Patient Modesty: Volume 8
From Fisheaters.com, a Catholic website:
"Ecclesiasticus (Sirach) 19:26-27: "A man is known by his look, and a wise man, when thou meetest him, is known by his countenance. The attire of the body, and the laughter of the teeth, and the gait of the man, shew what he is."
I Timothy 2:9-10: "In like manner women also in decent apparel: adorning themselves with modesty and sobriety, not with plaited hair, or gold, or pearls, or costly attire, But as it becometh women professing godliness, with good works."
Read the link. I thought that the picture, the biblical notations and the religious narrative at the Fisheaters website seems to be suggestive, in my opinion, of the view currently being discussed on these Patient Modesty threads: that physical, bodily modesty is considered less an issue for men than for women. I would be most interested to know how my visitors fit religious doctrines (not just Catholic but perhaps Muslim and others) into this discussion of patient modesty and differences in what is generally considered or practiced between genders. ..Maurice.
NOTICE:
AS OF FEBRUARY 7 2009 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 9" TO CONTINUE COMMENTS. ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:11:00 PM
122 comments
122 Comments:
JW: The incident with my father was back in the 80's. An interesting note it happened in the same memorial hospital referenced in "my angels are come". Without being graphic it was worse than that. I was stunned, I was a lot younger, after reading this post decades later, I know I would react differently today...that is for sure.
Jimmy, no doubt most of the department heads are former nurses, therefore female, which probably contributes to the double standard. But, when they make that move they become part of the admin. And when it comes right down to it, the personality of the facility is heavily influenced by the folks at the top. If they felt exceptional attention to modesty drove the bottom line, and instilled that in their team...it would be SOP not something a doctor would have to permit.
Dr. Bernstein, you have touched on this a little before. I really don't know where my strong feelings toward this issue come from. While I am religous, I really think that has only a small percent of influence in this issue. While I think the concept of Adam and Eve showing shame at their nakedness has something to do with it, it isn't anything like the Mulsim belief, that I am aware of.....whether it is family upbringing, life experiences, or something related to some other part of my psyhic....I can't honestly tell you.
CHILL
I hope at some time you will join back in the conversation and encourage others to come with you so you have some back up. As I understand it you are at the begining of your pofessional life. That would put you in your late 20's early 30's. I hope you don't mind a little advice from someone a "few" years down the road. I have always been a business man, I have taken a ton of criticism from employees, the community, from every direction, everyone seems to know how I should, how they would, without really knowing what it takes to do what I do. So while I am not a Dr. I know a little what you are feeling when you came to this blog and got alot of emotional "feedback". Take all the stuff that comes your way, sort it out, assimilate and use some of the stuff that has value, even in my 50's I learn daily from the strangest places. Sometimes I reject it only to realize later...oh yeah....and the rest, learn from them also, learn to hear what they say and develop the ability to say "ok but I know things that you don't and am confident what I am doing is right so I can be content with what I am doing". Somewhere between taking everything to heart and being arrogant and rejecting everything is the sweet spot of happienss in your professional life. Took me decades to get there. I hope you will return to the fray and bring some reinforcements, your input was valuable and not without applicable thoughts. It opened my mind a little, your blogs read one way, then you clarify and I find myself saying....oh yeah...that does make a difference or sense...in any case good luck with your life, working a ER in the battlefields of this country certainly has to have its challenges............alan
Alan, my interest was not regarding whether religion played a specific role in those visitors who are concerned about lack of attention to male physical modesty. However, I was interested in whether such a lack of attention, if a generalized phenomenon throughout our society, could be related to ages old beliefs perhaps originating in religious doctrines. As an example, the slant of the writing in the Catholic Fisheaters example would make one wonder whether male physical, bodily modesty is given equal emphasis as that for the female.
As an example of gender inequality, why are men allowed to expose their breasts to the public and not women in many of the worlds cultures? Where did this permission as a gender difference originate? Does this come out of religious teachings? ..Maurice.
Most of this has been said before through various posts but I think the attitude of ignoring male modesty from female nurses is due from the mindset that "it's just the way it is" attitude. They really think it is a non-issue because they haven't heard men screaming about it and refusing female providers. So they in turn feel that silence means acceptance. End of story. They feel that because "they can they will" without asking if it is okay. They feel they have every right to proceed with intimate genital procedures and treatments because they ARE THE NURSE, the one assigned, the one trained, the professional! And, it doesn't bother them so therefore why should it bother YOU! That's it.
JW
Doctor:
I do believe that religious beliefs do relate to our feelings about modesty -- even if we're not religious. Judeo-Christian ethics and doctrine have embedded themselvesin Western secular culture.
It's a complicated topic that's no doubt been covered by social historians, but here are a few thoughts:
Historically, modesty has been more a female than a male issue. Some of this involves issues of power, I think. Historically, women were considered men's property, and one always wants to protect one's property. We see that attitude in many Islamic countries where women are veiled. What's interesting and difficult for some Americans to understand, a significant number if not most women in those societies want their modesty protected from other for safety as well as cultural/relgious reasons. They choose to wear that veil. Now some radicals may say they've been brainwashed. That argument can be used for anyone with a religous belief.
I'm not sure all this says that men aren't modest or don't need their modesty protected. Most paintings of Adam and Eve in the Garden of Eden after the fall show both ashamed and protecting their genitles. As you, doctor, have shown in several of your graphics on this thread, paintings do show men protecting their modesty.
From a social/historical point of view I think the difference between men's and women's modesty may have more to do with power than anything else. Men as a gender are physically stronger than women. We can add to this the male biology, too -- men's libedos, sexual drive, etc. It's all part of the picture. It can be argued that men are hardwired to reproduce, biologically -- some have said with as many women as they can handle. But now we're getting into why monogamy developed, etc.
But to get back to your main question, I don't think many scholors would question whether religion has contributed to our feelings and attitudes about modesty. I believe it's an accepted theory.
Note, too, that the link you provide talks mostly about how women are to dress and how provocative dress contributes to temptation of males. From a theological point of view (Judeo-Christian and Islamic), protecting women's modesty not only is connected with protecting women physically from men, but also with protecting men's souls from eternal damnation.
The term modesty is a smokescreen
to conceal the real violation of
privacy. Personally I think religion has no part on the concerns of privacy for individuals. Are you going to give
a muslim more privacy over say an
eskimo.Should all people and both
genders be treated equally. When
is our healthcare system going
to move from this superlative
mentality to one of consideration
and caring for all.
CLW wrote the following to this thread this morning but I haven't received their e-mail addresses as yet from either CLW or PT.
MY E-MAIL ADDRESS IS
DoktorMo@aol.com
Note the "k" in the address.
..Maurice.
PT,
I have sent my email address to Dr. B with permission for him to send it on to you so that we can begin exchanging information.
Thanks,
CLW
‘Historically, modesty has been more a female than a male issue.’
This has been noted several times on this and other blogs that I’ve read/posted to but is this really true? I’m not sure how much or if any this has to do with the mindset of female staffed providers but it’s normally females who carry the responsibility of birth control. That, more than likely means that once a year they have to get an annual exam/pap smear which by all standards is a very involved exam and doesn’t leave much to hide. Men on the other hand don’t even see a doctor or go for any type of exam usless it’s necessary for work or they’re very sick, on average. Women do this religiously, without a second thought. I believe it’s because of the influences that have told them that it’s just a part of being a woman (whatever makes them sleep at night). But, to my point. Women have to endure this each year so does that in turn drive them to refuse the request that we’ve been talking about here? I can understand their point, I’d have a chip on my shoulder if it were required of me to do that as well. Has anyone else thought about that? Also, what does that say about their modesty? They go through those exams once a year for just a piece of mind (statistically speaking) where as men don’t bother unless there’s a need. So are they really that more modest, or does modesty have a different meaning to women when it comes to medicine? Just something to consider. Jimmy
While no doubt religion plays a role in modesty, and in our Christian religion that historically has been linked to the sin of Adam and Eve, I don't believe it has a lot to do with the difference between men and women's level of modesty. The Bible to a large part is written in reference to males, the main text is male oriented. Modesty, or perhaps the shame of nakedness is used frequently in literal and metaphoric references. The person who is shamed is often male.
The issue of standards such as bare breast is more cultural I believe than religion. Many European nations, even the Catholic nations practice topless or nude sun bathing, where here in the states it is a rarity, the religous base is the same, the cultures are different.
I believe a more telling historical reference is the disapearance of the male orderly. At one time many of the very items we are discussing here were performed by male orderlies. They were not medical people per se, they were there to protect the modesty of male patients. When the medical community discovered they could use female nurses and aids for these and get away with it, they began doing so and expanded the application to the point where they claim "gender nuetral" and modern day patients accepted it much as females accepted male doctors in the past. There developed the belief there wasn't a choice so accept it. The policy has little to no benefit for the patient, but huge economic benefit for the providers. Seems the issue was recognized at one point.
Something that is a mystry to me is why or how we came to the point where we allowed providers of all levels to take away our autonomy, our right to self determination. We have gone from following doctors orders, to blindly following the orders for nurses, nurses aids, etc. Some facilities have started color coding scrubs, many don't so the young lady telling you to remove your clothes for a shower may simply be an aid with a couple hours of instruction, and yet we feel like we HAVE to do what she says.....we may be economically and socially advantaged, and yet we allow a 18 year old high school kid to order us around.....if she was behind the counter of a McD's we wouldn't allow her to tell us anything...yet stick her in scrubs and put us in the hospital and we had over our free will....why??? alan
In the late 70's I was a full time
student attending college and working part time at a hospital. In
my 3nd semester I had as my course
load 2nd semester calculus,organic
chem 2, 1st sem physics with labs
and human anatomy. By occupation I
work as a chemical engineer. For the degree requirement I needed 2
courses in biology. I needed permission for the anatomy as it
solely was reserved for nursing
and resp techs.
There were 300 students in the
anatomy lecture. Among myself there
were only perhaps 5 other males in
this anatomy class. Approximately,
96% were female nursing students.
On the first anatomy test I recieved a B grade which was good considering I was carrying 20 credit hours that semester and worked part time.
Over 150 people failed the first
test. I'll never forget seeing all
these nursing students outside the
lecture hall throwing tantrums and
some were crying that they failed
the first test.I couldn't believe
it. For that class they actually
made an extra credit test so these
people could get through.
I believe that most of these people were less that average students during their life and
decided at age 18 or so that they
wanted to be a nurse. For extra
money I tutored algebra for the
university. Many of these women
apparently struggled through high
school classes. Their math requirement is 1st and 2nd sem
algebra which on the surface is
9th grade algebra. If they had
trouble with anatomy one can only
imagine the trouble they had with
math.
Do you really think they were
paying attention when privacy
issues were being lectured in their
nursing classes.
PT
PT, a very close relative was in nursing school in the early 70's. There was no instruction regarding patient modesty. Matter of fact the one nursing instructor who had been in the ARMY told the students if a male got an erection to "flick" it hard at the base with their finger and it would take care of the problem.
Of the 65 students (2 males) only twenty-eight graduated. My relative carried a full load and had been a math/science major in high school.
Some good comments. Someone wrote:
"I believe a more telling historical reference is the disapearance of the male orderly. At one time many of the very items we are discussing here were performed by male orderlies. They were not medical people per se, they were there to protect the modesty of male patients."
I strongly disagree. From my reading, the male orderly was there to protect the sensibility and modesty of the female nurse! If you read the history of nursing, especially in the 19th century when nursing began to be professionalized, you'll find many references to this. Remember, in those years many female religious orders (Anglican and Catholic) were dedicated to nursing. There was much concern with protecting them from having to deal with naked male bodies.
I believe this attitude still exists, to what extent I don't know, in healthcare.
My comment referred to privacy not modesty. There has always been instruction pertaining to privacy in all medical procedures notwithstanding people sleeping in class nor paying attention etc.
PT
From Twitter, here is "as it happens" (real time) someone's personal description of his vasectomy. Short of a video, this is what I call real data. The sequence starts at the bottom. ..Maurice.
17. #kevsnip am done. Off home to lie down 9:19 AM Jan 8th from TwitterBerry
16.#kevsnip nurse getr me says wants to see if bleeding when standing.am not. Prods me in balls.am still not.let's me get dressed 9:14 AM Jan 8th from TwitterBerry
15. #offered water. Shrug it off. Am manly about it #kevsnip 9:07 AM Jan 8th from TwitterBerry
14. #kevsnip am snipped and being stitchfd. Nurse tells me I bled a lot 9:04 AM Jan 8th from TwitterBerry
13. #kevsnip this one easier doc humming happily 8:59 AM Jan 8th from TwitterBerry
12. #kevsnip injection for Mr Lefty. Hurts like a bastard 8:54 AM Jan 8th from TwitterBerry
11. #kevsnip 'let's get out of here before anything else goes wrong' jokes doc as he stitches Mr Righty. Ha ha ha 8:52 AM Jan 8th from TwitterBerry
10. #kevsnip feel very odd pulling as doc ties off ends like threading needle with wool 8:46 AM Jan 8th from TwitterBerry
9. #kevsnip apparently Mr Rightys tubes are 'poor' nurse cheerfuky tells me am pissing blood 8:40 AM Jan 8th from TwitterBerry
8. #kevsnip doc tuts nurse says that's not good I say what? 8:35 AM Jan 8th fromTwitterBerry
7. #kevsnip injection fucking ow 8:28 AM Jan 8th from TwitterBerry
6. #kevsnip manually locating tube on Mr Righty externaly by squeezing•not nice 8:27 AM Jan 8th from TwitterBerry
5. #kevsnip swabbed down with ice cold stuff ack 8:21 AM Jan 8th from TwitterBerry
4. #kevsnip ok I'm in gottastrip ptu on gown 8:17 AM Jan 8th from TwitterBerry
3. #kevsnip looking like he's an hour behind;welcome to the nhs 7:08 AM Jan 8th from TwitterBerry
2 .#kevsnip checked in doc running late 6:50 AM Jan 8th from TwitterBerry
1.#kevsnip on way to docs 6:41 AM Jan 8th from TwitterBerry
Health care has been one of the largest sources of new jobs in recent years,viewed as a haven for workers even in recessionary times.
But now hospitals are scaling back
hiring,cutting temporary positions
and paring budgets. The bad economy
means fewer patients. Hmmm, does
this mean that the card in my
wallet carries more clout. Perhaps
as a paying patient people will be
more attentive to my needs and concerns. Maybe ceo's will see
unique opportunities to attract
patients.
PT
Someone ever "flick" me there they
would be picking their teeth up
from the floor.
Anonymous Saturday 10,10:50. I
can't imagine anyone with the
desire to assualt someone there
and considering that some have been
left permanently impotent.
Only confirms my belief that anyone can get in to nursing school. Very disturbing.
PT
We’ve actually discussed the religious question briefly on Dr.Shermans blog. Here’s the link:
http://patientprivacy.blogspot.com/2008/01/religion-patient-privacy.html
I personally feel that if you can make an effort to accommodate based on religion, than you should show the same respect to others. The only problem that I see is that we aren’t the minority so I don’t feel as though we can get the same benefits as those. If a hospital chooses not to treat based on religion, I’d say that would be grounds for a lawsuit. Instead, many hospitals have started to advertise accommodations so they can win business. Amazing…isn’t it. Jimmy
Last fall I had occassion to return to where I was raised because of a very ill close relative.
The hospital now has several male RNs where they used to have none, but they have no male cna's. This hospital has had to run shorthanded because of low funds according to one male RN who also is the patient advocate for all patients.
When I asked about requests for same sex care his comment was I could ask all I wanted but I would have to take what I got.
As to the comments by Chill... the satement about bleeding to death or ending up with a scar cause you kept your pants I find hard to believe...I would think that most patients would know if they were injured down there...or that is you were truly bleeding it would show through pants long before you bled out. I think teh blanket "make em naked" is mainly a assembly line approach.
This is why I have once lied to ambulance personell about if I l;ost conciousness and the second time I flatly refused transport..much to the aggravation of paramedics and police at the scene ( both times I had been broadsided by a drunk driver).
To be fair to Chill...I think long hours at a stressfull job and being overloaded with patients when some of them are just runny noses might take a toll on your sense of humor and probably your bedside manner.
I would like to state thatif you are in teh ER because of an injury it is not likely that you had to choice of going to your private Physician...mine would just have sent me to the ER anyway.. My insurance company is not much help either...if I refuse to be treated or in some cases refuse a particular treatment even ER visit , I might have to pay all the bill.
It would take a serious accident or illness where I was severly incapacitated or unconcious to get me in an ER. I am not going to the ER any other way.
leemac
I posed a question and leemac's post made me question again, why do we assume we HAVE to comply, why do we feel we have given up our rights to self determination? The case of the forced rectal exam brings up a point, if we are taken in to the ER, and refuse to allow them to "make us naked", and inform them we are fully cognicent and prohibit them from cutting off our underwear...what is the legal ramifications of doing so. While we could very well be jepordizing our health, that is our right. Go to McD's all the time, smoke, you are making a decision to jeprodize your health. If we refuse, I suppose they can refuse to treat us, but I question whether they can FORCE us to submit.....they will be ticked, but...I doubt many would take it the extent of forcing like the famous case especially if we toss in there a couple of I know my legal rights or my attorney has told me failing to honor my wishes constitutes assult, peppered with a reference to lawsuit here and sue there....I hate the suit happy society we live in, but if someone really feels their rights are being denied....you have limited options....anyone know legally what rights we give up or don't when we enter the ER fully concious..........alan
All patients who have the mental capacity to make their own decisions or if not then their legal surrogate who comes with them has the right to refuse any and all examinations and treatments. Any exam or treatment not consented to could be legally considered battery. The determination of lack of capacity is made by the attending physician and the basis for that conclusion must be documented. In a life threatening emergency all necessary examination and treatments to preserve life can be performed on a patient with no capacity and no surrogate to provide consent. ..Maurice.
I should also state that I sure do not wish to tie up the ER staff with just some minor thing...There are many who want and need emergency care because of a life threatening situation.
I looked into the capacity issue and found that there are many circumstances where the Doctor may may determine that your illness/injury is serious enough that he feels compelled to begin treatment and worry about competency later.. I understand their position...it is a catch 22 sometimes... as in "can I trust that the patient fully understands what is going on?" or is there enough time to explain and determine competency.... between legal liability and the sense of responsibility felt by the doctor to do his/her best....it must add great stress to them.
One can only hope that ones modesty is protected to the best that can be under those circumstances.
leemac
A large hospital near me just opened a new Emergency Room...it has individual rooms rather than teh curtains in many hospitals.
A neighbor asked the question,,,"Did this give greater privacy at the risk of being "forgotten about" or a greater risk of abuse as the patient was not as visible/audible to other patients in the ER?
I also wish to state that no matter my own personal feelings.. I do not want my familly or my fellows citizens to be deprived a first rate medical service at an ER.. but I do want everyones modesty guarded and maintained. AND my intentions are not to just make life harder for ER staff..o
by the way although the comments are too short to be sure who is posting.. many of the "get over it" comments sure are exactly the same verbage used by some of the nurses on allnurses... but then that feeling could be held by many and there are just so many ways to say it.
leemac
I don't really care what they say
on allnurses. Most of those people
have a tv remote duct-taped to
their left hand with a bucket of
bon-bons at their side if you can
visualize that picture.
They are the ones with the serious
issues. Anyone in healthcare who is
overweight which most are and making comments such as "get over
it". Do you as a patient want
someone like that looming over you.
No thanks!
PT
I don't really care what they say
on allnurses. Most of those people
have a tv remote duct-taped to
their left hand with a bucket of
bon-bons at their side if you can
visualize that picture.
They are the ones with the serious
issues. Anyone in healthcare who is
overweight which most are and making comments such as "get over
it". Do you as a patient want
someone like that looming over you.
No thanks!
PT
I have to tell you, I really wonder about all the accusations of abuse against providers. I think its like a plane crash, very very rare but it makes big news when it happens so we percieve it to be more frequent than it is.
On the ER I think as Dr. Bernstein pointed out, the provider is making split second decisions with huge ramifications. The point I was trying to make was even in the ER we have in a majority of the cases the ability to direct the way our privacy is dealt with. If we can demonstrate compentency we can tell them, no you can not cut my underwear off or before you cut them off put a sheet over me and then remove them. We can also request non partcipants leave, etc. In the ER like the rest of medical experience we do not in most cases forfiet our self determination, we fail to enforce it. We have the right to direct or demand certain accomodations, but we don't. Now that all assumes some degree of reasonablity, and then we get into defining what is reasonable. I would not request all males, but I would demand that I be covered at all times and no outside partcipants. By covered I mean a privacy towel over my pelvic area. That may be something else to others. The key points here again are communicate these issues and stand up for them, they should not be of such a nature to cause undue issues for the staff, no should they be such that unreasonably compromises care, but we can find a middle ground and if we don't ask or in some cases..demand, we can expect the issue of modesty to be applied to the benefit of the providers for efficency as well as care...alan
I think that unless you are taken into the trauma room...you will be able to make your feelings known and honored. If you wind up in the trauma room...the fact that you are there automatically means your injury or illness is severe. These are the times that you may find enforcing any feelings very difficult. These are the times when your ability to make judgements has some strikes against it. These are also the times when the doctor is having to make decissions very fast. From my reading of doctors statements here and elsewhere, they, at best, aren't much into hearing anything except answers to any questions they ask you...and from a couple of responses and statements some actually feel the patient has no real say.. they are there for whatever help is needed and anything beyond that is not relevant..
I am not saying this is always the case, but it is reflected in many online comments and by my own observation.
leemac
Some injuries, possible injuries, or where high fevers, and severe dehydration, are conditions whereby a Physician may question a persons ability to make judgements for themselves...and may be considerations for paying little or no attention to anything a patient says.
Although I am totally against online electronic medical records because the security of private info is not very good, maybe if you use this or your doctor does you might have your feelings in the record...in a real emergency it would probably not get retrieved soon enough, but it might help.
leemac
A couple of comments. My mother (elderly) went to an ER via ambulance. It was not life/death situation, no car accident, etc. Before the doctor even saw her the female nurse started to insert an indwelling urinary catheter. She did not even draw the curtains and did not ask me (male) to step out. I was shocked. My wife stepped in and ask me to stand behind the curtain, which she had pulled for privacy. I really didn't know what was about to happen but I sure did want to be witnessing my mother's privates! What is with these providers! They should know better. It is absurd.
I have seen shows on TV (medical ER shows) that they bring in patients and cut away everything (blurred area on the screen) and the patient is lying there fully exposed with all kinds of male/female staff. This is again absurd.
I always love seeing all the extremely big boned nurses smoking outside as I enter a facility. Such a picture of intelligence and heatlth.
Keep yourself as healthy as you can and try to AVOID hospitals at all costs.
Go the "How Husands Feel" blog. They post article after article of doctors/chiropractors/dentists that abuse their position.
Sorry, typo on the previous post..left out a very important word..NOT. Did not want to witness my elderly mothers' private for a catherization. Guess you surmised that I missed the word affirming the negative.
A few years ago my mother was having a lot of kidney trouble after her heart bypass.ON one of her trips to the ER, a nurse came in (ther were curtains) witha foley and tray...I had no doubt what was going on.. I do not know if she would have asked me to leave or not because I nearly pulled teh curtains down leving. My sisters were there...they said the nurse only gave them some sort of knowing smile at my abrupt departure..
I wonder, if when trying to tell a meical oractitioner of the opposite sex about your feelings, saying something like " I realise you are a proffesional and I also realise you are not embarrassed or you would change professions. I am a patient who is embarrassed and patients don't have the choice of being something else... only of going somewhere else" would be of any use?
leemac
Alan,
I’m going to have to agree with you that abuse is fairly rare but in healthcare I’d also say that one case is too many. This is what these people do for a living, there’s no excuse for the amount of cases against providers. I’m sure that a few are false but still, these are the people whose job is to look out for your welfare. They need to have stiffer penalties for anyone who’s been accused multiple times. That’s why it happens, because that has become part of their culture. They make little to no effort to protect patient’s privacy/modesty and it just rubs off on the entire staff. Seriously, if you saw your coworkers all doing the same thing wouldn’t you? If providers would actually take the time to tell the patient what needs to be done and ASK if it’s okay to do this, then maybe others would do the same. I guess though that just takes up to much time and isn’t productive enough to amount to anything.
I hope that everyone agrees that if you’re in a trauma room, chances are your probably really hurt and need attention. On the shows that I’ve seen, these patients are never conscious. Your health should come first in these cases. On the ER front though, as long as you’re able you can determine what happens to you. I was involved in a MVA 10 years ago where I was taken to the ER by ambulance. It was hard enough for the paramedics to convince me that I needed to go and I told them up front that my clothes are to remain on. Once I got to the ER, I told the nurses to not cut my clothes off (scissors in hand) and I would put the gown on over my jeans. No issues… had the X-rays and went home within a few hours. My girlfriend (wife now) and I made it through that accident with two stitches, but the car was a mess. Flipped it up hill three times before resting next to a tree. Those Cavaliers were stout cars…. Jimmy
thanks for great post!
Ambulance drivers and emt's drive
around in search of road kill. That's what they do. When they
bring patients to the hospital they
are rewarded with cookies,drinks
and donuts. Seriously! Sometimes
they bring in a patient from a
motor vehicle accident who is not
injured at all. If the car has
considerable damage but no apparent
injury to the patient the emt's
will talk you into going to the
hospital. They will strap you
to a board and after arriving at
the hospital you will be treated
as a level one. Clothes cut off
etc. When they realize you don't
have a scratch on you their excuse
is "trauma by mechanism".
Watch out for this scam.
PT
Alan,
There is good evidence that around 1 in 10 physicians have engaged in sexual misconduct. The figures are often based on surveys of doctors themselves, so it seems reasonable the actual number could be higher.
Imagine if the same numbers were true for schoolteachers! Next time you're in a large medical office building think about which doctors among the ones listed might be the offenders.
The numbers are not hard to find using Google searches.
Here are some links:
http://www.informaworld.com/smpp/content~content=a713845651~db=all
http://www.advocateweb.org/hope2/article57.PDF
http://www.californiaprogressreport.com/2008/09/how_california_2.html
http://www.tmb.state.tx.us/news/Spring02/spring02.php#%93JustSayNo
http://www.astm.org/JOURNALS/FORENSIC/PAGES/JFS4561184.htm
CLW
I would like someone to tell me what "trauma by mechanism" is...
Thanks
leemac
sorry last post was incomplete. In context of comment by PT, what would trauma by mechanism be? I understand trauma by mechanism.. the different types..blunt force, puncture, torsions, compression, etc. , but am unclear if it can also mean possible injury that is not readily visible?
leemac
CLW I am not trying to dispute your data, but I would caution that one has to be very careful at accepting data at face value. I read a report where over 70% of women had been abused by their husbands or male partner...of course when you read the fine print abuse was defined as raising voice, saying things that the women interpeted as negative, demeaning, or threatening, and cross or menancing looks. As I have said before, I am surprised it wasn't 100% of women,,,and 100% of men. The study was conducted by a womens rights group. Maybe I just want to live in a rosy world, but I still believe the vast majority of providers are good and compassionate people and abuse if very rare, serious and traumatic when it happens, but very rare....take the number of Dr. visits devided by the number of reported and unreported abuses and the fraction has to have a lot of 0's in front of it...but thats just my thoughts and feelings....alan
Trauma by mech is considering the
damage to the car you (the patient)
might have injuries that might not
be apparent.
Formula one drivers walk away from 200 mph crashes,you can be
in a horrific accident and walk
away. My take is this, if you
feel ok and can walk away great.
Let the emt's look for real road
kill, not just a quick trip to
the er to see some obese nurses
and a few free donuts. Not to
mention a $5000.00 medical bill
at your expense.
A level one trauma through the
door is $2000.00. An ambulance cost
is from $750.00 to $2000.00 Not
to mention a trauma surgeons fee.
PT
Alan,
Airlines fly many, many passenger miles without accidents, but it is still significant when a plane does crash.
One in ten doctors is a tremendous number, perhaps 100,000 doctors who admit to molesting (mostly female) patients. One hundred thousand doctors molesting even a few women each year would amount to several hundred thousand women molested by physicians each year.
Your comment reminds me of the remarks of a lawyer who was defending a highly regarded cardiologist not too long ago in Beaumont, Texas. The doctor was being tried (and was convicted if I recall correctly) for molesting a little girl (not a patient). His lawyer said, in effect, the people of Beaumont were fortunate to have such a skilled physician, they should tolerate his molesting the occasional little girl.
CLW
CLW
I am not disputing the seriousness. In fact, I would say the transgression by a Dr is worse because of the level of trust we are suppose to put in them. Society has told us and we have to accept that we place more trust in providers than any other person other than our family and a few trusted friends. We place our very lives in their hands, we allow them access to our body like we would no other. We have to have a higher level of trust in them, thus when they violate that trust with a patient, they have effected the trust of everyone for the whole profession. Thus the violation of trust may be even more as the expectations of the Dr is greater. I think trust is a key issue in this whole thread.
I still caution to not take data at face value and with perhaps a bit of caution. After all, we heard a statistic here that a vast majority of males would rape if the thought they would not get caught.....sorry I don't believe that either. Would I believe a large majority of men have had fantasized about it, yeh I would believe that, but fantasy and reality are two different things for a majority of people. How many people have said, I could or would like to kill that ***** , how many or would...just saying, I really question the number AND I question the real impact it has on what we are discussing in this thread...do you really think perverted Dr.'s are the main or a big reason we have a difference over how modesty is respected in the medical community....alan
I completely agree with your viewpoint, Alan. Professional abuse from the medical world is NOT the reason people have strong feelings about patient modesty and violations of patient rights.
Abuse is a separate issue. To say the reason you don't want your spouse to see cross gender providers is no doubt for other reasons and not the abuse issues. Maybe one can use that as the main reason but that would be more of an excuse not the real reason.
JW
I agree that the issues of modesty and physical assault and abuse are two distinct things.
I do not have any fear of being assaulted by medical professionals...in a sexual way anyway.
My concern is along the line of the mental and emotional aspect.
The modesty issue is not adequatley addressed for men....either by law or by custom and practice in many medical situations.
I do not want a chaperone..I just would appreciate medical services from a same sex provider,,doctor, nurse, x-ray/ultrasound or whatever tech, because it is a matter of what gives me greater embarrassment..not because of worry over improprieties of a nature that the law already covers very well...and law enforcement will take action on.
It would take a really egregious act of humiliation and embarrassment for me to think it was a jail offense..that would net the practioner a felony.
leemac
Since 1980 there have been 981
confirmed indictments of people
posing as physicians who performed
gynecological examinations on
unsuspecting women. Many of those
were molested. The most notorious
was arrested last year in manhattan. Included in the statistics are fake abortionists.
Equally disturbing are the number
of female clerks at military afees
and meps centers who felt it was
ok to make themselves present and
leer at young men recieving entrance medical exams. Apparently,
some saw it as a chippendale male
revue, others wanted to play female doctor. Those privacy violations numbered into the hundreds of thousands over only
a five year period.
PT
PT, please provide us with the references to all the statistics and trends which you have presented here. ..Maurice.
People posing as doctors and commiting crimes are just like those who pose as policemen and commit crimes... neither their fraud nor the crimes commited while they were "posing" should be tar for doctors who really are doctors.. As I said earlier..these are the ones for whom a felony fits and obviously if they were caught...the law enforcement folk are doing their job.
I have a cousin (female) who ws a navy flight surgeon. (The Navy helped pay for medical school)
She allowed no one of either sex to be present at any exam unless that person had a valid function there.
There are and always will be, I guess, those who want to leer at a member of the other sex.. Which is only an argument for increased protection of everyones modesty.
I most certainly would go after a "fake" doctor..but I would want his/her head and jail time for him/her. I want to get bona fide medical people to be considerate of my feelings about modesty...not send them to jail.
leemac
You may be interested in what is going on at the thread "Use vs Abuse of Hysterectomy: Hysteria vs Realism" where gender inequality has been noted and dwelled upon in many of the postings there. Here is an excerpt from a current posting.
I would like to take this opportunity to again note and elaborate upon the unfair disparity of treatment that the medical profession continues to promote between the genders. When it comes to sexual, reproductive and endocrine organs, the "standard of care" applicable to men is ultra conservative whereas for women a far more radical approach is routinely taken.
Perhaps you want to go to the thread and express, after reading, your views about the conclusion of the posters there. Write your views there on that thread rather than writing on that subject here. I will invite the posters to the hysterectomy thread to come to this thread to read your views on gender inequality in providers and express their views here. OK? ..Maurice.
An interesting site is askmen.com "locker room etiquette" It gives a lot of views and some interesting observations.
leemac
I think that for a while prostate trouble got the same treatment as hysterectomies for the ladies...but I think it is now a last resort to use surgery and radical removal.
I feel medical science not only advances in its stockpile of treatments...but has had to advance in its "bedside " manner..the way treatment is dispensed. One of the ways they have room for improvement is in considering male modesty as real. Just as real as any other considerations they must have with each patient.
leemacaz
I have spent the evening surfin the net trying to get a good handle on what informed consent and what constitutes patient competency....really are and how they are viewed by doctors and courts. I read a lot of online papers by medical professionals... While there seemed to be agreement that competent patients should make determinations for themselves frommost...I was amazed at some doctrines called a) pateralistic b) benefience.
These to one degree or another virtually took a patients right to say anything.
To be honest.. I am probably more confused than I was..
If the tangled web is as bad for doctors...I can see why they often feel like Chill seemed to.
The host of other doctrines and methods are mind boggling...
leemac
Since there is a site called
howhusbandsfeel,why not a site
called howwivesfeel? Is it because we don't matter or is it just
another dimension of the double-standard?
Previously, I mentioned about
physician imposters as well as
privacy violations at various mep
and afees centers. My point was
not to relate the two,however,if
I do speak of privacy violations
I'll point out that this happens
more to men than women.
PT
Informed consent is tricky. A physician/surgeon is suppose to cover all of this when they see you and/or do a pre-op evaluation. However, they don't have you sign an informed consent at the time they are suppose to be giving you this information. It is only when you finally get scheduled (maybe 3or 4 weeks later) for a procedure/surgery, a nurse flits in and throws a form in front of you and tells you to sign here.
With "patient rights" I think much of this came about with HIV and protection of a patients medical records, etc. HIPPA and the rest. As far as a patients rights with regard to dignity, respect, preference, etc. it all sounds good but try to do something about it after the fact! Big joke.
I really think most physicians and even nurses get very little to none of inservice on this issue. They don't see the importance of it as a patient does. One day they will all be patients or a member of their family and then and only then will they "get it."
JW
I came to this site over a year ago with moderate concerns for my hubands and my own treatment by medical'professionals' a few months ago I stopped coming to this site as I found myself upset and stressed over the whole situation. I have just read through most of vol 7 and now have major concerns to the point where my recent decision to stop seeing any medical personal whatsoever and to cancel my private health insurance (im in Australia) because I wont be needing it, my decision to cancel my regualr appointment with my specialist ( i have 2 brain and one spinal tumors)i now feel allthese decisions are right for me. Under no circumstances will I put myself in the hands of any medical staff given what I have read here especially by Chill...what I thought over a year ago was obviously an understatement. I would rather live what life i have left, howerver long that may be with dignity and in control.RM
PT
perhaps you would be willing to to start a blog about how wives feel.
RM
I can not and would not interfere with your right to decide your own course as to health issues, but Chill and his comments do not mean your own health care professionals will be that way. One thing that has been stressed on this blog..is at least talk to your doctors..maybe they have a far different view of patients and patients wishes.
leemac
RM, I'm sorry to read that these threads, instead of providing support, have only added to your emotional burden. I fear this is happening to other visitors who are not writing here but only reading. Your experience with what you read is precisely why I have felt that the tone of these modesty threads should be changed from complaining to uplifting and constructive discussion about how to mitigate these complaints through communal action.
I can't argue that in every case and at all times that patients should be following the directions set by their doctors. There are times when the patient knows far better than the doctor their own personal goals for life and there may be a time when patients should demonstrate their autonomy and divorce themselves from their physician's perhaps paternalistic approaches. Nevertheless, there are times when a patient needs comfort care and it may be only through access with skills and capacity of a physician to provide this necessary care. At those times, give the physician a chance to help. ..Maurice.
Good for you RM. My cousin passed
away several years ago. He was
diagnosed with lung cancer. He
went through radiation treatment
and chemo. He had in the 4 year
span 48 cat scans, 5 pet scans
and a dozen NM scams along with
6 mri's. When he died his medical
bill was a little over a million
dollars.
Since he was a teacher his insurance paid all of it! He
didn't die from the cancer, he
died from a respiratory arrest.
The radiation from the cat scans,
nm scans and chemo destroyed all
of his lung tissue. He just couldn't breath. His quality of
life was not good.
PT
RM
I’m sorry to hear that this blog has brought you further grief. In the time that I’ve spent on this site, I’ve found a lot of useful information on how to approach this subject with a doctor. I respect your decision to decide for yourself what is and isn’t dignified in your mind, now you should share that with the doctors who are treating you. You may find it helpful just to address your concerns with them and it will, in the long run, help what we all want to accomplish here. Nothing gets done by remaining silent and just accepting what is put in front of you. I know that this blog has at times focused on all the negative things that have happened with providers but there are many, many more good things that providers do for us. I have been a part of both good and bad but I have learned that the trick really isn’t to force your will (except for when I started to walk out of a procedure, that was before I found this blog) but to approach the subject in a manner to where the provider can deliver the care that you need without risking your mental and physical health. They work by their own set of beliefs that are different from ours so we have to work with them to get the care that we desire. Jimmy
Good suggestion about starting a site "howwivesfeel". The HC system we all deal which reflects a double standard for men is a great problem for men and their wives that are not accepting of female providers doing genital procedures. This does effect the wives of many men. It effects the feelings of the couple and their marital relationship. Being ill and/or seeking medical care is upsetting enough without adding emotional issues to the ordeal.
Leemac
I am not married! Although I do
have numerous girlfriends I couldn't really care less what wives feel let alone husbands. I'm
merely illustrating the double-standard.
PT
RM
I truly hope that you have an earnest talk with your doctors befor you make your final decision.
Things complained about here are not a gurantee of how your doctors will act or feel....remember doctors come in all flavors just like teh rest of us...
I do hope that ahousewife will do the blog....it will add a venue for others to exchange experiences and ideas....
leemac
Dr Bernstein
I for one can tell you that I have gained a lot from this thread. As I related before, I had an ultrasound which was negative and accepted what was offered. I had made the decision never to go back and put myself from tht again. Becasue of what I got from this thread I have had a follow up ultrasound, colonoscopy, and several other screening procedures ON MY TERMS, I have learned I do have the right to self determination, and if one facility or provider will not accomodate...there are others, health care is a business and they need customers, even if they call them patients....you have done good....alan
Alan, out of curosity, when you had your colonoscopy, did you request "no females" in the room?
From my experience, this is hard to get. I had one years ago and there was a female in the room assiting the GI doctor.
JW
No I did not request this, it was done at a local small facility with limited choices in staff. The anesthesolgist was female, what I did ask for that was, I did not want to remember any of it so they started the "sleep" a little earlier than normal, asked if it would be possible for the anesth. and the assistant to stand on the front side which they did no problem, when I woke the nurse told me I needed to "expell" the air and she needed to verify before they could release me. I told her please give me an extra "gown" or blanket to cover my backside and I will go in the bathroom and let you know how it goes. She said we are suppose to make sure, I joked a little with her and told her I wouldn't lie to her about something like that...she was a little hesitant but laughed and said she understood and thats what we did. While I would have preferred a male to assist its one of those meet you half way things for me, I have much less concern about modesty when I am out as long as I don't know them or have to face them in the future...the issue is so specific to the individual, what our preferences are vary so greatly. I think some of the most important things I have learned from Dr. Bernstein and Dr. Sherman's efforts are communicate, communicate, communicate, early, often, and then make your own choice...we have that right. It is important to communicate preferences before we are in the gown or facility, sometimes they can schedule you for certain procedures by gender choice if they know about it in advance. And, I have found that nurses/providers as a whole are less resistant to reasonable requests than we think if they simply know about it. They get so used to doing them a certain way...they don't even think about it. My preference was a male team, but I could achieve a level of comfort that was acceptable by the requests I made...that was my version of reasonable...alan
Alan, as you said the issue of modesty (conscious vs unconscious) varies with each of us. To me I really don't see any difference if I am sedated or fully conscious. What is happening is the same. Matter of fact I find it somewhat more offensive in a way to be sedated. It is kind of like a date rape pill being given to a female. Because she was out does that make it less offensive?
I don't know when or where you had the colonoscopy done, but I have never heard of this ritual of the nurse having to know you have farted (expelled air). They should be giving everyone a second gown out of decency. But then again ..what can we expect from them??
Thing is much is displayed on a big flat screen TV panel and whether these people in the room during your procedure were standing at your head or your side or your feet, they all saw everything glistening with KY jelly, MAGNIFIED. I wasn't sedated for a sigmoidoscopy and I saw what is seen by all in the room. They no doubt chuckled when you asked for them to stand in a particular spot! But do you think they'd level with you? NO. They just go along and don't tell patients the real truth.
If a peeping tom is spying on you
through the window would that be
a privacy violation or a modesty
violation. If you are having a
medical exam and someone is there
in the room that is not needed and
therefore should not be there which
of the above would you choose.
Consider that this person looking
through the window is say doing so
at a distance perhaps through binoculars or is standing in your yard.
Whats the difference? Lets consider that you are under anesthesia and for this example
you later found out that someone
touched you inappropriately or
viewed you when you should have
been covered and that this person
should not have been there.
Would the circumstances have mattered had you been awake or not.Certainly modesty is not a
suitable description for these
kinds of violations and only
diminishes the severity in the eyes
of those responsible for patient
privacy.
PT
my point was we are all different, I am more comfortable with being unconcious and with people I don't know, you are not, others could care less concious, out, male, female...we are all different.
As for the rest each facility is different, a woman in our office told of her husbands colonoscopy...which I am sure he would not have appreciated, when they brought him back he had a small straw like tube in his rectum to allow air to escape, she said when he would let one rip the nurses would cheer and say that was a good one...I have heard others tell of the similar procedure, and the facility I was at did not have a large screen for everyone to watch, it was a smaller screen suspended over the bed not visable from the other side of the bed. My PCP did the proceedure, he is very very considerate of a patient modesty and I can assure you, when he knew my wishes I would lay money they were honored. Not all providers are these evil non caring jerks that you seem to think they are. I feel sorry for you, I thought I was a little over on modesty, but the anomostiy showen toward providers as a whole is sad. There are some really great people in health care, once they know how you feel they are reasonable and accomodating...not all, but many...I feel bad for you that something really bad must have happened to generate such mistrust and anomostiy....alan
After a very tramatic health care experience the question I have in regards to the statment as to "how one can show anomostiy toward providers as a whole" is how do you tell the good from the bad?
Do they wear different colored smocks?
kcs
How can you tell good police from bad, good teachers from bad, good white people from bad, good African Americans from bad....yet would you justify saying they are all deserving of annomosity and condemnation...do they wear badges that identify them. Was every single person involved in your care bad?
Now don't get me wrong, I am not defending the system or the providers. I still think it is inherently wrong that they do not ask or seek to determine what we as patients desire for comfort. I truely believe it is a don't ask becasue if we acknowledge we know we have to respond....that is wrong on so many levels. For a profession that prides itself on patient care and comfort to ignore what they have to know is an issue to at least some patients is awful. But, I don't think it is a case where the providers are such evil people, I think its more they have always done so, the system is set up to do so, and quite frankly I think its just easier for them which to me is self serving and a bit lazy....BUT...that doesn't mean they are vicisous preditors waiting to prey on defensless patients. Many of us have these very triats of taking care of ourselves and do the same thing to a degree in our work place. The difference is we are expected to place and unbelievable amount of trust in them, like no where else, in order for us to do so they have to earn that trust, they have to show they go above and beyond the normal, they can not treat us like a buick and expect us to give them that elevated level of trust. If you tell me its different because "your a professional and are just looking out for the patients welfare" then act like it, consider it from my perspective not what is easy or SOP. Do I think there needs to be a change, absolutely, do I think its becasue providers are evil...no I don't....alan
Alan, for the record, I have had involvement one one or another with sigmoids and colonoscopies with various GI doctors, in various places (10 different times-family members, me included) NOT once was there this air expelling issue.
Calling healthcare people "evil" is not proper, but MOST don't give a hoot about a patients' feelings, modesty, decency, respect. They aren't the ones naked. They think because they are trained to do things, people shouldn't have any modesty about cross gender care. That is absolutely an assumption that is filled with ignorance and inconsideration even though the PATIENT RIGHTS document in every institution states that a patient has a right to "preference".
I am not an endoscopist, however,
I am concerned about this straw
or tube in the rectum to check
for expelled air.
Seriously folks I doubt this
happened. In an endoscopy or an
ercp which is through the mouth
there is always a concern for
perforation of the intestinal
wall. There is always air and
saline that is introduced via
the endoscopy tube. In an egd
or an ercp the patient will
always burp air. Thats normal
in that procedure.In a colonoscopy
it is normal for the patient to
pass air via the rectum for
a period of time which is normal.
There is no reason whatsoever
for anyone to place a rectal tube
to facilitate passing of air. Why,
and how are you going to quantatively measure it. If the
endoscopist perforated the intestinal lining which happens
and is a real possibility he/she
would be unaware of it. Usually
the patients presents to the er
in a day or so with severe abdominal pain and you guessed it,
surgery and a colostomy bag.
Personally I wouldn't have any
kind of an egd or colonscopy,the
risks are great for a perf. The
newest diagnostic tool are swallowing small pills that contains minature camera's by
which data are transmitted to a recording device. This technique
actually is much more accurate
and safe.
PT
Well PT you can doubt whatever you want, but all I can tell you is what I was told and I hav no reason what so ever to doubt what she said. There are a lot of differences between faclities. I have personally had an endo and colonoscopy. She said they told her it provided quicker release of the air and made the patient more comfortable. I can tell you from personal experience the air was uncomfortable until I got rid of it. I recall laughing to my wife and nurse when I woke up saying "I'm pregnant" from the extension of my belly. The nurse said, he does use a lot of air to get a clear picture. So, doubt what you may, I have no doubt it did happen. And while you may advise against it...professionals advise getting colonoscopies for screening and I think I would place my faith in those trained in this area...risk, I would guess the risk of complications are far less than the risk of colon cancer.
My contention of considering provider evil was in reference who connected modesty issues with abuse. I think to some degree we are on the same page in agreeing providers do not give modesty issues their just consideration. I don't think there is a lot of disagreement on that, I would attach a little less malicous intent to it, but agree that is is the result of self serving insensitivity to the issue. But I think when brought to their attention most providers accomodate without a lot of resistance...some do, some don't.....alan
First I want to thank all those who have contributed to the threads on patient modesty starting with the first thread titled "Naked". As some of you may recall the name of the thread was based on the title of the article "Naked" in the New England Journal of Medicine August 18, 2005 issue by Atui Gawande. M.D. Dr. Gawande who two years out of his surgical residency had the opportunity to talk with physicians who have practiced in other cultures around the world describing how the concern of modesty is handled in their country.
As those of you who have been following these threads over the years (since August 2005) remember that there has been some degree of migration from mainly operating room modesty issues (the seeming acts of ignoring modesty in general) especially regarding female patients to male modesty and the challenges to male patients toward gender selection of healthcare providers. This slant on the modesty issue has been going on for some time. Of course, in addition, over the past 3 1/2 years (!) there has been conversations regarding the speculated origins of the individual's bodily modesty and various other aspects including my general advice for activism in all these matters. And, of course, Joel set up his blog to focus on the modesty issues.
I write this posting to get some opinion from those who come here as to whether the current continuing back and forth on the male problems have reached a point of diminishing educational and constructive value to our longtime visitors and for the newer ones. I wonder whether there are other aspects of patient modesty to which we can now migrate. I am looking for opinion here and not dictating a change.
Again, I do want to repeat myself and thank all those who have contributed to these threads from "anonymous" to "pseudonymonous" to the very few who told us their real names. Let's hear from you about these threads and how they are going. Though I am moderator of this blog, these threads would have been nothing without those contributions of my visitors here. ..Maurice.
I think we should move on from the discussion about the male problems. I think what’s important is getting the care on YOUR terms in regard to both privacy and modesty. We can all agree that the healthcare field has its share of unprofessional providers. No doubt! But I think it’s more important to get providers to recognize that this is a big deal and one that shouldn’t be taken lightly. I wish we’d spend more time talking about activism, which is the only way we’re going to get their attention. If we can force them to protect every patient’s privacy/modesty that may solve a lot of the problems we’ve discussed here. Seriously, what have we accomplished since 2005? We have a lot of useful information on how to protect ourselves but I thought we all wanted to get to the point where we don’t have to ask? I’m sure many don’t agree with what I’m saying, and I apologize if I offend anyone. I just know that nothing has changed since we’ve been discussing this issue so I think it’s pretty safe to say that their isn’t any hope that someone is going to take notice and address this issue. If we want it to change, we’re going to have to do it. Jimmy
Jimmy I agree with what you say. I think one way to address the issue to providers is for all of us to write a very professional letter to an appropriate person at several of the hospitals in the general area of where you live. The content of the letter could be centered on this issue in general and could make suggestions for the team in the OR and on the floors to be aware of in addressing modesty issues and cross gender intimate care. At least it would bring this topic to the forefront and give them pause for thought about the sensitiveness of this concern that many patients and their significant others have but they ususally don't directly hear about. I think that is the first step in making the concern heard.
I agree that something needs to be done. Pleasant letters of general nature will be met with bland evasive replies.
The issues are not gender specific in as much as the providers don't care at all about personal choice, be it male or female.
Being vociferous, persistent and consistent will eventually prevail.
a few simple questions.....
Would you or your partner be comfortable with being watched while using the toilet, by a person of the opposite sex?
Would the nurse or doctor involved in your treatment be unphased by having to use a toilet in front of you?
If the answers are honest we all know what they will be.
So why is it so difficult for providers to simply respect what are obvious wishes?
Money is what gets their attention,
not a nice little letter. Take your
business elsewhere. Complain to your insurance carrier about the
lack of concern.
PT
While I understand those who advocate a more aggressive approach to this, I think Jimmy's comments have some basis for consideration. Starting on an amblicable basis to start a relationship with the provider causes no harm. If you get the feeling you are getting the run around or the brush off you can always esculate. But if you go in guns blazing and alienate them, make them think you are a crack pot, or a nut...thats a long way back to fixing that. I think to often we write a letter and do not expect a response...a real response not a form letter. I believe the key is to write a letter that lets them know you have some knowledge of the system and how it works, refer to JACHO, Hippa, etc without threatening them or getting in their face. When you get a response if you aren't satisfied go back to them and make suggestions, make specific references and don't stop, if you are corresponding with a patient advocate and aren't satisfied, take it up a notch and refer to your previous correspondences, if you can get other people to do the same, or at least let you include them via reference so the understand there is more than one....I really like e-mail as you can enter into more of an ongoing interaction while still gaining the....don't know exactly what to call it, so for lack of a better word...courage that writing provides vs face to face....you have time to think it through, research etc. and its easy to stumble when put on the spot face to face.
Now I agree there are going to be times when we will have to turn up the pressure and probably many or most cases will end up this way...BUT, and I do not mean this as condemning, but there is a right and wrong way to do this. The outright attacks on Dr. C and Chill accomplished what for this thread...we ran them off, we no longer have interaction with them...so we got to vent and we lost the value that we could have gained from their knowledge and experience and we lost the opportunity to perhaps get Chill to see a little more of our side...instead we probably convinced him that the folks on this side of the issue are a bunch of lunatics who attacked him with out really understanding what he was facing....we might never have convinced him....but we lost the opportunity. And Dr. Alex
C was on our side, she was proactively looking for ways to make her patients more comfortable...and I would assume we scared her away from Dr. Shermans blog. Heck if I was her I would have pulled the pic and hid thinking someone was going to come after me....the aggressive approach has its place....but opening up with an all out assult will likely close as many doors as it opens......
Dr. Bernstein, I agree we may be beating the proverbial dead horse...so where do we go from here....alan
Alan
You can't communicate with those who have a specific mindset
and see things onesided. I seriously doubt there is anything
to learn from these people.
How do you even know they are
real and actually work in healthcare. In addition, how did
they know this thread even existed
if this is not their mindset? Why
would they bother even leaving a
comment? Have they not read at least some of the threads here
to get a synopsis of what is on
peoples minds.
It is not up to them anyway,at
least in a hospital er they ARE
supposed to be the patient's advocate and adhere to the core
values of the institution. Whether
they are employees or working independent of the hospital they
must adhere to the facilities values, therefore their opinion
does not count!
The best response I can suggest
to readers is this
" Maybe you don't value my privacy but I do,therefore I would
appreciate if you would"
I always follow up with a complaint letter.This is the response I use if it becomes apparent if someone dosen't respect my privacy in any
medical setting. I'm careful in
who I choose when making an office
visit.
When I initiate a complaint I
never ever complain to heads of
nursing. I always start with the
ceo and my reasoning is that if
you do complain to the nursing
department they will stonewall
your complaint. Remember in their.
minds there is no double-standard.
PT
I don't think that we have turned Chill or any other physician away necessarily. I think it boils down to the fact that they do "things" their way and they can't understand or have an open mind or a caring mind to the true feelings of many people. They are unwilling to change their thought process and really empathize with a persons feelings about cross gender care, etc. Plus they are busy and can't sit and participate with a site as this. They made their point and moved on. Period. They are in a system that does things a certain way and it has been SOP for so long and they don't even care to think outside the box.
JW
I don't think we necessarily turned Chill or any other physician off. They stated their point of view. We stated ours. They are so indoctrinted with the SOP they are not willing to stop look and listen to a different attitude from a patient. They don't have to time to continue blogging when they certainly are not willing to change a viewpoint on cross gender care.
JW, please don't generalize since there are physicians just like me who can become educated to facts they never fully anticipated. Look, if I were one of those physicians you generalized about, I would not have kept these threads on patient modesty going for 3 1/2 years if I was convinced that the complaints represented an extra-ordinarily rare phenomenon, trivial and of no humanistic, ethical or legal or political significance.
Activism to promote a resolution of yours and the others concerns needs also that the activists believe that the objects (healthcare providers) of your concerns do have the ability to be educated toward your points of view. It just requires the proper approach.
Yes, just as many other problems in our society, following the established system is always the easiest and the least personally or socially trumatic. "Don't rock the boat" type of mentality. Particularly when an individual is actively involved in working within that system, it is more in keeping with time restraints and less bothersome to let some defects in the system reside unattended than to consider changes since changes in one defect may need multiple changes in various parts of the system. The job of correction then becomes too complex. I think this is the factor you folks are up against and not so much simply healthcare providers unable to be educated. ..Maurice.
Sorry,Dr. B. guess it would have been more correct on my part to say "the vast majority of physicians." You are an anomoly.
Thank you for your sensitive insight.
JW
PT I respectully disagree, I think we definately, if you go back and read Chill's final responses you will see he specifically references the feeling that he was attacked, ganged up on etc. and made the comment that the felling was "Chill sucks", he indicated he was leaving since all that was occuring was attacking him. And just as we accuse providers of being closed minded, we did not allow them to communicate, we decided they were against us and attacked everything they said. This was especially true of Dr. Alex. I came upon her thread becasue she was out there looking for advice on if she could abandon the practice of checking young males for hernia's during sports physicals becasue they were embaressed by them. That hardly seems like someone who is closed minded and insenstive to our or her patients concerns. Chill was definately a little tougher case, but he responded from his intial posts which I admit seemed pretty harsh, one could see there were other issues at play with him people using ER's for non emergencies, the over crowding, etc. Now I do not think any of these are excuses for ignoring modesty, but I do feel there was an opportunity to get some insight into how at least one provider, and if we had the chance might have brought additional in. We might have accomplished nothing by trying to communicate, but we assured nothing when we lost them. And, I would be interested in knowing how you think our contentions that providers are unthinking, uncaring, self serving, insenstive people who won't change no matter what....is any different than the what you accuse them of...being closed minded. When we get a chance we can either try to communicate and see if anything positive comes out of it or we can vent and attack and assure nothing does. I posted in my office a qoute that says "Whether you say you can, or say you can't do something...you're probably going to be right". Assume they won't listen going in and your probably going to accomplish that. At least TRY to communicate.
How do I know they are real, I don't, anymore than I know that you really have been mistreated...there is a certain amount of trust we have to have here...I presonally feel there is a large segment of providers who will be understanding to some degree or another...my personal experience if if we ask....it might happen, if not it won't for sure...........alan
I would venture to say that when
they need healthcare, they demand
a setting that suites their needs
and a different setting for every
one else. They have the option
of treating themselves and as such
our concerns are not their concerns.
One aspect of this subject I find very disturbing given the double-standards in effect toward male patients are the many male physicians responsible for the lack of privacy provided to male patients.
I have never seen a female provider disregard the privacy of a female patient whether the provider was a physician, nurse or
technician.
The most classic example were the 65 afees and later mep centers from the mid 60's to 2003. In a single day an afees or mep center would medically process 500 to 1000men for the armed forces. In the vast majority of these exams female
clerks would make themselves present, not by archetectural
logistics but rather waiting in the exam room for the men to show up when they had no business there.
It is the responsibility of the
physician to assure patients privacy after all that is one of
the features of the hippocratic
oath. Do some simple math and one
can realize privacy violations of
a hugh scale. If you visit the
site US mepcom then headquarters their mission states that "Todays
applicants are treated with dignity" HELLO! What happened before this and in 2003 new guide
lines were issued that no cross-gender observers are allowed.
Last year at a prestigous medical
facility a 5th year chief surgical
resident took a picture of a male
patient's penis with his cellphone
while the patient was under anesthesia. The resident wanted to
show other people in the hospital
the tattoo on the patient's penis.
The newspaper got wind of this and the resident was fired and later reprimanded by the state
medical board. The resident was a
male and the patient was male. As we already have a lack of support
for privacy issues by female providers. Yes Dr B, you are an
anomoly!
PT
I agree for the most part with alan and Jimmy...
I feel we need to reiterate the ways we can be proactive in our care in medical facilities and in expanding the number of medical personnel who give equal consideration and treatment to patients.. of both sexes.
I have found how others managed to get the treatment they needed on terms they could live with to be very helpfull...
leemac
Dr.Bernstein
Thank you for your last comment. I feel that is a major obstacle that we all face. It’s not that we’re asking too much, it’s that we’re changing too much when we ask. Schedules are made in advance for staff and they don’t want staff, schedules, etc to be dictated by what the patient asks/needs. I’m not sure if this was ever covered in another thread but how long did the transition take to eliminate male orderlies? I wasn’t born during this time period but I’d venture to guess that it was a slow transition so that it wouldn’t be as upsetting to the patients. Was there any complaints from the patients during this transition and where the patients actually a part of the decision? What type of communication did providers use to get the word out that male orderlies would be a thing of the past? Those are questions that I think would be useful to know if you can find the answers. I searched a few times but didn’t come up with the information that I was looking for. Has anyone else thought about this or have experience during this time? Jimmy
You ask some interesting questions, Doctor. I've done some research into this, but I haven't found specific documentation that answers specific questions. I do have some theories and educated guesses, though.
Modern attitudes toward gender and caregiving in healthcare seemed to have gradually changed after WW2. The 1950's represent a period of great sociological change in this country. Many people think the
1960's just appeared out of nowhere. One theory is that the events that came to fruition in the 1960's, actually "began" in the 1920's. They were interrupted by the Great Depression and later WW2, but "began" again in the
1950's. I write "begin" because we can always go back further to see the seeds of these changes.
I've interviewed older nurses who recall when there were more male orderlies -- and when the assumptions were pretty much that these orderlies did the intimate procedures on men, and the female nurses and assistants worked with the women. That at one time was the general assumption. These older nurses seem to think their elimination began sometime in the 1960's and continued through the 1970's. But most have told me the change happened more rapidly that once thought.
It may have had to do with some of the civil rights legislation of the 1960's, what we call today the BFOQ laws. As gender roles became blurred, most women refused to be treated by the male orderlies, and some men didn't want them either (homophobia?). It appeared that men didn't mind female nurses. It was more efficient to eliminate the orderlies and replace them with females. As chaperones became more necessary for male doctors dealing with female patients, it also became more efficient to just have female nurses and assistants. The law supported gender discrimination and the institutations could support the contention that their clients would not use them, that they would go out of business if they didn't hire members of a specific gender. The courts supported them.
Why did this happen? What role did patients play in this change, especially male patients?
The second question -- If patients had had any role, I believe I would find more public documents. I can't find any. Perhaps we can agree that the culture of medicine and hosptials at that time did not encourage patient involvement in these kinds of decisions. Even today, although it's better, our healthcare "system" doesn't really encourage patient input as much as it should.
Why did this happen? I don't claim to have the answer, but I do believe it is extremely complicated and related to all kinds of sociological changes that happened during that time. Such as:
1. The growth of cities and the growth of large hospitals.
2. The feminist movement. The expansion of women into the workforce. I'm not saying this is a bad thing. I'm just saying it influenced our attitudes toward gender roles.
3. The Vietnam War and the draft.
4. Postmodern philosophy embedding itself in the academies and how that affected how doctors, nurses and other healthcare professionals were taught. Postmodern academics also began to redefine masculinity in our culture, and frame masculinity more in terms of feminist thought. This has something to do with, I believe the resocialization of men. We've seen this in the American educational system, especially in the lower grades. Some scholars claim this has a role to play in the large problem that boys have in education today. The statistics are staggering -- for example, the number of boys in special education as compared to girls, the number of boys who successfully commit suicide (girls are less successful than boys are at actually killing themselves). The claim is that we're losing these boys at an early age in our schools because we're not considering how boys learn differently from girls. All this is connected to what we're talking about.
5. Medicine as a big business. Advances in medical technology and patient expectations regarding what medicine can or should be able to do. Doctors have so much to learn. There's so much specialization. We're often not looking at the whole body but it's small parts. Few focus on how all these parts interact. As we've been discussing on Dr. Sherman's blog, how much time and effort is there anymore to really explore the psychological similarities and differences between men and women in healthcare? How much time do doctors have to really study communication skill? It's easier to just assume it doesn't really matter.
I will say that lately gender studies are recognizing more the differences between how men and women think, process information, are physically constructed, etc. As human beings we are, of course, more alike than different. But the differences need to be addressed, and that's starting to happen.
I've just touched the surface. Now, these are my educated guesses. I'd love it if some expert sociologist got on this blog and said I didn't know what I was talking about and straightened me out -- if I am way off. I could be.
I surmise we might find documentation for this is arcane papers, Master's Theses or PhD dissertations. Perhaps in letters or other documents discussing nurse or curriculums from the 1960's or 1970's.
Any historians or sociologists out there?
I apologize for the length of this post, but I thought this might tie in to the current conversation as well as spur some additional. In Art Stumps Book "My Angels Are Come" he writes the following:
In a corporate establishment whose function is to promote and maintain a vast hopsital enterprise, it should not be surprising to find examples where the organization's financial and poerational intersts find themselves at odds with the altrusitic principles of a caregiving staff. After all, the two camps are not necessarily of the same ilk. Strict adherence to a codefied set of caregiving values, for instance might be regarded by some administrators as a hindrance, a dispensable excess jusifably waived in the name of expediency.
To the extent that coporate interests prevail in such differences, especially in the absence of a decisive moral or etihical authority, the organizations "mission" can devolve over time, ultimately finding itself subordinated to increasingly fiscal concerns such as growth and profitablity. At that point virtually any percieved healthcare excess might be depreciated or summarily scrapped in service to the organizations now way-ward mission.
At its core of course the hospital system remains an organization, a structured aggregate of people and facilitied allied in the pursuit of an end, But any such organization, corporate, or otherwise does not simply spring into being fully formed: rather it evolves over time in fits and starts.
For an organization to remain vialble it must constantly explore competing prioriteis in the course of its own developement. As it does so......Obsolete programs that were once highly relevant and praiseworthy many have since become counterproductive, deleterious even. And yet they persist.
Unfortunately, even the most obsolecent of such programs, those totally lacking demonstratable merit can drag on indefinately under the defacto patronage of organizational inertia. Sheltered from change by both size and unresponsiveness of thier bloated host organizations such outdated programs can become the seeds of disaster."
The statement comes from an incident wherein the author was recieving a radiation treatment for prostate cancer and over heard one of the nurses/techs introducing a young girl in scrubs as a high school girl who was there to observe through their shadowing program...she said "she is just here to watch"...what was an very private procedure to the patient. He has some very good observations about the violation of trust but as it fits in here, how much of what we experience is policy and how much is people. Is the bulk of the problem the facilities need for profit limiting what is available to the patient even if caregivers wanted to. A couple of examples, the ridiculous johnny gowns that are standard issue at most hospitals. While the serve a purpose for surgery and some patients who have impaired mobility...for many/most patients there are other reasonable alternatives that would serve the purpose and provide greater modesty, yet even though everyone knows patients hate them...most facilities use them, one can only assume it is because that is what they always did and it is more efficent and cheaper to have one type of appearal for the paitent than options. This has no value for caregivers, but is a common practice...granted there are exceptions to everything...Interested I contacted the hospital involved and asked about these issues, I was surprised in that I recieved e-mails from 3 different people all female, from different departments. They were very consistant on shadowing, it is up to the doctor who is allowed in, it is policy that patients must give permission for a shadow to be present, and they would honor requests for same gender care and even went so far as to advise be sure to make your wishes known in advance and in each department....I was very impressed with their responses.....thoughts anyone? Process or people?...alan
I'd only believe it if I heard it
with my own ears.
PT
"policy that patients must give permission for a shadow"
1.Must as in they have no choice?2
2. Is this an accepted practice in the medical community? ( to have shadows that patients have no say about)
That they responded at all and especially and that 3 did is impressive...same gender care is impressive.
The shadow thing really bugs me though. I had not heard this term before....
leemac
Although I read a few complaints from males complaining that they don't get to choose having a male nurse, they might be surprised to learn that many male patients actually prefer female nurses. My sister is a nurse and she said that many men are afraid of homosexual overtones so they therefore prefer females.
I would also like to point out the actions of one of the most notorious cases of sexual misconduct and abuse by a OB/GYN. see link
http://viv.id.au/blog/?p=2183
CG
Shadows should always be approved by the patient. The females you talked to were correct in that approval for the shadow would have to go through the doctor first. If they say no it ends there. Shadows should always be over 18 years of age. Having someone shadow a personal procedure might be done if the shadow was interested in the field of urology or gynecology. How many would agree would depend on how the patient felt about extra people in the room.
-cm
I am glad that shadows must have patients permission in some institutions...
I am more familiar with teaching hospitals...where you will find (in small print) that students of all levels may attend you...or observe... although I am not sure about high schoolers just looking ....This would not get my permission..(you have no say about the students though.)
leemac
All large teaching institutions
(hospitals) recieve anywhere from
200-300 new residents each year.
If you are admitted to the hospital you are asked if you
want resients involved in your
care. My suggestions are to request
N0N-TEACH. This will place a flag
on your chart indicating non-teach.
PT
You can refuse students as well. If that's the case however you would be wise to stay away from a teaching hospital.
-cm
"I'm Dr. Nelson Soucasaux, the gynecologist whose article was quoted at the opening post on this page. First, I would like to thank you very much for the quote. But now I feel that some further comments are necessary.
"At the age of 56 and counting 32 years as a practicing gynecologist, I'm also one of the "old hippies" from the early '70s who struggled to put forward the so-called "sexual revolution". Fortunately, regarding sexual liberation great advances took place from that time — mostly when compared to the old "status quo". But sadly it seems that things are moving backwards once again. The fact is that the sexual prejudice seems to be invencible in our culture. Specially regarding the subject of this page, I ask: what's the reason for so many women, after all these years of considerable sexual freedom, remain feeling ashamed of having their sexual organs examined by a male doctor ?"
I just had to post this quote, even though I can see most of the conversation has come round to men's issues. This quote truly perplexes me. What has the sexual revolution got to do with modesty? I am not ashamed of my body. If this Dr feel really feels that liberated, he is most welcome to perform pelvic examinations naked himself.
CG
I supervise first and second year medical students as they interview and examine hospital patients. If they didn't have patients to learn from you would never have the profession of medicine. Students just can't learn from looking at a book or sitting in an auditorium listening to a lecturer. Even the modern use of standardized patients (actors) fail to simulate the real student-patient relationship. Students, in the first and second years, face the challenges of their own fears and emotions as they talk to and examine a person they never have known and who may be as old as their father or grandmother and worse, if the patient has a disease of their father or grandmother that identification is often very traumatic. But they have to learn to deal with these personal challenges if they want to function well and be therapeutic in later years. They also must face the fact that talking to and examining one patient with pneumonia is not going to be the same as talking to and examining another patient with pneumonia. All this and more as the students are experiencing and learning how to understand the information both historical and by physical examination from their patients. Though first and second year students don't have direct responsibility for the diagnosis and treatment of patients, they often contribute to the patient's care by discovering historical and physical facts, then reported to their supervisors, which were overlooked by the interns, residents and attending physicians.
To deny students the opportunity to learn from a real patient is truely unfortunate for the student but also the patient does miss an altruistic moment to contribute to the benefit of society.
"Shadowing" represents an inactive "walking along with the professional". First and second year medical students, as they interview and examine patients are not shadowing. Medical students may "shadow" physicians in their private offices to understand office practice. They may "shadow" surgeons in the operating room to observe techniques.
I want to be clear,if "shadowing" is carried out only for curiosity and for no purpose of learning to contribute to a future career in medicine, the "shadower" should be rejected. Enough said. ..Maurice.
There will always be some patients who reject all any medical students. And there are some patients who don't really care one way or the other.
Most patients, I believe, are in the middle. Whether they reject a student doctor under the superivision of a practicing doctor depends upon how the whole situation is approached.
From my personal experience, sometimes the student doctor is mentioned up front. Before an exam, the nurse will often ask if the patient would mind if a student doctor comes in with the doctor. Rarely is it stated whether the student is a male or female. If the patient says okay, it's probably assumed that, if the patient asks the student to leave for an intimate part of the exam, the student will leave. But rarely is that ever pointed out. It's just assumed by the doctor and nurse. Inexperienced patients are left to figure things like this out for themselves.
Unfortunately, too often, if a patient is undergoing an operation or procedure, the fact that a student or other observer may be with the doctor is either not brought up or is brought up while the patient is in a gown just before the event is to happen.
I recall twice I had to really ask during pre op exams about who would be in the room with the doctor. I have no problem with medical students learning their craft. I do have problems with not being told.
I really had to push to get an answer. The answer both times was that there would be a student, and a resident. The doctor didn't ask if I minded or for my permission, he just said they would be there. There's usually a sentence or paragraph in a form you sign that's extremely vague and gives the doctor permission to do this. Read those forms carefully.
I asked the doctor if he had planned to let me know about the student, and he said, yes, before the operation. When before the operation, I asked. Just before, he said.
I suggested a few things to him:
1. Let the patient know ahead of time, at a pre op exam or meeting. Don't wait until the last minute.
2. Ask permission. This is called empowering the patient. Patients feel powerless enough in their situations. If the patient feels uncomfortable with a student, this is the time to discuss it and explain why it's important.
3. Even better -- Have the student ask permission of the patient. That not only makes the patient feel empowered, but it also gives the medical student a chance to practice real communication.
3. At any rate, make sure the student doctor meets the patient sometime the day of the operation (or, even better, before). Have the student come in and thank the patient for allowing him/her to be present.
I'm sure some doctors will cringe when they read this. They'll come up with all kinds of excuses, not enough time, logistics, scheduling, etc. Sorry, but I don't buy it. This aspect of medicine is as important as the slicing and dicing.
Maurice points out the importance of student doctors learning to do their job. They need to work with real patients. But all this needs to be communicated up front, and the student doctors should see the various sides of what it is they are doing. They are not only helping a patient -- but they are also being granted the priviledge of working on that patient, by the patient. This needs to be a quid pro quo relationship.
I really believe that most patients understand the necessity of student doctors needing to learn. Most patients will be more than willing to allow this if they are approached properly.
Too often they are not.
Here we are back again at communication.
+
My only experience with something like this ( for me ..my family has more) was when I had a minor bit of surgery. The doctor asked me, after he had injected local anesthics, if I would let him show a doctor from India to observe his procedure as he made a cut that did not require stitches. (a painful hemorrhoid).. I had driven over 200 miles as this particualr doctor was someone I knew outside of medicine and trusted him a lot...I said ok....he just failed to tell me it was a lady doctor...the only redeeming thing was I was against a wall and neither of us saw the others face. but I still felt a bit embarrassed.
Thankyou Dr.Bernstein and MER for your clarifications on shadows vs students. WHat would the response from doctors be if a patient said ok...but only for same sex students?
I know, some prefer opposite sex providers...I have a neighbor who had to have stints after a heat atack...he ran every male nurse/tech out of his room..(even though not all were)..he labeled all of them as gay..
Communication is important..if it is two way...
leemac
This could be an opportunity to present patients views modesty to the medical students as well...if the nurse/doctor they are shadowing will allow it. (not rush students out if you say anything or not cut you off if you say anything) after all they are supposed tobe there to learn the realities of medicine and patients.
leemac
Dr. Bernstein your enlightenment about the issues that medical students must face..particularly those involving their own experience and their own families..is definately thought provoking.. and one to be given consideration by patients...
So how can we let them know that we have our concerns..and let them know that we are not aginst their learning..just that we want them to take our feelings seriously as well......I doubt if you re going to please the doctor in charge if you try to take much time..( a
couple of minutes?) As others have stated..it boils down to communication. From your ecperience are student sopen to patients talking to them this way? Are the doctors/nurses open to your having such discussions with their students?
leemac
It's been a while since I've posted here (been way too busy on a couple of projects), but I have lurked from time to time.
First off, I'm glad that there has been a significant reduction in the inflammatory and vitriolic nature some of the comments recently posted here. I firmly believe that if meaningful change is to come about in the area of patient privacy and modesty issues, it will have to be through intelligent and thoughtful discourse. IMHO, emotional outbursts and blanket assertions and name calling don't help the process, but in fact hinder it by getting you labeled as a "nutcase" and your comments disregarded, even though you may have a valid contribution to make.
When we, as patients, make requests or set limits along these lines, it needs to be done the right way if we want them to listen to us. It's OK to be direct, firm and set hard limits, but there's no reason to be rude or abusive in the process.
In his last post, MER correctly states "Here we are back again at communication." I agree, but think that the communication issue is really a symptom of the underlying problem - lack of respect.
We as patients should respect health care workers for the efforts they have expended to become competent in their field of practice and for the care that they provide us through their education and experience, while keeping in mind that they are human, with values & feelings just like the rest of us. Conversely, health care professionals must understand that we're not just an "appendix" or "knee" or "gall bladder", and should respect us as individuals, with values, feelings and fears, and the absolute right to fully participate in any and all decisions regarding our care, up to and including making the final decision on any procedure or course of treatment.
With regard to the issue of student participation and shadowing programs, I agree that the key is in how it is approached. I've been on both sides of it. In one instance I was asked ahead of time, there was nothing sensitive involved, so I agreed. Conversely, when it was dropped on me by surprise and I was "told" a student would be participating without asking me if it was OK, I vetoed it because to me it showed a complete lack of both respect and courtesy on the part of the doctor - and I told him exactly that and did so in front of the student.
Ultimately the patient has the final decision and should be asked ahead of time.
As MER pointed out, here we are back at communication - but I think the real underlying problem is one of respect.
Sorry this was so long - I'll go crawl back under my rock now......
TT
Mer, you make very valid points and it does all revert back to communication! Actually a lack thereof.
I had a procedure and "assumed" my surgeon would be doing much more than he actually did. He didn't even stay in the OR for the entire procedure. I found out after the fact that an RNFA did ALL of the closing and the surgeon was only in the room for 15 minutes or so. He left the facility completely and I was in the hands of an RN and an anesthesiologist. For me this was extremely upsetting. I felt betrayed and I felt I was put at risk. It was a free standing surgery center. An emergency would have been handled with a 911 paramedic call and I would have been transported to the hospital several blocks away. I will never go to a surgery center again and I have learned to ASK many questions. The healthcare field "ASSUMES" way too much.
My dog's vet is nicer and much more communicative and informative.
Again, MER, you are right on.
I would like to refer people to this student doctor site. The question is posed whether the sex of the doctor is relevant for ob/gyn. The hostility towards female patients preferring female doctors by the male medical students is disturbing.
http://forums.studentdoctor.net/showthread.php?t=558084
CG
MER,you wrote about the medical students "They are not only helping a patient -- but they are also being granted the privilege of working on that patient, by the patient. " They know this full well!! In fact, most medical students (perhaps all) express the view that they don't see why a patient would want to have a student examine them since the students feel that the students are not contributing anything to the relationship. It is the instructions the students receive in this medical school "Introduction to Clinical Medicine" course that they must go to any patient that has been assigned to them (usually by the nursing staff who feels that the patient would be appropriate and cooperate) and specifically inform the patient that they would like to take a history and perform a physical examination. They then ask the patient for specific permission to do so. If the patient refuses for one reason or another, the students usually thank the patient for considering the request and then leave the room and usually come to me or the other teachers asking to be assigned another patient. If they find their assigned patient sleeping, although the students are given permission to gently awaken the patient, most students will not do that but simply leave and notify the teacher that the patient is asleep.
What I am getting at is that, based on my experience over 20 years, students are acutely aware of the privilege they are given and make every effort not to cause discomfort either emotionally or physically to the patient. What happens in the later years of training as they become interns and residents, at which time the new doctor is "working on and for the patient",the attitudes by the doctors regarding various aspects of the doctor-patient relationship may or will change and perhaps lead to the frustrations some patients find with their doctors and as implied by the stories on this blog. ..Maurice.
Medical students asking permission to touch another person's body! Amazing! To do otherwise would be battery!
CLW
Leemac, I hope my last comment answered your questions. The first and second year medical students spend at least an hour with the patients and important communication about feelings at the outset will not be considered time consuming..by the students and certainly not by me. By the way, I want to be clear that what I am writing about the medical students is not just representative of my personal experience but via regular faculty meetings, I know that the experiences of the other faculty is similar. I also can't conceive that there would be a major difference in attitude of the students or faculty in another medical school. If there are 1st and second year medical student clinical faculty out there from other schools, I certainly would like to read your comments. ..Maurice.
Doctor -- I do claim ignorance as to exactly how medical students are taught. I have confidence in what you say.
I've also mentioned on this blog that I haven't had extensive experience within healthcare systems. Some experience, though. I don't recall ever being introduced to a med student before a procedure/exam or operation. I don't recall ever being asked permission by a student or thanked. I'm not saying it doesn't happen. I've just never experienced it.
If it did happen, I can say I would very open to that med student, male or female, working with me. When it doesn't happen, I'm less likely to agree.
I actually like teaching hospitals usually I find they cover all bases. As MER stated I do write things off to the side and if in the mode I would cross things out on the consent form. As I learned on this blog I always read the consent form with my glasses on. I have also learned here I need to take responsibilty in my health care as well as all the others treated me. So I read it from front to back and when it mentions students I write (with respect) and that just lets everyone know I read the form. This may sound very simple but if I think back in my employment history I have trained dozens and dozens of people and some had little or no expierence, every skill out there needs training, some is just a little more formal then others. If a student treats me with respect they will have my complete respect and then some.
Daniel
You did indeed answer myquestions...and many thanks to you and all of the recent posters.....it has been very educational...and eye opening...Your observations of student behavior in general will mean that I will not refuse a student out of hand should the situation ever arise. Unlike MER..I can not guarantee that I would allow a female...but circumstances might be so as I would...
leemac
I am curious...just what does the first or second year med student do?? what kind of exam(s) do they do? Is the purpose so that a doctor/nurse/profesor can see what a student figured out...based on findings they already knew?
leemac
forgive me for plastering you with comments tonight,,, I really would get ticked off if any medical professional brought a high school student to see me on "career" day...intimate exams or not...it would be a violation (in my opinion) of my medical privacy.. I would not say no...I would say bye..and leave..and fire the doctor on the spot..if it occured at any testing facility (conograms, xrays, etc. I would be at the managers office in a flash...at a hospital the same thing.
leemac
TT don't go away, i could not agree with you more, the name calling and attacks are very cournter productive. I have had some great experiences with communication with providers when approached with mutual respect, to respect I might add trust.
Dr. Maurice, you may be right on how students feel. I would agree with the difference between shadows and students, shadows are for the benefit of the student and the facility and have no benefit for patients.
The problem with patients views of students may in fact lay with the Dr.'s and facility they work with and for. I have witnessed this first hand, my mother was transfered from a small hospital to an ICU at a larger hospital, I was with her during the transfer, the Dr. walked in with a young woman in tow and opened with I am Dr. X, this is so and so she will be working with me. Over the next few days I got to talk to her and learned she was a med student. It wasn't a problem, she was a very intellegent and nice young lady, the problem wasn't with her, it was with the approach, there was no option, no introduction, which as TT indicated is mutual respect. Just as patients should understand it is beneficial for all to co-operate to help students gain knowledge and experience, medical providers must understand patients have the right to set boundaries and have ther right to partcipate or not. The limited experience I have had led me to believe it may be the mentor rather than the students who have problems with understanding or respecting the boundaries and mutual respect. This is not a generalization, my PCP was very considerate when he had a shadow, and from Dr. Bernstein's accounts there is consideration of the patients right. However in the account I sited, and what I witnessed with my mother, the insensitive party was the facility or the attending..not the student...just as providers should not label all patients, patients should not cast all providers in the same mold...respect and comunication on both sides is a valuable commodity....alan
OK alan, I've got to explain but not defend something that is widespread and recognized in medical education and as a major system problem we, in medical education, have got to fix.. but it won't be easy. I have written about this previously on other threads and the problem is called in medical education "the hidden curriculum".
If that medical student you describe was a third or fourth year student that student was already exposed to this ethically and professionally destructive curriculum. Her supervisor may not have been a teacher clinician with responsibilities for the basic teaching of ethical and professional behavior for the first and second year students as has been my responsibility. That supervisor may well have been a volunteer attending physician from outside the medical school who teaches 3rd and 4th year students, interns and residents the details and nuances of diagnosis and therapy but often disregard the fine ethics and behaviors toward patients that we try to instill in the earlier years. Why do these physicians tend to ignore the best of humanistic behavior and tend to teach the opposite by concentrating more on the disease process than the human being suffering the disease? It is because they were, as millions of doctors have been over the decades and more, taught in their later years of training by the physicians who had experienced and taught the same as they do. They too as students or in later training were faced with the power inequality between them and their supervisors and the need to be on the right side of the supervisor to get the needed good grades and reports. They would go along with unethical behavior or comments of their supervisors afraid of the consequences of talking back or "whistle blowing". This attitude, started in graduate training, is then cultured by the pressures and necessities of clinical practice. This becomes a never ending cycle and since it isn't the ethics and professional behavior that we teach students in their earlier years and because we no longer seem to have any control over the hour by hour, day by day hospital ward teaching by these outside doctors, this then becomes the "hidden curriculum". Unfortunately, medical teaching institutions, for financial reasons, need to use voluntary attending staff, who mix their outside clinical practice with attending on the wards, but who are poorly trained and experienced in teaching humanism as those of us in "Introduction to Clinical Medicine" courses do.
Before I quit this commentary, I want to say that, though you maybe won't believe me, first and second year medical students are to me visibly timid. Timid, because they are experiencing something unknown to most of them (unless they were an EMT or nurse in earlier years) and that is asking very personal questions to strangers and examining the strangers' exposed bodies. I have never found a student in my years of experience who behaved either in speech or action with any sign of personal sexual interest. Oh yes, I was made aware of one male patient who behaved sexually abusive to one of my female students. She quickly left the patient's room. When patients reject being interviewed or examined by a student, there is always no reason or some reason expressed but I don't recall the patient admitting that gender was a reason.
I think all that I have written is important facts for the writers to this thread to understand something about the students themselves and with regard to how we try to teach students to become doctors and then what issues come up later in education to lead to some of the conflicts in doctor-patient interactions that are described here. I hope I have helped educate you all. ..Maurice.
Leemac, as far as what examinations first and second year students do, they learn beginning in a series of demonstrations and then examinations of each other a sequence of systems such as vital signs,neurologic, eyes, ears, nose, throat, neck, cardio-vascular, respiratory, abdominal and so on and then practice their skills in each of these areas they are learning about by examining real patients usually who are hospitalized or in a clinic. As I have alread mentioned on another thread, breast and genital and rectal exams are initially taught on professional male and female teacher-subjects. Generally, in the first and second year, at our school, students don't do the genital and rectal exam practice on the patients they examine but will do that in the clerkships of the third and fourth years.
The purpose of doing physical exams on real patients is to develop confidence and basic skills in these students to perform these exams properly. That is mainly what we, as teachers, are observing. Their other goal is correlation of their physical findings with the history they have taken but that purpose takes time and experience.
By the way, we don't allow the students to read the hospital charts before they examine the patient so they are unaware of what other doctors have found and written. What they find on exam is of their own observation. And as I already noted previously, sometimes they find important things that the other doctors have missed. ..Maurice.
Dr. Bernstein I don't have a wide sample, but I have to agree with you that the med students that I saw seemed to be a little uncomfortable. They were extremely polite and almost apologetic. I have no problem believing they were intimadated. In the case of my mother, the student had a much more concerned and compassionate bedside manner, the Dr. was and older gentlemen was very dominant and not very friendly. That was a single case and a single person. My experience with a NP shadow was a little different, she was still in nursing school, and to be honest she was to much the other way, she was a chatter box that reminded me of a soriety girl at a party. That could have been nerves, but there wasn't the professional appearance that I have grown accustomed to with my PCP and other physicians.
I think after a time providers may tend to loose some of the human aspects for the benefit of the treatment of that person. The authority given any supervisor can gradually no longer be a priveledge or responsibility and become something that they use without thinking, the compassion give way to instructing the mechanics of the task. This comment to me is something that can easily be lost in the thought that a Dr.'s job is training the patient and treating the physical person. "A central tenet of ethical medical practice holds that patient privacy is an invoidable, irrevicable right of first principle, one that inheres in the individual patient-not the institution that provides the facilities, not in the doctors or caregivers who provide services,not the administrator whose interests and responsiblities are pecuniary in nature, but in the individual patient. That is the priority.
That is something I think that gets lost in the procedure of treating and training.,,,,alan
I am interested in learning about the specificity of the privacy/physical modesty concerns related to the healthcare provider's gender. What I want to ask those who have concerns about their physical modesty and/or privacy, how do they feel with regard to sensitive historical privacy with regard to the provider's gender. Would it make any difference in the gender selection of a provider if intimate questions are being asked or may be asked of the patient. For example, regarding sexuality or sexual practices or other aspects of the sexual history, if these questions were asked in a professional manner and were a necessary component of the patient's medical history? (I don't mean in an office visit for a simple "cold", the provider asks whether the patient masturbates regularly!) Or, in terms of general privacy, would responding to questions about financial worries in a depressed patient or marital discord issues require gender selection?
You should know that medical students are taught the biologic, social and psychological concept of disease and when performing a complete history private issues such as sexuality and sexual practices, home and work life, suicidality are among the personal questions they are taught to ask.
So.. is there also gender selection concern in history taking? ..Maurice.
With this comment, we will be at 117 comments in Volume 8, therefore I intend shortly to move the conversations over to a Volume 9. I'll let you know, of course, when I have Volume 9 set up. ..Maurice.
Interesting question, I never thought about it but any and all histories I have given have been to females and until you asked I have never even given it a thought. I haven't had any problems with that. This includes going to a urologist where I gave a history...evidently it didn't bother me becasue I don't recall. While I would be uncomfortable discussing my sex life with anyone, regardless of gender I don't think it would matter a great deal to me. I might feel more comfortable to the point of being more open with a male,,,or not, but I would never think about asking for a different gender for the history....just wouldn't make THAT much difference....same with non-intimate exams, I really don't care who looks down my throat or listens to my lungs or heart....my main concern is centered around nudity. I wonder if the fact that I have two sisters and our family is really...open when it comes to making jokes about those things but were very conservative about nudity....interesting question...alan
"So.. is there also gender selection concern in history taking?"
Interesting question Dr. Bernstein....in my case I guess the answer would be it depends.....
For the most part it wouldn't really matter to me the gender of the provider taking the history. Mainly that is because if they ask questions that I feel are inappropriate to the reason for the visit, I have no qualms about politely but firmly telling them that I don't feel it's pertinent and therefore really none of their business, that I decline to answer this or any other questions of this nature, so please move on.
If the questions are relative to the situation at hand, then that's different. I've never actually been in that position, but there are probably some things that I would feel more comfortable discussing with a same gender provider, especially if they would be the one providing any follow up exam or procedure.
TT
I found it uncomfortable to answer and discuss sexual questions with female office nurse. What I find also concerning is that many times a patient is asked to fill out a detailed and lengthy (several pages) questionare only to have either the nurse go over it all again (ignoring the questionare) or the physician to completely ignore the questionare. Therefore I have stopped complying with the request of the questionare. My wife was upset when at a derm office the female note taker was in the room during a visit in which there was no exam but a discussion between patient and doctor regarding biopsy results which were very bad. This is a breach ethics. No one needs to be in the room at such a time but the patient and the doctor. They just don't get it.
My concern about history taking isn't so much the gender of the history taker, but rather their professionalism.
I don't feel comfortable and will usually not agree to giving persomal, intimate histories to an unlicensed healthcare worker such as a medical assistant or a CNA. I don't mind them taking temperature, blood pressure, etc., but I don't feel obligated to give them private medical information. A licensed nurse? Yes. A licensed doctor? Yes. A medical student under a doctor's supervision. Yes.
I mention this because I think it's become all too common, especially in private practices, to have these unlicensed healthcare workers take medical histories, and, as has been discussed before, take notes and assist during what turns out to be intimate exams. In my opinion, this not ethical.
Having a licensed female provider take a personal history -- is usually not a problem. It totally depends upon the communication and people skills of the female. I can't say I'd be extremely open in answering questions if I didn't feel comfortable with a specific individual. But I'd probably tell them that.
I think medical providers need to give more attention to the probability that gender may matter in these situations, as far as patient comfort, which influences the reliability of the information you get.
And, by the way, doctor -- I appreciate your frankness in discussing the hidden curriculum. The fact that doctors like you are willing to openly admit this problem and recognize its seriousness while trying to deal with it -- this gives me great comfort and trust in the system. That attitude is part of what makes a "profession" a "profession," rather than just a job.
NOTICE: AS OF FEBRUARY 7 2009 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 9" TO CONTINUE COMMENTS. ..Maurice.
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