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Patient Modesty: Volume 5
Graphic: Photograph by J.Granier of ballet "The Modesty of Icebergs" by Daniel Leveillé, reproduced from the review at
uncoy.com. Note: My selection of the graphic was based on the current context and tone of the conversations on these more recent threads regarding patient modesty but more directed towards male patient modesty issues and the apparent difficulty of healthcare providers recognizing this concern. The photograph shows the three male dancers avoiding frontal nudity to the viewer and in fact avoiding looking upon each other. This photographic moment in the dance seems to me to represent an expression of physical modesty of these men. Though review of graphics is not the purpose of this thread, I would be interested to read if my visitors find my interpretation in error or something more or less related to male patient modesty in the photograph. ..Maurice.
AS OF OCTOBER 4 2008 THIS THREAD WILL BE CLOSED FOR ALL NEW COMMENTS. PLEASE GO TO
"PATIENT MODESTY: VOLUME 6" TO CONTINUE COMMENTS.
123 Comments:
Your interpretation of the photograph seems a pretty good one....I buy it.
leemacaz
Along the lines of the intrepretation of this is the question (age old) of motion pictures always showing female nudity (frontal) and never showing male frontal nudity. Why is that? Men are afraid to show the size of the penis to the world or is it that mostly men run the entertainment world? There should be equality with displayed nudity.
Anonymous, if your evaluation of the frequency differences by gender for frontal nudity in motion pictures is accurate, do you think this is a motion picture production policy or that of the male actors? In either case, what is the explanation of their decision? Further, if what you said was true could this help explain the male patient's concern with unwanted observation of the genitals and need for gender selection of the healthcare worker?
I usually don't attend movies where full nudity is displayed on the screen but I have gone to stage plays and my experience has been, in nudity scenes, full frontal nudity of males was not uncommon. An old stage play I saw with no discrimination of frontal nudity exposure to the audience was, of course, the musical "Hair". ..Maurice.
Dr. Berstein,
Whether one is an avid movie goer or not I don't think anyone would deny the fact that female frontal nudity is very commonplace and has been for many years. It is extremely rare to see more than a mans buttocks on screen. Even in Brockback Mountain nothing was revealed on screen during the scenes between the two men. They always show a woman naked in love scenes but never the man. So what's up with that? I have no clue if it is the male actors refusing to appear naked, the producers/directors.
If men want to see a female body I can tell you women have the same desires.
This topic has been discussed before, not sure here or on other blog. Lets look at it from this view, the display of genitals in movies draws NC-17, full frontal nudity for females does not usually include displaying genitals. The anatomical differences between the genders makes full frontal nudity different for that reason. Full frontal for females is breasts and pubic hair, for males it is genitals. Recently there were several movies displaying male genitals "forgetting sarah marshall, walk hard, etc. They got a R rating, they included extended periods where the actors penis was displayed front and center, on the other hand, when Sharon Stones famous leg crossing scence was first released in Fatal Attraction it was given a NC-17 because the censor felt her genitals were visable even breifly and it was modified with lighting to address that. Now if you want to talk about frequency of showing breasts and buttocks, I could not argue, female exposure is much more frequent. But if you want to talk about a double standard on genitals, I would argue that is still skewed to protecting females. Do you think if an actress was displayed reclining in a manner that exposed her vagina...it would recieve an R rating? Don't think so it would be considered porographic. I think it is important when one looks at the issue of full frontal nudity, to consider this fact. Further I would question using Hollywood as a measure of anything other than how off center Hollywood is.
I have a question: Do you think that the described bias toward presenting and classifying frontal nudity and genital exposure in motion pictures is a major factor that could have affected how society and particularly the medical profession looks and acts regarding the patient modesty issue and what the visitors here find as gender biased? In other words should patients be blaming the movies? ..Maurice.
Sorry the above post was mine and I forgot to ID myself. I do not blame Hollywood per se. I think it is a combination of past societal norms and practices (male restrooms have long provided less privacy, males were forced to swim nude girls were not, etc). These issues and double standard were just accepted as normal or acceptable much the way many of the wrongs imposed on women and minorities were. At one time it was acceptable to deny women and blacks the right to vote, it was acceptable to segregate, people knew it was different treatment,,,but thought it was OK. It was only when they resisted and challenged the status quo did we see changes. We as a society now recognize these wrongs and are trying to address them. Males on the other hand have been seen as benefiting from the double standard or causing it so there is little concern or recognition of issues when males are on the short end. Its hard to feel sorry for say white males as it is assumed they have so much going their way, its ok to discriminate against them. Sort of a see how it feels. I don't blame Hollywood, they have no shame and will play to whatever audience they can capture for profit. I am sure the shear number of instances of nudity in movies is heavily skewed against females simply becasue they are playing to males and feel males are more attracted to this. I think the recent trend to show male genitals has something to do with the fact that they found out they can get away with it and got a lot of free press with no consequences. The fact that women and women groups are far more prone to make their voices heard I feel has more to do with it. If they started displaying female genitals it would cause an uproar they don't want to deal with. I think the medical bias comes from the same factors, society has made violation of male modesty more accepted, the medical community has found they can ignore it for finaical benefit and by and large few males and even fewer if any male organizations will challenge it so they just keep stretching it to the point where they think it is acceptable. If every day I walked out and slapped one of my employees, and nothing happened, no one said anythng, eventually people would accept it as part a normal day. I don't blame Hollywood, I have no expectation of ethics or morality or even respect for them, its about agenda's and profit. I blame the medical community, society, and us males for accepting it and letting it become part of normal operating procedures...unless we resist it it will continue to be acceptable..what do the rest of you think? JD
The posting i made at the end of Volume 4, was very indicative of the double standard that exists across all aspects of male/female nudity.
The prison system basically says it is ok for female guards to strip search male inmates. The opposite is absolutely forbidden.. Case after case in the USA has upheld this double standard as "fair" because men are said to be less modest.
If you read again the case from Texas, you will see that the prison governor was allowed to have female guards routinely "strip search" male inmates.
How can a society consider itself civilised while such obvious abuse is tolerated and approved by the highest courts in the land.
As regards the comments about male vs female nudity in films, I completely concur with the observations of "Friday, August 01, 2008 9:58:00 AM, Anonymous", double standards yet again!
I think, when it's producing real art, Hollywood more often reflects the reality of what's in society rather than causing that reality. I think there are exceptions. For example, between the 1930's and 1960's, Hollywood's depiction of actors smoking contributed to the popularity of the cigarette. The danger is when Hollywood combines with Madison Avenue and product placement to influence buying. They can have dramatic affect of behavior. But overall, I think when good movies are made they reflect reality rather than create it, and sometimes we don't like what we see. The two movies I've mentioned in past comments, "The Doctor" and "Away from Her," are movies with medical themes that, I believe, are a reflection of how things operate in society.
Anonymous of Friday, Aug 1 states that frontal nudity is not the same for a female as it is for a male? That might be splitting hairs. Men have "outies." Nude scenes done tastefully of women (not porn crap) shows a woman's body.
When ultrasound techs say: "women techs do men patients and male techs do women patients" therein lies the obvious fact of life that a male is lying there with his penis visible (hopefully draped somewhat) and a female is covered with a drape at the pubic bone area which would be covering most if not all of the genital pubic hair. So to me it is very different for a female tech doing a male patient. Anatomically there is a difference affecting exposure of private parts.
If there are love scenes in the movies why should the female always be the one fully exposed and the male is very deliberately covered.
By the way, Sharon Stone's infamous scene (that launched her career as a big time actress-- due to the crotch scene) was "Basic Instincts", not "Fatal Attraction". Fatal Attraction was Glenn Close and Michael Douglas.
I wonder if I might ask a visitor or two on this thread to help me initiate my "My Bioethical Opinion is..." Google Knol. This was to be the format for my attempting to answer bioethics questions of all sorts if I had the capacity to do so. The idea with a Knol is that it is a space devoted for the owner to write a short thesis on a specific subject. Instead of my devising the specific topic, I thought it would be better and more of value for my visitor to select one.
After almost a week and putting up a thread about the Knol on this blog, I have had no questions posed. (I don't even know if I had any visitors!)
I don't want the Knol to be devoted only to questions about patient modesty but I did want to get started. Perhaps, with folks goggling the Knol, we wil get more visitors also interested in the issue and write their stories and viewpoints on this blog.
Go to my Question Knol and pose your question there. Make the question regarding an aspect of patient modesty ethics which was not as yet discussed on this thread. If I am able to respond, I will post my opinion on another Knol where others and myself can enter into a comment discussion on that specific subject.
Again, I am not sure how this Knol format will turn out but I guess I could use the help from visitors here. Thanks for any consideration. ..Maurice.
Does life imitate art or does art imitate art...OR do they imitate each other... as to who is exposed onscreen or in pics (as long as they willingly do so).. that is a personal choice... and may give rise to some thinking that all are ok with it...little thought is given that there are many who do not want exposed or photographed in the buff.
The manner that seems acceptable to display the human body sems to vary from culture to culture..from a period in time to a period in time..as well as what is acceptable to each person as an individual.
There have been posts by nudists that they are uncomfortable being naked when others around them are clothed..and especially when they are the focus of attention...(ie in ER..OR..etc.) That otherwise they don't have any issue with being viewed//or photographed naked.
The statue of David in Italy is viewed as art..great art....but if a visitor viewing David did so in the buff they would probably go to jail for indecent exposure.
It seems that opinions are based a lot on the context of being naked and the angle they are viewed from as well as the audience...Movies are not made just to express an artists ideas they are made to make money..what people will pay to see.. and the actors do it as much for the money as for artistic expression...They do not speak for all of the people or what everyone thinks is ok...and it is grossly unfair to base a judgement of all mens attitudes or feelings on what an actor does or does not do. Remember the saying "You could not pay me enough to do that"
Anonymous on August 02, 10:32 AM,
You made a good point here:
as well as what is acceptable to each person as an individual.
This is what I feel is the underlining problem. Medical professionals are trained to treat everyone the same and provide the same care but the fact is that we are all different and we all have different feelings as it relates to our treatment and exposure. Sure, we’re all made up of the same organs on the inside, but that’s were it stops. Unless you have an identical twin, you’re not the same as the other person and shouldn’t be treated as such. Each INDIVIDUAL deserves to treated how they themselves are comfortable with, not how they’re forced to be treated. Once patients are recognized as INDIVIDUALS and not jobs, perhaps things will start to get better. Jimmy
Jimmy, I can tell you that we teach our first and second year medical students who are just learning how to take a history and perform a physical exam the concept that the patient is truly individual and that the student should not bypass historical or physical points on assumptions regarding classes of patients. But our students have 1-2 hours to perform the history and physical. Hopefully, later when time is more limited and more patients need to be seen, the student or later the doctor will keep the concept of the unique individual in mind. Also, related to individuality, as we have discussed on another thread, classifying and identifying patients by their disease rather than their names(which interns and residents might do-- "the gallbladder in room 210") is demeaning toward the patient and ignores the patient as an individual.
In medicine, there is nothing more uplifting to the physician than to make a professional and almost spiritual connection to an individual patient. Making this individual connection has been documented to raising goose bumps on the doctor's skin. I can attest to that. ..Maurice.
Dr.Bernstein
Could you elaborate on how you knew that you made that connection with the patient? Was it that the patient was doing as you had outlined, treatment wise or was it just a feeling as you were talking to the patient? Jimmy
This phenomenon, which we also describe to our students, occurs not at once in a doctor-patient relationship but it occurs later and occurs when the relationship has developed true empathy and trust of the patient on the part of the physician and a true understanding by the patient of what is facing the physician with the diagnosis and treatment along with true trust of the physician. Both parties come to this feeling that "we are working together on this task." You look into the patient's eyes and the patient looks directly into the eyes of the physician and whamo! it just happens..the goosebumps and the doctor knows that this emotional or spiritual connection has happened. I can't tell you whether this connection raises goosebumps in the patient but you can tell that the patient is also affected by this therapeutic union. After this has happened, it would be very rare for the doctor-patient relationship to degrade. Piloerection (goosebumps or gooseskin) is a response of activation of the sympathetic nervous system. In animals with fur, this sympathetic activation with the elevation of the hairs with piloerection and vasoconstriction of the skin blood vessels both help maintain the warmth of the animal in a cold environment. ..Maurice.
We have never experienced any sort of a connection with a doctor as you have conveyed. It seems anymore doctors are so limited with their time they spend about 5 minutes and most are very much in and out without having any time to establish a relationship or do anything more than the very minimal of service. What you describe is the "old" days when a physician truly did connect with not only a patient but the family. If you are teaching medical students this in today's world, will they really be able to give this service and time to a patient once they are in practice? We signed up for "concerige meicine" because of the rudeness that comes across from so many family practitioners. It is a shame one must pay for good, thorough, polite medical care. $1500 bucks a year just to be treated like a patient used to be treated!
Notwithstanding the experience of Anonymous from today August 3rd, this connection is still happening-- it has continued to happen for me too. As I said, this experience does not occur with every patient, it does not occur on the first, second or third visit but occurs later in the relationship. I think it does not have anything to do with the time spent with the patient for each visit but it is directly related to how the doctor and patient spend that limited time and experienced the visit. Even with limited time, if the doctor demonstrates to the patient that he or she is attentive, listening to the patient's concerns, is interested to work with the patient to attempt to resolve the concerns, takes a pertinent history and performs a pertinent examination,and then explains to the patient what was found and what needs to be done, a short visit is still practical and will be acceptable to the patient. This also requires that the doctor arrange his office function so that he or she is not interrupted when visiting with a patient. On the other side of the relationship, during this office visit, the patient also has to demonstrate to the doctor attention with interest in what the doctor is saying and also a sense of cooperation. Rudeness should not be an element expressed by either party.
We still teach our students all of this "old days" stuff and hopefully later when they do have less time to spend with each patient they will follow the properties of an effective visit as I noted above.
A patient shouldn't have to pay extra money just to receive what all doctors should be delivering as a basic foundation of being a professional physician. ..Maurice.
The Broadway production, "Hair" was recently referred to by Dr. Berstein as showing frontal nudity of male and female actors.
In the Aug 11, 2008 "Time" magazine there is an article on the new production of "Hair" on Broadway. It runs through August at New York's Delacorte Theater in Central Park.
In the article it states that Rado and Ragni (authors of Hair) scoured the streets of Greenwich Village for people with the right look (original play). They had seen a couple of men strip naked in Central Park as an expression of freedom, and that gave them the idea to have all the actors shed their clothes at the end of the first act. It states, "though not all the actors were quite ready for the statement. Some were willing to disrobe, and some weren't; as an incentive, the producers offered a $1.50 bonus per show to any cast member who barred all." Interesting it stated that some nights not enough actors would be on-stage, and a cast member or two would have to double up on roles. Other nights total strangers would wander onto the stage and mingle with the regular cast. Diane Keaton and Melba Moore were in the original cast in 1967.
Doctor we are in agreement with all that you say. That said, it also represents a perfect world scenario and we all know a perfect world does not exist. Personalities, egos and other elements play into each persons agenda both on a physicians side and patient side. As stated by you prior physicians are people too with issues that are brought to the table. And, yes, people should not have to pay extra to receive what ALL doctors "should" be delivering but.... not all deliver.
I am a male and I work in a hospital. Time and time again I see
female nurses deliberately depriving male patients privacy. I've noticed them leaving unconscious male patients exposed to visitors in the er halls walking by. I believe they do it
on purpose and get their sick sexual kicks doing it. My oponion,
take it or leave it. Female nurses
are perverts and unprofessional.
They are walking on the edge as this is considered unprofessional
behavior and is cause for license
revocation. Finally, I am the person making claim that army exam
entrance physicals had females
viewing the process. It happened to
me. Fort Know Kentucky, 1972. Was it fair? No. I'll only tell you this. Wouldn't be good if I knew their names!!!
I stumbled on this discussion through a search on another topic but I read the military induction posts with interest. I had a pre-induction physical in 1986 and yes, I can verify that we were nude for about half an hour and while all 4 females present wore white lab coats, at least 2 of them did not have medical backgrounds because we talked quite a bit during the long wait during processing.
One girl had a data processing degree and the other one had just come there from a receptionist job so it was humiliating as hell when we were told to strip down and I had to walk around in front of them for the rest of the exam with no clothes on. I don't think it was an intentional army tactic however since most of the guys had no clue they weren't medical personnel.
I can laugh about it now because the first thing that goes through your mind is "oh shit" and you want to cover up but since none of the other guys were, I didn't either but it was extremely humiliating after talking to the receptionist for so long, having to walk up to her a few minutes later with no clothes on and my penis wiggling and act like it was no big deal.
The worst part is that I was too embarrassed to get her number and I was rejected by the military because of flat feet (although I have no regrets on that score)!
The last poster Thursday August 7th, I cant say I agree that all nurses are perverts, that is harsh in the extreme.
What I do think nurses are is complacent. They routinely deal with unclothed male patients daily, it ceases to register on them. It is the same in ALL walks of life, the routine becomes meaningless.
What needs to happen is that the nurses are reminded REGULARLY of the embarrassment that patients feel.
The double standard which has been espoused on many occasions in here definitely exist, consider the following example, a friend of mine recently underwent a flexible cystoscopy for suspected bladder cancer.
On the day of his procedure, he entered the room to be greeted by a nurse practitioner (who was to do the scoping), a nurse assistant and two student nurses who were there to observe.
As we all seem to do, he went along with things like a sheep to the slaughter.
All the above staff were female.
He was NOT asked if he would consent to the students being present, they were imposed on him. He raised it afterwards when he was dressed and felt less vulnerable.
Now, reverse the roles, consider a woman having a cervical smear, how would she feel if there were 4 men in the room while she had that done? It just would not happen.
Why do providers think it is acceptable for men to be treated this way?
To "gve" and the comments/ questions rasied:
We were "told" the reason for female staff performing intimate genital procedures on a male patient is because that is who works in "that area."
A mid -30's female member of my family had a colonoscopy recently. She was sedated (fully asleep). The GI doc was male, the nurse anesthetist was male, the nurse/assistant was male-- in a closed door private room. I'd say that was not proper. It was not discussed with the patient. She did not have the presence of mind to process the situation as things happen quickly and it was her first colonoscopy. She and her husband discussed it afterwards.
Yes, I fully agree with you. Healthcare clinicians are "de-sensitized" and numb to peoples' feelings and concerns. They think because they have done it a thousand times then YOU shouldn't mind. Thing is YOU haven't done it a thousand times!
The mid-30s female who had the
colonoscopy with an all-male team
should have protested, before or after.
I assure you things would
change, immediately.
I can also assure you that if a
mid-30s male found himself in the
same situation with an all-female
team and had the nerve to protest,
either before or after the fact,
NOTHING WOULD CHANGE.
That's the great double-standard.
Everyone has the right to the
gender choices they wish but since
this is ultimately a balance of
powers issue, another whining
female in a deck so heavily stacked
against men, gets little
sympathy from me.
Dean
In response to Anonymous who says all female nurses are perverts. Of course that's not true, and we all know that. But I do want to bring up a topic that may be disturbing and certainly controversial.
We cannot dismiss or even diminish the power dynamic that exists in hospitals and clinics. Part of the modern hospital "culture" is the patient's powerlessness. It's not a question of "Is it done on purpose?" It's embedded within the system. Part of the culture of the modern hospital is that the doctor and/or system is the keeper of the "Knowledge" and the patient is the recipient. It's basically the patient's role to just accept whatever happens. I know things are changing, but this is still a significant if not the dominant culture within hospital settings.
To quote Charles E. Rosenberg in his book, "The Care of Strangers: The Rise of America's Hospital System" --
"The evolution of the hospital has reflected a clear and consistently understood vision. That vision looked inward toward the needs and priorities of the medical profession, inward toward the administative and financial needs of the individual hospital, inward toward the body as a mechanism opaque to all but those with medical training -- and away from that of patient as social being and family member. It was a vision, moreover, so deeply felt as to preclude conscious planning, replacing it instead with a series of seemingly necessary actions." (page 7)
Power can be dangerous. You all know the quote about absolute power corrupting. There are some (a very few, I'm sure) medical professionals who enjoy power. They get a thrill out of humiliating patients, and exposing naked patients is one way to achieve this. These days, the risks are too high for these few men doing this with women patients, although there are all to many cases of male doctors abusing females. But the risk is less for those few female doctors/nurses doing it to men. An analogy can be made to male rape by women. It happens, but how man men will admit it, and how is it perceived in the public and the media? I'm saying that there are a small minority of female medical professionals who get their kicks out of humiliating and abusing men. And there are some (few) male doctors who enjoy the power of allowing their female nurses and medical assistants access to naked men.
The stories we're reading about some military physicals attest to power and humiliation. Some doctors who insist upon female chaperones for males may be guilty of this, too. You can't convince me that some people (those with the power) weren't enjoying that.
The modern hospital in this country was established by 1920. Many of the problem issues within hospitals today were brought up from the very beginning of the modern hospital's creation. The problems, however, have become more complex and worsened.
One more thought:
Read about the history of medicine, hospitals, nursing. You'll see how young modern medicine is. If you were a person of means in 1880 and you got sick, you didn't go to a hospital. You brought the doctor to you and were cared for by your servants or by people you hired in your home. In 1800 there were only two hospitals in the US -- in New York and Philadelphia.
The feminization of nursing is a 19th century, Victorian construct. It came out of the Florence Nightengale era. Women were always caregivers, but men were, too. In fact, male nursing orders were not uncommon throughout history. Nurses became primarily female beginning in the 19th century for several reasons:
1. The rise of professional nursing coincided with the reform movement, the industrial revolution and the woman's rights movement.
2. With the rise of industry and people leaving rural areas and moving to cities -- reformers were looking for a respectable profession for lower class, uneducated, females (especially former servants) to move into. Few professions were available for women. Nursing was one.
3. Some nurse reformers like Florence Nightengale didn't believe women were fit to be doctors. But, they insisted that, if men were to be the doctors, the women were to be the nurses.
4. Victorian mores established women as homemakers, housekeepers, doers of the dirty work within the home, servants, childbearers and caregivers, inferior to men, often incapable of (or in no need of) higher education.
4. Early hospital management was more about housekeeping than about medicine. There was food to be prepared, dishes and clothes and sheets to be washed, bedpans to be emptied, floors to be mopped. Cleanliness was as important as medical treatment, which wasn't very advanced anyway. This housekeeping was the woman's domain.
5. Once early hospitals became established and grew, nurses were a source of cheap labor. Most were young, uneducated, lower class, and not head of households, thus, not needed as a primary wage earner.
5. Nursing schools started in the US in the early 1870's, and soon flourished. They flourished, even within smaller hospitals, because one or two trained nurses could supervise 19 or 20 student nurses who were paid little or nothing and who were often sent out into the community to nurse people at home for a price, the income of which benefited the hospital. Again, they were a source of cheap labor.
It's difficult to find the research about exactly what these early nurses did regarding male care. There was concern that they shouldn't be dealing with males. But this began to change as medical techology increased, and the profession became more female dominated. At some point, I'm not sure when, it became just accepted that women would just do intimte care on men with our without their real consent. This subject is very difficult to research, as are many sociological, under the radar, topics. People didn't often talk or write about these things.
I suppose my point in most of this is that we need to realize how young modern medicine is, how young the hospital system really is, how young modern professional nursing is. I'm not making excuses for the abuses that are happening. But changes are happening in some cases, slowly, and we, as patients, need to be among the leaders in these changes. We need to be proactive and not afraid to make our wishes known regarding our personal care.
To gve
Do you really think that female
nurses or any female medical worker
are going to leave their gender at
the exam door. Are you really that
naive? I have had 5 female nurses that were unprofessional towards me. Additionally, I work in health care,I know what unprofessional behavior is!
To Anonymous:
I don't think anyone, males or females leave their sexuality behind in any hospital setting (or anywhere else). That goes for patients as well as doctors and nurses. Our sexuality is embedded within us genetically, and our attitudes and values are culturally embedded.
The question isn't whether doctors and nurses leave their sexuality behind when they do exams and procedures. There's no need for that question because the answer is simple. They don't.
What matters is how they deal with the sexuality they bring with them into the exam room. How do they handle their feelings? Are they able to control these feelings and/or urges? Most do, but the question is how. Do they create defense mechanisms that help them get by but make the patient feel uncomfortable or humiliated? Or do they use strategies that make the patient feel at ease, comfortable, empowered, secure.
When patients object to opposite gender care, and the nurse or doctor says things like:
-- Don't be silly.
-- We're all professionals here.
-- I've done this a 1000 times.
-- Don't think I haven't seen 1000 of those before.
These comments are designed to make the doctor/nurse feel better about what they're doing and to stop the communication so as to get things moving. They ignore the patient's feelings and focus on the doctor/nurse feelings.
I agree with you in it's naive to believe that some doctors and nurses don't occasionally enjoy feelings associated with power and seeing naked bodies, depending upon on the context. For some, these feelings may bring guilt; for others, they may not. And as I said earlier, the very few may actually put patients in embarrassing, humiliating situations for perverse enjoyment. I say "the very few," and I mean it, but I do believe this happens more often than we think.
As I said, how does one know how or what doctors and nurses really think about these things. These are not the kinds of thoughts they share with non medical people, and even within the profession. This is why some of the threads on blogs like allnurse.com can be so disturbing. To some extent,(it's difficult to say how much) we're getting an inner, accurate view of the kinds of attitudes that in the past were never made public. They may have been discussed "in house" in the break room, but never for public view. It's easy to say that these are just blogs and we don't really know who's writing them. But I've interviewed dozens of men about this double standard we're discussing and about their experiences, and, although I can't quantify my conclusions, I believe the stories they tell me. They match what I'm reading on this blog and on others.
The patient as a social, sexual, feeling individual has not been part of the hospital culture historically. It's expected that patients drop all that when they enter the hospital door. As I said, there are efforts to change this, but other forces are also hard at work to maintain the status quo. Systems will fight like hell to block change. And that's what we're seeing as well.
MER.
As always, a wonderful, concise, and thoughtful posting. I do hope you are saving all these
words and your other writing and research toward publication in a book form. It should be
clear that a great controversy is brewing here and the internet tool is letting it gather in strength for the first time. Any publication needs to have a
political position to be interesting. I see in all your writing and research a balanced approach but one that keeps reaching the inescapable conclusion that something is wrong here and the status quo
is covering it up. I hope whatever comes of this will have some of the zeal of the crusader and present a hard-hitting attack on medical personnel as
regards their self-proclaimation that patient modesty is not an issue. Good luck in your efforts to debunk this myth.
WJB
I have wondered how married men handle the fact that their wife who is an operating room nurse and handles penis' all day long: scrubbing, cleansing, inserting catheters, etc. accetps this. For all the men on this site that object to the double standard and the male modesty issues -- how would you handle that if that was your wife's profession? Certainly many careers in nursing do not include nakedness as a part of the daily routine in performing their duties. But for the nurses that do this routinely and then go home and jump into bed -- I wonder, as MER stated do they really leave sexuality behind and block all of that from their mind?
Don't forget about cvicu's,neuro icu. I once dated a nurse who was
in nursing school and when she came
home she found her job titilating
that she saw so many penis's. I dropped her like a hot potatoe!
I have had a female family member recently start working at our local hospital as a change in employment event. I haven't talked in detail with her, but a couple of observations, she recently completed her GED after many years out of school, she had some very limited training with a few hours a week in evenings for a couple of months. She now works in the post op at the med surg part of the hospital. So much for we are all professionals here, she is a great person, but a few hours of instruction and a set of scrubs does not a professional make. I asked her wasn't it wierd working on people she knows (it is a small town hospital). She said a little, some are very hesitant to let her "peek at certain areas" as needed. She said, I try to keep everyone covered, but some of the nurses who have been there awhile just whip the covers off regardless of who is there....so it comes back to the question...do providers become so used to it they project their lack of concern with nudity onto their patients...and I know from the blogs here, many don't have problems with nudity, as long as its yours and not theirs....which goes to the above posts. JD
This may be digressing from this topic but to further add to MER's previous post about the "history of" things and how new our medical system is, etc. one can go online and look at www.malenursemagazine.com. There is a link detailing the history of males in nursing. Even the history of the physician is interesting. Years ago physicians were not a "big deal" for lack of another phrase. They were not paid much and were not especially highly regarded or respected. Some history is listed on http://answers.com/topic/medical-profession-1.
If you do a google search on History of: physicians, nurses, etc. there are many sites that give great facts.
In 1948, Andrew Moyer received a patent for the mass production of penicillin. Not really that long ago! Look how far technology and medicine has come.
JD's post about people going into healthcare and are now "professionals," I can personally attest to that same scenario. I can't tell you how many times we have heard this same thing. A hairdresser in a "Haircutters" left and became a nurse. (I guess she was ready for the OR -- shaving hair!). A receptionist/secretary at a boat dealership left and was an RN. A sales associate at Penneys is now a nurse, a male accountant becomes an RN. On and on. Yes, they are now all professionals.
I want to bring attention by all my visitors to this thread who are interested in encouraging change in physician or hospital staff behavior to a new hospital requirement by the Joint Commission. This is the organization which officially accredits and certifies hospitals for participation in the Medicare program. Read all about it on my new thread "Hospital Doctors and Staff Must Now Squelch Disruptive Behavior!"
The new requirement of hospitals define disruptive behavior as both active (abusive language or worse) or passive (ignoring requests, inattention to phone calls, etc)
This requirement should provide some clout to those who want the hospital to consider their interpretation of disruptive behavior in terms of patient modesty issues presented here. Read the full order by the Joint Commission through the link on my thread and let me know what you think about it. ..Maurice.
Excellent development. Knowing
this was a fact would have changed
my reactive response to a hospital
regarding a modesty violation that took place 15 months ago.
Next time will be different.
BB
I'd like your reaction, doctor, to a question or two I have. I read through the Joint Commission statment on "Behaviors that undermine a culture of safety."
As I read it, it appears clear to me that what we're talking about on this blog, ignoring patient modesty, comes under what the commission calls "passive activities...manifested by health care professionals in positions of power." This comes under what they call "...intimidating and disruptive behaviors..." that "erodes professional behavior and creates an unhealthy or even hostile work environment."
This could include:
1 "refusal to answer questions" -- Or, when asked for same gender care, changing the subject, ignoring the request or...
2. Using "condescending language or voice intonation." That is, not taking the request seriously and responding with "We're all professionals," and other similar expressions in a condescending tone.
3. Not reporting or interfering when a fellow health care worker ignores a patient's modesty.
I could go on, but I think you get the point. My interpretation of this document is that, when asked for same gender intimate care, health professionals should take the request seriously and either grant the request or demonstrate that they have made a fair, consciousness effort to grant that request.
What I'm asking you, doctor, is whether you think I'm on the right track with this interpretation. I ask this for two reasons:
1. If left on their own, most hospitals will not consider requests for same gender intimte care as coming under this issue. They will focus on the more serous examples that involve "patient safety." They will not even think about patient modesty as a "safety" issue and thus ignore it.
2. This document presents a real opportunity for patients concerned with this issue to see to it that hospital internal boards and commissions that are tasked with dealing with this issue include patient modesty and the double standard for men as part of the problem. Some will resist, others make take it more seriously. But, with this report available, they cannot ignore the problem. They must face it.
What's your take on this, doctor?
Dr. Bernstein
The order that you've posted is a good idea but as you mentioned, it depends on how the actions are defined and by who. I don't think patients will see the full benefit if the health care professionals set the guidelines. As has been pointed out many times on this blog, everyone has their own idea on how and what actions are appriopiate so I think it would be difficult to come up with some generic guideline for all. Perhaps I'm reading to much into this but for things such as this I think patients should have some involvement to get the full satisfaction that they're wanting.
Jimmy
Here is my response to MER's question which I wrote on the "Hospital Doctors and Staff Must Now Squelch Disruptive Behavior!" thread noted above. ..Maurice.
MER, I would say that the suggested hospital Code of Conduct which should include the following could easily be interpreted as related to the response or non-response of the hospital or doctors to the patient modesty or the professional gender selection issue:
"Responding to patients and/or their families who are involved in or witness intimidating and/or disruptive behaviors. The response should include hearing and empathizing with their concerns, thanking them for sharing those concerns, thanking them for sharing those concerns and apologizing"
To both of my visitors: If you are not involved in hospital administrations or are a doctor or nurse in the hospital you may have no idea of the clout that Joint Commission holds and uses. They investigate policies and behaviors in an extensive and thorough manner of hospital and staff with regard to standards of hospital practice which they have ordered, without fully informing the hospital when the Commission staff will appear. And failure to comply is followed by warnings and potentially severe financial penalty with the loss of Medicare.
payments. The Joint Commission visits scare even the most sophisticated hospital administration. So this requirement by the Joint Commission is and will continue to be taken very seriously.
As a physician in my local community hospital, this Joint Commission order was clearly explained to us in a recent medical staff meeting. Yes, there was some discussion amongst the physicians about a value to abusive language directed to another staff member when that member was seen doing something critically wrong in an acute situation when a patient's life was at stake. However,some felt that one could notify that staff member effectively about the error without using abusive language.
Yes doctor you are absolutely correct in the the "pop-visits" or pre-scheduled visits from the "team" of JCHACO scare most facilities. However, the new legislation still depends on formally filed complaints and unless language specificaaly stating something along the lines of "patient gender request for intimate procedures is ignored by clinicians" I don't think this new "rule" will be intrepreted to an issue of patient modesty. Again, I don't think patient modesty is taken into account or taken seriously by the healthcare teams. They view it as a non-issue and think patient should accepts whatever and whomever does the job.
Even if JCHACO receives a complaint as this they claim to take it seriously, but if it is investigated at all on the following inspection, I am sure it is only discussed and then quickly dismissed. The facility is probably warned to "try to accomodate" a patients' request. End of story.
MER and other interested in posting to a new blogsite I encourage you do do so regarding patient modesty issues. The site is http://yournursingsite.blogspot.com
This was listed on advance for nurses and invitation to post thoughts and articles. There is a good article about the history of nurses serving those who "serve" (military). This would be a good forum for the patient modesty and double standard "care" problems.
For those who are interested, my article on my blog and the issue of patient modesty is scheduled to be published in the American Medical Association News by September 1st 2008 and is said to have a readership of over 200,000 physicians. I don't know how many of the 200,000 are going to read my article. Anyway, this is my contribution to "spreading the word" to physicians regarding patient concerns about modesty. I have been given permission by AMA to put the entire text of my article into this blog after the article has been published by AMA. ..Maurice.
To Anynomous:
No, it's not End of story.
Here's what we can do as patient advocates.
-- Contact hospitals. Learn their core values, usually found on their web sites. One or two of the core values usually have something to do with patient rspect, dignity and privacy.
--Find out who the medical ethics person is at the hospital. Ask him/her what the hospital written policy is regarding same or opposite gender intimate care. If they don't have one, ask how the impliment their core values, that is, how do the practice respecting patient privacy and dignity on a daily basis, specifically when patients request same gender intimate care.
-- Ask how they are respond to the Joint Commission's request to deal with the issues discussed in their paper.
-- Ask if they've formed a committee, or handed the issue to an existing committee to come up with suggestions to deal with the Joint Commission's new paper.
-- Ask if that committee has patient representation. If not, ask to be the patient representative.
-- If the hospital doesn't have patient representation or wont' discuss this, bring the issue right up to the hospital administrator.
-- If we can get to represent patient points of view on these committees, they perhaps we can get this issue on the agenda and into the hospital policy.
Granted, this takes work. But any advocacy issue takes work. Change doesn't just happen. People push for, lobby for, demand, change. Once they see you won't be going away, that you'll keep coming back with the questions and demanding the answers, they'll pay attention.
Dr. Bernstein. I'm sure the JCHACO warning has nothing to do with patient modesty. It is meant to influence staff involvement with each other. Medicine has always been accused of bullying between layers of authority. Doctors vs. nurses, etc. This can get very disruptive for retaining staff and keeping their focus on the actual jobs vs the politics at hand. As a result, patient safety suffers. JCHACO is only interested in this aspect. I'm positive they view patient modesty as more of an issue which divides staff and cuts into the number one considereation which is patient physical well-being. Mental well-being is not being considered. It's check your modesty at the door. JCHECO could
care less about any double-standard. That's a simple staffing issue that they don't wish to complicate further. I'm sure if a patient goes to JCHECO on a modesty issue they will say the new guidelines are being misread in patient self-interests for matters they are not deeming as a threat to health standards within a hospital, simply personal intangibles.
- Hudson
Hudson, rather than just assuming the attitude of the Joint Committee, why don't you contact them directly and get their response and then write the results of your investigation here.
Read about the Joint Commission's Public Policy Initiatives at this link.
My reading of the suggested hospital Code of Ethics "Responding to patients and/or their families who are involved in or witness intimidating and/or disruptive behaviors. The response should include hearing and empathizing with their concerns, thanking them for sharing those concerns, thanking them for sharing those concerns and apologizing" is pertinent to a patient who is "involved in..intimidating behavior" of the hospital or physician or staff. Certainly what has been described on these threads could meet the criteria for "intimidating" if not "disruptive" (interfering with the safe and appropriate treatment of a patient).
As MER has recently reminded us, it is important to act rather than simply talk to this blog. ..Maurice.
I agree with Hudson's comments regarding the intent of the JCHACO with this new directive. I do believe the modesty issues/staff assignments, etc. we are discussing here typically falls under an "ethics" issue if a patient's requests/concerns are not addressed. My spouse did assert themeselves and filed a complaint. It was only on the following inspection by JCHACO that it was addressed. It remained on their record for just the one period of four years and dropped. Nothing was achieved from the patients' perspective and they are still doing business as usual. Their routine did not change. The CEO of the organization responded with a brief written appology and stated that is what the "nurses" are trained to do. So I say again..End of Story.
A great many surgeries are now done in outpatient free-standing surgical centers and they are operated with a medical director and administrator. Thus there are no departments in place as MER stated. So if a patient is to address these issues the only source is the nursing staff or the administrator. Basically it is "check your modesty at the door" because many do not have male staff.
I understand your doubts and sketicism, but there are a couple things to remember, change doesn't just happen, it is caused. Even if you feel the JCHECO intent was not modesty oriented if enough people push it to them might expand the intent. Also, as a business owner, and make no mistake to the management it is a business, even if you don't get penalized, you don't want your facility being brought under the focus of a governing agency. It is a hassle, it takes time, it is stressful, and there is always that chance that they may toast you.
I would have agreed with the last poster before that nothing will change, ....if I had not got a local facility to change the policy at their imaging center, females were asked if they had a preference, I wasn't, when I wrote the patient advocate and did not get an answer (which could have been a non delivered e-mail) I contacted the VP of patient relations. They now ask both males and females if they have a preference for intimate exams and procedures....small victory...but a victory none the less...they may not change, they may not be able to accomodate, but they sure won't if you don't push it r at least ask. The other thing to try, ask them before, if they say no...tell them you are going to look for a facility that will accomodate...and let the money people know why...There is a really interesting blog going on all nurse where the nurses are complaining that facilities are becoming so customer service oriented and doing what the paitent wants it makes their job harder....they are really ticked that admin is siding with the patient for financial reasons...it's kind of funny..things are happening some places...I for one am not tossing in the towel and accepting it...JD
Yes, JD, you are correct, changes can be accomplished and I totally agree with your take on "causing" change. In all cases in the future, we will do just as you did ...by asking ahead of time and chosing another facility for elective procedures and treatments if same gender clinicians cannot be accomodated. I fully agree that it is a business and most if not all of what is done beyond what they are legally forced to do is based solely on the "bottom line."
Equality is now the name of the game!
Obviously all this is intended to improve the lot of women but, this can be used to the advantage of men too.
Most so called equality "gurus" are women, they are not at all inclined to be seen to be negative to men, the answer is to chase, harass, cajole encourage, (whatever it takes) these so called equality gurus to address the issue of male inequality.
Ask them how they would like a breast scan of cervical smear to be performed with 3 men in the room, see how they respond.
Equality has to cut both ways, I am already seeing results by being persistent, so can you!
Take you complaints all the way to the top, nobody wants to be seen as being discriminatory so they will not ignore you.
The nurses delivering the treatment WILL ignore your requests, they are only looking out for their jobs.
Here is the text of my article in the September 1 2008 issue of the American Medical Association News that I also put up as a separate thread.
Scenario: Can physician-written blogs meet legal and ethical professionalism standards?
Many medical blogs are anonymous and unedited, few contain reference sources for their authors' statements, and most are open to comments from patients. With these limitations on oversight and reliability, can medical blogs offer genuine benefits to the public and the profession?
Response:
Medical blogs can provide two benefits for the public. They can offer timely and accurate medical information as a supplement to what is available through other media. Perhaps more importantly, they enable members of the public -- often patients -- to express concerns about their health care experiences and to receive feedback from the bloggers and visitors who read their comments.
Writers to the blog can express their concerns fully because they are allowed to remain anonymous. Although many blog visitors comment on experiences they have had or anticipate having with their physician or physician's staff, most of them have not shared what they write about with their physicians, and, for their part, physicians rarely give patients the opportunity to talk about such matters.
There is no doubt that a lack of time and real and imagined power differences between physicians and patients, among other factors, contribute to inadequate communication. Medical blogs help compensate for the poor communication -- the anonymity, time and space to ask and say whatever one wants and the availability of immediate responses to one's comments make medical blogs a means of much-needed ventilation for many.
As an example of the role of medical blogs in the discussion of patient concerns, I'll tell you about my "Bioethics Discussion Blog," which, since 2004, has developed 600 topics related to the medical system, medical professionalism, medical education and ethics.
The most popular topic among visitors to my blog has been concern over violations of patient modesty. I have been aware of the importance of respecting patient modesty throughout my 50 years of internal medicine practice and never ignored it during many years of teaching the skills of physical examination to students. Only after reading more than 1,000 comments by visitors to my blog, however, did I become fully aware of the extent and magnitude of patient concern and distress.
Unfortunately, quantitative statistical analysis of blog responses is probably not realistic, but one can easily appreciate the qualitative aspects and nuances of patient concern for modesty. There are questions about respect for both unconscious and conscious patients during surgery, office procedures and physical examinations.
Visitors ask specifically how well the modesty interests of unconscious patients are respected in the operating room. What is the gender of the attendants who perform the surgical preps? What parts of the body must be exposed? Must genitals be exposed? What opportunities do patients have to express their concerns prior to surgery, and will their wishes be honored in the operating room?
In office procedures and examinations of genitalia, can the patient request that only attendants of his or her sex be present? Will that request be honored? The argument over right to choose the gender of physicians, nurses and technicians always arises. Most people feel that women are granted that right but men are not. Male visitors to the blog state that physicians either ignore their requests with seeming surprise or simply turn them down with an economic excuse or a "take it or leave it" attitude.
My visitors also have found that hospitals are generally uninterested or unable to change policies and employment practices to accommodate respect for patient modesty. Those who can't find a resolution for their modesty concerns write about postponing or disregarding necessary procedures or examinations.
Though my blog visitors are not my patients, and quantitative statistics are absent, I believe their concerns deserve professional and institutional attention. I tell them that, although ventilating on the blogosphere may be emotionally therapeutic, they may need to become more active in bringing about the changes they desire, and I encourage them to do so. At present, writers on the blog are discussing how to present their concerns to their doctors and hospital administrations. I have suggested they form groups of like-minded patients to advocate with those who can help change what they view as violations of their modesty. I think that my contribution of such advice is a legal, ethical -- and humanistic -- response. For professionals who moderate medical blogs, offering appropriate advice goes a step beyond merely providing discussion space.
Medical blogs, moderated with attention to civil and open discussion among the visitors and following guidelines for ethical operations, make a significant contribution to the medical education of the public and, I dare say, the profession.
--Maurice Bernstein, MD, assistant clinical professor of medicine, Keck School of Medicine, University of Southern California, Los Angeles; blogger, "Bioethics Discussion Blog" (bioethicsdiscussion.blogspot.com)
I really like the article, I am going to copy it and send it to some of the local providers with the suggestion they consider starting blogs to gather patient-customer input and thoughts. From there it could be expanded to specifically hit the issue of modesty. Consider the value in the political and music blogs have provided. It may be a simple way to do the advocate group work on a local basis.....Thanks Dr. Bernstein we may be able to use your thread to open local dialouge, I am going to send it to the facilities advocate, admin., and board of directors suggesting they each start a blog
Doctor: Let me be one of the first on this thread to congradulate you and thank you for a well-thoughout and provocative article. I like the way you approach the topic -- by place this modesty issue under the larger heading of the ethics of medical blogging, and how reliable these blogs are. That let's you slip into this controversial topic. Well-done. I hope you continue discussing this issue in future columns. You have the credibility that will make doctors think more about this issue. Maybe, after reading your article, they'll think back to it when asked in the future by a patient to consider his/her modesty issues.
Civil and honest discussion online or in person usually helps to resolve most conflicts as well as providing all parties with insight about others and their feelings.
Being able to do so anonymously also allows greater freedom of speech to private persons or to the shy ones. It is hoped that readers of these thoughts, experiences and feelings do so thoughtfully.
Being able to vent and share helps...but presenting these feelings in a forum, which hopefully will be read by medical practitioners, and helping to achieve change by education is the greatest value of these blogs.
Another benefit is the education of "patients" in how to get their doctors to give consideration to their modesty.
leemacaz
Thanks for the kind comments about my article. What I hope is that a darn good portion of those alleged 200,000 physicians actually cast their eyes upon and actually read the article and think about what they read. Otherwise, the article will not adequately spread the word to the profession. And spreading your words was the motivation for my accepting the offer to write to AMA News. Let's hope and see if any doctors at least are motivated to come to my blog and identify themselves as physicians and write their views. At least, if we can, start a conversation going with them, they may find the meaning to your concerns and there might be chance to initiate changes. By the way, for the doctors to write to a blog in their "free" time to discuss patient modesty may be more likely to occur than taking time out in the office to learn about patient modesty when there is limited time and patients with appointments waiting in the next room. The environment for listening and learning may be better for them over the internet than if their office. In any event, let's see what happens.
I have to be honest and frank with my visitors regarding my own view of the topic. As I repeatedly wrote in the past threads, I have always considered patient modesty as n non-trivial issue and have taught that to my first and second year medical students but have never understood the intensity of concern until I started this series of threads on my blog and I acknowledge that. I must say that, as a physician, I still have uncertainty regarding the merits of patient modesty trumping appropriate medical diagnosis and treatment regardless of the genders of those doing the diagnosis or treatment. Yes, I agree that males should have as much right to gender selection as females. And obviously currently that may not be the case but the reason must be a logistic one which eventually should be resolved and should not be a conscious intent by providers to discriminate. Anyway, this is my view and I look forward toward arguments to support the view that it is ethically right and a rational view that patient modesty should at any time trump effective diagnosis and treatment. ..Maurice.
I would agree with you to a point Dr. Bernstein that modesty concerns should not trump a patienst care....to a point. We as paitents still have the right to self determination. I ride a motorcycle, I know it is less safe than my car, but I have that right to choose to compromise my safety, it's part of our rights as free people. I know that if I eat a big Mac or Whopper it is less healthy, I still have that right, etc etc. We take chances every day of our lives that might not be the wisest choice for our longevity and health. The thing is, the risk we are willing to take for our modesty should be our choice...not the provider. Over time we-Providers have elevated the influence and control providers exert over our lives. Unlike the police, except in a very few instances, medical providers are protecting only us not the public, and that choice should be 100% ours, wise or not.
As I had said, I still have uncertainty over this issue so therefore I welcome any discussion on this very point of patient modesty trumping diagnosis and treatment. One argument I could give to Anonymous from today is that in other matters of patient's personal health decisions, a physician is not directly involved. With the modesty-diagnosis/treatment relationship, the patient has entered the medical system for help for a usually specific problem. A physician is usually involved and has some responsibility for the outcome. So in that regard the situation is different than a patient electing to eat a Big Mac.
A patient does have the right to make personal medical decisions by informed consent. To me, however, the right of the patient is usually to decide whether any physical risk to life or health is worth the potential benefits of a diagnostic procedure or treatment.
There should be some analysis by the patient based on provided knowledge regarding benefits vs risks. My uncertainty is whether patient modesty as a sort of emotional risk is worthy of challenging the advice and professional judgment of the involved physician as is a physical risk. Are all decisions related to one's emotions equivalent to decisions about one's physical outcome? This is the area that I await discussion. But please let us not enter to explanations based on concern about anticipated physican (or other healthcare professionals) sexual motivations or sexual/physical abuse of the patient. While clearly this does occur, it is a rare behavior and is not tolerated professionally or as a matter of law. And thus as with other physical risks which are extremely remote should be put in the proper perspective when making the medical decision.
So I hope I have clarified what to me is still unclear and I await all your views of this issue. ..Maurice.
p.s.- In order to make this or other discussions more understandable about the points taken though continuity, it would be advisable for those visitors who write as "Anonymous" to use some consistent pseudonym or initials at the end of the comment Please remember. ..Maurice.
Dr. Bernstein,
Emotional upset or trauma causes anxiety and stress - both of which are known to be either causative or contributory to a number of conditions that can adversely affect a person's health, both short and long term. Frankly, it baffles me why health care professionals, who clearly should know this, refuse to take relatively minor steps to accommodate a patients needs where it is or may be a factor.
With respect to what trumps what, here's my take......
In this country, individuals have the constitutionally guaranteed right (under the 1st, 4th, 5th, 9th & 14th amendments) of self determination. Numerous court decisions have upheld this with respect to both medical treatment decisions and privacy. So the bottom line in this situation is the individual's right to decide trumps everything.
That said, let's look at what is behind how people make these decisions. Over time, every individual develops what, for lack of a better term, I'll call their own personal value system. It comes from a lot of different influences, both good and bad, - some cultural, some based on experiences and some on education, just to name a few. To me, it's a dynamic entity that is clearly evolving as we experience or learn new things. In our society, every individual has the freedom to live their life in accordance with their own value system, as long as they do not take license by infringing upon the rights of others. The purpose of law is to set guidelines for what those limits are.
Applying this to the present discussion, a patient has the legal right to make any and all decisions about their health care based upon their personal value systems, as long as those decisions don't violate the law.
Physicians have both personal and professional value systems as well, and the problem comes when theirs conflict with those of the patient. When this occurs, from a legal standpoint the patient's decisions take precedence, and in my opinion, it is legally, morally and ethically wrong for a physician to attempt to force their own values on the patient.
TT I understand everything that you write and I agree about the patient's rights and for physicians never to force or even instill their own moral views or personal values on any patient but can simply explain them only if asked. (Though I am certain most doctors would be reluctant even to do that.) My question in this discussion would be, do you believe that the consequences to the physical and mental health of a patient by allowing their own modesty issue to trump any value of a proper diagnosis or treatment as significant as the consideration and balancing by the patient of the financial costs and other personal burdens and physical risks involved in consenting to a procedure or treatment.
I can think of a number of pertinent clinical examples, none of the medical situations are rare, which dramatize my question. How about a 27 year old white male who complains on the phone to a doctor about a newly discovered scrotal lump that by the history told by the patient makes the doctor suspicious of a testicular cancer. The patient is made aware of the suspicion but delays and procrastinates making an appointment for examination and further evaluation simply because of a personal modesty issue. If the mass is really a cancer, the delay or avoidance of examination and treatment could be easily life-threatening. A similar example might apply to a woman avoiding a gynecologic or breast screening for malignancy. Is the issue one of not finding the provider and staff of a particular gender or is the avoidance or delay related to unwillingness to expose one's body or body part to any stranger while either awake or asleep? If it is the latter, I would think that such modesty will never be in the patient's both emotional or physical best interest. If it is the former, I agree that there should be changes in society to make gender selection practical and equal for both men and women patients. ..Maurice.
Dr B, I have not yet received the printed issue of AMA News in question, but have looked at it online.
I was disappointed that 'modesty' does not appear in the title, which is Medical Blogs: Who Are They Good For?. You may have had nothing to do with picking a title. The physician who they had chosen to comment on your article said nothing at all about modesty and only talked about blogging.
In short I fear that very few physicians interested in modesty will actually notice the article. I hope I am wrong.
Joel Sherman
Sorry I was the annom. I forgot to ID, just to prevent a repeat, it is JD. It is easy to understand why there is a difference on this issue, considering providers main focus and motivation is the physical healing of the patient and get disconected from the rest. I was listening to the Doctor channel on Sirius radio (how wierd is that), they had Dr's back from the Gulf discussing how when an enemy soldier is brought in it causes conflict with the soldiers who may be their for one of their friends injured by the enemy. They both said when someone is brought in they loose all sight or consideration that it is a enemy and only see them as a person in need while the soldiers still see the enemy. Providers probably are influenced by that same thinking where we are patients aren't. I guess I would like to turn the tables Dr. Bernstein, if providers feel the outcome trumps modesty, why aren't they the ones aggressively addressing modesty including gender choice. We all know people are literally dying of embaressment by not seeking help...so while they may judge patients for not having the proper priority...they don't look at what we see as a more logical solution. I did face the very scenerio you discribed, twice. I had the ultra sound and was really upset when they assigned a female tech. It was removed no cancer. That actually sent me into a state where I did not bring a second lump up to my Dr. when I found it. It was only after I got involved with this blog that I took steps to get a male tech and had it checked...so I guess my long way of getting to the point, I have complete freedom to decide what I want for me, if I felt providers were doing everything they could, I would be more likely to accept treatment as provided, but I don't feel that way. Simple things, they make colonscopy shorts, how many provide them, they make disposable surgery shorts, hardly anyone provides them...so if providers are really that concerned, do something on their end then I may feel I need to do something on my end JD
I have to assume that most people are reasonable when it comes to the decisions discussed above. I can see reasonable people avoiding an exam or procedure because of modesty involving the opposite gender. If they continuously avoid it without making their feelings know to doctors and nurses, then the problem is more serious. If they make their problem known and are consistently dismissed, then, as far as I'm concerned, the problem is with the healthcare system.
Someone with a serious health problem who won't expose his/her body to anyone of any gender, probably has a more serious problem, and I would think that this case would not be as frequent. I'm not judging the reasons why people may feel this way. Some may be justified, some may not. But healthcare professionals need to recognize these kinds of situations and deal with them by helping the patients, and if that means accommodating them, the so be it.
In a free culture (in non free cultures, too) people make decisions every day that adversely affect their health and well-being, even their lives. That's part of what free will means if it means anything at all -- the freedom to make wrong decisions.
I recall once being on a jury were the defendant decided to defend himself and did such a miserable job of it that we, the jury, sent a note to the judge during our deliberations saying that we thought the man didn't get a fair trial. The just replied that the man was found to be competent to make that decision and, thus, took the responsibility of his own defense into his hands. He's now spending many years in prison because of that. I think a lawyer could have gotten him off or at least less time.
The real question becomes one of communication and of informed consent. Was the patient really informed of the adverse effects of his/her decision? Did the doctor spend enough time explaining things?
How does this tie in to what we're discussing about men and the double standard? I've just found some interesting research about men in these situations, which I'll share later. But for now, how about this for a statistic?
"Studies suggest that women are better at building relationships with their doctors than men. The typical number of questions a male patient asks during a 15-minute exam is zero, while women average six."
This statistic is from studies conducted by Dr. Sherrie H. Kaplan from UCLA. More on this later.
Now, if the man doesn't ask any questions does the doctor just assume he doesn't have any? I think that's the case. Either that or the doctor is so busy the doctor kids himself into thinking the man doesn't have any questions. Medical professionals need to be trained to deal with these situations -- and men need to start taking more responsibility for their own healthcare.
Men need to communicate more with health care professionals. And healthcare professionals must accept that fact that men just don't communicate as much as women and adjust their communications styles to help men. And they can't do this if men feel uncomfortable about the people giving them intimate care and procedures. Men will just shut down in situations like that.
I'll provide more of these studies to you in a later post.
I'll keep saying this over and over. It's about communication. That won't solve everything, but it's a key to solving many if not most of these problems.
I completely understand the comments of Dr B, regarding why patients have concerns.
The point he continues to miss is that i have no care on concerns about why or how the provider feels.
The fact that what they are doing is usual, commonplace, everyday, routine, normal, seen it all before, professional etc etc for them is of no consequence for me.
I want to feel comfortable when being examined or treated, NOT uncomfortable and stressed.
Having Three females in the room for a cystoscopy or Urodynamics procedure is fine for them , NOT for me.
By the way, can i add my praise for the content and existence of your article, my bet is most physicians will pretend they have not seen it.
Golly, a lot of valuable comments that is pouring in!
To Dr. Sherman, I wanted you to know that I didn't select the titles that you see on the website. I wasn't even told about them when asked to write. Actually, the editors simply wanted in addition to have an article about medical blogger ethics (Dr. Rob Lamberts) they also wanted an article as an example of a medical blog (me) and what I see is my contribution to medical blogging.
Of course, with the offer, I thought this would be a great chance to give as an example the various aspects of patient modesty which have been discussed on my blog...and especially important to my visitors since AMA News is a newspaper directed at physicians. With that, I wrote what you see and they accepted it with almost no editing. I agree that it would have been more effective for spreading the word if "patient modesty" was in the title or question of the column. But since the issue was ethics of medical blogging as a general subject, I can understand why "modesty" was not in the titles.
As I mentioned, I also wonder what will actually be the reception of my article particularly amongst physicians. I don't really know how to find out. Maybe, later, I'll google the subjects and see if my article is referred to in other professional media. (If others find something, let me-us know!) Anyway, this was the best I had the opportunity to do to "spread the word". ..Maurice.
Dr. Bernstein,
In response to your question, I believe that each patient needs to weigh the information they are given and alternatives for diagnosis, treatment or non-treatment in conjunction with their own personal value system and make the decision that is right for them. What's right for me is not necessarily what is right for someone else. For some patients in some circumstances, letting modesty issues trump other concerns may certainly be the right decision for them.
As MER points, what passes for informed consent is quite often woefully lacking in content. In the scenario you describe, I think that it is incumbent upon the physician to inform the patient not only what they recommend, but why. End the conversation with a reaffirmation, something like "I know these types of exams can be embarrassing. Most of the time it's nothing major, but there is a real possibility that the condition you described to me might be something serious, and I strongly recommend you get it checked out as soon as possible. If you don't feel comfortable making an appointment with me, I urge you to make an appointment with someone you do feel comfortable with. Please don't let this go, it could be really important to your health." At this point, it's the patient's decision to make. People really hate surprises. If they do make an appointment, let them know what to expect and ask if they have any preferences as to technicians, etc. If they do, try to accommodate those preferences, but if you can't, let them know ahead of time, explain why and see if there's some alternative. As MER said, it's all about good communications.
From a personal standpoint, there are some procedures that I would never consent to under any circumstances. The decision is mine, and I am willing to accept both the responsibility for my choices and any consequences that may result.
TT, gve, and JD all make good points..especially about a patients rights to make decisions for themselves about who is present and under what circumstances they are naked.
Situational nudity and exposure are viewed differently by each person. Medical folk merely see it as part of what they need to "do their job" most of the time.
I have found something from my recent experiences that surprised me... I learned that my doctor was somewhat embarassed at having to ask me to "drop em"..and the DRE is as unpleasant for him (don't blame him) as me... the fact that I had refused a female doctor also had made him nervous as to the extent my modesty issue was. I learned this from a specialist he had referred me to..when the specialist seemed hesitant at first.
I flat out told him I did not get as embarassed by males..but both because of some events in the past and the way I was raised you just did not go naked much at all and especially in mixed company... Nor was I crazy about having an audience beyond those absolutely necessary...
If I wanted that I would find a doc to set up an office at a nudist camp and join one myself. (before I get in trouble. I know that not all nudists are comfortable being naked in some circumstances..if I remember correctly one even added his comments to that effect previously in this blog)
I really hope that when doctors read your article...that they will take the time to look at your blog and not only for the ethics of blogging, but for the modesty issue as well.....if they use the same technique as in trying to determine what ails a patient, then they will also see another issue for them to consider. I do hope they will view not only the subject of ethics, but individual issues of ethics from the standpoint of their oaths...They reject a treatment if it does more harm than good...So what about modifying the manner of treatment in teh same way.
Doctor B...you can not make them read..or comprehend... (You can lead a horse to water but you can't make him drink) , you have done a great service to all by creating and maintaining this forum.
Thanks
Thankyou
I completely agree with TT post of 8-28. Communication is KEY and it is what is most times lacking. Anger occurs when expectations are violated. That statement holds true to many circumstances in life, not just medical issues.
Healthcare personnel of all levels for some odd reason does not appear to hold any respect, concern or give any attention to peoples feelings regarding modesty. The general tone is that "this needs to be done" so it doesn't and should not matter to people who is doing something of a very personal nature. That is what needs to change.
JW
Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston runs a blog titled "Running a Hospital" which I happened to discover through the Blogs of Note listing by blogger.com .
Since the discussions here on patient modesty including health provider gender selection were applying to hospital system policies, I thought it would be quite appropriate to indicate to Paul as the leader for his hospital, the discussion continuing on my blog and invite him to come and contribute his view of the issue as seen from a hospital administrator. If not, writing here, I hoped he might write on his own blog. Here is what I wrote. Hopefully we will all learn more from Paul and, if he was unaware, he might learn from the writings of my visitors. ..Maurice.
Maurice Bernstein, M.D. said...
Congratulations. As a physician, I know that Hospitals and their life and management are complex creations with many parts and functions. Therefore,I think that it is important and noteworthy to read about hospital systems as seen more broadly from an executive.
I moderate a bioethics blog that covers many issues in medical education, medical care and practice. I have been impressed by the well beyond a thousand comments written to one particular topic: patient modesty. As a physician and teaching first and second year medical students, I was aware of the need for physicians to be attentive to issues of patient modesty but until moderating the blog, I was unaware of the intensity or extent of this patient issue. One of the areas that my visitors emphasize is the lack of attention to their physical modesty concerns within the hospital environment and their inability to obtain their selection of a specific gender for their hospital care providers. Particularly the male patients feel that they do not have equal opportunity to request and receive male providers as do the women patients requesting women providers.
I, myself, am still trying to learn about all this and particularly how hospitals handle these issues if they come up and the pros and cons as seen from the hospital administration point of view. Paul, I would hope you might come to my blog and post your views on this topic or if not there to post it on your blog. I think that myself and a number of my visitors would greatly benefit from reading your views as you see them from your hospital system position. Again, congratulations. ..Maurice.
Maurice Bernstein, M.D.
Associate Clinical Professor of Medicine, Keck School of Medicine, University of Southern California
"Bioethics Discussion Blog"
http://bioethics.discussion.blogspot.com
August 29, 2008 10:18 PM
Paul wrote back on his blog that he will come to my blog. I then thanked him with the following response. ..Maurice.
Paul, thank you for planning to visit my blog. Unfortunately for the development of a full and fair discussion, virtually all of my visitors are patients who take one side expressing their great concern about how their modesty issue are not taken into consideration by all providers in the medical care system. There have been very few if any visitors that I am aware who can tell the physician's or the hospital's view of their concerns and whether their concerns can in some way be lessened or even mitigated away.
Issues of patient physical modesty, beyond simply provider gender selection, even include how patients are treated, conscious or unconscious, within the operating room. Topics include whether there is unnecessary exposure of their bodies within the OR and whether patients have, as part of the formal informed consent, the right to express their concerns and desires directly to the surgeons and hospital operating team.
Hopefully, for simply an attempt to "spread the word" of these patient blog visitors to those who read the American Medical Association News, I have an article there in the current September 1 2008 issue describing the series of threads I have on my blog dealing with the patient modesty issues.
Again, thanks for your consideration. Your views will be very important. ..Maurice.
I am publishing this statement by an anonymous visitor (with an institution name deleted) only to demonstrate what I would consider an uncivil writing that makes accusations but without any documentation or reference to resources. Although I agree with ventilation of feelings, since this is a discussion blog, the commentary should include a documented basis for those feelings, especially if accusations are made. ..Maurice.
I find the lack of respect for patient modesty to be intimately related to a lack of providing patient security. A janitor raped a woman under anesthesia at [institution name deleted] after I had heard from a nurse patients are often left naked in full view of janitors cleaning around them. How many women are raped and never know. All the male doctors, students, nurses who get upset at women's reqests, all the women doctors, students, and nurses who fail to respect women's requests for modesty, exclusion of males, or female presence during intimate exams or while under anesthesia are simply rationalizing. 60% of males asked said they would rape if they knew they could get away with the offense. You act like rape does not occur in the medical field, when the fact is that female doctors and nurses suffer much sexual harassment. Female patients are exploited. Sedated, stripped and used for both education on some sick men's sexual gratification. Truth be known, about 40% of the male population does not find rape erotic. The rest of you are sick sick sick and I hate hate hate you and the women who serve as your silent partners.
Obviously, you don't work in a hospital. For if you did you would know that it's FEMALE nurses who
do the groping and molesting. I've seen them fight over who gets to
insert a foley catheter into a young male patient! You watch too
much ER!
Dr. Bernstein
Very nice job on the article that you wrote and thank you for taking this seriously. Much like Joel, I wish the title would’ve included “Patient Modesty” as this may have got the readers attention but anything at this point is a plus in my view. I commend you on opening your eyes and seeing that this really is a concern to a lot of patients and now through this blog you have recognized that it shouldn’t be ignored. I read several basic medical articles that have questioned why so many people (male and female) choose to put off exams and don’t go for regular check-ups even though it could be beneficial to their health. I wonder how many of those people who have died or have gotten very sick are like many of us on this board. In my opinion, it should be the medical professionals job to ensure that every patient be treated as they see fit and if they took these concerns seriously and made an active attempt to do those little, inexpensive things like JD has pointed out, maybe that number would decline over time? As I’ve said before, it can work both ways and it wouldn’t jeopardize the patient’s health.
I can’t really comment on the last few post. Truth is, I don’t even want to think about those things and don’t feel it happens very often. I never consent to any additional people in the procedures that I’ve gone through, I’ve got a few nurses upset that I said no but I’ve never given in to that. My wife herself has been called into many OR’s in her time spent at our local hospital so I do know that people who have nothing to do with the patients case are sometimes present during sergeries. That needs to STOP. My wife went so far as to refuse to go in until the surgery was over once because she felt it was unethical and the doctor just had a fit about it. The really don’t give it a second thought.
I just went through a second knee scope a few weeks ago. Same knee that I had cleaned up in December. I went to the same facility that I went to the last time but I got a different prep nurse this go around and when she gave me that sexy gown to change into she told me to remove everything. I didn’t get mad, I just simply told her that I’d feel more comfortable to keep my underwear on and that it hasn’t ever been a problem with my doctor and that it wasn’t a problem back in December. She said that would be fine. I later asked her if they still offered briefs to their patients and then the truth came out, she said that some of the nurses do but she doesn’t. I dropped it at that point and let them get on with the business at hand (fixing my knee). I just don’t understand why it seems everybody has their own agenda, has anyone ever heard of consistency? Why doesn’t common sense apply to medical personnel? It’s time for them to take a look at their procedures and ask if it’s really necessary and consider the patient for a change. We shouldn’t always have to be the one to bring up the issue.
Jimmy
Just out of curiosity, I did a Google search on the institute that was deleted to see if I could find where this occurred. Found several news articles but found this discussion interesting:
http://www.concurringopinions.com/archives/2007/07/having_obstetri.html
Seems that we are not alone in how patients are treated. More proof that something needs to change in regards to patient care. This may be a good forum to post comments.
Jimmy
The article about the male raping a female patient in the OR somewhere. If the female writer who wrote the article would stop hating males so bad and blaming the entire male race for that female being raped. I bet 9 out of 10 it was a female nurse or tech or staff who left this female patient alone and naked. As we all know 90% of the caregiving staff in a hospitals are females.
I see the issue as the medical personnel taking into account the feeling of the particular patient. As for me, I am a male in my mid 40's who has had a female doctor for almost twenty years. I have never felt nervous with her seeing my privates or examining them-she is my doctor and I trust her. I was referred at one point to a urologist (after having kidney stones) and the male doctor had to insert a catheter into my penis-I was nervous about the possible pain but nothing else. I was prepped by a young female nurse and it of course didn't bother me. However, I did think later that he could have asked if that was okay-though he did tell me "Kathy" or whatever her name was was going to come in and prep me-I suppose I could have objected then. If I was a female I probably would have been asked before a male nurse would have done an intimate procedure. Another thing I find a little amusing is when my doctor does a physical exam, she has me be undressed completely but them has me wear a wrap around cover so that when she does an abdominal check-my privates are covered. To me, it's get uncomfortable with this moving piece of cloth-I'd just as soon have her just check me with out it-after all she has already seen every square inch of my body over the years-and in most cases will soon see everything when I bend over for my digital rectal exam. Seems kind of overboard to me-but I do understand not all people are comfortable with even their doctor 20 years seeing them naked. It is an interestindg topic.
Reading this on concurringopinions is disturbing and shows that most all people going in for a procedure and are anesthestized don't give a thought to what is going to happen to their body after they are unconsciously sedated. In retrospect, I now think about a couple of procedures I had done many years ago. The problematic issue in addition is the blantant "lying" that occurs. This is unethical although it appears to be rampant behavior as my spouse was a victim of being told a lie. The only way I see to alleviate this pathetic issue is to have a patient advocate (i.e. spouse or other responsible party to look out for your interest) stand-in during the entire time a patient is no longer in "control".
While I would not want unnecessary exposure while unconcious, it is not as great an issue with me as exposure while I am concious. The concern I have is in an unnecesary audience especially...(companytech reps and anyone not directly involved in my teatment. This is really so for ER's.
There are numerous antedotes about patients coming out from under anesthesia (but paralyzed by drugs) who have heard unseemly commentary by surgeons and others present. There is also the case of a doctor who took pics of a guys privates because of a tatoo....and sent it to several in the hospital.
I understand he was fired though.
These are unnecesary ....ridicule and violation of patients privacy and of the doctor/patient relationship...
I think the only way to make sure of privacy( no "audience") is to have the surgeon in charge ensure your wishes...I also personally do not want a movie or photos of my operation ... any photos would have to be limited to only some internal organ ....
AND it would not hurt to remind the staff in recovery that you might be capable of hearing them before you have opened your eyes..
leemacaz
There is a very interesting thread going on allnurse about a female patient who is suing her surgeon after she woke up to find a small removable tattoo on her "below the panty line". Seems he has done this in the past as a way of humor and releasing tension for the paitent... The conversation is long and heated and varies from no real harm he was just trying to be cute to this is abuse and assault. The difference of opinion is very different among the providers as it is among us patients. There is a post by wymnwise who is obviously the same person posting the I hate men, most men are rapist (qouted the 60/40 etc) here, that post is about 14 pages back thats really extreme. To me it is an interesting read because it highlights what we all see here, the difference in personal feelings and attitudes toward this issue, even among those on the other side of the gown...so while this is an unusual or perhaps extreme example, why in the world would providers not error on the side of caution...everyday...and while I do not advocate legal action as a solution all the time, and honestly think it may be a bit strong in this case...bet the good Dr. leaves the tattoos at home from now on....Alan
Alan there is no need for any discussion about tattooing a patient without consent, it is criminal battery. If it was to be a therapeutic treatment for "releasing tension" it would have been done after informed consent was obtained.
I think we should not be making generalizations about those participating on the allnurse web site. Just as it is impossible for me to estimate the magnitude of the patient population who are concerned about their own modesty and abuses within the medical system as described on my blog, I can't see how one can discover the same information and make similar generalizations from allnurses postings. All the responses to my blog and allnurses represent fully anonymous writers. I reviewed their registration page and there is no attempt to obtain the true name, the true professional occupation, address or phone number or any attempt to prevent one individual to post under several or many User Names, just as on my blog.
Yes, those who post here can write about topics they feel are significant on allnurses.com but I refuse to accept any attempts at statistical generalizations or allegations. Sure, descriptions of personal experiences without naming names is acceptable, but let's keep generalizations evidence-based and there is no such basis from allnurses.com nor my blog. ..Maurice.
Dr. B.
If your reference to Alan's comments was to the (60/40), then I get your point and agree. However, taking that out, I see nothing wrong with his entry. I have seen written in several blogs a wide range of opinions presented by bloggers on resident sites, and nurses sites, and blogs from Drs and all show a wide range of feelings and opinions about how patients are treated. The tattooing Dr. is no different. The same range of opinions on both sides were preferred about the pediatric surgeon who drew smilely faces on the tips of his young patients penises. So too was the case I brought up a while ago about the nurses crowding around to see the large penis of a patient that had been put to sleep due to an asthma attack in the ER.
I believe that it is safe to say that there are just as wide a number of opinions on patient care on the medical profession side as there is on the patient side -- which is the point I got from Alan's entry.
The medical profession (drs, nurses, techs, etc) should be held to a higher standard -- erring on the side of the patient. It is clear that they are not, and the profession tends to defend itself that these acts are somehow OK. Some get it, others clearly do not. I believe also that it is a case of learning. I remember a conversation we had with my wife's doc about something that happened with one of the residents. He made a comment that when he was younger, that could have been him making that mistake.
Patient care is learned. But more importantly I believe it is also market driven.
--amr
amr, my response to Alan was directly regarding the act of tattooing on a patient. The remainder of the post was a response to a clearly generalized expression of material on allnurses.com which was written by an anonymous visitor but which I didn't permit posting. I apologize to Alan for the confusion since his post was simply describing what was written by someone on allnurses. ..Maurice.
No harm, no problem. AMR captured my intent pretty much to the point. And your ponts on blogging were well taken Dr. Bernstein, we have a local paper that allows people to post whatever they want annonymously and I hate it, just a lisc. to bash.. I just read the term trolling where go from blog to blog and the fetish folks are always out there, which is why this is so much better than the voy blog. The point I should have clarified is if there is so much difference of opinion and interpetation of the issue and specific events i.e. the tattoo, the surgeon taking a picture, etc.. It is incumbant on us as patients to express needs and wants prior to appointments, we assume they (providers) know, they just don't care....with so much confusion on both sides...communicate, communicate, communicate...it won't happen over night but evolution is a process not an event...alan
The fourth amendment is your specific right to privacy. Female health care workers don't appreciate this concept as very
few have ever had to fight in a war
or conflict or carry a weapon and
serve this country. I'll bet 99.999% of them couldn't recite the fourth amendment if their life
depended on it!
LF
Visitor Maggie Quinn today wrote the following to Volume 2. Of course, Blogger.com has not allowed it to be published there and of course Maggie didn't read my warnings against writing to Volume 2. However, I thought the idea in her posting was worth debating it here on this volume: gender specific hospitals.
I think we should set up all male hospitals and separate female hospitals (this includes the staff). I'm sure this would be easy to do. It would include a lot of swapping but duable nevertheless.
But oh my think of the consequences. No more ER or hospital based series for TV. The loss of revenue on advertising. The loss of sexual tension.
Scary.
Yes, Maggie scary indeed. But I'm sure that the TV series producers would find a way to continue a single gender ER and compensate with something other than heterosexual tension. ..Maurice.
"I think we should set up all male hospitals and separate female hospitals (this includes the staff). I'm sure this would be easy to do. It would include a lot of swapping but duable nevertheless."
Except for purely obstetrical hospitals which used to exist, it's almost a sci-fi scenario. Apart from being impractical due to staffing needs, it's almost certainly against equal employment laws in this country.
Joel Sherman
Joel, If you are a doctor I think it only fair you let readers of this blog know this.
I really don't think same gender hospitals could be financially viable. And while at first glance one would question the legality on the basis of employment laws, you do see some accomodation for this almost for females. I drove the tristate around Chicago the other day and saw a billboard advertising "female providers taking care of females." There was an article about a group of female Dr.s who advertise colonoscopys for women with female only staff, males have been denied employment in OB's (though this has been a split decision depending on the state). I would think hospitals making the effort on specific days i.e. having an all male or all female staff available on specific days could garner an advantage over competition and provide services for patients if they so choose, unfortunately so far it has been limited and from what I can see only for women. There is a place for gender sensitive care, but no one wants to rock the boat and make the effort alan
Joel, If you are a doctor I think it only fair you let readers of this blog know this.
I'm surprised Dr B posted that.
If you've been on this blog for more than a week you would know who I am.
But if you post anonymously, I don't think you have any right to demand identification from others.
Joel, good point. I hope all my visitors identify themselves beyond "anonymous". If not their full name and occupation (as certainly Joel has repeatedly in the past and on his blog and of course myself)then at least use a consistent pseudonym but still give us a true occupation so the readers will all be able to better interpret the writer's views and understand which writer is which. ..Maurice.
After reading some of the threads on nurse.com, I get an even better feeling for the Vast difference of opinions...both male and female nurses have 1. said they do not see a problem with opposite sex intimate care...and 2. that they do see a problem with it..they are divided just like many of the posters here are.
While I would love to see more male techs and nurses available , I do not think a hospital for each sex would work.not only because of money, but because some patients want a care giver of the opposite sex...Where would you send them?
I was most fortunate that the tests at the urologists did not require me to to be exposed to anyone but the doctor. The ultrasound after the flow test only required my abdomen to be exposed.....any other test might have been a problem because they do not have male techs...none ever apply for a job they say...I could only hope the doctor would not get bent out of shape if I told him it was him or me to do any prep...or anything else.
leemacaz
Those reading the patient modesty threads may be interested in reading my thread on hysterectomy. The reason I am referring my visitors to that thread is to provide them with an example of the use of activism. HERS, an activist group and website, goal is to spread the word and educate women about their view that there is excessive use by gynecologists and other surgeons of hysterectomy with or without ovariectomy and inadequate fully informed consent. HERS also provides support for these women.
I would suggest that those visitors concerned about inadequate attention by the medical profession regarding patient modesty and the providing of specific requested gender medical assistants or nurses and who agrees with my previous advice to become more activistic should take a look at what HERS is doing. It may be of value to contact them for advice regarding how to become more activistic regarding your own concerns. ..Maurice.
Alan wrote the following today. I have edited it because the link was written incorrectly. I found the article excellent in terms of stressing the need for communication with male patients about modesty issues during male genitalia and rectal procedures but also stresses the differences between communication of providers with female patients. ..Maurice.
I don't know if this has been posted or not. Here is an interesting article on cancer screening and it addresses in part the myth of male modesty or the lack there of. I am trying to post the link, it is in the JAAPA, Talking with Male Patients About Cancer Screening, by Catherine Dbue, Barbara Fuller, & Margot Jackson... http://jaapa.com/issues/j20041201/articles/talking1204.html ..alan
I posted that link a while back, and on some other blogs as well. Here's another link by the some researcher. She interviewed men in focus groups about this issue and how they're treated by medical professionals, and this is the result. Here's what the men had to say:
http://www.brown.edu/Research/ICHP/Modules/Mod1MensHealth/TeachingMats/Focusgroupssummary1.doc
I have already given that link on my blog.
The article is good except she astounds me by saying that if an adolescent boy is embarrassed, you should bring in a chaperone, exactly the worst possible thing to do. If the kid is already embarrassed, the last thing he needs is another women watching his exam. My link above documents from UK studies that adolescent boys especially don't want women chaperones around.
Makes me wonder if they know absolutely anything about men.
That's a very good point, Joel.
By the way, the researher's name is Catherine Dube and I think she's out of Brown University. Her focus is on teaching medical personal how to better communicate with patients. My interpretation of what I've read of her work is that this problem can be handled with better communication. To an extent that's true. I've been saying that all along. But it's not the entire picture. She has posted on the web in other locations power points for doctors/nurses describing how to do these intimate exams using better communication techniques.
But, as you say, when she suggests that one strategy is to call in chaperones of the opposite gender, one wonders what she's thinking. As you say, studies clearly indicate that men do not want chaperones in general, and especially female chaperones.
But at least in her article about talking to men about cancer screening, she attacks these stereotypes about men not being modest or embarrassed by intimate exams. This is an excellent article, by the way, to carry with you into the hospital or exam room and use if you run into problems. Dube has authority, and those who read it can't deny that.
Doctor Bernstein,
Learned something from your post today - ovariectomy is a term I haven't heard before, always known it as oophorectomy (salpingo-oophorectomy if they remove the fallopian tube as well), mostly in the context TAH/BSO. I agree that the HERS site is a good example of the use of activism, but one advantage is that women's rights with respect to gender related medical care are already fairly well recognized, while men's aren't, and I think that's the first thing that needs to be changed.. (FWIW, my sister has been an L&D/OBGYN RN for almost 30 years, and would probably agree with most of the HERS viewpoint.)
In keeping with the post regarding ID of posters to this blog, "TT" stands for "Tiny Tim" a nickname that was jokingly hung on me by my fraternity brothers in college in the early 70's & stuck (Tim is my middle name, and at the time I was 6'3"/200lbs). I think I've referenced it in previous posts, but I'm an engineer - specifically BSEE/CS plus a post graduate degree or three.
It is embarrassing enough to be exposed to same sex where it is their job to look at you...to have an audience only compounds the feeling...especially if one or the other is of the opposite sex.
Then to find out that the "chaperone" is a clerk....Why not just do the exam/procedure in the lobby? ought to be a lot of witnesses for the doctor then. There is more chance the patient is just modest more than they worry about being sexually assaulted.
I have been asked if I wanted a "chaperone" (I am 56)...and they seemed even more taken a back that I did not want an audience period.
I just asked to have a male tech do the test...I am not worried I will be molested....I am just modest. And none of the cliches make a whit of difference.
What is so hard for so many doctors, receptionists, nurses and techs to understand this.
Now my insurance gave me three female dermatologists they would like me to choose from for a Whole Body exam..(I have some suspicious areas on the skin)...They seemed shocked that I would ask if they had a male doc on their list. (they do...but only if you press them)....And told me that they were sure a nurse would chaperone if it would make me feel better. Getting the point that you do not want to be examined by female doctors seems so foreign to them.
Dr. Sherman gets it...Doctor Bernstein gets it....
leemacaz
The practice of having just anyone in as a chaperone destroys a great deal of credibility (in all things) of the doctor....Doctors want us to listen to them and to have faith in their judgement and recommendations...that is not going to happen if you catch them in a blatant lie..whether it is by commission or omission.
The patient is going to think that the doc is only covering his/her butt..and that they (the patient) are incidental..
Just as it is hard to believe the doctor has your interest at heart if he/she has no respect for your wishes when it comes to modesty issues.You get the feeling of just being a means to their fee.
I read a great deal about being honest with and hsving respect for the doctor, but that is a two way street.
leemacaz
100% opposed to non-medical personnel being used as chaperones. If a chaperone is being utilized it should be someone with a medical background not the receptionist or office clerk. I find that to be a huge invasion of someone's privacy.
I'm also not a fan of chaperones being opposite sex of the patient i.e. female doctor and female chaperone with a male patient. While the chaperone is often there for the doctor's benefit to provide legal protection they are also supposed to provide comfort to the patient. I would flat out refuse it if I was modest. If they insisted on being there I would leave.
CM
First of all. I refuse any and all
women for any personal care. Secondly, nakedmaleclothedfemale
is a staple of fetish porn and
apparently its alive and well in
america!
For those not aware of this, I have communicated with Catherine Dube who is the lead author of the article we've quoted above. She has made some very gracious and valuable posts on my blog.
Anyone interested in chaperones and male health in general should read them.
She is a valuable asset and may be in a position to really help. There is hope for change.
Joel Sherman
Part of the problem with the whole chaperone issue in this country is that there are no medical standards here. What is a chaperone? Why do we use chaperones? Who is a chaperone? What exactly do they do?
Joel's right. Although the ethics statements behind having chaperones mostly talk about patient comfort and patient protection, the real reason for chaperones is to protect the doctor. Period. Until the medical profession can stop denying the truth of this, we're not going to make any effort to improve the situation -- unless, of course, men just start refusing the accept female assistants and chaperones and actually walk out of the office or cancel the procedure.
On Joel's blog, Catherine Dube does bring up this problem about standards. Perhaps Maurice and Joel can respond to this question: Why doesn the American Medical Association establish some standards in this area?
In a day or two, when I get some time, I'll post some interesting material coming out of Great Britain. Because the UK has a National Heath System, they do have published standards in many areas like chaperone use. Now, I'm not saying that the UK healthcare system doesn't have problems. During the last few years they've had great problems with dignity issue because of their mixed ward situation (men and women sharing the same wards, sometimes the same rooms).
But because the UK has a National system, patients and communities get more say in how these standards are established. I'll post some of this information soon.
But what I want to know is why the AMA doesn't start establishing more standards, not just guidelines, but actual professional standards, especially in areas such as the ones we're discussing regarding patient modesty. Perhaps they don't because either they're blind to the significance of this issue or they know that the kind of standards we need are so often being violated in everyday practice that they (AMA) would be up to their ears in ethics complaints if they established any standards.
the issue of chaperones seems to have several trains of thought...One is that they are ther for protection of the patient..the other is that they are there to protect the doctor.
In both cases it assumes that one or the other fears the other. Although it complicates teh issue of male modesty, some way needs to be found to separate the two.
I really do not feel like I am in any danger from advances from either sex... If I felt that way, they would have to look fast to see me leave... no chaperone would abate that feeling. And as I have said, I do not think that would ever happen to me. If I can not trust the doctor or he me ( I would have to be unconcious to have a female clinician) we do not have a basis for any trust and there would be no point in my sticking around.
Also, I do not want an audience... a chaperone would make it worse not better.
My issue is soley modesty and embarassment. I do not feel a female is less capable and I in no way am putting the ladies down.
I am all for the ability to choose the sex of any medical care provider by the patient. The issue of modesty is not discrimination against the ladies.. (I have read to much on allnurses.com where they seem to think it is, but it is not)
I do not see any way to give the doctors and nurses a way out from all of the agruments except by court ruling, legislative action, or teh big medical associations taking a stand...or a combination of the above... This further complicates things because there has already been so much said where doctors are tired of and afraid of litigation..And it is doubtfull you could convince them that it is only to achieve respectfull treatment of those who are painfully shy... not to make the doctors life more miserable.
Drs. Berstein and Sherman have exhibited an understanding of this...So how do we convince the rest of the medical community?
I really would like to find ways this can be done...The courts and legislatures weem to find ways of whacking both sides and coming up with a solution equally unpleasant for both.
At any rate it was only after finding these blogs that I found myself able to go to a doctor anyway..I have an idea how to deal with them on a one on one basis. which is Much better than just avoiding them altogether. So..if that could happen I think the transforming of other minds is possible too.
leemac
MER's commnents and statements are so correct about standards. After pursuing an issue it was learned that almost all of what is done is up to the physician/surgeon and the healthcare facility (administration/medical director). Organizations such as JCHCO, AORN, AMA, etc. state how things should be done and the like, however, it is NOT law. The statements are "GUIDELINES" only. Most places say they follow the guidelines, however, a patient cannot protest any of this based on the statements because they are only guidelines. So...what good is any of it. It boils down to the physician/surgeon can do whatever they want basically.
I stand by what I've said about standards -- at the same time we need to be careful. Some procedures, etc. can include both standards and guidelines, that is, there would be certain bottom lines, the standards, and other guidelines that would be determined by the circumstances.
Now -- regarding chaperones. Patients should always be asked if the want a chaperone and if they want same gender. That should be a standard. They should always be given those choices. There should be no justified reason why this shouldn't happen. Some may claim that staffing and budget won't allow it. That's not an excuse. In non emergency cases, patient dignity should always trump staffing and finances.
In other areas guidelines should be sufficient. There's got to be trust between doctor/nurse and patient. If we, as patients, feel we can't trust the judgment of our doctor/nurse, we should find another.
I'd like to see patients involved in the creation of these guidelines and standards, so when the debate happens as to which should be standard and which guidelines, patients can make arguments and offer input
MER's message of 9/25 10 am does state very worthwhile valid points, however, in reality, what ususally transpires is the cart before the horse so to speak. The learning curve most people go thru with a procedure/surgery is that you either find out afterwards or too late to do anything. The normal doctors' visit is brief in today's world so one doesn't get to know them and as far as nurses go one doesn't know who they are until the time of the surgery or procedure/treatment. So my point with this is that it is only after several experiences or an upsetting experience that patients "learn" and are enlightened to the "system".
As far as a chaperone, there are never males employed in doctors' offices which is where most cystos or other genital procedures are done nowdays. Even in an outpatient hospital/clinic setting there are few if any males. So a male patient requesting a male chaperone/ or nurse/tech assitant is out of luck.
I totally agree with everything you say, however, I just don't see it happening no matter how much a male patient requests it or how rigtht it is.
I had things done to me by a female and I was not asked if it was okay. I was extremely upset with it afterwards as it was all done after they sedated me. Either way, conscious or unconscious it was not what I wanted. But I was not informed or asked.
Some Doctors/Offices try to pass chaparones as assiting the the docter by writing in your chart or handing the docter a pair of gloves. One of the privacy laws basically says no one can witness your exam or procedure unless they assiting in your exam or procedure
(well it says something like that). So in the doctors eyes they do not even have to bring up the chaparones question, nor does the law mention gender. See how the present so called Privacy Acts has a majior flaw in it and again males get screwed in it since mostly females working in healthcare.
Annom
I understand your frustration and pessimism, but I have to disagree with you from personal experience. I have related before I had an testicular ultra sound the first time with a female tech, I was very upset over it. When I had to have a follow up I requested a male and got one. I wrote tot he hoptial patient advocate, they now ask for intimate exams and imaging if the patient has a preference....now I realize it won't be possible in all circumstances and as you said, until you have been through the process you don't know what is coming at you, but you can make a difference. Recently my Dr. wanted me to have some testing at our local hospital (not the one I had the ultra sounds), I called and asked, they said they only had female techs so I told them I was going out of town to the one that had male tech's they tried to convince me use them as they were local, I told them when they got a male I would use them. When they said they could not afford additional tech's, I told them to get creative and work a share program with another and thanked them. I called my Dr. and told them to schedule me at the other hosp. and specify a male, they were a little surprised but didn't argue, the drive was worth it to me. So it may take a little effort to get what you want...but in some cases you can get it done and it might just cause some change. Don't give up and resistance and persisance are the engines of change
When a physician is doing a procedure in an office setting most seem to think they need a female nurse in the room to hand them things or screw a lid on a small biopsy jar, etc. I find this absolutely ridiculous. The privacy and modesty of a patient is voided simply because a physician can't do the simple job. Everything is set up for them beforehand, so really one would think they would be competent enough to walk and chew gum at the same time.
I have to have a urodynamics investigation done.
I contacted the hospital where I am to have it done, i was told it would be done by 2 female nurses. I said I would not be comfortable with that, the response of the nurses was take it or leave it, (don't bother us any more effectively).
I took it up via equality channels. they almost fell over themselves to help me. The male consultant however was patronising and condescending. He told me (in all seriousness) that there would be female staff in the unit at the time i was having my procedure (not in the room with me, just in the same building) would i be bothered by that? How can people choose to misunderstand what is being said? I am looking for an all male team for my procedure, not an all male planet.
If at first you don't get what you want, become such a pain in the a** that they will do anything to get rid of you, it definitely works.
GVE, what department did you contact to go thru "equality" channels? Are you in the USA or UK?
When you say the male consultant was condescending and patronising, and then ask you if it would be okay if there were females staff members in the unit, it sounds like he was belittling your request with strong sarcasim. Maybe you should ask if the procedure room is private or if there is a glass wall where the female staff could view the procedure. Otherwise, what was his point of females in the unit question? If for no other reason, he had to be mocking your request. Real professional.
What protection does anyone think a chaperone affords to anyone but the doctor? I have read numerous state medical board discipline files wherein a chaperone is directed to report any misconduct she observes. There is never a mandate for a chaperone to intervene and stop the misconduct. So a patient could still be molested, even with a chaperone present and observing. Has anyone ever heard of a chaperone stopping a physician from doing something?
IN 1996 the New York Administrative Review Board for Professional Medical Conduct wrote:
"The board has expressed our reservations in the past, however, over trusting a patient’s safety to a third party monitor who is a paid employee of a Respondent and whose continued employment depends on that Respondent remaining in practice. The Board concluded that if we could never trust this physician around patients or their mothers without a third party monitor, that this physician was unfit to practice medicine in New York."
CLW
GVE
I hope you will report the male tech for his attitude to the patient advocate or the admin. As stated before, sometimes when you get to the people who pay the bills and they think there may be economic impact...it gets a whole different look. I am glad you stick up for your rights, if we all do it we may effect change.
gve wrote: "The male consultant however was patronising and condescending. He told me (in all seriousness) that there would be female staff in the unit at the time i was having my procedure (not in the room with me, just in the same building) would i be bothered by that? How can people choose to misunderstand what is being said?"
This is just the kind of "Behaviors that undermine a culture of safety" that the Joint Commission is talking about. The commission talks about "condescending language and voice intonation," and "intimidating and disruptive behaviors," and "passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities."
Patients can prepared in this regard, that is, point out to the "male consultant" that he is displaying just such attitudes as the Joint Commission considers to be "behaviors that undermine the culture of safety." Then write a letter of complaint to the patient advocate and the CEO of the hospital.
Knowledge is power. Patients are not expected to have this kind of knowledge. When you show that you have it, you have a better chance of fair treatment.
Gve mentions the male tech made this comment in all seriousness so chances are he was trying to be helpful and kind not patronzing and condesecending. Sounds like he wanted to inform gve of the conditions on the unit and as the tech might not be used to dealing with a male team request he provided additional information he thought would be helpful not hurtful.
I wouldn't report this man for stating that females would be on the unit. On the contrary I would applaud him for making the conditions completely known as it avoids a potential problem. Sounds like this tech should be given benefit of the doubt here.
CLW,
I agree that chaperones can be an issue even when a complaint is made against the doctor. They aren't a complete safety net not should they be.
The chaperone might fear for their job or retribution. Chaperones who aren't licensed professionals wouldn't even know what an appropriate exam should be as they aren't educated in the field which is just another reason to not to have clerks and office managers acting as chaperones. Complete invasion of patient's privacy is the other.
If myself or my wife weren't comfortable being alone with a doctor we wouldn't utilize their services nor would we recommend them. Neither of us have chaperones and neither of us have ever had a problem with it. It's all about trust on the part of the doctor and patient.
I do believe all patients should have the right to request a chaperone or bring someone into the room during a standard exam. I also don't believe doctors should be forced to do intimate exams without them. I do see it as a personal choice for both parties.
-cw
This is the 116th posting on this thresd and I would like to announce that I plan to shortly close down writing to this Volume 5 and begin Volume 6 for future comments. Please use the Feedback Thread only for any comments about my plan. ..Maurice.
To Anonymous: Of course, we weren't there when the male med technician commented to gve. But I'm just going by what gve said, which was: "The male consultant however was patronising and condescending." That was the "tone" that gve read in the remarks and I'm trusting his intuition. Furthermore, according to gve, the male med tech made a point ask if any females in the entire building (not just the unit) would disturbe gve. Doesn't that sound a bit extreme? Sounds more like irony, or riducule than actual seriousness.
Sorry, but I have to along with gve's take on what happened and I stand by what I wrote. This kind of behavior goes on more often than we think in hospitals, and not just with patients, but between staff. And it's not all in jest. That's why the Joint Commission is so concerned with this.
While none of us know the intent of the comments, I would say from experience the tech did not agree with the gve. The general attitude I get is providers feel gender requests are ridiculous, that it is a slap against them, They have a sense of entitlement to do the job as they see fit. While it has gotten better, I still feel many providers take it personal, that patients with these concerns are a problem, not a concern. We have taken equal rights in employment to far, the courts have allowed them to trump others rights to privacy and it shows in many areas. The more people speak up the less unusual it will be and the more they will accept it. Keep it up, stand up for your rights.
I previously said about getting agreement for my urodynamics without any females present. I had to phone to schedule the actual test. The person who took my call was not aware of the agreement to do the test without any females, i had to explain it all again. When i was done explaining, the woman asked "so do you have a problem with women?" When i asked if she would ask a woman the same question about men if she were asking for an all male team she just stayed silent, i restated my request and she merely laughed AT me. I hung up in disgust.
GVE I hope for your sake and the benefit of future men who feel the same way you do, do not let it end here. I hope you will complain to your Dr. and to the facility administation about her attitude. If you let them know it is discrimination and just plain poor customer treatment, AND that you intend to push it as far as you have to, and tell as many people as you can, you might be surprised. I related a similar experience with an ultra sound, followed up with the patient advocate and admin. and actually got the policy changed to where they ask the patient if they have a preference of the gender of the tech when it involves intimate procedures. These facilities are struggling finacially like everyone else, take it to the money people at the facility. If they think it will cost them... You were right on the money to hit them with the double standard, please don't let her get away with it...if no one follows up or pushes it, it won't change, good luck, let us know how it goes. alan
GVE:
Is this taking place in the US and if so what area? The treatment you are getting is ridiculous. If you can travel I personally would call other places and find an institution that would accommodate your request. This is appalling.
AS OF OCTOBER 4 2008 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 6" TO CONTINUE COMMENTS. ..Maurice.
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