Bioethics Discussion Blog: Patient Modesty: Volume 13

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Friday, April 03, 2009

Patient Modesty: Volume 13




Can't we all get along? The graphic adapted by me using ArtRage from an image on mdwilliams/myspace, sets the current issue being discussed on these volumes. Can't patients look at their healthcare providers as responsible and beneficent people whose profession is to help patients of all genders? Well, some visitors to this blog find that exposure or manipulation of certain "private" bodily parts demands the presence of providers of a gender requested by the patient. They find that doctors are unaware of this issue or simply ignore their requests for a specific gender. Though I, personally, am more interested in the skills and personality of my doctor, nurse or tech rather than the gender in all aspects of examination or procedure, I do appreciate the arguments that have been presented here. Come join us in the conversations. ..Maurice.

NOTICE: AS OF TODAY APRIL 11, 2009 "PATIENT MODESTY: VOLUME 13" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 14.

123 Comments:

At Friday, April 03, 2009 11:53:00 AM, Anonymous Anonymous said...

Excellent "rant" Zak. I couldn't say it better myself.
Alan -
"CSM "if I become a nurse, it is to serve all people, not just my own gender". And just why do you feel that your desire to serve all people over rides my personal right to determine who does what to my body."

Great argument! When will all medical professionals realize that patient concerns are just as important as the caregiver's concerns? Especially concerning female nurses and techs.

leemac -
"Zak, alan, MER..thankyou for expressing my feelings far beter than I have been able to. As I have said before, I am not good with words."

I agree that they all have a great ability to clearly voice their opinions leemac, but I think you also make many clear and valid points. I enjoy reading your posts as well as theirs. I would also like to add JW, cm, CHUCK McP, TT, PT, NU and Jimmy to the list. Thanks to all of you.

M -
I'm afraid your experience with your husband is very common. Completely out of line and very unprofessional.

Dan -the 77 yo 'Male' -
Thanks for responding and I also totally agree with you, especially because you returned to your doctor. Very wise choices. I do have 1 question; you said you "didn't care who saw what in my 'private' area." Was that because you were so out of it that you didn't even realize what was going on? What was different? Was it an emergency? Again, thanks for responding. Also, do you think your doctor might consider hiring a male nurse now?

Maurice -
I've announced your need for the input of nude art models and artists on a few other blogs. Hopefully we'll get some replies.

JW -
Great job turning down the exam by that particular doctor for his (what I consider to be) unethical methods. I would do the same thing. Opposite gender nurses don't belong in that type of situation and it ticks me off that no choice is given and it is just "assumed" we won't object.

Thanks again for this great blog Maurice.

DG

 
At Friday, April 03, 2009 1:02:00 PM, Anonymous Anonymous said...

Hi all, this is 58flyer from the allnurses forum. I have been reading this blog since MER told me about it last summer. It has been interesting reading. I have visited and commented on Dr Sherman's site.

I thought I would comment on the 77 year old gentleman's experience with the urologist. When I had a cysto done more than a year ago, there was no bladder irrigation/catheterization done. I detailed this on allnurses, but I will recap it here. At the initial consult, I explained to the doc my opposition to the presence of females during the procedure. He told me to tell the "nurse" during prep that the doc would be doing the procedure alone. I did this and the "nurse" gave me a confused look. But she didn't argue. I was careful to tell the "nurse" that at no time during the prep was she to expose me at all. She said something like "I'll try my best" and I stopped her and told very specifically that there would be no exposure allowed, try or not. My wife was present and I'm sure that helped. The doc came in and did the betadine cleanse, and injected the lidocaine gel into the urethra and put a clamp on to keep the lube in. He then inserted the scope after letting the gel take effect. It wasn't comfortable but tolerable. On the follow up I asked to what extent the "nurse" would have treated me. I was told she would have done the betadine prep and injected the gel into the penis. To me that would have been unthinkable, to allow an unchaperoned and unlicensed female to do that. I asked the doc why he employed no male assistants and the answer I got was that he left the hiring decisions to his staff manager, who, of course, is female. I suspect that any males applying for a position there would not even be interviewed. The doc also said that a female assistant can work with both male and female patients and a male assistant can only work with male patients. I asked him why this was so and I did not get a satisfactory answer. While there I saw at least 3 female clinical personnel and 2 non-medical female staffers. There was only the one male doc in the practice. I believe that he could have had a male assistant if he really wanted to. I told the doc that referring to his medical assistants as nurses was unethical at the very least. I realize it's just easier to say nurse with one syllable as opposed to medical assistant with 6 syllables. Too many folks don't know the difference.

I don't mean to bash medical assistants here but I think something needs to be pointed out. I my state at least, MAs are unlicensed. There is no provision in state statute that specifies the type of training the position requires; a doc can simply hire a woman off the street with no training or experience, attach the label "medical assistant", and put her to work teaching the MA only the things the doc feels the MA needs to know. I have no doubt that there are many MAs working today with absolutely no formal training at all. There is not even a requirement that they have a high school education. To make matters worse, the doc cannot be disciplined by the medical board for failing to supervise the MA. Civil liability maybe, but no license action. I went down this road once in trying to complain about the conduct of an MA and the failure of the doc to supervise her and the above is what I learned by trial and error. Ironically, the incident occurred at a uro clinic, but not the one mentioned earlier. In my opinion, MAs are just like using members of the public in doing intimate procedures on opposite sex patients. Female on male of course. I think medical assistants are the worst thing happen to American medicine. Not that nurses are perfect, and I have had my share of bad experiences with them, but at least a nurse is bound to some ethical considerations and they have a license to protect.

Back to urology clinics. You would think it's just good business practice to use male assistants with male patients. Patients are the only source of income for a doctor's office or hospital. Many more men would make use of urology services if the doctor's office website or yellow pages ad would make mention of the use of male assistants for male uro care. They would have an edge on the competition with other clinics that don't. More guys might step up to the plate and get that vasectomy or get care for uro problems sooner rather than wait for symptoms to become chronic or even fatal.

Mike (58flyer)

 
At Friday, April 03, 2009 1:19:00 PM, Anonymous Anonymous said...

I do agree that we need to get along...to Respectfully disagree if it comes to that...thanks for the new volume, Dr.Bernstein. my dial up often slows to 9.6 kbs...which can mean a 55 minute load time for the times there are a lot of entries.

 
At Friday, April 03, 2009 1:41:00 PM, Anonymous Anonymous said...

I think that we will find that porn actors/actresses and nude models have a lot in common with many who have posted here...some will have absolutely no issues at all...all teh way to having some major ones..depending on the situation. I cannot remember which volume it is in, but one of the posts said he was a naturist and he had problems in the medical situations...and suffered some embarrassment.
leemac

 
At Friday, April 03, 2009 2:04:00 PM, Blogger MER said...

In your introduction to this volume, Doctor, you seem to be
implying that patients either look at their healthcare prividers as "responsible and beneficent people whose profession is to help patients of all genders" -- and if so, gender doesn't matter. If gender does matter in some cases to the patient, are you implying then that these patients don't look at their healthcare providersas as "responsible and beneficent people whose profession is to help patients of all genders"?

I think the distinctions are much more blurred.

How about this? How patients feel about being examined by one gender or the other is very contextual. It depends upon what's being examined, or how intimate the procedure is, the patients past, the patients socialization, the demeanor and attitude of the provider and his office staff, and many other factors. And, it depends upon whether the choice is between a real expert in a particular field or a generalist or less experienced provider.

Most reasonable people believe that, in medicine, gender has nothing to do with skill. Most reasonable people, given the choice of the highest skilled doctor or a lesser skilled doctor in a particular field, would opt for the most skilled doctor regardless of gender. I grant there are exceptions e.g. those who are just completely opposed to opposite gender intimate care. But I think those are the exceptions.

You seem to be implying that the focus of patients who prefer same gender intimate care in certain contexts -- that their focus is always and only on gender rather than skill. I would argue that this is not the case.

Are women who prefer female prividers for their intimate care not concerned with skill? Is their focus simply on gender? Few professionals question that choice.

I believe that the psychological and sociological aspects of this issue are quite complex and can't be reduced to simple issues of gender vs. skill.

I'm reading an interesting book: "The Lived Body: Sociological themes, Emboddied Issues." by Simon J. Williams and Gillian Bendelow. It's not an easy read but I think it perhaps explains the evolution and complexity of some attiutdes we have about our bodies and how others view them. It does have some interesting things to say about medicine, mostly how technology is changing how professionals view bodies. As the books says, "a panoply of 'screens' now pervade the modern technological hospital." All kinds of screens. Bodies are becomming less and less viewed as embodied, but viewed on screens.

The book goes on: "The upshot of this is that bodies become ever more elusive: instead of the patient's body being at the center of contemporary medical practice and discourse, we find instead 'multiple images and codings' whereby the body is endlessly 'doubled and redoubled' through a self-referential chain of simulicra." (pp. 85-86)

The problem may be that, although for the doctor and nurses, the body is no longer the "center of contemporary medical practice and discourse" -- for the patient, it is always the center of his or her contact with the external world.

When I'm through with the book, I'll provide a few more examples that I think may be relevant to this discussion.

 
At Friday, April 03, 2009 4:09:00 PM, Blogger CSM said...

The male nurse sharing and adjusted doctor procedures that alan describes sounds like a very practical way work with particular patients. While the "gender discrepency in nursing" might not universally be considered problematic, clearly something is operating, and needs to be dismantled, that encourages or discourages nursing as a career for both genders. Globalization is also at work -- for instance, for many decades in the Philippines, nursing has been considered a major service export industry primarily for women, but it is now also exporting many male nurses. How can "gender discrepency in nursing" be redressed without resorting to gender discrimination?

 
At Friday, April 03, 2009 4:39:00 PM, Anonymous Anonymous said...

I'd like to reiterate my concerns
regarding this issue. I've had bad
experiences from female providers
from a lack of concern for my
privacy to unprofessional behavior.
Now if I buy a ford vs a ferrari
and the ford is a lemon should I
keep going back to ford? Duh! Many
providers and I use that term loosely from emt's to physicians
can be incompetent. You can't find
these things out until you've made
the encounter. One can only learn
from past experiences. No amount of
education can make someone caring,
competent and sensitive to the needs of the patient.
At least by choosing the same sex
provider one can eliminate a certain degree of factors. Several
months ago I read an article about
a female plastic surgeon who states
in her ad " we employ no male personal at our offices." Initially
I thought well good for you,however,I doubt that would fly
at any surgical center. Would she
restrict the anesthiologist to a female as well. Does she accept
male patients. Does she have an all
male staff to bring in on those days? Lets reverse the roles for a
moment. A male plastic surgeon who
states " we employ only male staff
at our offices." Personally, I
somewhat loathe plastic surgeons
in that they prey on the issue of
vanity,however, I'll restrict my
field of view to this thread. It
wouldn't happen and not anytime soon. Plastic surgery is primarily
directed for women thus most providers will readily discriminate
against men while providing services for women.
When men complain enough or there
are appropriate lawsuits that address this widespread discrimination then things will
change!
Another point I'd like to make
in regards to the double-standard
issue. You will never ever read
anywhere in any nursing magazine
articles about the double-standards
stacked against men. Their mentality is not to even mention it."Best not to say anything,we don't want anything to change."
is their motto.
They hate to see male nurses in
nursing schools,it means change!


PT

 
At Friday, April 03, 2009 5:42:00 PM, Blogger Suzy said...

Hi, Suzy here.
I've noticed that the most anger, fear and general outrage is created when the patient is put in a position (literal or figurative) against their wishes. Dan, who posted about his experience in the Urologist's office, was upset not because the procedure involved his body being viewed, but because processes involving the viewing and touching of his body were 'sprung' on him without warning, and the technician (sometimes, I want to say 'mechanic')tried to coerce him into compliance.

I have had doctors forcing gynecologic procedures on me tell me that it would not be safe to take birth control pills without a thorough pelvic exam. I have been told that if I did not have proof of a recent mammogram or a thorough breast exam, a practitioner could lose their license if they prescribed birth control pills for me. I have been told that I was 'risking' ovarian and breast cancer by taking the pill without the exams.

Those statements were all lies. As I mentioned in a previous post, I was told to 'just relax' when I was assaulted repeatedly during my births. I was told that if I didn't want to spread my legs in public, I shouldn't have spread them in private. "You weren't embarassed getting that baby", one nurse told me, "so don't act like you're so modest now. We're not seeing anything that you didn't show to him (with a gesture toward my husband, who found it amusing and laughed)." I began to cry with humiliation, and they said 'Only room for one baby in this delivery room". and laughed at their own cleverness. They treated me like being pregnant was a crime, and this humiilation and violation was a way to pay my debt to society.

All of these statements were made by licensed practitioners, and all were either lies or straight up humiliation tactics to get me to comply with what the practioners wanted. It is at that moment that we realize none of what they are putting us through is for our health. It seems to be a form of punishment, a hazing for daring to seek help.

Suzy

 
At Friday, April 03, 2009 7:13:00 PM, Anonymous Anonymous said...

"For example, both men and women have breasts, so breasts can be taken off the "intimate exposure" list, right?"
CSM, there is a difference between male and female breasts as females are required to cover them up in public. Also you are a naturalist, meaning although you are nude in front of others, you are not allowing others to touch you.
When I had my baby, he was born a month premature. That meant that he did not have the sucking reflex. So I had to express the milk. My hospital does not allow the use of breast pumps until the "milk comes in". So therefore, I had to hand express the colostrum. As I could not do it, I had to get the nurses to do it for me. That meant the nurses had to squeeze my breasts with their bare hands and milk me like a cow. As bad as that was, I think if would be perverse to have a male nurse do it. And I don't think that even a naturalist would feel too comfortable with that, but if you have any female naturalist friends ask them.
LH

 
At Friday, April 03, 2009 7:21:00 PM, Blogger Maurice Bernstein, M.D. said...

A few comments:

First, I never really thought that keeping each volume limited in the number of comments might substantially reduce the loading time for some computer systems. But I guess that is an advantage.

Second, I suddenly discovered I forgot to include another occupational class of individuals whom I think we would all like to hear from regarding their own patient modesty issues if they had any: lets add male and female prostitutes to the list of pornographic actors and artists nude models. Of course, I wish we also had physicians add their views to this discussion. Do you think, pehaps as exampled by Chill that we scared them away? As far as medical students contributing, I have offered my 2nd year "Introduction to Clinical Medicine" group of students the URL of this thread and encouraged them to participate and to do so anonymously as desired, but I can't academically "force" them to do so.

Don't take my introduction to this Volume as any statement that what is being discussed here is trivial and unnecessary, even if I, myself, have no qualms about physical modesty and the gender of the providers who have cared for me. By the way, I was hospitalized once and I felt awkward when a female physician, I knew, who was employed by the same clinic as myself, worked me up. It wasn't because she was female but because she was a fellow employee. I think doctors do feel awkward also to be a patient in a hospital where the doctor practices. I'm not sure it is strictly due to patient physical modesty but more to do with general privacy for history, diagnosis, "doctor being sick" and being on the other side of the bed railing and "not in charge" in an environment where many of the workers there are known and where the doctor has previously been the "doctor" and not the "patient". ..Maurice.

 
At Friday, April 03, 2009 8:00:00 PM, Anonymous Anonymous said...

Thanks 58flyer....great info
Suzy..I cringe when I read your experience...and I thik it is both...embarrassment and having something come out of nowhere...without any warning...and it get compounded...when they ignore or put us down the embarrassment is intensified...as is frustration...
I have heard nurses (my neighbors) who also had a problem with being treated by co-workers, Dr.Bernstein, and one said it was difficult nursing a doctor she worked for at the hospital.. a lot more than the physical body involved...That, at least, most of us do not have to contend with...
leemac

 
At Friday, April 03, 2009 8:51:00 PM, Anonymous Anonymous said...

Maurice re your question about prostitutes. I recall reading recently on the net that the first "professional" patients that medical students used some 30 years ago for practising pelvic exams were prostitutes.

 
At Friday, April 03, 2009 9:08:00 PM, Anonymous Anonymous said...

Thanks for your kind words, DG..
I am gratefull to all who post here. Y'all have taught me a lot and it nice to know that I am far from being alone in my feelings.
Thankyou,Dr Bernstein..Your project to find how extensive male modesty was when you found it to be real has provided a venue for myself and others to share experiences, knowledge and support.
None of these things would not be possible but for your efforts and knowledge and your valuable input...it really does mean far more than you can know.
leemac

 
At Friday, April 03, 2009 9:39:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, the more I think about it, the more I feel that by getting a sense of what workers in those three occupations (nude model, porno actor and prostitution) where presumably (but then who knows) they are comfortable with their undress at work yet how they feel exposed to physicians and other healthcare providers when they are ill. CSM has given us his view and experience in the naturist culture. Can we extrapolate his observations to the entire group of folks in that culture? Does the setting of the routine nudity make a difference in views? For example, the nudity of the naturist is not as a requirement as part of an occupation but occurs in activities which are outside of the work environment. Whereas for the others, it's part of work and can we compare the comfort to be naked by these three as compared with naturists? Would these three be less likely to be comfortable being an exposed patient? I think, though this has been argued in the past volumes, there is a "dynamic" to understand about patient modesty itself and therefore getting some input from these folks would contribute to that understanding. Anyway, that's my opinion. ..Maurice.

 
At Friday, April 03, 2009 9:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac has provided me with this link where there are comments by male nurses suggesting their concerns regarding the greater chances of legal repercussions and accusations than female nurses. ..Maurice.

 
At Friday, April 03, 2009 10:42:00 PM, Anonymous Anonymous said...

I read the link and what I've come away with from that is that it has convinced me even more that same gender care would just make things more simple. It really is a waste of resources if male nurses feel that they need to bring in a chaperone. Personally I hate the whole chaperone business as it just brings the whole distrust issue up between patient and doctor.
LH

 
At Friday, April 03, 2009 11:13:00 PM, Blogger MER said...

Doctor: Those two pages of comments by male nurses that leemac provided in that link -- they contain much, much more than just comments about legal repercussions. Much more.

You get an insight into the difficulty some of these men have working in a female dominated occupation; you learn how these male nurses feel uncomfortable when women engage in "girl talk" which would be considered unacceptable or sexist if they as men did it; you learn that some of their supervisors want them to be more "assertive" if females don't want them for intimate care (female nurses are often told the same thing) And you learn that there's a significant amount of "switching" going on (males working with males, females working with females), not just for legal protection -- but because I think there's a rarely discussed discomfort level than many nurses have also in working with members of the opposite gender. They'll do it if they have to, but a significant number of them feel more comfortable working with their own gender.

That's what I get from reading not just this link, but other blogs where nurses discuss this issue.

If they survive, some day someone might really study these blogs and learn much about what's going on underground in an occupation where the work is sometimes so personal and intimate, that the nurses themselves often don't feel comfortable talking about it outside of the profession.

Links like this one are not rant, voyeuristic blogs. They're real. People are saying things they often don't feel comfortable saying with their name attached. This doesn't mean they'll say just anything. It more often means they feel free to tell the truth as they see it without worrying who's looking over their shoulder.

 
At Saturday, April 04, 2009 12:02:00 AM, Blogger CSM said...

LH, my comment about both genders having breasts was precisely aimed at the point you raise -- to look at the modesty "dynamic" of whether or when a doctor's office is following "public" norms. It appeared to me that we sometimes mix up "public" matters, such as open backed gowns, with "intimate care" issues. The surprise attendance of "non-essential" staff, for example, may switch the feeling for the patient from "intimate" to "public". Such a switch would obviously be less disturbing for a "naturist" patient than for a "modest" patient. The corollary thought was that it might be possible to have a rule-of-thumb for modest patients that in intimate care situations when dealing with trained professional caregivers, the gender of the caregiver would only be an issue for "privates" not shared by both genders, while in other situations, such as when general staff were around, more "public" standards would apply. (Your example of expressing milk is particularly intimate, requiring both considerable expertise and trust. I will try to ask about this as requested.)

 
At Saturday, April 04, 2009 3:01:00 AM, Anonymous Anonymous said...

58flyer, thanks so much for your excellent post. I have also admired your posts on allnurses.com and Dr Sherman's site.

It's strange that you decided to post here today because just yesterday I posted a comment about you on a voy forum. There's a string called "EEK -- there's a woman in my room: A nursing technique for dealing with an erection?". At least one commenter there said that "not one poster on these boards ever mentioned such an experience." and "I'm sure if a guy had such an experience, he would be only too glad to tell us about it here and on other boards."

I had to finally quote a couple paragraphs from your post on allnurses.com (I go by the name "D" on the voy board). You might want to check it out and leave a comment there. I imagine Maurice might not want me to give the URL, so you can just search for the "EEK......" string on the voy forums if you're interested.

Maurice, I hope I'm not out of line with this post. I'm aware of the reputation the voy boards have.

DG

 
At Saturday, April 04, 2009 3:10:00 AM, Anonymous Anonymous said...

DG again. (I might have forgotten to mention my name on my last post)
There is another post on the same string that I wrote about in my last comment that might be of interest here because the poster gives the URL to the sites he is refering to. It discusses "Old school scrotum thumpers" and is written by nurses that were taught to thump the scrotums of "disrespectful" boys that got erections while being "handled" by the nurses.

Here's the URL,

http://www.voy.com/219711/83.html

Maurice, if you think this post is innapropriate then feel free to delete it.

DG

 
At Saturday, April 04, 2009 6:08:00 AM, Anonymous Anonymous said...

I also would like to express my appreciation for everyone that contributes here, and for Dr. Bernstein & Dr. Sherman. Both your blogs are professional and provide constructive diaolouge.

58flyer, I have seen your postings on allnurse. Do you think there is any chance you can get some of the nurses there to join us? While there is discussion as to the validity of posters there...most of the discussion is to clinical and boring to the average person not to be real...

I think Dr. Bernstein's heading to this section does bring a great point into play and lets couple that with with his observation about being a patient. Do providers really have a handle on their side of the equation. When we ask ourselves, why are we modest, where does it come from....most of us have some difficulty explaining it...then we have the provider, a couple common responses we are professionals, etc seem to relate to the heading, the defensive posture that gender preference by a patient is some how linked to degrading or disrespecting the provider and or the providers ability, though to most people, the skill of the provider isn't being questioned in any manner. Why, what causes the provider to jump to that defense, is it strictly a defense, to put the patient on the defensive, to make the patient feel guilty? Or do they honestly feel preference of a gender is a reflection on their skill? It seems male providers accept this a little more as they have been the object of well noted accusations of immoral actions and wish to avoid that, female providers however are not subject to this prejudice and therefore may see it as a personal...me..accusation rather than even my gender....and the link, providers often speak of being uncomfortable when they are in the patient role, and often try to link that to the familiarity side of knowing the other caregivers....yet we as patients say, if you truely feel as a provider, providers don't see patients that way...you should actually feel more comfortable KNOWING how providers think....my guess is providers like patients don't even truely know why...or perhaps even how they feel as a patient or provider. They know how they are supposed to feel and think....but when they strip off the scrubs (literally and figuratively) they are in the same environment with the same people...but the role changes and so does how they see things, while they may truely think it is becasue they know the provider...but is it....alan

 
At Saturday, April 04, 2009 6:15:00 AM, Anonymous Stella said...

I have heard some shocking birth stories - I think the difference is that women are unable to take control in that setting - they're at the mercy of the doctors and nurses.
I think it's therefore critically important to pick your Dr and the hospital. Large public hospitals are to be avoided - private insurance is essential.
The thing that surprises me...is the sadistic treatment of female nurses as well as doctors. Can't they put themselves in the woman's position? Maybe they were treated badly, so now it's your turn...
I gave birth privately - a female Dr and one female midwife (I was introduced to the other midwife in case I laboured longer than 8 hours) - I said NO to any other medical personnel. My husband was also there to speak on my behalf if I was unable to do so...
I was in control and was treated with dignity.
I think the difference between public and private care is HUGE - it's the difference between economy travel and first class. In first class, people are there to keep you happy and make sure you walk away a satisfied customer. If not, heads will roll...
In the public system, you're a number....
I hear horrible stories and they all relate to public hospitals.
If you look at websites like birthtrauma.com you'll hear hair-raising stories from women treated with absolute contempt - left naked on trolleys, treated disrespectfully and disgracefully.
It seems in many countries, your bank balance determines your treatment and that also, applies in the medical system.
I had a closed theatre in a private hospital for my second delivery - once again, my modesty/privacy was respected...
Why is it that public hospitals can't manage the same sensitive care? I suppose they're underfunded and the system is in crisis....
The damage they do - they probably assume a healthy mother and baby is a great result - but when the mother is left traumatized, I think they've failed dismally....

 
At Saturday, April 04, 2009 6:31:00 AM, Anonymous TT said...

Suzy,

I am appalled at both the attitude of the nurse and nature of the comments that she made to you. Anyone with that kind of attitude should not be allowed any contact with patients. If anyone ever made a comment like that to my wife, I'd make sure that they were immediately removed from caring for her, and it wouldn't stop there.

TT

 
At Saturday, April 04, 2009 8:22:00 AM, Blogger Maurice Bernstein, M.D. said...

DG, here is my policy on links from this blog to another site:

I will not accept links to websites which are primarily commercial to sell some product or service. As you notice, I have no ads on this blog. I have nothing to sell but freely provide space for discussion.

A link to a forum website or another blog is acceptable, however I don't want direct quotes, either small or large, to be brought back and reposted here.
The poster here should simply describe the concept or argument or view the writer presents to that forum and then provide the link. Therefore the visitor here, if desired, may follow the link to read the actual text.

Yes, on forums and discussion blogs there can be very good, civil and rational commentaries presenting a view, as there certainly has been here, but there also, depending on the moderation of the site, can be uncivil, nonconstructive and irrational statements made by individuals whom nobody can specifically identify. The same can potentially happen here on this blog, but I hope I can moderate it well enough to keep the discussions productive and of value.

As I said, provide the link but not the text and let our visitors decide for themselves if they want to follow the link. ..Maurice.

 
At Saturday, April 04, 2009 10:01:00 AM, Blogger Maurice Bernstein, M.D. said...

NOTE: Because of the increasing number of postings to this thread and since the blog is moderated and since I have a life beyond sitting in front of the computer, you may find that your posting takes a few hours or more to be published. Please don't resend the commentary but just wait. I will not ignore any commentary awaiting publishing and I will eventually get around to yours.

Thanks to all for their participation on this thread. ..Maurice.

 
At Saturday, April 04, 2009 11:09:00 AM, Anonymous Anonymous said...

58 flyer you are so correct. I too have a big problem with office assistants being referred to as nurses. I think many patients think these females (many very young) have some "certified" special education. Fact is as you say.. most have little to none and get trained on the job. Learning the particular doctors wants/likes/procedures/dislikes- his/her protocol of doing business. Each doctor is different as OR nurses will attest to. They each want their own "packs" done up with "their wants" included. I am with you, I would never succumb to a procedure with some "off the street" female doing such intimate procedures. Fact is prior to her being hired by this doctor she may very well have been flipping burgers at the local fast food place or ringing up the register at the mall.

I think most patients endure this because they are too intimidated to exert themselves in a doctors office, state their feelings and "speak up" so the beat goes on.

As far as the 77 yo being okay with the same thing being done while in the OR, I don't feel there is any difference and I would not be okay with female nurses there either. It is the very same thing so how can you feel any different about it?
JW

 
At Saturday, April 04, 2009 5:08:00 PM, Anonymous Anonymous said...

Reply to M - I didn't care "who saw my private parts" because I was under general anesthesia ~ and also, I was shaved before the seed implant procedure while under general anesthesia. I was brought into the operating room totally out from pre-op area when the anesthesiologist gave me "something to relax" and the lights went out.
Afterward, when radiation started, I had a male nurse at the hospital give me ultrasounds - I was very comfortable with that or there would not have been ultrasounds if it were a female nurse - I would not allow it under any circumstance.
I see my urologist this coming Wed., April 8th -he will do the ultrasound in his 'other' office - I will not go back to the office of the 1st incident - I am very uncomfortable about going back there because of that 'nurse'.
I really hope he would consider hiring a male nurse, otherwise he will not do anything further with me unless 'he' does it himself - otherwise, it will have to be done at the ambulatory/surgical unit where I had my seed implants while under anesthesia.
And yes - typing earlier in 'Caps' about that incident - you can see how outraged and upset I was with that nurse - and I still am.(it's like a girl on a date, when she says no, he should stop) - when I said "I am very uncomfortable about this" - she should have stopped and gotten the doctor.
I was not going to be one of her submissive "jobs", no matter how much more aggressive she got in tone to me - she was treating me like a piece of meat with total disrespect - with an attitude of superiority over an 'old man' that has to obey her (she is about 28 yrs old).
If it were a male nurse, this matter would never have occurred and I'd had made medical progress with my incontinence problem with a very satisfactory ending.
When I last spoke to my urologist this past week at the 'other' office, I made it very clear - 'he' is to do the ultrasound - anything else is to be done at the out patient unit and I am to be totally anesthetized - he didn't reply yet - I think he may be waiting to see what the ultrasound results are.
The bottom line is, women have their rights and choices I expect the same regarding my privacy and modesty.
To LH - to clarify, I do not want 'any' female nurse touching my private area at all - I find it extremely disturbing, embarrassing and uncomfortable.
I might also add that if anyone wants to see exactly what a cysto is, Google: "Video of a cysto" - "video of prepping for a cysto" - there are many videos online with real patients and the 'dummy' for student nurses. You might also note that most of the cysto videos I saw were done by 'male nurses'.
By the way - does anyone know specifically where I may find any kind of information regarding 'the privacy of male patients' or something like that - I am sure many of you understand what I mean by that - as well as what nurses are taught, how to get a patient to submit, like that nurse was trying to do with me - ignoring the privacy of a male patient.
Thank you all for your thoughts, it is gratefully appreciated - I will post after the ultrasound Wednesday - stay well, Dan

 
At Saturday, April 04, 2009 10:01:00 PM, Blogger Maurice Bernstein, M.D. said...

It doesn't look good for developing a population of male nurses if the study described in a CBS News article of September 6, 2002 is still valid. "Recent graduates of the nation's nursing schools are leaving the profession more quickly than their predecessors, with male nurses bolting at almost twice the rate of their female counterparts, according to a new study. About 7.5 percent of new male nurses left the profession within four years of graduating from nursing school, compared to 4.1 percent of new female nurses.."
(This trend may have already been noted previously on my blog.)
There was also less satisfaction by male nurse with their work than female nurses.

It's interesting, since the trend may be related to a possibility that men want more autonomy, wanting to make more professional decisions on their own compared with women.

..Maurice.

 
At Saturday, April 04, 2009 11:29:00 PM, Anonymous Anonymous said...

Dan , you made it clear in your original post that you did not want any female touching your private parts. What I am asking is why didn't you explicitly say " I do not want to be touched by a female, I thought the doctor would do this" instead of "I am uncomfortable with that" three times? Every patient she has, whether they want a female nurse doing the procedure or not, probably feels uncomfortable with it. To her mind you turned up voluntarily for the procedure. She is probably trying to figure out what you mean exactly.
When I've gone for a pap smear, (and by the way, more than once I have had male doctors surprise me by asking me if I need one), I think I have said "I am uncomfortable with that". I am just conveying my anxiety, it does not mean "please stop" or "get me a same sex provider". I'm basically just letting them know that I want it over and done with as quickly as possible.
LH

 
At Sunday, April 05, 2009 3:02:00 AM, Anonymous Anonymous said...

Dan,
I love your style, only I agree with JW. No female nurses will ever be involved in my intimate care, no matter where it's done.

I have to have complete control over my body and don't like surprises. Obviously I can't always be awake during a surgery, that's why I make sure I can trust my surgean and I like to get as much pre op stuff done as I can before they put me out. If someone is going to give me a nipple to knee shave I want to be awake for it. That way I can make sure a male nurse does it and there won't be any teenaged CNAs watching and giggling at my nudity.

I also DON'T want to forget what happened afterwards. If I was mistreated I want to remember it so I can take appropriate action.

 
At Sunday, April 05, 2009 8:41:00 AM, Blogger MER said...

Doctor:

You mention the trend in nursing, more nurses leaving the profession, especially male nurses. The trend also seems to be to make a BSN standard rather than just two years of training.
What's disturbing, though not unexplainable, is that the most common response to the nursing shortage isn't to raise salaries or improve working conditions to give nurses more status. The response is to replace them with quickly trained cna's, medical assistants and -- I love this term -- patient technicians.

These are the "professionals" that are as likely as not (probably more likely) to do the bed baths and surgical shaves, attend the showers. Right now most of them are they're not doing procedures like foley caths, but just wait. That will come next.

Why this shift. Economics. They're cheaper and can be trained faster. With the economy as it is, people out of jobs, we'll see more and more of these workers entering these healthcare areas.

I mention this because, as I read this and other blogs, the intensity of the patient modesty problem seems to increase as we work our way from doctor to nurse to these other "professionals." Problem is, as I see it, many patients don't seem them as "professionals" in the same way they see doctors and nurses.

Is that why there tends to be such a blur as to who is who in the hospital/clinic setting? The last several times I've had work done, there was no discinction made between nurses and assistants and techs. I had to ask to figure out who was who. Only once did I see someone with a specific name tag that identified her as a medical assistant. Most didn't wear name tags at all.
I get the impression that most of these assistants don't want to wear name tags with their specific titles listed. They find it easier to get the job done if there if the patient just assumes they are a nurse. And some patients do assume this. Granted, to some patients this doesn't matter. To some it does. And as we've discussed, the seriousness of the patients condition and treatment does frame the entire situation.

But this seems to be where we're going in medicine. And I'm not against these medical techs in principle. I don't mind them doing the paperwork, taking my blood pressure, temperature, and in some cases taking some history. That saves the doctor time. But for many patients there is a line, and once that line is crossed, they want specifically trained, licensed medical professionals. Some want gender specific care. I do include nurses along with doctors in this category. I do not include these other techs.

What bothers me most in all this is the apparent attempt to blur the line between professional licensed medical people like doctors and nurses, and these other workers.

 
At Sunday, April 05, 2009 10:34:00 AM, Anonymous Anonymous said...

Perhaps male nureses are wanting greater autonomy...it is worth study..
I would like to add firement to your list of people who migh tcontribute to our commentary...one reason is that they have to have total body skin exams on a regular basis...this is conducted a whole shift at a time...all naked in one of the bays witha variety of other folks of both genders present..I ead a dermatologist saying this (a female one) and would like the other side of the story.
The varying people we encounter in medical care...especially as presented by 58flyer and MER...are very sobering...
The argument that RN's need more compensation is a bit of another story though...at the hospitals around me they get around $50 per hour and their medical plus a whole host of other benfits...(My neighbor is one and she is very open about her compensation) The problem is short staffing and this results in rapid burnout according to her...The hiospital tries to compensate by using more cna's and patient techs...at a far less cost (they still get very good money though)
LH...it might be that Dan was afraid of gettintg a treatment such as Suzy described as having happened to her...Nurses have a host of cliches and most of them are real put downs to guys...all too often males are looked at as a person who would walk naked down main street are only after sex..anytime anywhere...and about with anything they can...and we get told so...so why are we complaining...stereotyping ...much like someone saying ladies only want a hunk for a gyn...not true in either case...and a really lousy joke and we have all heard them many times.
When you are surprised and have some procedure or aspect of that procedure sprung on you..it is often hard to have a good comeback ready on your tongue. I can't speak for Dan, but I think it fits what he said went on..Guess we just need to think faster...or be prepared for the unexpected.
leemac

 
At Sunday, April 05, 2009 1:39:00 PM, Anonymous Anonymous said...

A look at wikipedia under the subjects of medical assistant, physicians assistant, and surgical technologist is surely eye opening...it backs comments by both 58flyer and MER...it makes me wonder if we are retreating to barbers for surgeons to cut costs too..
leemac

 
At Sunday, April 05, 2009 2:53:00 PM, Anonymous Anonymous said...

To me the word prostitute conjures
up a pimp with a big brim hat driving a buick wildcat or a cadillac. Mistreating his "ho's"
while carrying on business.
Fact of the matter is times have
changed and after watching a commentary on "working women at the
chicken ranch" this movie certainly
reflects this despite the fact I
recall this program on tv about
8 or 9 years ago.
What these women do is their business and although I've never
used their services I will not
judge them. What I find disturbing
though is the fact that our government says its ok for a woman
to kill her unborn child,yet its
illegal to sell her body. Makes
no sense to me and as it relates to
this thread it dosen't matter what
you do in life one certainly is
entilted to respect when it comes
to medical care especially in the realm of privacy.
I would suspect that a call girl
would expect privacy more so perhaps than the average person,just my opinion.Furthermore,
I don't really see the relationship
as it relates to health care and
that pertains to the naturalists
as well.
The suggestion was made to invite
those from the allnurses site. I
certainly don't see that as productive considering that most
any subject matter relating to this
thread is quickly shut down as it
pertains to male patients on their
site.
Personally, I don't believe their
comments are sincere,but made only
for the good of their forum!
Recently, I learned that a nurse
at a hospital where she is employed
visited the er. While recieving an
ekg she was exposed to the entire
waiting room, curtain drawn open
by another female nurse. As a result of this she complained to
administration and as a consequence of this complaint
recieved absolute scorn from the
nurses who violated her privacy.
This phrase " no honor among
thieves" quickly came to my mind
regarding this violation. I believe
this problem is widespread in the
healthcare industry. I used to work
in healthcare and it was bad like
this then,however, somewhere respect and trust seem to have become forgotten and it obviously has gotten worse.


PT

 
At Sunday, April 05, 2009 2:55:00 PM, Anonymous Anonymous said...

There has definitely been a switch to cheaper labor and passing off assistants as nurses. Next time any of you are in a doctor's office and the "nurse" comes in the room ask that what their title is. You have the legal right to know. If they don't tell the truth you can report them to the BON. Often times they are insructed by their bosses (doctors) to say they are a nurse as they do know people will be more comfortable with someone who they know has years of education and training versus someone who can be hired off the street and work under a doctor's license in a office environment.

It's all about the bottom line. Why hire a nurse when you can lie and probably get away with someone cheaper especially if they want them to take notes and act as chaperones. The latter is what many will find particularly offensive. Call them on it and report them if they falsify their information. I'd also find another because I wouldn't go to one who didn't have staff represent themselves accurately.


-L

 
At Sunday, April 05, 2009 7:44:00 PM, Blogger CSM said...

Had a chance to talk with three naturist women (they were chatting together before I arrived) about LH's question on expressing breast milk.

I told them that " I've been participating in an online discussion about modesty and health care. Most of the participants are very concerned that doctors and nurses don't respect their feelings about modesty, especially with intimate care. I've been kind of the lone naturist voice and a female participant asked a specific question for me to ask naturist women. She's been in a situation where nurses had to help her express breast milk for her new baby. She felt that it was very initimate and any woman would have throught it perverse for a male nurse to have been involved. What do you think? Would an opposite-gender medical person be a problem for a naturist woman?"

They had three comments. First, that hospitals were "mixed" environments, so that "textile rules" (ie. non-naturist attitudes) applied, and as a result their reflex would be to be more cautious than with their normal doctors where they knew everybody. Secondly, that if the hospital nurses were total strangers, they would definitely be more comfortable having female assistance expressing milk, but that if there was a male nurse they'd gotten to know or who they knew had been specially trained to assist, it ultimately wouldn't be problem. (There was some light-hearted repartee about how many women might suffer during a male nurse's learning curve, but also about whether and why female nurses would be any better at helping, given that they'd probably only have had prior experience with their own breasts where a male nurse might have had "more varied personal experience.") Anyway, they finally came to the conclusion that in principle the gender of a competent nurse wouldn't be an issue for them as long as they trusted that he/she was acting in a professional and respectful way, that it certainly wasn't "a matter of perversity unless the nurse acted like a pervert", and that in terms of patient modesty "breasts of course shouldn't be any more private for women than men." (On the last point, I should note that two of the three are activists about this -- background info at TERA, GoTopless, and BraFree)

 
At Sunday, April 05, 2009 8:11:00 PM, Anonymous Lila said...

My aunt has just retired after 48 years of nursing.
She has seen many changes over the years.
We were discussing patient requests recently.
In her early nursing days, they received requests for female doctors from some patients. These women were patronized and dismissed. Initially, because there were so few female doctors.
She remembers victims of sexual assault leaving without a medical exam because the police surgeons were male. These girls/women simply could not cope with the exam.
The attacker in these cases got away with his offence.
When female doctors started to appear, they tried to distribute them to the areas of greatest need, like sexual assault victims and very young patients.

My aunt noticed a shift about 15 years ago. Previously, patients were embarrassed to ask for a female Doctor and some became upset/distressed when their requests were ignored/dismissed, but the patient didn't take it further.
Increasingly, female patients REFUSED to see male doctors in some situations and preferred to wait to see a female or leave and find a Dr elsewhere...
She noticed these requests were initially resisted, but in the end it became such a frequent request/demand that the system was forced to change it's attitude.
She said male doctors became more aware they were in competition with the female doctors (in gyn/obstetrics especially) and some seemed to try harder to be sensitive and professional. One male Dr who delighted in the telling of dirty jobs was actually reported by another male doctor - probably concerned that this man may make things harder for other male doctors. Once the dirty joker would have been accepted/tolerated...

She said male patients rarely asked for male nurses (a rare breed in the early days)but this group has followed women asking for female doctors. As male nurses appeared, men started to ask for their care in increasing numbers. This started about 10 years ago...
It seems as same sex providers appeared, many patients preferred their care rather than suffer the extra embarrassment of being cared for by the opposite sex.
Neither group will back down (usually) and thus change has been forced upon the system.

She also said patient modesty was disregarded from time to time, but now patients are far more likely to object or complain and so, nurses and doctors are more aware and usually, more careful - thoughtlessness or callous disregard has consequences (usually)...
She believes this shift in patient attitude is due to the fall from grace of the medical profession in the eyes of most people.
Also, people regard Dr's and others as workers in a service industry; providing a service to them and it's the patient's prerogative to accept or decline their care. The patients increasingly are calling the shots. It is now commonplace to hear a patient challenge a Dr or refuse an exam or ask for a second opinion. My aunt said that was almost unheard of years ago.
Thought you might find this interesting.

 
At Sunday, April 05, 2009 9:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Wow! A pair of very interesting postings. Thanks CSM and Lila. By the way CSM, thanks for the links, though "GoTopless" link doesn't work.

You know, I am impressed that there are TERA and BraFree and of course for anti-hysterectomy HERS organization. Have any of my regular visitors here or others found an organization already active to promote same gender healthcare providers? If not, you guys (and gals) ought to start one. Again I mean, not just a blog (though I think that my blog and Dr. Sherman's blog have been helpful to provide a space for comments)but an activist organization that can provide some group clout. I know I have kept this mantra going on almost every Volume and I haven't seen anyone report that something was developing. Perhaps it is more difficult de novo to get something like that going than what I imagined. ..Maurice.

 
At Sunday, April 05, 2009 10:07:00 PM, Anonymous Anonymous said...

I want to thank all of the ladies who post here...I often do not respond, but that is because I just do not know what to say...I appreciate your views..and cringe at mistreatments...I know I do nnot want any of my family,,,nor anyone else to be mistreatedLila, may I ask what country your aunt is in?..I suspect Great Britain just because of the use of the term police surgeon...and maybe you could ask her views on male modesty...thanks
leemac

 
At Sunday, April 05, 2009 11:34:00 PM, Blogger Maurice Bernstein, M.D. said...

In an attempt to delve back into the dynamics of patient modesty (yes, I know some here find there are no "dynamics" only libertarian rights), I suggest a reading of the Psychoanalysis section of Answers.com on the term "modesty". Here is an excerpt:

Apart from the issue of the difference in metapsychological and psychogenetic status between shame and modesty, a question raised by the notion of modesty is that of how the anal instinct, the phallic signifier, and genitality are articulated together, whereas orality is governed by a different moral code; this is aptly shown in Luis Buñuel's film The Phantom of Liberty (1974), where the characters gather in a circle to defecate together and hide in the lavatory ("au petit coin") to eat.

One can wonder whether the force of modesty is not directly linked, individually or culturally, to the importance of infantile sexual theories about the anus, which might persist and become more pronounced, not only for obsessional personalities, in the access to genitality.


Have we discussed whether sexuality orientation or preferences play a role in patient modesty related to the need for gender selection of providers? Or is that way off base? I am just trying to expand the scope of this topic. ..Maurice.

 
At Monday, April 06, 2009 2:49:00 AM, Anonymous Anonymous said...

Thanks for asking your friends CSM.
Maurice, to answer your question about sexual orientation, I have no problems with having a lesbian for intimate care. I don't know why. Somehow I just feel that women are more able to concentrate on the job that they are doing and block out any inappropriate thoughts better than men. Of course, I don't really know this but I think that is my intuition.
LH

 
At Monday, April 06, 2009 4:50:00 AM, Blogger MER said...

Some very interesting posts lately. First, the last one from CSM. Notice how the attitudes of the women naturalists he interviewed are very contextual. CSM writes: "She felt that it was very initimate and any woman would have throught it perverse for a male nurse to have been involved."

Notice how what's "intimate" for a non naturalist is even "intimate" for a naturalist with a medical context. My guess is that the same principle would apply to sex workers, artist models, strippers. They may or may not be comfortable within their own professional activities, but the hospital or doctor's office is an entirely different context. I'd bet we'd be surprised to see how modest some of these people are.

CSM also writes: "Anyway, they finally came to the conclusion that in principle..." Sitting around in a comfortable situation talking about this issue is one thing. We can all be very open and liberal not really caring one way or the other -- expecially if we've had little experience as patients. But once we're in a real situation, how we view this in contaxt is very different. I note that these naturalist women commented on trust, that once they got to know and trust a nurse -- that's a key factor. How often do patients who are quickly in and out of hospitals for quick, relatively minor, yet possible intimate and embarrassing procedures -- how often do these patients really get to know these strange nurses and cna's? Not very often I'd suggest. I've had a few day surgeries. You don't really get to know anybody. Trust doesn't get a chance to develop. Patients go from a trusted personal doctor, to an unknown specialist to a completely strange hospital situation.

Lila's post is also very interesting. I've found basically the same comments from other older nurses. But note that things have changed today but there's almost no public notice of it. The system doesn't acknowledge that they will make these accommodations. They know they must in order to survive. I believe they'd really rather not, and just hope that the patient doesn't bring the issue up. But this shows how important it is not only to ask but to insist.

I urge readers to go to this link on Dr. Sherman's blog and read about an incident he observed involving two female cna's giving a bed bath to a completely naked 30year old man who was in great distress. Apparently, the older cna was teaching the younger one how to give a bed bath "properly." He reported this to the supervisor. From my interviews with nurses and other health care professionals, this happens all too frequently.

You'll find his story near the bottom of the page:
http://patientprivacy.blogspot.com/2007/11/what-can-we-do-to-improve-privacy.html

Dr. Sherman also talks about Alan's recent account of all the things he's actually doing to help solve this problem short of forming an organization or group. I think we should all go back and read Alan's summary again and start doing some of those things. As Lila demonstrates, things will change if individual people start speaking up, making requests, writing letters, letting the system know they're looking for places to go that will accommodate them and will not go to providors who won't.

I mention Dr. Sherman's story because it's rare for me to find doctors recounting stories like this -- unless, of course, they end up in the hospital and feel that their personal modesty has been violated. Why is this? Is it that most doctor's never see these violations as they make their rounds because they don't really "see" them anymore or regard them as problems? Or they don't want to talk about them pubically?

I ask Dr. Bernstein -- have you personally observed these kind of modesty violations in your long career? How did you feel about them? Did you report them?

 
At Monday, April 06, 2009 8:57:00 AM, Anonymous Anonymous said...

leemac, do you know any more about the fireman situation you mentioned? Was the dermatologist specific about who the "variety of other folks of both genders present" are? My cousin is a fireman and we are close enough that I think he would have mentioned if something so unethical happened to him here in our town. Then again, this is a VERY religious town.

leemac, you also said "When you are surprised and have some procedure or aspect of that procedure sprung on you..it is often hard to have a good comeback ready on your tongue.....Guess we just need to think faster...or be prepared for the unexpected." You are right on. One of the major reasons I spend so much time on this blog is because I like to read about other peoples bad experiences so I can prepare myself for what I would do if the same thing happens to me someday.

Thanks Dr. Bernstein for making this possible and to all those that write about their bad experiences and discuss possible solutions.

DG

 
At Monday, April 06, 2009 10:07:00 AM, Anonymous Anonymous said...

Someone brought up the subject of prostitutes. It got me thinking that sometimes in my medical care that's what I feel like, a male prostitute, and my doctor is my pimp.

I feel like my doctor pimps me out to every female nurse, assistant, tech and receptionist in the hospital or clinic, with no regards to how I feel about it. All those women come in and gawk, poke, fondle and show me off to other women.

Other times when I'm standing or laying there totally naked for such a long time while one or more women of many occupations stare at me it makes me feel like a nude model in a college art class.

I know this isn't what Maurice was refering to when discussing prostitutes and nude models but they are a pretty good comparison.

 
At Monday, April 06, 2009 10:48:00 AM, Blogger Maurice Bernstein, M.D. said...

I have never seen a patient lying naked in a hospital bed or examining table. I have watched patients having clothing or gowns removed but done in sections with the open areas quickly re-covered. Nor would I ever want to take a history or perform a physical exam on a person in such as state. As I keep reminding my students, a valid history is obtained from a patient only through establishing a trusting relationship. A patient lying naked and the physician dressed would never lead to such a relationship. To perform the physical exam, nudity is not necessary (even as I have explained previously in a full skin screening)and will lead to consternation about the doctor's motives, will not lead to trust and will only lead to chilling which can interfere with an effective and accurate physical exam. I suspect that intentional allowing a patient to remain nude and uncovered is an exceedingly rare act and if it ever would occur would go against a major principle of nursing care which is patient comfort. I would say that much of the examples written here about how patients are mistreated are stories to make a point but in reality, though obviously some may occur, are as noted, rare. ..Maurice.

 
At Monday, April 06, 2009 11:12:00 AM, Anonymous Anonymous said...

I still recall the day I was sitting next to two doctors on a long flight. They were talking between them and one doctor told the other how humiliated he was to have an emergency appendectomy and was prepped by nurses and operated on by his staff. I really wanted to join in the conversation and ask them...so did it make any difference in how you viewed what your paitents go through? I to question how much of it is truely don't see, don't see it as that big of issue, think the situation makes it ok, or just don't want to acknowledge as thats not the way they want it to be. LH I think there are a lot of women who feel its different for females in medical care than males...but I would suggest it is more that we have just pushed and validated that myth rather than actually verifying it or basing it on imperical data. Females account for the vast majority of complaints at air port screenings...even though the screenings are done by other women. Males in health care have to deal with the stigma that as a male they are a risk to female patients...when the reality is they are more at risk of being ACCUSED of doing something...so the perception of make caregivers as being dangerous is promoted...unfairly I might add. Sort of like saying, women are bad drivers becasue some women have accidents.
Dr. Bernstein, would you consider facilitating in some way a place where some of us could exchange e-mail addresses. Jimmy has indicated he would be interested and has starting learning web site design for this effort. I would like to contact him to offer help...but don't really want my e-mail address out there for everyone...just a thought or if someone has an idea how we might communicate without publishing our e-mails...I would like to hear it.

thanks.......alan

 
At Monday, April 06, 2009 11:31:00 AM, Anonymous Anonymous said...

DG...all I know is that ther are the dermatologists ( male and/or female) plus whoever takes notes..and occcasionally representatives of the fire department..there seems to be rasons/excuses for others as well..it is why i would like to know how the firemen handle it as I understand that it is mandatory teting for them to keep their jobs. Perhaps your cousin would tell you of his feelings and how he handles it..Because this is a case where the firemen are older than recruits for the military ...they may have a far diferent outlook...something that may be of value to us when we are faced with a situation we can't control and have to "gut through" something.
I also hope you read the good experiences, DG. Without those we would all just go hide under a rock.
leemac

 
At Monday, April 06, 2009 12:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, I have previously indicated that I would be willing to hold in confidentiality the e-mail addresses of my visitors to relay them to some specific other designated party. Of course, I would have to know that other party's name and e-mail address to know where to reply. As you can understand, I can't be absolutely sure that an e-mail representing "that other party" is truthful since anyone can identify themselves with someone else's pseudonym and looking at the e-mail address may not necessarily be absolute verification of identification. I can do only so much within the limits of the anonymity that comes with these blog postings. ..Maurice.

p.s.-Of course, if I am missing something in my logic, please let me know.

 
At Monday, April 06, 2009 12:15:00 PM, Anonymous Anonymous said...

To be a naturalist is a participant
in a porn movie but sidelined. As
to be in a baseball game watching
but not playing. Whats the point
and how does it relate to health
care and should it matter.
It detracts and dosen't account for issues such as discrimination and unprofessional behavior. Along
the mentality, " I don't care why should you care." People have just
simply forgotten the golden rule.
The effects of keeping patients
warm post-op has only been appreciated within the last 15 years. Look back 25-30 years ago
and many patients were not at all
covered in intensive care units.
The fact is heated air blankets
became available in the mid 90's
and most scu's have but a few. Many
pacu's i've seen had to borrow the
one they had.
Furthermore, prior to the early
90's the general attitude was not to cover patients up post-op nor
in icu's. Naturally, of course if
the patient was running a fever that was a different story.
At one facility I worked at
nursing deliberately refrained from
giving patients blankets, pillows
and the nurses call button. That
meant more work in changing linen
and if you didn't have a call button you can't really call and
bother the nurse can you?
Clean linen is something you get
when you visit a hotel or motel,
it's called hospitality, isn't that
where the word hospital is derived
from!
I always use the analogy, if they
don't care about simple creature
comforts, what makes you think they
care or will respect your privacy.


PT

 
At Monday, April 06, 2009 1:40:00 PM, Anonymous Josephine said...

What about the operating theatre?
Have you observed patients fully naked while they're being prepped?
Does anyone take responsible for the people that seem to hand around in the theatre?
A nursing sister told me once that orderlies and techs were often permitted to watch catheters being inserted and other intimate procedures. No one asked them to leave or get on with their job.
It seems patient's are completely vulnerable in this setting.
We all remember the articles in the newspaper when it was revealed that unconscious patients were having multiple unauthorized intimate exams carried out by medical students...
Do we really have any control while in theatre? Who protects us if someone wants to lift the drape for a look or deliberately walks to the other end of the table for a look? Can anyone just enter the theatre to observe? Are these people ever challenged and by whom?
I fear ever needing surgery.
It's when we're unconscious that we're least able to protect ourselves.

 
At Monday, April 06, 2009 5:44:00 PM, Anonymous Anonymous said...

DG, I do not want to discourage or depress you..or stress you out...Do not get to wraped up in what may happen...there are many times in life...things just happen...that we have no control over...and at those times we may have to let our control over us rest in the hands of others. It is scary...but there may be little we can do....I reference accidents or sudden serious illness..The bes twe can do...is try while we can to see that our modesty is preserved and respected as much as the situation will allow.
By the way...this also highlights why we need to find a doctor we can trust...so we can keep a lot of serious illness at bay. I spent years avoiding doctors...and now think I made a really big mistake.
leemac

 
At Monday, April 06, 2009 5:58:00 PM, Anonymous Anonymous said...

They are now called surgical suites
and no longer theatre. The bigger the facility the more you can
expect unnecessary exposure,simply
due to more staff. I've always said
request non-teach. Not only from
the resident side but nursing side
as well.
I agree, we are at risk the most when unconscious, however, I believe patients should be able to
request an advocate when in the OR.
This is a medical or non-medical person of the same gender that
essentially keeps an eye out for
you. They essentially don't exist
but I believe will catch on in the
future. I have much experience in the OR and what I've seen disturbs
me. Considerably amout of unprofessional comments from the surgeon, anesthesiologist and nursing.
Remember, these patients are in
a position not able to defend
themselves and are essentially in
the most vulnerable position you
will ever find yourself in your
life.
Yes,people have been sexually
assualted while unconscious in
the OR, women, men and children
and worse things have happened as well. If it is permitted I'll tell
some of the things I've seen.
Not trying to frighten anyone from seeking healthcare, thats the
last thing I want,however, you have to protect yourself whenever
you find yourself in these situations.


PT

 
At Monday, April 06, 2009 7:14:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, you have made your general point based on your professional experience and I don't find that detailed description of the events you have said to have witnessed or what you were told about are necessary to make your point clearer.

You know, it is interesting that in the recent postings, our topic of "Patient Modesty" is now migrating from the provider gender selection issue back to what was the main discussion years ago on the initial thread "Naked".. the concerns of, as a patient in the operating room, while unconscious, being viewed unclothed by others. ..Maurice.

 
At Monday, April 06, 2009 8:41:00 PM, Anonymous Josephine said...

Doctor, have you observed disrespectful behaviour, inappropriate comments, unnecessary exposure and non-essential people in the suite?
If you did, what action did you take? Would you take...
If you saw anything inappropriate, like a patient being fondled, would you inform the patient?
Would you give family members any advice if they were having an operation?
Like suggesting a closed suite or staying away from a teaching hospital.
If you knew it was a hospital where unauthorized exams were carried out in the operating suite, would you warn them?

We had a case in this country a few years back, of an orderly fondling women on the way to recovery. He was eventually caught, but it became clear over the course of the investigation, many people had observed his behaviour over several years. One witness said the cone of silence applied; what happens in surgery, stays in surgery. No one wanted to make any waves or be labeled a whistle-blower.
It seems to me that no one takes responsibility for the patient.

I agree, we definitely need someone to watch out for us while we're unconscious.
It's hardly worthwhile seeking out a male or female surgeon and nursing staff, if anyone can wander into the suite.
I plan to write to a local private hospital to see whether they offer closed suites or whether I can have a representative in the suite.
If it makes a private hospital more attractive to patients, I think they'd try to accommodate patient requests. I don't need surgery, just want to check their attitude.
I see you have also had problems with orderlies.
http://www.11alive.com/news/local/story.aspx?storyid=118930&catid=3

 
At Monday, April 06, 2009 8:45:00 PM, Anonymous Anonymous said...

Perhaps some reasons for the return to the starting point, Dr Bernstein, are that new folks are finding your blog, it is an issue that has not gone away, and it is part and parcel part of the overall concerns of many... The issue of modesty seems to have many forms and aspects..not to mention multiple perspectives...
I think that many feel betrayed that caregivers do not shield us when we are vulnerable...it goes to the heart of trust. We are nervous enough at giving up control...and thus self defense..to someone who has given us the feeling by direct words or implied...that they are truly going to ake care of us...including seeing that our bodies are not display items in some showcase.
leemac

 
At Monday, April 06, 2009 8:57:00 PM, Anonymous Anonymous said...

Yes Dr.Bernstein. It seems we have turned full swing back to earlier topics. I think the reason for this is the number of new posters over the last year. It also seems the longer this blog stays active, the more interest it gains. With the number of comments coming in now, perhaps we should look into some kind of summery screen for specifics topics/areas of concern that have been discussed? It’s time consuming to navigate through all the volumes so that is why I suggest some type of summery screen. Just a thought…

Alan and anyone else interested. I actually do have an email address already established to where I could exchange/gather email information with anyone else interested. You can email me at medical.privacy@yahoo.com. Feel free to also exchange thoughts/ideas on organization on Dr.Sherman’s blog under the Organizing for Patient Privacy/Modesty thread. Jimmy

 
At Monday, April 06, 2009 11:11:00 PM, Anonymous Anonymous said...

Dr. Bernstein:

I believe it would help those
who run across your blog for the
first time to realize that there
have been about 2500 previous
postings. This awareness might
well be served by starting each
new volume with a list of active
URL links to each of the past volumes, especially the earlier ones which ran several hundred entries each. I would also hope that the so called "lost" entries that you have said are retrievable
might be reached though a direct
link given in such a listing.

I think the first fifteen-hundred or so postings concentrated on many different types of modesty
violations that we've heard less
about in the last thousand or so
entries. For those who are just joining, who might like a more concise overview of all the key issues, I would like to suggest that they also connect to Dr. Joel Sherman's, "Medical Privacy: A Patient Oriented Discussion". As you know, he was once a regular poster here but now has his own blog with a thousand or so entries to date.

Indeed, the movement appears to
be growing. I last logged on to
read Patient Modesty 10. When
I returned a couple of weeks later, I was surprised to find you on Volume 13! That's remarkable. I hope you're finding time for the rest of your life.

Thanks, again.
- Avram

 
At Monday, April 06, 2009 11:24:00 PM, Blogger CSM said...

LH, I have more feedback on your question about expressing breast milk. I asked the women over at clothesfreeforum.com and got a number of interesting responses. Even one from a male nurse. Selections are below or you can see the full responses here.

"I think that when it comes to intimate procedures, like the breast milk expressing tutorial, the mother should have at least been notified that there would be a male nurse attending and asked whether she felt comfortable with his presence/assistance."

"I have [recently] switched, coincidentally, to a female doctor. I didn't think it mattered whether my doctor is male or female as long as they have the professional boundaries. I still think I feel that way, though it is nice to have a doctor who is female. There is something different. Perhaps it is just her personality."

"I suspect that I would feel more comfortable with a female nurse for the expressing milk issue. Never-the-less, I have met male nurses who could probably do this with kindness and suitable boundaries. If the health professional respects my modesty and boundaries, it does not matter to me if the person is male or female. The bottom line is that I have to feel respected and that the professional is concerned about my modesty and dignity."

"Maybe as a male nurse I can shed some light from my prospective. As a healthcare professional you must always be aware of what is most therapeutic for your patient. In that situation a qualfied female nurse would most likely be best. It is important to keep the patient at the center of all of your actions. I have found in some situations a patient responds more positively to a male caregiver without regard to what care is being given intimate or not. I have also found that the most therapeutic thing may not be what the patient is comfortable with and a professional matter a fact attitude is important. Nudity in a healthcare setting also is not the same as nudity in a home setting for example. Once I became a nurse even my own extended family members allow me to care for them in intimate situations as a nursing professional, something that would not have been considered before that. I feel many things enter in when considering this topic."

 
At Tuesday, April 07, 2009 5:16:00 AM, Anonymous Anonymous said...

Josephine and others speaking of the operating suite, I can tell you that a disturbing issue is that a commonly used consent form has language that when signed by the patient allows for "others to stand in and observe and video and photos allowed. This form is given to a patient at the last minute and most times eye glasses/contacts are already removed so the chances that a patient actually reads the entire form is NILL. One piece of advice whenever a surgery is planned ask for and receive ALL consent forms one or two weeks ahead of time so you can read ALL of what you will be signing. If anything is not acceptable to you then you can address it.
JW

 
At Tuesday, April 07, 2009 5:27:00 AM, Anonymous Anonymous said...

Thanks for the response leemac. I will ask my cousin the next time I see him, but as I said before, my town is very conservative (Mormanville).

Many things are different here. Modesty, morality and dignity are (generally speaking) much more important to the people here. Our hospital has an abundance of male nurses, female gynocologists and only one female Urologist that treats primarily women. My sister recently had a colonoscopy and she had an all-woman team. Though I'm sure that might not be as easily done for men.

So I imagine it's likely that the firemen are given more privacy and same-gender dermatologists and assistants here (at least I hope so). But I still like to hear how it's done elsewhere in case I'm wrong.

I do enjoy reading the good experiences. I always hope that each experience has a happy ending. If it doesn't, I try to learn from it.

DG

 
At Tuesday, April 07, 2009 6:04:00 AM, Anonymous Anonymous said...

"we are at risk the most when unconscious"

Absolutely! I mentioned in an earlier post that I will insist on having as much of my pre op done as possible while still awake. That of course doesn't completely solve the problem since I would soon be asleep anyway, but I consider "nipple to knee" shaving as personal as it gets. I also like to know that I'm well covered when being wheeled into the operating room from the pre op area. I've heard many sad and humiliating stories about that.

I've also had nightmares about what could happen to me in the recovery room. I hear that many if not all recovery rooms often have many recovering patients together and many nurses doing whatever it is they do in there. I know they do things like fiddling with the catheters and checking the dressing on wounds in intimate areas. Can everyone in the room including possibly some patients that begin to wake up see it when the nurses check the catheters? I can't remember much about my recovery room experiences but that doesn't mean I didn't care who saw me in compromising positions.

DG

 
At Tuesday, April 07, 2009 9:17:00 AM, Anonymous Anonymous said...

I encourage everyone to go to the link provided by CSM...it is worth your time. Thanks,CSM. I also encourage folks to read the various sites on Dr. Sherman's blog concerning photographing patients and consent forms...Both of these sites are great adjuncts to our discusion here...and maybe we can see if we can further define teh various psychodynamics of how we feel, perhaps why we might feel that way.
I hope everyone gives alan and Jimmy what support and help they can....The task they have undertaken is important...and should help yield results that just talking about the issues can't achieve.
Thanks Avram and all the others some really insightful and informative posts.
leemac

 
At Tuesday, April 07, 2009 9:54:00 AM, Blogger Maurice Bernstein, M.D. said...

Avram, thanks for your suggestions. Though the majority of the visitors to this bioethics blog go to the other of the currently over 670 different bioethics topics, most of those who write comments come to the Patient Modesty threads. I will, however, shortly put up a list of links on the sidebar to each of the Patient Modesty threads including the first two and the two threads of the recovered comments that had been wiped out, unexpectedly. I think putting the links in the sidebar would still make them available but eliminate the need for repetition on each new Volume.

Thanks to all for continuing the discussions here and I offer my encouragement and best wishes toward the beginnings of some activist organization. I would also hope that those new visitors here would go to Dr.Sherman's blog limited to the patient privacy and modesty for additional discussion. ..Maurice.

 
At Tuesday, April 07, 2009 11:48:00 AM, Anonymous TT said...

Dr. Bernstein,

On the subject of how to implement change in respecting patients' privacy/modesty concerns, I agree that some type of patient activism is the best approach, but I believe it has to start with the individual. In the oft quoted words from the Tao of Lao Tzu (often incorrectly attributed to Confucius)"A journey of a thousand miles begins with a single step."

In a recent post Alan gave some excellent examples of proactive steps the individual can take, as have leemac and others that post here. If enough people stand up to be counted, the health care industry will pay attention.

The role I would envision for an activist organization along these lines would be in a primarily informational capacity, with the primary focus of helping provide the information an individual needs to be able to stand up and make their preferences known, and to do so in a proactive manner that encourages a cooperative response. Let them know that they're not alone, and there are lots of others that feel the same way. Beyond that, it could act as a resource to conduct surveys, exchange information on health care organizations, provide information to medical organizations, politicians, news media, etc. I'm also thinking it might be more effective as part of a patient's rights organization encompassing other issues as well.

Health care organizations aren't stupid. If enough people make their preferences known, and are willing to back it up by voting with their feet and taking their business elsewhere, they will pay attention.

Some have advocated a confrontational legal approach, filing lawsuits, etc., but I think that would be a huge tactical mistake. You would be facing an industry with deep pockets and a strong lobby - it would take years, if not decades. Further, by "putting their back against the wall", you would almost guarantee a complete lack of any type of cooperation or accommodation on their part, as to do so could have bearing on a legal case. Better, I think, to spend the time and energy educating patients and helping them stand up for themselves - create an environment that lets the health care industry "recognize a need" and react by "providing a needed service that improves patient satisfaction and outcomes." If letting them take the credit for recognizing a need and reacting to it is what it takes to make changes happen, so be it.

Just my $0.02....

TT

 
At Tuesday, April 07, 2009 11:49:00 AM, Anonymous Anonymous said...

DG I can tell you that most if not all pre-op prep is purposely done in the OR after they give a patient sedation such as Propofol. It is very quick acting and you are asleep immediately. As far as I have read it is then the anesthesiologist gives the Okay to the OR circulating nurse to begin undressing and prepping the patient. Patients don't know anything about this area of care because they are "out" and nursing staff does not bring this to a patients attention either..purposely. Unless a patient learns the hard way (thru an unpleasant experience of direct learning) or if they have been told by other people (this site as an example) they are NOT informed of this stuff. The teams like it that way because then they don't have to deal with accommodating patients that DO CARE about the prepping.
JW

 
At Tuesday, April 07, 2009 12:03:00 PM, Anonymous TT said...

DG,

Slightly off topic, but relevant to your post. In regard to "nipple to knee" shaving...finally, evidence based medicine is putting an end to this practice. Studies have shown that shaving a surgical site increases the risk of postoperative infection, as much as ten times when compared to no hair removal or using electric clippers or depilatories.

Even JCAHO is now on board. I quote from their current national patient safety goals (NPSG.07.05.01) "As of January 1, 2010, when hair removal is necessary, the hospital uses clippers or depilatories. Note: Shaving is an inappropriate hair removal method."

TT

 
At Tuesday, April 07, 2009 4:15:00 PM, Anonymous Anonymous said...

CSM thanks for the link. I think this comment is interesting: "However, nudists are not exhibitionists and typically only practice nudism around people they feel comfortable with and trust." It means that you are no different to me really. Only the circle of people that you are comfortable being nude in front of is much larger than mine (my husband and children).
Unfortunately there is no time to get to know the nurses before you can trust them. On each shift, you meet a new nurse and the baby is not going to wait for you to get acquainted! The best nurse actually had no children of her own but grew up on a farm milking cows. lol.
LH.

 
At Tuesday, April 07, 2009 4:26:00 PM, Anonymous Anonymous said...

Thanks JW and TT...JW I think you are refering to the "cone of silence" it is thought that there are some things that would unduly stress a patient...or cause a refual of surgery as I understand why they do it...
leemac

 
At Tuesday, April 07, 2009 4:47:00 PM, Anonymous Anonymous said...

TT,
You are correct about the current recommendations by JCAHO and AORN organizations.

However, I was informed by administration, head of surgery and the CEO, etc. that they are just that RECOMMNENDATIONS only! IT IS NOT LAW. Therefore, it is still up to the surgeon to do what he wants. The OR staff's policy and protocol (P & P) is based on what the surgeon wants for his case. He's the Captain of the Ship!

Electric clippers have been used for many years rather than razor shaving. Infection rates have diminished.

It is all one in the same. A female shaving you whether it is a razor or a clipper it is remains to be very personal and intimate care. In addition, whether or not you are shaved, the 15 minute cleanse and scrub of the genitals that is done prior to surgery is more than intimate and personal!!
JW

 
At Tuesday, April 07, 2009 5:30:00 PM, Anonymous Anonymous said...

Dr Maurice

To repond to your comment regarding this issue perhaps coming
full circle. I don't believe so
necessarily as the perceptions of patients differ as well as the central theme of trust hinges in
the minds of many.
What if people just come out
and say it," I don't trust those
people around me when I'm naked".We
have since childhood been instilled
with modesty and clothing issues as well as entrusting those with our health care. Complicate that
matter with negative experiences
as patients along with what we read
and hear.
How many people get a good
experience buying a good burger
as an example and how many people
get a good experience in health
care. There are certainly more
burgers sold in america vs those
seeking healthcare. Do you trust
those making your burger? Do you
trust those delivering your health
care? Would you trust them if
suddenly you were unconscious for
as long as they wanted you to be?
Most probably say yes only
because there is a crowd and the
probability of something negative
occuring in front of many diminishes.You are not necessarily around a crowd while unconscious and as well don't forget the crowd
mentality. Often times its just you
and the nurse and often times it's
whoever is there or walking by
depending on if in the or,pacu or
icu.


PT

 
At Tuesday, April 07, 2009 10:19:00 PM, Blogger CSM said...

LH, having grown up on a small farm myself, I got a chuckle from your comment about the farm nurse. On your comment that "the circle of people that you are comfortable being nude in front of is much larger than mine" and that "there is no time to get to know the nurses before you can trust them", I just wanted to note that it is not that naturists necessarily know all the other people they're with, but what they know is that everyone, even strangers, is acting according to same clear set of agreed norms -- which is actually what we are trying to get to here too. Another thing that is perhaps applicable here is that everyone kind of keeps an eye out for each other's comfort -- imagine if patients could/would do that, or at least could depend on having a buddy-caregiver always being present and watching out for them throughout any set of procedures. There is something about the cubicalization of health care that makes each patient sort of feel they are isolated and alone inside a big machine.

 
At Wednesday, April 08, 2009 12:07:00 AM, Anonymous TT said...

JW,

No it's not law (neither, by the way is shaving), but it is an evidence based recommended standard. Deliberately ignoring these and putting a patient at increased risk brings the legal concept of "specific knowledge" into play - potentially not a good thing for either the surgeon or hospital. (see Alan's post on Dr. Sherman's blog for more information on this concept)

The surgeon may be the "captain of the ship", but the patient still has the final say. Ask them to explain in detail what the prep procedure involves, refuse to consent until they do so and address any objections you may have to your satisfaction. If they insist on using an outdated prep procedure that puts you at increased risk as opposed to a recommended standard that is evidence based, call them on it. When you come to an agreement, make them put it in writing - one of the commandments of medicine is "If it isn't written down, it didn't happen". Make written notes directly on the consent form if need be.

By the way, it's best if this is done ahead of time so everyone knows where they stand going in. When you're sitting in preop/SPU is not the best time to be having this conversation.

If they can't or won't address your concerns to your satisfaction, fire them and find another surgeon. If it was me, I'd also write a nicely worded letter to the CEO and Chief of Surgery at the hospital where the surgeon practices explaining clearly and concisely that I declined the services of this particular surgeon and why, with copies to the BOM and JCAHO.

By the way, the recommendation is for no hair removal unless absolutely necessary, and even then only the immediate area where the incision is to be made. Prepping of the genitals is not necessary unless they are in the operative field. The disinfecting agents used for prep are very effective and kill bacteria on contact, and the prep procedure is very quick. The last couple surgeries I've had were done under either local or regional anesthesia (with no sedation, so I was wide awake) and the entire prep took between 1 and 2 minutes. Extensive scrubbing does not improve the effectiveness of the prep and is deliberately not done, as it causes breakdown of the epithelium and increases the risk of nosocomial infection - this is also evidence based.

Yes brief exposure may be required for some procedures. This is where you need to negotiate with your surgeon to insure that you're not unnecessarily exposed when it's not necessary, and limit who is present and participates when it is.

TT

 
At Wednesday, April 08, 2009 5:22:00 AM, Anonymous Anonymous said...

TT I agree completely with your approach. I think if we expanded the scope of who we are addressing to a patient rights site, we stand a better chance of attracting a larger number of members. We can make the first focus or primary focus patient modesty. But even tabs with information on JACHO, HIPPA for dummies, etc would be something that could give not only a wider exposure (no pun intended) but give it more legitamacy if providers visit the website. This approach would require the least amount of ongoing invenstment in time and effort. But...the greatest impact would be to have an association could claim a large number of members such as NOW. If a hospital got a letter or an email from a Patient's Right Association requesting information on how they handled this or that situation, are they-do they provide same gender care on request or do they offer it. If they knew the information was going to be on a directory of a web site that has 50,000 members or whatever....the mental impact compared to John Doe calling and asking would be much different. It would have some of the same impact as the legal approach without throwing up the attorney road block. Like wise if a patient were able to not only get examples of letters and guides, but have the ability to have "the association" address the issue...now, in order for this to happen there are going to be releases etc. for someone to inquire for someone...so it gets much more complicated....so someone has to decide if they want to spend that much time and money on it....I am going to contact Jimmy and perhaps we can exchange some idea's...and split some responsiblities if we are on the same page...

The issue of them prepping while out is a good example of how this is so individualistic and why it is important for providers to ask. I am very modest, my wife tells me I am wierd about this...but, then it comes to what is done when I am out...I go out of town where I don't know people for procedures, and once I am out, while I would prefer a all male team....I have realtively little anxiety about who does what, I prefer not to meet the people other than my Dr./Surgeon...and I really like it when I don't remember leaving or returning to the room...but knowing what likely happened and experiencing and remembering what happened...are two different things for me...don't know why...just is..so for me...take me in, knock me out, do what you got to do, wake me up, thank you very much let me get dressed by myself and have a good life I am outta here works for me...but that is just me,,so their approach to prepping after I am out works just fine for me.....alan

 
At Wednesday, April 08, 2009 10:31:00 AM, Anonymous Anonymous said...

Thanks leemac, JW, TT and PT.

JW, I appreciate your frankness. Like I've said before, I like to learn the hard facts so I can properly prepare for the day that it happens to me. It's probably easy to figure out that nothing bad like that has happened to me yet (that I know of) so I may have a different view than those that have gone through it.

I've never been in so much pain that I don't care who may be around while I'm exposed, and I'm sure my outlook will be a little different if/when I'm in that situation. The way I feel now, I wouldn't accept any exam or procedure that would require an opposite-gender person of any occupation if my nudity is involved. If I need to be sedated I would want to know EVERY specific detail and know about EVERY person that will be there, those that are involved directly and any possible bystanders. Like someone already said, if I don't approve of any part or any person, and they refuse to comply to my requests, I'll find a different surgean.

If I DO need pre op things like shaving and scrubbing, whether I'm sedated or not I would request and then demand a male nurse or assistant. I would also do my best to demand an all-male team, but I am aware of how difficult that is. I don't understand it though because I've seen plenty of male nurses and assistants, so I think it isn't because they CAN'T do it, it's that they WON'T do it.

I'm sure I'll learn the hard way though, like so many other people, that trying to make requests is a joke. Also, someday I'm sure I'll experience first-hand how my modesty may be forgotten when I'm in so much pain that I wouldn't care who sees me.

TT, I hope that the surgean I need some day will agree with the recommended procedure of not shaving. Thanks for the info.

DG

 
At Wednesday, April 08, 2009 11:01:00 AM, Anonymous Anonymous said...

There is an interesting thread running on allnurse. I realize the issue of validity has come up on the thread, but given the subject matter (which is often dry and technical) and terms used I think there are atleast many if not most valid caregivers on it. The thread was a nurse who said her hospital had started requesting testing for MRSA? (sorry forget the exact letters) infection on patients being admitted. The request two swabs, one nasal the other peri/rectal. The nurse finds it offensive and questions the need, she brings up a relevant issue here when we talk about trust and establishing a relationship with the paitnent...while she said the patient can refuse...she makes the comment about how is that for starting the relationship requiring the patient to first off put on a gown that exposes their backside and then asking them to let them swab them there before they have even settled in. The poster states it is humiliatign for the patient and is among the top of things "that strip the patients dignity" on her list. The thread is interesting for several reasons, the issue of trust and relationships...but also it is interesting that some providers suggest allowing them to do the swab themselves, one asks about the gender (though I don't think that was a provider) which everyone ignored, quite a few said they would refuse. There was an allusion to the adminstrative part and legal side that suggested a the administrative/business side was at odds with the caregiving side of medicine. There was mention of a Doctor who ran it on himself periodically as a precaution...which brought up a question, is the MRSA infection something a provider can catch, if so....why are not the providers who have contact with multiple patients being screened as well. It is an interesting read to see the providers discuss this and to see that many recognize this side of patient care. The poster even references this is why they hate being a patient....worth a read....alan

 
At Wednesday, April 08, 2009 2:38:00 PM, Anonymous MM said...

I've enjoyed reading through this forum.
I wanted to add:
I think it must be a shock for many men to face these concerns in mid life. Most men seem to avoid doctors up to that point.
Women have to face this threat and fight against it from an early age.
Many/most just give in and comply, never question the need or value of these exams and Tests.
Twenty years ago doctors thought nothing of routinely examining your breasts when you had the flu - no explanation, it was just done...
I knew breast cancer was rare in young women and I was there for the flu! I didn't give the Dr permission to do as he/she pleased...
I always refused and was chastised frequently.

I recently read that Doctors in Australia and the UK have been reminded NOT to routinely examine the breasts of women under 40.
(It can be "offered" to older women.)
Why? Cancer is RARE in this group and the exam is of little clinical value and likely to lead to false positives & biopsies.
That was my argument 20 years ago! It's rare and I believe the exam is unnecessary and I don't want it - I'll accept the tiny chance I'll get breast cancer - there is no guarantee anyway that a Dr would pick up a problem, more likely anything picked up would be benign and I'd face the anxiety of a false positive and unpleasant biopsies.
I don't check my garden shed for a fox every night - I know there are foxes in the world, but the chance of finding one in my shed is tiny - therefore I don't worry about it.
Sometimes it seems like Doctors use all of us to protect a small number of people. Our health, mental and physical, is sacrificed for the greater good of the minority. I find that attitude unacceptable - no one asks us whether we agree to testing and exams on those terms.
The rights of the individual are disregarded - it's fine to harm 1000 people to save one...

The cancer screening gravy train started; the propaganda with virtually no information. Again, I chose to refuse. If I was being told (I wasn't being asked or offered) that I needed an invasive genital exam every 2 years, then I needed a VERY good reason. I was amazed that doctors found this threatening and unacceptable. The pressure was enormous which made me more suspicious.
I suppose many patients just put up with unpleasant exams and tests and never question the need for. value of or risks.
I can't work that way; my life and health are important to me.

I have been appalled at the misleading and grossly inadequate information released by the medical profession and the women harmed by this unreliable Testing.
I certainly don't trust the medical profession. I think many women (& men) resent the paternalistic attitudes and complete disregard for our privacy & rights.
It frustrates me that so many women just do as they're told...to their detriment.
Doctors have always had a hard time understanding that patients have a right to say "yes" or "no" to exams and tests.
Now they're starting on men - PSA Testing - you may think it's a simple blood test - BEWARE...
It's an unreliable test and a false positive is likely to lead to a biopsy, a very unpleasant Test that carries a high chance of harm. Some say this blood test was rushed in, because men refused digital exams.
Many men are happy to agree to the blood test with no clue that they're being led down a dangerous and very slippery slope.
Men and women now face this threat together - I see it as a threat. Patients being exploited, deceived and our rights being abused/ignored...
I urge every person to be on guard - never agree to any Test or exam until you get to the truth and you're unlikely to hear that from your Dr.
I really envy my grandparents - lived into their 80's with none of this madness.
Lets go back to the days of treating symptoms, not harming healthy people.

 
At Wednesday, April 08, 2009 4:46:00 PM, Anonymous Anonymous said...

As with most communicable diseases
MRSA is often acquired while patients are in the hospital. The
average age for someone to have
MRSA is 68.
It simply means that you have a
specific staph infection that is
resilent to many antibiotics.
A nasal swab is more then adequate for a MRSA screening test
and rectal swabbing is absolutely
unnecessary. Furthermore, a more
complex test called mecA is available but not widely used though much faster in determining
if one has MRSA. Oftentimes an open
wound is swabbed for MRSA as well.


PT

 
At Wednesday, April 08, 2009 5:07:00 PM, Anonymous Anonymous said...

TT, I don't want to discredit you post on surgical information. However, I don't agree with much of what you have stated. As I know it from inside info and personal experience preps are done on a wide scale. Who would think that a podiatrist doing a surgical procedure on your toe would scrub and cleanse your entire leg? Who would think that heart surgery would include a total body scrub and cleanse? The most common surgical prep involves the abdominal area. The scrub involves from the nipple line down beyond and including the genitals (side to side to the table). The scrub starts in circular motion using such things as hexachloriphine starting at the center of the surgical site and moving in circular motion outward. This is to be done per protocol for approx 10 minutes at a minimum. Then the area is rinsed with sterile solution and dried with sterile towels. Anyone can pick up a used Surgical tech textbook and read about prepping. For a female patient the inside of the vagina is also cleansed. The genital areas are cleansed because they are contaiminted with bacteria.
Yes, the skin cannot be sterilized only cleansed to reduce as much bacteria as possible to prevent infection. And inspite of all the JCAHO and AORN recommendations the hospital and surgeon still have the last say as to how they want to do things. All the suggestions you make are excellent. I just wish I had known these things before I went in. My surgery would not have gone as it did!!!! FOR SURE.
JW

 
At Wednesday, April 08, 2009 5:24:00 PM, Blogger CSM said...

Just curious. In terms of power relationships, vulnerability, etc in non-medical situations, do the participants here have substantively different relationships with people of the opposite gender? It all of a sudden struck me at work today that 8 of 14 clients, 5 of my last seven last bosses, and six of my seven last successors (I had some control over this) were women. This made me think that perhaps, my experience coping with both genders, in a genderless way, in these various non-medical roles partially explains why I am so comfortable with either gender as health care providers?

 
At Wednesday, April 08, 2009 5:49:00 PM, Blogger Maurice Bernstein, M.D. said...

With regard to the examination of a woman's breast without cause, I just want to be sure those who are concerned realize that the bare chest of a woman could be inspected, could be percussed and could be palpated (touched), the latter often in the supine position in order to examine the heart for size and movement of the chest called heaves and for "thrills" which are heart murmurs which can be felt by laying ones hand on the chest. If the breast is being examined, the physician moves his or her hand in a circular or strip like fashion over the breast to detect masses. Any proper breast exam is incomplete simply by looking at a breast. All this I have written is what we demonstrate and teach our 2nd year medical students and if I was explaining here the obvious to those who wrote about unnecessary breast examination either as a child, youth, adult or aged, then I apologize. ..Maurice.

 
At Wednesday, April 08, 2009 9:13:00 PM, Anonymous Anonymous said...

CSM, I understand where you are coming from but unless all the health provider's uniforms are changed to flimsy gowns without anything underneath and their butts exposed, I will always feel this unbalance of power. Plus, as a non-medical person I am also disadvantaged by not understanding many of the terms, procedures, etc.
LH

 
At Wednesday, April 08, 2009 9:29:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, I think I noted this on one of the earlier threads..but how do you feel about the "unbalance of power" when you are flying in a commercial airliner? How is this similar or dissimilar with your experience as a patient in relation to the healthcare provider? And remember the passenger doesn't wear the experience, skill and clothing of the pilot and the pilot isn't sitting in the passengers' compartment. ..Maurice.

 
At Wednesday, April 08, 2009 10:13:00 PM, Anonymous Anonymous said...

Maurice,
I think you have to be careful in suggesting that there is a clear anology between a pilot flying a plane and a doctor treating a patient.
I am not a doctor or a pilot, but I do know that if the debate in medical circles about what is appropraite for certain illnesses, or what is an appropriate procedure in terms of medical checkups for example, was applied to a commercail aircraft, 50 % would crash.
It is at one level correct that when I am in the hands of a pilot I trust them to do the job and so with a doctor. But with a Doctor its my body, its my decision as to what is done when and how. I can choose to walk away (most times at least); when on a plane I cannot.

 
At Wednesday, April 08, 2009 11:33:00 PM, Blogger MER said...

Sorry. I guess I just can't grasp the relevance of the last two analogies. Comparing the medical power dynamic -- patient - doctor/nurse to an airline pilot and passenger? Or comparing the gender power dynamic to males working with female supervisors or bosses?
If we were just talking about knowledge, the analogies would be more relevant. Of course an airline pilot knows more that the passengers. Of course we put our lives in their hands. But when you add the knowledge difference to the lack of clothing and possible intimate exposure in medical contexgts, you're dealing with apples and oranges.
LH, in his last comment, came closest to exposing the problems with these analogies.
The more I read these blogs and study this issue, the more I see this:
We can examine and analyize this modesty issue to death. Why do people feel the way they do about intimate exposure to the opposite gender during medical exams? I suppose if we gave detailed surveyes and questionaires along with interviews, we would learn more. But short of psychoanalyzing each patient who makes these requests, we're basically stuck with -- that's just how some people feel. They may or may not know the reasons why they feel the way they do. If they do know, they may or may not want to share that information with caregivers. That is their choice.
I believe the bottom line for this is respect for patient dignity. The bottom line is that, within reason, the patient gets to define what dignified treatment means for them. It may be different for different people as it is with different cultures.
Respect for patient dignity doesn't mean that these accommodations can be granted every time requested. But it does mean that the requests will not be disregarded out of hand because caregivers have a different ideology. Respect for patient dignity means that the modesty will be recognized and acknowledged openly and honestly by the medical profession. It means that patients won't be ambushed or intimidated or worn down until they finally agree to whatever gender happens to be assigned or available. It means that the profession will attempt to staff to accommodate patient modesty requests whenever possible.
I've come to believe that this issue isn't as complicated as we often make it. Accommodation is not impossible.
The reasons for patient modesty may be complex -- but the practical solutions are more a matter of common sense, creative hiring and scheduling, and developing the will to get it done. It's a matter of respect.

 
At Thursday, April 09, 2009 4:59:00 AM, Anonymous Anonymous said...

I realize the PSA test is flawed, I personally have a full physical every 2 years and on the between years I have a blood occult, PSA, and cholestral as well as a skin exaim (past history), if the PSA has an issue, I want to know...doesn't mean I will jump up and have a biopsy or anything but I will make sure to monitor. When my brother's PSA was suspcious they gave him options, wait and monitor, biopsy, etc. they gave him recomendations and let him choose. My wife found a lump in her breast early in life, again they gave her options needle biopsy, removal, etc. just because they screen it doesn't mean you have to get radical if they find something. I drive a 1 year old car, still every once in a while I check the oil just in case.......

When we get on a plane we have no knowledge of how to fly the thing, we really don't have options. We know the rules upfront. If I am having heart surgery, I really can't tell the surgeon where or what to cut. There are certain things that are simply out of our ability and those things we hand over to the pilot and the Doctor. However, if the pilot or attendant came back and said take your shirt off, take you fingers and put them in your mouth and cluck like a chicken, something I found demeaning and unneeded, I would resist. Many of the issues here are things we precieve as unneeded, we believe there are reasonable options that are not being offered becasue the provider just doesn't want to or becasue they are simply abusing their power. There are many situations in life where the power dynamic comes into play, police, boss, etc. we accept a certain amount of control by others if we percieve it as reasonable, justified, needed, and a big thing..if we trust them. I have a great deal of respect for police officers, on the few occassions where I had "official interations" (lead foot), I was respectful, took my medicine, and recognized the power dynamics. Once however I nearly got arrested when a young cop was just being abusive to a couple of kids just becasue he could, there was no reason for it, he was hassling and deameaning them just becasue he could. I will submit to things if I feel I have been given consideration, respect, and an honest effort was made to take care of my wants. Doing something that makes me uncomfortable, just becasue someone in scrubs tells me to, or becasue it is easier for them.........that is not a valid use of the power dynamic. I also feel providers at times have a inflated view of their power position. You are not a warden, you are not a law enforcement official, you do not have control over my body, I still have control over who does what to me and sometimes, providers forget that, even if it is the best thing for me...I still have the choice....alan

 
At Thursday, April 09, 2009 8:27:00 AM, Anonymous TT said...

MER,

AMEN!

TT

 
At Thursday, April 09, 2009 9:32:00 AM, Anonymous Anonymous said...

Alan, I am with you to a degree. I am going to be unconcious..so I won't have a clue as to who sees me how...But I do not like the idea of non-essential people being present....and they need to make sure I am unconcious...I would prefer males if anything is going to be done while I am awake..It would not do for an incident as has been reported about a patient regaining conciousness,,,but unable to let anyone know...but then that is for more than modesty.
CSM, I am not picking on you and I thankyou for your help with the milk question and for the lnk to your responses, but...I notice your photo of your backside..seems a bit out of place with your writings here..a) to some showing a ackside to them is an insult ( I know you aren't doing that)) b) it seems you may be a bit shyer and more modest than your writings would have us believe,..just an obsevation.
I have had no real issues with females in the work place...any problems were not gender related...
leemac

 
At Thursday, April 09, 2009 10:08:00 AM, Anonymous gve said...

I also think that attempting to analyze why people feel as they do about modesty issues is missing the point, the whole point. The reason why is of absolutely no consequence as far as i am concerned. There will probably be as many reasons as there are people who feel this way.

It is a case of addressing the symptom and not dwelling on the cause. If, as seems very likely, we have people who are avoiding medical treatment (as many men who have prostate cancer discovered late do), this is hardly the sign of a civilized country that we pretend it is not happening and fail to address the problem. We should not refocus our sights on correcting the "attitude problem" of these modest individuals, but instead provide a route into medical care which will make these people feel welcomed, not feel like lepers.

At the end of the day the health care providers should keep one thing in their mind and focus on it; it is the patients who PAY their wages either directly or indirectly. It is not for the provider to tell patients how they should or should not feel about modesty, it is instead, up to them to accommodate it. Personal modesty is not some crackpot cult, it is not the patients trying to score points over the providers, it is a deep rooted, strongly held feeling.

You cannot "cure"someone of feeling modest any more than you can "cure" someone of being gay. It is a state of being which for some people is a fundamental aspect of their identity.

The focus of participants in this blog (and I include all those who read but seldom if ever post) should be to encourage health providers to make a more individually oriented health provision, NOT tell us what to accept.

In future, every time you are exposed to the vagaries of the world of medicine, make a point of checking in advance what you will be exposed to, formulate a position you would be comfortable with and stand by it.

I did just that when faced recently with Urodynamics, I researched the procedure generally, found out what the "norm" was at my hospital and thought about it for a while. As a man, I then decided that having this procedure done by 2 females was unacceptable and firmly but steadfastly stated and restated that I wanted the procedure doing, but only with males present, no females. I had to wait a while longer for the procedure, but eventually they complied.

Strangely enough, they appeared to change their mind when i threatened to set up a web site to encourage men to request all male care at their hospital. If there would have been no call for it, why would they have been worried about me planting such a seed in the mind of local men?

Providers KNOW that what they are doing is WRONG. They know full well that they are being disrespectful of patients when they ambush them with embarrassing tests involving opposite sex providers. For some perverse reason, almost paralysis like behaviour sets in when we are patients, if we were faced with a menu containing inedible food at a restaurant we would get up and walk out, no qualms at all, yet when we are suddenly told to put up with being naked in front of a room full of opposite sex "health workers", we simply comply... totally bizarre, and its time it changed.

Apologies for the length of this posting.

 
At Thursday, April 09, 2009 11:29:00 AM, Anonymous Anonymous said...

Dr. Bernstein, I agree with your posting at 11:33,April, 8. It seems to be a very feasable idea..
I really like the not ambushing, intimidating or wearing down patients. What you propose is pretty comprehensive, but not
onerous or unreasonable and covers the greatest part of providing respect for modesty that can probably be had in reality.
Thanks
leemac

 
At Thursday, April 09, 2009 1:56:00 PM, Anonymous Anonymous said...

MER, JCAHO affirms that a patients' rights and personal dignity should be respected and care should be based on individual needs. "The number one indicator of patient satisfaction involves staff concern for the patients' privacy. Informed consent for surgery states that a properly executed informed consent must include identifying all other practitioners, other than the primary surgeon that will perform significant and important parts of the surgical procedure, even when under the direct supervision of the primary surgeon.

The patients' right document states that a patient has the right to "respect" for cultural, psychological, spirtual and personal values, beliefs and preferences. A patient has the right to information about all aspects of treatment, the right to privacy and the right to refuse treatment. It states that a patient hs the right to make decisions regarding medical care and receive as much information about any proposed treatment or procedure as the patient may need in order to give informed consent or to refuse a course of treatment. This information shall include the names of the persons who will carry out the procedures and/or treatments.

This is what you just commented on, however, from my experience I was not granted these rights or given proper informed consent. I don't think most patients are given these rights (as written). These documents "hang" on the wall of most every healthcare faciltiy in the country.
JW

 
At Thursday, April 09, 2009 4:57:00 PM, Anonymous Anonymous said...

Any Hipaa violation is a privacy
violation and assures someones
termination although not necessarily a fine for the facility. Hipaa violations are akin
to DUI tickets. You get to keep
driving and maybe,just maybe the
facility gets a $100 fine or a
$100,000 fine. Or maybe they don't
get a fine at all.
As previously, I mentioned about
an er physician and a respiratory
tech who were both terminated. I
learned that they both took pics
of a patient with their cellphones.
The patient presented to the er
with his penis caught in his zipper
and both felt inclined to photograph the patient and then
proceeded to show everyone in the
hospital. Administration caught
wind of this and actions were taken.
What I find disturbing not only
of their behavior but the fact that
patients are unaware of the extent
of this problem or are they.
Has technology only opened pandora's box in that this bad
behavior already exists, but that
technology only aids the eventual
outcome of violating someones
privacy.
Is this really what patients are
afraid of, that their providers
cannot be trusted? Any egregious
behavior by medical employees should have to be made public by the medical facility.
After all, communities must be
informed about sexual predators
moving into the neighborhood,
therefore, I believe we the public
should know about behaviors that
occur or occurred at any medical
facilities so we can decide if
they deserve our business.


PT

 
At Thursday, April 09, 2009 6:02:00 PM, Anonymous Anonymous said...

Maurice the difference between a doctor and pilot is simple. If a doctor makes an error, I die, not him/her. If a pilot makes an error we all die. So I do trust a pilot more than a doctor.
Also if clothing is not important, why do health care providers wear uniforms, why do doctors dress to a certain standard?
Why is a form of torture stripping people of their clothing? Is it to make them feel more vulnerable?
LH

 
At Thursday, April 09, 2009 6:20:00 PM, Anonymous Anonymous said...

Oh and another point Maurice, pilots go through rigorous psychological testing before they get their license. Doctors could be psychopaths and still be practising. For example this ob http://www.smh.com.au/news/general/bega-doctor-charged/2008/09/10/1220857595078.html
LH

 
At Thursday, April 09, 2009 7:48:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac, I think your reference today at 11:29 to a posting by me "11:33" yesterday was in error and you were possibly referring to a commentary by MER a 11:33pm on April 8.

By the way, the reason I didn't moderate the numerous posts sent to my blog till this evening was because I was gone all day at the medical school and all afternoon I was helping first year medical student learn about performing a neurologic exam but also with emphasis about attending to the comfort and modesty of the patient during the examination. They are going to have a first year final examination performing the components of the physical exam they had been taught. It will be carried out on standardized patients (actors who can give feedback to the student) and attention to patient modesty will be one of the items for which specific points credit for the exam score will be given if attended to and withheld if forgotten.

Despite our teaching regarding general issues of patient modesty as noted above when you write:"Providers KNOW that what they are doing is WRONG. They know full well that they are being disrespectful of patients when they ambush them with embarrassing tests involving opposite sex providers", I will say again, I really don't think most providers KNOW about what you and the others have such concern. I know and Dr. Joel knows but that is because we are immersed in this discussion but unless the patients specifically tell the providers, they won't know! ..Maurice.

 
At Thursday, April 09, 2009 8:40:00 PM, Anonymous Anonymous said...

I stand corrected...Thanks MER..it is as I said comprehensive but not ridiculous in scope or expectations or in implementation..
sorry for the error..I was getting ready for my first MRI...non-intimate and went very well...but I saw only one male working there..and he seemed to be doing clerical not tech duties..and was in street clothes.
Dr.Berstein, you may have answered this before, but do the students undertand when a refusal is made because of modesty as a gender issue that it is not against them individualy...that usually no offense is intended? They are not being accused of incompetency or of having less than honorable intentions?..
Thanks again to all other posters....and again thanks to MER.
leemac

 
At Thursday, April 09, 2009 9:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac, we are dealing with first and second year medical students, at most 2 years out of college and not yet invested with the title of "doctor" or any ego of a physician and who all are aware how little of medicine they know. Frankly, if a patient refuses to have a history taken or examination, I never heard a student express any concern that it was about themselves, in particular. Actually, most patients who refuse a medical student give no explanation escept they are tired and want to be left alone or they just say "no". Of course, our experience is mostly with county hospital patients and the gender issue is not brought up. ..Maurice.

 
At Thursday, April 09, 2009 10:44:00 PM, Anonymous TT said...

JW,

The information I posted earlier regarding surgical prep is accurate. It comes from a variety of reliable published sources - I can provide a list if you like.

There are two types of disinfectant currently used for almost all surgical prep and the recommended prep time is 2 to 4 minutes depending on the type.

I asked a friend who has been an OR nurse for more than 20 years. He said that the "nipples to knees" procedure you describe is an outdated, old school procedure - he hasn't seen it done in almost 10 years. Current practice is to prep only the area where the incision will be plus enough surrounding area to allow a margin for draping and extension of the incision if needed. Genitals are not prepped unless they are in the operative field. He also said they almost always use povidone/iodine solution (unless patient has a known allergy to iodine), which is a 2 minute prep process (it kills all bacteria, fungi and viruses in less than 30 seconds).

TT

 
At Friday, April 10, 2009 12:27:00 AM, Anonymous Anonymous said...

Many great posts. gve, I'm glad to see your method worked well. That is exactly how I would have done it but I haven't been put in that position yet so I'm glad to read that it has worked well for someone.

 
At Friday, April 10, 2009 8:02:00 AM, Blogger CSM said...

I'm trying to get beyond the "that's just how some people feel" approach, which doesn't distill modesty out of other things. And, as in Dr. B's pilot analogy, I want to understand how, why and when we patients are willing to transfer our personal sovereignty and safety to a team trained to do something we can't do ourselves.

The notion I have been trying to get to is "sexuality-free gender-neutral modesty", the idea that alan long ago alluded to in his idea that it is a patient's own feelings that need to be respected, not that of the doctor or nurse, and that a person may be modest about certain parts of their body, no matter what, as part of their sense of personal dignity.

"Sexuality-free" depends on the idea that sexuality is a distinct activity that can be projected by either the patient or the health worker in thought, word or deed. Sexuality is only socially accepted when it involves mutual consent inside certain kinds of private relationships. Hence both sides agree that it is completely inappropriate in health care situations and can/should be dealt with as misconduct.

"Gender-neutral" with regard to modesty depends on the idea that potentially "undignified exposure" is only happening on the side of the patient. From the health care provider's perspective, their job is to apply their expertise to the patient's needs without the slightest reference to their own unexposed gender (otherwise it is misconduct). In other words, they are required professionally, ethically and legally to act in thought, word and deed in a role, not as a gender. From a patient's perspective, health care is inescapably personal. Physical gender, gender identitiy, sexual gender preference, and learned gender relational protocols are in one package. Still, for the patient in a health care context, physical gender is a given, gender identity is inward-looking, and sexual preference is not being projected (otherwise it is misconduct), so that the only element in play is protocol. Patients suspend or replace restrictive gender protocols to varying degrees in health care situations. At the extremes, patients may only see defined medical roles or may only see individual people doing medical tasks.

The crux of the matter then is whether a patient disassociates respect for personal dignity from their own sense of private gender/sexuality and/or from their perception of a health care provider's private gender/sexuality. If disassociated from both, then modesty is sexuality-free and gender-neutral. A patient's sense of "undignified exposure" can then be respected harmoniously from both patient and provider attitudinal perspectives. Otherwise, modesty and dignity will always be forced to the back of the bus until each individual trust relationship is constructed, Modesty disentangled from sexuality and gender is really the only solution.

...
(PS. leemac, my avitar photo over at clothesfree.com is supposed to represent looking out idealistically to the distant horizon -- my penchant, noticed here, for focusing on what should be, rather than what is -- it never occured to me that it was a photo of my backside! LOL!)

 
At Friday, April 10, 2009 8:40:00 AM, Anonymous Anonymous said...

gve, I think the web site alan and jimmy are working on will interest you.
Thanks, Dr.Bernstein. I have had family in county hospitals (sometimes the only hospital for a hundred miles) and in a county/teaching hospital affiliated with a medical school. The latter was a really well run place and offered treatments that were cutting edge.
The pilot/doctor comparison..is like a lady I used to know ..she would not fly because it might be the pilots' time and she was not going with him...If I choose a doctor I am willing to let him be a pilot in a way..if I don't like the flight...I just get off at the next stop...I do not know how to fly a jet..nor do I have the training/education to be a doctor...that is why I hire them both...
I know this is a bit off topic...but I think a depilatory is way to scary for me..besides it would take someone to put it on...wash it iff...and that would take a lot longer than clipping...it is not just exposure, but the time needed for the exposure as well.
leemac

 
At Friday, April 10, 2009 9:03:00 AM, Blogger Maurice Bernstein, M.D. said...

CSM, I couldn't write what you wrote today any better..in fact, I might had ended up more ambiguous than clear. My thanks to you for your commentaries. ..Maurice.

 
At Friday, April 10, 2009 11:04:00 AM, Blogger MER said...

I appreciate what you're saying, too, CSM, but I still don't think you're at the center of the issue. You write: "The crux of the matter then is whether a patient disassociates respect for personal dignity from their own sense of private gender/sexuality and/or from their perception of a health care provider's private gender/sexuality."

I'm not convinced no do we have any evidence that that is the crux of the matter. I don't think we really know what the crux of the matter is, and if we really did the indepth research, we'd find it would be more mixed or uncertain, I believe.

You also write: "Modesty disentangled from sexuality and gender is really the only solution." I'm not convinced there is always this entanglement. It could be sexuality. I could also be general self-worth and self-esteem issues. It could be control issues. It could be manyt things.

If a patient, let's say, has been sexual abused or assaluted, and wants a specific gender for intimate care -- is that patient required to reveal this information to the caregiver? Why should he or she have to? There are some men and women who have been sexually abused who have never even revealed this to their spouses. Why should they have to reveal this to a caregiver for a basic urological procedure, or a bed bath, or genital shaving,or an exam any other routine intimate activity?

From an academic, intellectual point of view, I find these discussions stimulating. From a practical point of view -- I don't find them useful at all, as I said in my previous post. Within the everyday world of the healthcare system, we're never going to find the time to delve into the psyche's of patients to determine why feel the way the do about modesty. I would be in favor of more studies to learn why people feel the way they do, but based upon the studies I have found, I'm concerned with why and how these studies were done. Some had so few samples that any conclusion is unfounded. Others dealt with very specific populations, didn't take age into consideration, and, as far as I can see, didn't really ask the right questions.

Asking why people feel the way they do about modesy is a little like asking the old philosphical question: Why is there something rather than nothing?

Try discussing that one over a few beers.

 
At Friday, April 10, 2009 11:06:00 AM, Anonymous TT said...

LOL, I hear what you're saying. Leemac! Fortunately a depilatory is something you can usually do yourself if need be. Remember, the recommendation is for hair removal only when necessary - which means when it would interfere with the incision or suturing, though in some limited circumstances it could apply to the post op wound dressing. We're talking an area maybe 2 inches wide & 2 inches longer than the incision. Believe it or not, the hard chitinous-like surface of body hair is actually easier to disinfect than the skin itself.

As to the comparison with the airline pilot/passenger dynamic, I agree with MER, it isn't relevant - and I'm a licensed pilot.

TT

 
At Friday, April 10, 2009 11:52:00 AM, Anonymous Anonymous said...

Please correct me if I am wrong. What I get from the post by CSM..is that the ideal situation is where patients
patients lose any sense of dignity when it comes to opposite gender caring for them medicaly. To many a great part of diginity is tied inextricably on the fact of two genders...two sex's...
Maybe so....but I don't think that that is ever going to be reflected in reality...For the many reasons already posted here.. I see inorder..the gender of a provider (it is the first thing you actually do see)..next I see what title they are supposed to have...next I try to find out their qualifications...
I admit if the first is opposite gender...it has to be a special circumstance before there is anything to consider for the next two items.
I had an MRI exam last nite...all females..they were very good and I liked them a lot...but there was no exposure of private parts (You may have noticed my typing is really bad at times) I respect these lady technicians..they were thoughfull and good at their jobs.
I would never think of letting them do a test that called for exposure though..the embarrassment to me is not worth it.
CSM, I noted that even among naturists...there was greater modesty issues for some when it came to medical things than there is in a naturist setting..
OK , I see what you are trying to represent by your picture, I do not in any way condemn your idealism...but idealistic and realistic are light years apart...
leemac

 
At Friday, April 10, 2009 11:56:00 AM, Anonymous Anonymous said...

TT,
Thank you for your input from your OR friend. All I can say is that my penis was not in the operative field (inguinal hernia) but it was cleansed. I was informed of this after the fact - NOT PRIOR!! I was told the penis and scrotal areas are cleansed because they are "dirty."

I had showered that morning. It mattered not. This was done fairly recently - several years ago. I was also shaved with a clipper by a female. All I know is that from the time I went in to the time the knife hit my skin it was 15 minutes of exposure by females of which by the way, I had not consented to.
JW

 
At Friday, April 10, 2009 1:33:00 PM, Anonymous Anonymous said...

I also appreciate CSM's comments, they really brought a spark to the thread. But, I have two main issues, and I put this very simple, my writing is pretty basic, 1. Just because you as a naturalist feel it is appropriate for you...it has no value in determining what is right for me. I and others recognize your right to live the naturalist life and apply it to other area's such as medicine...naturalist on the other hand seem the need to impose that lifestyle and practice on others. 2. I recently saw an interview with several "skinheads" and to be honest, could not help but reflect back on your posts here. I find the views of racist and semites very distasteful, that is not what I am saying, where they were similar is they are a small fragment of society, and they are convinced it is their lot in life to convince the rest of society to see the errors of their ways. Society does not embrace the naturalsit view of modesty, anymore than it does the skin heads view of race...yet, both think it is society that needs to change to fit their minority and in some way extreme views.

I also throw this question back to you Dr. Bernstein, why is it that providers, feel they have the right to declare gender nuetrality for themselves in their profession but not recognize it elsewhere in society or even society as a whole. Could not the same claim be made by janitors. Female reporters make that claim as they enter into locker rooms, but I would bet there are those who enter male locker rooms that choose female gyn's. Can you honestly say that providers would accept the arguement they use from others. Would providers accept an opposite gender plumber, who is only there to change the shower head in the locker room while they change or shower. Of course not, that would be ridiculous...but who says so. Gender nuetrality is almost always claimed by those it benefits not by those who are subjected to it. And I have heard more than one provider, perhaps even you, state they do not feel opposite gender reporters should be allowed in the locker rooms...do providers deny this is self serving.

We talk about trust, trust who, we don't know you as providers, we are shoved through the system in the shortest period possible for effiency and just becasue you have scrubs on automatically we are suppose to trust you and do something society has taught us all our lives is humiliating....I am sorry, but just becasue you are a provider doesn't mean you are instilled with a level of morality and ablity that is beyond unquestion. We should be able to trust priest without exception..but we know that isn't so. I think it is perhaps a show of some arrogance that providers think just because they are providers that patients should lose all those inhibitions that they are to have with "the rest of society". Just what makes a provider think their claim to gender nuetrality has any more validity than the plumber, the reporter or the janitor, the plumber wears a uniform and was probably went to school as well, and the plumber may even have more education than some of the "medical assistants" that are being used in hospitals today. Just becasue someone or a group thinks people should be able to dismiss their upbringing or societal condictioning...doesn't mean the should or even can. Idealism is as stated above great for dicussion...but we live in reality not idealism...If providers truely felt gender nuetral was possible or preferred they could accept it in others...but let me ask you, do providers use the same restrooms with their opposite gender co-workers, do they shower with them....of course not, so I fail to see how they could expect patients to accept them that way just becasue providers say so....alan

 
At Friday, April 10, 2009 1:45:00 PM, Anonymous TT said...

JW,

I'm truly sorry for your experience - clearly you were blind sided. This is one of those situations where they don't tell you what's going to happen, then spring it on you and take advantage of the element of surprise, and you're left with a fait accompli. I agree that just because it's the recommended standard doesn't mean that everyone is still going to automatically comply - some are going to hold out until they're forced to change simply because that's the way they always done it.

Your situation clearly illustrates the point I've been trying to make. Patients need to take steps to get the information they need to empower themselves and take back control of their medical care. Unless/until we do, it's not going to change. It's a sure bet that the health care providers aren't going to do it for us as that certainly would not be to their advantage. Unfortunately, it sometimes takes a bad experience before we will act. As the saying goes, "fool me once, shame on you - fool me twice, shame on me".

People need to get over their awe of health care professionals. What they are is highly trained consultants in the medical field that we engage to perform a service. Although some may bluster and profess otherwise, the only true power they have is that which the patient chooses to give them.

TT

 
At Friday, April 10, 2009 3:22:00 PM, Anonymous Anonymous said...

I just did some looking up about depilatory...I do not want opposite gender clipping me...but better that I do it myself....that stuff sounds like liquid plumber or oven cleaner...Now I would have two things I do not want...and will do my utmost to keep from happening...
Thanks MER, JW, TT, and Alan
I think many of us worry about being blindsided like JW was...and that has been one of the reasons for exchanging ideas here.
TT, although the analogy of pilate versus doctor may be irrelevant, would you expect a passenger to want to get off as soon as possible if they lost trust in your flying abilities?..Would you expect them to even get on the plane if they did not trust your ability...and that they would not be subjected to all kinds of wild flying antics? (for me I don't care... if I get on it is beause I have good reason to believe we are going to get to wherever in a manner and by a route that doesn't take me where I do not want to go...I figure if the pilot is confident he can do it..I don't care if he flies sideways, upside down or backwards...as long as I see the ground a good ways below.)
leemac

 
At Friday, April 10, 2009 4:56:00 PM, Anonymous Anonymous said...

TT,
If you could provide a listing of published sources regarding surgical preps I would appreciate it. I would like to read this information.

Also,thanks for your comments. You are so correct, people who are not versed on the procedures & protocols are indeed "blind-sided".

When question is raised which goes against the grain the nurses act completely "shocked" and ask: "is there a problem with that?" I think most all of us on this site would answer a very emphatic "YES" to that question. The nurses act as if this has NEVER come up before. That is hard to believe.

Alan, the true feeling female nurses have is very simplistic. They feel they have every right to do everything "no matter" if it is cross gender care based on the facts that "they are TRAINED to do this and they are PROFESSIONAL". Ask any of them and that is what you'll hear. Men are suppose to just accept them based on those principles.
JW

 
At Friday, April 10, 2009 5:03:00 PM, Anonymous Anonymous said...

" people need to get over their awe
of health care professionals.What
they are is highly trained consultants in the medical field that we engage to perform a service."

Any one that discriminates
against a gender group is not
professional! Most nurses I've
known struggled through nursing
school barely passing each course. Many physicians I know
failed organic chem and took it twice. The endo tech at the hospital was previouly worked
in housekeeping.
Highly trained dosen't mean that
mistakes won't be made and yes even
covered up. It's the moral compass
and compassion that is lacking and
the end result is a paycheck.
We are cattle being moved through
a maze in that not so glorious
process. Only when we complain and
take our business elsewhere do we
garner attention for change.


PT

 
At Friday, April 10, 2009 6:01:00 PM, Anonymous Anonymous said...

From the last few comments, it is clear that blind siding may have two co-causes...one is that not most of the powers that be do not know about folks feelings (as is oft stated by Dr.s' Bernstein and Sherman) the second is a desire to avoid the change by those who perform these blind sidings so that they do not have to adjust anything in their work lives.
You are right TT, we neeed to speak up..and let them know we do not want their procedures and policies and ignoring the effects they have on us.
I have been reading about teh FDA decided to force some unapproved drugs off of tehmarket...one a liquid morphine has been a boon to terminal patients in the home setting..so many ,including doctors objected ,that they removed it from their list...for now. How many of those terminal patients are that way because of modesty issues?....From statistics and postings and articles by doctors...a lot of men are dying because they are embarrassed to go to a doctor. I assume the same is true for women. While not all modesty issues can be resolved by one approach....not having to endure the embarrassment of some procedures...or the procdures done by a certain gender or other...would, I believe, greatly reduce the need for this morphine (There seems to be some shortage of morphine or morphine based drugs as it is. I do not know why).
leemac

 
At Friday, April 10, 2009 7:54:00 PM, Blogger CSM said...

A couple responses. My previous comment, alan, was not at all based on being a naturist. It was a personal reflection on our discussion, thinking about the difference between some of the views expressed here and what seems to be the more common view of people who, while they may similarly feel vulnerable and modest in health care situations, are not necessarily concerned about the gender of care givers.

As MER notes, if we had the research, we might find that attitudes about modesty "would be more mixed or uncertain", not just sexuality and gender, but also such things as "general self-worth and self-esteem issues", "control issues", or undisclosed experiences of having "been sexually abused or assaulted." What seems to cause this discussion to loop round'n'round is the periodic impulse to denounce sexual misconduct and demand same-gender nurses/techs. "From a practical point of view", given everyday impracticality of finding "the time to delve into the psyche's of patients to determine why feel the way the do about modesty", that is why I think sexuality and gender can only be logically handled as sub-issues of modesty.

Anyway, my reference point was less naturism than traditionalist modesty definitions like that of the Vatican Catechism which emphasizes "the dignity of persons and their solidarity" and "purification of the social climate" -- in sum, to promote pureness of heart, in contrast to "prevailing ideologies" of sexual misconduct and gender stereotyping and objectification.

 
At Friday, April 10, 2009 9:03:00 PM, Blogger Maurice Bernstein, M.D. said...

I can't defend doctors or other professionals who veer from the professional position they should be taking, but I can explain the position. Physicians and the others deal with the intimate aspects of a person who is not a family member or marriage partner in the process of taking a medical history, performing a physical exam or a procedure or nursing care either basic or technical. Because of the very concerns about behaviors (including sexual implications or simply voyeurism either of the history or the body) as discussed here, these trained individuals are taught and conditioned to accept a view of patient interest as primary and to avoid self-interest acts which could lead to misinterpretation of intent. If this view is faithfully maintained in terms of behavior then the gender of the healthcare provider is of no consequence. It takes an active demonstration and education of the patient that the patient’s interest is paramount and that the provider’s behavior will only be in that direction. I can also see that some patients will still find it is in their own interest to select the gender of the provider and for this the provider, as I have written, also must be educated. ..Maurice.

Addendum: I see after only 1 week, Volume 13 has reached 112 comments. I guess, I'll have to be looking forward toward another Volume. I presume that if there appears to be some therapeutic benefit to individuals by these Volumes and if there appears to be actions developing to mitigate the issues and the concerns then it seems that all these Volumes are worth the internet space they occupy.

 
At Friday, April 10, 2009 9:30:00 PM, Anonymous Anonymous said...

Dr.Berstein, I believe that the therapeutic value that has come from these volumes does indeed justify the space they take up. I also feel that that the education and support many of us have recieved through this blog, courtesy of your very kind efforts, could never have been found elsewhere..and has indeed helped in our feelings, understanding, and ability to do something about how we feel..rather than think we would have to go it alone...knowing that there are others with similar feelings and ways of dealing with the issue, but not having the slightest idea who to talk to..or even what to do.. Which in a very real way...would mean we were at higher risk for the need for liquid morphine when we need not be. (a reference to what I said in an earlier post) I know you started out of curiosity as to how prevalent male modesty issues were, but you have also achieved a patient education and empowerment far greater than you may realise...we got the services of a provider..that woud never have been available to us in any other venue or forum...both you and Dr. Sherman...have no idea of the positive impact you have had...or of the contributions you have made..the best examples are of those of us who simply avoided providers, but don't now..because we have an idea of how to approach them...and deal with them...in a realistic and respectful manner.
I like a quote I heard at a movie (Schindler's List).."If you save one life..you have saved the world".
If one of us gets a test or treatment that we would not have otherwise and it saves us..and I bet it happens...for many now...
Thankyou
leemac

 
At Saturday, April 11, 2009 1:10:00 AM, OpenID normaldude79 said...

I recently was ordered a stat ultrasound (here for radiology stat is within 14 days of the order) I called to make the appointment and Once all the information was given I was told that they have to get a time and date from the radiology dept as they were booked up but i was assured that the test would be done within the 14 days I then said I can come in for the test at any day or time as long as the ultrasound tech was Male. This started a long drawn out process as they did not have any male techs on payrole ever. I was then told that there is a occassional male tech from an agency only when a female tech called out sick ... I told them to schedule the test and have one of the females call out. they obviously said no and then i said just call the agency to get the male tech and of course they refused I was then asked or rather drilled as to why i was being discriminate towards female techs as all there techs were highly qualified. I told them that if it is between the needed test or a female tech doing the test I would NOT have the test done. They laughed. I eventually got transfered to another phone rep she politely said call your insurance company and see if they can out source you to another facility (the one i was talking to is the only one my insurance pays for) I did call my insurance and they were pissed ! they never asked why i wanted a male or even hinted to be a man and just let the female tech do the test. after hours of going back and forth the origional facility manager called me directly to set up an appointment with a male tech he said that he couldnt control if by chance the male tech calls out sick etc I told him that if the male tech was not there to do the test, the test would NOT be done period! he got the stern voice trying to intimidate me and said then you just have to reschedule if that happens ....

The point it i stood up for myself even though i was being treated like i wasnt a man because i dont want a female touching me . I am a healthcare worker and we do the gender request all the time without any problems if i can do it for my patients they can definatly do it for me.

 
At Saturday, April 11, 2009 2:45:00 AM, Anonymous Anonymous said...

CSM, if medical experiences should be "sexuality-free gender-neutral modesty", the doctors and nurses should be totally exposed as well. Why would the patients need to observe this but not the doctors? You know it wouldn't be "gender neutral" to the doctors and nurses if they were required to do the same things they require the patients to do.

 
At Saturday, April 11, 2009 2:55:00 AM, Anonymous Anonymous said...

"I had an MRI exam last nite...all females..they were very good and I liked them a lot...but there was no exposure of private parts", "I would never think of letting them do a test that called for exposure though..the embarrassment to me is not worth it."

Exactly how I feel leemac. I welcome friendly female nurses and techs with open arms for anything that doesn't involve nudity. For anything involving my nudity their presence is inappropriate and I would never allow it.

leemac, did you go in knowing that there was no chance of nudity? If they tried to do anything that would expose you how would you have reacted?

 
At Saturday, April 11, 2009 3:19:00 AM, Anonymous Anonymous said...

JW
"All I know is that from the time I went in to the time the knife hit my skin it was 15 minutes of exposure by females of which by the way, I had not consented to."

Did you think to object? Were you asleep through it all so you didn't have the opportunity to object? How would you react now if they tried to do the same thing? (before if you were awake or after if they didn't bother to tell you until after the fact)

Alan
Thanks for the comment on April 10, 2009 1:33:00 PM, that is an excellent question for all providers but particularly with nurses or assistants that have little if any education.

What's even more important is, how many of them have had a full background check? We're supposed to trust our sleeping body with an assistant of some kind without even knowing anything about them. Maybe one is the receptionists niece with no education hired off the street to assist the doctor with whatever they need help with. She could be a high school dropout that enjoys taking pictures of unknowing naked patients on her cell phone. How do we know she won't? How would the doctor she works for know?

 
At Saturday, April 11, 2009 7:05:00 AM, Anonymous Anonymous said...

CSM: I reread your post after I posted (the e version of speaking before you think) and realized I had interpeted it wrong first time through and meant to apologize today. I agree, one of the things that people have stated is there is no REASON for the feelings of the poseters here toward modesty, they are varied and diverse. I believe even within a single person there are multiple factors that wiegh in on why the individual feels a certain way and even those with many of the same factors put different value to each of them. If two people said religous upbringing, family socialization, and body image were the main three...it is likely when the two ranked the three, they would not rank them 1-3 in importance the same way. If we accept that premis, then which makes the most sense, simply asking the level of modesty and trying to accomodate those feelings or trying to figure out the complex and varied reason my and then trying to develop and even more complex and extensive plan on how to "convert, convince, or resocialize" that diverse group into accepting conpromised modesty and or gender nuetrality. We all have to fill out numerous forms when we go in, how about a couple of lines What if any modesty conerns do you have. Do you have any preference or concnerns on the gender of your provider, what steps would you find acceptable to make you feel comfortable in the area....follow it with a statement that while everything is not possible you will do what you can...seems a lot simpler than trying to figure out why each person is different and how to resocialize them. For me there is a seperation of sexuality to a degree from modesty...I don't feel the provider is getting any sort of sexual gratification from seeing me nude, that isn't the driver, if the provider was a 75 year old woman, I would still feel wierd being naked in front of her. If my 90 year old grandmother or neighbor walked in while I was showering I would still feel embaressed...not much sexual connotation there.

Another interesting question, someone made the statement about losing our awe for providers. Does anyone else think that actually is happening and may in fact be contributing to this issue. We are encouraged to seek a second opinion, there is a ad for a cancer center running that suggests that, my insurance company pays for second opinions. I feel there is less of a feeling that we can't question, that providers are all powerful, and I believe that is bleeding over into areas such as modesty. I witnessed a patient get up and tell the receptionist he was leaving after waiting to long, he told her...why do you all think your time is more important than mine...well its not. Could that attitude be fueling this as well...I know it does in mine....have a Happy Easter everyone.........alan

 
At Saturday, April 11, 2009 7:55:00 AM, Blogger Maurice Bernstein, M.D. said...

Leemac, you wrote: " I know you started out of curiosity as to how prevalent male modesty issues were.."
Actually, it was not particularly on male modesty but on lack of standards of how to examine a patient while attending to patient modesty. This topic started after I read the medical journal article as I note below in my introduction to the first thread
"Naked".


The problem in the American medical practice culture is that there are no strict and uniform rules regarding how to expose the patient’s body, whether or not to have a chaperone present with regard to genitalia, rectal or female breast examinations or other areas of the body and if present, who the chaperone should be.

This topic is discussed in the Perspective section of the current New England Journal of Medicine August 18, 2005 issue with the article “Naked” by Atui Gawande. M.D. Dr. Gawande is two years out of his surgical residency and has had the opportunity to talk with physicians who have practiced in other cultures around the world describing how the concern of modesty is handled in their country. He also discusses his own initial reaction about how he should examine a patient with strict attention to patient modesty such as avoiding the patient using a gown and simply or not so simply moving around the clothing. This action clearly became awkward and he resorted to gowned patients. Finally after noting the real professional problems of physician sexual misconduct but also false patient accusations due to misinterpretation, he concludes that explicit standards of what is a “normal” physical examination be set up or tightened so that both doctors and patients know and better doctor-patient relationships can be established.


The article by Dr.Gawande really wasn't directly concerned about "gender selection". Nevertheless, through these threads it appears that the need to consider patients' concern for gender selection of providers should also be considered. ..Maurice.

 
At Saturday, April 11, 2009 8:12:00 AM, Anonymous Anonymous said...

Anonymous, I knew that I would be allowed to keep my boxers on and would at least have that gown...as it turned out I got to keep even more on...at an MRI you just can't have zippers or metal items on your person.
Thanks for your clarification, Dr.Bernstein. The results still include those I wrote of above..and I think that this effort is going to have an impact establishing standards..that give modesty a bit more consideration...and that will benefit more than those of us who read/post here.
leemac

 
At Saturday, April 11, 2009 9:46:00 AM, Anonymous Anonymous said...

JW-Here;
Anon of April 11- 3:19 asking if this happened while I was out or not. Of course it happened while I was OUT! I was given a quick acting sedative like what is given for colonoscopies. Propofol. Knocks you out as soon as it hits your vein. That is when I was disrobed and prepped by females. I had been told different when I asked prior. BLIND-SIDED!!

Future: NEVER AGAIN!!!!!!!

 
At Saturday, April 11, 2009 11:16:00 AM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY APRIL 11, 2009 "PATIENT MODESTY: VOLUME 13" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 14.

 

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