Bioethics Discussion Blog: Patient Modesty: Volume 9

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Friday, February 06, 2009

Patient Modesty: Volume 9




Continuing on from Patient Modesty: Volume 8, the current ongoing discussion was about the discomfort of some male patients to be examined or procedures carried out by female healthcare providers or their female assistants because of physical modesty issues. Described in the postings are examples where for one reason or another, the patients can’t request and receive the same gender providers with whom they would be more comfortable. It seems that providers and institutions fail to consider these patient’s rights of privacy. I changed the context of the discussion a bit with the following question:

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? … So.. is there also gender selection concern in history taking?


Go to Volume 8 to read visitors’ responses to my question but now continue the discussions here since that Volume is now closed for further comments. ..Maurice.

Graphic: Cupidon by William-Adolphe Bouguereau (1825-1905} from Wikipedia

AS OF NOW ON FEBRUARY 24 2009 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 10" TO CONTINUE COMMENTS. ..Maurice.

126 Comments:

At Friday, February 06, 2009 10:29:00 PM, Blogger Maurice Bernstein, M.D. said...

PT wrote the following comment just after I closed down Volume 8. ..Maurice.

I've seen statistics that suggest
that a resident kills at least
2 patients during their residency.
Furthermore, large teaching facilities usually have the best
qualified and trained physicians.
Most incompetent physicians will
seek work at the smaller facilities
where they can be inconspicous.I'll
say again you can request non-teach
as you have a right to decide who
participates in your healthcare.
While we are on the topic of
questionaire topics I do find it
concerning regarding the information displayed in a patient
chart. When you are an inpatient
there is whats called a face sheet
in your chart. That face sheet has
your home address,home phone,dob,
place of employment,ssan and other
private data.
With your name,dob and ssan anyone can get your birth certificate. The first three digits
designate what state you were born.
This is a prime source of identity theft. Recently, two women
employees were arrested for stealing credit card numbers from
a patient. Incrediously, neither
employee knew each other. One can
only guess how much private data
find its way south of the border.

PT

 
At Saturday, February 07, 2009 1:02:00 AM, Anonymous Anonymous said...

"So.. is there also gender selection concern in history taking?"

That’s a question that I’ve never thought about. In my experience though, I’ve never had to give anybody else my history except for the physician. I’d have to agree with MER that as long as they weren’t an assistant, CNA, or office manager I wouldn’t have any issue with the gender. Most of the new patient forms have a section for history and the nurse always just checks and makes sure it’s filled out. I guess things work differently at other places.

As far as the discussion on teaching hospitals is concerned, I think that should be left up to the patient. I think there are plenty of willing patients that have no problem exposing themselves to anyone with a white coat on. Those that do care shouldn’t be punished. I understand that anyone needs to be trained to do their job well but again; providers are dealing with people that have emotions, beliefs and feelings. Not something that you can simply issue a command and it executes it on queue. And yes, this is just simply a case of respect. Jimmy

 
At Saturday, February 07, 2009 6:58:00 AM, Blogger MER said...

I posted this on Dr. Sherman's blog, but I think it's worth another post.

I want to call attention to a book that covers much of what I’ve talked about in past entries regarding the sociological aspects of medicine, especially nursing.

The book is: Sociology as Applied to Nursing and Health Care by Mary Birchenall. It’s a British publication. As I’ve noted before, this topic along with that of patient modesty, seems to be covered more in Brittain, Canada and Austraila. Is just a coincidence that all these countries have a national health system? Perhaps. That’s a whole other topic.

The link I’m providing should take you to the section that discusses the use and abuse of power in medicine in general and nursing in particular. When you get to the link, go to Chapter 8 -- page 152, “Nurses, Clients and Power by Martin Johnson.” Later, I’ll give you another article by Johnson that is quite insightful regarding nursing and power.

I’m not suggesting that most nurses (or medical professionals, in general) abuse power. I’m just pointing out that this issue is well known, discussed, debated, incorporated into training programs, etc. within the profession. It’s just not a subject that gets out into the general public. Most patients, although they feel this power dynamic and sense it intuitivly when they enter hospitals, have probably never really read much about it. It’s embedded within the hospital culture. It’s part of the “under the radar” rules of the road. After a while, either patients “get it” or don’t “get it.” If they “get it,” they either comply with the rules, negotiate, challenge them, and/or become “difficult” or "complient" patients. If they never “get it,” life can become quite confusing and possibly miserable for them, unless they go along with what they don’t understand. Rarely, if ever, are patients ever formerly instructed in this dramaturgy. At best, they’re “guided” along by the doctors and nurses. They’ve got to figure it out for themselves. As the chapter I’ve given you points out, some nurses use their power to empower their patients. Others do not.

And, make no mistake – power is necessary for doctors and nurses in the healthcare system. But, power itself is neutral. It can be used positively or negatively. And medical professionals need to exert a certain amount of power over their clients to do what they have to do. It’s how they communicate that power, exert it, distribute it, delegate it, that makes the difference.

Here’s the link:

http://books.google.com/books?id=KwGzXROJP3wC&pg=PA168&lpg=PA168&dq=naked+intimate+exam+nurse&source=web&ots=_oqaHEPrXR&sig=J1Z-B_84ayy5Mc96fFpzmKy5FKQ&hl=en&ei=McmMSbbiOZmMsQPbj6mSCQ&sa=X&oi=book_result&resnum=10&ct=result

 
At Saturday, February 07, 2009 7:34:00 AM, Blogger Maurice Bernstein, M.D. said...

MER, thanks for the reference. But two issues with the referral: 1. There is no page 152 available in the Google book reproduction and 2. the URL you wrote did not appear as a clickable link on my computer--so let me try to make it clickable now:

http://books.google.com/books?id=KwGzXROJP3wC&pg=PA168&lpg=PA168&dq=naked+intimate+exam+nurse&source=web&ots=_oqaHEPrXR&sig=J1Z-B_84ayy5Mc96fFpzmKy5FKQ&hl=en&ei=McmMSbbiOZmMsQPbj6mSCQ&sa=X&oi=book_result&resnum=10&ct=result

However, despite that page not being included, what I did read was very interesting in the context of power in medical "care".

Why do you think one might look at power within the medical care system differently than looking at it in the police, penal system, banking system and other systems where the average person is unable to personally manipulate the system to fit their own particular wishes? The answer to this would apply to the issue of trying to get healthcare providers to attend to the gender concerns of some patients. ..Maurice.

 
At Saturday, February 07, 2009 1:29:00 PM, Blogger Maurice Bernstein, M.D. said...

Those writing to this thread may be interested to go to a new thread I put up today titled "HIPAA: Medical Information Privacy but also Patient Access". It summarizes the patient's rights to their medical record as described in the HIPAA law. Perhaps the thread is related to the concern raised by PT in the first posting here. ..Maurice.

 
At Saturday, February 07, 2009 1:44:00 PM, Blogger MER said...

Actually, it's page 153. If you just scroll back you'll get to it. The whole book is quite interesting and contains many issues related to our discussion.

To answer your question about power within different systems -- your reference to police and penal systems is relevant to medicine. Systems like banking, in my view, have little relevance.

Why? With police, penal and medical systems we're talking specifically about a persons atonomy over his/her body. As Lawler calls it, somology, the study of how we deal with the body in medicine.

Note that the book I refer to talks about the philosopher Foucault. Without going into detail, Foucault writes about, among things, penal systems and how, sometime in the 18th, early 19th century, the Western attitude toward punisnment changed. We used to punish the body, rip it apart, draw and quarter it, burn it, disembowell it -- all publically. And the victim was most often naked. A side note: I've been doing some research into our historical attitudes in the West toward privacy, specifically nakedness and private body functions. This attitude changes about the same time Foucault claims are methods of punishment change. The whole concept of "privacy" changes.

As attitudes changed and institutions developed (prisons) we tended to punish the spirit, the soul -- rather than the body. Foucault also writes about the birth of the clinic, medicine, the medical "gaze" etc.

Note that the connection, architecturally, between prisons and hospitals has been recognized for years. Modern prisons and modern hospitals came into being at about the same time. They were both designed to control populations for efficiency in "surveillance." Side note: as the concept of "public health" developed, the need for control of large populations and individual bodies developed -- for the benefit and safety of the overall populations.

"Surveillance" was the term that was used, not "observation," the word we use today "Surveillance" doesn't sit well with us today -- it has negative connotations -- but that's a foundational aspect not only of modern medicine but of modern science -- the empirical process. You observe and observe and make note and make note -- and that's how you discover reality and reach the truth.

To sum up, the difference between power within hospitals and prisons and other insitutions is significant. It involves not only control over a persons body, but it can even involve control over their mind, spirit or soul.

I refer you to another fine article by Martin Johnson:

"Notes on the Tension Between Privacy and Surveillance in Nursing"

http://www.google.com/search?hl=en&q=martin+johnson+surveillance+nursing

 
At Saturday, February 07, 2009 3:42:00 PM, Blogger Maurice Bernstein, M.D. said...

You know MER, I scanned Johnson's article and I wonder if all this concern and consternation about how both men and women are treated by medicalcare providers in terms of bodily exposure is really all about the degree of self-control of the situation the patient desires. The patients who are not upset by "being seen" by others may have easily and for their own therapeutic benefit turned over control to their providers. The patients who abhor the idea or the actuality of "being seen" by others regardless of the clinical situation are in essence refusing to relinquish their control of their body to someone else.

Couldn't this single factor, self-control, be the main reason why people react differently to what goes on in terms of bodily exposure in a clinical examination or procedure? Some people never want to give up their self-control. However, if it's professional, if it's clinical, if the outcome is to be beneficent for our health then some of us would easily give up that self-control. If something was to be done for some other reason, there would be, without a doubt, a reluctance to give up control.

Could this personality difference perhaps so-called type A, sets self-control as a major force in their decision-making and behavior. Thus, perhaps, by watching people behave within their occupation or at home with regard to control over situations and decisions, one might be able to predict who is going to demonstrate bodily modesty in a clinical situation and who might not. Is it simply the need for self-control that sets the response? What do you think? ..Maurice.

 
At Saturday, February 07, 2009 4:58:00 PM, Blogger MER said...

Interesting comments, doctor. I agree with what you say to an extent. In the end, a patient must be willing to give up sufficient control. Some refuse to give up any control, some negotiate what is sufficient, and others leave it up to the doctor.

In your first paragraph, it seems you're reducing the control element to two extremes -- those patients who refuse to be seen unclothed and those who don't mind.
Both of those groups, I believe, represent small percentages. Most patients reside in the middle and could go either way. Which way they go depends upon the "context" of the encounter between doctor and patient. Medical professionals have much more control over this context than does the patient. Thus, it becomes up to the professionals to create contexts and atmospheres that will empower patients enough so they will, with trust and relative comfort, give up that control.

As you say, "self control" may be the single factor -- but that factor, most often (except for the extremes we discussed) is not embedded within the patient. It is constructed, it is created by the context of the encounter between doctor and patient. Context, I believe, is everything. Context includes a medical professional person skills, good communication, respect. But, ironically, it also includes things that the doctor may or may not have immediate control over -- the atmosphere of the clinic or hospital waiting room, the overall attitude of receptionists, nurses, CNA's, etc. Context begins to be created perhaps when the patient makes an appointment and talks with the receptionist, and then continues to build right up until the exam. Frankly, the patient's confort level may already be determined before he/she even meets a new doctor -- determined by everything that led up to that appointment.

Now, a good doctor/nurse can notice a patient's discomfort and, using good communication skills and empathy, turn it around. But the professional has to be open, and focused on the patient, sensative to feelings, empathetic.

Again, in your last paragraph, you're positioning the "self control" force within the patient, not within the context. All the context (including the doctor/nurse's background) leading up to the appointment brings something to the table. Then the patient brings his/her personality and background to the table. The two factors mix and create how the patient responds, and how the doctor/nurse responds.

I don't deny that we can learn much about individual patients by observing them at work, etc. But unless these patients reside on the extreme ends of the spectrum, which way they go, I really believe, depends upon the context created by the medical encounter.

In that book, and the Johnson article, notice all the references to context.

 
At Saturday, February 07, 2009 6:30:00 PM, Anonymous Anonymous said...

I am not confortable discussing as I am not comfortable being naked, with those of opposite sex.....in my private life I have to be well aquainted with any female to discuss most of those issues as well...I am not real comfortable talking to a male doctor...a female is tooo much for me.
Part of the issue is very probably that I do not like to give anyone any more control over me than I can help....this goes outside of medicine as well..
hope that helps some with your question Dr Bernstein
leemac

 
At Saturday, February 07, 2009 7:36:00 PM, Anonymous Anonymous said...

I don't thik embarrassment is a result/function of control though...
leemac

 
At Saturday, February 07, 2009 10:03:00 PM, Anonymous TT said...

I think that MER's latest post makes some good points. The context of the encounter does make a huge difference for many people, myself included. Very few people are comfortable with giving up complete control of their person to another, even in a medical setting.

I think big part of the problem is that the majority of the medical service industry as a whole has an institutional mind set that expects the patient to give up complete control and just do what they're told and not ask questions. Why? Probably a lot of reasons, not the least of which are old habits from the days of paternalistic medicine and that it simply makes things easier for the providers. Fortunately, paternalism and beneficence are almost dead - may they forever rest in peace.

IMHO the patient should only be asked to give up the amount of control that is absolutely necessary in the specific circumstances. And this can vary depending on the patient. As MER said, a good physician or nurse should be able to sense the patient's discomfort, or better yet, ask them if there are any aspects of the exam or procedure they are uncomfortable with, and try to accommodate them if possible. If this became the predominant standard of care, I think you'd see a lot fewer posts on this blog.

Unfortunately, many times things are done the way they are not for the benefit of the patient, but for the convenience of the providers. This is absolutely wrong and needs to change.

I also feel that it is commensurate on us as patients to take ownership of our health care.
From a personal standpoint, there is no such thing as a "blanket consent", and I put that in writing. I will never consent to any exam, procedure, medication or other treatment unless/until it is explained to me. I ask for, and expect to receive a detailed and complete explanation of everything involved - not just what will be done, but why - and "it's standard procedure" is not an acceptable answer. I'm not rude, but I am firm, and nothing happens until I get the information I ask for.

As you can gather, I'm one of those that will give up only the absolute minimum amount of control necessary in a given situation - and there's a reason for that - survival. I used to be a lot more trusting, but twice in my lifetime I have narrowly escaped becoming one of the 80,000-100,000 people killed in the US every year by medical errors. Both were 100% avoidable and the direct result of either arrogance or complacency on the part of a physician, and I'll be damned if I will give them a 3rd opportunity. My body doesn't go anywhere that my mind hasn't already been in excruciating detail....

TT

 
At Saturday, February 07, 2009 10:37:00 PM, Anonymous Anonymous said...

I think that perhaps modesty creates a heightened need for control. To avoid/reduce exposure to embarrasment is a natural response for anyone.
For myself, thinking about situations which may arise, such as an emergency room whereby I may find myself exposed to others and not have any say in the matter, triggers some feelings of resentment and frustration. I think that both my feelings of loss of control and my embarrasment at the exposure would exist.. the feelings of loss of control would be more accute because of the embarrasment. leemac

 
At Sunday, February 08, 2009 12:41:00 AM, Anonymous Mary said...

This is an article about medical students being encouraged to find "hilarity" in their patient's physical being. It reported that most of this humor is directed toward the obese patient. Do members of the OR team really go into fits of laughter when the unconscious morbidly obese patient is undraped?

http://www.medscape.com/viewarticle/586717?src=mp&spon=25&uac=101920EK

 
At Sunday, February 08, 2009 1:32:00 AM, Anonymous Anonymous said...

The use of forced nakedness in the military and penal institutions is at times a tool they use to remind the individual of their loss of control over themselves...I doubt if this is the case most of the time in medical situations (I guess if you are naked in the ER you aren't likely to streak the waiting room in a bid to escape...and you couldn't get far on the street in that state of undress )
The sense of loss of control...is probably more over not being able to heal yourself anyway...and it may be excerbated by modesty issues or exacerbate them.
I do not think you will get any nurse , doctor or tech to say they use nudity as a control though...
If patients do feel that it is a control issue over their own bodies...refusal to recognise this might be the reason some interventions fail while others succeed all other things being equal. The patient might just give up more than just give in...also called the loss of the will to live.
Situational and contextual nudity and modesty do deserve to be explored more fully.
TT and MER seem to have some pretty good observations ..
leemac

 
At Sunday, February 08, 2009 9:29:00 AM, Blogger Maurice Bernstein, M.D. said...

To Mary: "Do members of the OR team really go into fits of laughter when the unconscious morbidly obese patient is undraped?" I hope not. Even before undraped, the presence of a morbidly obese surgical patient should simply cause concern and caution to the OR team in terms of transport/transfer, anesthesia, operative difficulties and post-operative care and complications. Nothing at all to laugh about. ..Maurice.

 
At Sunday, February 08, 2009 9:58:00 AM, Anonymous Anonymous said...

I don't know about fits of laughter with naked patients lying on an OR table, but I can tell you first hand that many a comment has been made regarding patients when they are unable to hear or respond. Healthcare providers (I will not reference "professional") are human and at times insensitive and even downright cutting and rude. They will make comment and talk among themselves. I have witnessed this poor behavior over the years. Not all, but it does happen.

 
At Sunday, February 08, 2009 10:01:00 AM, Anonymous Anonymous said...

TT

It was in 2000 that the prestigous institutes of health
cited 98,000 deaths each year due to medical errors. Later that number was underestimated and
200,000 was a more accurate statistic.
Keep in mind that these deaths
included accidents as well such as
a little boy killed in an MRI suite. This occurred when someone left a free standing O2 tank and during the scan the 02 tank was pulled in toward the magnet killing the little boy. Another
accident occurred when the support
arm broke on a NM camera falling
on the patient and killing her.
Included as well are patients
acquiring infections due to nurses
not washing their hands,thats a big
one as well as drug contraindications. As far as obese
patients I have heard a female nurse state that " he is so fat I
cannot see his penis" while the
patient ws alert and oriented.
Let's reverse the roles for a moment. Would she say it if the patient were female?


PT

 
At Sunday, February 08, 2009 10:41:00 AM, Anonymous Anonymous said...

When one is in prison or police custody one has assumed that they are FORCED to give up certain rights. Those are punishments that go with crime. But even in such situations while they have a diminished leve of rights, the issue comes into play to a certain degree, in some states males are not allowed to pat down female inmates, opposite gender access is restricted to certain tasks, not in all but some....AND in the case where a person has been arrested and not yet convicted, they are allowed a higher level of protection for their modesty among members of the opposite gender as per the case where the female in Ohio was forcably strip searched. While as in the case where the Dr. forced a rectal exam on a patient, they claimed it was for her own protection...neither the public or the court was buying it.

The issue of control is definately a factor. Forced nudity has been a way to punish people in many cases, Abu Grief one of the most current and notorious. While religion played into it, that was not the only factor. Asking a person to give up control and blindly follow instructions is very difficult to a differing degrees for people. But part of that decision on how much trust you have the person requesting the act. If I feel the person has my, and only my best interest at heart I have an easier time letting go. If on the other hand I feel the person making the request has their own interest to any large degree....I don't trust them and will attempt to resist and exert or regain control over. For example, if I went in for a sonagram and wanted a male, they denied that request becasue they were to tight on scheduling, the concern is for them, their schedule is more important to them than my comfort, if on the other hand, they said they would love to do so,,,but they don't have any males on staff right now...I could probably go with it. I have to trust them in order to relinquish control. Trust comes from many aspects of the visit, professionalism, appearance, history with them, and not the least a belief that it is about me..not them. I find less concern about the issue when I go into surgery and am out partly because I have to trust them, I have no way to remain in control, so out of self preservation, I can hand it over more easily. In Art Stumps book he makes two observations that come to play here. One where the facility allowed a high school girl shadowing to attend his treatment, he spoke of the breech in trust, that he had trusted them with not only his physical well being, but his modesty and his emotional well being, by allowing an "outsider" in for their benefit they had breeched that trust and it caused him great pain. The other was about power, some nurses/Techs he felt were more into the power dynamics than others. He used the example where when he had radiation, he would lay on the table and slid his boxers down so far. One nurse would always repostion them by sliding them lower, he started intentionally moving them lower to start with, and ineviatabley she would reposition them lower, regardless of how low he started. His conclusion was, she was defiantely letting him know who was in charge. If it is this type of feeling, I would definately fight to maintain control....we do not give up control of our body just becuase we are in a medical setting, even to the point where it is detrimental to our health...still our choice.
And Dr. Bernstein...while I would hardly use banks as an example of anything to base anything off of...even in banking, I have negotiated concessions for them to have my business...alan

 
At Sunday, February 08, 2009 12:56:00 PM, Anonymous Anonymous said...

To answer your opening query for this volume, Dr.Bernstein, yes, for me gender plays a big part..even in the taking of medical history or queries about present conditions, etc. and it would determine if I was co-operative...(as in when nurses ask all those questions before you even see the doctor...although I have never been asked anything about my sex life from anyone in a doctors office...
Gender would be the first determinator and the impression made by the individual would be second...
leemac

 
At Sunday, February 08, 2009 3:04:00 PM, Blogger MER said...

Re: the article in the British Medical Journal -- inappropriate humor about patients.

Two points:

First, note that this is in a British journal of medicine. Again and again I find articles like this in British, Australian, Canadian medical magazines. Is it any accident that these countries have a national health system? Is there some connection? Or does it have to do with how these studetns are trained as compared with American medical students? Just asking.

Secondly, the point of the article is that this kind of humor is inappropriate, even if the patient isn't aware -- because this kind of humor can desenitive the doctor and possibly result in inferior medical care. So -- it's a good article. It shows a profession confronting inappropriate activities among their peers. That's what makes a profession a profession.

Question: Generally, I just don't find these kinds of articles coming out of American medicine -- except on blogs like Dr. Bernstein's and Dr. Sherman's. Perhaps I'm just not looking in the right places. When I do find them, they are in obscure, extremely specific medical journals and not in the major ones. It seems to me, and I could be wrong, there's a different medical culture in the countries I mentioned regarding certain ethical issues. What do you think, Doctor?

 
At Sunday, February 08, 2009 3:28:00 PM, Anonymous Anonymous said...

It puzzles me as to why men or women with modesty issues find it different for cross gender intimate genital care in the OR. What inherent difference is there if you are sedated/unconscious or alert or semi-alert? To me there is absolutely no difference in any state of consciousness. What happens is what happens. That doesn't change the equation. The patient is lying there exposed for a good length of time with a huge bright light uluminating your private parts while the opposite sex is viewing and handling your genitals for at least 15 minutes!
I personally find this absolutely digusting in any form of consciousness. This should be discussed with a patient prior to sedation. They are counting on the patient never knowing about this part of the procedure. People in general think only a very small area is cleansed and then all is draped over when in fact a HUGE area is cleansed - genitals included. Out of decency to a patients emotional health this should be disclosed and the patient should be asked if they have a preference of gender. Male nurses tend to female patients in the OR as well. It goes both ways.

 
At Sunday, February 08, 2009 5:11:00 PM, Anonymous Anonymous said...

I am one who has a strong preference when I am awake, but no so much when I am out. My preference would be to see no one who is going to be involved other than my Dr. For me the anonimity is a big factor. When I am awake it is more me the person, there is interaction, they can likely see my embaressment, they talk to me,I can see them, they seem me. When I am out, especially when I don't have to see them...it is my body, lacking of personality, interaction. I am very forgetable as a body, it is the personality that makes me a person....that said, if you feel different that is just who you are, we are individuals, and they should do a better job of determining our preferences up front. For me, ignorance is bliss.........alan

 
At Sunday, February 08, 2009 7:02:00 PM, Anonymous Anonymous said...

I was just wondering (as somebody who just had a caesarian), why can't patients have the option of being conscious during some operations as they are during a c section? Dr Maurice? I am sure that would put their mind at ease that nothing inappropriate is happening during their operation. I hope you don't say because doctors fear that patients would be nervous if they are conscious, because I certainly was not nervous at all during my operation. Even though I am well aware of the huge incisions that they were making through my body. I could even smell my burning flesh when they were using the electric knife. That didn't faze me either.
CG

 
At Sunday, February 08, 2009 8:00:00 PM, Blogger Maurice Bernstein, M.D. said...

CG, I am not a surgeon or anesthesiologist, but I suspect the differences with a C-section is that the technical complexity and duration of the operation along with the potential to produce adequate anesthesia to the area involved within that time duration is sufficiently satisfactory to avoid general anesthesia. The other, more humanistic reason, is to give the mother an opportunity to immediately participate in the child's birth as she would have if she had a normal vaginal delivery. Remember, general anesthesia would always be an option quickly available if complications arose.

Why don't you ask you OB doctor who delivered your baby, he or she might be able to explain it better than me. ..Maurice.

 
At Sunday, February 08, 2009 9:06:00 PM, Anonymous Anonymous said...

Approximately 10 years ago there
was a full page report in the local
newspaper regarding patients not
recieving adequate anesthesia for their surgery.
Many recall the pain from the scapel and could even recall what
was being said during the surgery.
One female patient in particular
stated that the anesthesiologist
made sexual comments about her
breasts during the surgery. After
her surgery she confronted him
and said " I heard every thing
that was said". The anesthesiologist said to the patient that was not possible.
When the patient mentioned every
detail and relayed about the sexual
comments that was said he was stunned. The patient later sued and
won a settlement in court. A male
patient stated that the nurses were
laughing and making comments about
his penis despite the fact that they thought he was under.
Personally if I were that male
patient they can make all the comments about my penis they want,
just buy me a new ferrari and we
will call it even!

PT

 
At Monday, February 09, 2009 6:16:00 AM, Anonymous Anonymous said...

Alan, the error I see in your analysis of the annonimity of being sedated and not having interaction with the people working on you is that "you" do have conversation and interaction. Most times in the OR holding area the circulating nurse comes out and talks with you. My wife and I spent a least 1/2 hour talking with this woman prior to surgery. She saw my face, my personality, my thoughts and discussion. I saw her face, heard her voice, heard her discussion. There was back and forth exchanges between the three of us. Cozy little group. It was only afterward that I learned this woman did the prep. I had requested and been told a male would do this. The truth was not relayed to me and my spouse. For their convenience. After the surgery I saw this woman as well. She rolled me to PACU (recovery). So your thinking is not correct.

 
At Monday, February 09, 2009 6:45:00 AM, Anonymous Anonymous said...

Coming out from under anesthesisia to overhear comments isn't real pleasant either...especially if you are a kid...
The issue of patients experiencing pain and overhearing all that is said...is made possible because of the paralytics used...you can't move or speak but you can feel and hear...and there seems to be no sure fire way for the anesthestist to know if you are out or not..I will not give permission to use these drugs if I ever have surgery again...and will specifically tie any permission to their not being used...
leemac

 
At Monday, February 09, 2009 9:15:00 AM, Anonymous Anonymous said...

I recognize the annom. post's as someone who posted here before. I respectfully disagree with you, while my thinking may not be right for you, as stated here numerous times this is an individual issue that varies from person to person, not something we can make blanket statements or even apply our feelings to others.
I understand the process, I have been through several proceedures. The circulating nurse plays an important role in the process. She helps minimize the chance of doing the wrong procedure on the wrong patient, she helps make sure the patient understands what is about to happen, what to expect, not in small detail but over all. And yes, I understand she will likely be in the OR when I am prepped and or during the procedure. That is one of those things that I can accept because she provides a valuable function. As stated I have had several procedures one to remove a lump from my testicle. The nurse (female of course) came in after I was gowned, had me confirm why I was there, had me confirm which side, asked if it was OK to put a mark on my leg to verify the right side, she explained they had just but in the IV and shortly they would administer a sedative to relax me and I might or might not remember leaving the room, once in the OR they would put me under, they would shave a small area, etc. etc. Was I a little uncomfortable talking with her about it, a little, was I uncomfortable knowing she was going to be in there, a little. Did it bother me a lot, no it didn't. I felt she was part of the team and I personally am OK with the surgery team, I would not want to reduce the skill level of the team by demanding they bring in all males who had not worked together even if they could. I did not see them shave me, drape me, operate on me. I was not awake while exposed, that what is important to me, I still feel less of a person when out even if she did talk to me before hand. I woke up back in the room with some sort of wierd supporter on with stiches in my scrotum and gauze over the incision. Did this and other women see me naked, prep me, handle my privates...I would bet the farm they did......but...I did not see it happen, and other than the circulating nurse who I never saw again and the anesteologist I didn't see them before or after. Would the ultimate preference be an all male team, yes, but this has to be a compromise between us and them. Where on that continuim you feel is the correct balance is an individual preference. If there was a need to be awake during this like a heart cath, I will get through that as well....when it is something like imaging or other things that can reasonably be done with something as simple as scheduling or asking a male to do it...I am no longer afraid to ask for that....so sorry got carried away, but no, my thinking is not wrong...for me, anymore than someone who says gender doesn't matter to them at all is wrong, its all individual preverence ....alan

 
At Monday, February 09, 2009 10:36:00 AM, Anonymous Anonymous said...

Alan, I did not mean to insinuate that your thinking was wrong. Whatever, you are comfortable with of course is every persons right. All I meant to say to reiterate this process is that it is the function of the circulating nurse to do the prepping. The assist usually cleans the wound and dresses the wound and put on the sling type thing you referred to. All I was relaying is the fact this is usually not discussed with a patient ahead of time. I am not disputing the importance or denying the duties of a circulator. All I am saying is that it can be a male that does this work. 'nough said. For me personally, the excuse of being unconscious doesn't change the scenario. Maybe they think it does.

 
At Monday, February 09, 2009 7:16:00 PM, Anonymous Anonymous said...

It may be the circulator or it might be the surgical technician
that does the prepping. It may
depend on the surgery.
I will say that that when that
female circulator or the female surgical technician needs surgery they usually won't have surgery where they work. They will usually
go somewhere to request all female
teams and they KNOW where to go.
That being said it boils down to
two programs. One for them and one
for male patients. I know of a female nurse who needed neurosurgery which of course required several days of stay in
a neuro icu. She then went to a
facility where she used to work
and spoke with the unit manager
to insure that only female nurses
would be assigned to her care.
Lets reverse the roles for a moment and assume that the nurse
was a male. Now what do you think
the response would be if he made
such a request. Would he be accomodated? Probably not.
I believe that being unconscious
for the procedure dosen't alleviate the concerns for privacy
but rather be proactive about what
makes you comfortable. The more
male patients make these concerns
known the more change we can effect.

PT

 
At Wednesday, February 11, 2009 3:49:00 PM, Anonymous gve said...

I have to have urodynamic investigations soon. I have had a MAJOR battle with the nurse who normally does most of this to get an all male team. Eventually she realised i was not about to be forced into a mixed team. The clearly unequal fact is that for women, they offer an all female team, for men they offer a male and female team as though that in ANY way is equality. I simply kept saying no.

They have now relented and I will have my wishes observed. It has taken about 5 months to achieve this.

I do NOT see this as in any way a victory, just equality, the nurse involved clearly sees me as a trouble maker.

Unless enough men make stands, things will not get better, they will get substantially worse.

 
At Wednesday, February 11, 2009 6:13:00 PM, Anonymous Anonymous said...

GVE
you may not consider it a victory....Yet your achieving your goal...is a victory for all of us.
leemac

 
At Wednesday, February 11, 2009 6:54:00 PM, Anonymous Anonymous said...

That nurse,in the scheme of things
is a pawn and the one who is a)a
troublemaker and b)not being your
advocate. Why it took you 5 months
is beyond me. It would have taken
me just a few days after a phone
call to my insurance carrier and
the facility CEO. You are paying
their salary,they are working for
you.
My first reponse would be,maybe
you want to watch! I'm not beyond
calling them a pervert.

PT

 
At Wednesday, February 11, 2009 7:20:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I wonder if your "first response" is really the the best response since calling the individual face to face by a generally accepted derogatory title usually will not improve communication or attaining the goal you desire. If you have evidence of perversion, specifically sexual perversion and that the individual is using you for their own sexual pleasure and which is therefore unprofessional, you should file a complaint to the professional's licensing board. To me, if you have evidence, that appears to be a more direct and productive way of dealing with unprofessional behavior of that individual and perhaps making an imprint on her employer.

Contacting her employer first, communicating your needs to her employer is the best way. Remember, employees are bound to follow the "road map" set by their employer. To change the course in the map, it is the employer who needs to be informed and educated. ..Maurice.

 
At Wednesday, February 11, 2009 7:31:00 PM, Anonymous Anonymous said...

PT
You are most fortunate to have your insurance company back you...mine does not..their position is that you must accept treatment from any provider in their system taht your doctor refers you to...if you are carefull you might get the doctor to go along with your wishes...the one good thing is that they have many providers in this area..so you can call around...and make sure you will be able to have your preferences honored. As a very larg number of the physicians are female, it rally does pay off to do your homework.
leemac

 
At Thursday, February 12, 2009 4:39:00 PM, Anonymous Anonymous said...

It is not up to some nurse to decide who delivers my healthcare,
that decision is mine.
Lets reverse the roles for a moment and assume that a female is
asking some male nurse that she wants all female staff. If his response is no what do you think
will cross her mind. Well I have
the same rights as she does.
I have the same right to perceive
anything that she does. Everyone
should be treated equal. I'm paying
for a service and if I have to
complain or offend someone thats
not a problem.
Things are the way they are because most of us never stood up
for fairness and equality. It's not
just about heathcare either. This
problem is pervasive throughout
our society. There is an attorney
somewhere in New York who filed a
suit against a bar due to "ladies"
night whereby drinks are only 25
cents each.
This price applies only to women
and if you think about it,its
discriminatory. Just one more
example of two programs,one for them and one for us. I personally
don't patronize any business that
discriminates, especially a medical
facility as I take complaining to
a whole new level.

PT

 
At Thursday, February 12, 2009 6:56:00 PM, Anonymous Anonymous said...

Dr.Bernstein

I’d buy the analogy between healthcare and the penal system. In each one of these systems they take what’s important to an individual and hold it hostage until you give in to the system. I think it’s more so in the penal system then in medicine but the patient just like the accused subject is always left the negotiate to keep a hold of what’s important to them. For me, it has nothing to do with self control and everything to do with what my beliefs and feelings are on the subject. It’s not up to the providers to determine what’s acceptable and they’re not there to judge me based on my beliefs, they are there to help me and if they can’t, allow me to move on to someone who can.

GVE: I’m glad to hear that you were able to get the care you needed and deserved. I wish you well during your test and hope you get better. Indeed, if we communicate our needs to the provider up front and with courtesy we can usually get our wishes honored, even if it does take five months. Jimmy

 
At Thursday, February 12, 2009 7:42:00 PM, Blogger MER said...

Dr. Sherman and I have been discussing the "total institution" concept on his blog, under the "We're all professionals here" thread.

We've had some thoughts that might aoply to what's posted here -- and I don't want to just rewrite or paste them on this blog.

 
At Thursday, February 12, 2009 8:15:00 PM, Anonymous Anonymous said...

A firm and consistent insistence on being treated with consideration to ones beliefs and feelings (including modesty), delivered with civility seems to have prettty good results...and maybe with less unpleasant consequences than an antagonistic approach.
leemac

 
At Thursday, February 12, 2009 10:17:00 PM, Anonymous Anonymous said...

Simple litmus test. Have a lady friend,sister whomever call as many
surgery, inpatient facilities and
have her ask them if they can
accomodate her with all female
teams.
Then have a male call the same
facilities later on and ask the same question. What would be the outcome.
It seems to me that if the female
is accomodated in a higher percentage versus the male patient
then how would that be percieved.
Would you consider it discrimination, since you provide
a specific service to females but not to male patients.
In vitually every state the law
states that if you secretly record
your conversation with another
individual it is perfectly legal
without their knowledge as long as
your voice is on the recording.
For a few dollars one can record
the entire conservation in both cases. If you can document that a
facility discriminates against males could one sue the facility.
Oftentimes it takes lawsuits to
change the behavior of business. In
this country we are taught that
discrimination is wrong and illegal. Most facilities recieve
medicare and medicaid payments from
the federal government. Specific
criteria are expected and as such
discrimination is not one of them.
Discrimination has several facets,power and dominion from
which an ulterior motive is the
driving force. Where different genders are involved you can guess
what the motives are.

PT

 
At Friday, February 13, 2009 5:45:00 PM, Anonymous Anonymous said...

DO folks here think that requesting "same sex" or "same gender" comes across better?
It seems more common to use same sex in discussions ...but to take "sex" out of the equation..same gender seems to work...
leemac

 
At Friday, February 13, 2009 9:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Early on in these threads, I have looked for individuals to write comments here to give the perspective of patient physical modesty by those who come from a nudist culture or who work as nude models. I seemingly have never found a visitor who represented those cultural groups. I think it would be appropriate to see what those who under certain circumstances are not concerned about revealing their body would respond to revealing their body in the circumstance of being a patient in an office, hospital bed or operating room.

Though I, myself am not a nudist, I joined a ClothesFree website and invited those who read my post there to come to this thread and read what has been written here and express their views. You may be interested from what I read there, some concern was expressed about intentional peeking by casual passersby in what should be a professional examination. I hope some members of that website come by and write. ..Maurice.

 
At Saturday, February 14, 2009 6:27:00 AM, Anonymous Anonymous said...

While I may not be a nudist in the truest sense of the word (I don't go to organized events) until I was diagnosed with bladder cancer in 1996 I was fairly modest. After an overnight stay in a hospital with a catheter installed for drainage, I seem to have lost what modesty I had.

Nurses and assistants in and out all night checking the drainage bag, lines etc uncovering and recovering me took care of that. I wasn't uncomfortable being revealed nor being checked every what few minutes. The room door was left open but being at the end of the hallway, there was no traffic.

There was no giggling by the nurses or assistants, instead they went about their jobs with a very professional attitude. Occasionally one would stop to just chat a few minutes and I appreciated it. It made me feel less like just a lump in a bed to be taken care of and more like a human.

All in all, I would have to say that nudity in mixed company, clothed or unclothed doesn't bother me in the slightest anymore. While I'm not an exhibitionist by any definition I'm now comfortable with my own body. I think that had a lot to do with the professionalism of the staff.

 
At Saturday, February 14, 2009 6:38:00 AM, Anonymous Keith said...

As long-time nudists, and frequent users of the health care system, my wife and I both have experienced many situations in both hospital, and in office situations where the nudity issue has arisen. We have found that we have been more comfortable with our nudity than the doctors/nurses/PSW that have looked after us. Such a fuss is made over draping for such simple things as a breast exam for my wife.

 
At Saturday, February 14, 2009 7:42:00 AM, Blogger Maurice Bernstein, M.D. said...

I want to thank Keith and Anonymous from 6:27am for coming over to this blog and thread and writing their views and experience. I am sure that my repeat visitors and writers will find the comments of those visitors from the ClothesFree website of value in helping us to understand patient physical modesty in patients with different backgrounds.

To my new visitors--please, please identify yourself, if you want to remain Anonymous, with some consistent pseudonym or initials to help us all facilitate the recognition and continuity of subsequent postings. Again, thanks.. ..Maurice.

 
At Saturday, February 14, 2009 8:16:00 AM, Blogger Maurice Bernstein, M.D. said...

If I might, I would like to copy here a comment by one of the members of the ClothesFree website and then my response which I think brings up another aspect of the patient modesty issue: the physician's concerns with regard to the seductive patient.

The member wrote:

There are different aspects about comfort of a patient being nude or not, from patient and health care provider perspectives. There are actually exhibitionist type patients who are 'comfortable' being nude, but tend to make staff feel uncomfortable, even staff who are otherwise comfortable with nudity (and nearly all health care workers are). It should be understandable that this type would be encouraged to either keep clothed or be clothed when appropriate.

I also think being a nudist helps in regards to phobias of being nude, but feeling comfortable nude in various situations is different for everyone and varies with the situations. I haven't noticed that someone has to be a nudist to be void of body shame.


I responded with:

I agree that most doctors are comfortable with degrees of undress of their patients, though I think some are not (similar to the discomfort of first and second year medical students.) What doctors are probably most concerned about with regard to undress is any associated behavior of sexual seduction by the patient. The seductive patient is an important professional issue that can challenge both the medical student and the practicing physician. Physicians, male or female, are human beings with their own sexual drives which under the professional codes and societal laws and simply ethical behavior clearly restrict doctors from acting on those drives. Therefore if patients, and some do, use their degrees of undress to attempt to manipulate the doctor by seductive behavior for one reason or another, this should be recognized and mitigated.

I want to thank 2 visitors apparently from this website who have already contributed to my blog thread. More are certainly welcome To me, this is very important if we all want to get the full picture regarding the dynamics or mechanism in patient physical modesty.


..Maurice.

 
At Saturday, February 14, 2009 8:56:00 AM, Anonymous Anonymous said...

Hi,
For me just because someone says "I am a proffesionals or we are all proffesionals" does not always even out the playing field for me in a medical situation. Just as I am and most of the medical workers and the entire world we are all humans and we are not perfect. I am consider a proffesional in my field of work, I make mistakes and occasionaly I find out from others and myself I could have handle some situiations different. I am very respected in what I do but I never let that respect cloud my judgement and tell someone this is how it is going to be because (I am a proffesional). I was very ill with cancer as a young adult and yes I beat cancer but it also had a small price tag that went along with it. At that age being a male basically spending that much time in a hospital with surgies and test you hand over trust and as most things in life some handle your trust and life with care and some cut corners to make there life easier but I believe they hoped thay had the same ending results as the group who cared from the start.
Today I love my life and I am very proud of myself because I had to get myself through the cancer alone, I had no family so I had to learn to trust even if I did not even really understand what the word trust meant. Today looking back I have better clarity of the situation of what I was feeling. When nude or having to exspose myself in situation where night and day situations. The nurses, doctors and techs that took a few extra minuntes and fully explained the test procedure or even a bed bath then explained that there is going to be an awkward situation for me and also would explain that the exsposure would be limited and proctect my modesty the best they could. Most of these caregivers would start the procedure at the time when I was ready and answered my questions at that age what questions do I really have. My point to all of this is basically that I had two different expierences from caregivers, one group treated me like a human, with the fullest dignity. The other group that was the (matter of fact group) did there job and I believe they did there job as well. I bet both groups would have used the golden phrase that "we are all proffesionals here" I would not and I hope, I just explained why that phrase does not always fly with me and in both groups at aleast 98% all females workers.

Today I have some modesty issues but I do not care what sex a caregiver is it all boils down to respect and communications and that is what seperates the staff from the proffesionals.

I recently was asked to partisapate in a project that a local photograper was doing in memorey of his wife who died of cancer. It was an incredible expierence for me, the project is going to be an coffee table book with cancer surviors stories and then several photos of that person. Of course there are no before pictures but for most people with cancer, the hair lost, bloated looking from steroids and just being so sick you do not even look the person before you got sick and the dignity lose with all the medical procedures. The book is basically (We will get through this) and I will be honest as I knew upront that some of the pictures are tasteful nude shots. The person heading this project wanted us to be proud of who we have become and show off some of those physicals scares that we all have survived and we are all beautiful and a little airbrusing never hurt,LOL.
Cancer made me take off most of my clothes and in the long run I took off some of my clothes off for cancer.

Daniel.

 
At Saturday, February 14, 2009 10:17:00 AM, Anonymous Anonymous said...

Also arriving from the ClothesFree website and having read only a few posts here, I thought I would just add a few personal observations on medical staff and modesty. Growing up in and having parented a naturist family, I find that gender issues are for us much less concerned with physical traits than with personality. We tend to see gravitate toward doctors oriented to the "whole person" as opposed to being "body mechanics" so over the years our family doctors have often been women. However, as we are comfortable in mixed-gender situations from childhood, the gender of the doctor or staff is really of little default importance. We are also used to treating sexuality as a distinct private activity separate from nudity, but this makes us perhaps not only more comfortable with our bodies than the norm, but also more alert and aware when medical staff behavior is not impeccably normal and respectful. Our family has lived for extended periods in both the US and France, so we are aware of cultural and legal differences. With our current US family doctor, we made a point of telling her right away that we were naturists so that American-style modesty issues were clear. She and her staff seem to appreciate being able to dispense with the usual clothing gymnastics. We just disrobe as needed for consultations and, if unclothed, only put on the strange paper-open-back gowns for trips down hallways. While we don't have "typical" physical modesty issues that doctors must be so sensitive to in the US, we also realize that not all medical staff have thought through the human respect issues that naturists take for granted, so we know we need to be alert if family members are in a situation, for instance, of being sedated. In general, though, American medical folks have been very friendly and adaptable, and often seem almost to breathe a collective sigh of relief when they find out we're comfortable about having a body. A footnote: our family doctor in France is also naturist, so we're already on the same page. (posted by CSM)

 
At Saturday, February 14, 2009 11:33:00 AM, Anonymous Anonymous said...

Daniel
Thankyou for your comments...and congratulations onsurvivng a horrible disease.

Thank you Dr.Bernstien for going out of your wwway to get the clothesfree bunch to give their thoughts here,
leemac

 
At Saturday, February 14, 2009 11:35:00 AM, Anonymous Patrick said...

I am a veterinarian and have had many surgical procedures in my 50 years on this Earth. When I was 20, I had to have an inguinal hernia repaired and I was extremely modest. The fear of nurses and doctors seeing me naked and probing me during and after surgery far outweighed the fera of the surgery itself. That experience convinced me that I needed to get over this phobia and I went to Hippie Hollow Beach in Austin. It is a clothing optional beach and I bared all in a public setting for the first time! It was truly a liberating experience. Since then I have become a card carrying nudist and am naked most of the time at home. I am raising my kids without body shame. We live on 23.5 secluded acres where I can be nude inside and out as much as the south Florida weather permits. Fast forward a few years and I now have a long history of kidney stones (5 lithotripsies),and prostatitis (3 prostate biopsies), I have had 2 colonoscopies with another scheduled for next month (polyps found on the previous 2). I have absolutely no issue with being seen naked by anyone in the health profession, male or female. I insist on having a DRE on my annual exam, along with my PSA. I believe that my comfort level with my own body has enabled me to seek medical care and keep on top of things before they got out of hand. I have a client, my age, 50, who was diagnosed with a fist sized rectal tumor, that the doctors surmized was 7 years old. His wife was livid that it had not been picked up on his annual physical. He reluctantly informed her that he refused the DRE each time when given the option by his physician. He now has a colostomy bag. Large price to pay for modesty, n my opinion. I was a much happier, confident person,and I dare say healthier person because I have long since shed my modesty issues. I realized that humans come in 2 basic forms, and it would be rather egotistical of me to think that I am so special that I would be singled out for ridicule if I were to be seen naked. Sorry to be so long winded, but hopefully it adds another "wrinkle" to this fine discussion.

 
At Saturday, February 14, 2009 12:01:00 PM, Anonymous Anonymous said...

Maurice --

Thank you for visiting the clothesfree website and asking for input on this issue from nudists/naturists. While I confine most of my nudity to the privacy of my own home, I have, on occasion, had the opportunity to be nude with others at a nudist park or nudist home, and I find that I resonate with much of nudist ideals and values.

I find your invitation to be very timely, as I was, just this morning, thinking that I should probably consider talking with my doctor about a colonoscopy, as it has been about 6 years since my last one. But I find myself hesitating because, more than anything else, I dread those horendous gowns.

And I expect I'm not alone. Just a few days ago I saw a local hospital ad on TV that featured a man dressed in a hospital gown, doing various things that a person might do throughout the day. The message of the ad was that men need to be tested from time to time for various things, and the tagline said, "Real men wear gowns." Apparently this hospital felt that enough men hesitated going through testing because of the gown that such an encouragement was necessary. And I wondered, how many guys fail receive the health care they need because of those gowns.

I find hospital gowns to be tremendously degrading. They send a message to me that my body is so shameful that I need to cover it up with the most ill-fitting, uncomplimentary garb ever designed. I know this may sound strange, but I really find them to be insulting.

Believe me, I would much rather be allowed to remove my clothing and remain nude. In doing so, my healthcare providers would be telling me that they respect my body as it is, and that I don't need to cover it up. It would tell me that I can trust them to care for my body while I am semi- or unconscious, because they don't consider it shameful.

Contrary to some of what I read above, I don't find being nude in front of others who are comfortable with my nakedness to be a loss of personal power, but rather an increase of it. Because, by allowing me to be nude and accepting me that way, they are telling me that their acceptance of me is not based on my clothing, or my physique, or any other outward thing, but rather only on my being myself. And that gives me power, and builds trust into the relationship.

My only question that remains is this: The next time I'm told to get undressed and put on a hospital gown, how do I tell them that I'd rather just get undressed and leave it at that?

Lee

 
At Saturday, February 14, 2009 2:43:00 PM, Anonymous Anonymous said...

Pertaining to the gentleman who detailed his hospital care for bladder cancer, I just wonder if a female patient had male nurses coming in and out of the room exposing them all hours of the night and day checking tubing, cath bags, urinary cath exposing the vagina etc. and there were no giggles from the male nurse...wonder how many female patients would be geezz "they were really professional and I was real comfortable with the whole process." Just wonder how that would go over and how their husbands would feel as well.

 
At Saturday, February 14, 2009 4:38:00 PM, Blogger MER said...

Re: Anonymous's comment. In the hospital culture today, the default position is that female nurses just do these things intimate procedures with male patients. That's just the way it is.

Another default position is, I believe, that gender shouldn't be an issue. Nurses are nurses and both male and female nurses should work on male and female patients. This is a more questioned position, because male nurses still often need chaperones to work on female patients, and male nurses are not always welcome in OB units. But the general attitude is that this shouldn't be the case, that gender should not matter to either the patient or the nurse. In this matter, I suggest to you that there's a significant amount of "reeducation" or "resocializing" going on in the hospital culture. Getting patients to accept this "gender doesn't matter" culture is part of the "hidden" mission. If a patient wants same gender care, the agenda is to convince the patient (especially men) that it shouldn't matter and the the nurse should be allowed to get on with the task at hand.

These assuptions so embedded in the culture that it can be dangerous to question them. If patients do question them, they could be considered difficult, not complying patients, or even anti-feminist. In some quarters, these assumptions cannot be challenged in any way, shape or form. It's a deep, ingrained cultural attitude coming out of the postmodern academic ideology, i.e. gender is just a cultural constuct. There is absolutely no biological element to gender.

I've been reading a book written by two British nurses (Mary and Peter Birchenall) called: "Sociology as Applied to Nursing and Health Care." What makes the book even more interesting is that it puts sociological topics into the context of Britain's national health system.

In the last chapter, "Sociological Perspectives in Nursing," the authors' write:

"The rights of patients to state preferences as to the gender of their carer are recognized."

The authors then quote HBM Heath writing about nursing theory and the fact that the women's movement has caused female patients "to seek more responsibility for and control over their bodies, health, and lives in general."

Then the authors write something very interesting:

"As with any social movement the demands of women to redress centuries of inequalities has been countered by a 'backlash', and the rights of men have a growing focus in health care. There is a growing incidence of 'well-men clinics' and recognition that the emotional needs of men are legitimate and need acknowledgement."

Now, this book was published in Britain in 1998. I challenge anyone reading this blog to find a similar statement from that period in an American textbook designed for American healthcare workers. Lately, there have been several books coming out about men and what it means to be masculine in today's culture -- books about problems boys are having in our school system, books about men's health. But I don't think you'll find much if anything about this even in today's books designed to train modern American health care workers.

I hope I'm wrong. Someone find something. Prove me wrong.

 
At Saturday, February 14, 2009 5:32:00 PM, Anonymous Anonymous said...

Thankyou , Lee, Patrick and the person from France for you input into the discussion here..your views and how the medical community has reacted to them are interesting..
leemac

 
At Saturday, February 14, 2009 9:39:00 PM, Anonymous Anonymous said...

Those from clothesfree have expressed their experiences and thoughts about themselves and their feelings....if it is not putting them in a hard spot...I wonder if some of them would care to tell us how they view those of us who are not comfortable with teh nudity thing and our desire for minimal exposure and/or same gender medical workers
leemac

 
At Saturday, February 14, 2009 11:58:00 PM, Anonymous Anonymous said...

I suspect that having nudists visit
this site does nothing but cloud
the true issue. My interpretation
of modesty is this," gee Frank drives a modest car" or "Frank lives in a modest house."
If people want to walk around nude
at a nudist beach or a nudist colony thats their business.What
ever turns them on. I couldn't care
less as that does nothing for me.
The point I've attempted to bring
to the table is an issue of two
programs. One for female patients
and one for male patients. I never
had modesty issues until I saw the
double standard being a patient and
the realization that its discrimination and nothing less.
In the broad sense the female
feminist nursing movement has had
to deal with the increasing influx
of male nurses and the subsequent
challanges this imposes on their
control.
Therefore they have created this
gender dosen't matter construct and I'm not buying it. It's just a
cloud cover as they know they can't discriminate against male
nurses forever and in this regard they'll try to have their cake and eat it too. It's too late, the cats
out of the bag and discrimination
is its name. Despite the fact that I hate attorneys sooner or later
they will have a field day with
this and one way you change the
behavior of companies is through
lawsuits.

PT

 
At Sunday, February 15, 2009 1:09:00 AM, Anonymous Anonymous said...

The issue of being uncomfortable in unclothed situations in respect to health care, is not just a single reason for feeling that way...at least in part, the comment by MER reflects a bit of the idea of loss of control...by virtue of the fact that a patient should just accept whatever the health practitioner wants the way they want really magnifies this...it leaves me feeling they are arrogant and paternalistic (not in a good way either)..I also want to note that I accept folks for who they are....and not on physique, looks, or clothing they wear.
If it is in mixed company I would be extremely uncomfortable with anyone being naked....if it is in male company I would feel ok if it were situational. ie...showers at the pool or gym...skinny dipping.. etc....Just simply was not raised where nakedness was acceptable except in limited situations is another reason.....as these are my own feelings I am in no way puting down anyone who has more liberal feelings about nudity.
leemac

 
At Sunday, February 15, 2009 11:06:00 AM, Anonymous Anonymous said...

The patient gown is so old and nothing has changed for decades. They do have gowns now that will accommodate an IV line, etc. But really they could easily put patients many times in scrubs like the nurses and doctors wear. They also need to accommodate men much better as the "gown" doesn't cover much. It is yet another example of not meeting patients' needs and desires.

In the case of the man that didn't find the tumor because he did not want the DRE, well, that tumor may very well have not been picked up with a DRE. It may have been missed even if the man had routine physicals and exams. A scan would have picked up something like that but without symptoms a scan probably would not have been ordered. So don't blame the guy totally for this happening as it did.

 
At Sunday, February 15, 2009 11:51:00 AM, Anonymous Anonymous said...

Think about it for a moment. A gown
is a dress and as such designed for
female patients,not male patients.
Ever go have a radiological procedure and they have you put on
a gown( dress) then make you have a seat in a large waiting room full
of people. I refused that part and
said " I will change in the room and when you are done with me I will change after the exam. The looks on their face,priceless!
Notice that these are women expecting you to do this. Nothing
like dis-empowering these people
although a little slow some can
see the light if you point it out
to them!

PT

 
At Sunday, February 15, 2009 2:44:00 PM, Blogger MER said...

Since PT brought up a radiological procedure, I'm posting here a pamphlet out of Great Britain from the Royal College of Radiologists called: "Making your Radiotherapy Service more Patient-Friendly." It's worth reading.

PT writes about being in the waiting room in a gown. Read what this pamphlet says about "waiting" on page 9. There's a whole section on communcation. Under Planning and Treatment, the first two items are "Maintaining dignity and privacy," and "Gowns." On page 17, the pamphlet states:

"The vulnerability and uncertainities felt by patients before and during treatment cannot be overstated. Patients' altered body images following surgery or chemotherapy will compound these feelings. It's really important that staff are sensitive to this."

"Patients should not need to wear flimsy and ill-fitting gowns in public areas. Undress in full view of radiographers and other staff within the planning and treatment rooms can be very distressing..., etc."

The fact that a pamphet like this is written and confronts such privacy and modesty violations, strongly suggests that these violations happen more frequently than we want to admit.

I haven't been able to find such a pamphlet from this country. I'm not suggesting in any way that American health care providers don't know or care about these issues. I just don't find these issues discussed as openly as I do in Great Britain, Canada and Austraila.

Now -- here's a radical suggestion:

This pamphlet is written for radiology staffs. Why don't hospitals create pamphlets like this for patients -- pamphlets that assure patients that staffs are aware of their moddesty concerns, that staffs will address these concerns, that staffs are willing to discusss these concerns openly and honestly? I strongly believe that pamphlets like this will help reduce many fears that patients have when they enter hospitals for intimate procedures.

That's one way we on this blog can be proactive. Contact hospitals. Get copies of pamphlets they hand out to patients for these kinds of intimate procedures. See what's being covered in these pamphlets. Show hospitals pamphlets like the one I've mentioned here and suggest to them that they follow this philosophy. Then follow up. See if they're actually doing anything about it.

Here's the link:

http://209.85.173.132/search?q=cache:p3JLKPeEbLEJ:www.rcr.ac.uk/docs/oncology/pdf/COPLG_web.pdf+Making+your+radiotherapy+service+more+patient+friendly&hl=en&ct=clnk&cd=1&gl=us

 
At Sunday, February 15, 2009 3:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks MER for the URL. But a simpler and more direct way to the pdf file is the following:

http://www.rcr.ac.uk/docs/oncology/pdf/COPLG_web.pdf

..Maurice.

 
At Sunday, February 15, 2009 4:49:00 PM, Anonymous Anonymous said...

I notice that the pamphlet states that when same sex provider can not be provided that there be a discussion about ways to minimise the embarassment to the patient with the patient. Thankyou and MER for the info..I think I will print some copies and send them to several radiology labs and hospitals here where I live.
leemac

 
At Sunday, February 15, 2009 5:49:00 PM, Anonymous Anonymous said...

Why are American women forced to have annual pelvic exams and pap smears using stirrups? Australian women don't have to put up with the indignity of stirrups, and pelvic exams are no longer done as they are considered unnecessary. American women should refuse both.
LK

 
At Monday, February 16, 2009 3:46:00 PM, Anonymous Anonymous said...

I think the input from the cloth free folks only shines the light brighter on the question I continue to ask and ponder...with such a diversity of patients, why in the world would the medical community not attmept to establish the basic level of modesty and preference of the patient when they are getting patient information, why do they ignore this and force the patient to bring it up...my assumption is if they ask they have to deal with it..don't ask and I can pretend it isn't an issue which is easier for me...
Lee, the "real men wear gowns" is a national campiegn by the US department of health. They realize men do not as a whole seek medical attention as they should...while you put one perspecitve on it, let me give you another...I hate the dang gowns because it does not provide enough modesty for me, it has an open back, and at 6' 2" it is to short...my anger come from the fact that they know we hate the dang things, there are alternatives, and they still use them. To me it shows a complete lack of consideration for me to make things easier for them. I think that the campiegn is intended to get men to accept that wearing the gown for exams is "manly". Once again it is the medical community trying to sell "be a man and wear this even if you don't like it" rather than saying, you don't have to wear a gown we have these alternatives which will make you more comfortable...its a different version of they we are all professionals here....it should be about the patients comfort not trying to get the patient to accept what is uncomfortable for them for the benefit of the providers...in your case that may be being nude, in my case it would be scrubs or a gown that is longer and over laps....I think the issue with the gowns for most men is it doesn't cover enough...not to much...I think you imput if interesting and valuable in that it reinforces we are all different...but to have a nudist tell me I should just get over it and be comfortable with my nudity is a little like a sky diver telling a person who isn't comfortable with hieghts to get over it...and just becasue we are not comfortable doesn't make it a phobia...I drive fast, my wife doesn't, she isn't comfortable when I drive fast...does she have a phobia???not saying you said those with modesty concerns were phobic..if we decided it on numbers...nudist are a very small minority of our society...I am not condemning you for your life style, its your choice i have no problem with it....but, we are all different..not right or wrong...just different...alan

 
At Tuesday, February 17, 2009 1:42:00 PM, Anonymous Anonymous said...

I'm having trouble grasping this idea that men would be uncomfortable with female medical care. Didn't all our mothers take care of us when we were sick? So I can only assume that it is something learned later when women became linked in one's psyche to sex. Similarly, the issue of male nurses is a mystery to me -- it must come from an presumption that all men are incurably lascivious, which is another myth naturists can comfirm is indeed a myth. Didn't more than a few of us men raise daughters? If sexuality is the issue, are gay male nurses ok for women and not for men then?
One of the first things learned in a naturist setting is that seeing someone nude provides hardly any extra clues to what they are like sexually, or for that matter how they play golf. Sex is an activity, nudity is a state of being. Another thing learned is that gender is way down the list of significant differences between people compared to upbringing, life outlook, personality, education, etc. If you tell me someone is a doctor from Switzerland or Johns Hopkins, I will have a lot more worthwhile information than if you tell me their gender.
Respecting each patient's sense of modesty is certainly important, and part of respecting and treating the whole person, but a default (instead of exceptional) segmentation of medical service personnel by stereotypical notions of gender sounds to me truly misguided. I am completely with Alan that a more sophisticated handling of the diversity of patients is the key. Don't make me wear one of those awful "gowns" because you think it will make me more of a "real man"! Ask me how I'd be most comfortable. Its just elementary common sense to come up at least with a little grid of comfort preferences, rather than force both patients and staff into binary piles of "type M" or "type F". (CSM)

 
At Tuesday, February 17, 2009 3:03:00 PM, Blogger Maurice Bernstein, M.D. said...

CSM, thanks for coming over and writing. Though, I fully agree with virtually all that have written to this subject since I started it that there definitely is a problem with the medical profession and system in recognizing and acknowledging that modesty is an issue for some patients and that this has resulted in the kinds of clinical behavior that has been described numerous times here. On the other hand, there are other views on the patient modesty issue and its impact on personal medical care. I am so glad that visitors are coming over from the ClothesFree website providing these other perspectives, some of which are in agreement with what has been written here previously and some providing a fresh look at the issues.

I want to make it clear to my long time visitors, as a "clothes on" person I am not in anyway trying (nor I hope neither are the ClothesFree visitors) trying to convert you to become nudists. I just wanted to provide some different views and different reactions, not from me, but from folks that have personally experienced medical situations and acted on them in their way. ..Maurice.

 
At Tuesday, February 17, 2009 3:37:00 PM, Blogger MER said...

Very interesting post, CSM. It seems we agree on some of the important issues. It's interesting ot get a naturalist point of view.

A few questions:

Naturalists are comfortable naked in front of both genders within certain contexts, that is, in a naturalist setting -- correct? Would naturalists be comfortable walking naked down a Chicago street? In other words, are there contexts in which a naturalist would be embarrassed to be naked in front of members of one and/or both sexes? What are these contexts? Are there various attitudes about this among naturalists?

I would suggest that most men who are uncomfortable with a female medical worker, have little problem with public showers with other naked men, or being naked in front of other men in certain contexts, a male doctor, for example. Body modesty is contextual, too.

Typically in our culture, most men are naked in front of a woman as part of a sexual ritual. Or, changing clothes, showering, etc. in front of a wife or close family member or even a close friend of the opposite sex. But modesty and embarrassment has little to do with the sexual act.

Although we are taken care of by our mothers when little -- there are definite boundaries in our society drawn in this regard when boys reach a certain age. It's not discussed openly often, but mothers, when their sons turn a certain age (10, 11, 12?) don't bathe them, don't do certain intimate things anymore. It's one of those not spoken cultural assumptions. It's a cultural norm. It's learned, your correct. But don't discount the significance of learned behavior. I find it interesting when people talk about, let's say modesty as a cultural construct -- as if cultural constructs aren't powerful. Democracy is also a cultural construct. Being comfortable naked in mixed groups is a learned behavior, too. It's also a cultural construct. Or, are you suggesting that naturalism is the standard univeral truth and everything else is culturally constructed?

Most naturalists I have know over the years have had the attitude that naturalism is psychologically healthy and body modesty at its best is not healthy, at worst, neurotic. Do you see it that way?

Do you think it's possible for someone who has reasonable modesty issues (or is that an oxymoron?) to still have a health attitude toward the body?

Essentially I agree with what you say about gender. At the same time I think we discount the importance of some gender differences -- regarding the whole concept of gender as socially constructed. Listen to this quote from "The Embodied Self: Evidence from Cognitive Psychology and Neuropsychology" by Paul C. Vitz (in The Self: Beyond the Postmodern Crisis (2006) by Paul C. Vitz, et. al. --

"Many postmodern theoriets today claim that there is no human nature; that is, there is nothing important that is intrinsic to the human being. Consistent with this general assumption, postmodern theorists have also claimed that there is no self or at least no natural or true self. What postmodernists mean by this statement is that the self is a socially constructed concept and therefore essentially plastic and capable of being constructed in whatever way one might wish. There is, therefore, no natural self with basic universal charactristics. Likewise, the more general idea of a human nature is also seen as a socially constructed idea." (p. 113)

A bit heady, I admit. But the idea is, as I've expressed before, that gender, as part of the self, really doesn't exist as a universal human trait. This is the most popular intellectual, academic world view today. I would suggest that medical professionals trained in the 1970's through the 1990's may have accepted that as received truth by the academic community that instructed them. It is a theory, but one with a philosphic based, not a scientific base.

Granted, some human characteristics are socially constructed. No one will argue with that. But not all. There are universals.

See for example the work of anthropologist Donald E. Brown in works like "Human Universals" (1991). By the way, Brown lists "modesty" as one of his human universals.

Cognitive psychology and brain research are beginning to show that there are significant universal imbedded (hard-wired?) "gender" differences.

CSM writes: "Respecting each patient's sense of modesty is certainly important, and part of respecting and treating the whole person, but a default (instead of exceptional) segmentation of medical service personnel by stereotypical notions of gender sounds to me truly misguided."

I agree with both parts of that paragraph. But remember, the stereotyping goes both ways. In the name of medical heuristics (shortcuts -- a necessary cognative strategy) patients in general and men in particular are stereotyped as to their values. Men with strong modesty issues improperly stereotype female medical workers. But medical workers who have been socialized and educated into the postmodern world view regarding gender, stereotype patients as well -- i.e. the gender of the care giver doesn't matter to men. Ironically, there's often a disconnect in the minds of these medical workers regarding their own modesty issues. While at work, they belive one worldview. When they get in the hospital, that world view may flip flop when it comes to their on gender choices and values.

Sorry to get so much into this one post. But I enjoy your contributions, CSM. Let's have some more.

 
At Tuesday, February 17, 2009 3:45:00 PM, Anonymous gve said...

This whole issue (patient modesty) appears to me to be about the comfort of the patient, NOT the comfort, convenience, ease, lack of consideration of the carers. Surely in every other walk of life the customer is king, would we take kindly to being told how to have our steak? would we accept being told where to go on holiday? would we think it reasonable not to be asked? of course not. The issue of patient comfort is not rocket science, it is not difficult for anyone to grasp. The whole issue revolves around what is currently easy for providers. Every other walk of life has been influenced by equality, we now have female fire fighters, female builders etc etc. NO campaign has been fought to encourage more men into nursing. The long term prognosis (with more and more females becoming doctors) is that men will have to just shut up and accept all female teams for almost everything. Is that equal? Is that fair? is that how we should accept things? If the tables were turned, would women just accept it? History is just that, history, I am talking about the future, women are seeking more fair play while at the same time ignoring this issue for men. Something has to change

 
At Tuesday, February 17, 2009 7:28:00 PM, Anonymous Anonymous said...

Thanks for your input CSM..and as usual MER, DR Bernstein..and the other posters.
leemac

 
At Tuesday, February 17, 2009 7:38:00 PM, Anonymous Anonymous said...

lots of stuff here all of a sudden. While not a natuarlist, and while it is not in my nature, I have visited a nude beach out of curiosity spurred by this thread. While it took me two trips before i would shed my clothes and even on the third visit remained back in the less traveled areas, I did find that I could be relatively comfortable sitting nude on a towel in mixed company. This leads me to believe that the power dynamics is part of the issue at least for me. In a scenerio where I am the only one nude, infront of females I have more concerns than when we are all in the same state. I prefer male caregivers when I have to be exposed...I do not equate males with sex so perhaps that has validity, on the other hand...while I understand the statement that males are cared for by their mothers, as stated that stops when the male gets older, I bathed my daughters when they were young but stopped when they got older....it was just natural according to my up bringing. So is it an issue of sexuality with female caregivers or is it society has taught us when we get older we are not to be nude infront of the opposite gender. There fore while it is loosely connected, I am not sure you can draw a strong correlation between naturalist and those who have concerns for modesty....they have similar issues, but are different enough to question the comparision.
On a side note...and off the subject, I have had some positive feed back from a facility regarding gender choice, it was encouraging...only to walk by an open door while visiting a friend in a different hospital to see a nurse helping an edlerly man to his bed either from a wheel chair or from the bathroom in the typical hospital gown wide open exposing his back side to me and anyone else who happened to be walking by at the time....so we are all individuals and each facility is unique are as the caregivers.....and I do agree, males are going to have challenges until we get more men into nursing....alan

 
At Tuesday, February 17, 2009 8:01:00 PM, Anonymous Anonymous said...

Thanks for your inputs CSM..and MER and the other posters...I am appreciative of the clothes free folks coming here...I am glad they have been extremely civil and open....
leemac

 
At Wednesday, February 18, 2009 1:44:00 AM, Anonymous Anonymous said...

Reading the many perspectives here show a common ground in most...that of respecting individual sensibilities in how they think people should be treated...whether they have modesty issues over nakedness or not. The folks from clothesfree have provided how they have dealt with the issue..with some having lost their embarrsment and others seemingly having never had such feelings to begin with.
In an earlier volume there was a naturist who said he that the scrutiny necesssary for a exam by a doctor was when he got nervous...If any from clothes free would care to share their thoughts on whether scrutinty (not just someone staring in a rude manner) had any effect on them.
I notice that my not being much concerened about being naked when in a group setting such as skinny dipping or showering (not with mixed company) does not carry over to a doctors exam..although I am able to gut through it if the Dr. is male..I try not to show it in that case because it seems to make the doctor a bit apprehensive..maybe because he is not sure why I become a bit distant..(that going to some place far off in the mind)
leemac

 
At Wednesday, February 18, 2009 5:52:00 AM, Anonymous Anonymous said...

Dr M, sorry if it sounded a bit like we were "trying to convert people to become nudists." Not in the least! We are not anti-clothing (see below) and fully respect others' ways and views.

MER, so many questions. I will try to be brief in responding.

If we weren't arrested or didn't freeze to death, naturists in principle would "be comfortable [ie. not embarrassed] walking naked down a Chicago street." But naturists respect context and aren't anti-clothes. We also have work clothes, church clothes, etc and have merely added "no-clothes" as one informal option to our wardrobe when it makes sense, like when swimming or at the beach. Think of it like one of those sleeveless Chicago Bulls basketball jerseys. Would you wear that on a cold day, to church, on the street? There are lots of good contextual, protective or activity-related reasons to wear clothes. Gawkers etc might make us uncomfortable, but, off-hand, I can't think of any context where we would be "embarrassed" to be without clothes "in front of members of one and/or both sexes."

There is a whole spectrum of "attitudes" among naturists, depending on backgrounds and prevailing social context. Some come from "always totally clothed" families and only became naturist as adults, and even then maybe only at home. Others, like me, grew up in naturist families where we only dressed to go out to do some activity, and whole holidays were spent with family and friends without anyone ever doing laundry. Some live in countries like France where a woman being "topfree" at the beach is not considered "nude". Others live in places, like Germany, where sunbathing nude in a public park is ok. Being clothes-free in public in Spain or Oregon isn't illegal as long as you're not being sexual, but in the Philippines and much of the rest of America, being nude=indecent, period. All this gets reflected in naturist "attitudes", attitudes toward naturists, and everyone's sense of modesty in doctors' offices. So, as you rightly say, "body modesty is contextual" and naturists attitudes vary accordingly.

On bathing, my mother also stopped bathing me somewhere around 10-12 yrs old, but it was because I was expected to bath myself. We still all bathed without closed doors. It wasn't considered an "intimate" activity. But that was just our family culture. Every family is different. And as you note, "cultural constructs" have a powerful impact on how people interact. We have no claim on naturism as "a standard universal truth" but some of the precepts of naturism, such as respecting an individual whether clothed or not, we share even with the Vatican (whose catechism by the way has great section on "modesty".) Respecting the individual, particularly in a medical care context, is what this discussion is about.

No, naturists do not see "body modesty at its best not healthy, at worst, neurotic" -- modesty is a attitude of self-respect and respecting others. We just don't view any part of the body as indecent by default, or associate modesty with fabric. In contrast, some clothing like those hospital gowns, by selectively hiding some parts and highlighting others, can make one feel indecent. Again, whether or not an individual has added no-clothes to their fashion choice or considers a hospital as an informal situation appropriate to nudity is not necessarily linked to a person's "healthy attitude toward the body."

I think most naturists would disagree with the Vitz et al theory. We very much believe in the "natural or true self" and individuals finding a harmonious place in nature. Gender is part of that and gets reflected in many ways (eg. physical/hormonal, gender identity, gender preference) probably with more variety than is commonly thought. The point for our discussion is that medical professionals need to be sophisticated about the diversity as they apply their technical knowledge to patients, and patients need to be sophisticated about accepting care without it being overly skewed by simplistic gender stereotypes. Smart medical care may be able occasionally to leverage "imbedded (hard-wired?) gender differences", but my experience is that personality, background and education always trumps gender.

Stereotyping of course "goes both ways" -- for the "men with strong modesty issues" and the "female medical workers" who "flip-flop" their own in-clinic/outside modesty attitudes. But what we are trying to do here, it seems, is to discuss how both groups can recognize the challenge, get on the same page, and relate to each other in a more sophisticated way. I suspect the "understanding/response" process is exactly the same for flip-floppers whether interacting with "strong modesty" or naturist patients. (CSM)

 
At Wednesday, February 18, 2009 8:37:00 AM, Blogger Maurice Bernstein, M.D. said...

CSM, as you will see your commentary is much appreciated on this blog. This is just the analysis that this thread needed to further the discussion. Also I want to clarify: I didn't want to imply that I thought visitors from ClothesFree would be trying to convert others here to their culture. Again, many thanks! ..Maurice.

 
At Wednesday, February 18, 2009 10:03:00 AM, Anonymous Anonymous said...

CSM, great conversation. I didn't take your comments to be conversion or indicating an attitude or rightousness. I would like to put the point out there that I don't think most of the "modest folks" feel or have indicated the preference is driven by the feeling that one gender or the other is the superior or more knowledgable provider, most including myself have expressed for exams, procedures, etc which do not involve exposure...I have no preference what so ever. The qualification of the provider is not gender related...my comfort level for exposure is...and while it may be my issue...it is about the patient being treated, not the provider though their deameanor does make an impact...alan

 
At Wednesday, February 18, 2009 3:35:00 PM, Anonymous Anonymous said...

I am a woman and I support how you men feel but can you stop saying "Can you imagine if women were in this situation, it wouldn't happen". It still does happen. Chill refuses to accommodate female modesty. Women have been subject to humiliating pelvic exams by male students without their knowledge. That is still happening.
When I was in hospital as a young women the one time I saw a male nurse was when it was time for a sponge bath. Now I look back and think coincidence ? I doubt it.
If you look at Sweden they have taken away women's rights to request a female gynecologist in the public system (unless they are Muslim or have been sexually abused). I recently had a baby by caesarian. Just by luck I had only one male in the OR, the anesthetist. But why did he go the the bottom of the bed when I was about to be prepped and pull my legs apart before the nurse could put in the catheter? ( she didn't ask for help). He had no business down there, he should have been up near my head. I saw him have a look too.
Women have been disrespected and humiliated by male doctors for years. Can you imagine back when there were only male gyn/obs?
I respect everybody's right to modesty, so please stop complaining what women have because it's still not perfect for us.
LH

 
At Wednesday, February 18, 2009 3:55:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, interesting observation before your C-section and I can't explain it except only to say that the anesthesiologist is responsible for managing and charting not only for the fluid going into the body but also the fluid going out of the body such as the urine. I am not sure why he looked prior to the catheter insertion except to check your female urogenital anatomy to make sure you didn't have a cystocoele (prolapse of the bladder) which would complicate catheter insertion. He would want to check after the catheter was inserted to make sure the urine was flowing and the tube wasn't kinked. If you were concerned, you should have brought it up to someone later for explanation or investigation. Sometimes the only way for unprofessional behavior can be identified is by someone to report what was observed. ..Maurice.

 
At Wednesday, February 18, 2009 6:06:00 PM, Anonymous Anonymous said...

alan, I meant to respond before that I think you have something in your idea about "the power dynamics" -- of it feeling different when you as a patient are in a position of having to deal with several female staff or several male staff, and you feel more comfortable and in control with male staff. It made me think of the way I feel confronted with nobody who speaks French. If it's a serious health situation, I've got enough to cope with without worrying about mis-translating the name of the place that hurts. Irrational or not, I want to be in perfect control without extraneous concerns.

leemac, you asked about "scrutiny" -- I suppose you are talking about a one-on-one exam where you feel it is getting so intimate and you want to be confident that the physician's only interest is professional? Or do you mean your own feelings when a physician needs to closely examine "private parts"? Personally, in the first scenario, I have never had concerns with male or female doctors. I always see them click-over into technician mode. In second case, you may find my personal feelings extraterrestrial, but when it comes to doctor exams, I really don't have any parts that I feel are more private than others -- just the standard set, vas deferens and all. I have however heard naturist women complain about the "neanderthal" behavior of "textile" (non-naturist) male medical staff.

gve, you are making the argument for assuring gender balance in medical training in order to have gender balance in health care providers. As a guiding philosphy, I doubt this would get much sympathy from naturists who are the original "focus on the person, not their reproductive organs" gang.

LH, clearly the issues being discussed cross gender lines and it should never get so bad that a patient feels humiliated. Sweden is a good illustration because they have made a conscious, well-debated, explicit decision to take gender out of the equation for health care provision, with few and only truly exceptional exceptions. Personally, I am sympathetic to the Swedish model of making expertise and professional behavior the yardstick for care providers, without reference to gender. Of course Sweden's whole social, political, educational and professional culture is resolutely gender neutral.
(CSM)

 
At Wednesday, February 18, 2009 6:56:00 PM, Anonymous Anonymous said...

With all due respect Dr M but the
responsibility of whether the
patient needs a foley catheter
falls on the obstetrician.
Additionally, observing,securing
and manageing a foley catheter
falls on the responsibility of
the OR nurse. I believe the
anesthesiologist has enough concerns rather then check someones
foley or genitals.

PT

 
At Wednesday, February 18, 2009 7:03:00 PM, Anonymous Anonymous said...

Maurice,
I'm not really that hung up by it. If that made his day, so be it lol. I'm not really bothered by being naked per se, just when I have to submit for a pelic exam or pap smear.
LH

 
At Wednesday, February 18, 2009 9:02:00 PM, Anonymous Anonymous said...

CSM
I thankyou for your response. Actually it was both of the counts that you answered that I was wondering about.
I am one who hopes we do not follow Sweden in their view of gender choices for health care providers. It is most likely a difference in cultures.
I notice you like the idea of feeling in control as well. After a great deal of reading here and thought about the matter, I feel like I have little control when naked in the circumstances we are describing...probably irratrional...but the feelings are very real..
leemac

 
At Wednesday, February 18, 2009 10:15:00 PM, Blogger MER said...

Re: the Swedish model.

First of all, I don't know the details of the Swedish rules regarding gender choice, but my first impression...

If it becomes necessary to create a firm policy preventing gender choice in medicine (with few exceptions), what does that tell you about people's natural tendencies? Why did they have to create that policy?

It appears that a significant number of people (most likely women) wanted that choice -- thus requiring this change in policy. Governments can force social changes upon populations -- changes that go against natural tendencies, feelings, attitudes. Sometimes that's good; sometimes not. Depends upon what tendiencies and inclinations we're talking about.

Also, consider that this policy appears to be a "political" or "economic" decision, not a medical one.

Of course, if gender doesn't really exist -- if it's just a construct, as those behind the policy probably believe -- then it doesn't really matter if we eliminate it from the so-called equation. Governments can them just mold human personality -- the so-called self -- as they see fit to make them good little, obedient, conforming citizens.

I see it quite differently. Humans are social beings. And gender is an important part of society and culture. The self exists as does gender. To force patients to drop these at the hospital door eliminates the real need to treat the whole person -- body, mind, spirit. It's an excuse to make things more efficient. It's the institution looking at what's best for itself and not best for the patient.

I'd like to learn more about Swedish culture to see how really gender neutral that culture is. The fact that they had to apparently force that policy upon the population suggests that a significant number didn't want it which furtuer questions how really neutral gender is in that culture.

 
At Thursday, February 19, 2009 4:17:00 AM, Anonymous Anonymous said...

I'm sorry, but being a nudist and sitting around with friends and family for holidays in the buff is against societal norms. Just as the cults live with multiple wives in Texas, etc. In addition, it is unsanitary. Who would want a "behind" and urinary tract hanging around and sitting on furniture? That is why underwear are worn. It is beyond weird and in my opinion this way of acting and thinking has absolutely nothing to do with "healthcare modesty." We are not comparing apples to apples. Period.
JW

 
At Thursday, February 19, 2009 5:05:00 AM, Anonymous Anonymous said...

I love this site, while it sometimes gets heated and or emotional there is a lot of good intellectual exchange.
I actually read about the Sweden issue. It seems that females were choosing female gyn's over males at such a rate that the male gyn's were going out of business and or leaving the country, the fear was the rate was so great they were afraid there was going to be a shortage of qualified gyn's. I have several issues with this first as Dr. Bernstein points out, I fear governments naturally continue to expand their roles into peoples personal lives and choice. Conforming to government standards..and hospital standards puts efficency infront of patients autonomy. If I am not mistaken Sweden is a socialist society which makes this loss of autonomy more acceptable to them. That is a slippery slope. The other issue, I have a problem with making exceptions such as "for Muslims", not intending to single out Muslims, but who is to say the trauma to a Muslim woman in this situation is more severe than a Christian or Atheist who has been condictioned from birth that it is wrong, who can say that it is worse for them than a young male who was ridiculed or mentally abused as a young man....

LH I agree females are the victims of this as well. I think the issue here is the gender make up of providers is heavily skewed to female providers which provides more challenges for men. If you walk into a exam room or are wheeled into an OR the chance of having a male assistant for the Dr. or an all female vs all male OR support staff is very different. The other part of this is the general attitude is females are more modest than men so there is more acceptance to accomodate females requests than males. The combinations make the challenge for men more pronounced.....HOWEVER, it does not make it more severe to females when it happens. That is the same reguardless of the gender of the patient and the approach that ALL patients are entitled to these basic levels of respect for modesty solves the issue for all. I know this is hard, but don't take the "imagine if this happened" as a statement that it is not an issue for women, we understand it is. I still stand by my belief that it is more widespread and less recognized for men. This is a societal thing as evidenced by different standards in areas such as college locker rooms and correctional institutions which we have discussed before...alan

 
At Thursday, February 19, 2009 11:34:00 AM, Anonymous Anonymous said...

I reread my last post...I donot mean to imply that quality is of no importance...it is just that I do not think that as quality is gender neutral that I should not be able to choose teh gender of my health care persons...
If one is not particualr about the gender issue, life must be a bit simpler...
Again I wish to thank All of the posters from clothesfree....your taking th etime to post here is appreciated and your civility is too.
leemac

 
At Thursday, February 19, 2009 2:25:00 PM, Anonymous Anonymous said...

I raised the question of French and jumped on the Swedish bandwagon for a reason. I want to get to the real question. Now that we are all agreed that medical professionals should get better at responding to the diversity of patients' sense of modesty, where and how do we set limits on preference? Male doctors for males, female for females, Spanish-speaking for Hispanics, African heritage for African Americans, Christian for Christians, Muslim for Muslim, atheists for atheists, fat medical staff for over-weight people, .... There are always good "comfort" reasons, just not enough resources.

Except in a hospital where affluent patients can afford to support abundant qualified staff of their liking, preference is simply not sufficient. Shouldn't the default limit be when not responding things like patient modesty issues 1) has a clear negative impact on the quality of medical care and 2) is directly related to the care being given? Gender doesn't meet that standard -- the gender of the doctor or medical staff doesn't impact their expertise (the same medical knowledge is available to both genders) and the reproductive organs of a care giver are frankly only directly related to their capacity to reproduce (which is clearly not going on between doctor and patient). If a a patients' modesty issues, or other feelings of discomfort or embarrassment, can be easily accomodated as part of thoughtful medical care, great, but otherwise it is not enough.

I am just making the argument. (CSM)

 
At Thursday, February 19, 2009 2:39:00 PM, Anonymous keith weaver said...

Note to JW, "In addition, it is unsanitary. Who would want a "behind" and urinary tract hanging around and sitting on furniture? That is why underwear are worn."

That is why Nudists sit on their towels.
As for beyond societal norms, does that not depend on your locale?
A good part of the world sat around nude for thousands of years, until christian missionaries arrived.

 
At Thursday, February 19, 2009 2:42:00 PM, Anonymous Anonymous said...

JW, naturism may be against your "societal norms" but for us its in fact a health thing -- to give the body a break to breathe normally. Even Ben Franklin and Winston Churchill were avid air-bathers -- hardly cult figures in your sense. Happily, one can do other healthy things while air-bathing, like sports. An added health benefit of skinnydipping is avoiding the risks of bacteria-filled polyester -- although it admittedly has the inconvenience of nowhere to sew on a Nike logo. Anyway, just to reassure you that naturism is not a cult and our furniture is safe.) (CSM)

 
At Thursday, February 19, 2009 4:44:00 PM, Blogger MER said...

A few responses to your last post, CSM.

You wrote: "I want to get to the real question.Now that we are all agreed that medical professionals should get better at responding to the diversity of patients' sense of modesty, where and how do we set limits on preference?'

We agree. That's the right question, but from there you committ the logical falacy of Reduction to Absurdity. You write: "Male doctors for males, female for females, Spanish-speaking for Hispanics, African heritage for African Americans, Christian for Christians, Muslim for Muslim, atheists for atheists, fat medical staff for over-weight people..."

In logic, Reduction to Absurdity, is a method employed to disprove an argument by illustrating how it leads to an absurd consequence or consequences. That's what you've done. I find this a not uncommon technique used when this issue of patient modesty is discussed.

Even the courts in this country have recognized the difference between our rights regarding being seen naked by a member of the opposite gender, and the other examples you mention. Case law relative to medical situations is out there, where the courts comment on a persons right to protect his or her body modesty. Past volumes of this thread contain much discussion of this with specific cases listed.

I do agree with you that the gender of the doctor doesn't impact their expertise, but you can't claim that the gender of the doctor/nurse cannot have a negative impact on the quality of medical care.

That is, unless you reduce quality medical care to fixing body parts. If that's all were talking about, working on a body, then you're correct. But if we're also talking about the spriritual and psychological person; the social being, e.g. the individual who lives within a family and has the role of father, mother, brother, sister, son, daughter, etc. -- if were treating whole human beings,not just pieces of the body, then we disagree.

The health care system doesn't get dibs on defining quality medical care. The patient gets a shot at contributing to that definition as well.

I think one of the best arguments the medical profession can make for limiting gender choice has to do with educating doctors which, in the long run, creates a better system for everyone. Doctors of both genders need the experience of working on both men and women and need enough practice so the feel comfortable themselves and can make the patients comfortable.

But the solution to this problem isn't forcing patients to accept whatever gender is provided them. If approached properly with good communication skills and humanistic treatment, there are enough patients who will volunteer to allow opposite gender medical students to work on them. This need bit be a problem.

As far as the debate about naturalism -- I don't see it as a debate. It's a valid lifestyle. I could see myself experimenting with it. I can see it as having many healthy advantages.

 
At Thursday, February 19, 2009 6:30:00 PM, Anonymous Anonymous said...

CSM
I agree it is probably impossible to have a provider for every combination of desires (religion, race, etc.) , but gender is not as difficult as many other preferences to accomodate. There really aren't a large number of genders afterall (male/female). As there are more males entering the various disciplines of medical care than has been the case in the past, having both genders on staff and allowing patients to express preferences does not seem onerous.
Having a male on staff and forcing a male to accept a female (or vice versa)when he is uncomfortable with the female..makes no sense.
And it has kept many males from seeking medical attention when they should. Many medical establishments (doctors offices or hospitals or radiology labs, etc. would do very little..if they are held only to a standard of what is easy for them...they would admit you through one door..send send you straight to the pay desk at the out door.
I hold that quality of care also means that the patient is as comfortable with the people tending him/her as possible. If I am not comfortable with my caregiver, I am not likely to a)get treatment at all or b) I will not do as well with the treatment and I most certainly will feel more like an adversarial relationship exists rather than a partnership where I feel comfortable talking to...which most likely will also determine my level of trust in that individual..
leemac

 
At Thursday, February 19, 2009 7:11:00 PM, Anonymous Anonymous said...

I don't see the correlation between
nudism and being a patient. It is
a form of exhibition and falling into that category are those who
are flashers ( weirdos in trench
coats flashing children). Ask yourself where does it end!

PT

 
At Thursday, February 19, 2009 7:42:00 PM, Anonymous Anonymous said...

Dr. B,

You really show your stripes the way you make excuses for the behavior of LH's anethesiologist. Doctors covering up for doctors is a very big part of the problem when it comes to this sort of thing. You seem to take the view that the patient is the only one in the whole system who has to act responsibly.

CLW

 
At Thursday, February 19, 2009 7:53:00 PM, Anonymous Anonymous said...

"Shouldn't the default limit be when not responding things like patient modesty issues 1) has a clear negative impact on the quality of medical care and 2) is directly related to the care being given? Gender doesn't meet that standard"
CSM, it may impact quality of medical care received when a female patient is too embarrassed to answer intimate questions completely honestly with a male doctor. They may gloss over important details.
If I was living in Sweden and I had to see a gynecologist for a personal problem and when I arrived at the practice I was assigned a male, I would probably change what I say I went to the doctor for and just ask for birth control pills instead. Then I would make another appointment and hope next time I would get a female. If others do the same the government might realize that their policy is going to cost more in the long run and they might revert their policy.
"the gender of the doctor or medical staff doesn't impact their expertise "
That is true and I know that but I would prefer a mediocre female gynecologist over a top male gynecologist any day. I really would.

I really think people underestimate people's modesty. I remember my mother telling me that when she was a young women she and lots of other women she knew would go into a shop to buy menstral pads and buy something else instead if they were served by a man. They would have to go back another time to get what they really wanted.
I also know a lady who has said she would rather die of cervical cancer than have a pap smear (given by a man or woman).
I have had all my pap smears done by women except for one. The male doctor was good but I cannot get his face out of my mind. On the other hand I cannot remember any of the faces of the females who have performed pap smears. It really is that traumatizing for some of us.
LH

 
At Thursday, February 19, 2009 9:55:00 PM, Blogger Maurice Bernstein, M.D. said...

CLW, you write "Doctors covering up for doctors is a very big part of the problem when it comes to this sort of thing." Was I "covering up" when I explained a possible explanation in terms of the responsibilities of anesthesiologist to LH's concern about what she observed? As you may recall, I think I was balanced in my response when I also told her "If you were concerned, you should have brought it up to someone later for explanation or investigation. Sometimes the only way for unprofessional behavior can be identified is by someone to report what was observed."

I am all in favor of doctors being brought to professional or legal justice if they have demonstrated or acted in an unethical or illegal way. There is no doubt that most doctors for a multitude of reasons are hesitant to report other doctors behavior but many will do so if they can remain anonymous.

By the way, the comment by PT as to who inserts the Foley is most often correct but it is the anesthesiologist who is responsible for the fluid balance during the operation. I can't speak for what happened in LH's surgery because I wasn't there. That is why if she observed an unexpected behavior, the best approach is, if possible, tell someone and ask and if the answer is unsatisfactory, tell again..up the chain. ..Maurice.

 
At Thursday, February 19, 2009 10:41:00 PM, Anonymous gve said...

LH made a very valid contribution to this debate. The fact is that many patients (myself included) will change what they present with when suddenly confronted by a doctor of the opposite gender. There are many articles on the web (certainly in the UK where I live) which describe how men have died through embarrassment. Men who have declined to have prostate investigations done and subsequently died of prostate cancer for example. In the UK as the US, there is a headlong rush towards the use of nurse practitioners (95% of whom are female). Numerous articles appear in the UK press encouraging men to seek check ups for prostate cancer, most end with lines like "if you would prefer, simply ask to see a male doctor". How is that meant to help? IF one does seek out a male doctor, all subsequent intrusive tests would then involve at least one and in many cases several female staff. If anyone out there in any way doubts the impact of gender on patient comfort, there is no clearer example of how it impacts than men who fail to seek help for prostate cancer or women who avoid smears for cervical cancer and subsequently die. Is it the ego of health professional that matters most, or the health of the patient? All the health professionals need to do is identify which areas of medicine are most involved (e.g Obs/Gyn/Urology) and staff them accordingly. I may be modest but I have zero concerns who treats my ingrowing toe nail or my broken arm etc etc etc. Is it simply ignorance of the problem or do doctors really care so little about their patients that they can pretend there is no issue when clearly, there is an elephant in the room.

 
At Friday, February 20, 2009 5:38:00 AM, Anonymous Anonymous said...

One thing that is paramont in this and any discussion is perspective. CSM brings observations from a perspective that is a little different from most. Therefore I understand where they can equate gender on the same level as race, religion, etc in making their argument. Though I think they know there is a difference to most people, it is put foreward for the sake of argument. That difference is societal norms, our society and our courts have backed that as a whole exposure of ones body to the opposite gender is unaccpetable, even illegal in most cases, further society has supported and taught that we have the right even, obligation to shield our naked bodies from the opposite gender. We have gender specific restrooms, locker rooms, changing rooms, etc. Courts have gone so far as to apply that to L&D in hospitals. While I have no problem with the naturalist life style it is not the dominant lifestyle in our country, therefore the perpsective CSM brings is not one that the majority of our society. It is considered normal not to want to share the restroom with a member of the opposite sex, it would be considered unacceptable to refuse to share that same restroom with an hispanic, an obese person, or other persons as cited above. Perspective also affects how providers and patients feel about the importance of modesty in this issue...from a provider perspective it has less importance, from the paitent more. The interesting thing, some providers admit their views change as they move into the patients side of the equation...change of perspective.

On the contribution to health care, I think it obviously does. The fact that men do not seek medical attention like women probably has many contributors, but for my personal experience I feel uncomfortable, perhaps intimidated becasue the local facilities are almost completely female. I traditionally avoid any scenerio that makes me uncomfortable. Many of us have seen the movie where they young man goes in to buy a condom, and buys a comb, tooth paste, etc and at the last minute asks for the condom from the female clerk. I personally went to my PCP for a check on a severly sprained ankle, I was also having problems and thought it could be prostate related, without warning when I got there they told me the Dr. had a NP working with him, he wasn't there so she would see me, when she came in I didn't bring up the prostate issue. I just wasn't comfortable and downplayed it in my mind. You can debate all day if you want whether that should or should not be the case, but it doesn't change the fact that in some cases it is. So, if you want to adopt the idea that you have two choices you can accept opposite gender or you don't get medical attention...then you must accept the fact that it will cause a certain number people to avoid care and therefore will contribute to a certain number of deaths. One thing to remember, we are not asking for something that is a monumental task in most cases. We are asking for a little accomodation, one could even say a little compassion. If caregivers find making accomodations of this nature for a patients comfort an intrusion or imposition...one has to question the mantra that providers hold high of compassionate care, treating the whole person, and caring about the person......alan

 
At Friday, February 20, 2009 12:47:00 PM, Anonymous Anonymous said...

"...It is the anesthesiologist who is responsible for the fluid balance during the operation."

A physician who orders an IV is ultimately responsible for it as well. Is that physician supposed to monitor its insertion, make sure the vein is competent, etc?

You made excuses for the bad behavior of the anesthesiologist. The real reason was he could look and no one would stop him!

CLW

 
At Friday, February 20, 2009 5:06:00 PM, Anonymous Anonymous said...

I had a similar experience as Allen...I was called to come in on a follow up..whenI got there A female doctor came in the room and proceded to ask a lot of questions...to which I answered that I was completely fine..and only came in to learn the results of some tests which they wouldn't give me over the phone...
I also agree if gender accomodation is too much for a provider...then they are way to busy to see me at all.
leemac

 
At Friday, February 20, 2009 5:56:00 PM, Blogger Maurice Bernstein, M.D. said...

CLW, of course the operating surgeon is "the captain of his/her ship" during the operation and where the "buck stops" but it is impossible to consider that the operating surgeon is going to monitor all aspects of the patient's anesthesia, vital signs and fluid balance while concentrating on what is going on within the operative field. Yes, the surgeon will be in direct communication with the anesthesiologist and check with him or her frequently regarding these ongoing parameters. However, since the anesthesiologist is responsible for acquiring the data, it might be of clinical value to establish that insertion of a Foley catheter would be complicated or not or when inserted that the urine was flowing properly. I don't know if this was the motivation of the anesthesiologist in LH's case or if she made a correct observation.
But regardless, if she felt that unprofessional behavior occurred, I think and state she should have made a fuss about it to the surgeon or administration. That is how investigation of professional behavior can be started. ..Maurice.

 
At Friday, February 20, 2009 6:57:00 PM, Anonymous Anonymous said...

Maurice please don't question my observation. I know what I saw. The anesthesiologist did not watch my catheter go in. He only spread my legs apart for the nurse and then he walked away from that end of the table. So I was laying there for a little while with my legs spread before the nurse inserted the catheter. At best he thought he could help by the lifting the dead weight of my legs because he was the only male in the room (but I am very petite), or he felt like seeing a vagina that day. I really don't know the motivation, but there was no medical reason.
Anyway how can I make a fuss over that? I would be dismissed as a crackpot.
LH

 
At Friday, February 20, 2009 10:16:00 PM, Anonymous Anonymous said...

I would like to introduce in my
opinion the worst of the lot,women in radiology. They all seem to have this mentality that men are undeserving of privacy.
They will rather quickly provide
females with a gown and a dressing
room whereas they expect men to
change in the room and often times
with no gown.
Excuse my antequated jargon,but I
love to "bust their chops". Once I
went for a chest x-ray. The tech
at that point asked me to remove
my shirt and stand up against the
machine.
I stated that I wanted a gown and
I then stated to her "how often do
you clean and disinfect the surface
of that machine ". The look on her
face,priceless!

PT

 
At Monday, February 23, 2009 3:47:00 AM, Anonymous Anonymous said...

Alan, I am all for "compassionate care" and, gve, I understand that a certain generation of patients is reluctant to confide in medical personnel just because of their gender, but I still haven't heard an argument for those of us without "gender issues" (and I suspect that includes nearly all of the population under 30) for why we should subsidize the extra medical staff costs needed to cope with the patients with "gender issues". leemac, isn't this something those with gender issues should make clear to their doctors, investigate medical facilities that can respond, and then pay the "worthwhile" extra costs associated with their personal choice? CLW and LH, I really have trouble believing that medical staff are "sneaking peeks" at genitals or otherwise have the time or interest to bring private sexuality into non-erotic medical situations. Exceptional cases, as Dr M says, should be reported. PT, why "bust their chops" instead of just politely asking for a sanitary shield? I do this all the time on airlines with regard to head-rest shields -- nothing really to do with gender. (CSM)

 
At Monday, February 23, 2009 5:10:00 AM, Anonymous Anonymous said...

LH I fully agree with your take on what occurred in your experience with. That said, what about all the female OR nurses handling mens' genitals. Some brag that they handle more penis' than whores.
JW

 
At Monday, February 23, 2009 9:17:00 AM, Anonymous Anonymous said...

CSM I respectlully have to disagree with you. First off I think as stated earlier I think your point of reference (naturalist) is influencing your point of perspective and you are projecting your personal perspective to the larger population. I want to address several points seperatley. "I understand that a certain generation"....."(andd i Suspect that includes nearly all of the population under 30). First off, those under 30 are not the majority of the population, the age make up is heavily shewed in those over the age of 30. Second I would challenge your opinion that the majority do not care, paticularly those under 30. How would you explain gender specific instutions such as womens health centers some of which advertise women caring for women...or colonoscopy centers that have "womens day" which advertise all female staff on those days, then there are the fitness centers, one of the larges growing chains in our area is "curves" which is female staff for female clients, our local Y added a womans only room. The majority of people using these facilities are young females...not the "older generation". Further the number of female gyn's is growing by leaps and bounds.....further I don't see a lot of change in the area's typically associated with gender and modesty. I have don't see to many unisex restrooms, showers, suana's, etc popping up in the general population. From a personal point I have worked with kids including my own in sports for many years and I don't observe a marked difference in their attitudes in this area, they still are embaressed by the same things we were. Now I can not project that on the general population as it could just be the people I associate with are similar to me, the same as the group you associate with are similar to you and share your beliefs. I would venture my opinion, which just like your statements are just opinion, that the majority of our population still has gender preferences when it comes to intimate exams....especially with the rapid increase in hispanics which my medical friends tell me as a whole are more modest than our society.

But just for the sake of argument lets say your view is correct. That its mainly the older generation...then let me ask you, should we charge hispanics for the cost of providing not only medical but other services, the dual language efforts cost society in all area's signage, translators, etc. And the elderly, should we not charge an fee as it costs more for them, and obese folks...some of them are obese not out of medical reasons..put life choices, should we not make them pay extra beyond the just services used? The choices to charge extra could be endless...Muslims, non or poor English speaking, obese, those needing accomodation for many reasons.

Sorry CSM I have to say I don't believe your perspective is the majority. And to propose an extra fee for those with modesty concerns seems a lot like letting your personal perspective justify placing a minority opinion on how the majority should conduct themselves. Further, our country has a long history of protecting the minority....seems like even if that were the case (minority) you would make an exception for your lifestyle.

Now this seems a little critical but I don't mean it to be that way. There just seems to be a tendency of those who do not have modesty concerns to judge or condemn those who do. Those who don't care feel there is something wrong with those who do. And while no doubt there are those who have modesty concerns who may condemn those who don't, there seems to be a lot of conversation that if you don't care, thats fine no problem, but I do. Now the naturalist segment of society I am sure bears more criticism than most. For strictly modesty issues...there seems to be a little more criticism or perhaps less understanding for those who have concerns from those who don't.....alan

 
At Monday, February 23, 2009 10:35:00 AM, Blogger Don said...

Most of us have positive experiences with medical personnal, but when doctors, nurses and others do not respect our modesty, patients become suspicious, or even hostile.
Years ago my wife had a severe gall bladder attack and after extensive testing her primary physician (a female) determined that she should have her gall bladder removed. Her surgeon was a young man about 30 years old. She was asked to appear at his office the day prior to the surgery for a "pre-op" exam, which we understood was to determine if her heart and lungs could stand the strain of surgery. After listening to her vital signs, he then ordered her to lay back and put her legs in the stirrups and he was going to perform a pelvic exam. (He was alone with her in the room - there was no nurse chaperon.) She was so intimidated that she complied. She was a very attractive 27 years old and we have always suspested that the pelvic exam had more to do with male voyeurism than with any medical needs.
Some years after that I decided to have a vasectomy and during the consultation with the urologist, I was assured that he and I would be the only ones in the surgery suite. I shaved the night before and he prepared the site and proceded to perform the operation. In the midst of the procedure, the door opened and in came the female nurse. She walked over to view the surgical sight, looked directly at my exposed genitals, told the doctor he had a phone call to return, and walked back out. There was no emergency involved either in her voice or the message. The only conclusion I can make is that she wanted to take a look. The doctor neither reproved her or apologized to me.
Patients are very vulnerable in medical situations and this blog testifies to the ocasional failure of medical personnal to provide due respect. All of us to read and contribute to this forum appreciate Dr. Berstein's efforts.

 
At Monday, February 23, 2009 10:38:00 AM, Blogger Don said...

Dr. Bernstein,

I apologize for not providing a name on my recent blog about my vasectomy and my wife's gall bladder operation. Please add my name "Don" to the blog is you like.

Don

 
At Monday, February 23, 2009 11:03:00 AM, Blogger Maurice Bernstein, M.D. said...

Don, you had registered with Blogger.com and so your commentary is officially designated with your name. Thanks.

Well, we are at 107 comments so far. This volume is filling up quickly. What does everyone think about volumes limited to somewhat over a hundred comments. I think it is easier to review than if a volume contained several hundred or more and then I don't know if we are going to start to lose comments as we had in the past with many hundred comments in a single volume. Are we ready to start a new volume? Let me know. ..Maurice.

 
At Monday, February 23, 2009 12:13:00 PM, Anonymous Anonymous said...

LH,

The doctor moved your legs to help the nurse as they would be dead weight. I don't agree with it but I believe that to be the case here.

The doctor however wouldn't need to check your anatomy at that time. If the RN had trouble inserting the catheter they would call a urologist in to help out. The doctor might look in that case as he would oversee actual output and records pertaining to any issues but looking before foley insertion wouldn't be necessary.

-cm

 
At Monday, February 23, 2009 4:56:00 PM, Anonymous Anonymous said...

To CSM

Obviously,you have never worked
in health care. I could write
volumes and volumes of unprofessional behavior that I
have witnessed in health care.

PT

 
At Monday, February 23, 2009 5:26:00 PM, Anonymous Anonymous said...

Don, you raised a good point. I think that sometimes you will only see inappropriate behavior when the patient is attractive ( like me. ha ha).
LH

 
At Monday, February 23, 2009 7:23:00 PM, Anonymous Anonymous said...

Dr. Bernstein, it would be a good time to start a new volume....the old one is getting to be a long read..it would be especially so for a new reader.
leemac

 
At Monday, February 23, 2009 8:52:00 PM, Anonymous Anonymous said...

And I just wanted to add Don, that with your experience if she had any decency, she should have just stood at the door. How rude of her! Did the doctor take the call?
LH

 
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 8:22:00 AM, Blogger Maurice Bernstein, M.D. said...

CSM, I want to thank you for taking the time and interest to make the multiple surveys and present the results and your interpretation here. The expression of the writer's personal "feelings" here is worthwhile but to get a sense of the "feelings" of a community is also important when discussing issues that deal not only with the writer but with others who may not necessarily come to this blog and express themselves. So, again, CSM, I thank you.

If everyone is in agreement about migrating to a new Volume, I will make the switch very shortly. For those who will continue on to the new Volume, for continuity, if you will be responding to comments made in Volume 9 or in previous Volumes, it would be so helpful if you would identify the Volume and the posting date of that comment so readers can easily go back to find the comment that lead to the response. Any questions? ..Maurice.

 
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 Fen 24)

 
At Tuesday, February 24, 2009 9:43:00 AM, Anonymous gve said...

CSM,

why do you think no solid evidence (rather than anecdotal very small sample size indications) of gender preference exists?

On allnurses.com, they shut down any threads which even dare to raise the issue.

NOBODY wants the cat out of the bag, there is a self interest in NOT discussing this issue, let alone doing some scientific research.

I recently suggested that my health provider (who have been most unhelpful about an all male team for a very intrusive personal test) to run such one pilot service. They could use the lack of demand for that service to prove me completely wrong.......

They ignored my suggestion completely.

 
At Tuesday, February 24, 2009 1:33:00 PM, Anonymous Anonymous said...

Coinciding with the migration to a new Volume, business travel is taking me away from this blog for a bit, but it has been interesting and I thank Dr Bernstein for inviting us, and all of you for so graciously considering our perspective. We would of course also welcome any of you dropping by for a visit at http://clothesfreeforum.com (not all naturists over there, btw) where there are lively discussions on a variety of topics that you may find relevant and interesting. (CSM)

 
At Tuesday, February 24, 2009 2:13:00 PM, Blogger MER said...

CSM:

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...

CSM,
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.
LH

 
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...

Dear CSM

In reference to Dr M's comments
that medical staff get in principle
an enormous amout of training about
proper conduct holds very little
truth.
Consider the analogy, most know
the dangers of running red lights
yet even the most seasoned drivers
do it.


PT

 
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...

MER:
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:

http://www.stmichaelshospital.com/
programs/imaging/ultrasound/exams.
php

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:"
(etc).

The hospital is in Toronto
but the text adds that "technologists... are registered under provincial Canadian and American governing
bodies."

Hope this helps show what can be done.

CHUCK McP

 
At Tuesday, February 24, 2009 8:52:00 PM, Anonymous Anonymous said...

Dr. Bernstein:

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
BE DEFENDED.
- 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."
SBMJ
So they are saying that it never is the case? So what do we make of all the sexual misconduct cases?
TT

 
At Tuesday, February 24, 2009 9:44:00 PM, Blogger Maurice Bernstein, M.D. said...

AS OF NOW FEBRUARY 24 2009 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 10" TO CONTINUE COMMENTS. ..Maurice.

 

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