Patient Modesty: Volume 10
Here we go..on to Volume 10 on the subject of patient physical modesty. To aid in the transition from Volume 9, I will copy below my selection of some of the most recent comments. ..Maurice.
At Tuesday, February 24, 2009 3:09:00 AM, Anonymous Anonymous said...
Alan, I accept your admonishment for my making an extreme argument on cost-sharing. I was of course just raising the issue of the cost of responding to gender-based modesty.
Here's where I was partially coming from. Since joining this blog, I've done a kind of informal survey. It wasn't scientific, but I was careful always to formulate two questions in the same way. The first was, "Do you have a preference whether doctors or nurses are male or female?" The second was, "Do you feel uncomfortable in terms of modesty depending on whether doctors or nurses are male or female?"
I asked my mother what she thought her close group of women friends (65-85 yrs old) would feel. She said they probably preferred doctors to be men and nurses women because that's what they have always been used to, but male nurses "are like mini-doctors" and more women in general is good. I asked my Dad and his tennis foursome (same age range) and they all agreed they preferred male doctors and had modesty issues with both female nurses and doctors. I mentioned to my university class (ethnic and gender mix 20-26 yrs old) that I'd be participating here and asked the same question. Overall, they said it didn't matter at all. A couple of the young men, however, indicated they were more comfortable with both women doctors and nurses. Randomly asking maybe a dozen friends (ethnic mix of 30-48 yr olds and among them only one other naturist), the consensus was no preference or modesty problem. One Danish friend said he sought out female doctors because "they usually had to be twice as good to get into med school." A friend from Chile commented that she suspected it probably varies among hispanics depending on whether they come from the city or countryside. An Egyptian-American friend admitted that he thought he might have issues when he and his wife some time ago switched to a female doctor, but he was very happy, and it helped with his mom who "can't cope with any male medical care."
All this made me think that maybe "modesty issues" with regard to the gender of medical staff is both age-driven and actually more problematic for men. The older women, even those with a preference for male doctors, don't seem to have a problem with increasing numbers of women in medicine. Young people of both genders seem largely gender-blind at the doctor's office. In-between, women seem used to the male medical contingent (worries about sex-crazed anesthesiologists aside) but welcome more women. Does it make sense, then, to think the hump of the modesty problem is with older men who are still dealing with conflicting images of women's social and professional roles? If so, this might help medical staff be more alert, and it might help with short- and long-term staff resource planning.
(PT, I think we are trying to understand here is patient feelings and perceptions so that health care personnel are clear what constitutes "unprofessional behavior" with regard to "modesty." As Dr M has pointed out over on the clothesfreeforum, medical staff in principle get an enormous amount of training about proper conduct.) (CSM)
At Tuesday, February 24, 2009 8:48:00 AM, Anonymous Anonymous said...
CSM, I didn't mean to admonish you personally. I do agree with you on many of your observations. While I think the younger generation as a whole are less modest, I know from conversations in my office and among friends the modesty issue is still there. It also has some regional influence. Being from the midwest I would suggest we are more conservative and would have a different view than Calif. I don't have conflicting images of female physicians or nurses, for any procedure other than those requiring exposure I have no preference. It isn't that they are Doctors that I have concern with at all. I have two daughters and want them to be what ever they want...we have an office that has been together for over 10 years and have become very open over those years....the topic came up one day that a new Dr. (female) gyn had come to town, the vast majority of women from late 20's-50's all talked about trying her out and were glad to have the choice of a woman not only for themselves,,,,but for their daughters. I also know at a family get together they were teasing a nephew about his physical...he went to his family Dr. (male) only to find out he was on an emergency and the female NP did the physical...all of the nephews (16-25) winched and said they would have rescheduled when he talked about the hernia and DRE...now that is a pretty small group...but I think it is preobably indicative of the area I live in...the interesting thing,,,very few studies seem to exist in this area...not so sure there is a norm...but I have to agree with your observation that it varies by age, gender, ethnic make up, region, religion...all sorts of things play into it...so my question is why not err on the side of modesty, and allow those to opt out if they so choose...the cost has to be wieghed against the old "dying of embaressment" issue...the fact that the government ran a campeign "real men wear gowns" would make you think there is some recognition of the issue at the upper levels.....and CSM sorry if I came off to critical...didn't mean it that way.....alan (responding to Tues Feb 24)
At Tuesday, February 24, 2009 2:13:00 PM, Blogger MER said...
Perhaps your informal survey does indicate some trends. It's hard to say. But let me toss this out.
First of all, I don't think we can assume the word "modesty" means the same thing for everyone.
So asking people whether the feel unfortable in terms of "modesty" depending upon the gender of the provider -- may or may not produce a valid answer. If the questions were to be more specific relative to observation during a shower, shaving or an exam of the genitles, prostate exam -- then maybe you'd get specific responses to specific situations.
Secondly, perhaps one reason for the difference in attitude between older men and younger men -- if there is, indeed, a difference:
Most younger men have had little experience with intimate exams and procedures (excepting perhaps physicals)or long-term hospitalization. Thus, many of them are dealing mostly on theory, i.e. how do you "think" you would feel. There's a big difference between "thinking" about how you would feel and actually facing the reality of it. It's only when men get older, in their 50's and 60's, when then start having prostate and other problems that might need intimate exams and procedures. There are exceptions to this, but they are the exceptions.
Thirdly, that fact that this gender issue is so far under the radar in both medicine and the general public, shows how uncomfortable we all are with it.
Go to various radiology websites and look under various intimate kinds of procedures and exams. See what they say about embarrassment and/or the gender of the technician.
You'll find nothing. The silence is deafening. It's as if the problem doesn't exist.
This is true for other medical websites that deal with all kinds of intimate procedures. They'll explain the procedure in detail. In some cases they'll say there's no or little discomfort (meaning physical), that't it's "fast and easy" (from their point if view), etc.
Then, talk with patients about these procedures and see what they have to day and listen to their experiences.
When subjects like this are hidden away, it doesn't mean they don't exist or they're not a problem It more likely indicates they are problems that people don't want to face.
So -- I appreciate your survey. But what I'd like to see are exit surveys -- surveys done with patients as they leave the hospital asking them specific quesitons, some like the one's your asking, and other more realistic ones. Questions not about how they "think" they feel about things, but questions about how they actual "felt" about how things were done and whether they would have asked for same gender care if it had been offered and/or was available.
At Tuesday, February 24, 2009 4:39:00 PM, Anonymous Anonymous said...
My reply is if gender is not an issue for most why are female gyns busier than male gyns and why are male medical students refused more often than female students the opportunity to practise on real patients more so than ever before?
See these two articles: http://query.nytimes.com/gst/fullpage.html?res=9E00E4DD1631F934A35751C0A9679C8B63 and http://student.bmj.com/issues/06/03/careers/112.php
Clearly these show that there is a growing preference for same sex care for intimate issues.
At Tuesday, February 24, 2009 5:28:00 PM, Anonymous Anonymous said...
An interesting thing is that many of the facilities make no effort to address it on the front end, however will address it or accomodate when asked, I recently had some back and forth with a facility that was very supportive of acknowledging and offering to accomodate AFTER I asked, they indicated it was a valid concern and not the 1st time the issue had been brought up. I think it indicates more of an awareness than we might think, but they are not going to intiate the effort becasue of the "burden" it would put on them. We have discussed numerous reasons the fact that they take act as if it is about them (I have done this...) etc. CSM I intend to visit the site and appreciate hearing all sorts of perspectives......the one we seem to be missing is the professionals...I would assume some have visited...but whether they don't want to be confronted about it or the tone of confrontation....we don't get much from them...that would truely add to this....alan
At Tuesday, February 24, 2009 7:12:00 PM, Anonymous Anonymous said...
In reference to Dr M's comments
that medical staff get in principle
an enormous amout of training about
proper conduct holds very little
Consider the analogy, most know
the dangers of running red lights
yet even the most seasoned drivers
At Tuesday, February 24, 2009 8:11:00 PM, Blogger Maurice Bernstein, M.D. said...
LH, two excellent links. Thank you.
New York Times article
Student British Medical Journal article
I hope all my visitors take a look at both. They certainly add to the discussion on this thread. ..Maurice.
At Tuesday, February 24, 2009 8:31:00 PM, Anonymous Anonymous said...
Back in 2007, there was a link posted on this blog which indicated the "gold standard" in gender sensitive care. The page is still online:
Let me quote some of it here.
"A Gender Sensitive Exam is an
examination that involves touching and/or inserting an instrument into a body cavity by a technologist or radiologist of the opposite sex...
No matter what exam you are scheduled for, everyone has the choice to request a same sex
technologist to perform the exam. If the same sex technologist is not available in a timely manner,
you have the following options:"
The hospital is in Toronto
but the text adds that "technologists... are registered under provincial Canadian and American governing
Hope this helps show what can be done.
At Tuesday, February 24, 2009 8:52:00 PM, Anonymous Anonymous said...
The New York Times article on
the rights of the male OB-GYN
physician misses the point as
to why such discrimination is
allowed. It's not that women
feel more comfortable with women
doctors. That would be like
claiming a legal position
exists in that white people
feel more comfortable associating
with white people.
The legal position is that the
BFOQ provisions of the 1964
Anti-Discrimination Act allow for
discrimination in hiring when the
patient makes a request for
privacy LINKED TO MODESTY. These
female patients are actually voicing that position when they talk about their comfort level.
That's totally within their rights. The issue immediately
becomes WHY ARE MALE PATIENTS
NOT ENTITLED TO THE SAME MODESTY
PROVISIONS UNDER THAT LAW.
I once asked a constitutional
law professor how this position
can be maintained. He said it
is only maintained for the
same reason the "whites only"
position was the rule throughout
institutions in the south at one
time -- IT HASN"T BEEN CHALLENGED
IN A COURT. AS SOON AS IT IS IT WILL FALL. THE PRACTICE OF ENFORCING THE BFOQ POSITION AS IT
FAVORS WOMEN BUT NOT MEN CAN NOT
- CHUCK McP
At Tuesday, February 24, 2009 9:27:00 PM, Anonymous Anonymous said...
"The Hand That Rocks The Cradle don’t help to dispel the idea that some male doctors have something other than a mere clinical interest in the female genitalia."
So they are saying that it never is the case? So what do we make of all the sexual misconduct cases?
Graphic: From www.gutenberg.org, an illustration from a book "The People's Common Sense Medical Advisor or, in Plain English, Medicine Simplified" by R.V. Pierce, M.D.
"Carefully Revised by the Author, assisted by his full Staff of Associate Specialists in Medicine and Surgery, the Faculty of the Invalids' Hotel and Surgical Institute." January 1895.
To me, it is interesting that the illustration seemingly showed no concern for depiction of a enlarged, pathologically filled man's scrotum and yet demonstrated modisty by not allowing the reader to see what would have been a normal penis under the leaf.
The text within the illustration was present as the description of the illustration in the original book. I added color to the original illustration for emphasis using ArtRage.
NOTICE: This Volume 10 is now closed for further comments. Continue the discussion on "Patient Modesty: Volume 11". ..Maurice.