Bioethics Discussion Blog: Patient Modesty: Volume 6

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Saturday, October 04, 2008

Patient Modesty: Volume 6



AS OF DECEMBER 17 2008 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME7" TO CONTINUE COMMENTS. ..Maurice.

Graphic: Photograph of a statue in the statue garden of the Getty Museum, Los Angeles June 2007 and modified by me with ArtRage.

105 Comments:

At Saturday, October 04, 2008 4:31:00 PM, Blogger Maurice Bernstein, M.D. said...

gve wrote the following today to Patient Modesty: Volume 5 just after I closed it down. The visitor might want to return to Volume 5 to read the context for this message. ..Maurice.

This is taking place in the UK.

I am ashamed of what is happening to me for from the point of view of the providers.

They don't seem to care AT ALL.

I have taken the time to contact about 60 different hospitals.

They all think it is ok to impose all female teams on male patients.

It is not the provider who is wierd, it is obviously the patient who is odd.

And they would all be comfortable with obs/gyn with teams of 3 or 4 males......

The double standard is staggering.

 
At Saturday, October 04, 2008 8:41:00 PM, Anonymous Anonymous said...

I feel comfortable with a female doctor and her female assistant. When I first went to her about 6 years ago I was a little nervous about my penis being seen by both of them.

I feel very relaxed in this situation now. Even when she has a training assistant in the room also. I would probably not go back to a male doctor again.

Nick

 
At Saturday, October 04, 2008 8:56:00 PM, Blogger Maurice Bernstein, M.D. said...

I'm not sure that this question was fully answered in the past patient modesty threads: Why is it that some men tolerate genital exposure to female physicians and their female assistants and other men express their great concerns regarding modesty issues? Did we decide in the past postings that this difference is related to childhood experiences? School experiences? Or family experiences? For example how modesty was handled by the father? Or by the mother or siblings? I think it would be important to understand the psychodynamics of such personal differences between men. Actually, there appears to be also differences in physical modesty between women too as noted in many of the early postings on this topic. So I think the same question would apply to women. Anyone have any suggestions or know of any studies related to my question? ..Maurice.

 
At Sunday, October 05, 2008 4:32:00 AM, Anonymous gve said...

Dr B,

I am surprised you are asking why some men feel uncomfortable with females in attendance when naked. The NORM is NOT to be seen naked by members of the opposite sex, hence male toilets and female toilets, female changing rooms at swimming pools and male changing rooms, female changing rooms at stores to try on clothes and male rooms etc etc.

If some men are comfortable with the ABNORMAL, then thats fine by me, good luck to them, what i resent greatly is for the Norm to be set aside simply for the convenience of providers in the health "so called" profession.

I say so called because my experiences of late have revealed MOST providers to only care about themselves.

 
At Sunday, October 05, 2008 5:19:00 AM, Blogger MER said...

In the AMA Journal of Ethics Virtual Mentor. July 2008, Volume 10, Number 7: 429-433.

"Patient Requests for a Male or Female PhysicianStrategies for responding to patients and their family members who request a physician on the basis of sex."
Commentary by Muhammad Waseem, MD, and Aaron J. Miller, MD.

Among other things, they quote a study published in Pediatric Emergency Care in 2005 entitled "'Doctor' or 'Doctora': Do Patients Care?"

It found that "Among the children, 80 percent of girls and 78 percent of boys preferred a woman doctor, and none chose the doctor with the most experience [2]. Among the parents, 60 percent preferred a man, 19 percent preferred a woman, and 21 percent preferred the doctor with the most experience [2]. Of parents who had a preference for one sex, only 28 percent said they would be willing to wait longer to see the doctor of that sex, whereas all of the parents who preferred the most experienced doctor stated they would be willing to wait longer."

I was surprised at the results. Apparently younger children, in this study, seem to prefer women doctors.

This article also says: "Why do such preferences exist? How should physicians decide whether to accommodate these preferences? How can physicians get all of their patients to be more comfortable with them?...Sex preferences have numerous foundations—e.g., culture, religion, past experiences with a man or woman—that can affect a person's comfort level when he or she must be naked in front of a doctor and can lead to judgments about a physician's caring or competence. Knowing that certain groups of patients are more likely to have strong sex preferences can make doctors aware that they may need to spend extra time discussing certain topics with those patients; however, research on the topic of human desires and fears will always have limitations. Every time a doctor walks into a room to meet a patient, he or she must do so with an open mind and avoid making too many assumptions."

This is one of the few articles I've found that really addresses this issue. The next paragraph is equally interesting, but I won't quote it all. You can find the article online at:
http://virtualmentor.ama-assn.org/2008/07/ccas1-0807.html

Perhaps, Dr. Bernstein, you could contact the authors of this article and ask them if they'd like to post on your blog. They seem to cover this issue with a good focus on choices and the importance of communication.

 
At Sunday, October 05, 2008 5:29:00 AM, Anonymous Anonymous said...

Dr. Berstein,
I don't think you could answer your question with any certainty.
For myself, as I have aged my feelings have changed. I now much prefer going to same gender physicians. When I was young I didn't think much about it and quite frankly many years ago women did not have the number of female gyn's available. People did not have choices as they do now. For the most part now no matter what specialty one must see there are both genders available.

For men, I think men in general do not speak up. But, they are clearly relieved if a male walks through the door if the problem involves genital exposure.

Men are suppose to not care. That is the "norm" of opinion. I think many do care but they don't shout their feelings because they might not appear manly. Then there are lots of men that are idiots and think it is cute to see a female. Like they are getting something sexual out of it all. They are the dirtbags of the male race. And there are plenty of them running around.

 
At Sunday, October 05, 2008 10:28:00 AM, Blogger Maurice Bernstein, M.D. said...

gve, I was wondering about what cause or causes were responsible or related to why there is a difference between the two classes of male responses to physical modesty. I was not suggesting that one is less "normal" than the other or which view should represent the social "norm".

I think that MER's contribution to my questions is worthy. Obviously, trying to understand the reason for the differences between men and the differences between women with regard to physical modesty will educate everyone and particularly physicians. Physicians, who are truly interested in their patient's emotional welfare may use such information to anticipate the issue in the patient they are attending and perhaps mitigate the distress of those patients where modesty and gender selection is of great concern. ..Maurice.

 
At Sunday, October 05, 2008 2:23:00 PM, Anonymous js md said...

I read your reference MER.
It is surprising that boys prefer women physicians, but it's a meaningless statistic without knowing the age of the patients. Young children are used to being taken care of by their mother, but it is a whole different scene for adolescents. I'd be very surprised if those statistics held for adolescents, especially for intimate exams which also need to be studied separately from general exams.
Joel Sherman

 
At Sunday, October 05, 2008 4:51:00 PM, Blogger MER said...

Joel: I agree with everything you said. That's why the research surprised me. I see it as flawed, too. But I don't think it's "meaningless." It may be an indicator, especially if we could get the ages of the children studied. I posted the reference because, overall, it had some good suggestions for physicians. And it does indicate the kind of research that is out there -- and that tells us the kinds of questions people are asking. The key is asking the appropriate questions, worded appropriately, and then followed up with questions that clarify.

 
At Tuesday, October 07, 2008 7:06:00 AM, Anonymous Anonymous said...

While the study is relevant in the narrow boundaries it was conducted. As state, age would be extremely important. There is currently a discussion going on Dr. Sherman's blog with a pediatric Dr. about sports physicals. It would suggest the opposite in her specific case when it comes to teenage males and hernia exams. The problem comes in trying to project very young paitents thoughts, at a time when they are under duress, at a stage in their lives where they may still be very attached and identify with mothers, and drawing parrells to teenagers or adults latter in life. The interesting thing is......there seems to be very little data on the issue. One comment on Dr. Sherman that stuck in my mind had to do with the evelution of medicine as we went from primarly male Dr.'s and had male orderlies to a mixed Dr. and female nurses displacing male orderlies...while the system changed in gender and responsibilities it did not include modesty concerns for males or at a minimum made them secondary to cost and benefit to the instiution.....that education or evolution from the patient, paticularly males, is just starting....alan

 
At Tuesday, October 07, 2008 2:45:00 PM, Blogger MER said...

As I read more in the history and sociology of modern medicine, I'm struck by two items relative to our discussion.
1. The issue of modesty historically deferred to women, but in two senses. First, involving exams and procedures. That is, doctors and nurses were more concerned with female modesty and either diminished or ignored male modesty. Secondly, in terms of the history of nursing. When it came to female nurses dealing with naked men, the fear was more for the modesty of the female nurse than it was for the male patient.
That is, there was and has been more concern for the sensibilities of the female nurse, the fact that she might be disturbed, offended or compromised -- than there has been for the feelings of the male she is treating. The nurses modesty trumped the male patient's. I think this still exists today to whatever degree. That's why some female nurses (and some female doctors) will have chaperones (often other females)during intimate exams with men. There's a concern about being sexual harrassed and/or having their modesty compromised.
2. I posted the URL for a British article (I think on this blog) about how to do a foley cath on a male. Part of it discussed the history of this procedure and pointed out that, initially only male orderlies did this procedure on males. But the problem was that, as time went on, many males had to wait in pain because there were not enough males to accommodate them. So they taught female nurses to do the procedure to help.
However, now it seems the crux of the procedure is merely convenience. Initially, male privacy was considered. But something happened to change things, to switch things around. We went from complete availablility for males to be accommodated, to some accommodation for males, to where we are now -- almost no accommodation.
My research suggests that some important attitude changes occurred in our society regarding male modesty within the last 30 years or so -- especially within modern medicine. I wish a sociologist would comment on this blog. It seems that these changes began after WW2 and began to consolodate during the 1960's and 1970's.

 
At Monday, October 13, 2008 1:15:00 PM, Anonymous Anonymous said...

In a recent article of the LA Times stated that nurses licensed prior to 1990 will have to submit fingerprinting and list all convinction prior to receiving a renewal. One case was a male nurse in prison renewing his license. Supposedly there is a good deal of male nurses with this conviction.

 
At Tuesday, October 14, 2008 7:12:00 AM, Anonymous Anonymous said...

Sorry, the convictions were "sex attacks."
Annon

 
At Tuesday, October 14, 2008 1:58:00 PM, Anonymous gve said...

I have posted quite a few comments on these blogs.
Some may have the impression that I am some sort of wierdo or crank. The problem is that I am faced with that attitude every time I ask for the same considerations routinely extended to women, i.e same sex care.

Obviously "I have a problem", Obviously, the providers are "normal" and I am not, Obviously most men don't want same sex treatment because they don't ask for it, etc etc.

Where is their empirical evidence? If I am so odd, and unusual, there would be a plethora of studies, research papers, testimonials to prove that most men prefer to be treated by females for embarrassing, intrusive & personal care. THERE IS NONE. Why, because they are afraid to ask men what they would prefer as this would be problematic if a lot of men said "actually, for such personal care, i would prefer the less embarrassing and uncomfortable situation of being only seen naked by other men". How would the callous, uncaring, selfish, self preserving females of the medical world cope with those sort of findings?

It's about time someone had the courage to undertake such simple research.

Prove me wrong, if you think you can.

In the meantime, I plan on being a constant thorn in the side of all health providers who show me less than common courtesy and kindness.

If same sex care is normal for women, how can it be abnormal for men?

 
At Tuesday, October 14, 2008 7:38:00 PM, Blogger MER said...

gve:
I think we all sense your frustration. But we don't have to be an abusive thorn in their sides. I think we'll get more positive response if we do the following:
1 -- When we get the response "We're all professionals here" -- we can say -- "That's why I came to this hospital/clinic. I know you're professionals. That's why I'm certain that you'll respect my personal right to privacy and dignity, because that's what professionals do."
2 -- If they say that "most" men don't care or prefer female caretakers, get into a little epistomology. Ask they how they know that? Doctors and nurses are men and women of science. Where's the science, the studies that back up that assumption. Make them back up what they say. If they they know what they know from experience, from observations -- ask if they actually ask men how they feel or just assume how they feel. Ask if they give men a choice. If not, ask why?
3 -- If they persist in what might be considered intimidation or demeaning behavior, ask them to state the mission statements or the core values of their institutions. Almost all hospitals have something high up there that talks about treating patients with respect and dignity and respecting their privacy. They may not be able to state those core values -- but make sure you know them.
Do all this politely,calmly, respectfully and with dignity.
I'm not saying this will always work, but I've found that knowledge is more powerful than anger. Don't get angry. They may still refuse to talk with you or laugh, or ridicule -- but that's their defense mechanism for knowing that you're right and that they have no answer for you.

 
At Wednesday, October 15, 2008 4:35:00 AM, Anonymous gve said...

MER,

I have tried the gentle, almost "begging style " approach.

Female nurses are not in the least bit interested, they just want to get you off the phone and off their back as quickly as they can.

They have often told me that most men are happy with the involvement of female staff for such invasive procedures, when challenged for evidence, they quickly resort to "nobody complains" as though that is definitive. When I ask them precisely how many men they have asked about their preferences, they simply go silent, they just want to get rid of you. They get off the phone with me and hope I go away (perhaps they even hope i will go away and die so as not to bother them again). They certainly do not do anything as sympathetic as raising it as an issue within their hospital, I KNOW because I have followed up in some cases.

Change of the sort many are suggesting (i.e. choice of gender of carers for men as well as that offered routinely to women) will only come by central governmental action involving positive action of the sort that was applied to the police, fire service, teachers, doctors, politicians etc etc.

While health care individuals can ignore such simple requests, they will.

Being right, is of no comfort to me whatsoever. Having care in a way I am comfortable with, would be.

 
At Wednesday, October 15, 2008 8:39:00 PM, Blogger MER said...

Sorry, gve. We're not communicating. I'm not talking about a "gentle" approach. And I'm certainly not talking about "almost begging." I'm talking about a polite but firm stance that makes it clear you know what you're talking about. A strong, confident stance that makes it clear you know who you are and what you stand for. A stance that demonstrates that it's not just about your personal preference. It's about the entire concept of dignity. It's about gender discrimination. It's about them "really" being a professional, not just saying they're one.

And, I'm not suggesting it will always work. But that's not my point. Going into a situation like the one's we're talking about -- it's similar to going into a negotiation process. You need to know ahead of time what your bottom line is, and if it's not met, you need to know that you'll be willing to walk out.

Now, I agree. Dealing with people on the phone is another matter. It's easier to be rude to someone on the phone, easier to hang up. But when we face these professionals eye to eye and state our case in calm, determined yet polite manner, it will have an effect. We may still have to walk out, but our stance will make a difference in the long run, especially if we follow up with a letter of complaint to the right people.

And, if we have a condition that requires if not immediate, but still relatively quick treatment and we can't find our gender preference, we need to make it clear that, if we decide to go through with the, that we're doing so under protest, but doing it only because it's an important health issue that must be done. And we want the fact that our privacy needs are not being met to be part of the record.

 
At Thursday, October 16, 2008 11:44:00 AM, Anonymous Anonymous said...

MER,
You points of discussion are right on point. It is difficult for a male to have a all male team. I have read so much on this after a bad experience. Fact is nearly all hospitals have mixed teams and they all insist that they are all professionals and you want the best team that work together to get the best outcome. I really don't like the idea that after you are "under" that several woman handle your private parts. It would be just as unsettling for my wife to go in and have a male nurse do intimate procedures. To me it matters not that the patient is under. Either way it is still happening. In the future I will speak up and find a place that can hopefully accomodate same gender care. In the OR there are both males working on female patients and females working on male patients. "They" see absolutely nothing wrong with it. Because it goes on everyday and is acceptable routine. But, the patients don't know this (until maybe afterwards). The other big response you get is that : "well that is who works in that area."

 
At Wednesday, October 22, 2008 9:40:00 AM, Anonymous gve said...

I get the impression that this blog is losing some momentum. I guess this is due in no small part to the fact that most people (patients) feel a sense of paralysis in terms of actually effecting change.

Polite letters are exchanged, understanding sympathetic remarks are made by some providers, once they get you off the phone or have written you a letter, they are only to happy to just dismiss you as a crank.

Men in particular are treated as second class citizens with limited rights and made to feel very silly for having any concerns of modesty. The only way significant change will happen is for some sort of concerted letter writing to politicians and judiciary.

Equality has to cut both ways, not just be a constant battle for better treatment for women at the expense of men.

I don't care how well qualified a woman is, i dont care if she is a professional, i don't care if she is the best person for the procedure, i don't care if a male might be less gentle or caring while doing the procedure, I will NOT accept females for intimate, intrusive, personal and embarrassing procedures - PERIOD.

Medical staff "KNOW" my attitude is reasonable when the sexes are reversed, but "KNOW" I am a crank when i ask for it.

The days of caring and kind people going into medicine and nursing appear to be long gone.

 
At Wednesday, October 22, 2008 4:55:00 PM, Blogger MER said...

You may be right, gve. I hope not. We all have different preferences, and different degrees of comfort or discomfort. I respect your preferences. But I don't think the letters will make much difference.

The change will occur when nurses around the country start going to the charge nurse and say, "Gee, that's the 3rd man I've had today who refused imtimate care from a female and requested a male. We had to get a male nurse from the floor above." The change will occur when healthcare professionals begin to note that more than a few men request same gender care, are refused, and then say, "Please leave the room while I get dressed. This exam/procedure is over" -- and follow up with a written complaint. Changes will start happening when the system notices that the hospital patient advocate is requested more often by men who are not granted same gender care, and when those men file written complaints with the patient advocate. Changes will occur when numbers of men call clinics and hospitals ahead of time to ask who will be in the room while their male doctor is conducting an exam or procedure, and then stating their preference. When receptions start talking among themselves say: "Gee, that was the 4th man who called today requesting a male medical tech instead of a female. When I said we didn't have any males, he said he'd find another provider." Changes will happen when the owners of the above clinic get letters from those men explaining why they will not use their services, and saying they will warn other men about the double standard practiced at the clinic. Changes will start happening when men sit down with their primary care providers and have an open, honest, heart to heart talk about how they (the patient) feels about this issue, and requesting the PCP to make sure these feelings are respected whenever the PCP recommends a specialist. Change will happen when men ask their PCP to call the specialist they are recommending and request that their patient's feelings in these matters be taken seriously. Change will start happening when men, like women have done it the past, become empowered about who they are and how they feel about their bodies -- when they cease to be ashamed to say that these are my values and I feel comfortable with them regardless of how the system feels, and demand that my values be respected. Change will happen when men realize that to have some modesty doesn't mean that you're less of a man.
Now -- how will this come about? I don't know. Men need to organize, convince other men to demand the dignity they deserve. But that won't be easy. Still, enough of us can start doing what I've stated above to make the system aware that it's not business as usual anymore.
That's how change will occur. And those of us who start need to just accept that we'll often get the "deer in the headlights" stare, or ridicule or the cold shoulder. But we need to stand our ground, remain professional and polite, remind doctors and nurses and techs of the double standard and gender inequity, read to them what their core values say about respecting individual dignity, and then remind them their code of professional ethics requires them to treat us with the same dignity they treat their female patients.
If everyone on this blog who agrees with this starts doing this, and convinces at least one other man to do the same, and that man convinces at least another man to do the same, we may start planting the seed.

 
At Thursday, October 23, 2008 8:09:00 AM, Anonymous DG said...

I love this site! I've been searching the internet for months looking for a board t like this. Every other board I've gone to don't seem to want to tolerate my comments on this subject that sound VERY similar to most of the comments I've read on this page. About 90% of the comments I get on my posts call me a homesexual, an immature child, a rebellious troublemaker, a woman hating biggot and many other insults just because I prefer a male doctor. I'm so sick of hearing "it's no big deal" or "We are professionals" or "I've seen thousands before, yours is no different" or "it's OK, I'm a nurse" or a dozen others. To me they're explaining why THEY have no reason to be embarrassed. My embarrassment doesn't matter to them. We are just expected to drop our drawers on demand to any and every female doctor, nurse, practitioner, nurses assistant, X-ray tech, 18 year old uneducated assistant note-taker, receptionist filling in as a chaperone and god knows who else. But I'll bet if I were to ask any of them to do the exact same thing they had just ordered me to do I would get a slap to the face and six months in jail. I don't know if a nurse or a nurses assistant or a nurse practitioner are actually qualified to give me a prostate exam or a hernia check but the fact is I go to this particular doctor to be checked out by the doctor, not a twenty year old nurses aide.

On another board of this type we got into a big discussion as to why it is so common for a doctor/nurse/practitioner to bring in a teenage, straight out of high school female assistant do to nothing but take an occasional note or two but usually do nothing but sit a few feet away and watch the exam. She's absolutely useless but I am expected to triple my humiliation by stripping completely naked in front of her for absolutely no reason except because "I need her here to assist", when she probably won't even get out of her chair. How dare they think I would actually allow that to happen? I think the only thing this doctor would accomplish by having her in the exam room is to give me a hard-on, and then telling me "it's OK, it's a natural reaction. It's not your fault, don't be embarrassed. It happens all the time" while trying to hide the smirks on their faces.

But the most pathetic part is the fact that the vast majority, nearly all the guys I've talked to or have read their experiences on these discussion boards, although admittedly humiliated, consented to the demand, dropped their shorts and found an area of the wall to stare at to try to hide their defeated shame.

Every time I read a new experience I stop, clench my fists, look up at the ceiling and yell out loud "WHY? WHY DO YOU DO IT? JUST SAY NO! SHE CAN'T FORCE YOU TO DO IT! BE A MAN! SHE'S JUST A NURSE FOR GOD'S SAKE!" It blows my mind! The guy who wrote it is obviously completely humiliated. Why do they do it? Stick up for yourself!

 
At Thursday, October 23, 2008 2:57:00 PM, Anonymous Anonymous said...

MER said it best, we have to organize and get the message out to providers either by not getting care or having it noted in our chart that our privacy needs couldn't be met and follow that up with a letter to the hospital administrator. This is just a thought that I had but what if we could all come up with a generic letter that each of us could print off and just add our signature to the end. We then would in turn mail it to our surrounding hospitals. For me, I could send that to at least ten hospitals and if we get twenty or so people willing to do the same and our letters are consistant, we might get their attention that way? What do you guys think? I know we have two different blogs to post on about organizing but they have become dorment. Jimmy

 
At Thursday, October 23, 2008 4:49:00 PM, Blogger Maurice Bernstein, M.D. said...

You have the right to be listened to.
You have the right to be treated with courtesy
and respect.


Both of these rights for patients are listed in the brochure published by the Joint Commission on Accreditation of Hospitals titled "Know Your Rights" . I am sure these rights are also part of every United States state licensing board requirements for the physicians under their responsibility.

Do you see what I am getting at? Shouldn't your letters also go to these important regulatory bodies? Shouldn't these letters also go to both state and national legislative representatives? Shouldn't they also go to the American Medical Association or in the UK to the British Medical Association and so on?
I know I have written all this on an earlier thread but it seems this recommendation is still pertinent.

I can understand your frustration about the subject. Look.. with my article in the American Medical Association News Sept. 2008 (read by "over 200,000 physicians")disclosing the concern about these threads on patient modesty, I haven't gotten any e-mail from a physician nor have we received a comment to this blog from a physician on this topic--unless I missed one.

I understand it is "work" to actually perform this broadcasting of your concerns but I think it must be done if you want your concerns to be acted upon. ..Maurice.

 
At Thursday, October 23, 2008 6:09:00 PM, Anonymous js md said...

DG,
One further thing you can do if a provider insists upon bringing in an opposite sex chaperone into the room is to send a letter of complaint to the state medical board that arbitrates these complaints. Women make these complaints all the time. Put the stress on the provider violating your privacy. Will the board take any action? I doubt it, but the complaint will reach the doctor and he or she will think twice before doing it again. This complaint is only valid if the offending person involved was really a chaperone and not a medically needed assistant. If you can't be sure, ask the provider what this person will be doing to assist.
My thread on chaperones has more info on this particular grievance.
Joel Sherman

 
At Thursday, October 23, 2008 6:22:00 PM, Anonymous Anonymous said...

Thank you Dr.Bernstein. I completely agree with you but just one person isn't going to get anyone's attention as we've all learned through our and other posters experiences. There have been enough people that have posted on these blogs that could actually send up a red flag if we do something as small as this. Imagine if you had over a thousand letters go out to various hospital organziations and other regulatory bodies. Do you think they's ignore that many people especially in these economic times? I can tell you, if you feel it's bad now, give it five more years at our current rate. It will be horid! I think we are at the point of this board were we should give something a try because right now, we're going to be ignored. I'm not that great a formal writing so that's why I asked if someone would/could assist. Just something fairly simple and not time consuming that we could do. Any takers? Jimmy

 
At Friday, October 24, 2008 1:28:00 PM, Blogger MER said...

Joel -- In your last post, you wrote: "This complaint is only valid if the offending person involved was really a chaperone and not a medically needed assistant."

Of course, that's the crux of it, isn't it? What constitutes "medically needed" and who gets to decide? Is someone taking notes a medical necessity? How about someone to squeeze some jelly on to the doctor's gloves? There are, of course, obvious examples of medically necessity. But often we're talking about these blurred situations where, as you state in your thread on chaperones, the doctor is really using the medical assistant as a chaperone but covers that by saying she's doing something else.

What are your thoughts on this?

 
At Friday, October 24, 2008 3:30:00 PM, Blogger MER said...

I don't know how many readers of this blog have ever looked at The Joint Commission's check list/form for hospital accreditation -- but the first chapter titled "Rights and Responsibilities of the Individual" contains the following standards, which I'm quoting directly:

1. The hospital has written policies of patient rights.
2. The hospital informs the patient of his or her rights.
4. The hospital treats the patient in a dignified and respectful manner.
5. The hospital respects the patient's right to and need for effective communication.
6. The hospital respects the patient's cultural and personal values, beliefs, and preferences.
7. The hospital respects the patient's right to privacy (See aloso IM.02.01,EPs 1-5). This element of performance (EP) addresses a patient's personal privacy.

Note especially numbetrs 6 and 7. This seems extremely clear to me. What we don't seem to be really emphasizing on this blog is that we're complaining about rights that we already have. If we're not granted these rights and we complain to the Joint Commission, especially in numbers, the hospital invovled would be in danger of losing its accredation.

You can find a copy of these standards on the Joint Commission website. Print it out and keep a copy with you when go to the hospital. Be armed with this information.

This is about empowering ourselves -- and knowledge is power. The Joint Commission has also created a series of brochures about everything from recovery to research, and they focus on patient rights. Dr. Bernstein gave the link to the brochure on patient rights. Print it out and take it with you to the hospital. Take a look at the other brochures.

Remember -- knowledge is power. If you're preferences and values are not treated seriously, let the hospital know (through the patient advocate and the administration) that you know your rights as a patient and they're not being met. Go through the hospital first with your complaint. If you're not satisified, go to the Joint Commission.

 
At Friday, October 24, 2008 4:08:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, "How about someone to squeeze some jelly on to the doctor's gloves". You know, sometimes doctors forget that there is some other helper in the room. Often it can be the patient him/herself that can help for minor services if it is practical. Certainly removal of clothing is the patient's responsibility if physically or mentally capable. Patients should be encouraged to be engaged in active participation in all aspects of obtaining a history, performing a physical examination or procedures and not be treated as an inert subject of all of this.

Patients should also be able to question the doctor about the necessity of other employees being in the room. The physician should admit if that person represents a chaperone. Since the purpose of the physician selected chaperone is for an important self-interest of the physician, it may be unlikely for that person to be removed from the room. ..Maurice.

 
At Saturday, October 25, 2008 4:07:00 PM, Blogger MER said...

My comments were ironic, doctor. The doctor's need to have someone take notes or squeeze some jelly on his gloves should not trump the patients rights of privacy. I like your suggestion, though. The patient can assist the doctor.

As is discussed in Joel's blog in the chaperone thread, a significant number of doctors (especially dermotologists) may be using female medical assistants -- who have little to do during an exam -- as chaperones, and the patient isn't being informed as such. That's unethical. The general ethics of chaperones is that they should be medical professionals (not receptionists) and that they should be of the same gender of the patient (esp. if requested by the patient). So you see, a doctor can get around those rules of thumb by saying he or she "needs" an assistant to help with the exam. The doctor gets to define "needs." Now if it's a procedure that requires instruments to be handed back and forth specifically -- that's different. But "taking notes?" Or "squeezing jelly" on gloves?

But the doctor will always have the edge in justifying why he or she "needs" an assistant that may really be a chaperone.

But let's be really honest about chaperones. If, as you say, the chaperone is "for an important self-interest of the physician," then the person is not a chaperone -- the person is a witness. And the witness is being paid by the doctor. So, ethically, and realistically, the witness has a conflict of interest and no real credibility. Frankly, I can't see the testimony of a witness like that standing up in any court, can you? Juries find paid witnesses very suspicious, especially one who is an employee of the person being accused of wrong doing.

 
At Saturday, October 25, 2008 6:13:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, of course the chaperone selected by the physician is chaperoning the physician not the patient. However, I fully agree with you that as a salaried employee of the physician, a potential conflict of interest could be a conclusion derived from legal scrutiny. ..Maurice.

 
At Sunday, October 26, 2008 1:58:00 PM, Anonymous Anonymous said...

I just went to the derm doc and the doc had a small computer to enter data on the patient instead of a paper chart. This office went electronic about 6 months ago. Now, I went to another office in the past and the derm doc there had a female walk right behind them in the room, unbeknowist to the patient, without any warning or consent. This female sat in the room the entire time and entered data on the small computer while the doc examined and dictated notes. This last visit the doc themselves did it but it did not stop a female from entering the room during the visit-- and there was no reason for their presence. She did nothing but tear the paper off the table. I find this completely offensive. I go to no other doc that has a female enter the room during time with the physician. I just don't get it. The next time I go or my spouse goes we are announcing before getting undressed (and to any degree) that we only want to see the physician in the room -- period.

As far as MER's comments on the Joint Commission's rules. You might as well throw it in the trash. It is all rehortic.

 
At Monday, October 27, 2008 4:38:00 AM, Anonymous Anonymous said...

MER you state excellent points about bringing the list of patient's rights to the attention of hospitals, however, we did experience a violation and "after the fact" all this means nothing.
This is not law but guidelines as we were so politely informed by CEO's and administration. It all looks good on paper but in reality does absolutely nothing. They still feel totally justified in running things "their way." It isn't BURGER KING in healthcare for the consumer.

 
At Monday, October 27, 2008 11:42:00 AM, Blogger MER said...

All I'm suggesting here is that these are the guidelines that the Joint Commission uses to grade and accredit hospitals. When they look at these criteria, if they have no files containing complaints, they will probably just depend upon what the hospital is telling them about their policies. But, if they have a file of complaints from patients, especially men (especially in numbers), they can't ignore them -- and they would reflect on the hospital's accreditation.
I agree that there is probably a problem with the Joint Commission. But I don't think a file of complaints would be considered as "nothing" to them, especially if they also become part of the public record.

 
At Tuesday, October 28, 2008 4:39:00 AM, Anonymous Anonymous said...

I would agree with mer. While there may not be a lot of teeth in the commission, no business, and health care is a business...wants poor performance documented regardless of the penalties. Letting the provider know you are going to file a complaint may get more attention than the act actually warrents for fear of what MIGHT happen. The other thing it will do is give the provider notice you know how the system works. It's easier to ignore you if they think you can't cause them problems. If they think you know the channels they have to assume you are imformed and may not let it drop with the commission. And while it is easy to get discouraged and toss in the towel, don't...I can attest, you can make a difference...a couple letters to a local hospital administration caused a change in the imaging department where they now ask if you have a preference for the gender of the tech for intimate procedures.....it does happen, but won't if we just take it and don't say anything....alan

 
At Tuesday, October 28, 2008 4:02:00 PM, Anonymous Anonymous said...

I do agree with Alan and MER but that said fact is MOST patient/people don't know about the Joint Commission and patients' rights. People are very ill-informed about how to go about filing complaints, etc. They just "go-along" with the pathetic system. A complaint made to the Joint Commission if they find authenic and valid will just be put on the record of the facility for 4 years and then removed. It isn't much of a penalty. How many people do you know would call the commission to ask if there were any complaints on record before using a facilty. Zero percent.
I think it is worth complaining and making change but such a small percentage of people do it in any walk of life I just am not convinced of the effects. This isn't to say people should not insist on change and complain.

 
At Tuesday, October 28, 2008 8:08:00 PM, Blogger MER said...

In reference to our current discussion, I recommend you check the URL I've given at the bottom of this post.

On allnurses there's a thread started by a nurse who ended up in the hospital and was treated unprofessionally. She describes it. The posts that follow adviser her about how to complain.

Read these carefully. This advice is from the experts, nurses and other medical professionals -- people who know where the complaints will be most effective. Most of what they say we already know and have talked about on this blog. But check out this thread nevertheless. It shows we're on the right track. And it demonstrates, I believe, that the right kind of complaint to the right place will make a difference.

http://allnurses.com/forums/f100/nurse-patient-treated-badly-wanting-rant-335378.html

 
At Thursday, October 30, 2008 5:34:00 PM, Anonymous Anonymous said...

I love it when they get a taste of their OWN bad medicine!

 
At Sunday, November 02, 2008 11:55:00 PM, Anonymous Anonymous said...

I’m not sure if anybody else has noticed this or even commented on this before but if you read some (actually more than) of the post of allnurses regarding mistakes/privacy/etc… they always end the statement with a “hope your feeling better” or my favorite “I hope he/she survived their surgery.” Am I the only one who feels like we have evolved beyond those kinds of statements? I actually do have faith in the doctors that I’m not going to die on the table but the more I read these comments the more I think they actually have this mind set. Is this part of their training or part of their defense system? I tend to think it’s a little of both to justify to themselves that they are doing a good job and not having a negative influence on others people’s lives or even justify to themselves that everything they do (despite many of our feelings) is moral and necessary. Don’t want to start a debate on this, just wondering if anyone else has noticed this pattern? Jimmy

 
At Monday, November 03, 2008 7:55:00 AM, Blogger Maurice Bernstein, M.D. said...

Jimmy, healthcare providers offer these humanistic wishes because probably better than anyone else including the patient or their family, they are fully aware, by experience, of the uncertainties in medical diagnosis and treatment. For me, when I told my patient "I hope you are feeling better", I meant it! ..Maurice.

 
At Monday, November 03, 2008 4:19:00 PM, Anonymous Anonymous said...

Jimmy,
I think personally that nurses see so much and many times go wrong. They see that too. They know of the downside of being in a hospital so I think they offer those words. It is not rhetorical so much as the truth of medical mistakes, misdeeds, errors, etc. Where I had my surgery -- 2 years later a man in his 50's died in PACU after being out of surgery for less than an hour. He was in an outpatient surgical center and had a routine, elective, knee surgery under general anesthesia. Long story short when he was intubated that did not have the tube in the trachea. He was eventually transferred to the acute care hospital across the street where he was pronounced dead.

 
At Monday, November 03, 2008 9:05:00 PM, Anonymous Anonymous said...

I'd like to bring up a practice that occurred at military induction
centers in the 60's,70's and early
80's. Female clerks would make their selves present when young men
entering the military would get a physical. I would like to add that
these women were government service
employees. It's extremely disturbing that anyone would want to violate someones medical privacy
during a medical exam. How sick is that? These are young men entering military service.
How about 100 men stand and leer
at them when they get a pap smear.
I had an induction physical at ft knox in 1972 and this was exactly what happened. They just came up to watch in a big exam room. What I didn't know was this,were they prostitutes off the streets of louisville or were they
flown in from vegas.
These women were the same people
who handled your private medical data. Think about it. They should have been doing clerk work instead
they wanted to be perverts. If they
could not respect your privacy as a human being,do you think they
could respect your personel data?
I have be doing research on this
subject. The induction centers back then were called aafees I believe. Today they are called meps.There are 65 meps centers
throughout the us and puerto rico.
The usmepcom is located in chicago. Interestingly, if you visit the commanders website one of the statements its makes is respecting your dignity. I suppose after perhaps complaints were recieved things changed. The government unions were responsible
for the employees. Even the physicians were guilty . The oath of hippocrates "I will respect the privacy of my patients".
SICK!!! lm

 
At Tuesday, November 04, 2008 2:09:00 AM, Anonymous Anonymous said...

I have no doubt Dr.Bernstein that when you tell a patient that, then you probably mean it. I was merely referring to how I seen it used, mostly when a nurse was defending a mistake/error either by a nurse or physician. They take the emphasis off the error and direct the meaning toward a you should just be thankful that you could have the surgery. I just feel we’ve moved beyond this point and sometimes they can just say it was a mistake and shouldn’t have been done. Just an observation I made. Jimmy

 
At Tuesday, November 04, 2008 4:32:00 PM, Anonymous Anonymous said...

Jimmy,
I think that legal counsel advises doctors to never admit an error, applogize, or even talk to a patient when there is a disgruntled patient or an error. That was my experience. I was very upset with a surgical experience and was not informed of several important aspects of my direct care. Neither the surgeon or the anesthesiologist/medical director had the decency or professionalism to speak to me. Even after many complaints were formally filed.
It's kind of like when you get in an auto accident they always tell you to never admit fault at the scene.

 
At Friday, November 21, 2008 2:13:00 PM, Anonymous Anonymous said...

Is there a problem with this blog?
Nothing has been posted in a long time.

 
At Friday, November 21, 2008 6:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous,nothing wrong. Nobody has posted since November 4th because nobody has posted until your post.

Could it be that all has been said that needs or could be said about the issues in patient modesty. Hopefully, folks are out being activistic about their complaints. ..Maurice.

 
At Saturday, November 22, 2008 7:04:00 AM, Anonymous Anonymous said...

Nurses can't seem to wash their hands or respect your privacy!
Hospitals are no longer being
compensated for patients that acquire infections while hospitalized. What do they teach these people in nursing school.

 
At Saturday, November 22, 2008 7:36:00 AM, Blogger Maurice Bernstein, M.D. said...

I have no idea of how or what nurses are taught in nursing school about the issue of patient modesty. I know what I teach my medical students about patient modesty as they are learning to perform physical examinations: awareness and methods to aid in the preservation of modesty and yet performing an effective examination.

Any patient in a hospital who finds that the nursing staff is, as a practice, ignoring patient modesty should report the nurses behavior to the hospital administration and document the communication and expect a response. ..Maurice.

 
At Saturday, November 22, 2008 10:41:00 AM, Anonymous Anonymous said...

My daughter attended nursing school many years ago. I can tell you that patient modesty was not even addressed! They were taught to cover the patient during procedures such as bed baths and only expose the single part of the body that was being cleansed. I don't think bed baths are even given much at all in todays' world of hospitalization. The patient is rolled into a shower or quickly sent home or to another type step-down care. When my father was hospitalized 12 or so years ago there was very little to NO personal hygiene. They didn't even shave him because of the lack of nursing staff! Whatever you need done to your loved ones..better plan on doing it yourself or have private duty care sent in on your buck!

 
At Saturday, November 22, 2008 3:48:00 PM, Blogger Maurice Bernstein, M.D. said...

The Agency for Healthcare Research and Quality, a branch of the U.S. Dept. of Health and Human Services have a website section on"Real Men" and with the "come-on" ad line "Real Men Wear Gowns". Well, after reading all the concerns by men of modesty issues on my blog, I thought "By golly, the U.S. government has finally acknowledged the challenges in medical practice described here."
But..oops! Go to the site and watch the videos. They are good public health ads for men about getting medical checkups and tests but nothing regarding privacy and modesty issues.

On the page "Real Men Talk to Doctors (doctors, physician assistants, nurses, nurse practitioners and pharmacists)", we learn:


Men who know how to work with their doctors are more satisfied with their care and have better results.

Give your doctor as much information as you can about your health history, any medicine you’re taking, and any problems that you may be having – even if they’re embarrassing (they’ve heard it before). With this information, your doctor can help you decide what medical tests you may need.

Be sure to ask questions if you don’t understand something your doctor said. If you don’t ask, your doctor may think you understand. Write down questions before you visit your doctor. You can also bring along a family member or a friend to ask questions and help remember the doctor’s answers.


So there, you Real Men, is your pass to tell the doctor your problems, misunderstandings and all that stuff for better patient satisfaction with the care and get the better results. So "go to it!"

Oh yes, there are pages on the website for "Real Women" too. ..Maurice. p.s. What about those in the population who are not quite "real" this or that?

 
At Sunday, November 23, 2008 12:03:00 AM, Blogger MER said...

That Real Men site is interesting. They say that men need to participate in their medical care, ask questions, cooperate. I agree.

Of course, they may not like the questions I ask. And they may not like how I decide to participate. But they are saying what we're talking about here. They don't refer to male modesty, except to say that we're supposed to wear the gown -- which suggests to me that what they're really talking about is doing what you're told.

But, by asking men to participate in their care, they're opening this up to us bringing up opposite gender intimate care and requesting our preferences. Of course, they're answer may be that "real men" don't deal with that. We're supposed to be honest, give them the information they need. So let's do it.

Essentially, they're on our side. They just don't know it.

 
At Sunday, November 23, 2008 12:33:00 AM, Blogger MER said...

On other blogs, I’ve read comments by men who are surprised at the hypocritical attitudes of some female caregivers. They see no problem with having access to intimate care for men without asking permission of the men – but they themselves will not accept the same kind of care from male caregivers. These women recognize the double standard, even feel it’s unfair, but, because it’s just part of their job, do it anyway. One writer asks: “What is the thought pattern going on here?”

Here are my thoughts on what may be going on:

Many nurses and other female meds recognize the double standard. They know it's there. Most try to accommodate if they can. Some don't. But, as those who benefit from the double standard, why should they try to change it? It works in their favor. They know it's not fair, but they know about not fair because the older nurses have had to put up with it themselves within our healthcare system. But why fight a system that prefers their modesty over men’s modesty? Why fight a hospital culture that privileges their gender?
from the book Men, Masculinities & Social Theory edited by Jeff Hearn & David Morgan. From an article in that book called "After fifteen years: the impact of the sociology of masculinity on the masculinity of sociology" by Michael Kimmel:
"That which privileges us is rendered invisible by the very process that constructs that privilege...Marginality is visible, and painfully visceral. Privilege is invisible, and painlessly pleasant." (pp.93-94)
Let me elaborate on that quote. Within the medical system, female nurses and med assts, techs, are privileged. Within their culture it's considered routine that they have access to male bodies. They are the privileged ones. Some don't even see this privilege. It's invisible, because it's just the way it is and always has been. They don't question the whys. It's embedded in their professional culture. The fact that some men don't want this, don't speak up, become embarrassed or humiliated, -- that becomes invisible after a while. Either they don't even notice it or it just doesn't bother them anymore. These cultural values embed themselves so deeply in systems that we often don't even see them.

Now, men have been privileged in medicine for a long time. They still are. Look at the frequent uncomfortable power struggles between male doctors female nurses. These male doctors are privileged within this hospital system and the female nurses are often marginalized. I think things may change with a new generation of doctors. But I do recall reading research that, generally, the nursing profession has been disappointed with the female doctors entering the profession. They had thought that would help with relationships between doctors and nurses. Evidently, that’s not the case generally. I could locate the source for that if requested.

But, within the context of what we’re talking about on this blog, males are most often the marginalized ones. They’re surrounded by many females who don’t ask but just assume. Nurses and med tech, etcs who have just accepted the assumptions behind the values embedded in this healthcare culture. Some of these women are vividly aware of the problem, others don’t even see it. As the quote says, "Marginality is visible, and painfully visceral." Men see the double standard and feel it viscerally. We sense the lack of empathy, the pity, the invisibility of our feelings. Some nurses may see it, but I would suggest that most don't feel it as the men do. That's part of the problem. There's little empathy.

Now, these women feel it when they go to the doctor or to the hospital their modesty is compromised. But they know their modesty will be more often taken into account, and if not, that even the smallest complaint will get action, usually. But a good many of them are not able or willing to transfer the negative feelings of modesty they sometimes experience or have experienced into empathy toward the men they do intimate care on. Now, I'm talking about empathy, not pity. I often read that the nurses "feel sorry" for men, or are embarrassed for them. But that's not empathy. That's pity. Patients recognize pity when they experience it and most resent it.

I’ve come to believe, to some extent anyway, this might be what’s happening under the radar within our healthcare system. As I’ve written on other blogs, there’s little written about this form a sociological or psychological point of view. So, I'm presenting here theories based on reading, research, interviews and some personal experience.

As I often do, I need to add that I’m not condemning healthcare professionals. We all are living within contexts that we sometimes don't see through. We don’t always ask what we do and why we do it. We just assume. As has been mentioned on this blog, much depends upon how these professionals are taught, and how they are taught to deal with the baggage from their lives that they carry with them into the profession. I don't know how deeply doctors and nurses go into the sociology or psychology of men and women, how we're alike and how we're different.

I do know that there is an attitude in our culture that gender doesn't matter, and we see that in our healthcare system. But the research doesn't support that assumption.

 
At Sunday, November 23, 2008 2:54:00 PM, Anonymous Anonymous said...

MER, I have corresponded with the AORN nurses and was really surprised witht the response and attitude I received. The nurse that responded to me was almost surprised that this (male modesty and male patient preference) was an issue. She had heard about women requesting only women in the OR but not the other way around. They are very used to having women rejecting male nurses but not the other way around. Could it also be that so many men are really "dirt bags?" And only a very small percentage have any concern of privacy and decency in not wanting a total female stranger (albeit a nurse) do something so personal? There is another blog that had been mentioned here so time ago. It was "how husbands feel" which mostly pertains to male doctors molesting female patients and also husbnads not at all accepting of having their spouse exposed to another man because they know "how men think." What about the men having personal care by other women? What is the difference? There isn't any.

 
At Monday, November 24, 2008 5:12:00 AM, Anonymous Anonymous said...

The comment of privledge and invisibilty when benifiting from the double standard is interesting. There seems to be a common response when female providers are confronted with what we percieve as hypocracy when they prefer a same gender provider but feel entitled to perform exams on males. Awhile back we dicussed a thread where a female urologist wrote a scathing article something like "sexism at its best" when a male patient walked out when he found out his Dr. who he met for the first time was female. She admitted she preferred and went to female Dr.s etc. This scenerio has been put forth on allnurse and other threads as well. There is one thing that I have yet to see, female providers acknowledge this is wrong, or for that matter truely wrong or is hypocritic. On the all nurse blog whenever this issue is brought up, it gets heated and gets locked down and or removed. I took it as hypocarcy as did many, perhaps it is really the case where as being on the priveledged side of the double standard they don't realize it..and when confronted with it, are unable to answer so they deny, avoid, or can't answer...I really have trouble with the double standard and especially when the provider admits a strong bias for same gender providers, some on allnurse admit they REFUSE male providers...perhaps it isn't a case where they won't explain, perhaps they can't explain it. Has anyone ever had a provider discuss openly and intently the apparent issue of them having a same gender bias but expecting their patients to accept it?

 
At Monday, November 24, 2008 5:51:00 AM, Blogger MER said...

To Anonymous:

Unless more nurses start talking to us, we don't really know what's going on in their minds. We get some clues from the blogs like allnurses, but I don't know how representative that is. Also, there's Lawler's book, Behind the Screens, where she interviews nurses about this issue. I believe we can depend upon the authenticity of those interviews.

But I really think it has more to do what I said above. Some nurses just don't see this as a issue. They're really blind to their priviledged status. They see how men feel. Some just don't have the empathy. I'm not convinced they really look into the eyes of the men who are embarrassed, uncomfortable and don't speak up. That's where real empathy would develop. Some just avoid real eye contact and get on with the job. Remember, they're taught, I think, that it's "okay to be embarassed." Actually, "it's natural" to be embarrassed. They're taught to "manage" that embarassment rather than accommodate it. Read Lawler's book and nurse textbooks.
And, of course, men are stuck in this macho attitude that real men don't complain and just take it. And there are men who are really homophoboc. They don't want other men fiddling with them. I think the nurses notice those men more than the ones who would prefer a male nurse.
Who knows? I think it's telling that we don't see, as far as I can tell, any nurses on blogs like this. Do they not know it exists? You'd think that if not beside nurses, at least nurse educators or nurse supervisors would check out this blog, offer us their perspective, and perhaps learn a bit from what some men are saying -- and teach us a thing or two. I'd like to hear from them.

There could be many reasons why they're not participating -- They don't think this is an issue and think we're a bunch of cranks; they believe it's an issue and they deal with it already and don't really need our advice; they know it's a problem and just don't want to talk about it, perhaps, because due to lack of staffing they don't have solutions. Perhaps they see this as a all male blog that just bashes nurses. I hope not.

I've noticed on allnurses, for example, how it seems that they're not often open to "outsider" opinions about anything. There's a thread on there now about what makes a "good" or "bad" nurse. Someone posted an article written by a journalist. Of course, some nurses take that criticism openly; but others just don't accept that anyone outside the profession has any business telling them anything about what they do.
Of course, that's true with many insular professors -- and nursing, because, can be quite insular and protected. Mostly men in any profession can be the same way. Look how some male doctors respond to constructive criticism by patients.
Am I wrong here? Have there been or are there any nurse on this blog or lurking? I hope they don't feel unwelcome.
Remember, Dr. Bernstein didn't get any responses from his article about patient (male modesty). At least that was the last I heard.
Have you had any responses from doctors or nurses, doctor? You teach doctors. Do you have contact with nurse instructors? What do they say about this issue and how nurse are taught to deal with it?

 
At Monday, November 24, 2008 8:53:00 AM, Blogger Maurice Bernstein, M.D. said...

MER, I see from review of my Sitemeter results that I have gotten a few visitors from the AMA News website, though I may have had additional visitors who simply pasted in my URL and therefore the referral would be unidentified. It seems that no medical person except for our patient modesty blogging colleague js md has written here.

With regard to my contacts at the school of medicine, the nursing school is spatially separated and the medical school teachers have no contact with the nursing teachers. Your question though is interesting since for a number of years, I was teaching the first year med students at a private hospital where simultaneously with us there were numerous nursing students there with their instructor. I may have communicated with the teacher about issues with patients on the ward at the time or casual conversation but all this was before my blog here and reading all the concerns and so I never had the thought then to talk about the issues you and the others are now presenting.

I want to add a concept to this discussion of the described inconsistency of nurses behavior.
As medical student teachers and having gone through similar experiences in the past, we know that examining the unclothed body of a patient of the same but even more so of the opposite gender at first is an emotionally taxing experience and especially in a 22-24 year old where the hormone levels are still high. The same must also apply to nursing students. We (and I am sure also the nursing teachers) teach the students it is essential in order to be openly professional providers to attend only to the completion of a effective examination or procedure.
This would imply that the sexual connotations of what is being seen or done are suppressed. I suspect that generally this directive is followed by most doctors and nurses although the licensing boards are aware of the exceptions.

So here is what I am getting at: there are two aspects of a doctor or nurses response to examinations and procedures related to gender. Professionally, gender and personal sexual reactions are suppressed and attempted to be ignored. Personally, the doctor or nurse's reaction to their own attending physician or nurse may not be suppressed or ignored and thus one sees the apparent inconsistency. I suspect that doctors and nurses in their professional role with a patient assume that the patient knows that they intend to behave professionally and therefore are not attuned to investigate the patient's discomfort, ironically despite some having their own discomfort when they are a patient. I welcome any discussion on this explanation based on my understanding. ..Maurice.

 
At Monday, November 24, 2008 1:05:00 PM, Anonymous Anonymous said...

MER, I believe nurses feel they have the right and duty to provide care/treatments/procedures to a patient, period. Because the majority are female (perhaps 90% of nurses are of the female gender) they just "do their job" without regard of the patients' feelings. They think the patient just accepts this fact and "goes along." Basically, NO CHOICE. The response of "they do it (personal procedure) because that is who works in that area." That pretty much sums it up. The nurses don't care about how a patient feels. It is kinda like going to the market and accepting who checks you out at the checkstand. They have the attitude that they are trained to do this stuff so why should a patient complain. A lot of patients go along with this attitude. The minority like ones on this blog must be a minority. Because nurses don't get rejected on a daily or multi-daily basis they assume (and perhaps rightly so) that most patients (males) are happy with the situation. For the male patients that are homophobic all they need is for some male nurse that has the slightest appearance of being gay come near them and the male patient is right away asking for a female nurse.

Would a female patient do the same?
Would a female patient reject the care by a female nurse that has the appearance and mannerisms of being a lesbian?

 
At Monday, November 24, 2008 1:09:00 PM, Anonymous Anonymous said...

Dr. Berstein,
I have read numerous posts on a blog of "how husbands feel". They post article after article of male healthcare providers molesting female patients. Articles of doctors charged all over the country and Canada. How much have you researched, if any, on this topic? The regular bloggers on that site do not understand why male doctors are allowed or why a man would enter the field of OB/GYN. They say because they know how men think that it is impossible for them to separate sexual feelings when doing pelvic exams and breast exams? Your take on this would be interesting.

 
At Monday, November 24, 2008 3:07:00 PM, Blogger Maurice Bernstein, M.D. said...

To the last Anonymous: Of course nobody really knows what a person thinks, including the thoughts of a doctor or nurse. Whatever the doctor thinks, the evaluation we all can make is the doctor's behavior and satisfactorily completing the assigned task. We ask our students only to behave professionally. We cannot control what they think. However, a doctor acting professionally under circumstances which might lead to erotic behavior means that these erotic thoughts are, in a sense, being suppressed. That's all we can ask for and expect.

By the way, another reminder to those who sign on as Anonymous. Please, please end your posting with some pseudonym or initials, so we all know which Anonymous has written what. By the way, I know of ethicists who won't respond to anonymous postings to my blog simply because they will not accept responding to a poster who doesn't have the will, the courtesy, the self-confidence to identify themselves with their whole true name. This issue I think is worth starting a new thread about it since there is merit and it is ethical for disclosing ones own identity. ..Maurice.

 
At Tuesday, November 25, 2008 9:01:00 AM, Blogger amr said...

This last comment about ethicists not responding to a blog unless it is "signed" is amusing. I remember awhile back a whole discussion with ethicists on this very blog where Dr. B had to get their permission to post their comments (which is fine), but their names were "Ethicist 1" and "Ethicist 2" - or something like that. Their names were definitely obfuscated.

As far as retaining anonymity on the blog, there are real consequences to being "outed". It could mean the hospital / doctor could refuse service. Recently, my wife and I went back to her plastic surgeon to see what touch-up steps would be available, and because we had complained about sales reps being in the OR even though she had opted out of such in the surgery consent form, his assistant chaperoned the consult. So by complaining (legitimately) it cost us our privacy.

Whistle blowers seldom are rewarded.

--amr

 
At Tuesday, November 25, 2008 10:00:00 AM, Blogger Maurice Bernstein, M.D. said...

amr, I did create a new thread just to discuss this issue of commenter anonymity on blogs. You might want to join the discussion there. ..Maurice.

 
At Saturday, November 29, 2008 9:31:00 AM, Anonymous Anonymous said...

I don't know what the true purpose of signing off would be. Does putting a name/initials or something make the statement or comments more valid, true, worthwile, accurate or meaningful? Just because it is signed anon. doesn't mean it doesn't have merit or that it is created by some kind of a quack (if that is inferred).

 
At Saturday, November 29, 2008 11:02:00 AM, Blogger Maurice Bernstein, M.D. said...

To read about the general issues regarding anonymity on blogs go to the thread on this subject.

The practical value of using at least a pseudonym or initials is to aid in the continuity of the discussion. So we know which Anonymous had written what previously. "Quack" has nothing to do with the above practical value. ..Maurice.

 
At Saturday, November 29, 2008 11:24:00 PM, Anonymous Anonymous said...

“The minority like ones on this blog must be a minority. Because nurses don't get rejected on a daily or multi-daily basis they assume (and perhaps rightly so) that most patients (males) are happy with the situation.”

This has been stated many times on this blog but I’d be interested in learning what would be the common response by males if they were all given a choice in the matter? I also think it’s unfair that the medical community assumes that this is okay (without any data to back it up) without those choices available and without asking the patient (male or female) how they truly feel. It’s my opinion that if everything was okay with everyone, you wouldn’t have these blogs popping up all over the internet were patients are venting! Talk about a need for quality control.

I have to agree with MER. This is just the way they are taught. It’s in their interest to ignore this so they don’t have to change the way they do things; (and yet they preach patient satisfaction and doing what’s best for them?) I think this is why many don’t post here or welcome our opinions on their board. I dare any of us have a say in what happens to us while we are PAYING for their service… All we can do is voice our displeasures and hope others are doing the same. Jimmy

 
At Sunday, November 30, 2008 9:43:00 AM, Anonymous Anonymous said...

Jimmy, I think there are several telling behaviors that make one question whether this really is a minority or a silent majority and if the providers understand this and ignore it or if they really don't. First consider the double standard, it is assumed females are modest, and assumed males are not....yet we as a society fight the double standard and almost every case as being intrincuestly wrong...so why do providers ignore this one, there have been numerous cases where the provider admits they have a gender preference for intimate procedures when they are the patient, yet they expect the patient to accept them when they are the provider...find one that will discuss this or examine the hypocracy in it...if you can't justify something its easier to ignore it. There is a thread trauma naked on allnures. One nurse makes the statement that as she was doing the post she realized that they had admited they had preferences but were making accusations that patients were wrong when they expressed them...she wondered if they were being hypocritic?????????? I think they know silence is not agreement in many cases...just don't want to deal with it

 
At Sunday, November 30, 2008 9:46:00 AM, Anonymous Anonymous said...

When you are a patient you are the BOSS. You have the right to decide WHO participates in your health care. PERIOD! You have the right to choose the same gender in personal care. PERIOD!

PT

 
At Sunday, November 30, 2008 4:29:00 PM, Blogger Maurice Bernstein, M.D. said...

Here are three attempted postings to Volume 2 from yesterday. They were not posted at that now inactive Volume but despite they may be out of context here on Volume 6, I felt I should still allow the postings here. The visitor may want to go back to Patient Modesty Volume 2, if desired, to understand the context of these commens.
..Maurice.

Ruby on "Patient Modesty: Volume 2":

My fear of male Doctors started early - as a 5 year old girl in hospital - being surrounded by male medical students, stripped naked (I had amputated a finger and it had been reattached using pioneering micro plastic surgery) - one of the "men" put his finger in my vagina and they all laughed...even at 4 I felt vulnerable and terribly afraid - like a tiny creature being surrounded by slobbering predators.
I screamed the place down - the nursing sister appeared and ordered them out...
I have avoided male doctors ever since...
As a young lawyer I felt the need to face my fear and worked for sometime at the Medical Board - the things I heard made it clear some male Doctors are opportunists, some are predators...
I simply will never feel comfortable around male doctors or male anything in the medical field - I've lost trust forever.
I stayed away from Doctors for many years - finally female doctors started appearing...
I don't really like going to the Dr at all - I read up and refuse anything that doesn't make sense - I don't allow myself to be railroaded or treated as a child.
I had to stop working at the Board - I found the cases upsetting and they played on my mind. Commercial criminals are now my focus...
I'm pleased in a way that I was alert to the dangers before I was older - I saw many cases of abuse of teenage girls and young women. The latest to be imprisoned was a male dermatologist - exams that included digital rape. At least the Board has been forced to stand up and take notice - don't give these men chance after chance...
Thankfully, in many cases we can go straight to the police now and avoid the Board - they're criminals and shouldn't be permitted to hide behind a professional Board.
In my years at the Board, I didn't see any cases of female doctors sexually assaulting male patients - but I can tell you that I would fight just as hard for their rights.
NO ONE deserves that...
We have choices today...in the past there were so few female doctors...it was male or no one.
The answer - to be informed and watchful - don't assume anything and stand up for yourself...
Don't be afraid to walk out of a consultation or make a fuss.
If you have a traumatic experience it often stays with you forever - it ends up being imprinted on your soul.



Ruby on "Patient Modesty: Volume 2":
Chuck McP - I don't understand your comment - women had no choice of doctor for many years. In 1989 there were only a handful of female doctors and a couple of female gynecologists.
We KNOW what you're talking about - been there, done that....
I don't believe it comes down to male v female patient care - we're all entitled to be treated respectfully.
Knowledge is power...question, refuse, leave or ask for someone else.

Julia on Patient Modesty: Volume 2":
A patient advocate is a great idea...many improper things happen when a patient is unconscious.
Medical students have been permitted to perform pelvic exams on unconscious women, orderlies hanging around to enjoy the view while a patient is exposed, medical technicians behaving improperly...
What a shame we never have the option of an all male or all female team.
Even if we make sure we have a male or female doctor - we never know who will be the anethetist or the make up of the theatre staff.
Lets hope someone takes the initiative...
I know some doctors and nurses can request a closed theatre for their procedures - not sure if that option is available to the general public.

 
At Wednesday, December 03, 2008 3:12:00 PM, Anonymous Anonymous said...

This has been discussed somewhat in the past. Most times women can request and receive an all female team in the O.R. It is very unlikely a male patient can receive the same type request.
It is the ancillary OR team that really sees and handles the patient not the surgeon (s). They are usually entering the OR Suite only after the patient is sterilely draped. Prior to that the patient has been exposed and scrubbed. Depending on the case it can be from chin down to the toes. Most preps involved the nipple line to the thighs including the genital/pubic/anal areas. People don't realize how extensive these preps are. I think all patients should be told about this and it should be fully dsclosed and discussed and if a patient wants same gender care it should absolutely be accomodated.

 
At Thursday, December 04, 2008 9:42:00 AM, Blogger amr said...

To: Anon 12/03

First off, PLEASE indentify yourself by a unique "signature". It really is important to this thread in order to understand who has been saying what. It does matter.

From the research I have conducted I believe your assertions here are not completely accurate though the tenor is correct. It can be said that exposure of the pts body in the OR is a requirement, it is difficult to make general assertions beyond that statement. Each doc / surgery / institution has its own rituals.

"Most times women can request and receive an all female team in the O.R. It is very unlikely a male patient can receive the same type request. "

Although it is more likely that a woman who requests this will be able to have an all female staff, which would mean a female surgeon and anesthesiologist, with camera feeds in the OR and other support staff coming into and out of the OR, (and PACU after surgery) not to mention some OR suites that have large picture window glass walls that makes the OR easily observable from the hallways, there is always the likelihood that cross-gender "observation" of the pt will occur.

I am not so sure how often this in practice occurs given the overall number of procedures that are done in the U.S. alone each day. The percentage in my view is probably still quite small.

"It is the ancillary OR team that really sees and handles the patient not the surgeon (s)….."

This is surgery and surgeon dependent. For my wife's surgeries, the surgery documentation indicated that the doc or resident performed the pubic trimming. The nature of her surgery was such that she was probably fully nude when this took place. Furthermore, there can be post anesthesia assessment made of the pt. prior to prep and draping.

Draping is another matter. I have seen surgeries on the net where clear draping was used. Depending upon who draped the pt, the breast area was fully exposed to not exposed at all for the duration of the surgery, even though that part of the body was not involved in the procedure.

"Most preps involved the nipple line to the thighs including the genital/pubic/anal areas."

For abdominal surgery, above nipple line to pubis, side to side is the general practice. In general a wide area is prepped to help insure a sterile field (which is REALLY IMPORTANT). However, the area prepped is surgery dependent on the surgical approach. For neck surgery, I have seen a female patient fully nude on the table with the neck down to her abdomen being prepped. If a foley is placed, then genital manipulation will occur. Anal prep for most surgeries is not done.

As far as disclosure is involved, I've been told by surgeons that most pts don't really want to know what is going on. Also, to a certain extent I believe this is a $$ issue. Medicine is big business.

--amr

 
At Friday, December 05, 2008 9:45:00 AM, Blogger MER said...

amr

Your last comment is interesting. This is where I think communication breaks down. I believe that "some" patients don't want to know what will happen. I also believe that "some" patients do want to know what will happen and who will do what and if there will be any observers and how "open" the room will be. And "some" patients have absolutely no idea as to what will happen and who will do what. They find out afterwards. At that point, they either don't care one way or the other or they are offended.

As I see it, doctors and nurses hold too many assumptions about how their patients "feel" about things like this. They most often do not ask. They just assume. Their assumptions are correct for some of their patients, but not all, and these assumptions are quite convenient for the system. They make things go faster and are probably more cost effective.
Patients who want to know have the right to know the conditions under which they will have surgery. They have the right to know who is essential for the procedure and who is just observing, and they have a right to decide who can just observe.
Some don't care. Some do.

 
At Saturday, December 06, 2008 9:17:00 AM, Anonymous Anonymous said...

The case in Albert lea Minn nursing
home where teenage girls were
sexually abusing patients is
nothing new. This happens all the time in hospitals!

 
At Saturday, December 06, 2008 9:58:00 AM, Blogger Maurice Bernstein, M.D. said...

For those not familiar with the story, here is the link via Google to the Associated Press article. ..Maurice.

 
At Saturday, December 06, 2008 11:28:00 AM, Anonymous Anonymous said...

MER,
You said it right on!!
The medical world assumes too much about how each person feels about modesty, privacy and intimate procedures. Each and every patient has the right and should be given full disclosure about who is going to be doing "what" to them even while "under." Offended is the WORD. When something that you would not consent to is done to you while you were without control and then you find out afterwards it is upsetting beyond words.
This simply is not right and I fully agree with you MER that it is out of convenience and cost effectiveness for THEM. They think they have every right to do WHATEVER they want without regard for a patients rights and feelings. Offensive is the WORD.

JW

 
At Saturday, December 06, 2008 5:59:00 PM, Anonymous Anonymous said...

Yes MER, you are very correct, a perfect example is infant circumcision. No one has the right to cut off a perfectly healthy part of a baby's penis.

 
At Saturday, December 06, 2008 9:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Oops! Please, please.. let's keep continuity in the thread topic "patient modesty" and not start a discussion on male infant circumcision which is fully and extensively covered on another thread. ..Maurice.

 
At Tuesday, December 09, 2008 10:31:00 AM, Blogger MER said...

I found a very interesting article in the May 8, 2008 issue of The New England Journal of Medicine -- "Etiquette-Based Medicine" by Michael W. Kahn, M.D.

As I read it, the heart of the article says that, although doctors/may be tired and busy, there are certain behaviors they can do that indicate they care about the whole person. Even if you're tired, rushed, stressed, try to do these actions:
1. Ask permission to enter the room; wait for an answer.
2. Introduce yourself, showing ID badge.
3. Shake hands (wear gloves if needed).
4. Sit down. Smile if appropriate.
5. Briefly explain your role on the team.
6. Ask the patient how he or she is feeling about being in the hospital.

Some doctors/nurses reading this may find this to be basic, but I think it doesn't always happen, especially to patients who are in strange surroundings and don't know their providers. That is when these actions are even more necessary. When a patient knows a doctor or nurse well, some of these may or may not be as necessary -- but I do think it's still advisable to do them.

1. Most doctors/nurses knock on the door, I hope, but few ask permission to come in. I don't how practical or necessary that is, but it does extend an added respect to the patient's atonomy.
2 & 5. In my experience, rarely does a doctor or nurse, in addition to introducing him/hersself, also show their ID and explain their title/role. This could be important for patients who would like to know whether they're dealing with a LPN, RN, CNA, Med. Asst. Student doctor/nurse or whatever. Many patients, I believe, especially in a hospital situation where they're dealing with many care prividers, appreciate knowing who's doing what and what an individual's specific role is. I've even experienced those who don't wear an ID and don't introduce themselves, but that is not common.
4. I found this to be standard in my care, shaking hands -- at least with doctors.. It's a good strategy. I've never had a nurse offer to shake my hand. I'm not saying that's necessary or needed. It's just an observation.
5. This question is rarely if ever asked, in my view. And this is partially what I'm getting at when I say that doctors and nurses assume too much. Asking how the patient feels about being in the hospital, or having a certain condition, or about to undergo surgery -- gives the patient a chance to open up to the doctor/nurse and express some feelings he or she may not have been willing to express before. These concerns may involve modesty issue, fear, vulnerability. Responding to these feelings gives the doctor/nurse an opportunity really extablish some trust.

I offer this article in the spirit of trying to find solutions to the problems we're discussing instead of just complaining.

I'd enjoy hearing your response to this article, Dr. Bernstein.

You can find this article at:
http://content.nejm.org/cgi/content/short/358/19/1988

 
At Tuesday, December 09, 2008 6:02:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, you bring up a good topic..but, I'm pleased to say, I created a thread on this very NEJM article and to date have 9 comments. I think to discuss the general topic of etiquette, I suggest my visitors go back to the thread. However, I did feel that etiquette is not the same as physicians expression compassion and empathy. I wrote:
" To me etiquette behavior is in a way 'just acting a role' whereas true compassion and true empathy are not acting but feelings by the doctor and is the stuff, beyond the doctor’s skills, that makes the doctor-patient relationship most meaningful."

 
At Wednesday, December 10, 2008 6:46:00 AM, Anonymous gve said...

Readers may be interested in this book.

http://books.google.com/books?id=QxHhRhanSnkC&pg=PA137&lpg=PA137&dq=patient+drape+%22operating+theatre%22&source=web&ots=Dc_RPxAcdh&sig=_n59s92mHWT3Y2fYuUEzD2MGhRQ#PPA131,M1

 
At Wednesday, December 10, 2008 6:48:00 AM, Anonymous gve said...

and this book.....
http://books.google.com/books?id=nTmmCVsBC3QC&pg=PA50&lpg=PA50&dq=operating+theatre+rituals&source=web&ots=_7j-nc46P6&sig=ey4g8FkOKXLBlLSVwa3PEzsI2zc#PPA51,M1

 
At Thursday, December 11, 2008 9:06:00 AM, Anonymous Anonymous said...

gve, I could not pull up the book with the long site you listed. Is there a book name specfically you are referencing with a page no?
I would be interested to read what you found of interest. Thanks.
JW

 
At Thursday, December 11, 2008 11:13:00 AM, Blogger MER said...

Doctor:

I'm looking at that article specifically from the point of view of that last question the author recommends doctors ask:

"How do you feel about being in the hospital?"

I think that's such an important question. As I said above, asking it honestly may get the patient to open up about all kind of issues that will help the doctor or nurse get the patient better. And, specific to this thread, if the doctor or nurse establishes real trust with a question like that, issues of modesty may come up and can be dealt with.

 
At Thursday, December 11, 2008 12:39:00 PM, Anonymous Anonymous said...

I’m sure some may have seen this already but I’ll post.

http://www.msnbc.msn.com/id/28179848


Just more evidence that something has to be done about how easy it is for the professionals to behave in this manner. We patients deserve better than this and it’s just sad that this is documented and nothing will probably get done about the underlining problem which is what we’re discussing on this blog. The article says that this is the perfect job for a predator, I feel that their job made most of these people this way because how easy it is for them to get by with it. Jimmy

 
At Thursday, December 11, 2008 1:23:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, I think that your question to the patient "How do you feel about being in the hospital?" could be way too far "open-ended" and maybe, if the hospital staff is really interested in patient modesty, they should go ahead and ask the patient a more direct question such as "Some patients are very concerned about their physical modesty. Do you have any modesty concerns regarding any future examinations or tests? Tell me about them so that I can help resolve them if possible?" That should help bring out the concern since I am sure some patients wouldn't even think that the doctor or nurse was thinking about modesty when being asked your general question.

Jimmy, sexual criminal acts by medical care workers is an entirely different topic and should be discussed, if there is any reasonable debate (I think not!) about whether it was ethical or not, on another thread. This behavioral issue is totally different than discussion of professionals not considering or frankly ignoring a patient's (male or female) physical modesty concerns. ..Maurice.

 
At Friday, December 12, 2008 8:49:00 AM, Anonymous Anonymous said...

Dr.Bernstein

I don't understand how the two aren't related? If some of the boundaries mentioned on this blog were put in place, it would more than likely filter down to the lower levals as well. Forget about the crimes, those people will get what the deserve. Focus just on the cause and how easy it is for this to happen anywhere. That was my point. Jimmy

 
At Friday, December 12, 2008 4:20:00 PM, Anonymous Anonymous said...

In my community there were fireman
having sex with 16 year old girls
who were supposed to be sponsors.
Additionally, I find it disturbing that paramedics and fireman seem to hang out in the trauma room a little too long after
a patient is stripped down nude.Yes, I've even noticed female
nurses from air evac helicopters
hanging out in the trauma rooms
leering at nude male patients!

 
At Friday, December 12, 2008 5:45:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from 4:20pm today, if you were in a position to witness this behavior on the part of these individuals "hanging out" or "leering" when their clinical responsibilities have concluded, a active approach would have been for you to notify ER managers about your concerns. ..Maurice.

 
At Friday, December 12, 2008 7:28:00 PM, Blogger Maurice Bernstein, M.D. said...

Here are the two links that gve noted on December 10 2008.

http://books.google.com/books?id=QxHhRhanSnkC&pg=PA137&lpg=PA137&dq=patient+drape+%22operating+theatre%22&source=web&ots=Dc_RPxAcdh&sig=_n59s92mHWT3Y2fYuUEzD2MGhRQ#PPA131,M1

and

http://books.google.com/books?id=nTmmCVsBC3QC&pg=PA50&lpg=PA50&dq=operating+theatre+rituals&source=web&ots=_7j-nc46P6&sig=ey4g8FkOKXLBlLSVwa3PEzsI2zc#PPA51,M1

Presumably, the content that gve wanted us to note was on the page which appears on that URL. gve, is that correct? ..Maurice.

 
At Friday, December 12, 2008 10:28:00 PM, Anonymous Anonymous said...

I started reading these posting and I thought it was some sort of joke. Then I realized that at least some of these people are actually serious. I can not think of anything less important to me than having my body parts seen by a nurse. I asked some of my friends and they all thought it was silly too. I can see it for little kids, but eventually we need to grow up and behave like adults. So someone saw you naked! Get over it.

 
At Saturday, December 13, 2008 12:59:00 PM, Anonymous Anonymous said...

with regard to the two sites gve refers us to: I can say that it is usually NOT the surgeon that cleanses and preps a patient. The circulating nurse ususally does this task prior to the surgeon coming in to start the surgery. This is up to the surgeon and the case. Many podiatrists do their own preps, etc. But, speaking from experience I was both shaved and prepped by a female nurse without my knowledge or consent. As discussed on this site previously by several people the scrubs are extensive. A patient is not disrobed or touched until the patient is "out" either by sedation or general anesthesia and the okay given by the anesthesiologist. Thus, they hide this ritual from the knowledge and awareness of the patient. In my mind, disgraceful. This should be discussed prior and if a patient has an issue with the ritual it can be addressed and the patients feelings accommodated. That is the only DECENT thing to do.
JW

 
At Saturday, December 13, 2008 1:29:00 PM, Anonymous Anonymous said...

Annon of Dec 12 10:28pm:
It is impossible to judge people and to pile all people into one group that think the way you do.
That said, until perhaps you personally have an experience that is upsetting to both you and even perhaps your significant other DON'T pass judgement on others.

A nurse seeing someone naked is perhaps one thing. A nurse handling a person (opposite gender) for 15 min IS ANOTHER thing, especially if this is not something a patient is accepting of or has not given consent to.

 
At Saturday, December 13, 2008 1:58:00 PM, Anonymous Anonymous said...

I personally find it interesting that people who do not have modesty concerns are always telling others to get over it. We all have different concerns, preferences, and levels of comfort. Perhaps we should haul people whith fear of hieghts to the top of a tall building and tell them to just get over it, or toss people with claustrophobia in a crowded room and tell them to just get over it, and the double standard that is discussed here so often,,,women should have just gotten over it, Rosa Parks...should she have just gotten over it? If you have no concerns thats fine, but condemning those who do, telling them to get over it....thats the stuff bigots and sexist thrive on...you aren't like me so just get over it. An interesting item, the manual seems to come from the UK, on page 51 it says the underwear should be left on unless the area is involved, if they might be soiled furnish disposable underwear...they continue to say, the ritual of removing underwear is basically useless and causes undue embaressment to the patient....I guess the people in the UK just can't get over it...alan

 
At Saturday, December 13, 2008 4:47:00 PM, Anonymous Anonymous said...

The more I re-read annon of Dec 12 10:28 PM and contemplated the words and tone ...... the more this sounds like a female nurse condeming potential patients about modesty issues.

 
At Sunday, December 14, 2008 11:17:00 AM, Anonymous Anonymous said...

I agree regarding the anon comment
of dec 12 10:28PM, yes she is probably a female nurse who thinks
it silly until someone files complaints against her. SHE won't
think its funny then!

 
At Monday, December 15, 2008 11:12:00 AM, Blogger MER said...

I can't let the last two comments just pass by. We have no idea who wrote the comment referred to. To assume it's written by a female nurse is absurd.

This kind of "nurse bashing" on this blog is both wrong and counter productive. Most nurses are talented, caring, professional, and aware of and concerned with the issue we're discussing. They do the best they can to deal with it.

Whenever you get a profession, like nursing, that is dominated by one gender, you get problems like what we're discussing. The same applies to professions dominated by men.

I say this attitude is counter productive because most nurses are really our allies in this struggle. They follow their mission, to protect patients, advocate for them, and deal with their comfort.

There are always exceptions to this, as in any profession. But the exceptions are not the rule. Every profession has those who don't belong and should get out.

The more I deal with this issue, the more I realize I can't, and am not willing to fight this battle for all men. Men have to communicate, stand up for their beliefs in a polite, tactful way. It most cases, doctors and nurses will work with them and do the best they can. I am doing some other work, some advocacy in this area for both male and female patients. But patients need to be willing to talk, communicate, let medical professionals know their values and their needs.

And let's stop the nurse bashing. The healthcare system has its problems, but we're not going to solve these problems by demeaning the good people who work in that system.

 
At Monday, December 15, 2008 2:04:00 PM, Anonymous Anonymous said...

I agree with you about 99% MER, first off blindly saying it sounds like a nurse...go to the voy thread...sounds a lot more like some of those guys who bash people with concerns. I feel the vast majority of providers care and if you ask will make an effort to accomodate. The part that I have a little more issue with is I believe nearly ALL providers could ask, they know this is an issue but don't ask...we can speculate why, don't care, don't ask because they have to deal with it if they do, etc...but until we have conversations with them we won't know, and if we continue to attack them on this site...they will not partcipate..why would they. And even if they do partcipate we will only get some responders and can't say ALL nurses. We condemn them and say they think ALL men are not modest....then say Nurses like they are all the same. If there is one thing the allnurse thread shows, they are just as devided on this issue as we are. To lump all nurses in the same mold rather than addressing each nurse on their own merits or even on each actions....is just as wrong as them assuming we all have the same level of modesty....in any case, we need to have constructive conversations with them rather than accusing them of being perverts and such....I agree with MER for the most part they are very caring and compassionate people, it falls upon us to communicate to them...but it does not relieve them of the duty to ask either...alan

 
At Monday, December 15, 2008 2:46:00 PM, Anonymous Anonymous said...

I agree with MER and Alan. I believe all this assuming is a major issue in healthcare on both sides.

Patients assume doctors and nurses will know their feelings on modesty. They don't. Patients assume the doctor will know they don't want a chaperone in the room. They don't. Start speaking up and stop assuming.

On the flip side many doctors assume patients don't want to hear about scrub procedure. Some do. They assume a patient will be okay with an opposite sex assistant taking notes. Wrong again. Start asking for permission and introducing the assistant by name and title.

If everyone would stop assuming facts and start communicating many of these issues could be dealt with in an easy and quick way.

-cm

 
At Monday, December 15, 2008 3:47:00 PM, Blogger Maurice Bernstein, M.D. said...

I fully agree with cm's comments. If I am an example of the ignorant physician, I accept that nomination. As I have repeatedly written on these patient modesty threads, though for years I was teaching and practicing behavior consistent with patient modesty, I was never fully aware of all the nuances of concerns that both male and female patients can carry with them until I read about them on my blog. Without communication in both directions, no resolution of these concerns can ever happen. ..Maurice.

 
At Monday, December 15, 2008 4:17:00 PM, Anonymous gve said...

I am a male patient who has had to fight female nurses prejudice at every step.

My experience has been that female nurses are anything but caring and compassionate, they are solely out for themselves.

It is stupidity to suggest that nurses care about anyone but themselves.

 
At Monday, December 15, 2008 4:22:00 PM, Anonymous Anonymous said...

The 7 experiences I had with female nurses and ma's were all negative. Not one respected my privacy. Should I as a male patient have to ask for
privacy. Why should I have to ask. Isn't it rather basic, aside from the fact that I am essentially paying for the service .

 
At Monday, December 15, 2008 10:33:00 PM, Blogger MER said...

Regarding the last two comments. I'm not going to question or doubt your experiences. I believe you. This is the big problem in life. When trust is lost it difficult to get it back. Both gve and Anonymous have had bad experiences and now no longer trust the system and female nurses.

But we must go into these medical situations, as patients, with our eyes wide open. Bad things can happen. Not always, but when they do they do. Sometimes we need an advocate, a spouse or significant other or friend by our side. Anonymous resents that we might have to ask for privacy, or make requests. Alan wonders why we're not asked. All of you are right. We shouldn't have to ask. They should ask.

But that's not the way it is. That's the reality. We can talk about "shoulda, coulda, woulda" all we want. Then, after we talk ourselves hoarse, we've still got to face reality. The reality is that, as I see it, the culture of the healthcare system, their worldview, is such that they usually won't ask. They assume. But we, as patients, assume, too.

Dr. M in his last comment gave us real insight into how he used to feel, see things -- how he used to think. Now he thinks differently, and no doubt behaves differently and teachers differently. The way Dr. M used to think represents the worldview, the culture of the system. That's how it is. But it is changing -- though, slowly.

With Anonymous, who has had seven negative experiences -- have you spoken up at all of those experiences? Were you accommodated at any of them? I would think that we might get better at this as patients as we have more experience. Have all these experiences been in the same area?

Of course we're all going to run into negative situations, but the point is that we should be expecting that possibility and ready for it and prepared to deal with it. Be clear, kind, respectful, firm. Know the core values of the hospital you're dealing with. Know the AMA Bill of Patient's Rights. Know. Know. Know. Knowledge is power. Demonstrate that you understand, that you know the ethics involved. Use the word "dignity." Know what the professions say about how you should be treated.

And still, sometimes we're going to run into good people who have attitudes, beliefs, worldviews, values contrary to ours. But don't back down. Express yourself. Let them know where you stand, and stand firm. Challenge their belief system. Challenge their assumptions. All in a respectful way. Make them think. These are smart people, some quite intelligent. Some may resent it, but they'll understand.

But also try to see things from their point of view, too. You don't have to agree with their stand point to empathize with it. Don't make their job difficult in areas that don't apply to this problem.

Sorry for the rant, but I just heard a story from some friends I know well about a bad experience they had in hospital, some of it involving the modesty issue. It was extremely upsetting to experience how emotionally exhausing it was for them, and how much trust was lost. So -- I know these things happen. I'm not saying they don't. But for our own sakes and for the benefit of the system, we need to learn to say the word "Stop." We must speak up.

 
At Tuesday, December 16, 2008 4:34:00 AM, Anonymous Anonymous said...

I am sorry to here of the bad experiences you have had. I have had very positive experiences with providers, its the rituals and SOP that I see as the issue. Once I have asked I have recieved what I considered reasonable consideration. The issues I have had were caused by them doing what they always do. I reported here an incident involving a female tech with an scrotal ultra sound when a male was avialable. I wrote a letter to the hospital and complained...I had three people (all female) contact me not only to apologize but to tell me they were changing procedures. The head of the imaging called and we talked for some time, she said, "I just never thought about it, it's just the way we always did things" . They changed to offer a choice. At my PCP the nurse was leading me back to my room and said, the Dr has a NP in training shadowing him and I HAVE to ask if she can observe and gave me this look. When I said she could but would have to step out for hernia & DRE, she looked at me and said I don't blame you a bit....she understood. If I ever get flack for it I am taking it up the ladder to the people that pay the bills, most hospitals have a board of directors, some are not providers talk to them. We can say we shouldn't have to ask...and while I believe they should ask, you can either ask if they don't or suffer the consequences. How we ask will influence their response....but by and large I stand by my personal experience...most providers are good people and want you to be comfortabale...some have the attitude of entitlement, they are professionals, I do this all the time, etc. but by and large most are great

 
At Tuesday, December 16, 2008 8:15:00 AM, Anonymous Anonymous said...

The comment made about the person making the comment "is this a joke...and get over it" stated it "sounded" like a female nurse. Only because this is what MOST nurses say on this topic. This did not articulate an assumption or accusation but a comment that "it sounded like a female nurse." And when I read this it did not BASH nurses. Many are crude and feel impowered to do genital based treatments and procedures because it is in the realm of their job descriptions but they don't take into consideration a patients' personal feelings. They don't even contemplate that it "is" or can "be" a problem with some people. PERIOD. I have read some nurses on "allnurses" say "where do these people come from" "are they nuts?" "Are they kidding?" All the same exact reactions and comments that was stated in that short note. So whoever stated it sounded just like many of the comments made on allnurses site.

That said I agree with nearly all that MER writes and he/she is eloquent in his style and articulation. Doctors and nurses feel no modesty because they do this day in and day out. I guess.

 
At Tuesday, December 16, 2008 8:38:00 AM, Anonymous Anonymous said...

I agree with MER and others that most providers are caring people getting paid to do a job. I think that is wherein the problem lies. Doctors and nurses do this stuff day in and day out and "it just doesn't occur to them that people have an issue with being handled and viewed by the opposite sex." The more they "hear about this from people" will be the only thing that will change it.
The remark made by that person about "grow up and get over it" and "are you kidding?" does indeed sound like many female nurses that blog on the allnurse site. That is the attitude most of those nurses expound. I don't read that as a BASH but a factual statement of so much that I have actually HEARD with my own ears when I complained loudly after I had a BAD experience. Some don't even give an appology and just plain consider you a weirdo giving no credibility to your feelings or complaint.

 
At Tuesday, December 16, 2008 8:47:00 AM, Anonymous Anonymous said...

I to don’t feel that nurses are the problem. I have ran into some that just strictly go by the book and aren’t willing to even listen to a compromise but in those cases I simply refused treatment and found a provider that would listen and work with me. Through all four of my surgeries I had to work with female nurses and all were very professional and kind. I do think they do the best they can but I also feel like the rules or SOP’s are outdated and need an overhaul. The best thing that we can do as patients is just speak what we’re feeling ahead of time so it doesn’t cause stress down the road. Like many, I don’t agree that it should be me that has to say anything since it’s my body and a service that I have to pay for. I honestly can’t comprehend why they themselves can’t/won’t do more for patient privacy but like anything, you have to have enough people to voice concerns before anything gets done about it. If enough of us do that, we can force a change but we have to do this as a group, just as Dr.Bernstein and others have stated on several occasions. Jimmy

 
At Tuesday, December 16, 2008 9:21:00 AM, Blogger Maurice Bernstein, M.D. said...

There is so much interesting back and forth commentary that it is a shame that some folk continue to fail to use a consistent pseudonym or initials so we can all follow along with more understanding of who is trying to express what and how the opinion of one Anonymous differs with another Anonymous.

By the way, I don't know if Blogger.com has fixed the system which caused a failure to publish. However, again, out of precaution and since we are now over 100 comments on Volume 6, I plan to shortly move on to Volume 7. ..Maurice.

 
At Tuesday, December 16, 2008 4:52:00 PM, Blogger Maurice Bernstein, M.D. said...

AS OF DECEMBER 17 2008 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME7" TO CONTINUE COMMENTS. ..Maurice.

 

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