Bioethics Discussion Blog: Patient Modesty: Volume 14





Saturday, April 11, 2009

Patient Modesty: Volume 14

Here we go with Volume 14 in this apparently never ending quest by patients to find solutions regarding their bodily modesty concerns and why they feel they are being ignored by healthcare providers. Specifically, they are concerned why their right to modesty and privacy is actually being violated.

PLEASE NOTE: Since there is a lot of back and forth discussion between those who write here, it would be important for clarity and continuity to identify who writes what. Therefore, each writer if desiring to remain anonymous should at least use a consistent pseudonym or initials at the end of their posting or even log on to Blogger with that pseudonym so your posting will be identified at the outset. Thank you. ..Maurice.

Graphic: The Unconscious Patient. A photograph from Auckland District Health Board, New Zealand and modified by myself using Picasa 3.



At Saturday, April 11, 2009 12:21:00 PM, Blogger MER said...

Despite my comment that I find the theoritical aspects of why patients feel modesty in medical situations almost useless -- despite that, I want to make it clear that I find this blog extremely useful. I think it's most useful in giving patients strategies to deal with this issue when confronted with it. We can learn from each other.

I want to also ackowledge how frustrating Dr. Bernstein must feel sometimes, knowing that he is trying his best to teach his students how to deal with modesty ethically -- yet knowing that this may not be happening or being taught as well in other medical schools. Dr. Bernstein started this blog with an article that commented on the lack of medical standards in examining bodies. Maybe there needs to be more standards in medical education, but I'm not familiar with what the standards are now.

Ultimately, we can begin to solve this problem by facing it on on individual basis. We can form groups, which is fine, but as individiuals confront this issue one on one and politely and firmly stand their ground, things will begin to change.

Having said that, I want to respond to normaldude79's comments in the previous volume. Remember, he was given the run-around when he requested a male tech for an ultrasound.

I think it extremely important in situations like this that people like normaldude79 write a letter describing this unethical treatment and send copies to several parties. This is what it means to advocate for this issue. Make the incident public. Get it in writing. But don't rant. Just describe what happened as objectively as possible. Make sure enough people get copies of the letter so the clinic or hospital involved won't feel comfortable just filing the letter and forgetting about it. The last time I wrote a letter similar to that, I got a phone call from the clinic with hours of their receipt of the letter apologizing and granting accommodation.

No patient should be intimidated and given the run around like that. This is where honesty comes in. If the clinic were honest, it would just refuse to take the patient and say we won't do what you request. Go somewhere else. What they're doing instead is trying to wear the patient down using intimidation and delaying tactics. Whether it's true or not, it makes you wonder whether they're just interested in the money.

And I'll repeat something I've said in past posts because I think it's important. I know some on this blog will disagree. Most female nurses and even most cna's and assistants are our allies. They may forget sometimes in the routine of their work, but they know how it feels to be treated poorly regarding modesty.

I recenty read a comment by an army medic who did military induction exams during and shortly after Vietnam War. He said that initially there was a mix of male and female medics and the men felt extremely embarrassed being naked in front of the females. He said this bothered the female medics most and they were the ones who complained and got the procedure changed so the men's modesty was respected.

Don't write off female nurses, cna's and medical assistants. They have husbands and sons and fathers. They want them respected. If we approach the vast majority of them with respect and dignity, they will respond in kind.

At Saturday, April 11, 2009 4:50:00 PM, Anonymous Anonymous said...

Hi ~ the 77 yr. old is back ~ well, I went for the ultrasound Wednesday ~and this is the way it went.
For my 10am ultrasound, I had to drink 32 oz. of water between 8 & 9am.
While sitting in the office of my urologist at the "other" office, the receptionist told me to tell her when I felt an 'urgency'.
A half hour later I told her - she told the nurse - the nurse called me in. Now here I am getting upset with her being there because the urologist said 'he' was going to do the ultrsound.
The nurse said, "Mr. _____, if you will please sit over here on the table ~ the doctor will be in shortly. (wow, with a deep sigh of relief, I thought I was going to walk out again if she was going to do the ultrasound ~ yes, even w/an ultrasound). She left and didn't return.
The doctor came in - 'he' did the ultrasound - short discussion - it was over - he didn't bring up anything - and there I was, a very happy comfortable patient.
Now, replying to 'M' in his/her previous
post when I said, "I didn't care who saw what", it was because I was under general anesthesia - and I was shave in the OR under general anesthesia because I was totally 'out' when the anesthesiologist came out to pre-op and said he was going to give me 'something to relax me' ~ and the lights went out, and I was wheeled into the OR.
After that, having 112 seed implants, I had 5 weeks of radiation at the hospital - at times, while there, at my request ~ a male nurse did my ultrasounds.
And yes ~ by tying in 'caps' previously about that coercive 'nurse' that 'ambushed me about the cysto she was going to prep me for with a Foley catheter, you can tell how outraged I was. Particulrly since the doctor never explained or gave me a clue as to what a 'cysto' was - and that 'he' was going to do it.
The first words out of her mouth was, "First I want you to cover here and sit on the table, and then am going to insert a catheter into your penis - - ". - to which I responded loudly and angry, I am not comfortable with this!" - It took 3 times to tell that idiot that, & she still didn't get the message - to go get the doctor, that she has a very uncomfortable patient - and I walked out. The thing is, in reading this, you cannot realize the tone of her voice when she was 'dictating' to me - 'to assert 'control' - glaring at me with total disrespect - to have this 'old man' submit to her so she can get on with her 'job'.
If it were a male nurse, I wouldn't be here writing about it.
And now I have to say - - I have learned an awful lot about those "professional" (they call themselves) nurses by reading so many posts here in allnurses and ultimate nurse - and their disrespectful, disingenuous remarks about male patients (male whiners they call us) and their their private parts. Curious though, I didn't see any of the same remarks about female patients ~ well, not as many shall I say.
Hereafter, if any doctor wants me to have any exam or procedure - I will make it very clear that I will never be subjected to anything that has to do with a female nurse officiating in any way - I will never again be so humiliated.
I must add as well, that their are very decent nurses out there that are "very professional and respectful" and they do respect male modesty.
Last but not least ~ my sincerest gratitude to Dr. Maurice Bernstein for enabling me to post here and express my views about male modesty ~ until I started reading here, when I first found this blog by the doctor, I would never have believed any other male had the same feelings in many ways that I have.
Thank you so very much Dr. Bernstein ~ for giving all of us this opportunity ~ Dan

At Saturday, April 11, 2009 5:29:00 PM, Anonymous Anonymous said...

Thanks for telling us the rest of you experience, Dan
I agree MER. I do think most providers are going to respond to civility and respectfulness by returning the same...But look how hard it can be to the health professionals to comment here...Dr.s Berstein and Sherman excepted...I am not sure many want to get involved to any extent...and will help in individual situations..if it is convenient and fits their feelings..How do you think we should respond then? If we are confronted with one who doesn't care...

At Saturday, April 11, 2009 5:56:00 PM, Anonymous Anonymous said...


The rules regarding military physicals were only changed in 2003
regarding usmepcom. These rules only pertained to cross gender
observers which always involved
females viewing males.
Females recruit exams were always carried out in private
rooms. The complaints came exclusively from male recruits over the years. I should know, I
was one of them!
If you visit usmepcom rules
regarding induction physicals females are allowed only if directly involved in the exam
I've written off female nurses,
cna's and techs a log time ago.


At Saturday, April 11, 2009 6:16:00 PM, Anonymous Anonymous said...

I too find it comforting to know that other men feel as I do. that said, I don't really comprehend how Dan can feel so strongly regarding not having a female insert the foley cath in his penis when he is awake and NOT care about the female who shaved him and handled his penis when he was sleeping. Makes no sense to me. One in the same in my book. Female/penis same deal

At Saturday, April 11, 2009 6:55:00 PM, Anonymous Anonymous said...

Maurice, there was a study I came across, which I cannot find the link to now, that found patients spent more time discussing issues with their doctor when they were of the same sex. Males spent more time with male doctors, females with female doctors. For men this must be an especially good thing as we know how much they hate going to the doctor. I thought we could discuss this issue a bit more as we've done nakedness to death and not really discussed discussing private issues with providers of the opposite sex. I thought about this because a few months ago my male doctor brought
up my periods. He was completely comfortable talking about it but I wasn't. I wasn't blushing embarrassed, but would I have preferred to talk to a female doctor about it. I'm not saying he has to experience it to know about it, but to me it is a sort of female camaraderie issue. It's hard to explain, but it really feels like an intrusion of my privacy when a doctor brings up something personal that I did not plan on discussing.

At Saturday, April 11, 2009 7:28:00 PM, Anonymous Anonymous said...

JW - I have the same right a female has - would your post be the same remarks if it I were a 'female', or Dan was 'Diana' - I think not!
First of all, I don't know if it was a male or female nurse that shaved me while under general anesthesia - and you sound like one of those insensitive "professionals" I mentioned above. If I had a "professional nurse" like you trying to give me a catheter in the hospital just by boldly walking in and saying 'I am going to insert a catheter' without asking, I would charge you with sexual assault - that's how strongly I feel about it! But then, there 'is' a minority like you out there who think a patient is just a piece of meat. And you consider a 'female/male' as the "same thing"??? NO, not the "same thing" at all when it comes to a patients rights"!!! You try to make it so trivial - I would expect your kind of comment in allnurses where I've read similar disrespectful remarks about male patients.

At Saturday, April 11, 2009 8:55:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, good suggestion..but not for these series of threads on patient bodily modesty. I think it is important to continue this subject here until a consensus of the visitors claims that everything that is need to be said has been said and that there is no further value to additional discussion. I am not sure that the time has as yet come.

Nevertheless, the issue you raise of modesty issues related to physician history taking is certainly an appropriate issue. I started to cover the matter on a thread back on March 2 2006 titled "Invasion of Patient Privacy, Physical and Historical: Are Doctors Unaware?"

Nevertheless, I think that the issue of modesty you raise is very important since without disclosing some very personal information, proper diagnosis can be delayed or entirely missed to the possible harm of the patient. And yet patients have very good reasons to avoid communicating this personal information to the physician. I think I will call the new thread "Things I Don't Want to Tell My Doctor and Things My Doctor Shouldn't Have Asked!" That title should cover modesty and other reasons. What do you think? But let's keep discussions on this for the new thread. ..Maurice.

At Saturday, April 11, 2009 9:58:00 PM, Blogger Maurice Bernstein, M.D. said...

LH and other visitors here, "Things I Don't Want to Tell My Doctor and Things My Doctor Shouldn't Have Asked!" is up and here is the link. ..Maurice.

At Saturday, April 11, 2009 10:40:00 PM, Blogger MER said...

To LH and others:

See the book "Doctors Talking to Patients, Patients Talking to Doctors" by Judith Hall, et. al. I recall reading in that book studies that showed that female doctors spend more time with their female patients than with their male patients; and male doctors spend more time with their male patients than with their female patients. There's other gender related information in that book about how doctors and patients communicate.

At Saturday, April 11, 2009 11:42:00 PM, Blogger CSM said...

Having participated through four volumes here and with warm weather approaching, it is time for me to retire and refocus my "provocateur" energy on some upcoming naturist things. In departing, I just wanted to thank everyone for patiently listening to my antipodal views. For me, my body is the vehicle that my soul rides around in as it moves about the world. So I like to keep my body healthy and tuned up, The doctor's office is where I go to get tests and repairs done that I can't do myself. It's that simple for me. I really don't care which mechanic sees or works on my carburetor as long as everything ends up running well. At the same time, I empathize with anyone facing social or systemic pressures to conform to someone else's views or norms. So I sincerely hope that your continuing discussion leads to a happy modus operandi that allows health care to be at its best while fully respecting patients' diversity, including concerns about modesty.

At Sunday, April 12, 2009 1:16:00 AM, Anonymous Anonymous said...

I can relate to what Dan is saying about being unconscious and comfortable or conscious and not comfortable. I have gone through IVF. I chose a female fertility specialist for modesty reasons. She did the first egg retrieval for me which wasn't successful. For my second cycle, I didn't know it, but my specialist rotates with a male specialist. So I think the day before the operation, I found out a male doctor was going to do the egg retrieval. Although I was very apprehensive about it, I wasn't going to refuse because of modesty issues as that would be a waste of a cycle. The procedure is done under GA and although I have a fair idea of what happened, it is hard to comprehend that it actually happened to me, so I do not really have any embarrassment about it.

At Sunday, April 12, 2009 3:58:00 AM, Anonymous Anonymous said...

Someone 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."

I agree completely but I interpret it differently. People do need to get over their awe of health care professionals, but what they need to remember is that health care professionals are human and the only difference between them and everyone else is their education and their occupation. They are not gods and we don't have to treat them like they are.

Some are highly trained and others have little or no education or training. If they are true professionals and are highly trained they should be able to adapt their methods needed to "engage to perform a service". Patient participation is crucial to produce the best outcome possible. During an actual surgery the surgeon, scrub nurse, etc don't need the unconscious patients help to do their jobs but in every other aspect of the treatment the patients and the medical "professionals" need to work together and communicate well. If the patients and the "professionals" are constantly clashing because of modesty, ego, disrespect or other problems the best possible outcome won't be achieved. Even if the patient keeps his mouth shut and does what the professionals order him to do there will be problems, particularly with the communication. An intimidated or uncomfortable patient may not be honest with his feelings or answering questions because he may feel that if he says anything it might make the medical person angry or it might prolong his miserable experience. If he's uncomfortable he might not trust the medical person or is too embarrassed to divulge something important. He might also not bother to return for follow ups or even seek medical help in the future.

I don't believe compassion can be taught by going to school for a year or two. A person is either compassionate and understanding or he/she is not. I find it difficult to believe that all "uncompassionate", disrespectful and impatient students are filtered out before entering the medical field and all that do enter it have all of these important characteristics. For anyone to say that all medical people are "professionals" seems ludicrous to me. I don't believe that gender-neutrality can be taught either and that all "professionals" think that way.


At Sunday, April 12, 2009 4:35:00 AM, Anonymous Anonymous said...

Anon-Sat -April 11:
You obviously read my post wrong.
I do NOT want female nurses tending to intimate genital care!
Your rant is NOT my opinion.

At Sunday, April 12, 2009 7:01:00 AM, Anonymous Anonymous said...

Bravo normaldude79!!! Even if those medical "professionals" threw temper tantrums, belittled you and forced you to go through hell to get an appointment you as the patient should expect to have arranged for you, your plea for fair and ethical treatment will be engraved in their minds. The next time someone who wants to be treated fairly does what you did they'll remember him, and you. After a while maybe they'll get the message. Although I imagine that everytime anyone else demands the same fair treatment they'll act surprised and tell him it has never happened before.

"Future: NEVER AGAIN!!!!!!!"

It's great that you learned your lesson about trusting Medical "Professionals" and are now educating some of us through your experience. Now many others will know what questions to ask and what preparations to take so we hopefully won't get blind-sided our first time around. Thanks for the info.

It's just as TT quoted, "fool me once, shame on you - fool me twice, shame on me".


At Sunday, April 12, 2009 7:18:00 AM, Anonymous Anonymous said...

Dan - Proof-positive that things will change for the better if we stick up for ourselves. Everytime someone else repeats your performance the more and more they'll get used to it and it will someday be the standard. Great job Dan!

At Sunday, April 12, 2009 11:10:00 AM, Anonymous Anonymous said...

Right now we can encourage a lot of the money for retraining under the stimulus to get a lot more male nurses, cna's , and techs (ie sonogram/x-ray) into the field..
I hope CSM has a great summer...and appreciate his best wishes.

At Sunday, April 12, 2009 12:50:00 PM, Anonymous Anonymous said...

Dr. Bernstien, Dr. Sherman, I am really interested in how providers feel about the ligitimacy of other professions who claim gender nuetrality. Female reporters for example, massage technicians, do they feel their claim to gender nuetrality has the same ligitiamacy. As stated this is a great place to learn from each other and get a glimspe at both sides. I asked half jesting, but it does bring the point, providers want us to see them as gender nuetral, yet......I would guess many would not accept that in other areas of society if others compromised their modesty for the same reasons they stake claim to this position...efficency, training, just doing their jobs etc. So in all seriousness, why do you think providers feel justified in claiming this right...a self proclaimed right..that they do not exptend to they feel medicine is at a higher plain...and so are it staff?

So great advice above, if you want to get results, CC several people with a complaint...or a compliment, a department can ignore, if they think the patient advocate or business side of the hospital knows....I discussed the concept from My Angels are Come that there are two sides to a facility, the business and the care giving....if the business side finds out the caregiver side just blew off a couple grand in revenue becasue they didn't want to accomodate...might get attention.

And like someone said, we are all so different which is why trying to resocialize patients to accept won't work. While I would prefer an all male team, if I am out, especially if I never have to see the providers involved, what happens while I am out has much less impact on me, I can easily dismiss what MIGHT have happened and from who,,,,but when I am awake, I KNOW what happen and it is the emotion of that momment as well as the memory of what happen that sticks in my mind and keeps haunting me.....don't ask me why, its just the way it is.......alan

At Sunday, April 12, 2009 5:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, speaking for physicians as a physician and teacher of physicians-to-be, society has given all licensed physicians a legal permission (I'm not calling it a "right" since I am not sure that is the right word) to examine another person's body of either gender and the examination may involve examining sexually or modesty sensitive areas. This can be done with the patient's permission. Others in the healthcare team can also perform their approved activities on a patient's body. If all of us do this in a manner society has allowed us to act, we cannot be subject to any legal harm for these acts. To perform these acts without any implication of sexual self-interest we must assume a non-sexual, non-gender stance and if that means we are at the time of the act "gender neutral" than that is what we are. When we are examining or treating the patient's body we are not to act cozy, "lovey dovey" or in a familiar manner. Our aim is, as I have said in the past, to attempt to complete a task for the interest of the patient and not for the physician's self-interest. If this is done, then I am sure that society will be satisfied by our behavior.

With regard to other workers who may view or interact with individuals whose bodies are exposed, I am not aware of what guidelines they are given by society but certainly permission by the patient is part of the rules. ..Maurice.

At Sunday, April 12, 2009 5:47:00 PM, Anonymous Anonymous said...

Maurice, I don't that society has given doctors permission to examine patients intimate areas. If you look at the history of medicine, from what I understand, doctors gave themselves carte blanche to do whatever they liked with patients' bodies. They acted as if they owned another person's body, especially women's bodies. Remember one hundred years ago, the average person was not well educated so a doctor could exert a lot of power. I think we a still living with the carry over effects of that attitude. And if society starts asserting itself more, doctors will find themselves with even less access to our bodies.

At Sunday, April 12, 2009 6:30:00 PM, Blogger Maurice Bernstein, M.D. said...

When the licensing of physicians was introduced that represented society's grant of permission. If society is not satisfied with the way current physicians practice medicine, society has the power to make changes. ..Maurice.

At Sunday, April 12, 2009 7:32:00 PM, Anonymous Anonymous said... in standardising modesty issues and treatment..As to many of the other concerns listed here either a)They are also issues for instituions to deal with..such as what tests are of value..the same for treatments..and I think medicine is in a continual state of flux...making changes they are confident need change. b)they are more of a law enforcement issue.
I do not see a need for change in licensing procedures.And as has been stated by many here..the practice of medicine has responsibilites found no where else and as such society has recognised that providers must also be granted permission to do things (in a medical vs, sexual vs, criminal way)that no one else is allowed to..
I think the thrust is on how they perform these tasks..not that they should be banned from them out of hand...if that were the case..I would do just as well to go to a curandera or medicine man.
I do not wish to tar anyone with a brush they do not deserve. So I hate to make blanket statements concerning all providers..for what a few do...We have come a long way..and no longer have our barbers let the ill humors out by bleeding us...I don't want to return to tht era...I want a provider who is competent..I just think that a great part of in respecting my feelings.

At Sunday, April 12, 2009 7:55:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac, I would say that the way for the physicians to respect your feelings is:

1) Patients should make their feelings known to the physician.
2) The physician should be given more time to spend with each patient. That means, instead of seeing more patients in a given length of time, the doctor should see less but NOT paid less for that work.
3)With the added time to listen to the patient, physicians should be now educated to the issues patients are most concerned. In my experience with first and second year students, I don't see that "what are the patients concerns that need to be attended listened for and attended to" being stressed. I am not sure it is even being covered in the later years. Yes, we do talk about modesty but in a very general way and not the specific issues that have been brought up on these modesty threads.

I am sure that if physicians had the time, had the education and had the direct input from the patients, much of what is now felt as physicians ignoring the patient would be resolved.

Most doctors want to do good for their patients and if they could do even better I am sure most would try. But the odds, not necessarily originated by the doctors, seem at times against them doing better. ..Maurice.

At Sunday, April 12, 2009 8:43:00 PM, Anonymous TT said...


I'm the one that posted the comment about "patients getting over their awe". I have no arguments with your subsequent comments - guess I should have been a little clearer. When I refer to "health care professionals" I am referring to licensed professionals such as doctors, nurses and PA's that have completed a formal degree program from an accredited education institution and have passed state regulated licensing exams to verify their knowledge and skills. I don't include MA's, PCT's, aides, etc. in this definition.

The point I was trying to make is exactly what you stated - they are not gods, and people need to quit treating them like they are. They are just ordinary people with a specific type of training, and they put their pants on the same way as the rest of us - one leg at a time. A significant number of doctors buy into it as well - it's called a demigod complex. And it's not just doctors - I've encountered a nurse or two with the same attitude. If you ever encounter one of these, don't walk but RUN away from them as fast as you can!

It's an old joke, but fits the topic:
Do you know the difference between God and a doctor?........God knows he's not a doctor!


At Sunday, April 12, 2009 9:14:00 PM, Anonymous Anonymous said...

Did society give medical students permission to practice pelvic exams on unconscious women without their knowledge? Did society allow medical students to watch women giving birth without their consent? No. Society is us and the women I have spoken re these issues did not agree to these practices. So who gave them permission? This area probably does not fall under licensing of physicians, as we're talking about students here but it set the tone of our future doctor's attitude of respecting the patient.

At Sunday, April 12, 2009 9:32:00 PM, Anonymous Anonymous said...

I agree with all you said, DR.Bernstein. The family practice my mom goes to was purchased by a large health the doctors have to see two or three times as many patients as they used to in a day..and the doctors are not happy with it..but I guess a private practice takes a lot of money..and can not offer services a network can...a benefit that is also a detriment..
Communication between provider and patient is an issue...and if the provider is taught to listen to and address them..AND the patient will speak up in a civil manner I think most misunderstandings and hurt feelings can be avoided...
A lack of communication seems to be a real bugabear,,and seems to come from many comment about not wanting to return to barber that I don't want such an upheaval in regulation that physicians flee altogether..I just want to tweak (fine tune) where things can be changed for the better...and maybe that means also finding a either talk fast and hope my PCP is a speed listener or helping find a way to get him more time with me...
I guess I have been lucky and so has my family...I do not think we have ever had to deal with a doctor who did not make us think that he did not want to do his best by us. That includes the one who told me when I was teen that teenagers gave him a bellyache (he was real angry with his son who I went to school with)..even then I had no doubt he was going to do is best by me.
Maybe if we could figure out how to get the efficiency experts out of medicine and make private practice (patient load) less onerous and expensive the odds would be better for the docs and patients.

At Sunday, April 12, 2009 10:05:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, it all has to do with "implied consent" and I know, I know that the so-called "implied consent" has been abused especially in the aspect of pelvic exams by students. There has been recent recognition of this abuse and obtaining permission of the patient is now more frequently carried out. However, it should be known by all patients when they enter a "teaching hospital" (where students, interns and residents practice) that on admission there is automatic consent (fine print of admitting forms) but that patients have the opportunity to opt out in certain circumstances. Unfortunately, if a patient wants to be treated in some hospitals there is no opting out since a resident and intern may be the only physicians present to provide hour by hour care for the patient. The attending physician teaching and supervising the resident/intern may appear only once a day and most of the workup and care is done by the resident or intern. ..Maurice.

At Monday, April 13, 2009 3:58:00 AM, Anonymous Anonymous said...

Alan's post of Sunday April 12 12:50 pm..states he's not as upset with cross gender care if he is "out" because he can dismiss what MIGHT have happened and from who... but when awake I know what happened. The problem I see with that statement is that if you are truthful with yourself YOU DO KNOW what happened when "out". You know you were completely naked and viewed and handled by females, you know you were cathed if you came out of surgery with a urinary catheter, you know you were shaved if you come out of surgery with pubic hair gone, you know your surgical site was cleaned up and dressing (exposed again). If you receive your medical/surgical file you know the names of those persons who performed these duties in the OR and most times you actually see and speak with the circulating nurse prior (so you see the person who has done this). So basically you or anyone else is pretending and not admitting that this actually makes them feel better? It is not reality if you can say because you weren't awake therefore you don't know. YOu can picture all of this in your mind and the truth is it really isn't different then if you were awake and staring at the ceiling and lights during the whole process.

At Monday, April 13, 2009 4:52:00 AM, Anonymous Anonymous said...

I guess I am a little slow on the uptake sometimes. I think this discussion occured at a level that went right over my head. I can remove the sexual content from the exam, the environment-circumstances allows me to do so, So I assume I see this as sexually nuetral, however, the gender is right there, there is no way to dismiss that, the provider is male, or female period. That is impossible for me to dismiss as I know they may be able to act a certain way, but there is no way they can not be female or male, there is no way they can not see themselves in this manner. Much in the manner in which we see say younger or very old people. I do not see them in a sexual context in any way, but I still see them as male or female.....and I guess my quesion which would be impossible for you to answer for others I they recognize that while they can do everything they can...the patient in most cases is unable to see them as genderless much to the extent that they do not see other people doing their job as genderless, and when we see gender...we automatically can not see them as gender nuetral, when a nurse wears earings, make up, prepares to come to work...does she do so thinking she is gender nuetral or wants to portray herself like that, do they understand that if they do not, can not see themselves as being gender nuetral all day long...that it is impossible for patients to do so....

I agree with you 100% Dr Bernstein, medicine has gone from the family practice where the Dr. controlled the ship to a business where profit demands drive numbers and efficency and the patient and the doctor have both become a little less in the equation. I think perhaps the system needs to recognize this and get out of the box a little, as stated, we all fill out tons of paper work going in, hospitals and facilities chart everything, the chart travesl with you...if the provider/facility is truely interested in treating the whole person.....wouldn't it make sense at this point to ask a few questions and note that....something as general as "Do you have any special concerns or requests". I know from previous discussion there was concern about putting the thought in paitents minds by asking specifically about the gender of the provider...which I still say is weak compared to the benefit to patients who care but are to intimidated to say anything....something that could give a little insight to the patients personality without taking to much time for the provider. I know with growing shortage of Dr.'s it isn't going to get better, so maybe it's time to look at alternatives.....

The increase of the numbers, 125 in a week would lead one to believe this hasn't run it's course...just wish we could get more providers...though it would be intimidating ....alan

At Monday, April 13, 2009 5:42:00 AM, Anonymous Anonymous said...

"society has given all licensed physicians a legal permission..... to examine another person's body of either gender and the examination may involve examining sexually or modesty sensitive areas."

I don't recal voting in that election. I certainly would have voted against it if I had participated.

At Monday, April 13, 2009 5:48:00 AM, Anonymous Anonymous said...

You're right, I didn't understand you completely. Thanks for clearing that up. It seems we agree on many points.

(Great joke. I'm still laughing)


At Monday, April 13, 2009 8:17:00 AM, Blogger Maurice Bernstein, M.D. said...

To Anonymous from today who wrote: "I don't recal voting in that election. I certainly would have voted against it if I had participated." You probably voted for officials who were elected and who following the "will of the people" developed and established and activated licensing procedures and boards which set the standards for what physicians are allowed to do and what they are not. That is the democratic system for the way society can set their own standards of behavior for a profession or other occupation. ..Maurice.

At Monday, April 13, 2009 12:14:00 PM, Anonymous Anonymous said...

It is interesting that many of you men think that women's requests for "all female" staff is respected. I requested and "all female" staff for a mastectomy, GYN surgery, and colonoscopy, every time my requests were grossly violated. Not only were males involved in very intimate and violent care, but I was left alone with males while sedated. I now have and STD the my husband of over 20 years does not have. This after I suffered unexplained physical trauma and pain post a procedure, and then started having break outs in the pattern of a new infection.
You all call the women pervs, I think they are disrespectful, but few are rapists like many men can be given the right opportunities. This is women's risk, and given violations of their female staff request in the context of a rape culture, perhaps their fate.

At Monday, April 13, 2009 2:56:00 PM, Anonymous Anonymous said...

I truely think the instance of abuse and mistreatment is something that is another thread all together. I do not think for the vast majority abuse or even misconduct is the issue. When it happens it is tragic and deserves the most severe consequences. The hate women hate men thread has a whole different problem.

The concept of society giving permission I understand and agree completely. By necesity we are going to have to accept a certain amount of this or make the decision to put our health at risk, still our choice but we do give providers leeway legally and to a degree morally/socially. However, what I see happening is what often happens from a legal and social context, that is medical providers are expanding the needed to the convienent. Where they used to provider male orderlies, they replaced them with
female nurses to cut staffing and costs...that was by the providers for the providers. Female reporters sued under equal opportunities now the locker rooms include female camera people and even female assistants to the reporters.....that is the issue. Likewise, I would think that those who by choice of profession are given priveledge, and it is a priveledge, to invade a presons modesty would be more accepting of others doing the same to them...but from what I read, that does not seem to be the in point the female urologist who called a patient sexist for not wanting her becasue she was female but openly admitted she purposly chose a female gyn...and seemed to not recognize the hypocracy. Likewise I assume they would not accept an opposite gender janitor yet assume we should easily accept them. That is the issue to me, that there seems to be a lack of recognition of the concerns of patients when in reality the providers often have the same concerns for themselves....alan

At Monday, April 13, 2009 4:03:00 PM, Anonymous Anonymous said...

You bring up the example of the female urologist, but there a also many, many examples of male gynecologists guilty of the same. The point is health providers whether male or female are hypocrites re gender issues.

At Monday, April 13, 2009 4:36:00 PM, Anonymous Anonymous said...

Many years ago while working at a
hospital a 19 y/o female clerk
working in my department told me
that during her 5 minute employment
physical, her breasts were examined
by the male physician.
I don't remember any of the specifics on why we touched on that
subject but recall her being a little upset that her breasts had
to be examined. Let me put this into a little better perspective.
The human body has miles and miles of vascular, lymphatic and
neural plumbing. It has 100's of
muscle groups,bones and numerous organs capable of complex
biochemical interactions.
Today much is still unknown at
the molecular level. Yet, in a 5
min physical exam the breasts of
a 19 y/o woman had to be examined
just so this young woman could work
as a clerk in a hospital.
Furthermore, I'll fast forward a
few years later and I find myself
at a major level 1 trauma center
about to recieve an employment physical. In walks an older, short
female nurse with enough makeup
on her face to shame "Homie the
clown". She hands me a pamphlet to
read through. In this pamphlet among other questions is this one
question that says," do you want
the nurse to examine your penis."
In all the little box's I marked
no and handed it back to her. She
stood there looming over me with this somewhat angry look as she
looked through the pamphlet.
Why at that moment of that day
would someone think that I would
need to have my penis looked at.I
use it to void 4 or 5 times a day
and shower 2,3 times a day. Wouldn't you think I'd know if something was wrong with it. I
hope most have a clue as to why we
are really discussing these issues.


At Monday, April 13, 2009 11:20:00 PM, Anonymous Anonymous said...

Maurice, I think this is a great letter regarding modesty, written by SB.
I don't know if you want to copy it or just give the link.

At Tuesday, April 14, 2009 4:48:00 AM, Anonymous Anonymous said...

Responding to alan's post of April 12th 12:50, I would like to add my 2 cents. I personally think when people say they are more comfortable and accepting of what went on to their person while asleep rather than being aware ARE IN DENIAL. You absolutely are kidding yourself. When you come out of surgery you know you were disrobed, exposed, handled by female nurses. You know your were shaved if you come out with no pubic hair, you know you were cathed if you come out with a tube in your penis, you know you were exposed, cleansed, wound dressed, re-dressed with a gown. YOu know all of this and yet you can say because you didn't see it therefore it didn't exist and happen? Come on. DENIAL.

At Tuesday, April 14, 2009 5:31:00 AM, Anonymous Anonymous said...

LH, I used the example of the female urologist becasues it was one that was examined on this blog so some people here are familiar with the blog. She actually blogged the issue and put it into writing. Of course the issue crosses gender lines. The examples I used were not intended to indicate is was a male only issue. I use the female reporter example as it is the most obvious example where legally opposite gender "professionals" are given permission to enter the opposite gender's "modesty space". I have also posted a conversation I overheard where a Doctor was talking about how humiliating it was to have an emergency appendectomy at the hospital he worked at. This is not a male-female issue, there are special challenges that each face that is unique to that gender, but the issue as a whole is the same and would cure the unique aspects each gender faces if it were addressed. Providers not recognizing they are being hypocrits when they expect patients to see them as gender nuetral when they do not see themselves that way when they are patients is universal. The dispairity in the gender make up of providers is unique to males. Pelvic exams, pregnancy, etc are unique to females, etc etc. .....trying to make this a male or female thing does nothing for patients, however, we can not ignore that there are issues that are unique to the gender and recognizing them is part of fixing the larger problem. I do not think this is strictly a problem for males, I think it is equally problematic whether it happens to a male or female, hope that clears up my post..........alan

At Tuesday, April 14, 2009 12:12:00 PM, Anonymous Anonymous said...


When you had your employment physical you said "She hands me a pamphlet to read through. In this pamphlet among other questions is this one question that says," do you want the nurse to examine your penis."

Did they give you a choice about which parts of the examination you wanted and those that you didn't? Was she asking whether you wanted her to look at it instead of the doctor? It would sure be nice if we had the opportunity to refuse certain parts of the exam (I'm being sincere, not sarcastic).

To Dan

Have you refused to have female doctors, nurses or techs check out you nudity throughout your life or just recently?

At Tuesday, April 14, 2009 4:14:00 PM, Anonymous Anonymous said...

Alan, I have actually read the source of the male encounter with the female urologist and she does not call him sexist. Her only complaint is that she found the way he objected rude.

At Tuesday, April 14, 2009 7:38:00 PM, Anonymous Anonymous said...

To anonymous poster regarding questions pertaining to my employment physical. That employee
health department did not have a
physician on staff, only a pa(physician assistant). On that
particular day he was male. Yet
the nurse (the one with hyper
make-up) was the one wanting to
do all the examining.
The exam part was optional,however, it was odd to me
that there was a male pa there. In
retaliation when she drew my blood
she was so forceful that she gave me a huge hemotoma in my arm. I
have brachial arteries that any
plebotomist would die for and as
such I knew it was intentional.
She went and got the pa to look
and it. The result of this refusal
was that I had to sit there with an
ice pack on my arm. You have to
watch out for these people, its


At Wednesday, April 15, 2009 1:13:00 AM, Anonymous Anonymous said...


CORRECTION, the female Urologist titled her Blog, "Sexism at its best"

At Wednesday, April 15, 2009 5:13:00 AM, Anonymous Anonymous said...

I am not in denial, I don't think they magically wave a wand and all of this stuff happened. Of course people did that, and I have no doubt that they were most likely female, if not female there were females assisting. What I and others such as the 77 year old seem to feel is the intensity of knowing what happened, and not seeing the proceedure or the people, is less intense for us than looking them in the eye and watching who does what. I feel like when I am out I am less of a person and more of a patient or breathing body void of what makes use people...personality. My point was, and this exchange emphasises that, this is and individual issue, we all feel differently about it. I am not in denial at all, I fully understand what is going on, but not seeing them or it happen, makes it more acceptable for ME. Evidently its more of a problem for you...but, that is you, not me.

LH the female urologist (you can get the link on Dr. Sherman's site, under we are all professionals), titles the post "Sexism at its Best". While she cites the rudeness, she says have you ever heard of a female acting this way, she refers to the percentage of females graduating from medical school. She talks about being frustrated by another patient who would not let her take care of him in the ER., of course it was about sexism. And, I stand by my contention that providers, including her, who have these same preferences, choose their providers by gender, and ask or accept special accomodations for their modesty when they are patients while expecting their patients just to accept them as gender nuetral are hypocrits. Doesn't make them terrible people, incompetent, or anything else. They may not even recognize this, we all have those quirks, if I had a dollar for everytime I told my kids to do somthing or not do something that I did or didn't do...but then this just my opinion, doesn't make it right.

Back who gave providers the right...I think Dr. Bernstein stated society did give providers the right. It is the application or expansion of that right that I feel is questionable. I happened to catch a show called the Dr. yesterday, noon type show with "real Doctors". They were doing a no needle vasectomy on a guy. They had a drape that hid his privates from the camera. There was a female nurse standing there...and the whole time all she did was stand there. The only thing she did was help him sit up it was over. I have cited here before about three guys getting vasectomies (one was me), two doctors, my doctor did mine without a nurse, the other did one with and one without. I think there is no doubt legally and socially we have given permission to the medical community, the problem is I beleive they have transformed that permission into a right or entitlement, and they have taken if from necesity to a convienence. Many of these procedures can be done without exposure to opposite gender, but it is easier for the provider so they dimiss or rank the modesty concerns of the patient lower than the ease of having the additional person there. It is this expansion of permisson that I find offensive. A simple example, hospital gowns, everyone knows patients hate them, providers know and joke about this, yet, even for patients who are fully amblatory they are standard issue. There are gowns that over lap, etc. but for the ease and efficency of the facility, the open back mini skirt is provided for all. This is minor, but it shows the mentality compromising modesty for the sake of ease and efficency. I am not an attorney, but I would make a bet, if I hired a male or female janitor, and told them that their job duties were to clean both genders restrooms on the hour and they were to do so whether they were in use or not, I would bet, the employee could not be found quilty of anything in court. I would further bet that I would not be found guilty of anything illegal....however, it would be just a matter of time until I had no customers. The public would react and I would have to change my operations or go broke. If we apply that same mentality to the medical community, we will also get change as these facilities are becoming more and more competitive for our revenue. This is especially true if you have insurance. As Dr. Bernstein has said numerous times. the key is to communicate to your provider before, and if not satisfied after. If you aren't satisfied, do not hesitate to the people who pay the bills, the administration...if you don't complain I will continue to just use one person to clean bathrooms, complain, threaten to or take your business elsewhere and I will do something about it...I need your do they......alan

At Wednesday, April 15, 2009 6:08:00 AM, Anonymous Anonymous said...

I don't feel too bad for women that complain about their male gynocologist because they almost always have a choice. It doesn't make much sense to choose to see a male gynocologist and then complain that their gynocologist is a man.

Men can't choose the gender of their nurses. They are assigned a female and there's no arguing about it. These nurses know that all they have to do is insult their masculinity and almost all men submit to the orders of this all-powerful nurse.

If women don't want men involved with their intimate exams or procedures, put your foot down. Unless time is critical you should be able to find a place with an all-women staff that will accomodate you. Same with men. Don't let anyone push you or trick you into doing something you're uncomfortable with.

Stand up for yourselves. There have been many experiences described here where someone stood up for themself and it worked out well. I have yet to read an experience where someone stuck up for themself and it backfired on them. If a nurse or tech or even a doctor roll their eyes at you or insult you or claim that "this has never happened before", who cares. Let them throw a temper tantrum.

It's so common for someone to request a nurse of their own gender but when the nurse they already have begins to snarl at them and belittle them they finally give in and allow that nurse to do what she has (or wants) to do. If you get to the point where the nurse is mad or feels insulted enough to start throwing insults at you, she should be the last person you want treating you after that.

At Wednesday, April 15, 2009 6:26:00 AM, Anonymous Anonymous said...

To the "DENIAL" poster, you are right on. That's exactly how I feel. Instead of overseeing what's happening to their body and having the power to question what's happening to them if they want, they are just giving themself completely to strangers who know they can do whatever they want and the patient will never know.

I don't trust nurses and I will never let myself be put under their complete control with no means to defend myself. So many people have commented about nurses they have seen and heard acting very unprofessionally and I would guess that it is extremely common. I don't want nurses gossiping to each other that my penis is too big or too small or too erect. I don't consider most nurses to be actual "professionals".

At Wednesday, April 15, 2009 9:58:00 AM, Anonymous Anonymous said...

How does "implied consent" for an unconscious patient in a teaching hospital work? If someone is taken into the ER unconscious do 1 or more medical students observe or participate without the consent of the patient or his family?

At Wednesday, April 15, 2009 1:30:00 PM, Blogger Maurice Bernstein, M.D. said...

The "implied" part of the consent is that if the entry to the hospital documents that the patient is to read and sign indicates that medical students or nursing students or medical interns or residents are part of the hospital function, they may be present for various activities for which specific patient consent is not requested. However, a changing program: the presence and acts of medical students performing pelvic exams on unconscious patients, without specific patient consent, which is not for the patient's benefit but only for the benefit of the medical student is now being re-evaluated and no longer practiced in many teaching hospitals. ..Maurice.

At Wednesday, April 15, 2009 3:01:00 PM, Anonymous Anonymous said...

Dr. Berstein,
What is your knowledge of having a patient adovocate (spouse,etc) go into the surgical suite while the patient is under a general (or otherwise for that matter)?

Have you seen this accomodated if the patient requests it?


At Wednesday, April 15, 2009 3:08:00 PM, Anonymous Anonymous said...

So I guess the woman who is slipped a "date rape" pill and is raped and violated feels less pain, anger and violation from the expereince than if she were awake. Because she didn't look at her attacker while it was happening it was less of an act or violation.

At Wednesday, April 15, 2009 4:11:00 PM, Blogger MER said...


Do I read your comments correctly? You write:

"However, a changing program: the presence and acts of medical students performing pelvic exams on unconscious patients, without specific patient consent, which is not for the patient's benefit but only for the benefit of the medical student is now being re-evaluated and no longer practiced in many teaching hospitals. ..Maurice."

Are you saying this is still being done today without specific patient consent, not for the patient's benefit but for the benefit of training doctors? I thought this practice had completely stopped. You're saying that this implied consent is buried in the forms the patient signs?

This is incredible if it is still happening, and demonstrates how much a problem we still have in the culture of American health care.

At Wednesday, April 15, 2009 4:40:00 PM, Anonymous Anonymous said...

Doh! I don't read the big print!

At Wednesday, April 15, 2009 4:45:00 PM, Anonymous Anonymous said...

For female providers to dismiss male patients for same gender care
is the absolute essence of ignorance. To advocate for patients
is to provide for their physical
and emotional needs.
Many women claim that there were
no choices for them as far as female physicians. In 1970, 9% of
all physicians were female. They
did in fact have the availability
of choice when choosing physicians
and that includes ob-gyns. A recent
study by Kaiser indicated that only
24.8% of women had gender preferences regarding physicians.
Yet today 40% of all physicians
are female. In my opinion, any
female provider that would dismiss
the request from a male patient
for same gender care is unprofessional behavior. Anyone with that mentality is not going
to advocate for you and as such
you really wouldn't want them as
your provider in any capacity.
Any female provider that would
dismiss me upon the request of
same gender care is ok with me as
long as they are willing to pay
me porn star rates. They want to
peek, they have to pay.


At Wednesday, April 15, 2009 5:01:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, to the best of my current understanding, such exams have not been eliminated by 100 percent of teaching institutions unless you have found otherwise. Perhaps we should Google this issue. ..Maurice.

At Wednesday, April 15, 2009 5:20:00 PM, Blogger Maurice Bernstein, M.D. said...

JW, As an internist, I have rarely been in operating rooms where patients are under general anesthesia. As a facilitator for first and second year medical students, I have been in operating rooms occasionally with my students. I have never seen nor heard about any family member and/or patient-advocate as allowed in the operating room. The numbers of simply observing individuals in an operating room is limited including students. The concern about having family members or other supporters of the patient would be distraction of the staff and surgeons if that person fell ill or fainted. Another concern would be if the patient's condition suddenly "went sour" such as with a cardiac arrest, the family member may interfere with the established resuscitation process by the emotional excitement of the family. By the way, when I was with several students in an operating room watching shoulder surgery and the patient suddenly arrested. Even we (the students and I) were all shooed out of the operating room. Of course, husbands are allowed to attend routine deliveries of their spouses. This all I can tell you. ..Maurice.

At Wednesday, April 15, 2009 7:22:00 PM, Anonymous Anonymous said...

I sure may know what happened to me after surgery, but if I am out..I will not have to endure it when it happens..I think date rape drugs and anesthesia...very seldom equate...I just have to trust that enough others are their to protect me from something (which isn't likely to happen to an ol guy like me anyway)...and that same bunch of peole...would make it seem like I was on display to an audience if I was concious..and that would be more than I could handle guess that come off a bit gutless...but it is the truth.. because ther is gonna be a eason for my being in there...and it won't be vanity surgery. This is not denial...
As to anything being done that is untoward...I think it is very hard for anyone to get a way with...and it is a very very few who are apt to even try it.
I had a real surprising discovery this of my doctors I see at my PCP office..and one who has been great and done an outstanding not a doctor, but a PA-C...nobody wears name tags there..but I also see the doctor..he is good, but he doesn't talk to me like the PA-C does...and the PA-C is one very capable least he has been for me...and now they have one male nurse... Because insurance is lowering what they pay for each procedure...and with so many folks losing their insurance (this office tries to help all they can and try to give everyone who walks through their doors the best they can) these doctors are having to try to find ways they can cut costs without sacrificing care...and it seems that using PA-C's allows for a larger number of patients to be seen...with less cost than an equal number of MD'S and nurses... a fact in the world today...and not one of just convenience for the MD'S. This office tries eal hard to match patients preference to doc of each gender..and trying to see that enough of both genders for other duties,,
I may be moving an area I will not have such choices...and will have to accept that there will be times...I may just have to gut through it... an unpleasant thought..but reality.
I think allowing a family member in the operating room...would really be more of a chance for disaster...especially if they freaked out.. I know a couple of mine who would do great...but others I would refuse surgery before I would let them in with me.
Besides I have had to vet enough critters including cattle and horses to know that most of not something ya want to see when it is a loved one..or yourself being operated on...even a simple has a way of looking worse then it is...

At Wednesday, April 15, 2009 9:23:00 PM, Anonymous Anonymous said...

Every major level 1 trauma center
that I've worked at naturally had
residents. It's a teaching hospital
for physicians. They usually recieve 200-300 new residents each
year in the various specialities of
general surg,neuro surg,ob-gyn,
internal medicine and family
practice to name a few.
When you enter one of these facilities as a patient you are
asked the question, do you want to
be teach or non-teach. If you request non-teach then these words
of non-teach are on your chart.
That means hands off to residents
and interns, period! Usually, nursing students will ask you point
blank if they can shadow the nurse
assigned to your care.
It's really simple folks,if you
are concerned about exams and etc
while unconscious then simply request non-teach.
Be absolutely certain about this
request as often times your body
is their playground for residents
while you are under. Oftentimes I've seen 5th year residents doing
the surgery and the assigned attending was nowhere in sight!


At Wednesday, April 15, 2009 9:33:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, the assigned attending is always responsible for the conduct of those residents under his/her supervision. The attending is present for the complex defining procedures but not necessarily present for the routine "opening" and "closing" aspects of the surgery which are probably more skillfully performed by the trained residents. In any event, the assigned attending surgeon is responsible for all that goes on in the operating room even when absent and must be able to return at once when called. Finally, the surgeon must include in his surgery dictation exactly what portions were performed by him/her and during which phases the surgeon was absent but available.

At Wednesday, April 15, 2009 11:17:00 PM, Anonymous Anonymous said...

Here's another incident that worries me. I heard of someone who was learning nursing and who was doing her hospital training see a woman who obviously was going into or just finished gynecological surgery fully exposed, unconscious, legs in stirrups just laying there forever! This nurse in training was horrified. Every sort of employee was walking passed she said.

At Thursday, April 16, 2009 12:23:00 AM, Anonymous Anonymous said...

Thanks for the reply PT. I wasn't aware PAs or nurses could give physicals.

At Thursday, April 16, 2009 12:46:00 AM, Anonymous Anonymous said...

Thanks for the great information Maurice, Alan and PT.

At Thursday, April 16, 2009 9:43:00 AM, Anonymous Anonymous said...

I think that residents have to be more meticulous when making an incison or closing...they are eager to show they are proficient and the surgeons and other staff are highly critical about their work...and even a small sloppy job can do incredible damage to their future..remember they are on a kind of probation..if they make the surgeon look bad or lose trust from other OR providers (ie nurses and anesthesthetists)..they are gonna have a hard road..just to stay in the program...
At one doctors office, I saw a sign that forbid PA's from doing a physical. It plainly stated only an MD was allowed to perform one there. It wasn't where most would see it..and I only did by accident. But all of the staff..Pa's nurses and front desk knew about it.

At Thursday, April 16, 2009 3:38:00 PM, Anonymous Anonymous said...


"Re: I think peri/rectal swabs are a humiliating 'welcome' to the hospital
OMG. I'm glad we're not the only facility that is doing this. LOL I haven't read all the posts, but the nasal swabs are for MRSA and the peri/anal swabs (we actually swab the arm pits, then groin, then rectum) are to test for acenitobacter and VRE.
Our facility is only doing these on transfers from nursing homes and from other hospitals, but I'm just waiting for the day that they start doing these on all new admissions.
My first swab was on a young, attractive male transfer from another hospital. Boy that was fun! LOL
We actually have caught some acenitobacter and MRSA that were not disclosed to us on admission by doing this, so I guess it's serving it's purpose, but yeah, what a great way to start your stay."

"My first swab was on a young, attractive male transfer from another hospital. Boy that was fun! LOL"


At Thursday, April 16, 2009 3:51:00 PM, Anonymous Anonymous said...

PT, If you read the about the female provider and her male patient you will see that the patient dismissed her. And his reasons were that a woman could not possibly be as competent as a male. At least nobody on this thread thinks like that.
And in reply to your "women had choice" of female doctors, I can give you the link if you want to, but in 1970 there were 20 states that had 5 female gynecologists or fewer. Wow huge choice.
Maurice, you've been in medicine for 50 years how about some support here.

At Thursday, April 16, 2009 4:10:00 PM, Anonymous Anonymous said...

Given the context they meant it wasn't fun. The vast majority of nurses on that thread don't agree with it and would refuse it for themselves. They even would prefer the patients to be able to do it privately and hand them the swab and I'm sure many here would prefer that as well.

That thread is a good example of nursing feeling for the patient's plight where privacy is concerned. They seem to realize how a rectal swab is the last thing they want to do on a new patient as they feel it gets the relationship off to a bad start.

I was happy to read this thread and it should bring some here some relief because these nurses are on their side and feel for their privacy. It's a good start.

At Thursday, April 16, 2009 4:21:00 PM, Blogger Maurice Bernstein, M.D. said...

Chuck McP, please let's avoid using anecdotes written by unknown writers to another website. To me, they are meaningless and cannot be used to support any argument regarding nursing behavior or misbehavior. One, who is not specifically identified, can write anything they desire, whether factual or madeup. As I have said previously, anecdotes even written by an anonymous individual to this blog can also be questioned even though it seems like a truthful account. Until writers provide information about themselves so that they can be identified and contacted, what is written about their experiences or that of others cannot be taken as absolute factual description. I will not allow further anecdotes to be published from other sites where the writer and the context is unknown. I am open to discussion here on this matter. You might feel uncomfortable that I look at your personal stories with a tint of skepticism but I think that I am realistic where full anonymity is present and unfortunately it is present on these websites. Remember, general concepts is one thing ("I have modesty to expose my genitals to a healthcare provider of the other gender") but detailed description of an encounter with the provider could be another matter ..Maurice.

At Thursday, April 16, 2009 4:36:00 PM, Anonymous Anonymous said...

Dr M.

For the sake of my argument I'll refer to Dr Gary hall, ophthalmologist. He was reprimanded
by a state medical board for telling his patients that he would
be doing their surgery when in fact
his associate was doing the surgery.
Another notable cardiac surgeon too was reprimanded for the
same infraction. To my knowledge
the non-teach rule applies across
the board. I realize this subject
is beyond the realm of our usual subject matter,however, I think it's relevant in that perhaps the
selection of the surgeon may be
gender motivated.


At Thursday, April 16, 2009 5:58:00 PM, Blogger amr said...

Dr. B…..

Are you really a doc….. ? How do we really know that you are? You sound like you are. Have I looked up to see if you are? No. How do we know that "Chill" is a doc?

The grandeur of the web - and this blog specifically is the ability to exchange information. This is not the only blog where this information is exchanged. Taken in its totality, we must take each of the entries and "judge" for ourselves their veracity.

If you take your logic seriously, you should consider shutting down this blog, because according to your thinking, you and Joel are the only "real" people making entries. All of the rest of us are just making it up.

Also, for that matter, just because someone reveals themselves, does not immediately mean they are telling the "truth".

Taken as a whole, entries in allnurses and such, paint a revealing and consistent picture. The power of what you are doing is maintaining a spirited dialogue.

Take care that your constraints not kill what you have started. As I have stated before, your efforts here are of great value.

That being said, I want to use as an example the resident taking the pictures of the man's tattooed penis in the OR and the blogs on allnurses. On the one hand, there seems to be people blogging about their experiences in a way that without anonymity, they would be idiots to do so. On the other hand, an immature doc did something that became very public. But that something is "consistent" with the breath and width of the conversations on allnurses. Thus, to exclude it (allnurses et al), is to shut down the conversation. It paints a tapestry that is the picture of healthcare as it pertains to patient physical privacy.

And since I'm on a role here, Chuck McP's reference is not inconsistent with other blog entries on allnurses. Taken as a whole, it would be hard for me to believe that allnurses doesn't greatly add to the conversation.

(So too was the thread with residents discussing non-consensual pelvic exams.)

Maybe it would have been better to have summarized the entry with a link to the entire thread. That way the entry can be taken in context with what others were saying about the subject.

Let "us" all be the judges. We all can blog in and question an entry - especially you. But to censor it is antithetical to the conversation.

-amr (btw these are my real initials :)

At Thursday, April 16, 2009 6:13:00 PM, Anonymous Anonymous said...

I looked at the site on allnurses and was surprised to see a number of nurses who seemed in favor of same gender nurses for doing this procedure...
I had a family member get c-dif..oh man was that rough..and I know a person who has MRSA...a truly horrible illness......and many nurses also stated most patients were capable of doing their own swabbing...maybe the modesty issue has benefited from this procedure..we can hope anyway I agree PT...the using of someone else besides a surgeon you chose might well have a negative impact ..on how you felt if treated by an opposite gender provider you had not consented to. I am not sure if that is one of the things that would be rendered moot by my being unconcious....or if I would feel dissed..
It merits remembering to discuss with a surgeon if I should ever have need of one..then again it might hinge a lot on what was being operated on too.

At Thursday, April 16, 2009 6:21:00 PM, Anonymous Anonymous said...

Stop apologizing for the "sexist" female urologist. All the males here know there was a great double
standard at play when she made those comments on her blog. Your selective reading is just smoke for your agenda. And please, don't
ask Dr, Bernstein for his support.
The jury left with a conviction
on her over a thousand postings ago. Also, it's not 1970
anymore. 50%+ percent of new
doctors are women. Any women
who wants a female gyno has one.
When the 90+% of female nurses and
med techs reverses to perhaps a 75
to 25% position then men will begin
to see some relief from the great double standard. Unfortunately,
as male nurses and med techs are
aware, there is a gynocracy in
place that is resisting this at every turn.

At Thursday, April 16, 2009 6:34:00 PM, Anonymous Anonymous said...

Thanks anonymous...that is how I read it too.

At Thursday, April 16, 2009 7:31:00 PM, Blogger Maurice Bernstein, M.D. said...

amr, you can look me up in the AMA list of physicians or the California Medical Board. I am not trying to resist the obvious: anonymity is part and parcel of much of the communication on the internet. And with anonymity one has to assume that what is written represents a valid contribution to the discussion on a blog like mine. I assume most of what the visitors to my blog write is valid but I can never be sure. I am more unsure about what others might be writing to another forum and referred to here. I have to admit that my suspicious views of anonymous postings is colored by my many years experience of being a subscriber to a bioethics listserv which is moderated and approval must be granted by the moderator to subscribe. Each subscriber is identified by the full name and academic position and virtually all who write are well known in the ethics field. Much of the writings come with reference documentation and I have confidence that the facts presented and the views expressed have more validity than if everyone was truely anonymous.

I don't want to stifle productive discussion but I don't want a bunch of "hokum" by an anonymous writer to contaminate the discussion. Finally, I wouldn't be continuing these threads if I felt that I was dealing mainly with polluted verbage and I wouldn't also be advocating activism for those with modesty concerns who have written here. ..Maurice.

At Thursday, April 16, 2009 9:41:00 PM, Anonymous Anonymous said...


Lets assume for a moment that
Dr B is not a physician. Would it
really change anything? Aside from
that who would go through the
tremendous effort of designing this
web site and maintaining it?
Additionally, I am acutely aware of the chief resident who was
fired for taking a pic of the patients tattooed penis. I knew of
his termination before it was
announced in the Arizona republic.
Many of us on this site have
health care experience or once
worked in healthcare. The resident
was reprimanded by the state medical board as well. What many
don't know about this case was that
an OR nurse (female) started the
problem in that she was laughing
about it and drew attention to his
tattoo. Perhaps if she had kept her
mouth shut and at the least acted
professionally there might be a
surgical resident out there not
looking to repeat his last two
years of residency.
Unfortunately, sometimes you get
this crowd mentality but that it
only takes one person to start it,
yet a stronger person to prevent it. What Dr B and Dr Sherman have
done is raise the awareness
tremendously of this issue which
otherwise ceertainly would never
be discussed on allnurses. Most
of those people on that site don't
deserve a job let let alone take
care and advocate for their patients.


At Thursday, April 16, 2009 10:10:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, you wrote: "What Dr B and Dr Sherman have
done is raise the awareness
tremendously of this issue which
otherwise ceertainly would never
be discussed on allnurses. Most
of those people on that site don't
deserve a job let let alone take
care and advocate for their patients." My point: PT, how do you know that those writing those unprofessional stories to allnurses are indeed nurses or in fact may be individuals who have an agenda to degrade the nursing profession? Now, I have read comments on allnurses and many or most of them involve rational discussion as occurs here. It is just those outliers that I worry about and don't want to be carried to our blog as factual information.

At Thursday, April 16, 2009 10:41:00 PM, Anonymous Anonymous said...

Dr. Bernstein:
The "outliers", as you call them,
are actually glimmers into the "cone of silence" as it exists on That is why patient modesty issues are frequently censored on that blog. Patient Modesty has few friends among nurses when it comes to the need for gender-sensitive care. Remember, "We're all professionals, here." (Even when we joke about tattoos in the OR or enjoy getting a hunk for a hot anal swabbing.)

Sorry, that's the reality as I see it.
(Kyle K.)

At Thursday, April 16, 2009 11:33:00 PM, Anonymous Anonymous said...

Chuck D, Don't put words in my mouth. I have never said 2009 is like 1970. But PT irritates me when he refuses to acknowledge that women were treated badly by male doctors in the past and did not have hardly any choice in the matter. I only have to talk to my mother and her friends to hear humiliating stories. And I have never in all my posts dismissed grievances by you men. You men will achieve nothing if you alienate half the population. I don't know what is so constructive here when you men keep going on about women getting this special treatment blah, blah, blah. That is still debatable. Concentrate on your issues and stop worrying about women have had to work hard for.

At Friday, April 17, 2009 12:28:00 AM, Anonymous Anonymous said...

And furthermore Chuck D, I was asking Maurice for his support regarding the choices that women had for female gynecologists back before 1970, not for taking my side for the interpretation of the urologists blog. That's why I said he had 50 years medical experience. He would know better than most of us how things were as I'm no medical historian.
And while I'm back, you tell me where I've misinterpreted the urologists blog. She tells two stories. In the first, she tells of the man who gets a surprise that she is a woman and walks out. This is her direct quote. "What I object to is the rudeness of that first patient whose first words to me were:"I think we're done here...". I understand if you (male patient) don't feel comfortable with me (female physician) doing a DRE (digital rectal exam) on you. Personally, I always seek out a female gynecologist or a female internist for my own medical needs. But have you ever heard of a female patient rudely leaving the office because she didn't know her new doctor was a man?" I'll repeat it in capitals "I UNDERSTAND IF YOU DON"T FEEL COMFORTABLE WITH ME (FEMALE PHYSICIAN)".
In the second story, at the hospital, the patent refused to let her put in the stent "because of a lack of confidence in the fact that I was a female physician. He trusted neither my medical judgement, nor my surgical abilities." That's another direct quote. Note, the second patient had no modesty issues only issues with the fact that she was a woman and therefore must be incompetent.
Now let me quote PT "For female providers to dismiss male patients for same gender care
is the absolute essence of ignorance." Where does he get the idea that she did that? Please now give me YOUR interpretation of the two stories.

At Friday, April 17, 2009 1:28:00 AM, Anonymous Anonymous said...

"we actually swab the arm pits, then groin, then rectum"

Yeah, I'd love to see them try that on me. I'd stick something up her rectum!

What happens when a patient refuses to allow that nonsense? Would he get kicked out of the hospital or forced in some way to do it? I would consider that a sexual assault.


At Friday, April 17, 2009 1:41:00 AM, Anonymous Anonymous said...

I know now how rigged the allnurses site is. I have posted a couple of comments I believe to be appropriate and non-confrontational and I got banned from the site for "Blatant disrespect for membership".

What a joke.

At Friday, April 17, 2009 1:59:00 AM, Anonymous Anonymous said...

"how do you know that those writing those unprofessional stories to allnurses are indeed nurses or in fact may be individuals who have an agenda to degrade the nursing profession?"

While that is certainly possible I think the mods there have their ways of rooting out imposters and banning them.

Unfortunately I think the most common way of "discovering" imposters is to reprimand or ban all those who's opinions differ from the majority of the group. Another way is to reprimand or ban anyone that writes anything negative about nurses.

They obviously don't care to carry on an intelligent discussion with differing opinions. It's primarily a site where nurses go to praise themselves.

At Friday, April 17, 2009 6:05:00 AM, Anonymous Anonymous said...

To annom on Apr 15. I don't really see where someone slipping someone a date rape pill and molesting....has anything to do with whether I am comfortable or not while being exposed while out....except it does point out some of the different camps on the issue. There seems to be those who view providers as predators and vile people who can't be trusted. You have that right, I have no idea why or what happened to you to make you feel that way. Obviously something. Now personally that has not been my experience nor do I feel that way nor has that been my experience. My experience has been more along the lines of this is the way we have always done this or this is easier for us so you should accept fact I have found that when I challenge this or bring it to their attention...I have been treated with respect and even compassionate understanding in many cases. The issue for me is more that we have to ask or cause it to happen vs them offering. Of course someone being drugged and molested is awful, I have stated the previously, but by and large the vast vast majority of interactions do not involve anytime of criminal activity or even malicous conduct by providers. Using the extreme to define the normal isn't something that really has a lot of benefit for normal discussion. Personally, I do not have alot of concern that the provider is bad or approaching my procedure with malice, I approach it from my perspective. I am not comfortable exposing myself to the opposite gender. I am less concerned about it when I am out, period, it is about me and how I feel and really has little to do with the provider...they may be completely professional, they may truely be so used to it it means nothing, they may be gay, it doesn't matter, it is how I feel and not how they feel or think. That would be an interesting poll, of the people who have modesty concerns here, how many would place them in one of two broad classifications...concern about what the provider feels, thinks, or does and concern about how I feel or think....

I do feel most of the people posting on allnurse are legit. Most of the threads are clinical in nature. I actually beilieve it is a good resource as the percentage of people posting there who are legit providers has to be pretty high. You do have to register etc....that said, I think we all have to look at every post here with a certain amount of introspect and ....for lack of a better word....skepticism. Personally I think references to allnurse has some value, but should be treated with the same skepticism we apply to any annom. post...maybe direct quotes provide some issue I don't know. BUT, this is Dr. Berntein's site, and the time and effort he puts in this just amazes me, so if you decide not to post anything...that is your right. I appreciate the effort Dr. Sherman and you put into does help, you are accomplishing things whether you know it or not. Personally, I think there is a lot of difference between allnurse and say voy...but whatever you decide is fine...I just appreciate the outlet.......alan...or is it really alan????

At Friday, April 17, 2009 9:10:00 AM, Blogger Maurice Bernstein, M.D. said...

"Why can't we all get along?" To be very frank, I think the issues described both by male and female visitors are for virtually all examples not a matter of perverse behavior for sexual gratification by the healthcare provider but a problem in the management of the healthcare system. Of course, I fully accept that, as with anything dealing with human beings there will be some creatures who disregard their responsibility for beneficence toward the patient and take advantage of patients for their own personal psychic motivations. But they truely are outliers in the profession and should be treated appropriately for their behavior. Most doctors do their job well and the differences which patients see in them (as well as the differences doctors see in patients) are natural variations of all humans' character and behavior.

I feel that bashing each other's opposite gender either patient or healthcare provider wise is not helpful for the primary goal of providing a system for medical care where patients of either gender are comfortable and well treated. I think we all agree that the system should be changed.

The need for both male and female patients to inform their physicians about their concerns and needs has been offered and I have agreed since I know that doctors are ignorant and uneducated about the concern regarding gender selection. Next, the discussion must extend to practical ways to change the system to facilitate physicians who become aware of patients gender modesty concerns to do something to mitigate those concerns and strengthen the doctor-patient relationship.

Let's trash the bash and direct the discussion to how we can all participate together to accomplish a constructive goal that will allow us (physicans and patients of either gender) to get along. ..Maurice.

At Friday, April 17, 2009 9:46:00 AM, Anonymous Anonymous said...

Dr.Berstein, in reference to your post of the 17th at 10:00 am...shucks beat me to a long winded plea for folks to do just that...we all know various problems have occured for various we need to get together and find solutions to the ones that we can do something how we can educate both sides in a manner that leaves everyone in an amicable frame of mind..(this is with the understanding that there are always going to be cretans from both sides that are an unfortuante part of life..but only a minority of them)..Rehashing old injustices serves no one if it is just done to escape doing anything constructive about it.

At Friday, April 17, 2009 11:47:00 AM, Blogger amr said...


I know that Dr. B is a doc. I was being….. facetious. I haven't blogged in awhile, so some of the current regulars may not have read any of my entries.

Dr. B,

In response to my post you wrote in part: "...I have to admit that my suspicious views of anonymous postings is colored by my many years experience of being a subscriber to a bioethics listserv which is moderated and approval must be granted by the moderator to subscribe. Each subscriber is identified by the full name and academic position and virtually all who write are well known in the ethics field."


Why then did the two ethicists that contributed awhile back remain anonymous wherein you referred to them as Ethicist 1 and Ethicist 2? I have brought this up before, and it is still disturbing to me.

And as I have mentioned before, I would like nothing better than to use my full name on this blog. I am, however, protecting my wife and my in-laws from possible retribution. I have actually said enough whereby the right people could piece together who I am if they were to read this blog and do some patient research.

Were it not for an off-handed comment that her female general surgeon made to me, I would not have ever found this blog nor would I have had a problem with this "modesty" issue. I've actually begun to think of more as "physical privacy".

Not too long ago there was a discussion here about a doc mentioning in a social setting about viewing a pt with a dancer's body. In my case, my wife's doc mentioned with a twinkle in her eye how "thin" my wife was. This "little" comment got me thinking about how exposed my wife was (for many hours) in the OR. That and the circus-like jocularity in pre-op of all the "young" male residents got me thinking.

Up to that point, the issue of modesty and the hospital was a moot point for me.


At Friday, April 17, 2009 12:13:00 PM, Blogger Maurice Bernstein, M.D. said...

amr, you will have to refresh my memory with the specific dates and threads regarding those anonymous ethicists' comments. However, I can easily give you an explanation. I have published comments directly from the bioethics listserv with the permission of those who have written. However, some (not all) argue that their comments which they write to the restricted listserv may be in conflict with what they have published in journals for widespread distribution. This is because, they may be expressing to the listserv thoughts to challenge discussion and they would rather not, as yet, be identified with those they request anonymity for that material on my blog. There are some ethicists such as Steve Miles and Erich Loewy whose philosophy is that anything they expresses anywhere on the internet is in the public domain and can be identified to them personally.

I, myself, would like all communication on this blog identified without anonymity but I am aware and understand the practical consequences that have been expressed about that.

amr, I hope this has answered your "well.." ..Maurice.

At Friday, April 17, 2009 4:28:00 PM, Anonymous Anonymous said...

Seems most posting here are disgusted with the swabbing routine discussed on allnurses.
However, in my opinion worse yet is the prepping (not much different than swabbing) of your genitals by opposite sex clinicians in the OR and where is the "screaming disgust?" Same thing, not any difference.
A procedure serving a purpose in the good of mankind and required by the healthcare facility.

It is true any discussion of patient modesty on allnurses gets shut down. The females don't want to discuss it and feel it is absurd for anyone to think differently than the normal protocol of female nurses doing everything! It is, "how stupid and ridiculous is this jerk?"

The date rape pill scenario was meant to be an analogy of "can't see it, don't see it therefore if a female does all of this while my eyes are shut it is okay!" But if I see it, see her, then it isn't okay! Where is the logic in that? A patient does see the person who preps 99% of the time. They usually roll you in the OR and talks to you and more than likely rolls you out of the OR. Duh! Maybe they should introduce themselves and tell you ahead of time while you're awake what they will be doing to you.

Dr. B, it is nice charting should include what the surgeon and others that provide surgical intervention should be documented. From my experience the surgeon did not chart what he did and what the RNFA did. He didn't even stay in the building which is illegal. He was long gone while I was in surgery "under" for a long time. All kinds of illegalities go on day in and day out and they get away with it.

At Friday, April 17, 2009 4:58:00 PM, Anonymous Anonymous said...

Dr B

You said" how do you know that
those writing those unprofessional stories to allnurses are indeed
nurses or in fact may be individuals who have an agenda to
degrade the nursing profession".

Realize I have many years of
healthcare experience. I have seen
the very negative stories they relay and then some.I have as a patient experienced unprofessional
behavior at its worst by female providers. In my opinion the
nursing industry is already degraded and they did it to
themselves as there is no trust.
Discriminate against any group
and it will come back to haunt
you in spades and thats exactly
what they have done to male patients.
I have read threads on allnurses
and interestingly they can moderate
but that they choose to moderate
only what they prefer. Odd that
jokes about male penis's abound and
articles about unprofessional
behavior continue. Yet, if a thread
regarding privacy issues becomes
heated it is shut done and some
are banned.
The old adage" the proof is in
the pudding. I don't need to question the authenticity of authors, I've seen it all and I don't say that in a bragging manner
in that there are behaviors I've
wished I've never seen. Patients
treated in ways I've wished I've
never seen.
Sites like allnurses are a dime
a dozen. Those described behaviors whether real or not to me are irrevelant as I've seen them mirrored in real life. Nursing is
an industry riddled with problems,
behavorial,distrust,arrogance and greed!


At Friday, April 17, 2009 5:52:00 PM, Blogger MER said...

I have no problems with using my real name on a blog or listserv where everybody is identified. I, too, sometimes play Devil's Advocate and express what are not necessarily my personal opinions but are designed to elicit discussion. But I suppose that could be made clear within the comments. And our opinions do change, or should. I know I have been enlightened by this blog and other sources since I started contributing. So I suppose there is an tendency to not want to be attached to old opinions as we learn more about this subject.

I can see why some people would want to tell their stories and remain anonymous. In medicine there is that dangerous tag called the "bad" patient. Realistically, there are some really "bad" patients. But too often anyone who complains, especially publically, is tagged with that title and things may come back to haunt them.

At Friday, April 17, 2009 9:56:00 PM, Anonymous Anonymous said...

to alan and MER for todays posts. Thanks...all I can add is ditto..
I have no problem telling Dr.Bernstein who or where I am.. Like MER said..we are all growing and learning...and changing how we feel about a lot of large measure because of the exhange of knowledge, viewpoints...and exposure to different perspectives and experiences...I just do not want to get judged by a viewpoint that I may no longer have...because I found my old one to be in error..or because I have grown beyond it...old dogs can learn new tricks...if they want to bad enough.

At Saturday, April 18, 2009 6:59:00 AM, Anonymous Anonymous said...

to Annom Fri 17 4:28 I don't want to get into a back and forth between you and I, that isn't the purpose of the thread so I will try one more time and then I am done with this exchange. My point was every person has different experiences, different feelings on the issue, and different comfort levels. For me and some of the others that comfort level is different when we are out than awake. I have had numerous procedures where I was out that required me to be exposed. In all cases but one they administered what ever they give you before I left the preop and I don't remember leaving or returning to the recovery. The recovery nurse who waited with me did not go into the OR. The only people I saw from OR were the anestheologist and the circulating nurse. The circulating nurse had the responsiblity of making sure I was the right patient getting the right procedure. For my colonoscopy I was awake but drowsy when they rolled me in and went out quickly. Now I can tell you I much prefer being out before I rolled out and the following when the Anesth. came in I flat out told him, I really like it when I don't remember leaving the pre op and I like it when I wake up back here, can you do that for me, they laugh and say you won't remember a all goes back to what Dr. Bernstein has been saying...communicate. That little part of just telling the Anesth. I wanted him to put me out before they show up to haul me away and I want to wake up back there made it all a lot better for me. You can DUH me if you want, but it really comes down to personal preference. The fact that a person has a preference that is difference doesn't make it wrong for them...might be worng for you...I have no problem if the prep while you are out is an isn't so much for me, so...trying to convince someone they should have more problems with modesty or procedures is about like providers trying to convince you you shouldn't have issues, we are all different with different feelings and, there is no way you are going to convince me feeling OK with what happens while I am out is easier for me to accept than while awake...its like saying I shouldn't like sea food...personal preference is just that...personal.

Dr. Bernstein I would have no problem registering with you...however..I have to tell you a wierd coincidence. I live in a small town in the day on another site I saw a post by a male nurse offering to talk off the blog and answer a quetion for a person....I thought it sounded familiar and guess what, I recognized the e-mail address he provided for contact as I belonged to a club with him and we share through e-mail. There is no way I would take a chance of having someone from my town read about my colonoscopy experience or about my testicular ultra sound that I was unhappy world...but registering and "gualifying" off the blog wouldn't be a problem at all.....alan

At Sunday, April 19, 2009 4:14:00 PM, Anonymous Anonymous said...

I really don't care one way or the other if you are personally okay with being handled by females only if you are "out." That is your personal feeling and choice and that is fine for you. The fact remains that the circulating nurse you mentioned IS the one that does more than make sure you are the right patient. She is the ONE that undresses you, exposes you, handles your genitals (if need be), preps your genitals, redress's you etc. That is her role. The others are in sterile attire and do NOT do prepping.
Whatever you are happy with that is certainly your business.

At Sunday, April 19, 2009 8:28:00 PM, Anonymous Anonymous said...


I came across this policy by the medical practitioners board in Victoria Australia. (where I live). The policy is in relation to intimate examinations. A few things I found interesting were:
- Recognition is made to the patient being unconfortable and suggesting doctors should be alert to that. Whilst in theory this is the case, in my own experience, I have found this not to be the case in practice. And no mention of the gender of the patient and their doctor being a potential issue and what to do about that.
- Also the policy on examination whilst anaesthetised.
On another matter I note that there is comment about students in the context of teaching hospitals. Again in Australia the large teaching hopital, where i had major surgery,they have both medical and nursing students, its the written policy (on the website)that the patient has the right to refuse treatement by students.In my case, I requested my prior approval of any student invovement in my surgery and in both cases the sudents came out a sought my permission prior to surgery. In the case of nurses whilst in hospital, I found that you weren't really asked if they could be involved in your ward based care. I suppose I could have said no student nurses as a blanket rule, but I din't feel the need to do that. It would be interesting to see how they reacted if I did.


At Sunday, April 19, 2009 9:44:00 PM, Blogger MER said...

Thank you for that link, Chris. It's fascinating not for what it says, but for what it leaves out. It's a good example of what I've been talking about on this blog -- the elephant in the room -- the genderless worldview. And how language is manipulated to hide or prevent communication rather than to aid it.

The article takes a pose of what I'm not calling gender neutral anymore. Now I'm calling it "gender blindness."

Read the link Chris provided. There are two characters in the story -- the patient and the practitioner. There are no males or females in this drama. No men and women. Just patients and practitioners. They're like genderless robots.

This is a good example of the current attempt to completely neutralize any gender references at all when it comes to intimate care in medicine, pretending gender doesn't matter. Patients are uncomfortable, embarrassed for no apparent reason besides the fact that the exam is intimate. It's only the intimacy that causes patient discomfort, not the gender of the "practitioner." In this worldview it's normal for patients to just be embarrassed by intimate exams. There are no degrees of embarrassment based upon the gender of the caregiver and the gender of the patient. So -- if there are no degrees of embarrassment then, obviously, the gender of the caregiver doesn't really matter.

In this culture, the gender of the practitioner and the patient is irrelevant. It doesn't really exist.

I suppose it's possible that those who write pieces like this are oblivious to the whole gender issue. It's possible. But I have a difficult time believing that people can be that obtuse. Can they really be that blind?

Or is this a conscious, ideological attempt to make sure that gender gets left out of the picture. Not only is the elephant in the room but let's make sure we build a cage for it and then cover the cage with a tarp. That way we can really make believe it isn't there.

If I'm off base here, someone enlighten me.

At Monday, April 20, 2009 5:02:00 AM, Anonymous Anonymous said...

MER I have the same question, is it really a case where the provider doesn't recognize gender is an issue in modesty or is it more the case that the pursuit of a genderless provider view is so engrained in the throughout the education and training process that they simply deny its existance so often they begin to believe or just repress acknowledging it ...until they are the patient.

Just a side note, in the exchange I had with an annom. poster about the issue of modesty while I am out, I wonder if the fact that I and others who feel this way do not actually "experience" the procedure and the related embaressment in a concious state it isn't as intense or imprinted in our minds. I can still tell you the details of the ultrasound I had several years back, but I recall very few of the details before or after the procedures where I was out when exposed....could it be something similar for providers, they have two factors repeatation and "the work vs personal" mind set. For them they become calloused to the situation from their side, so since it isn't traumatic or a problem for them...they don't experience it...they don't feel it. I think a lot of this issue is self serving for providers, but could there also be desensitization to the point where they actually don't think about. That said, its even more important that we remind them......alan

At Monday, April 20, 2009 6:42:00 AM, Anonymous Anonymous said...

I think that some of the reasons these articles are written in a genderless manner is because they are size fits all..and another is that in the medical community there is a desire to show impartiality and that they are not discriminating against anyone in dispensing medical services...that everyone will get identical care. I won't dispute that they will try to do so from a medical perspective (ie. treatments,surgery, etc) They just forget what a major part each individuals feelings about intimate care or exposure is to how that individual percieves that treatment. Medical care is not the same as selling/buying a sandwitch at a deli...where gender truly makes no difference..
The fact that they know that embarrassment is normal yet make no distinction about degrees based on genders involved does seem to make them clueless about what they should be addressing. That the feelings of embarrassment they speak of can either be mitigated or made more acute by the gender of the provider...and not just the demeanor of the provider.

At Monday, April 20, 2009 11:30:00 AM, Anonymous Anonymous said...

Rereading manyof th erecent mainly comes down to what Dr. Bernstein has been saying. Most providers are simply unaware of how patients really feel. They are part way there by admitting most do feel some embarrassment...they are just unaware of degree or even that gender is a big issue.So we just need to do what has been suggested by Dr. Bernstein...speak up and make it an issue for more than just the doctors we see...but for all providers to recognise.

At Monday, April 20, 2009 12:37:00 PM, Anonymous Anonymous said...

PATIENT PRIVACY OR PATIENT MODESTY - WHAT DOES THE PATIENT 'REALLY' KNOW ABOUT WHAT GOES ON ??? - When going in for surgery ~ in pre-op - you are asked to put on gown - you lay on the litter or gurney - the nurse starts an IV - she goes through a list of questions - she then gives you something to 'relax' by injecting it into the catheter in your arm an hour before surgery.
Then the anesthesiologist comes in - reviews & confirms the nurses form - asks you a few questions then asks you to sign a "Informed Consent Form for Surgery". (by this time you are perhaps in the frame of mind as in a ".08" as in a DWI test). (is your signature legal under drugs?)
The nurse is asked to witness your signing the "Informed Consent Formfor Surgery".
What I am so curious about is, if this is supposed to be an "INFORMED" consent, why isn't the patient 'informed' about the paragraphs I write below before signing the form??? This is usually toward the bottom of the form in small print that you can't make out because you are "relaxed".
It state in usually paragraphs 8 or 9 or more:
A - "I consent to the admission of 'observers into the procedure for the purpose of medical education or science."
B - "I further agree that photographs and a narrative of my case may be utilized for medical or science, including publications in professional journals and medical books."
C - "I understand that photographs and movies may be taken of this operation, and that they may be 'viewed' by 'various personnel' undergoing training or indoctrination at this or other facilities".
I would appreciate it if all of you would post a reply as to whether you are aware or have ever been "INFORMED" about the above paragraphs (copied from an "INFORMED CONSENT FORM for SURGERY") at any time that you may have signed such a consent form.
I can just imagine the handling of your private parts showing "observers" how to 'shave' you -(male or female) - 'insert a catheter' - 'scrub' you - or holding and moving your private parts in a way to for video or photographing w/narrating, etc.
I might point out that some of these "observers" could be salesmen or saleswomen that are viewing the use of one of their products and may be handling your private parts as well to show how to do it.
I am also sure that maybe some of these photographs and videos are used for 'personal' use and observation by other than these "professional" people, perhaps for recreational purposes - quite possible, as to how entertaining they may be - particularly of women patients or maybe men patients as well.
I can imagine some interesting replies from this post.

At Monday, April 20, 2009 1:15:00 PM, Anonymous Anonymous said...

There was mention awhile back of someone thanking another for the information that a nurse practitioner could take a physical, etc. There is a bill in CA (SB 294) that is being opposed by the CMA. The bill is to widen the scope of the NP by allowing the NP to admit a patient to the hospital and be designated as their primary care practitioner.
Doctors are up in arms over this widening of scope for NP's.

At Monday, April 20, 2009 4:26:00 PM, Blogger Maurice Bernstein, M.D. said...

In no way is a patient signing an informed consent form with or without
disclosure about those attending or photography while treated with sedation medication or actually sedated is permissible or legal. The patient must have full mental capacity to make a decision whether to accept the surgery under the conditions presented, otherwise the consent should be offered to the patient's legal surrogate. If a patient's signing under these conditions is observed the consent is meaningless and this act should be reported to the hospital or clinic authorities at the least. Except in a life threatening emergency, performing any procedure or surgery without informed consent could represent legal battery. ..Maurice.

At Monday, April 20, 2009 4:54:00 PM, Anonymous Anonymous said...

The consent form has a significant
amount of information. It would
take you a good 20 minutes to
read through it. Much of the writing is in very small print,
particularly when the word observers and videotaping is
Odd that you get the form just
prior to your surgery, when you
are under the effects of drugs
to relax you. I'm willing to bet
that if you were to audit every
single patient that ever had surgery and asked them the one
question. What were the potential
risks of the surgery,most likely
98% of them wouldn't know. I
believe hospitals and surgery
centers should take the responsibility to educate patients
regarding the procedures they are
about to recieve. Patients should
be given adequate time to read
consents and ask questions.
Therefore I doubt they would know
any of the particulars that would
occur before and after the surgery.
As a sideline 3 patients from a
va hospital contracted hiv from
unsterilized endoscopes. Please read my recent thread regarding
an endo techs promotion from housekeeping to endoscopy.


At Monday, April 20, 2009 8:08:00 PM, Anonymous Deborah said...

I lost faith and trust in the medical profession when I was 17 years old, after the family GP (in his 60's) tried to take advantage of me.
I now greatly value the early lesson and warning.

If all doctors were men, I'd be in trouble.
I see doctors infrequently, but we all need a Dr from time to time.
I do have a new appreciation of the issue from the male perspective after reading this thread - almost all nurses are female.
Essentially, you face what we faced 20 years ago, when almost all doctors were male.

I'm not sure whether there are cases of female nurses assaulting patients, but disrespectful and insensitive behaviour and feelings of vulnerability and embarrassment would be common ground for all patients.
We stand together in that regard.
I remember reading about the Holocaust a few years ago and it was stated that the victims were stripped naked to keep order. People rarely retaliate when they're naked, we become submissive. Some women actually ran into the gas chambers to conceal their nakedness.
I think nakedness out of our control has that effect - it takes away our power, our ability to defend and protect ourselves - the person is stripped away.

I think doctors should tell their patients if they rotate with a Dr of the opposite sex or mention the anesthesiologist may be fe/male - the patient can then take steps.
Patients generally forget about the gender make-up of the surgical team, a time when they're most vulnerable and exposed.
Often patients feel it's too late to do anything when they're at the operating suite's door.
I doubt I'd EVER agree to surgery without having a representative present.
We have a retired female nurse in the family - forthright and no-nonsense.
I'd want her to be present.
I really think patients need a representative in these situations because often, it seems it's them against us or there is no one present who actually cares about us, treats us like a person, with dignity - we're more than just bodies.
I know most private hospitals would agree to this request. (pre-arranged, of course)

I think we need to move away from the "assumptions" which are so often incorrect and leave people feeling abnormal - for example, men aren't modest, men are always available sexually...
One example - I was recently working in Hong Kong and my teenage nephew accompanied me.
We had a few massages during our stay. On the last day of our stay we went to a nice Chinese massage spa near our Hotel - nothing indicated it was anything more than a regular massage centre.
I was having a foot massage and my nephew wanted a back and neck massage.
About 30 minutes into our 90 minute treatment, my nephew appeared and said he wanted to leave, he wasn't enjoying the massage. Chinese massage can be quite painful, so I assumed that was the problem.
He told me later, that he had been offered sexual services. He declined and then they started to pressure him. They were aware his Aunt was seated in the foot massage area.
He's a confident boy and restated he only wanted a back massage. When the massage therapist concentrated on his backside and kept pressuring him, he decided to leave.
I was furious and returned to the premises and told them how disgusted and angry I was that my nephew should be treated in that way. They apologized, but also, seemed a bit surprised, "was there something wrong with the boy?"
I made it clear it was THEIR conduct that was in question and that I would be reporting the matter to the Tourist Board and the Police.
I felt the need to speak to them directly.
It did bring back the memory of the attempted assault on me - THAT Dr got away with his behaviour.
I didn't mention it to anyone - feeling embarrassed, appalled, scared and confused.
I'm sorry now that there was no one to challenge this man and his disgraceful conduct.
My parents thought doctors were Gods.
It may also have made this man think twice next time.
When people get away with bad behaviour, it usually happens again - also, there is no closure for the victim - the incident stays with you - it marks your soul - the intrusion, the violation, the manipulation.
If you're running something other than a massage service, it should be indicated on your sign to protect members of the public. Or, you don't feature normal services on your sign - facials, pedicures, massage therapy...
We saw many places that were clearly offering more - topless massage etc...and some that didn't say - the vagueness there is also a warning.

I found it shocking that some people questioned the sexuality of my nephew or whether he was a "normal" male - why? Because he declined sexual services. Apparently, all men are ready for sex with anyone, anytime, anywhere...
I'm so proud of this amazing 15 year old boy - it takes courage to say STOP and to get up and leave.
I made it clear to him that he need never fear saying "NO" to anyone, it's HIS decision who views and touches his body.
I told him about the day I also said "NO" when I was a teenager.

I definitely have a fresh appreciation of the stereotypes that men also have to fight and challenge.

At Monday, April 20, 2009 8:52:00 PM, Anonymous Anonymous said...

Thanks for the information anonymous and for the clarification, Dr.Bernstein....

At Monday, April 20, 2009 9:47:00 PM, Anonymous Lyn said...

An earlier post mentions that a study showed only 24% of women wanted a female physician...
I think that's a unusual result.
I think it very much depends on the type of exam or procedure that is required.
I would not see a male doctor for many things and in fact, waited three months to see a female gynaecologist about ten years ago. (I've only needed to see a gynaecologist once in my lifetime)
I would certainly wait again (knowing what it involves) if I needed to see another one in the future.
I would choose a female for most things although, I have seen male dermatologists for dermatitis on my neck and hands and GP's for cuts, colds, sprains and travel injections.

I read a study recently that showed at a sexual health clinic almost 70% of women specifically requested a female Dr & if women had the chance to just tick a box requesting a female Dr, almost all women (92%)opted for the female. It seems some women are too shy or lack the confidence to ask for a female Dr and others will seize the opportunity if it's made easy for them.
On the website a male gynaecologist says he became aware that the nurses were asking patients whether they had a preference for a male or female gynaecologist.
He proudly states that he stopped that practice.
Clearly, he fears that his practice will suffer if all women have a choice - the shy, the uneducated, the young, those lacking confidence...
I don't think that's something to be proud of...
In fact, I found the "advice" given on that website quite disturbing. No Australian or English Dr would give that advice - much of it is in direct conflict with established medical thinking and practice in most other countries. The tone of the website is also a concern - Doctors clearly trying to frighten and intimidate - some are quite sensational and ridiculous. "I'll pray for you and hope nothing will develop that could have been caught in time" is directed to a virgin who chooses not to have pelvic exams or cancer screening.
Cancer screening is NOT offered to virgins in any other country and routine pelvic exams are NOT recommended in other countries. (I think Germany is the only other country that recommends these terribly invasive exams that many women find distressing)
Women with complete hysterectomies for non-cancerous conditions being told cancer screening was still important to cover vaginal cancer.
This is in direct conflict with medical opinion around the world (and even the States - if you look at medical association guidelines)
Why not also get all men to report for genital checks to cover the remote chance they might have penile cancer? It's absolute nonsense.
It goes on and on...I had to stop reading it started to make me feel quite ill.
I assume it's to keep waiting rooms full, bank balances healthy, labs and theatres busy and women compliant, ignorant and afraid...
I hope these women don't take this "medical advice" and do their own research. I've noticed many American doctors are now questioning the need for and value of some of these "essential" health checks.

At Tuesday, April 21, 2009 4:38:00 AM, Anonymous Anonymous said...

Deborah, well put. Thanks for sharing that it really does go right to the crux of the issue. The assumptions that we are OK with this or that without asking and for years we have accepted medical staff as authority figures rather than people we are paying. It has been a relatively recent trend to seek second opinions etc. Great post.

Someone made the point that at least they recgnze some or most feel some embaressment. Good point, my contention is there is no way they can not be cofnicent of the fact that the patient is embaressed or uncomfortable, they have to know. But, as stated, perhaps they just don't realize the extent. Perhaps they just don't realize how deep that is and or how widespread. Lets face it, in the past how did we handle it, we acted like it didn't bother us....I always did, I even recall thanking the female tech who did my testicular ultra sound even though I was humiliated and really angry becasue the female after me was offered choice of gender and I wasn't. So, perhaps we need to take a little more responsiblity for the current state of affairs than we want to. But, we personally have no excuse now, if we don't tell them its our fault, if we tell them and they don't accomodate...its their the question becomes...what do we do from here...alan

At Tuesday, April 21, 2009 7:18:00 AM, Anonymous Anonymous said...

Thanks Deborah for sharing your experience. I occasionally look through the comments at a few voy forums, and though I realize there is as much fantasy there as reality, I've noticed many posts that are similar to the problems at your massage parlor.

Quite often after reading posts that discuss the commenters uneasiness with opposite gender medical nudity there are a few homophobes that announce that any man who prefers same-gender intimate caregivers is a homosexual. They say if any male prefers or even accepts being naked in front of another man there is something seriously wrong with him and the only solution is that he is gay (similar to how your nephew was treated). So I understand your disgust. Thanks for sharing.

At Tuesday, April 21, 2009 8:02:00 AM, Anonymous Anonymous said...

alan, I had a very similar experience with my ultrasound last year..except the facility doesn't have a male tech for ultrasound (maybe not any male tech for anything)..I know the feeling you had during the procedure...
I think we just need to get our ducks in a row and educate the medical community the extent and degree embarrassment is an issue...and let them know that "gender neutral" doesn't may be a great ideal...but it is a very poor reality from the standpoint of the patient.
Thanks Deborah the questioning of sexuality is one that hangs over males requesting same gender providers as well. They are also intimidated with such phrases as "You are too old to be acting like such a baby"...

At Tuesday, April 21, 2009 8:50:00 AM, Anonymous Anonymous said...

I have to agree with a lot of what you say Lyn, in fact I think that those dynamics are in place throughout the medical community not just in gyn care. While there seems to be little reliable data on the subject it appears that a significant nummber of males would prefer same gender when it comes to certain intimate procedures and exams. Men also face the added attitude as put forth above, if you want a male Dr. you are a whimp or gay. That seems to be changing and was lead by women standing up for themselves. I think we face many of the same challenges and need to change the system not just our part of it. United we are a large group. Interesting note, there is a series embarassing body or medical or something out of England, they do various medical exams, when it came time for self exam of the testicles they used an attractive female doctor and attractive young male who stood completely naked for the procedure....differences in cultures are a whole issue on their own....alan

At Tuesday, April 21, 2009 11:08:00 AM, Anonymous gve said...

Whilst I have posted a few times about having persisted about wanting an all male team for a Urodynamics procedure, I have not really commented on how succeeding in my request made me feel.

Because they had no male nurses to assist, the test was conducted by 2 doctors. Knowing this was to happen, I felt totally relaxed, totally unembarrassed and stress free. I cannot even begin to imagine how I would have felt if the procedure had been carried out in their "normal" way of 2 female staff.

The procedure was much more relaxing for me despite the fact that the doctors had not conducted the test themselves for several years and were far less accomplished at the necessary catheterisation aspect of the procedure.

The evasive attitude of the female staff when I first made my request for an all male team appeared to be designed to make me feel awkward and a trouble maker. I am so glad I stood my ground and had the test in a way I was able to tolerate easily.

The message is, don't be put off by the bullies who want you to accept the status quo, stand your ground and you will be so glad you did.

At Tuesday, April 21, 2009 1:20:00 PM, Anonymous Anonymous said...

Lynn...I see the issue in two is the medical necessity or lack thereof of a procedure, exam or test...the other is the manner they are performed..including the gender of the examiner (provider)..They are both issues which need addressing..especially in light of health care costs and increased patient loads for a provider (doctor), and the number of people who do not get a condition found soon enough becasue they won't go to a doctor because of embarrassment. The first thought comes out of many folks minds is that provider gender preferences by a patient is more costly..but based on the cost of treating advanced conditions it is ,in my mind, undoubtedly a cost saver.
I think the incresed number of female doctors and womens health will bear this out..It is the same for guys..
I greatly appreciate both your and deborahs recognising males can have issues too without putting them down for it...

At Tuesday, April 21, 2009 1:25:00 PM, Anonymous Anonymous said...

Anon, Monday April 20 regarding the consent for surgery----
In spite of Dr. Bersteins clarification that it is not a properly executed consent what ANON states IS WHAT GOES ON DAY IN AND DAY OUT!!!! This is what I encountered and every other patient. The only way I found out what I had signed was that I requested my medical record from the surgery center. It was then I read ALL the fine print on the form that a nurse in the Pre-Op holding area had thrown before me (IV inserted, NO corrective lenses) and told me I needed to sign this as it was allowing a blood tranfusion if needed in surgery. In the fine print on this consent form is ALL of what ANON listed! I was outraged and angry beyond WORDS! People are bam buzzled and blind sided with this stuff. The AORN and the facilites are fully aware of what they are doing. It is outright WRONG!
If anyone is going to have an elective procedure, you owe it to yourself or your loved one to insist and receive ALL consent forms 1-2 weeks ahead of time so that you can actually read ALL of what you are being ask to consent to. This is very misleading and I think ILLEGAL but it goes on.

At Tuesday, April 21, 2009 1:36:00 PM, Anonymous Anonymous said...

alan, it is what you don't know won't hurt you. (being under sedation).

Same thing with the consent forms for surgery. Cone of silence, basically. They don't want you to know too much because if you did you would cancel the whole thing or WALK. They're out the money. They want you to show up and go through with it.

After they have your signature on the surgical consent form, what are you going to do legally? You signed it, try to fight it! You lose, big time. They have their backside covered.

At Tuesday, April 21, 2009 5:48:00 PM, Anonymous Anonymous said...

When male patients end up in the
hospital,er or worse an outpatient surgery center we face a 92% female nursing staff. Currently, 40% of all physicians are female.
Female patients have an abundance
of options and when they end up in
the hospital,er or worse an outpatient surgery center they face
a 92% female nursing staff to ensure their concerns for privacy
issues are complied. Female patients know and are told well
ahead of time that their gyn physicians are female.
Yet males are never told as if
it dosen't matter. If we complain
we are considered sexist. That is
the epitomy of discrimination and
how can a society consider itself
civilized if it discriminates against it's own people.
I have very little respect for
outpatient surgery centers as they
are very poorly equipped to handle
emergencies. They tend to mostly
hire predominately female staff and
when they have an emergency guess
what. They call 911!
Last year a patient had plastic
surgery performed which essentially
entailed removal of excess adipose
tissue. Unfortunately, the plastic
surgeon removed more than was
medically safe and advisable for
this patient. The patient went into
cardiac arrest. The outpatient surgery center called 911 as they
were unable to handle this kind
of emergency. Most of the surgery
staff went home before the patient
had FULLY recovered from anesthesia.
The patient died after being
transported to a hospital. There are numerous cases such as this
and I'm aware of some absurd
incidents as well regarding outpatient surgery centers.


At Tuesday, April 21, 2009 7:36:00 PM, Anonymous Anonymous said...

This is turning out to be a very complex but fascinating discussion about how patient’s feel about modesty/privacy/exposure in the course of medical care. I have learned a lot from those who have posted here. There is no denying that some feel the way they do because they were improperly informed (ambushed) or treated in an unprofessional (or sometimes illegal) manner by doctors, nurses or others. It is a tragedy when people avoid getting needed or recommended healthcare because of this. Some seem to only have modesty issues with intimate healthcare from the opposite sex, some even their own sex.

I don’t think of doctors and nurses as the enemy or genderless robots. I think of them as people in the healthcare profession and gender doesn’t matter to me. We as patients have the right to refuse any treatment by anyone for any reason we choose, especially disrespect.

I personally don’t have a problem being naked in front of any healthcare person when it is necessary and handled professionally. They are there to care for the human body, all of it, from head to toe and everything in between. I am the one who is requesting their expertise, so it is counter-productive to not want them to examine me, all of me if need be. They need to be able to see, touch and listen to your body for a proper diagnosis. In my few trips to various doctors since being born 50 years ago, my only minor incident was when I was 11 yrs old and had to walk in just my underwear out of the exam room and down the hallway to be weighed. Sure enough a girl my age walked right past me. That seems pretty mild in comparison to some of the horror stories I’ve read here.

At my last physical I was given a gown but I kept my boxers on and only wore the gown to keep warm. Once the exam started I said I didn’t need the gown and took it off. I have maybe 15-20 minutes of the doctor’s time so I ‘m not going let any go to waste. When it came time for the testicle exam and DRE, off came the boxers.

My vasectomy was 14 years ago, performed by a local urologist and assisted by his nurse. He’s done 1000s of these procedures (experience matters to me) and having his nurse assist was simply the way he does them and I had no problem with that at all. I do have a funny story to tell. Before picking this one urologist, I visited 3 other urologist offices in town. At one office the waiting room was rather full and chaotic but I walked up to the window and said I was interested in getting a vasectomy. “OK, we will be with you in a few minutes” was the reply. About 1 minute later one of the office staff with a small specimen jar comes into the waiting room, walks right up to me and says, “We need a sample.” I was flabbergasted! Well, of course she had the wrong patient, so I nervously explained everything, but decided there was no way I was going back to that office again.

For those who only have modesty issues with intimate healthcare by the opposite sex, first off, I respect your right to feel the way you do and refuse treatment. I just don’t understand WHY you feel the way you do. Please explain.

PT, I have read all of your posts, many are quite shocking, including the links to some discussions on allnurses. I wonder if they come over here to read what we say about them and much as we go there to read what they say about us. But please tell me you have met or worked with many fine women (and men) in healthcare that were always professional, who truly respected their patients and the bad examples you mention are just a few bad apples in with the good ones. I can’t explain why most of you seem to get all the bad nurses, maybe I haven’t been to the doctors office enough to run into a bad one, but since I’m 50 and things start going wrong with us old men right around now, I will be better prepared for when a bad apple comes my way.


At Tuesday, April 21, 2009 11:41:00 PM, Blogger MER said...


Interesting post. I don't know how many of the past volumes you've read, but you'll find explanations as to why people feel the modesty they do within medical situations.
But some men feel they don't really need to explain it. Just like you -- you don't need to explain why you feel the way you do. You just do.
Some men would claim that the modesty feelings they have represent the norm in our society, and that it's unrealistic to expect people to just drop that norm when they see doctors and nurses. We live in a society where we don't expose ourselves to strangers of the opposite sex -- at least that's not considered the norm.
Most men on this blog accept the extreme situations (some don't) -- ICU, ER's, etc. People have various value systems. Some people have been sexual abused. Others have been humiliated in medical situations in the past and refuse to have it happen again. Some people are just shy or modest.
That's how people are. Different. Most men who prefer same gender intimate care seem to have absolutely no problem with those who don't mind one way or the other. It really doesn't matter to them why you feel the way you do. Not that it isn't interesting discussing the subject. But from a practical point of view, it really doesn't matter.
It seems that many men who don't mind opposite gender intimate care seem to almost take pride in that position, claiming the higher moral ground. I'm not saying you expressed that opinion, but many men do express it. It's as if they feel they're right and the others are wrong. That people who are modest have a psychological "problem" that needs to be solved.
We live in a diverse society. "Diversity" is the politically correct word these days. Except, apparently, when it comes to preference for intimate care in medical situations. Medicine is all excited about what's called "transcultural" medicine -- that is, being sensitive to various cultures. That's a good thing. But this position seems only to be valid for certain politically correct "cultures" or "groups."
Personally, I have mixed feelings about this whole issue. What bothers me the most is medical secrecy. We've just been talking about the problems with informed consent. Not including information about the gender of caregivers when communicating with patients. Not offering patients choices for same gender care. Not including this kind of information in pamphlets or on websites.
As you say in your post, this is a very complex issue. And why people feel the way they do is complex and can't be simplified. Some people may not even really know why they feel the way they do. So much of it has to do with upbringing and cultural norms.

At Wednesday, April 22, 2009 1:04:00 AM, Anonymous Anonymous said...

William, thankyou for your post. Obviously you have read and thought about the discussion here and while you may not understand why we feel as we do, at least you do not attack us.....Something that is appreciated.
As to your question as to why some have an is in their posts for the most part...the mistreatment or abuse or an event causing great embarrassment..leaves its mark...The cultural factors of how you were raised and how you viewed nudity and exposure explain in part the depth of how these other events affected us...and trying to explain the feelings is often beyond words. Your walking down the hall in your undies might have caused greater sense of embarrassment to someone else...if something happened at around the same age as you but it involved exposure and with words involved and betrayal of amount of logic saying it was just words or that it is not going to happen again is going to stop the apprenhension (a very mild term)when anything remotely resembling the marking moment looms over you. It is not completely just that trust is is that the event was bad enough that the person is not going to take the chance on trusting is true in many aspects of betrayed is trust lost is lost...and few are going to let anyone know of this vulnerability either..simply because of the original is also why most of the cliches do pokes fun of us or demeans is much like the guy who lost to the lady in Texas..his comment about a female should just enjoy the rape...this is a poor explanation I know, but it is the closest I can come..
Jw, PT , alan and anyone who has posted about the consent form, Thankyou...My PCP told me today that I would soon be using one (I am not sure if I will agree to surgery), but if I do get it..I am going to make them give me the consent forms before I enter the hospital...and I intend to have a serious and informed talk with him days before...Things that I have learned from so many of you and Dr. Bernstein... I already know an all male team is not going to happen at the hospital I will have to go to...If I decide to..I will most definately want to be unconcious earlier and later than some might opt for.

At Wednesday, April 22, 2009 6:32:00 AM, Anonymous Anonymous said...


Thanks for the comments. As I’ve said before, I have no issues with female providers as long as my shorts are on. If they need to come off (which hasn’t HAD to happen but a few times in my 31 years) I’d prefer working with same gender care. I can’t explain why, the one thing that sticks out to me is being strapped as a child to a bed with leather straps and two female nurses removing my pants because I at age seven or eight wouldn’t remove them myself. I was hit by a car and taken to the hospital four hours after the incident. I don’t remember much from my childhood, but that sticks out as clear as anything so I know it’s just part of the reason why I prefer care the way I do. The other reasons are just mine, there’re just what I’m comfortable with and prefer just as you stated yourself. I’ve worked with many female nurses/assistants through all four of my surgeries and didn’t have a problem because I had the surgery under my terms and communicated ahead of time. I agree that they are just professionals but part of being a professional is caring also for the whole patient and that means both physical and mental. I don’t judge others for the choices they make and I shouldn’t be judged by the choices I make. Jimmy

At Wednesday, April 22, 2009 6:52:00 AM, Anonymous Anonymous said...

Aren't there any other ultrasound facilities in your area? Did you explain your disgust to them about not having any male techs?

If it were me I would refuse a woman and politely try talking to the management (about a male from another facility), but if that didn't work either I wouldn't be so quiet anymore. I'm not one to make a scene very often but in that case I would really let them have it. Something that unethical needs to be changed.

At Wednesday, April 22, 2009 7:00:00 AM, Anonymous Anonymous said...


VERY WELL DONE!!! You are an excellent representative for men and for what we have discussed on this site. If enough of us have the courage you have this disgusting and unethical practice (no choice in nurses) will soon be a thing of the past.

At Wednesday, April 22, 2009 8:29:00 AM, Anonymous TT said...


When it comes to the consent form, don't forget that you can cross out anything you disagree with (even though they may try to tell you otherwise). You can also add specific comments or instructions if there is room on the form, or do it on a separate sheet of paper if there isn't and make a note on the form that your consent is conditional to comments/instructions on the attached document.

Hope all goes well for you!


At Wednesday, April 22, 2009 8:33:00 AM, Anonymous Anonymous said...

gve, I had waited a long time to go to the doctor i the first place..and the problem was getting bad..I did not know at that time I could have gone to another facility..and I thought if I faked it..I might be able to overcome the really did not work...I managed to make it through the exam..but it took all I had to do so..and I have no idea what it would take for me to go through it again...but it would have to be really in teh future I will find a facility that can and will accomadate me...
Thanks anon, MER and Jimmy...I think your explanations represent what many many of us feel.

At Wednesday, April 22, 2009 10:21:00 AM, Anonymous Anonymous said...

William, welcome to the dicussion. Trying not to repeat what has been stated above. I really and truely can not say with certainty why I feel like I do. I can list what I think are contributors, but I think this is such a individualistic issue I am not sure it have value outside of my on case. With that in mind I restate what has been a pointo of contention, why do providers not ask if a patient has concerns vs the patient having to ask or even demand. For me I think the following contribute (1) I was raised in a somewhat conservative environment and we were raised it was wrong to expose ourselves to the opposite gender without differentiating for medical (2) being a male I have seen males humiliated through nudity i.e. kids pushed out of locker rooms nude, depants, intiations etc. (3) I think to some degree all of the joking and humor about "size matters" etc effects us similar to the "Barbie" body image is said to effect females (4) I have some of the same body insecurities as are recognized in women that make me uncomfortable with females...but I could care less what males think (5) I precieve hypocracy, perhaps misrepresentation from providers who have one set of rules for patients and another for their modesty (6) I feel there is (and have experienced) a double standard regarding male modesty vs female and I think this causes some resentment (7) I feel providers could do more to ease this situation and don't so that causes some problems for me. I really can't tell you how deeply any of these contribute to my feelings, but I would say they do have some place in there...and as stated before, I am not sure it really is the dominate issue of the debate. Its sort of asking, why some guys like blonds and others prefer redheads. Why do some women like tall guys and others are attracked to stocky guys...I would like to ask you a question. You seem to have no problem with the gender of your provider, how would you rate your over all modesty, high, medium, low. How do you feel about exposure in other circumstances, for instance if you were at a topless or nude beach...would you partcipate. What about issues such as opposite gender janitors, would you care if females came into your locker room while you were showering or changing. I think it would be interesting to hear your thoughts on would be easier if I felt like you, but I don't and don't know that I say 100% why nor do I think I can completly shed that feeling. I like some above am able to accept opposite gender exposure under what I consider reasonable circumstances and am resonably comfortable under others i.e. OR...but for example I have stated before I had two testicular ultra sounds, the 1st female and I was very uncomfortable, I read this thread and when it came time for a follow up and called, asked, and arranged for a male tech and felt much more comfortable. Some of that was probably the procedure and some from the fact that I was pleased with myself for taking action vs beating myself up for accepting what was handed out....alan

At Wednesday, April 22, 2009 10:23:00 AM, Anonymous Anonymous said...

I am confirming what "PT" stated about the problem with having surgery at an outpatient free standing surgery center.

all of what PT states is true. Female employees predominate, if there is a BIG emergency they are not completely equipped, 911 is called! I'll bet no one asks about this or knows this fact.

There is a surgery center in So Cal that had a healthy middle aged man go in for knee surgery and he died in recovery. You guessed it, lawsuit. The story was in the Orange County Register in 2008. The paramedics were called.


At Wednesday, April 22, 2009 2:35:00 PM, Anonymous Anonymous said...

MER, Jimmy, Alan, thanks for the comments, your answers to my question and your questions for me. I have read this topic all the way back to the posts of mid 2008. I am aware that many men and women feel the way they do because of accidental or deliberate mistreatment by the healthcare profession, and consider this a tragedy. I got a small dose of that mistreatment when I was 11 yrs old. I think it’s very interesting that there are so many answers presented to my 1 question of why. I guess I should consider myself fortunate that gender just doesn’t matter to me. I can pick those who are best capable of helping me and I don’t have to eliminate 50% of the doctors and 90% of the nurses right off the bat.

I actually consider myself very modest, never been to or wanted to go to a nude beach. I completely agree that it’s normal in a society for people to not expose themselves to strangers of the opposite sex. But does a doctor or nurse you want to examine or treat you constitute a stranger?

The very nature of the medical profession is the care of the human body, all of it. There is no getting around this. They are trained to care for both types of human bodies. This makes the medical profession different from all other professions out there like reporters, janitors, plumbers, etc. Seems to me the players could stay dressed while the reporters were in, and then kick all the reporters out, no unequal access there. That’s the way the WBA does it, problem solved. Janitors and plumbers should have to wait until everyone is out.

I certainly don’t want to be exposed if there is no reason for it or the doctor is just lazy or too callous to care about me being exposed if he opens the door or curtain. I don’t want to be exposed to other patients, their family members or anyone else who is not involved with my medical care and not trying to figure out what if anything is physically wrong with me.


At Wednesday, April 22, 2009 3:54:00 PM, Blogger Maurice Bernstein, M.D. said...

As William wrote: "The very nature of the medical profession is the care of the human body, all of it." In a sense different than permission by society to examine either gender as the primary orientation of the physician is "the care of the human body." What that means in practice is that, if we are following our teachings and professional guidelines, our mind is set at understanding the patient and his or her illness. I can tell you that gender issues are not on our minds as we attend to a patient. In fact, and I think this is the problem, we are anticipating that the patient's main concern is about symptoms and getting well and our concern is about making the correct diagnosis and treating the patient's illness effectively. I think I speak here for all doctors who don't look at what they do simply for self-interest, monetary or otherwise. Again, I want to emphasize that I think I represent an "average" doctor and I can tell you all with full earnestness that gender concerns by the patient was never expressed to me nor did I think they were hardly anywhere on the patient's list of concerns. I was thinking only of the patient's symptoms and doing something about it. That, in itself, is a whole lot of responsibility and occupies a doctor's mind. Believe me! Of course, now after over 3 1/2 years of visitor postings, obviously I have a slightly different attitude when I currently see a patient.. and wonder.."what is that patient thinking 'gender-wise'?"

I know I am probably repeating myself from my previous postings but since we are apparently not getting much in the way of input from medical professionals on these threads, I feel, with confidence, that I must speak for them. Thank you for your understanding. ..Maurice.

At Wednesday, April 22, 2009 4:02:00 PM, Blogger MER said...


You write: " But does a doctor or nurse you want to examine or treat you constitute a stranger?"

It depends. If we're talking about your personal physician (male or female), one you have chosen and have developed a relationship with -- of course, they're not a stranger.

But often your personal physician will refer you to a specialist, someone you don't know at all. They have a staff of assistants or nurses you don't' know. Are they strangers? Of course they are.

Next, the specialist may need to do a procedure or an operation, so off you go the the hospital or day surgery. There you're confronted with other people you don't know. Are they strangers? Of course they are.

Now, your questions seems to imnply an answer which is -- "Because doctors and nurses are trained and authorized to treat both males and females, and they do this every day, and this is just routine for them -- they that means they're not strangers -- patients shouldn't regard them as strangers.

That doesn't make sense to me. How patients regard these "strangers" depends upon many things. Some of it depends upon what the patient him/herself brings to the table. Some of it depends upon what these "strangers" bring to the table.

Some providers, doctors, nurses, techs, are real people persons with great personalities. They can make patients feel at ease right away. Others don't have that skill. Still others purposely create a distance between themselves and the patient for various reasons, including the fact that it makes them feel more comfortable.

Think about it, William. Why wouldn't a doctor or nurse you've never met before not be a stranger to you. And if so, then why wouldn't the typical societal norms, especially feelings, that go along with meeting and dealing with strangers be in play? We don't normally expose ourselves to strangers of the opposite sex. For some people, they don't feel comfortable doing that even with a doctor or nurse.

This doesn't mean that these patients don't want to be examined or treated. They want to be treated. They also want to feel psycholgically safe and comfortable. They prefer same gender care. That's how they deal with having to expose themselves in front of a stranger. There's nothing wrong with that. It's just a preference.

At Wednesday, April 22, 2009 6:08:00 PM, Anonymous Anonymous said...

The magazine Discover which I believe everyone is familiar with
has a plethora of scientific articles on the forefront ranging
from cell biology to cosmology.
Featured in this magazine is an
article called vital signs. It is
usually written by a physician
conveying an unusual diagnosis or
an unsuspected outcome. Quite a
few years ago the article featured
was by a nurse.
In the article it involved a male
patient and she out right stated
how female nurses enjoy performing
urinary catherizations on male
Should anyone dispute that this
was written I will provide the date
of this particular issue. It is
the last one I purchased since
cancelling my prescription. The
magazine has scientific articles
written by giants in their respective fields and for someone
to contribute trash next to great
articles is beyond reasoning.
How it even made it past the
editor is beyond me. Can you imagine the backlash if a male
physician made a similar comment
publicly if he stated how much
male physicians enjoy performing
pap smears.


At Wednesday, April 22, 2009 6:09:00 PM, Anonymous Anonymous said...

I think most people would agree that we have given medical permission to treat our bodies and on occassion that means exposure. Where the issue lies for me is what are the limits and who defines the paticulars of that. Medical people seem to think it is carte blanche, some of us feel it should be limited to some degree or another, others think never (speaking of opposite gender). My personal feeling is I should be asked, and I will tell you my preferences, I don't want to be exposed to the opposite gender when I am awake, I will accept it if it is nesecary and there has been reasonable attempts to accomodate, and I am less concerned when I am out. Now I find that reasonable. I find that more reasonable than providers just assuming the can do what ever is easy for THEM. The customer should be the focus, primary should be the physical but the emotional should also be important. I feel providers have used the permission we must by the nature of the relationship give them, to justify or expand it carte blanche to dismiss the issue of opposite gender modesty issues. The fact that in some cases maternity and some instances for women recognize the issue indicates there is some level of awareness. There was a level of awareness when male orderlies were used to provide intimate care for patients, it was the medical profession who came up with gender nuetral across the board, I don't think the asked patients. That to me is where the arguement we give our permission, we do, but not carte blanche and do so with the hope and understanding it is understood that it is not without limits....and we should have input into those limits.......but we often don't....alan

At Wednesday, April 22, 2009 7:43:00 PM, Anonymous TT said...

Just an observation on the whole "permission" issue...

While society may indeed grant permission to medical professionals to treat the human body, it is in reality only a very basic permission, just like the ones that say only a licensed plumber may perform plumbing work, or a licensed electrician perform electrical work. In no way does it override the requirement to have the specific permission and consent of the patient. The bottom line is the patient has the final say as to who they will allow to provide treatment.


At Wednesday, April 22, 2009 7:57:00 PM, Anonymous Anonymous said...

Thanks TT. I may cross out an dinitital soemthing I do not want to have or place restrictions on parts of the consent form. I think I will try to see how the surgeon relates needs vs wants

At Wednesday, April 22, 2009 8:42:00 PM, Blogger Maurice Bernstein, M.D. said...

TT, society does give physicians permission to ask intimate questions and perform intimate examinations but only with the tacit approval of the patient (no formal informed consent with signature is required). Nevertheless, the approval is often more than assumed. For example, the way we ask about the patient's sexual history is by asking "It is important to know about sexual transmitted diseases, can you tell me about your sexual history?" The patient can say "no" and that, depending on the clinical situation, could end the question.

On the other hand, if a procedure is to be performed where there is a significant risk to the patient (beyond a venipuncture to draw blood for tests), a signed informed consent is necessary. Thus touching the body of that patient without such formal consent could represent an assault or battery.

What I don't know is whether every one of the requests regarding gender in the procedure or operating room, whether written on the informed consent form or not is legally a necessary part of the consent, by law, to be rigorously followed. I thought the informed consent was to give the named surgeons or radiologists permission for the technical procedure itself and didn't require establishing by name or not the other individuals present nor for the routine, usual and normal other activities which go on in the procedure room or operating room that as activities themselves pose no physical harm or risk of significant harm to the patient. If anyone has a legal source otherwise, I would be very much interested. ..Maurice.

At Wednesday, April 22, 2009 8:53:00 PM, Anonymous PL said...

My fear of doctors started after being hospitalized at age 9.
I was stripped naked and made to stand in an exam room surrounded by men, I assume medical students.
I had an unusual skin condition although there was absolutely no need to remove my underwear.
I sobbed with fear and embarrassment.
I vividly recall the feelings of exposure, helplessness, isolation and distress.
As a teenager, I had problems with unwelcome male attention, being grabbed and pinched. I also had to fight off a man who tried to attack me on a train and was the victim of a peeping tom while in college.
These experiences mean I simply don't trust men when I'm vulnerable and exposed.
I dislike seeing doctors and feel ill at ease, but when it's absolutely necessary to see one, I see a gentle, patient and kind female doctor.
I found other women initially attacked or were rude about my wish for a female Dr.
They somehow resented that I should choose a female Dr.
I've never really understood why some people feel challenged and feel the need to be rude if someone prefers a female doctor..."Do you think he'll attack you"...
I don't think all male doctors attack their patients, but I feel extremely uncomfortable with the power dynamic (especially if an intimate exam were necessary)and feel MUCH more comfortable with a woman. Why should that be so hard for some to understand?
At this point, I don't feel the need to justify my choice of doctor. I'm paying for a service, it's MY decision.
The fact is, if an intimate exam were required and only a male doctor was available, I wouldn't have the exam.
I simply wouldn't attend...
I was recently required to have a breast lump investigated and my GP sent me to BreastScreen. Over the phone, I mentioned my need for only female medical providers and was readily and politely reassured that every person employed at the centre was female.
A courtesy I deeply appreciated...
It seems I'm not the only woman who prefers female care.
I'm sure the system wasn't set up just for me.
It's a clear recognition of the need to make women feel completely comfortable in an exposed and embarrassing situation.
Thankfully, things have changed and now, many, many women choose female doctors. My GP is part of a practice made up entirely of women - 12 female GP's and several female specialists.
It's reassuring to know that I can get medical care if and when it's needed...peace of mind.
This hasn't happened overnight, initially, it was very difficult and usually involved delays and standing up for myself.
I think men are probably just starting the battle.
You'll get the belittling cracks, the challenges and the takes time, but by refusing care that is unacceptable to you, you'll eventually force change.
Every man who challenges and demands, makes it easier for the men who'll follow...
Once the wave of requests builds in size, you'll find all male urology clinics won't be too far behind.

At Wednesday, April 22, 2009 10:51:00 PM, Anonymous TT said...

Dr. Bernstein,

You stated "society does give physicians permission to ask intimate questions and perform intimate examinations but only with the tacit approval of the patient (no formal informed consent with signature is required)".

I don't disagree with your statement and did not say that written consent was necessary. By seeking care the patient does give tacit permission. However, the moment a patient says "stop" or "no", or otherwise raises an objection, that permission is effectively withdrawn, and the provider may not proceed unless/until the patient agrees. At this point "tacit" is no longer applicable and the permission must be explicit, i.e., verbalized.

With respect to the consent form, it is a written contract. If the patient makes specific notations on the form, and the provider chooses to proceed with the procedure they have defacto accepted the notations as modifications to the contract. How rigorously they must be followed depends on the nature of the notations. Simple requests do not carry the weight of specific limitations or prohibitions. For example, "request same gender team" may or may not be honored depending on availability - this would need to be something you set up well ahead of time if you want it. On the other hand, a patient can put specific lititations or prohibitions in place that are legally binding - for example:

No observers/students/interns, etc.
No sedation/ conversion to general anesthesia/intubation, etc.
No photos/video, etc. without specific authorization
Consent only for the specific procedure
Require explicit permission for any procedure or treatment
Who may perform all or part of procedure
Prohibit specific medications or procedures

As long as the patient understands and accepts the responsibility for any additional risks they may incur, and the physician agrees to perform the procedure, these type of limitations are legally binding (may vary somewhat depending on where you reside). I know this for fact (at least where I live), because I paid an attorney to research this and come up with a comprehensive consent addendum. So far I've used it in my interactions with several providers and haven't had any problems - primarily because I am willing to take full responsibility for my choices in a notarized document.


At Thursday, April 23, 2009 1:59:00 AM, Anonymous Sarah said...

Dr, you mention that symptoms are the primary concern of doctors, not gender issues.
Sadly, we have moved away from symptoms and increasingly the focus is on preventative medicine.
I this this shift has alienated many patients, particularly women.
Not all patients want to be involved in "just in case" medical care and it should be our choice whether we wish to be involved...
This is rarely the case - our wishes are irrelevant, it's for the greater good apparently...even if it ends up hurting us.
Our health may be sacrificed to get to the few that will actually have a problem.
I strongly disagree with this approach.
My grandmother chose not to take part in cervical screening. During the last ten years of her life she chose not to see doctors and relied on a naturopath instead...
She became disillusioned when her decision was dismissed and she was subjected to pressure every time she went to the Dr for anything. The practice also sent her letters and made phone calls to her home. We believe she was harassed and the Dr's pursued her to achieve their screening target. Dr's in the UK receive large sums for reaching screening targets.
She stood firm and was then told she could no longer attend the practice.
My Nan was a defaulter or refuser.
My cousin is a solicitor; she became involved and the practice apologized and reinstated her as a patient.
Too late, my Nan never went back. Cancer screening meant she lost respect and trust for the medical profession.
Cancer screening in older women can be very difficult.
Some women have arthritis, others have atrophy making this sort of exam painful.
These ladies often bleed after the exam and are often recalled because the sample is unsatisfactory.
I'm afraid as a family, we were disgusted with the behaviour of the doctors. We all lost respect and trust.
I know we're not alone, there are thousands of similar stories in the UK and probably elsewhere.
The General Medical Council has now issued new rules stating doctors must respect and accept a patient's decision - informed consent is at long last, a top priority. It should have been all along...
How did this sad situation arise?
I think when you go to the Dr with a backache, you accept your back will be examined, therefore the exam is acceptable to most patients.
When tests and exams are forced onto healthy patients, I see a major departure in the traditional doctor/patient relationship.
Patient care and informed consent then falls behind screening targets and money.
Shame on all the "doctors" that behave in this way and if your behaviour continues, I hope you'll be reported.
Enough is enough - it's time for patients to enjoy their lives and obtain health care, free from this sort of harassment.

At Thursday, April 23, 2009 5:01:00 AM, Anonymous Anonymous said...

PL, sorry to hear of your experiences, you are right, men are behind the curve and the battle is just starting. And you are exactly right, every male that stands up moves that effort.

Dr. Bernstein, I don't think most people here are challenging the legal aspects of consent with this issue. We must sign consent form for surgery and procedures that is understood and that needs to be done for the protection of the providers and in theory so the patient understands. I don't want to argue that part right now but I really question how much genuine concern there really for the informed part when they hand it to you last minute while your in a gown or waiting for it to start and all wired and stressed. They schedule weeks in advance, it would be easy to give them then so they could be examined, and have them available if you forget them...but then thats another story.

What I challenge is the concept that we as patients give consent for providers to compromise our modesty, or more accurately give carte blanche permission. You can note list and get a sign off on every single aspect of care, its to massive and it changes as the process unviels what is going on with the patient. We understand that, what we are saying is just because we consent to you treating us. Providers seem to think that us giving permission means you can dictate exactly what you are offering and it is assumed we will just be fine accepting them becasue we have come to you for care which implies consent. It does not, I come to you, I give you consent to begin the process within the terms and boundaries I am comfortbale with. We normally see these relationships as we come to you who provide a service and we agree on what we are going to do and how, and we go forward. Medicine has evloved to the attitude that you come to me, and I do what I think is best for you and you just accept that. Granted, I don't have any idea how or where to cut, but, I am still retain control of my being, I did not give you complete control. You should ask...but you don't, you assume if it works for you, it works for us. That is the arrogancy of medicine that we have historically put them on a pedistal and you no longer feel the need to ask or consider anything other than what you feel is important. It is an interesting phenomona that in the face of an increasing provider shortage, the competition for patients (esp with insurance) has increased, all the advertising is giving patients the idea that, there is competition for my money and that gives me choice. I don't think this is a legal issue, and I don't question that I gave you permission, I did not however give carte blanche RIGHT to do as you see fit. If you took your car in for an oil change and the guy says since you brought it in and gave me permission to work on it I put new brakes on it and had my buddy paint it for extreme apples to orange example...but, similar mentality....alan

At Thursday, April 23, 2009 5:29:00 AM, Anonymous Anonymous said...

Excellent comment PL. I feel exactly the same way but from the male perspective. Woman like you have fought for and have now received the respect you deserve (in many clinics at least). Great job.

We men now have to follow that example. Though it appears not enough men out there have had the guts to do something about the unethical treatment we receive. A few brave men can get it started but we need many more to be able to accomplish our goal of ethical treatment.

Changing the subject, has anyone had or heard of an experience where someone has made a change on the pre-surgery consent form, such as not allowing students to participate or pictures to be taken? How was it received by the nurses or the surgery team? Were they surprised that you actually read the small print?

At Thursday, April 23, 2009 6:14:00 AM, Blogger MER said...

Read the link below. It's a short anecdote from a nurse who all of a sudden finds herself as a patient. It gives her some insight into what it feels like to be a patient. She focuses on the control issue, which I think is a powerful factor in much of what we're talking about. Also, read the responses to her story.
Two points:
1. Many nurses understand what we're talking about completely and deal with it daily. Some more successfully than others. Nurses are much more in touch with this issue that are doctors.
2. Many young providers, doctors, nurses, techs, etc. are relatively healthy and have never really faced any serious medical situtation where they've been a patient. Some are so young that they haven't had to deal with parents who have been hospitalized for serious conditions. They see things and do things everyday -- things that they see only from a professional, clinical point of view. They haven't felt it from a personal, emotional, psychological perspective. Here's the link:

At Thursday, April 23, 2009 7:12:00 AM, Anonymous Anonymous said...

Dr. Bernstein, I agree that most doctors are interested in their patients beyond money.
PL..sorry you had that experience. I am glad you have found providers that you are comfortable with.
I think Dr. Shermans' blog is a great read for the issue of photography as part of the consent form. I would only object to my privates or face being photograhed. I have no problem if there is something that a doctor could use to show/tell/ask another provider about that would help me or someone else..(ie some organ or tissue that shows something unusual or puzzling) I would also ask that my identity not be released with the photographs. I read a while back about a doctor (female) who wanted all of her operations/procedures performed under anesthesia filmed with a video camera and that she was to receive an unedited copy.
As I wrote earlier, any changes to a consent form would be after I had a serious talk with the provider (surgeon) and I will accept any consequences from any refusal I make.

At Thursday, April 23, 2009 8:53:00 AM, Blogger amr said...

To: Anon Thurs 4-23 5:29am

Please as a reminder to all on this blog, as Dr. B often requests, sign your posts with a consistent "name" or "initials" so we can all follow the tread of thinking.

Virtually all medical consent forms have verbiage allowing the doc or institution to take pictures and/or video. It is there to protect them (not you), and is there to deliberately force the patient to be a part of the medical education system.

I have crossed out portions of my colonoscopy consent referring to photos / video outside my body, and have limited the people who would be in attendance. I brought this to the attention of the circulating and had them initial it (and/or) note it in my chart.

When I had a problem with my eye not long ago, the consent form I signed to allow the doc to perform a procedure had the standard photo/video verbiage. (This would have taken place at his office, not a hospital.) I crossed that out and they didn't bat and eye (pun intended).

Teaching hospitals are an entirely different matter. From personal experience, you are told that you may not change the contract / consent form. If you attempt to do so, the hospital service will be denied. In the past, I posted on this blog a link to a PDF file put out by Stanford University about gyn surgery procedures. They provide an example of the consent form and explicitly state that the resident is to tell the patient that they must submit to pictures / video if the subject comes up. They are to explicitly state that the surgery will not be done at Stanford if the patient refuses.

Dr. B. -- You are right in your recent entry blog entry of Apr 22. (with emphasis the last paragraph). This is also the "cover" that has been used to perform non-consensual pelvic and rectal exams. As you know some doctors, on the record, have argued that the patient has a responsibility to submit to such tests for the betterment of educational medicine. They have also argued that the general release signed "covers" such education. And some docs have argued that to inform a patient they are to be "examined" my students would only frighten and confuse them, so they hide behind the general release as "permission".

The release is worded in such a way where the patient gives blanket permission for treatment which covers all personnel involved, including sometimes sale people.

Bottom line, yes, the patient signs a release. Yes, therefore, they have legally given consent. But they are in fact being given a nasty choice. Submit to the desires of the institution or go untreated.

This is a common legal tactic. Try and change your cc contract and see where that gets you, or mortgage or loan agreements.

Although it is common, I'm not sure that in the case of the medical release it has been contested in court. Most patients do not have the time or money to do so. Furthermore, unless the surgery is truly elective, patients do not have the luxury of time to fight the system. And most patients probably do not know the extent to which they seed their rights to the institution.

By the way, there are at least two releases that a patient signs. One is the hospital consent, and one is for the surgery. Sometimes they are combined. Both are designed to protect the doc and the institution. The protocols surrounding the administration of the consent forms however are there to protect the patient to the extent that the hospital makes sure that the patient (or their surrogate) understands why they are there, to make sure it is the correct patient for the correct surgery, and lastly to make sure that the proper body part is being operated upon.


At Thursday, April 23, 2009 9:11:00 AM, Anonymous Ray said...

If you asked for the consent forms ahead of time and made changes - would your wishes be respected anyway?
How would you know? You'd be unconscious and as someone said a while back, the cone of silence applies in theatre.
You'd never know whether a team of medical students did a practice session on you or not.
It seems the medical profession is quite skilled at keeping patients in the dark and disrespecting their wishes.

At Thursday, April 23, 2009 3:52:00 PM, Anonymous Anonymous said...

In response to Ray's comment of 4-23-09 9:11 am, I strongly feel that if I needed a surgical procedure I would insist on having my spouse stand in. That is the only way I would know for certain if my wishes were respected. One does not know what goes on otherwise. I truly don't see how they can refuse this as they do allow others to stand in..sales people, students and the like so what is the difference.

At Thursday, April 23, 2009 5:18:00 PM, Anonymous Anonymous said...

The term chaperone often widely
used in healthcare but most often
abused and very misleading. Often
occurs when a male physician examines a female patient in a
gyn setting.
Men don't need a chaperone and
never need to request one as there
is always a crowd of female nurses
and techs to observe. It's the old
saying why does it take three people to change one light bulb?
Fact is it only takes one person
to do a urinary cathether yet you
always see several other female
nurses and/or techs observing. If
you've got people standing around observing then there really can't
be a nursing shortage can there?
You will see this behavior mostly
in the er and surgery. By design
all surgery rooms have one entrance
whereby the patient is wheeled in
and another door which almost always leads to a hall or the surgery supply room. The other door
is easily accessible by other staff
and used frequently by staff to observe surgeries they are not
assigned to.
Both doors have windows with little flimsy shades which are
never drawn! To reiterite my point
women often may ask for a chaperone
yet men never have to. Female nurses and techs simply take it
upon themselves to be present.
How kind of them!


At Friday, April 24, 2009 7:28:00 AM, Anonymous Anonymous said...

Maybe the other nurses and techs are observing because they are trying to learn something. Maybe they can assist if something goes wrong. Maybe they haven’t done that procedure in a while and they’re thinking “I wonder how this doc/nurse/tech does it?” Anatomy does deviate from norms, how do they learn how to handle that? No don’t work in healthcare profession but I did stay at a hospital once (ok that was a lame joke), but why assume that the extra nurses/techs are there for nefarious reasons? My youngest daughter wants to become a doctor, how is she and the next batch of doctors/nurses going to learn if everyone clams up and won’t let her examine them? ---Kevin--

At Friday, April 24, 2009 8:19:00 AM, Blogger Maurice Bernstein, M.D. said...

I want to relate to my visitors an example of a "teaching moment" that I experienced and participated in yesterday. This is relative to the discussion about the role of the physician in intimate history-taking and intimate examination of the patient in terms of tacit consent by that patient.

My group of six 2nd year medical students were doing a learning exercise where one student acted as a patient and the other student acted as the doctor. the "doctor" took a focused history and then was to perform a focused physical exam pertinent to the history. The remaining 4 students sat observing and I monitored the activity.The "doctor" was to follow professional guidelines of behavior towards the "patient". The "moment" occurred when my female student was examining the bare chest of her male colleague. She performed well until in an instant of collegial fun, she picked on a hair of the male student's chest as to tickle him.

My instant reaction was to speak up to her and all the students reminding them about the tacit implied consent a patient gives for the physician to carry out a history and physical examination but only for those actions that meet a professional standard and are relative to the patient's condition. I explained that to act otherwise such as even picking on a hair on the patient's chest for jest was beyond the given implied consent and might be even considered by the patient or others as a legal assault.

I want to assure my visitors that such a "teaching reminder" which I gave my students would not be unique to my group but I feel confident, based on my communication, that the other instructors would react in the same way I did. There are more examples that I could give where instructors starting at the very beginnings of medical education make an effort to set the students on the straight path of professional behavior. And truly, I believe that the vast majority of doctors, notwithstanding the contrary examples presented here, are aware of the limits of their behavior as determined by the consent of their patients. ..Maurice.

At Friday, April 24, 2009 8:21:00 AM, Anonymous TT said...


Then they need to ask the patient's permission to be present to observe. Depending on the nature of the exam or procedure, many patients will grant permission if they are respectfully asked ahead of time. Curiosity or educational interest of the health care workers does not override the patient's rights to privacy and self-determination.

What patients object to, and rightfully so, is that some students, nurses, techs, etc. simply feel they have the right to barge in without asking first. It demonstrates a complete lack of respect for the patient.


At Friday, April 24, 2009 8:23:00 AM, Anonymous gve said...


there are many people who love the attention of being examined and being in the spotlight. Your daughter can learn by examining them. Those of us who prefer to retain control over our own body have that right. It is not the inalienable right of every student doctor, nurse etc to examine a patient, that is something which must be granted to them by the patient.

Use the patients who love the attention, leave those of us who don't, alone.

I notice that many hospital web sites now try to place the burden on the patient to deny permission (i.e. it is assumed) rather than get the student to seek permission, that is wholly wrong.

At Friday, April 24, 2009 9:03:00 AM, Anonymous TT said...


The way I heard the joke is:

Do you know how many bureaucrats it takes to change a light bulb?

Two - One to assure us that everything will be just fine.....while the other screws the light bulb into the water faucet....

Sorry....though it was time to inject a little levity.. :-)
Dr. Bernstein,

I agree that the vast majority of doctors strive very hard to act in accordance with professional standards, and I think most succeed. Yes there are some that don't, as the examples here document, but I believe that is a peripheral issue - they aren't a major factor in the issue being discussed here.

What I see as the fundamental problem is a disconnect in the way physicians and patients view these issues. To effectively communicate with the patient, the doctor or nurse needs to be able to see things from the patient's point of view, and many appear to have a real problem doing that. Trust isn't automatic - you have to earn it. It starts with mutual respect, and that will never happen if you can't communicate effectively.

The other problem I see is one of control. There are a significant number of health care workers that, for lack of a better term, are on a power trip. For some reason they seem to think they can simply order patients around and they should be obeyed without question - again a complete lack of respect for the patient. They treat patients like they are children, and the patients resent it, and fight to take back some semblance of control wherever they can. The result is what should be a cooperative relationship evolves into a confrontational one.....not a good thing.


At Friday, April 24, 2009 11:32:00 AM, Blogger MER said...


You recently posted about an article in Discover magazine. You wrote: "Quite a
few years ago the article featured
was by a nurse. In the article it involved a male patient and she out right stated how female nurses enjoy performing urinary catherizations on male patients.
Should anyone dispute that this
was written I will provide the date
of this particular issue."

Please provide us with the specific issue and date. i don't necessarily dispute that it was written -- but I want to read the entire article and view the comment in context.

At Friday, April 24, 2009 12:29:00 PM, Blogger Maurice Bernstein, M.D. said...



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