:00 AM, Anonymous js md said...

Dr B, I don't know how common any of the opinions are on here (or on my blog), but I have seen at least one other post (apart from Dr 'Keagirl') by a women physician who needed a vaginal ultrasound and who was afraid a male gynecologist was going to do it. This was posted without apology as if it was the most natural reaction in the world so I think TS's comment has some validity, at least it is a fair question. I will try to locate the link to this post.

 
At Tuesday, July 15, 2008 10:01:00 AM, Blogger MER said...

I'm tossing this out as a hypothesis, some theory based upon what I've been reading. As we've discussed on this blog, so little research is available in this area. Perhaps someone could actually do some interviews and observations.

As most of you know, there has been and still is an issue regarding male nurses working in OB-GYN. I think it's more accepted now, but it varies. Regardless, when a male nurse does work OB-GYN, it is, if not written, certainly unwritten policy that the male nurse ask permission of the woman before doing any intimate exam or procedure. If the woman refuses, it's not a problem. The male nurse just gets a female nurse.

Because of experiences like this, I believe it's much more common for male nurses to ask permission of women in other situatins. And, it seems to be accepted that male nurses, in most cases, will not do intimate procedures on young females. Certainly not without a female chaperone, but even with one it doesn't seem to be regular practice. I read many male nurses say they just don't do such procedures. The key is, I think, that this is accepted within the profession -- that male nurses will ask preference and they will just not work with young female patients. (Except in emergency situations, of course.)

The same practices, I believe, are just not accepted for female nurses. As a matter of written or unwritten policy, they don't generally ask and they don't stay away from working with young male patients.

Why is this so? I think there may be several reasons.

1. Male nurse may be more in tuned with observing non verbal communication from female patients. Frankly, their jobs may depend upon it. And they've become used to asking and observing. I've read several male nurses write that, even if they ask and the woman agrees, they still look closely into the woman's eyes to see how they may really feel. If they still see real discomfort, they'll open up more intimate avenues of communication and perhaps suggested a female nurse. I'm beginning to believe that female nurse may hold many more inaccurate assumptions about how men feel in these situations than do male nurses. Even if they do notice discomfort and even resistance, if there's not verbal objection they still may go on with the procedure for the two reasons below.

2. Female nurse may not ask because there is not option available. I some cases, there may be an unwritten policy not to ask. It's said, don't ask the question unless you want an answer. It some cases, I believe the system doesn't want an answer because of the social, economic and financial implications.

Now, some nurses write that male and female nurses on duty together work together accommodate their patients. I'm sure this happens more often than not, but there's no way of knowing. We need to realize that in many cases the system does try to work with the patient in thsi regard. But i\t depends not just upon attitudes, but also on staffing.

3. I'm also beginning to believe that female nurse are just expected to deal with intimate male care and not try to get out of it. It's a social thing, and perhaps even political. Part of the key, I think, is that more females refuse male intimate care than males refuse female care. So the males are just used to dealing with this issue. I think female nurse are more at risk, job wise, if they accommodate men too much. It's a job they're just expected to do and if they appear to be trying to get out of it, that may reflect on their professionalism. It may be considered standard operating procedure for male nurses to ask, observe closely, and actually stay away from certain types of intimate care. It may be unwritten policy (under the radar) that female nurses better watch their backs in this area.

These are just thoughts based upon reading many blog conversations between male and female nurses. Liek the doctor, I'm trying to see if I can come to some conclusions based on this information.

I could be wrong about this. But until more research is done, we won't really know. And, as patients and patient advocates, I think it important we try to understand the social and political dynamics of what's happening around us and between the lines.

 
At Tuesday, July 15, 2008 12:08:00 PM, Anonymous Anonymous said...

I wanted to share a positive development for a change. I have related my concern with a visit for a scrotal ultra sound and had a female tech when a male was available. I sent a letter at the time and didn't get a response. After waiting to long, I thought about the discussion on this blog and decided I needed to be more proactive and went to the VP of patient relations vs the patient advocate. I got a response last week. First from the VP and second from the advocate. They both stated the advocate had not recieved my correspondence but had recieved a similar letter annomously. As a result they had instituted a change in central scheduling where they had a list of intimate procedures and noted which ones had staffing available to offer choice of gender and were asking patients for preferences on scheduling. Not sure that Dr. offices are passing that through or not....but I was encouraged. We can make a difference.
Today I met with my state legislator and presented him information on the "are you man enough to be a nurse" program that is now liscenced and available. I gave thim the data about the looming shortage (1,000,000 by 2030) and numerous other facts. I intend to continue to push that effort at our state level. Might or might not work...but doing nothing will gaurentee the same. I would also like to add my appreciation to Dr. Bernstein for all he has done, I look forward to reading the article and providing it to my providers. JD

 
At Tuesday, July 15, 2008 2:23:00 PM, Anonymous js md said...

Here's the link for the woman physician who starts to panic when she fears a male gynecologist will do her vaginal ultrasound. The pertinent quote is:

And then, there’s this alarm that suddenly went off in my head that I could have a male ob-gyne ultrasound specialist doing the procedure on me, because I saw one of the male ob-gynes there and, unfortunately, he was also my professor back in med school. And that reminded me of my article for the recent edition of TBR. Wonderful. Maybe I’m getting my karma for what I said about male ob-gynes. Ahahaha.

The link this physician gives to another column of hers is also interesting as it talks about gender preferences.

 
At Tuesday, July 15, 2008 6:41:00 PM, Anonymous Anonymous said...

In response the the drs comments july 12. The patient went in with a strain not for a complete genital examination. While I realise she may have wanted to check for hernia he did not require a full genital examination. I personally would have asked for a cover. My penis would have had nothing to do with it. Did she think because she was there and his pants were down she would just doa complete genital exam without asking or explaing why. Why did the patient not ask why, but I guess what upsets me or makes me uncomfortable doesnt make everyone feel that way!! I guess I just feel that no wonder doctors, nurses etc. do what they like with no explaination is because not many people qeustion them, just do as they are told.

 
At Tuesday, July 15, 2008 10:01:00 PM, Blogger Maurice Bernstein, M.D. said...

To Anonymous from 6:41 pm today:

A symptom without any immediately obvious physical finding may be simply a symptom and not a diagnosis.
Yes, groin pain with a soft tender bulge in the groin can well be an inguinal hernia but groin pain without that bulge can be a symptom of other causes including infection involving the penis. In this litigious society (particularly in the United States) it is foolish to perform a genital exam half way and miss an easily detected abnormal physical finding. I can tell you that our medical students learning to perform a genital exam in a male are never instructed to do anything less than a full exam including the penis. I have never read anything about covering the penis in a genital exam.

Of course, what was missing in your scenario was an explanation by the healthcare provider prior to the patient undressing regarding the nature of the exam as related to the patient's symptoms and what the doctor was looking for. The students are instructed to continue the explanatory narrative as the examination proceeds and obviously that also was missing in the scenario. Finally, at any point, the patient should feel free to ask questions, expect a prompt answer and order the physician to abort the exam if the patient is unsatisfied with the response.

If there is anything that I can impress on my visitors in these modesty threads is the importance of patients "speaking up".. I would and I have myself as a patient..but on other matters. ..Maurice.

 
At Wednesday, July 16, 2008 5:11:00 PM, Anonymous Anonymous said...

Along the lines of dialogue of July 15th from MER, a response I received from a "nursing perioperative specialist for the AORN" was interesting. She said it is interesting the nurse gender issue is brought up.

A male nurse is used to having this addressed (especially in OB/GYN) but they do not understand the female patient rejecting a male nurse when they don't object to being cared for by a male OB/GYN physician.

From the tone and writing of her response I felt like she was saying that male patients do not reject females nurses. That only male nurses receive this response from female patients. Male nurses are very used to dealing with this. She did not specifcially state that but it was so much implied.

 
At Wednesday, July 16, 2008 7:23:00 PM, Blogger Maurice Bernstein, M.D. said...

I put up a new thread yesterday "A Doctor's Touch" which describes the value of a doctor's touch in communicating with and examining the patient. For those on this modesty thread you might find something there contextually related to the modesty issues here. I would think one aspect would be in relation to the recent concern about the touching the male genitalia and modesty. ..Maurice.

 
At Wednesday, July 16, 2008 9:37:00 PM, Anonymous Anonymous said...

My husband has visited the doctor on two occasions because of a lump in the scrotum. On neither visit nor during the ultrasound was the penis touched or looked at. If the testicals is the part of the genitalia concerned, why expose the penis and give more embarassment to the patient. We are both in our 30's my parents in thier sixties and none of us has ever had a physical as described here on this blog. If we have a problem then we see a doctor and for that problem only. My husband recently had to visit teh doctor for a new job. A few questions, blood pressure taken and out the door. He has his skin checked annually as he has fair skin. He always leaves his shorts on and just removed his shirt when they look at his back. We believe our bodies are for each other only. There is not much sacred to a couple anymore and as long as we can keepthis one himg we will. There are ways to keep healthy and see the doctor for examination without total unnecessary exposure. Yes a doctor may have seen a thousand naked bodies but they havent seen mine and I intend to keep it that way.

 
At Thursday, July 17, 2008 11:38:00 AM, Anonymous Anonymous said...

Dr. Bernstein,
I have a question for you. If a man goes in for an exam of the pelvic/groin area, say for a hernia check and he drops his pants, standing there naked, should the male or female doctor use a gloved hand to examine the genitals? Is it commonplace for them to use a glove?

Thanks.

 
At Thursday, July 17, 2008 2:46:00 PM, Blogger Maurice Bernstein, M.D. said...

There is no need for a male patient to stand naked for a genital exam. The patient can be otherwise dressed but then drop the shorts at the moment of the genital exam.

In the distant past I did not wear gloves except for the rectal exam but in recent years, I think that gloves are now a standard of practice and I wear them for both genital exam and rectal. There is no doubt that wearing gloves, while more sanitary, removes a significant degree of sensitivity from bare fingers. ..Maurice.

 
At Thursday, July 17, 2008 11:41:00 PM, Blogger MER said...

Doctor, in regard to your last comment -- when examining a patient, palpating (regardless of what part of the body) -- what's best medical practice, using or not using gloves? Can a doctor get a better sense of touch or feeling with his uncovered hands? Do the gloves make it less effective? Are gloves now used primarily to desexualize an exam or for hygene?

Also, here are two comments related to patient modesty written by a nurse and a doctor. I think when medical professionals themselves get upset with what they sometimes see, it's worth making note.

An emergency room nurse reflects on how patient modesty isn’t often protected.
http://ernursey.blogspot.com/search/label/Patient%20privacy

A doctor reflects on how to and now not to treat patients, based on how his sick father was treated.
http://www.kevinmd.com/blog/2008/06/sid-schwab-no-more-and-no-less-human.html#comments

 
At Friday, July 18, 2008 7:32:00 AM, Blogger Maurice Bernstein, M.D. said...

Gloves potentially reduce the sensation and some specific receptive information of touch such as temperature and superficial texture. We teach our medical students, in general, not to wear gloves except for genital/rectal/pelvic exams or exams within the mouth of the patient. Specifically, doctors must wear gloves for infection control when examining a patient with a known pathogenic organism that could be spread to other patients or the physician on the doctor's hands or a patient who his highly susceptible to acquire a serious infection and is in "reverse isolation" to prevent organisms on the doctor's hands from infecting such a patient.

Hopefully, de-sexulization is accomplished by professional behavior on the part of the doctor and adequate explanation to the patient of what is being examined and why a particular touching is being done. ..Maurice.

 
At Friday, July 18, 2008 9:31:00 AM, Anonymous gve said...

Dr. B,

I can understand that you may personally feel that the posters on this blog are a tiny minority of the population and be inclined to point that out in the article you are in the process of writing.

However, I am very computer literate, very comfortable with the use of a number of search engines and have worked in the Computer industry for many years, it is my profession. I point this out as even I had huge difficulty locating any blogs at all on this topic, despite searching for ages.

It may be interesting to see what might happen if a blog were set up and tagged so that it would be easiy found by most searchers, not just persistent ones like myself and your other contributors.

Any of the medical profession who dismiss your contributors as a minute number of cranks, would be taken even slightly seriously if they then conducted research to prove or disprove the volume of such concerns regarding patient modesty.

In other words, don't dismiss this blog without having FIRM proof that the posters in here really are the minority and not as I firmly believe, just those who have been willing to speak out amongst the great majority.

 
At Friday, July 18, 2008 9:52:00 AM, Anonymous Anonymous said...

When I saw a surgeon, he walked in the exam room after being with a male patient in the adjacent room. The walls and partitions were so thin I could hear almost all of their conversation. The surgeon did not wash his hands and proceeded to touch me in the genital area during the exam without gloves. It all happens so fast you don't have to process everything and speak up. After I gave the situation some thoughts afterwards, I was upset that he didn't wear gloves and he didn't wash his hands prior to touching me in the genital area. He had no doubt examined the male just prior the same way (he was there for the same problem). Plus he had opened the door touching a filthy door knob, etc. Seems awfully unhygienic for a surgeon of all people. This is off subject on this thread but not washing hand from healthcare workers is a BIG problem with the spread of germs from patient to patient both in the hospital and in the doctors' office.

 
At Friday, July 18, 2008 10:58:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today 9:52am- You should have spoken up, if not at the time, then later. If there is anything visitors can get out of this series of threads on patient modesty is the strong advice to "speak up!"


To gve: In my draft, I stated the prominent views expressed on these threads, nevertheless I cautioned, as I have here, that one really doesn't know the magnitude of the number of patients with this concern simply from reading it on my blog. However, I also tried to emphasize that even a few patients in ones medical practice with the concerns expressed here are worthy of consideration and should be listened to and not ignored. ..Maurice.

 
At Friday, July 18, 2008 1:45:00 PM, Blogger MER said...

The doctor is absolutely right -- patients must learn to speak up when things just don't feel right.

Having said that, I've got to add -- we all know the doctor/patient relationship, especially in the exam room when one person is dressed and the other is not, is not a ballanced relationship. There's also the knowledge imballance. As non experts, we can and should do some research and know about our condition. But we can never reach the point where we can communicate equally with a doctor.

Just as a teacher with children has an advantage when talking with their own child's teachers -- just as car mechanics can talk direclty with a mechanic working on his car -- so too doctors have the possible advantage of talking the same language with other doctors when they themselves are patients.

All this boils down to the fact that, as much as patients can prepare and learn to speak up, it still is in the ball court of the doctor to open the communication.

Anonymous brought up an important point. He wrote: " It all happens so fast you don't have to process everything and speak up."

That's a key. Doctors need to slow down. With some, it's so routine that they just move through it without thinking. With others, it may be part of the bottom line -- move'em and move'em out. I actually had an experience with a dermatologist like that. Later I opened up a discussion about this issue with him and he was very uncomfortable talking about it. He told me "The patient is always in charge." I told him, "Maybe you should remind the patient of that fact, tell the patient what you're going to do before you do it, and slow down so the patient has time to say "Stop!" or ask a question. Frankly, he didn't like that kind of feedback from a patient.

And that's the risk we as patients have to take when we speak up. There's a fascinating scene from the movie "The Doctor" starring Willing Hurt (based on the book "A Taste of my own Medicine."} Hurt's character, a doctor being treated for throat cancer, decides he wants to fire his doctor, so he confronts her. He reminds her that some day she'll get sick and have to go through what he's going through and she should think about how patients are treated. She says she's offended by that remark. He says something like this: "If I had a patient like me when I was a doctor like you, I'd be would have been offended, too."

Quite an insight. My point is that if, as a patient, you decide to speak up. You need to be prepared if the doctor is offended and shuts down communication. That may be an indication that you need to find another doctor -- you should tell that doctor as much -- and perhaps put it in writing for the record.

 
At Sunday, July 20, 2008 3:48:00 PM, Anonymous gve said...

On many occasions in this blog we have been advised to "speak up".

I have done so on a few times.

My experinces:

I have been treated as a crank.
I have been described (in writing) as being bashful (in an insulting way).
I have been treated with contempt.
I have been left in NO doubt that it is ME that is unusual, not the "system".

What needs to change is the arrogance, condescension and patronising behaviour of some physicians and medical support staff.

I will NOT be bullied into being silent, I will continue to speak out and demand dignity.

The sooner more people do so the better.

 
At Monday, July 21, 2008 10:34:00 AM, Anonymous Anonymous said...

GVE:
Your statements are identical to what we as a couple have experienced regarding this.

In addition to all your comments we have been laughed at by a physician. Evidently he found it quite humorous that we were both upset with opposite sex intimate care and that it was an issue for us and not acceptable.

Condenscending attitudes from the medical world is uncalled for and very unprofessional. Just because they find it trivial does not mean the patients feelings should be ignored.

 
At Tuesday, July 22, 2008 4:04:00 AM, Anonymous Anonymous said...

I can imagine the frustration if the providers did not take you seriously. I had the opposite experience, as I stated I filed a complaint with the VP of patient relations at a local hospital, got a e-mail from her, from the patient advocate, and I had a call on my answering machine from the head of radiology. If this is a hosptial, I would suggest going up the ladder, take it to the board of directors, remind them of the competitive nature of medicine today and let them know you won't keep it to yourself and intend to tell as many people as possible. The people trying to balance the budget will take that serious. Those who may be "inconvienced" may not be as willing to change, those paying the bills will. Good Luck and keep trying JD

 
At Tuesday, July 22, 2008 11:20:00 PM, Blogger MER said...

What we sometimes perceive as a condescending attitide from a physician or nurse, or ridicule -- may in fact be a cover for their embarrassment. The irony is that you -- the patient who brings up the intimate care issue is not the bashful one. The medical professional who won't talk about this issue with you, up front and in the open, is the bashful one.

It is well known in the medical profession (I'll cite some interesting studies if you like) that medical students have a difficult time with "body" issues at first. This includes everything from dead bodies,to diseased bodies, to maimed bodies, to naked bodies. I'm not making light of this. It's understandable. It's barrior that they need to overcome. But the question is -- how do they overcome it? What strategies or defense mechanisms do they use. Some are healthy strategies and some are not. Some empower the patient and some demean the patient. But, then, our defense mechanisms are not meant to make other people feel good -- they are designed to make us feel good. That's one problem patients need to face regarding this issue. They need to recognize when these defense mechanisms are being used and they need to decide how they feel about it.

My point is that those of us who try to engage our doctors and nurses in this discussion, sometimes run into defense mechanisms designed to cover their uncomfortable embarrassment. We are not the bashful ones. They are. And I don't quite know how to deal with that issue. How do you confront someone in denial?

 
At Wednesday, July 23, 2008 7:41:00 AM, Blogger Maurice Bernstein, M.D. said...

MER, I would fully agree with your assessment of the problem in the interaction between physician and the patient who tries to express his or her own modesty. What patients fail to remember is that physicians are humans just as the rest of us and have their own emotions and emotional defenses. Physicians can be hurt and embarrassed. They are taught not to express their emotions to the patient since if they did the relationship might be less than a therapeutic relationship. You can't have the physician arguing with a patient and yet at the same time doing something in only in the patient's interest to resolve the patient's medical or emotional problems. So the doctor, in a conflicting or embarrassing situation, may display a stoic attitude which may lead the patient to conclude that the doctor doesn't listen and doesn't care. He or she is actually caring a lot regarding what is transpiring.

I just wanted to give my visitors a bit of an insight of what is going on to supplement what MER wrote. ..Maurice.

 
At Wednesday, July 23, 2008 4:25:00 PM, Anonymous Anonymous said...

I don't know if I agree with MER's take on who is the bashful one. From experience, the nurses and physicians we have dealt with seem to trivialize the issue as non-meritous. They have given us the response that it is "their" job and they are empowered to do intimate care on everyone--like it or not. The old standard, "we are professionals". Completely disregarding a patients preference and feelings.

 
At Wednesday, July 23, 2008 4:25:00 PM, Anonymous gve said...

MER,

what an astute and undoubtedly valid observation.

The only weakness in this persepctive, And this is not a criticism of you, is that the embarrassment felt by Physicians is as NOTHING compared to that felt by the patient. The Physician is not naked at any time during the consult.

Whilst the physician may feel a little uncomfortable, I would have more sypmathy if they had to also consult while naked themselves!

I know that sounds absurd, but unless things like that are said, the average physician will think their discomfort and embarrassment equates to that of the patient,OBVIOUSLY it is not in the same league.

 
At Wednesday, July 23, 2008 7:03:00 PM, Anonymous Anonymous said...

I don't give a damn about a doctor's
embarrassment if he or she is going to use
this to further the discomfort of a patient.
Let's put the cart behind the horse. If medical
staffs worked in the nude, we'd all be in this together
as equals. Then I could take pictures of them with my sterile celphone and comment on the placement of their tattoos. We'd all be em-bare-assed, together. What a wonderful world it would be!
- CHUCK McP

 
At Wednesday, July 23, 2008 9:53:00 PM, Blogger MER said...

A few responses. Anonymous writes: "They have given us the response that it is "their" job and they are empowered to do intimate care on everyone--like it or not."

All I can say to that is, not only is it wrong (I mean legally and ethically), it is also unprofessional. I can't believe that most medical professionals believe that. I'm sure some do, but it's such an unprofessional stance that the ones who do must be in the minority. As I've mentioned in other posts, the courts have been clear about our rights to privacy regarding our bodies. If a medical professional were to use those words with me ("their" job and "empowerment") in the context anonymous uses, I would file a formal complaint. People like that need to be either reeducated or drummed out of the profession.

gve is, of course, correct. It isn't an even playing field. But my point is to make patients aware of what's going on from a psychological or sociological point of view -- so they can recognize it when it happens. Maybe the patient can say something like, "I know you may be embarrassed or reluctant or uncomfortable talking about this, but this is something that's important to me and needs to be discussed as part of any relationship I have with a doctor. These are my feelings and they are important." That might not work, but it might, too. It may be worth a try. As I've said in previous posts, it shouldn't be up to the patient to open up these lines of communication. The medical profession should be doing this. But it isn't happening most of the time, so we, as patients, need to face the reality and deal with it.

And re the doctor's comments. He's right. Patients need to realize (not just intellectually, but in reaity) that doctors and nurses are human beings just like they are, and doctors and nurses come with a past that has all kinds of baggage just like our past does. Some patients expect miracles from doctors, and think doctors are Gods, and expect perfection. In the past, doctors have been taught that they must have the answer. In medical school, it's not often good form to say "I don't know." They've been educated and socialized to be the "knowers," the "keepers of knowledge" in their field. It's difficult, and sometimes shameful, for some of them to admit they don't know the answer. I could privide a good article about "shame" in this context.

The doctor writes: "They are taught not to express their emotions to the patient since if they did the relationship might be less than a therapeutic relationship."

This may be a good general rule, but as all general rules go, one needs to know when it doesn't work, too. There is a time and place to share and express personal feelings, even emotions. But it's a difficult call to make. We can't narrow down the specific contexts within this discussion -- it's a professional call.

There's a great movie called "Away from Her" (2006)The summary: "A man coping with the institutionalization of his wife because of Alzheimer's disease faces an epiphany when she transfers her affections to another man, Aubrey, a wheel chair-bound mute who also is a patient at the nursing home."

I highly recommend it. The film shows a huge contrast between the administrator of the nursing home and one of the nurses. The administrator wears a "mask," is never really open and honest with the husband, but uses all kinds of defense mechanisms so as not to really fact the truth. The nurse, on the other hand, at one point really opens up to the husband and lays some truth on the line. Watch it, and see what I'm talking about as to how medical professionals can share and become personal with patients within the right contexts.

Well -- this post is long enough. See you later.

 
At Wednesday, July 23, 2008 10:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Chuck McP, I would suggest that medical care providers need not establish themselves to patients or others as equals--they are not. The patient is not diagnosing nor treating their doctors. The patient is requesting a function from the doctor which the patients cannot provide themselves. The medical care providers are not themselves ill with the patient's illness, nor should they be required to be so. There is no need for medical care providers to work nude. Even patients need not be fully nude for examination. Whatever exposure of the patient's body is required, it is required for clinical examination and not some other effect. To require medical care providers to work nude would be for some irrational and fully non-constructive effect and would not contribute to the diagnosis or therapy of the patient which is the goal of all medical care providers. Think of some other approaches for physician education about patient modesty. ..Maurice.

 
At Wednesday, July 23, 2008 10:41:00 PM, Anonymous Anonymous said...

Obviously, I don't expect medical staffs to work in the nude...
but a patient's point of view regarding modesty would be easier for doctors and nurses to understand if they did.
- CHUCK McP

 
At Thursday, July 24, 2008 4:01:00 AM, Anonymous Anonymous said...

To MER's response of Wed July 23-9:53, we concur that clinicians are wrong when responding that it is "their job and they are empowered to do intimate care on everyone-like it or not." It is wrong, but it is the standard response. "They" are trained to do these types of treatments and procedures including the operating room stuff and that is as far as their thinking goes. Complaints have been made to all levels including corporate officers and the thinking follows at all levels. There is always a brief appology and then it is followed by the standard lingo-: professional, trained to do the job. Complaints are not heard enough for them to change protocol. When patients are knocked out in the OR they don't know who does what. Yes, it is surgery but it is no different than if you are in an exam room.

 
At Thursday, July 24, 2008 5:56:00 AM, Anonymous Anonymous said...

I would hope Chuck didn't mean it literally. The concept is more to put ourselves on the same plain emotionally on this issue. There is a lot of feeling from the patients side, and I think it is valid, that providers feel completly different about the issue when they are on our side of the gown. You see is all the time from the female urologist who openly states she has a strong preference for female gyn's but demeans male patients as sexist when they express the same preference for a male urologist, there is a thread running right now on allnurse "trama naked" discussing a patients issue with being stripped naked and left that way for what he felt was an excessive time as well as the lack of concern/response from providers. One interesting post was from a ER nurse who said she and her team had discussed this and they all agreed if they were brought in they wanted the others to cover them, pull the curtains, shut doors, keep others out etc. things they evidently did not do for the "normal patient". I would hope that is what Chuck meant...conceptually. Of course requiring providers to be nude is absurd, treating us exactly as they would want to be treated...is not. They can toss the its different we work with...etc., but its just an excuse or justifying to us. JD

 
At Thursday, July 24, 2008 10:16:00 AM, Anonymous Anonymous said...

I’d like to expand on JD’s comment from July 24th

“One interesting post was from a ER nurse who said she and her team had discussed this and they all agreed if they were brought in they wanted the others to cover them, pull the curtains, shut doors, keep others out etc.”

I have an aunt that’s a retired nurse and a few cousins that are nurses. A few comments that I’ve heard from them:

“I’ll never let my co-workers see me in that position.”

“I’ve seen how he does surgery, we won’t touch me.”

“She’s won’t be my nurse, I’ve seen how she treats her patients.”

This came from a nurse that was going to deliver her baby at the hospital she worked at:

“I’ve spoke to the OB nurses, they are going to make sure there are no intrusions and that I’m covered at all times.”

Obviously, they all recognize that there’s a problem but most of them choose to go elsewhere for their health needs. I’ve also learned that it’s accepted by their peers when they make these type request or get these assurances. That tells me that they do understand what a patient has to go through and they also know how to make their experience better. What I don’t understand is the attitude by these same people when a patient asks for these same things?

JK

 
At Thursday, July 24, 2008 4:48:00 PM, Blogger Maurice Bernstein, M.D. said...

I would like to extend the discussion of patient modesty a bit into an area which we have not really fully clarified or explained on these threads. And that is: what is the psychologic basis for patient modesty? Is it that the patient is ashamed to allow ones body to be shown to another for fear that it will not look as an ideal body as thought by the patient to appear? Is it a decision that ones body is something that the patient owns and that only the patient's sexual partner can gain access to it? Is it a fear that being undressed and having ones body exposed might cause others to attempt some sexual act on that body? Or that it is a reaction to sexual abuse in earlier years? Does it have anything to do with excretory functions of the body? For example, as a personal example, though I really don't have much in the way of bodily modesty, I would appreciate to urinate or defecate more privately without being observed by others.

Or is it, as was noted in some old threads, simply a matter how one was brought up as a child and the mechanism is simply a mattter of conditioning from childhood and not some mechanism noted above or something else not yet mentioned? Those who proclaim patient modesty for themselves can you tell us why you think it is present? Though, I think patient modesty is very important factor in patient care and attempts should be made to help mitigate it so as to provide the best medical attention and care, I think it also important to understand why it occurs. Any suggestions? ..Maurice.

 
At Thursday, July 24, 2008 6:16:00 PM, Anonymous Anonymous said...

Dr. Berstein,
For us as a couple, the issue of modesty and having intimate procedures done by opposite sex nurses represents a violation of our patient rights.

We felt "violated". Much the way a person feels that is raped or the same feeling you have if your home is buglarized. You feel dirty. Someone has touched your belongings, gone through your drawers, walked on your carpet. You have no idea who the person was, what they looked like, etc. Unless you have been a victim of such you cannot understand the feeling.

We felt the same way after a procedure. Yes, I think many couples find it difficult to accept another person of the opposite sex touching and viewing their spouse. Even for so-called medical reasons. The nurses say it is not sexual. Nakedness is always to some degree sexual. Let's put it this way if a female nurse were assigned to an procedure or operation on George Clooney or Brad Pitt, would they really claim it was not sexual? The nurses would probably be fighting to be the circulator to do the prep.

There was a man some time back that started a thread on "How Husbands Feel." This, I assume, was all about men not accepting of their wives being viewed and handled by the opposite sex for medical procedures.

I had an operation many years ago and learned long afterward that a male prepped me. At the time I had no idea. It literally made me sick to my stomach to learn of it, even though it was many years ago. What I don't understand is why the medical world discredits this issue. And that they actually think that all people are okay with this and do not care about this.

 
At Thursday, July 24, 2008 6:35:00 PM, Anonymous Anonymous said...

Does it matter!!! Bottom line, treat all patients with dinity and respect and we can all get along!!!

 
At Thursday, July 24, 2008 7:12:00 PM, Blogger Maurice Bernstein, M.D. said...

Yes, it does matter. And the individual's basis for the patient modesty should be explained to the doctor so that the doctor can be aware that the issue is not trivial or arbitrary. It is all part of informing the doctor and, in effect, saying "I am your patient, this is the situation, what are YOU going to do about it." To me this issue is part of what a physician has to accept if they accept a patient. It is the "baggage" (important baggage) that comes with accepting a patient and like everything else the patient "brings with him or her" including the obscure disease is and should be the responsibility of the physician. We get the history of the symptoms, we should also get the history of the modesty issue.

The "baggage" would also include other emotional problems and social problems. Yes, doctors are also responsible for attention to the patient's social problems and if the physician cannot resolve it, is responsible for referring the patient to a resource for help. I am writing all this to emphasize why the explaining and detailing of requests by the patient is important and the physician is responsible to attempt to do something about it.
So it is important and does matter! ..Maurice.

 
At Thursday, July 24, 2008 7:13:00 PM, Blogger MER said...

In response to the doctor's last comment about patient modesty -- First, I think this is so complex a question that all of the answers you provide play some role. A good part of it (short of past sexual abuse, etc.) is how we're socialized.

But I think there's a problem with the question --What is the psychologic basis for patient modesty? I think, we need to leave out the word "patient," at least at first.

It seems that sometimes the medical community tends to separate general "rules" and taboos of modesty that apply in our culture (spoken or unspoken) from the hospital/clinic experiences. That is, a modest person should just drop any concerns once he/she enters the hospital. The "We're professionals" response.

Psycologically, that stance doesn't make sense. We bring our values, fears and taboos with us into the exam room or into the hospital. Yet, when we get to the hospital, there seems to be little attempt to learn what those values are (be treated as individuals). There's an attempt (I'm not saying it's always conscious) to resocialize the patient. Something like -- "Okay, you've been socialized to be modest, but now you're here so now you need to forget that and get used to how we run things. This isn't your world. It's our world. And this is how we do it."

Sociologists have studied how "strange" the hospital is to new patients. It's not our world. We don't know the rules. We don't know how things are done. It's a strange world and we're surrounded by strangers.

I'll call this the "stranger" situation. I think many people would have less problem with exposing themselves in a medical situation if they were able develop a trust relationships with the care prividers. But so often patients are confronted with "strangers" who just expect to have complete access to the patient's body without even asking. Often there seems to be little attempt to develop a relationship or trust. Frankly, often there just isn't enough time. Yet patients are expected to just drop many years of normal living in social situations.

It's also a question of atonomy, choice, empowerment. When one feels helpless, powerless, vulnerable, exposed, I think modesty issues kick in even more than they might normally.

So maybe what I'm saying is, the question should be more like -- "If some people are socialized to be modest and those are their values, why should they be expected to just change instantly when they enter a hospital or exam room?" It doesn't make sense psychologically that they should.

In other words, if the question is "Why do you feel modest in medical situations? -- the answer is "Given my cultural background and orientation, why shouldn't I be modest?"

And -- "We're all professionals here -- is not a sufficient answer, nor a logical one. Not from the patients point of view.

I don't want to dwell on this but too often efficiency has taken precident over patient values in medical situations. The nurse has many patients to care for. It's easlier to do it this way. The clinic doctor has a full load today and must move'em in and out. Effeciency, speed.

Overall, our health care system is broken, though made up of many caring, talented individuals who are trying to mull their way through the mess day by day.

 
At Thursday, July 24, 2008 8:55:00 PM, Anonymous Anonymous said...

As per usual, another great posting, MER. Well thought out. I hope you will use all your research to write a book on the patient as alien in the world of medicine.

Most businesses and professions proceed on the basis of winning the client's approval and contracts. Medicine operates on the premise that medical personnel know what's best for you. Take it or leave it.
(avram)

 
At Friday, July 25, 2008 5:20:00 AM, Anonymous Anonymous said...

MER stated many of the same thoughts I have. And stated them well. Very early on we are conditioned to cover ourselves from view of the opposite gender. Even the medical community recognized this as they used to provide "orderlies" to provide intimate care for male patients. It was the medical community who decided for economic reasons they could do away with this. It was not for the benefit of the paitent, nor because the paitent didn't care it was soley for their benefit. Expose yourself to a nurse on the street and you go to jail, its wrong we all understand that, but you are expected to walk into a hospital and strip naked on command and its OK, nothing wrong with it, you should be fine with it. You just can't place years and years of conditioning on a shelf becasue someone tells you its ok. Our minds try to trivalize this for self preservation, but its still there. And once you open that door to the realization that this is wrong and I can't accept it...there is no going back to repressing those feelings and convincing yourself you are ok with it. Plus the inconsistancies tells us it is really not true that it is nothing to providers. Womens health centers staffed only by women, no way you hire a male mammographer, providers with strong gender preferences when they are paitents. It doesn't add up to what we are being told.
I can accept it is not as sexual in nature as one might think, but not totally, I have heard nurses talk after a few drinks...and that doesn't cure the problem. I recently heard on the radio where a man was given 30 days for jogging nude. He had started doing it and enjoyed it so he did it at 4 in the morning so as not to impose...off to jail...not sexual, but illegal. Walk into the opposite gender restroom or shower if yours is full or out of order, not sexual...but I will lay money if I walked into the nurses shower becasue the mens was closed they would demand I be arrested, non sexual or not.

On top of the socialization and the norms set by society, for me personally there are other factors as Dr. Bernstein stated. I feel intimidated and controlled when being told to do something I am not comfortable with. The power dynamics come into play, and to be honest, I question myself how much this comes into play when it is a female telling me to lower my pants. I honestly can't say if its the fact that I am having to expose myself to the opposite gender, or if its the fact that it is a female "ordering" me to do so that bothers me the most. And I know body image is a concern at least for me. I am physically fit 6'1" 175, but....just as females have been subject to the barbie doll image of what they should be, paticularly breast size etc.. Males have been hammered constantly with "size matters". You can hardly go an evening without jokes on the matter on the entertainment media. This is the first time I have every admitted that it is a factor, it isn't something we can openly talk about, but for me at least I think about it. I have no fantasy of any relationship with the provider, but I wonder if I am being judged or compared...and I do resent a great deal providers often seem to have a do as I say not as I do mentality...so modesty comes for me at least from multiple areas...how in the world could I comunicate that to a Dr. who is always in a hurry much less to a female nurse....I haven't even shared that with my wife of over 15 years...so I think providers need to understand...it really doesn't matter why, whether my wife wears a burka, was abused as a child, has body images or not...it is still a significant part of the medical experience. JD

 
At Friday, July 25, 2008 7:17:00 AM, Blogger Maurice Bernstein, M.D. said...

I am pleased that anonymously commenting to a blog, such as mine, provides an important way of ventilating ones feelings and which I think is therapeutic in a way though not necessarily resolving the problem discussed. ..Maurice.

p.s.- We are at 79 comments here today and if it's OK with my visitors, I intend to go on to Volume 5 when we hit 100 so hopefully not to lose messages as in the past.

 
At Friday, July 25, 2008 9:15:00 PM, Anonymous Anonymous said...

I am going to my first ever trip to a urologist this week...I have never met him nor do I have any idea how he conducts his office or exams...I only know my PCP refered me to him.
I am not sure what happens at a urologists beyond DRE and testicular exam...
I hope he is not one of those who has to have an assistant present, but if he does it will be a good opportunity to try out the respectfull refusal.
leemacaz

 
At Saturday, July 26, 2008 7:48:00 AM, Anonymous Anonymous said...

leemacaz,
It might be wise to ask the doctor prior to him asking you to disrobe what is office protocol is. Otherwise, you might just be unpleasantly caught with your pants down (no pun intended!). In other words, it might be a safer bet to confirm ahead of time so that you won't have something happen that you aren't comfortable with. Most doctors don't explain to patients what is going to transpire because they assume that no matter what happens a patient will accept.

 
At Saturday, July 26, 2008 11:06:00 AM, Blogger MER said...

Asking a doctor beforehand your appointment about office proticol in this regard may or may not work. If this is a new doctor, and you've never met him before, he may or may not be willing to talk with you about this. Before an appointment with a new doctor, I tried once to have the him call me to discuss this. He wouldn't. Later, when I met with him, he said he felt no obligation to discuss this issue with someone who wasn't his patient, until a relationship had been established. I regarded this as poor communication and I told him so. Of course, that ended our relatiionship.

So anonymous is right -- it may be best to wait until you actually see him, when you are, in fact, his patient, to discuss this. But then, there may already be someone else in the room with him, a female nurse or assistant.

I'm beginning to think that what some on this blog have called an "ambush," that is, being surprised at the last minute by an opposite gender care giver or assistant -- is in fact a conscious or unconscious stragety used in medicine. In these situations, doctors and nurses have learned that when patients are surprised, their defenses drop and their embarrassment and vulnerability causes them, more often than not to just go along. The exam goes faster that way, more efficent. The job gets done.

Studies on embarrassment show that we often become embarrassed when we're in a role playing situation (doctor/nurse and patient) and someone suddenly stops playing his or her role or digress from the "script." For us as patients, it's so difficult because, although there is a script, we're not familiar with it and we don't even know if we have any lines. And if we do, we don't know what they are.

In an exam, our role is to stop being a person and become an object (or body part) to be examined. Part of that means that, in most cases, unless asked, we're not supposed to talk -- unless it's specifically about the body part of the exam. If we suddenly start talking, asking questions, digressing from the protocol or script that the doctor and nurse know by heart, we can cause them discomfort, even embarrassment.

There's a thread running on allnurses asking about how to react during a foley cath process if a man gets an erection. The general advice to this nurse is to ignore it and just go on. That's the script. If the man speaks up, depending upon what he says, he may diffuse the situation and make it more comfortable, or complicate the situation and make it more embarrassing. Basically, his role in this little drama is to shut up, and if he digress from it there could be trouble. In fact, he could say something that could cause the nurse to feel she is being sexually harrased.

So, leemacaz -- it helps to be prepared for possible scenarios. If you bring this topic up in the exam room with the doctor and the female assistant present -- realize that you may be diverting from the script/protocol and that may cause an adverse reaction, possible discomfort or embarrassment for them. We don't often want to talk about about such things when we're embarrassed.

Still, it's very important to open up this line of communication and try to establish a trust relationship. Let's hope you get a positive response.

 
At Saturday, July 26, 2008 11:18:00 AM, Anonymous Anonymous said...

Because you often see a nurse and he/she tells you to disrobe before you ever see the doctor, I may have to direct my concerns to them first. This doctor has an excellent reputation and is supposed to be one of the best and it is really hard to get in to see him...I respect my PCP and he made the referal...I want to address my concerns without losing the doctor.
leemacaz

 
At Saturday, July 26, 2008 1:17:00 PM, Anonymous Anonymous said...

If this is your first appointment you might meet with the doctor before the exam even begins in their office. You can make your needs know then. I don't think you will have any problem having a DRE and testicular exam done privately as neither need an assistant. If they insist then leave but I don't think either will be an issue.

If the doctor walks in with a nurse you politely and firmly ask the nurse to leave and say you'd like to speak with the doctor privately.

If you need a straight cath that is done by the nursing staff prior to the exam. You could ask for a male nurse at that time. Scopes are prepped by nurses as well but I'd get through the exam first and take the rest as it comes.

 
At Sunday, July 27, 2008 10:05:00 AM, Anonymous Anonymous said...

A straight cath??? UH ok...why would a straight cath be used? I am not incontinent.
leemacaz

 
At Sunday, July 27, 2008 11:33:00 AM, Anonymous Anonymous said...

leemacaz,
DRE's are normally done by the physician with no assistant in the room. If not, speak up and tell the doctor, no assistant please!

Annonymous of 7-26 1:17pm talking about asking for a male nurse for a cath? There are no male nurses/assistants in doctors offices.

A cysto, if advised, is many times done as an office procedure. It would be a second appointment more than likely. They take some time and a female assistant assists the urologist unless modesty issues are raised and this could be accommodated. Maybe it could be scheduled in an outpatient hospital setting where there is a chance of having a male assistant available.

 
At Sunday, July 27, 2008 9:15:00 PM, Blogger Maurice Bernstein, M.D. said...

An anonymous visitor identified as jh wrote the following to the now inactive Patient Modesty Volume 2. ..Maurice.

Apparently, at many of the meps centers throughout the U.S.,facilities that provide the medical entrance exams to the military men in groups of 30-40
are brought into a large room with
just their underwear, then are told to drop their underwear while
female office workers are allowed
to watch as sometimes male and female physicians conduct the physicals.

jh

 
At Monday, July 28, 2008 11:20:00 AM, Blogger MER said...

I would question whether that military exam practice is being done as policy on a regular basis anymore. But it wouldn't surprise me if this didn't happen in some cases, even today. It certainly used to be done. It's different with a volunteer military as we have today. But with a draft, things change.

The purpose of such exams was to break down the soldier, humiliate him, prepare him to accept any treatment from higher ups and accept any orders. The connection between nakedness and power is obvious. When you're taked, especially in front of the opposite sex, you have no power, no control. Military powers wanted to remind and reinforce to these recruits that they were powerless now and had just better get used to it.

Now -- I'll take a leap here, but I find it no accident that this kind of criminal activity took place at the Abu Ghraib prison in Iraq. It was actual government policy to humiliate these Muslum men by forcing them to be naked in front of, and to be controled by, young American women.

I'm not suggesting that war crimes aren't commited against women during war. They are, and they are horrible. Just look at what happened in the Balkins. What I am suggesting is that when it does happen to women, it is immediately recognized as war crimes. When it happens to men, as it did in Abu Ghraib, it isn't taken as seriously.

All this is connected to what we're talking about on this blog. When it comes to body privacy in our culture, men are treated differently. The double standard involves more than just intimate care in hospitals.

 
At Monday, July 28, 2008 1:30:00 PM, Anonymous js md said...

"The purpose of such exams was to break down the soldier, humiliate him, prepare him to accept any treatment from higher ups and accept any orders. The connection between nakedness and power is obvious.

You can't possibly document that claim MER. Their major motivation was to process hundreds of guys every day in the most efficient way possible. Protecting draftees modesty was a zero priority to them. In most of that era, men weren't even supposed to have modesty. Undoubtedly some sadistic officers enjoyed humiliating men, but certainly it was not the rule.

 
At Monday, July 28, 2008 1:45:00 PM, Anonymous Anonymous said...

The thread on allnuse on " trauma naked" included a comment by a provider who made the comment that if they had a difficult patient they made them wear nothing but a gown as it intimidated the patient and they tended become more submissive.

I will take you one futher that Abu Graib, a court in this country ruled that it was not curel and unusual punishment when two female guards forced a male inmate to strip naked for a search and then pointed and made fun of his genitiles, they further stated it was not sexual harassment as he wasn't touched. Meanwhile courts have ruled male guards can not pat search female inmates as it is cruel an unusual punishment. The inconsistancy is glaring, and as MER said, reverse the gender of the partcipants and see if it changes. Several colleges allow female reporters in male locker rooms but ban reporters from female locker rooms. This is college, not professional. AS MER stated, all of this contributes to what we are dealing with here. The thought process that male modesty is not as important as females, and abuse of males in this area is not as a serious offense. Being it is a societal issue than spans many segments of our lives, , we have to stop assuming it is recognized and we have to educate and stand up for our rights. Evolution is a slow process and it only comes when it is faced with a reason to change for survival. Medicine has become a very competitive business. You can't drive anywhere without seeing multiple billboards for providers....there is the need to survive.... JD

 
At Monday, July 28, 2008 3:48:00 PM, Blogger MER said...

In response to js md: Of course it's difficult to document this beyond doubt. There is anecdotal evicence (letters, journals), but just try following a military paper trail when it comes to questionable policies like the one we're describing. Even today, look at the difficulty in tracing some of these questionable policies very far up the command.

And your comment: "In most of that era, men weren't even supposed to have modesty." Try documenting that. That's an extreme point of view. Let's see some evidence.

What possible reason would there be to have female office staff observing naked men during an exam? You talk as if intimidation wasn't part of military training, that intimidation (even humiliation) wasn't an intrigal part of boot camp. Part of the purpose of boot camp is to break down the personality and reassemble it. It's a resocializtion process. How else do you expect to get men to follow orders without too many questions?

I suppose the main point I'm trying to make is that there is a direct connection (historically, psychologically, sociologically) between nakedness and (lack of) power. In prison, in war, in any power situations,(look at the Nazi concentration camps) -- you make people naked to intimidate them, to humiliate them, to make them feel helpless.

That's why this issue we're discussing, within a medical context, is such a touchy one. One shouldn't take the psychological aspects of nakedness for granted. When you start "ordering" someone to take of his/her clothes, or intimidating someone to become naked, or laughting at someone, ridiculing their nakeness, you could be hovering over a dangerous line that you don't want to cross.

 
At Monday, July 28, 2008 5:38:00 PM, Anonymous Anonymous said...

MER, you win this round. JS MD you lose. The fact that you(JS) were a medical officer in the 1960s insured you a different level of treatment than the average draftee. You were being treated as an officer, not humiliated as a grunt.

Obviously, ANYTIME you force
naked men to be with clothed women who have no medical function in such a scenario, the question HAS TO ARISE, "Can we do this without women clerks present?" When the answer comes back, "We don't care." Then the choice to humiliate the males has been made, consciously and deliberately.

That is as old as a recognized difference between the sexes.
-(avram)

 
At Monday, July 28, 2008 5:42:00 PM, Anonymous js md said...

I don't claim any military expertise as my experience in the army was brief. But my induction physical was benign. See my blog. The majority of men did not undergo experiences like described above with women present so it could hardly have been official policy.
Every examining station did pretty much what they wanted in terms of procedures used. Remember these were normally pre-induction physicals, the men were not being inducted yet and many never were. The actual induction physicals were usually very brief and pro forma. Once in the army I've never heard that nudity was used as a disciplinary measure against our own soldiers. They were trying to meld them into a fighting force, not destroy them. They had many ways of enforcing discipline and nudity was not one of them as far as I have ever heard.
But it was a different era. I too don't think it happens today with a volunteer army.

 
At Monday, July 28, 2008 7:04:00 PM, Anonymous js md said...

"The fact that you(JS) were a medical officer in the 1960s insured you a different level of treatment than the average draftee."

Nope, I received an enlisted mans pre-induction physical. The people working there didn't bother to look at my paper work until later. They apologized, but it was no big deal.

 
At Monday, July 28, 2008 9:19:00 PM, Anonymous Anonymous said...

It has been a practice among many civilian and military prisons to strip naked prisoners at times for more than body searches. There is a psychological aspect that among many cultures the naked person is more vulnerable and less likely to resist authority.
The physicals are also conducted in the mannner they are because it is efficient.
These are things a former Marine officer told me...he also added that in most situations there is simply no ability to accomodate modesty issues. Privacy is for all practical purposes non-existent.
The presence of female civilians (while I strongly feel they should not be there) are based on the idea that guys love being viewed...it is somehow a show of masculinity ..therefore these clerks and whatever function they serve are not an issue,..also a quote from the Marine (retired).
This same guy was extremely vehement that his daughters and wife be treated with great care as to their modesty...

leemacaz

 
At Monday, July 28, 2008 10:06:00 PM, Blogger MER said...

I'm not saying that this type of behavior was standard or official policy for the US military. But, as js md says: "Every examining station did pretty much what they wanted in terms of procedures used." They were pretty much on their own.

I've encountered several stories from soldiers who said, even though females weren't officially viewing the exam, the men were paraded around enough so that female office workers could see them throughout the exam. So it did happen. And, if not done specificially to humiliate the men, the lack of any concern just shows were we as a culture stand on that issue. Regardless of the motives or intent, it was humiliating for the men. There are enough storeis from recruits out there to make a case. The fact that it even happened, and to men only, suggests an attitude toward men's privacy that exists throughout our culture.

I am saying, though, that it was official police at Abu Ghraib prison in Iraq. And what makes that especially dispicable is that it was done knowing that men in that Muslum culture would be especially humiliated by being seen naked by women. We need to wonder what makes men and women just go along with that kind of behavior, what makes them justify it? Would male soldiers have worked with women soldiers to humiliate Muslum women as female soldiers did to humiliate Muslum men? Would American female soldiers even cooperated to do that to Muslum women? Maybe. But probably not.

But I don't want to get way off from the issue we're discussing here. What does all this tell us about our attitudes toward how men and women are treated? Then, how does all this filter down in our culture toward our specific discussion on this blog? I think it's quite relevant.

 
At Tuesday, July 29, 2008 12:37:00 AM, Anonymous gve said...

The position in the USA and UK on equality for males coud not be meade any clearer than by the two postings linked here.

I leave the reader to imagine the outcry if genders were reversed.

http://www.peterboroughtoday.co.uk/news/Strip-search-rule-change.4044693.jp

http://bulk.resource.org/courts.gov/states/Tex.App.12/5989.html

 
At Tuesday, July 29, 2008 2:30:00 PM, Anonymous Anonymous said...

GVE. Thanks for the two URLs on
the strip search. The only problem with both of these incidents is that the men involved are protesting under their religious beliefs. The US and UK authorities won't challenge the religious convictions of Muslims
but it doesn't seems to give a damn when it comes to Christians, Jews, or other western religious
groups. We need a test cases where a Christian man says this is against his understanding of
his faith. Perhaps we need to stop attacking the status quo on gender-equality. Go for the sacred cow to make this work. Hell, use it in the doctor's office if that's what they need to hear. Attack with religion as
your sword. It appears to work.
Put them against the wall with
insulting your faith. Let them
say they don't care. That could
take this out of a fringe issue
in a minute. If it works, use it.
- CHUCK McP

 
At Tuesday, July 29, 2008 2:58:00 PM, Anonymous js md said...

gve's links are especially interesting to me.
As prison rights are somewhat off topic here I have posted my thoughts and further links on my blog which some of you may be interested in, especially those interested in men's rights. See my last post.

 
At Wednesday, July 30, 2008 6:01:00 AM, Anonymous Anonymous said...

This might be off-topic here,,but why is it that men walk into a restroom and all stand together out in the open to urinate?

I can't see women going into a restroom and dangle over an open urinal pit?

The two scenarios are quite the same but women would not want to urinate that way. Why do men find that acceptable? Why wouldn't men want to go into a cubicle with a door or at least a partition?

 
At Wednesday, July 30, 2008 8:27:00 AM, Blogger Maurice Bernstein, M.D. said...

AS OF JULY 30 2008 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 5" TO CONTINUE COMMENTS. ..Maurice.

 

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