Bioethics Discussion Blog: Patient Modesty: Volume 15





Friday, April 24, 2009

Patient Modesty: Volume 15


More and more discussion on the issue of patient bodily modesty, the attention and inattention or even violation by healthcare providers in the many environments where patients go for medical attention.

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: Photograph from the United States Defense Department and titled by me with Picasa 3. A member of the U.S. Army's 947th Forward Surgical Team (FST), Newington, Conn., grabs surgical instruments for the doctors during an appendectomy operation on a soldier. The 22-member FST is based out of Bagram Air Base in Afghanistan. Photo by Staff Sgt. Jeremy T. Lock, USAF


At Friday, April 24, 2009 12:51:00 PM, Blogger Maurice Bernstein, M.D. said...

In the context of the graphic for this Volume 15 thread, does any know or have experience regarding patient modesty issues of service personnel in the "battlefield" environment. There, gender allocation of healthcare providers may be most difficult as one example. I remember we have had multiple comments of life in the military induction center line but I am interested if certain "rights" to the modesty issue is not available when one is in the Armed Forces. ..Maurice.

At Friday, April 24, 2009 5:02:00 PM, Anonymous Anonymous said...

Well MER, perhaps a better to say what I mean is there is a level of trust inherent in being a medical professional that makes them not a stranger in the normal sense of the word. Let me explain. Consider the average person I meet on the street, gym grocery store, or anywhere outside a medical setting. I know nothing about them, so to be safe, I have zero trust in them, and I consider them a stranger. Now consider when I meet a new doctor. They know nothing about me, so I’m the stranger. But since I picked the doctor from the list on my insurance website, I also checked the doc out on ratemd, found out where they went to school, when they graduated, how long they have been in practice, etc. I am just now meeting them but I already know a lot about them. Since they are licensed to practice medicine in my state, they have been trained and scrutinized by numerous teachers (like Dr Bernstein) and made it through residency. Now granted we can’t do this for medical techs and assistants but I expect doctors, nurses, surgical centers and hospitals (who are licensed) to not tolerate anyone they work or are employed there who doesn’t meet professional medical standards and have them dismissed or arrested depending on the circumstances.
Maybe one day there will be self serve ultrasound/MRI diagnostic hospitals or robots to do the diagnostics and procedures, and we won’t have to worry about this anymore. But until then, people will be doing these procedures, and as I have said as long as they are professional and treat me with respect, gender doesn’t matter to me. You know something, once the urologist and the nurse had their scrubs, masks and hair covers on, as long as they didn’t talk, I couldn’t really tell what sex they were.


At Friday, April 24, 2009 5:34:00 PM, Anonymous Jess said...

I think it's just common sense - many people will object to being gawked at...
Most of us will prefer to be treated privately for things requiring exposure.
My mother gave birth with a crowd of strangers watching. She was not asked, they simply walked in during the late stages of her labour.
She did not want them in the room, but her protests were ignored...
To this day, she says the "crowd" ruined the delivery. Instead of being happy at my arrival, she wept at the humiliation of this crowd of men watching her deliver and being stitched up and washed...
It has made me very careful. If I give birth, I will ensure my right to privacy is respected, if not, I'll see my solicitor.
There is no right to learn on all patients, in all settings. Studying medicine does not give you the right to trample over people.
Needless to say, I'm an only child.

At Friday, April 24, 2009 9:32:00 PM, Blogger MER said...

First -- To William who responded to my post to him: I respect your point of view. If that's how you feel, fine. Others don't feel that way. You and some others seem to want to quantify these "feelings" of modesty some men have. Good luck. Feelings are feelings. By definition feelings are not necessarily "rational." That doesn't mean they are "irrational." It means they are not necessarily subject to a rational process. They are subject to an emotional process.

Secondly --

I’d like to mention a book that focuses two topics essential to patient modesty and intimate care. The book is "Hippocrates’ Shadow – Secrets from the House of Medicine: What Doctors Don’t Know, Don’t Tell You, and How Truth Can Repair the Patient-Doctor Breach." The author is David H. Newman, M.D., who runs a clinical research program and teaches at Columbia University and in the Dept. of Emergency Medicine at St. Luke-Roosevelt Hospital Center.

In my past posts, I’ve talked about the importance of honest, open communication in medicine -- and how the medical community often doesn’t talk about certain issues openly, issues like patient embarrassment, modesty and opposite gender care for intimate exams and procedures. I’ve written about stereotypes that doctors and nurses sometimes have about patients -- assumptions they make about people instead of asking specific questions about preferences. I’ve talked about the culture of medicine and how certain assumptions are embedded within that culture and fiercely protected. I’ve based these assertions on interviews and readings, but it’s rare to find a book like this one, written by a well-respected, prominent doctor that echos some of these ideas.

Here are some significant quotes from Newman’s book.

“The fact that patients’ and doctors’ goals have diverged is apparent to anyone who has been to see a doctor recently. But there is a phenomenon within the culture of modern medicine that guarantees the widening of this patient-doctor chasm. The phenomenon renders true communication virtually impossible, and precludes reconciliation or mutual understanding. Ultimately this phenomenon leads physicians to be aloof and misunderstood – to have, even, a cultlike sense of separation from the rest of humanity. The phenomenon is secrecy. Doctors have secrets, and we have lots of them.”

Newman goes on to say: “My book is an attempt to reveal those secrets, to halt the masquerade. But this is easier said than done. Not all secrets are easy to expose. Some lie deep in the minds of physicians and are difficult to access (without help), while others are as simple and as clear as the light of day. Some are so obvious that everyone knows them, though few have spoken them aloud. Some are manifest in almost every interaction a doctor has with a patient, while others are specific to a disease, or a condition, or an encounter. There are so many secrets that this book can only begin the process of unveiling.”

These are the elephants in the room of modern medicine – one of which – only one of which is this modesty issue we’re discussing.

Newman continues: “It is my hope that physicians will read this book and see that it isn’t a whistle-blowing expose designed to vilify individuals or individual groups. The truth is, the real secrets of modern medicine are protected by tradition, group-think, and system constructs that punish inquiry and self-examination. They are embedded in the presumptions and thought patterns that we are taught to embrace during our indoctrination and on which we come to rely. They originate at the highest levels and trickle down; physicians are often merely bit players in a system – and systematic – dishonesty stemming from these secrets. These are the secrets and lies that shape the practice of modern medicine.”

The doctor does make sure to note that this situation isn’t black and white. “Those who teach us don’t intend to be deceptive,” he writes. “For the most part, physicians are outstanding human beings with an abiding love of mankind and a true interest in improving the world.” But, he says, “Traditions and embedded assumptions are often obstacles to clear thinking, detriments to time-pressured problem solving…The essence of medicine is a profoundly human, beautifully flawed, and occasionally triumphant endeavor.”

There a few other quotes I’d like to share, but I’ll save them for another post. This book seemed to fit into our discussion, especially the recent posts about informed consent.

At Friday, April 24, 2009 10:07:00 PM, Blogger Maurice Bernstein, M.D. said...

I think one of the problems in changing physician behavior in the practice of medicine is that teaching professional behavior is still not evidence-based. The teaching is based on what has been going on before and before and before. It is taught to students, interns and residents primarily by physicians who recall what they themselves were taught and how they themselves practiced medicine in their subsequent years. Any freshness into the thinking and teaching is instilled very slowly usually because of some problem in general professional behavior in doctors which comes to light by publicity. This is in contrast to more acceptance of evidence-based reasoning in diagnosis or therapy. As I may have mentioned in the past, inequality between patient and doctor has been slow in resolving because of the resistance of physicians for giving up their eons long history of expressing a paternalistic attitude toward patients. This "doctor knows best" attitude is probably involved in the modesty issues that have been discussed here.

The goal is to change the balance between doctor and patient to a more equal partnership in the doctor-patient relations. This can be accomplished by empowering patients to speak up to their physicians and getting doctors to appreciate that the patient have issues and important information that if the physician can take time and be willing to listen and understand can be productive in the relationship.

MER, I think one of the "secrets" in medical practice is that our professionalism is stale. Maybe patients know that but to the doctors it still may be a secret! ..Maurice.

At Friday, April 24, 2009 10:59:00 PM, Anonymous Anonymous said...

Dr. Newman's book is getting good reviews over at Amazon, I think I will get myself a copy. I sure hope he says DREs are unnecessary because I sure hate them.


At Saturday, April 25, 2009 6:03:00 AM, Anonymous Anonymous said...

Kevin I would echo the statements expressed above. There are patients who would enjoy the extra attention, there are patients who don't care one way or the other, and there are patients who do care. Given it is the student who benefits from this, it should be common sense that it is incumbent upon them to genuinely in good faith get permission and respect the patients wishes and feelings. The patient is not there to educate or be practice, they are their for their own needs. This is perhaps refective of the paternalistic attitude of not only the doctor, but the medical care system. What many have argued here is (1) ask, don't assume and (2) consesnt to treat does not give carte blanche nor does it imply I give up right to self determination. Just becasue your daugther wants to be a doctor does not mean I reduce my rights for her to achieve that. There is an interesting book called My Angels are Come. One key section focus's on an instance where the author was recieving a treatment for prostate cancer. As he lay on the table exposed for the treatment he heard a nurse introduce a masked female as a high school student who was shadowing her, "she is just here to watch". He went on at length to talk about the damage it did to his relationship with the providers, how he had trusted them and they had used him, that they treated him as no more than a tool to help the recruit future nurses. That attitude of thinking caregivers have the RIGHT, they are entitled to train on patients is the issue. Not that they need to train on patients. It is a priveledge and needs the consent of the patient to be so, other wise it is simply an entrusion. Perhaps that is also the paternaistic mentality, what is good for the medical profession is good for the patient. Gender nuetral is good for the profession so....

The author also explores something that I feel comes into play here, how much of this change we seek comes from interacting with providers, and how much comes from interacting with the administrative side of medicine. Many policies and prodedurs are influenced not only by the provider, but by the administrative side of the equation. If the administration in the example sets the policy, no patient will have a student caregiver unless they have signed an permission slip, failure to do so wil........what would the effect be? If providers follow rules and it is enforced...all of the providers, not just some would seek permission before injecting a student into treatment and the patient would be given an opportunity to opt out....while we focus on direct care providers, I think we are missing an important component if we ignore that side of the equation.

Dr. Bernstein I agree with you and the others who have had by and large very professional care. Through my own experiences and through the care of my elderly parents I can say 99% of the providers were great people. The system that they work in is more suspect to me in this issue than they are. I have witnessed a couple that could have been better, and one (a Russian immigrant) who we just flat out asked to be replaced as she was just mean. While not ruling out it doesn't happen, I don't think the issue is bad or malicous providers. I think as stated above its a diconnect on who has the right to do what, and especially who should be asking....alan

At Saturday, April 25, 2009 11:18:00 AM, Blogger MER said...

The paradox of this issue -- informed consent, student doctors and nurses, modesty -- is that the best way to mitigate it is to face it up front. The worst way to deal with it is to pretend it doesn't exist or be oblivious to it.

There's a continiuum. On one end are patients who would never permit opposite gender care or allow student doctors or nurse involved with their care. On the other end are those who actually want it and may indeed be exhibitionists. These are the extremes and respresent small populations.

Most of us, I believe, are in the middle and can go either way depending upon the context. The context includes whether the patient perceives he or she is treated with rspect and dignity and actually listened to. Are patient feelings and emotions being considered? Is there eye contact? Is the caregiver there, really present? I can't emphasize enough the importance of actual presence.

The irony is that if asked and approached respectfully and honestly, if if they feel caring is really there, those patients in the middle will develop trust may grant the kinds of permissions we're talking about. When this doesn't happen and it's forced upon them or hidden from them or they are made to feel out of line for requesting preferences or asking questions, they will shut down, emotionally. They may acquiess, but it will not be real consent. Unless providers are dealing with life saving emergencies, a patient just "going along" with everything but not feeling good or trusting about it, is not enough. There must be a higher standard.

At Saturday, April 25, 2009 11:19:00 AM, Anonymous lady patient said...

In 2003, California passed a law (AB 663) that was in reaction to an uproar about unauthorized pelvic exams in the OR. Here is the wording:

"A physician and surgeon or a student undertaking a course of professional instruction or a clinical training program, may not perform a pelvic examination on an anesthetized or unconscious female patient unless the patient gave informed consent to the pelvic examination,

(does this mean explicit consent beyond the general hospital consent forms?)

"... or the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination to be performed on the patient or,in the case of an unconscious patient, the pelvic examination is required for diagnostic purposes."

(if these 2 points are met, does that negate the need for consent and that anyone can perform the exam?)

Questions in parenthesies are mine

I had 2 gyn-related operations in a major hospital in Los Angeles in the past two years. In both operating reports it stated that a pelvic exam was done. Permission was not asked beforehand. Personally, I have no issue with the necessity of this exam in my case, but the bottom line was I wasn't notified beforehand as indicated by this law. Let alone know who actually did the exam.

Do medical people rely on "no harm, no foul" ethics? Do they rely on the secrecy provided in the operating room for their own convenience? Have my unanswered questions exposed legitimate loopholes allowing for business as usual?

I would be curious if anyone else feels that this well-intentioned bill has been intentionally watered down to muddy the waters.

At Saturday, April 25, 2009 1:33:00 PM, Blogger Maurice Bernstein, M.D. said...

My read of the law is that no informed consent is necessary if "the performance of a pelvic examination is within the
scope of care for the surgical procedure or diagnostic examination
to be performed on the patient or, in the case of an unconscious
patient, the pelvic examination is required for diagnostic purposes."

Of course virtually 100 percent of the training pelvic exams would be performed on women where the standard of practice would call for a preliminary pelvic examination. They would not be done on a woman who came in for an elective gall bladder surgery and had no gynecologic symptoms. I can't find the words in the law preventing unconsented pelvic exams if done in appropriate clinical settings and thus this law does NOTHING to protect a woman against one pelvic or several pelvic exams by students. ..Maurice.

At Saturday, April 25, 2009 2:58:00 PM, Anonymous lady patient said...

Thank you, Dr. B, for your clarifying opinion of the California law. If a patient wants to be protected from practice pelvic exams or unnecessary observers in the operating room, would the following qualifications on the informed consent protect them?

"no practice pelvic exams" or
"no gyn exams by medical students"

"no lay observers" or
"no non-essential observers"

Would these caveats be resented? Ignored? For the record, I have no problem with medical or nursing students observing in the operating room, as long as they are in a dedicated training program sponsored by the hospital.

At Saturday, April 25, 2009 4:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Lady patient, I don't know the answers to your questions since it would depend on the policy of the institutions involved. When a patient is under anesthesia what goes on in the OR is out of the patient's direct observation or control. It would only be up to some observing employee to recognize the conflict between what is written and what is taking place and be the "whistleblower" for the patient. ..Maurice.

At Saturday, April 25, 2009 4:53:00 PM, Anonymous Anonymous said...

In the movie “Places in the Heart” Sally Fields plays a young widow trying to make a living farming cotton on her land during the depression. One of her hired hands is blind. In one memorable scene, Sally is taking a bath and the blind hired hand accidentally walks in on her. Her first reaction is to gasp and cover herself (reflexive, emotional reaction, normal and understandable for a woman in this situation). But then she realizes who it is, and figures (rational thought process) there is no need to cover up in front of someone who is blind.
This wonderfully illustrates what I, in my humble opinion, think may be going on here. It seems to me that those who are uncomfortable with opposite gender care of an intimate nature are reacting as Sally first reacted (emotional) but never making it to her second reaction (rational). I think that truly professional doctors/nurses/techs do not see your nudity as non medical people do. They are in a sense blind to it.
Now before some of you get all mad at me, let me say if someone insists on a particular gender for their medical care and can find a facility that offers that, and they like everything about them, well, then everything is good to go, as they say. For discussion sake, you can call me Sally.

At Saturday, April 25, 2009 6:10:00 PM, Blogger MER said...

Not a bad analogy from "Places in the Heart." But here are the problems with it:
1. Being "really" blind is one thing. Being "figuratively" blind is another. We can measure real blindness. Either people can see or they can't see or they can see shadows,etc. We can't measure as easily measure the kind of "blindness" you claim, which is not true blindness.
2. There are many contexts to being "seen" naked. We can't just lump them all together. Your assumption seems to be that, just because medical providors do this all the time and may be "blind" to nudity, that should make the patient feel okay about it. I'm sure in some cases it does. In other cases it doesn't. I think it's more complicated than that.
3. Finially, this medical "blindness" you talk about varies from provider to provider and from context to context. I can surly see it for a complicated operature or procedure. The doctor and team are masked and are concentrating and focused, and the patient is mostly draped and most likely unconscious. But other contexts are different -- conscious patients, routine yet not life-threatening exams and procedures, extra unneeded assistants, observers or students. I think the doctor/provider's professional or figurative "blindness" varies in degree depending upon the context.

But, I must admit, there is some validity to your analogy as far as it goes.

At Saturday, April 25, 2009 7:10:00 PM, Anonymous Anonymous said...


I will dig out that particular
Discover magazine and provide you
with the date. I'll even post it if I can.


I was referring to observers who
are trained yet still enjoy observing and obviously haven't gotten over the thrill of it.


Actually there are many variations to the saying. My favorite one is " How many lawyers
does it take to screw in a light bulb,one to screw it in and two to
sue for unsafe working conditions."


At Saturday, April 25, 2009 7:15:00 PM, Anonymous Anonymous said...

Obviously Sally you have never worked in healthcare. Additionally,
odd that you use a female as an example and then continue the comment with "and can find a facility that offers that" which
to me is a problem for male patients and not female patients.
You cannot use a female to describe a male problem,it just
dosen't work that way!


At Saturday, April 25, 2009 9:26:00 PM, Anonymous reluctant patient said...

Sally said:

"I think that truly professional doctors/nurses/techs do not see your nudity as non medical people do. They are in a sense blind to it."

That assumption may be true, but the fact that the caregiver may have seen thousands of naked bodies, performed hundreds of intimate exams or procedures won't assuage the reluctant patient's apprehension over exposing their bodies to certain groups of people who make them uncomfortable. The caregiver's comfort level with nudity isn't the issue here. It's the patient's comfort level with their caregiver that should be of concern.

At Saturday, April 25, 2009 9:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks to Sally and any of the other few visitors that have presented points and views which may contrast the bulk of the commentary which has been written on these threads. This is "Bioethics Discussion Blog" and discussion with alternate views makes the discussion more interesting and potentially more productive of a balanced conclusion whatever that turns out to be. Right? ..Maurice.

At Saturday, April 25, 2009 9:59:00 PM, Anonymous Anonymous said...

If people like you and William and Sally enjoy or don't mind being gawked at by whoever feels like dropping by, then great, our young doctors and nurses can practice on you. Everyone appreciates your "sacrifice".

But to those that expect to be treated with respect and dignity like all human beings should be treated, those gawkers have no business being in or peeking into the room. We don't have to put up with it. As long as the patient is conscious, he or she is the boss. If something needs to be done with a catheter, tell all but one person to get lost. If you're not comfortable with the gender of that person, tell them you want someone of the other gender. Period. No arguments. That's the way it's going to be no matter how much the nurse whines or threatens you. If you have to raise your voice, do it.

As others have said, the patient is not a teaching tool unless he/she wants to be. It's bad enough having one nurse gawking at and fondling your private parts. Any more than that is just an audience watching you perform naked on stage.

I'm tired of people complaining about what unethical things happen to them. Don't let it happen! Don't just lay there feeling humiliated, tell the audience to GET THE HELL OUT! If an incompetant nurse exposes you in front of someone, cover yourself back up and tell her to get the housekeeper the hell out of there. If you're having something intimate done to you and a nurse or receptionist bursts through the door yell at the pervert to get out! Don't put up with it. They have no right to do that to you.


At Saturday, April 25, 2009 10:50:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, is anyone here concerned with the U.S. Transportation Security Administration (TSA) using whole body imaging (currently voluntary in place of a "pat down") for passengers prior to flight boarding? Would it make any difference as the TSA website says "Passenger privacy is ensured through the anonymity of the image. The security officer attending to the passenger never sees the image and the officer viewing the image is remotely located and never sees the passenger. The officers communicate wirelessly via headset to clear the passenger for travel. The image cannot be stored, transmitted or printed, and are deleted immediately once viewed. In fact, the machines have zero storage capability. Additionally, all facial images are blurred."?

I recognize that this isn't the same as the healthcare provider-patient relationship but I was just wondering since if not patient modesty, passenger modesty would be involved. ..Maurice.

At Sunday, April 26, 2009 1:16:00 AM, Anonymous reluctant patient said...

when I wrote "The caregiver's comfort level with nudity isn't the issue HERE. I didn't mean HERE on this thread. I meant HERE with the reluctant patient's feelings. My apologies if it came across like I was trying to shut out other opinions.

As for the the airport whole body imaging, so far it doesn't bother me for modesty issues...yet. I haven't read the whole article, but I might be more concerned with any radiation exposure.

Here's are a couple images I found of what the airport screener sees:

At Sunday, April 26, 2009 7:46:00 AM, Blogger Suzy said...

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

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. "

This is posted on Volume 14 the Patient Modesty blog. It is an eye-opening perspective.

While I was not able to put it into words before the above comment helped me to recognize that basis for my modesty issues is lack of trust for medical providers.

I am not embarrassed at the beauty parlor or massage therapist. I do not see these providers as predators because they services that I want when I choose to have the service. While they may offer other services, I've never been blackmailed as I have been in a doctor's office. A beautician touches my body and sees many exposed body parts for hair removal, but never says "We won't sell you moisturizer unless you have a bikini wax and a manicure or bring proof that you have recently done so."

I didn't realize how much frustration is fostered by societal demand for the "well-patient" visit. It has always felt predatory. From childhood, I have felt a sense of shame from the disregard for the patient's feelings. Doctors and nurses(in my eyes) were people who could make me take off my clothes, expose my private parts, and hurt me with needles.

I never recognized any benefit to these search and destroy missions.

I recall my mother's helpless response to my complaints about being ashamed and feeling miserable about being naked with "They're doctors...that's what they do. They have to make sure you are healthy". As a child, I remember being frustrated beyond belief that my mother needed this white-coated molester to tell her I was healthy. From my point of view, if nothing hurt, I was healthy.

A doctor could say those dreaded words, "I'm going to order some tests", and my mother would deliver me to any torture he chose, again with that helpless, empty explanation, "They're doctors, they have to make sure you are healthy".

I don't blame my mother. She was socialized to believe that doctor were gods put here to save us from ourselves. I recall the many visits that required nudity while doctor poked at me like I was a worm found on the driveway, nurse handed him the instruments of torture, and mother allowed it.

I was told I could not go to school unless this molestation took place. Again (from my point of view), my healthy body was offered up as some kind payment for being allowed to go to kindergarten. Mother smiled, nurse smiled, doctor smiled, and my dignity was sacrificed as the doctor lifted parts of the gown and exposed me over and over.

Our pediatrician did something called a 'worm check' which consisted of a quick peek at my anus and vulva by having me kneel and lean forward. He would then spread my buttocks briefly, followed by parting my vulva and spreading the vestubule with two gloved fingers. It took only seconds, but my face would burn with shame as I felt the exposure, and I often burst into tears.

I recall begging my mother to tell the doctor that I had never had worms. He said 'maybe not, but we like to check, just the same'. Even as a young child, I recall the outrage caused by hearing this man tell me that what HE liked to do to my body was more important that what I wanted done with my body! Having no symptoms and my mother's word that I'd never had worms was not enough. HE had to personally peer into my private areas before I could be declared free of vermin. His nurse and my mother also were allowed to see me in that humiliating, revealing position, and I could not stop them.

My mother washed and dried those body parts for me daily. I felt no humiliation there because I could easily see the need to be kept clean and fresh-smelling. The humiliation I felt from the doctor's visits stemmed from my not accepting that the viewing and handling by a stranger had benefit for me.

An ice cream cone did nothing to soothe me after such a visit. It seemed an insult that my mother thought that a sweet would make me forget that she'd offered me up to what felt like a sexual assault. For days, that feeling of humiliation would spontaneously attack me for days afterward as I would have flashbacks of that parting my rear to look at my upturned private parts. The strongest feeling was that it was for HIS satisfaction and not in any way beneficial to me. My mother did not understand my modesty and feelings of violation, and dismissed all with "Stop being so silly. He's a doctor, he has to make sure you're ok." I wondered why my mother needed someone else to tell me that I was ok.

From those well-child visits came the feeling that doctors were predators. I think it is the feeling of being 'prey' that activates much of the modesty response.


At Sunday, April 26, 2009 9:07:00 AM, Blogger Maurice Bernstein, M.D. said...

Notwithstanding those who write here and say that patient modesty need not be analyzed since it involves mainly a matter of personal liberty and rights,Suzy, you bring out an important issue as some of us still try to analyze the basis for patient modesty as expressed on these threads. I just wonder how many doctors realize what an impression their actions explained as prophylactic healthcare management might be affecting both their childhood and adult patients. I suspect they think that they are simply following standard guidelines of practice. I can't recall what you write about even discussed in my own medical education. I think that your experience and that of others should be written up in medical journals. ..Maurice.

At Sunday, April 26, 2009 10:30:00 AM, Anonymous Mary said...

Reading Suzy's story shocked me. I wonder how long ago such exams took place. I am in my 60's and have never heard such things, even with my own children. But then again, my generation hardly went to the doctor, maybe if you broke your arm or worse. Mainly because there was no health insurance when I was young, and also parents relied on home-spum remedies if you got sick.

But one thing I can identify with in her story is when I was growing up people blindly trusted authority figures. I have a feeling my mother would have gone along with a school requirement to have this type of invasive exam and would not have questioned the doctor's methods and would have given me a stern look if I complained. Just like my father would never show anger when his boss made unreasonable demands, or the local policeman giving him an unfair traffic ticket. You didn't challenge in those days, you obeyed and endured. I don't think such things could go on today without public scrutiny. Thank goodness.

Mary (age 61)

At Sunday, April 26, 2009 10:57:00 AM, Anonymous Anonymous said...

Hey TL don’t lump me in with Kevin. I never said I liked being gawked at by whoever drops by, I never mentioned students and the like, I said so long as I was treated with respect & the exposure was necessary & handled professionally, the gender of the provider didn’t matter to me. Please go back and read what I said and didn’t say. I provided personal examples, as many others here have, of the medical events and circumstances that are the basis of their opinion and now regret doing so. I think I’m done here.


At Sunday, April 26, 2009 4:58:00 PM, Anonymous Anonymous said...

It’s Sally again, back to stir the pot. A new medical office opens next week that specializes in medical diagnostic procedures of an intimate nature. All of the doctors and nurses are board certified. All of their equipment is state of the art. They charge half the price of everyone else if you don’t have insurance, and will waive the co-pay if you do have insurance. You can get an appointment anytime you want. The service providers wear a spacesuit that completely covers them similar to the one in the first Andromeda Strain movie, the helmet doesn’t let you see their face and their voice is altered. You are not allowed to specify the gender of the service provider. Would you get your health care from this facility?

At Sunday, April 26, 2009 6:12:00 PM, Blogger MER said...

Interesting post, “Sally.” I love these games. And it is a game.

So – what you’ve done with your scenario is to remove nearly completely the human factor in medicine. This is the “hide the gender” scenario. If it doesn’t exist, how can it be a problem, right? But you see – gender does exist. There’s a gender inside the suit, behind the mask, underneath the skin. Nothing you can do eliminates that fact. Basically this is the “What you don’t know can’t hurt you” scenario.

But you’re really clever, because you include money in the equation. You’re basically challenging people to see how really important gender selection is when it’s put beside the wallet. How much is a patient’s modesty worth? For what price can we buy it? Not fair, not fair -- mixing up money and gender selection!

And we can get an appointment anytime? Amazing. Not fair! Can we get green stamps,too -- or is that too retro.

Instead of the spacesuit, we could go further and just say that the procedure will be performed by two robots being operated by two other robots in a room nearby – the second two robots being controlled by two humans in spacesuits whose gender is unknown. Boy, that would make me feel safe.

Seriously, I’d stay as far away from a place like that as I could get. I want the human touch, either male or female, depending upon the context. I want eye contact. I want human beings who I can see, talking with me. I want a sense that I’m not a disease that my providers need to suit up for so as to protect themselves (or me from them). I want to feel like a person, not two ounces of plutonium.

I’ve said before that seeking the truth involves searching for and then asking the right questions. This isn’t the right question. Still, I gave you my answer, and I’m curious to see how others will answer.

I'm using my favorite wooden spoon to stir this pot. How about you, "Sally?"

At Sunday, April 26, 2009 7:01:00 PM, Blogger Suzy said...

I would not get my health care from the first facility, the one with providers in spacesuits and altered voices. The reason? Because I can't see them, but they can see me! How would I know if the seemingly-genderless practitioner who was rummaging around in my bum that morning was the guy who rode home next to me on the commuter train EVERY evening?? Worse still, he would know that the bum he'd rummaged belonged to the 'lady on the train.

I might attend the facility that had robots operated by robots operated by humans, but only if I could choose the services provided instead of being blackmailed into taking services that I don't want because they are perceived to be helpful.

In that scenario, I could receive the services I request without any embarrassment. That perfectly sums up the reason I will accept a pelvic MRI (a test where they send me through a tube fully clothed and use machines to take pictures of the targeted organs), but I will not have a manual pelvic exam involving a doctor or nurse viewing my body and penetrating openings with their hands.

I don't want any human touch from a stranger if I can avoid it. Robots are not demanding, not condescending, and do not make wisecracks about a patient's body or who should have access to it.

I might also attend a facility where the doctor/nurse/tech was in a space suit with altered voice, and as a patient, so was I. They would not be able to see my face or identify me in any way. Instead of a name, I would have a number assigned to me by a remote method so that no one at the clinic would have a name to associate with a particular chart.

All body parts but the one being attended to would be completely covered or disguised. In this way, my modesty would be protected because the balance of power would not be upset by one of us knowing or being able to guess the identity of the other.

I still would not allow unnecessary tests or exams.


At Sunday, April 26, 2009 7:05:00 PM, Anonymous Anonymous said...

Sally, let me ask you, are religous values and beliefs rational? Should we then dismiss them? And who exactly gets to define rational, and when we wiegh in double standards, hypocracy, and other issues that have been brought up here...who gets to say they are rational or not. One could question is it rational for a woman who has been molested by one man to distrust all men includi
ng male, Sally, I don't think your analogy quite tracks as well as you think. The other thing that comes into play, is when providers are patients, many have the same feelings as where did the blindness go? But I appreciate the different views you, william, and others bring to the blog

Dr. Bernstien, personally I have no real issue with the scenerio you put forward in the airport security line. I am anonomous, it is not my "skin", but then, I also have a lot less concern when I am out again, I think it comes down to the individual...alan

At Sunday, April 26, 2009 9:47:00 PM, Anonymous Anonymous said...

Having a blind person not see you..isn't all that much different than having walls and doors folks can't see through...remember we are all naked under our the visual aspect is highly important...being touched is another....on msnbc there is an article where a Canton in Switzerland banned nude hiking. If you read discussion (newsvine),it has a lot of viewpoints on nudity...

At Sunday, April 26, 2009 10:13:00 PM, Anonymous Megan said...

Sally's posts are spot-on in my view...unwelcome and unnecessary intrusions and feeling helpless, like a victim, causes long term damage.
This approach to medicine causes much more harm, than good.
In Australia, it's not as bad, in fact, nowhere near...

My younger sister studied in the States for four years.
She loved the people, the country and the University, but loathed the healthcare system, in fact, she rejected it.
She went to the Doctor with a severe allergy (she works with animals and it happens from time to time) and was ambushed and lectured about preventative medicine. My sister kept insisting that she follows the Australian system and these exams are NOT recommended unless a woman has symptoms.
She also advised that cancer screening is voluntary, it's the patient's decision whether he or she wishes to be tested. He was appalled to hear such a ridiculous suggestion.
My sister said the doctor's attitude was quite intimidating and her only thought was to escape this man. She felt her body was being threatened.
She was told the script would not be provided until she agreed to the health checks. My sister is not easily intimidated; she was completing a residency in vet science.
My sister said she'd be contacting the appropriate Medical Authority and reporting his behaviour. If a patient attends with an allergy, she's entitled to receive treatment for the allergy.
She felt to refuse to provide the script until she agreed to cancer screening was outrageous and she suspected, medical misconduct.
He reluctantly provided the script, but was very short and offered a parting crack, "You're VERY foolish taking such risks with your health".
My sister did not see another American Doctor during her stay.
She was quite shaken by the encounter.
She relied heavily on a friendly and helpful pharmacist during her stay.
She'd love to return, but would need to factor in the cost of returning to this country for her healthcare.
My sister mentioned this experience to her American friends and they all groaned or nodded knowingly. They all had ways of avoiding doctors.
One of her colleagues said that US doctors regard their patients as bodies that are devoid of intelligence, rights and feelings and they have free range with your consent, often extracted using intimidatory measures or by coercion.
What a terrible state of affairs.
We have our problems in this country, don't get me wrong, but we can receive treatment for an allergy without our treatment being held as ransom.
I'm so sorry to hear about your horrible experiences. I fully understand why you feel the way you do. I would feel exactly the same way if I'd endured these intrusions.
I hope you can change this system, which seems to be damaging so many healthy people.
People deserve to be treated like thinking, caring, feeling human beings.

At Monday, April 27, 2009 4:40:00 AM, Anonymous Megan said...

Megan again...
Sorry, my first line should read Suzy, not Sally.

At Monday, April 27, 2009 8:32:00 AM, Anonymous TT said...


A patient has the absolute right to refuse any specific test, treatment or procedure, without prejudice to obtaining any other medical treatment they may need. In your sister's case, the physician's conduct unquestionably violates that principal. Not only was it unethical, but IMHO it borders on extortion - in fact, if he stood to gain financially if she would have knuckled under to his pressure, it might even meet the legal test of a criminal act ...... have to ask my D.A. friend about that......

In any case, a complaint should have been filed with both the facility and the state BOM. I agree that women are far more often targets of these tactics, but men get hit with it too. If patients would file a complaint every time something like this happens, maybe that would bring an end to it.


At Monday, April 27, 2009 9:00:00 AM, Blogger Maurice Bernstein, M.D. said...

TT and Megan, no physician is required to write a prescription or administer a medication simply at the request of a patient. If an examination or test is required as part of the standard of practice prior to prescribing, the physician need not follow the patient's request if the patient refuses the test. However, in Megan's example, if the examinations and tests are in no way related to the disease present or the medication to be prescribed, it is unreasonable for a physician to require a patient to take those examinations or tests before writing a prescription or administering a medication. It sounds like Megan's example doctor was out for his own personal interests. Promotion of health practices is not facilitated by such behavior by the physician. ..Maurice.

At Monday, April 27, 2009 9:45:00 AM, Anonymous Anonymous said...

The space suit scenario isn't much different than "alan" being okay with being "out".

People like alan would be okay with accepting care from cross gender providers under a circumstance as this. Can't see them, can't identify a face, don't have a conversation, therefore now it is genderless/ painless/ neutral and non-intimidating. They are still viewing you, touching you --- you just can't see them.

At Monday, April 27, 2009 9:58:00 AM, Anonymous Anonymous said...

One has to wonder if we are not seeing a period of the evolutionary processes that all businesses go through. I think medicines position as authoratative/paternalistic where providers directed and patients accepted is giving way to one where patients are feeling freer to challenge and question providers. Then there is the profit motive, I know my Dr. at one time started marketing this cure all majic vitamin elixur, his exuberance was not recived well as he was profiting as its representative. Didn't take long before he quit selling it do the patient resistance. Lets face it, profit and income are part of the equation, we may not like to think they play determing a roles in decisions but we would be naive to ignore its role altogether.

The other thing I think a lot of folks from places like the UK and Austrialia don't understand is the role lawsuits play in our society. I forget the number but we have something like 100 times the number lawyers as we do doctors, you can get sued here for what you didn't do as much as what you do. There has been an exodus of providers from OB due to the large insurance premiums for that area of medicine. If a child is born with anything wrong providers are often the target of suits. In our town we are down to a very few who will deliver babies. A doctor friend of mine says he actually looses money delivering babies due to the premium, but does so becasue it is his favorite part of his practice. One has to think what is seen as over screening comes from several area's a history of always doing so, self protection (I understand certain birth control methods can have serious side effects), and of course....profit. To what degree each wieghs in is the question.........alan

At Monday, April 27, 2009 4:24:00 PM, Anonymous Nicole said...

Dr, do you know how many doctors refuse to follow this rule?
If you take a look at "Managing Contraception", a woman asks why cervical screening and pelvic exams are required by most doctors to get birth control pills when WHO, US Food & Drug Administration and the American College of OBGYN's all say they are NOT required for the safe use of BCPs.
Yet this is totally ignored every day by most doctors.
Dr Hatcher, who runs the site, even offers to speak to this woman's doctor on her behalf.
His colleagues all agree these exams are unnecessary.
If a Dr is afraid of being sued, wouldn't it be safer to follow the recommendations of these authorities?
Medical hurdles mean women either resent it happening or manage with other methods, some less reliable.
This woman also mentions being refused treatment for toe nail fungus unless she had cancer screening.
All of my friends were refused birth control pills unless they agreed to these exams and many have been refused treatment for unrelated things, unless they agreed to screening. This is common, very common, almost standard.
I refused to be blackmailed, particularly when I knew these exams were unnecessary. I must have asked six or seven doctors over 4 years, assuming it was just a matter of finding an ethical doctor.
I've given up and my husband has had a vasectomy after spending years managing with condoms.
Why aren't men asked to have rectal exams if they want Viagra?
Why is Viagra readily available on the Internet?
It seems these blackmailing techniques are directed at a group of women who can be easily coerced into submission.
Why can't these organizations stop this unethical conduct?
There is absolutely no point saying these exams are unnecessary, if every doctor refuses to follow these recommendations.
As far as many women are concerned, we don't have access to birth control pills in this country because of unnecessary and unethical medical hurdles.
We're no better off than the countries that only offer condoms.
It shouldn't be necessary for women to access birth control in Mexico or on the black market or use condoms...just to avoid these unnecessary exams.

At Monday, April 27, 2009 4:39:00 PM, Anonymous Anonymous said...

If you follow high court cases then
you've most likely heard the case
regarding savana Redding who at age
13 was strip searched at her high
school by the school nurse who also
was female.
Apparently, another student accused Savana had prescription ibuprofin. Savana recently turned 19 as the case was heard at the US supreme court. In my opinion strip searches are best left to the police especially in this case as no drugs were found.
What I thought peculiar was such
a big do over this 13 year old vs
all the hundreds of thousands of
young men whose privacy was violated when non-medical women
(clerks) were allowed to watch them
recieve a physical.
Each and every one of those cases
should have went to the supreme court and somebody should have to
cough up national debt cash to make
up for those privacy violations.
Just one more example of the gross double standards. What if a
13 year old boy had to be strip
searched by a male school nurse.
You'd probably never hear about it and keep in mind that the 13
year old girl kept her underwear
on during the search. Too bad those
supreme justices never had to walk
in my shoes during my induction
physical. That would give them
something to really ponder over!


At Monday, April 27, 2009 6:51:00 PM, Anonymous Gail said...

Nicole, you're talking about the elephant in the room. Everyone knows it goes on, but no one is prepared to do anything about it.
Why doesn't a spokeman for these associations give an interview and remind all women to contact them if they face this problem? They know it goes on every day in every clinic in the States.

My 24 year old niece (a virgin) went to the doctor a few months before her wedding to get birth control.
She was told the pap smear could wait for 6 months. (no choice, it was compulsory. He wasn't interested to hear that she and her future husband were both virgins)
I've read recently (maybe on this forum)that consent is necessary for smears and women are free to refuse them. Some women refuse them because they're inaccurate or they are low risk.
Virgins would have virtually no risk of these sorts of cancers. Even so, having these Tests should be OUR choice, our decision. If I smoke, I accept an increased risk of lung cancer, if I refuse an exam or test, I accept the risk as well. (although I read recently that mammograms are more likely to harm you)
Maybe many of these tests and exams are more likely to hurt us, our minds and our bodies.
In this country, patients often feel these tests are compulsory. If you can't get treatment or Pills unless you agree, surely that makes them compulsory.

The Dr tells my niece that he wants to do a visual inspection of her genitals and a bimanual/rectal exam.
She refused and stated that she'd rather only have those exams if she had any problems.
The Dr refused the script and they used condoms on their honeymoon.
Her husband was shocked and does not want his wife to agree to these exams (they were both virgins and don't believe these exams can be justified at all) and is looking at ways of dealing with birth control without involving doctors.
The doctor's attitude was, "most women don't mind it after a few years"...
I wonder if he'd feel the same way if he were required to have unnecessary probes of his genitals to get condoms or drugs.
How can a doctor justify putting a woman through this sort of exam to get birth control?

This is a BIG problem in this country and no one is doing anything to get the problem solved.
Just sit in on any group of women talking, it's a black cloud that surrounds our lives.
Why can't some senior people go public? Why don't you take the first step, Dr Bernstein. The women of America would be very grateful!
I'm a teacher and feel frustrated that we hear all the talk, "NOT NECESSARY" "CONSENT" but nothing changes.
Doesn't that mean the medical profession are blatantly abusing or taking advantage of women?
Why don't senior and ethical doctors feel compelled to do something about it?

At Monday, April 27, 2009 6:53:00 PM, Anonymous Anonymous said...

nicole, I just assumed there was some medical reason for the exams and contraception. From what you post it would not seem to be the case. I do not however think this type of thing is something perpatrated upon only on women. As indicated above male students are routinely given hernia exams, yet I would venture to guess the number of hernias discovered in junior high boys is less than the number of problems turned up from pelvic exams for birth control. I carry a commercial drivers lisc that and must have a physical every two years..including a DRE..while I am OK with it as it forces me to get the exam...a prostate exam to drive a vehicle makes about as much sense. I really don't think it is a gender thing as much as it is just something that providers have always done and for what ever reason...old habits, profit, etc continue. I think its pretty obvious medical people get set in a pattern that often makes no sense to us. Everyone including medical staff knows patients hate those stupid gowns, they are ridiculous, yet even when they aren't required..that is often what you are given. That said, like the issue of modesty, only resistance will change it. Go in for shoulder surgery and you are going to be naked under the gown...why becasue there is a chance you will code or something and they will need access to the the odds, what are the odds a patient will code during shoulder surgery multiply that times the odds they will not be able to access other areas and multiply that time the odds removing underwear or prvovider furnished paper shorts will materially effect the outcome...and you get the odds that are so small they are almost immeasurable....but...the vast majority have to submit to this....none of this makes sense to us, we are not given a choice of risking the "odds" even if we want to.....alan

At Monday, April 27, 2009 7:42:00 PM, Anonymous Megan said...

Megan again...
Thanks for your comments.
My sister would have reported the doctor however, she got the impression from her friends and colleagues that she'd be wasting her time. This doctor's conduct was not unusual, just part of the way medicine is practised in the States.
Her Australian GP gave her a letter requesting that any American doctor seeing my sister respect the fact routine gynaecological exams are not recommended in this country and that all cancer screening is merely offered to eligible patients, not required or even recommended in asymptomatic patients.
She didn't see any more doctors, so the letter was never tested.
It's curious that others accepted his conduct as normal when it seems that probably wasn't the case.
I'll certainly mention this to my sister.

At Monday, April 27, 2009 8:37:00 PM, Anonymous Mary said...

re being naked under the gown in surgery:

Alan, the nurses argue that occasionally a patient's bowels or bladder "let loose" during surgery. Besides not having to deal with soiled underwear, the patient is easier to clean without them on. So, I guess there is a practical reason for this requirement.

At Monday, April 27, 2009 11:36:00 PM, Anonymous Nicole said...

Alan, a DRE to drive a vehicle?
If you decided to refuse this test, would the Dr refuse to clear you for your commercial permit?
Surely that amounts to coercion...doesn't it?
I refused parts of my pre-employment physical and after a bit of fuss, I was given employment despite the incomplete exam. I suspect it was because of a shortage of skilled people in my particular field.
I'm afraid it's the "requirement" to have unnecessary and totally unrelated exams and tests that annoys me.
It then becomes something very invasive, uncomfortable and embarrassing (and possibly painful)being done to you for no good reason, if that makes sense...

At Tuesday, April 28, 2009 5:09:00 AM, Anonymous Anonymous said...

Mary my question would be and just how often does this happen. Every surgery or procedure I have been through included a period of fasting and no fluids for this purpose. Dr.'s say its becasue you might code and they might need access down there. My wife had lump removed from her breast, she asked the nurse, can I keep my underwear on...the nurse said as long as they are cotton..leading me to believe it is more SOP than essential or material to the saftey of the operation. so, I would challenge them and ask just exactly how often does this happen...what are the odds. And once again I would challenge the thought process, lets say 50% of patients would feel more comfortable if they were provided "paper shorts" or something to cover "down there", and what 5% might have an accident...we will make 50 out of 100 feel more uncomfortable than they have to, just so the nurses don't have to deal with 5 cases even though the focus supposedly is on the patient. Further, if they provided "disposable shorts" the additional effort to remove and discard them would be minimal, it might even help to contain it..Not every patient would want or care, but the one size fits all menatlity is strong in medicine..I have talked to nurses/techs at our local hospital who indicated they allow coworkers to wear scrub bottoms etc when they are having procedures if the procedures allow it. Of course they use the its different becasue we work with each other.....I still say it boils down to providers placing what is convienent for them over what is comfortable for the patient. I personally feel this is one of the biggest contributing factors to the issue we are discussing here...don't really think it is malicous in intent, just has always been that way and isn't challenged, sort of like pelvic exams.

At Tuesday, April 28, 2009 7:21:00 AM, Anonymous Anonymous said...

Men aren't asked to have rectal exams if they want Viagra, but if they are forced into the alternative, vasectomies, they are treated as unfairly as women are with the pelvic exam. It's true they aren't forced into it (by the medical community), so maybe it isn't a good comparison. But for a man enduring a vasectomy it can be just as unethical and humiliating.

Unless discussed beforehand in some cases, most doctors take at least one (always women of course) nurse with him to do little or nothing during the procedure except watch. It has been declared by many, many doctors that there is never a need for a nurse or assistant, yet most doctors use them without the patient's consent.

There are many ways of keeping the penis out of the way other than having an uninvited, unwanted woman there fondling you the entire time. Yet most patients don't realize she is completely unnecessary and just do what the doctor or nurse orders them to do thinking the doctor knows best and wouldn't allow unnecessary humiliation unless it was necessary.

It needs to be explained by the doctor to the patient that the nurse really isn't needed and there are alternative ways to perform the procedure without a nurse or assistant. To me, it's just as big a deception for the doctor not to mention alternative ways of performing the exam as it is to lie to the patient and tell them the nurse IS necessary. It's very unethical and should be legally unethical.


At Tuesday, April 28, 2009 7:48:00 AM, Anonymous Anonymous said...

"Alan, the nurses argue that occasionally a patient's bowels or bladder "let loose" during surgery. Besides not having to deal with soiled underwear, the patient is easier to clean without them on. So, I guess there is a practical reason for this requirement."

So why do nurse's arguments override patient's comfort. If it's a serious problem I would assume the surgeans would have something to say about it. Besides, I don't really see the difficulty pulling down a pair of boxers or panties unless the problem is in that general area.

When I had knee surgery it was recommended, not tolerated that I wear some type of shorts throughout the procedure. I would think it would be more difficult to remove shorts during a knee surgery than a shoulder surgury (though I know that was just an example). If patients are warned before certain types of surgeries that it might be necessary to cut your shorts off in an emergency why would using scissors be so difficult?

I have in the past and will in the future refuse to go buck naked for a surgery not involving that particular area. A "gown" is not much help in that situation. That means I will tell the surgean or whoever I talk to before the surgery and the nurses that I expect to not wake up naked. I don't trust nurses in the first place.

Considering most would probably be elective surgeries or well-planned serious surgeries we should be able to find a surgical team that cares more about the patient than their paychecks. Fortunately I think patient comfort and dignity is becoming more important these days so I hope the traditional barbaric methods will soon be a thing of the past and more doctors and nurses will at least pretend to care about their patients.

Mary, I'm not interrogating you, I realize you are just the messenger.


At Tuesday, April 28, 2009 9:12:00 AM, Anonymous Mary said...

To: Anon. 5:09 am (is this Alan?)

Paper undewear during surgery sounds very reasonable to me. Do they exist? Would they work with a catheter? I'm going to ask about them on my next hospital visit. The nurses reasoning about the possibility of soiling during the operation was from an AllNurses discussion I read. They also mentioned that in pediatric surgeries, they leave the underwear on until the child is anesthesized, then remove them for the surgery, then put them back on before the child awakens. I guess the deception is justified so as not to upset the child.

At Tuesday, April 28, 2009 10:57:00 AM, Anonymous Anonymous said...

Mary, I think the soiling possibility is no doubt a lame excuse. Would like to know percentage of time this actually occurs. Weak. Truth is they just feel they have all the power to force people (patients) into doing AS THEY SAY, regardless of logic and the patients feelings. Too much of what goes on is "it is they way they've always done it."
So .....does that make things particularly right? NO. Guess what most times when they do allow a patient to wear underwear into the surgical suite (as you say with children) the circulating nurse removes them once the patient is OUT. Even the hospital gown is completely removed for "most" surgeries. It is a sense of FALSE modesty for the patient wearing the gown in and then once they are fully sedated ALL MODESTY is out the window. The patient is redressed in a gown once the procedure is over and they are rolled out to PACU.

At Tuesday, April 28, 2009 1:17:00 PM, Anonymous Anonymous said...

Mary, sorry left the ID off. Yes there are, to me while this is a smaller issue, it is very telling of the attitude providers apply to the whole experience. There are indeed disposable surgery shorts, they are a paper type material, the have velcro enclosures at the waist and bottom of the short leg on both sides that provide easy removal in emergency, they have slits on the sides for access and they have a velco panel to allow access for a cathater though they noted the legs are room to accomodate leads and cath's. Likewise there are longer gowns that have over lapping panels and fasten on the side to provide more modesty....yet how often do you see them used. What this tells me is there are options, however since providers think the answer is for patients to accept what they offer, the we are professionals, we do this all the time, etc. is preferred so if it is acceptable or what providers feel is appropriate or sufficent, the other options are not implimented or even considered. I had an endoscope to check for throat problems, they made me wear one of those stupid gowns and nothing else. I am over 6' tall, the thing was like a mini skirt, my father had a heart cath. (different hospital) the gown they gave him went down over his knees and over lapped.....there are options, providers just prefer to address modesty on their terms not on ours. SOP is require pelvic exams for birth control, SOP is use to ridiculous gowns (a nurse friend says they call the ICU gowns as in I see you) regardless of how mobile you are. If they resist the little things like choice of gowns....its easy to see how they resist bigger issues like choice of provider. The focus is on providing modesty...on their terms....alan

At Tuesday, April 28, 2009 5:44:00 PM, Anonymous Anonymous said...

I've seen many patients in surgery
that were allowed to keep their
underwear on under the gown.
You might ask who were these patients and why were they allowed
to keep their underclothes on.
These patients looked as if they
haven't had a bath in a week. Some
were illegal's from mexico. My
observations were that the more
clean cut you were the more likely
they wanted your underclothes off.
This issue about patients possibly voiding or passing stool
during surgery. What would it matter if you had underwear on or
not, the patient would need to
be cleaned up irregardless. Funny
they always seem to have an excuse.
Usually anesthesia prevents that
from happening most of the time. At
least the countless times I've been
in the OR I've never seen it happen. I've never heard of these
paper disposable underwear and it
sounds like a great idea. I'm sure
they are inexpensive but they
remove power from some people in the OR and believe me its all about
these nurses on power trips!


At Tuesday, April 28, 2009 6:10:00 PM, Anonymous Anonymous said...

I had a breast reduction in Australia several years ago and was given paper underpants and a gown. I awoke still wearing the pants. They were reasonably strong for disposable pants and not see through...
I certainly felt more comfortable.
Lots of these things are just procedures that fall into place and become set in stone. A few letters to the hospital administrator might get things moving, blow away a few of the cobwebs.

At Tuesday, April 28, 2009 6:25:00 PM, Anonymous Ann said...

I think lots of men have vasectomies in this country to save their wives the humiliation of these complete gyn exams to get Pills.
The decision was pushed forward in my marriage. I couldn't face it anymore and started to resent my husband. I basically decided I'd prefer not to have sex than go through that business every year.
The vasectomy was the greatest gift he could have given me.
He did visit a few doctors beforehand to double check no one would give us the Pills without the exams. He clearly felt painted into a corner as well.
It's worked out for us.
One of my friends is having trouble in her marriage. She has also had enough of the exams and has gone off the Pill.
Her husband doesn't want to have a vasectomy and hates condoms. I hope their marriage isn't doomed.
A big thanks to all the doctors who have joined together to make things as difficult as possible for women and couples.
When I read these exams are completely unnecessary, it makes my blood boil AND that women in most other countries don't have them. This site has been VERY educational.
I'm pleased my torment is over.
My heart goes out to the women still living with this abuse.
Someone earlier used the word "abuse" and it made total sense to me. It feels like abuse.

At Tuesday, April 28, 2009 10:10:00 PM, Anonymous Anonymous said...

It’s Sally again. I thought about writing another episode of doctor/patient “blindness” but decided to go another route. The two articles below indicate that, depending on the specialty, sometimes men are better doctors than women and sometimes the reverse is true with “better” being defined as performing a more thorough exam, listening better, even just spending more time with you.

It would seem to me quality is more important than gender.

At Tuesday, April 28, 2009 10:36:00 PM, Anonymous JS said...

An earlier post caught my attention.
I have also had trouble with American Dr's.
I was born in the UK and have lived in Finland since I was 16 years old.
I have studied in the States for the last 3 years, completing my postgraduate degree.
In Finland, cervical screening is not carried out until you are 30 years old.
At that age, most women discuss this testing with their Dr and decide whether they wish to be tested.
The screening is voluntary and available to women from age 30 to 60.
The test is suggested every 5 years until age 50, 55 or 60. The end date is set by the patient and her Dr.
My Finnish mother-in-law stopped at 50, having only 5 tests in total.
It was her wish to be tested and no pressure was applied to her.
I was simply told by an American Dr, shortly after my arrival, that I "must" have this test.
It sounded like it was a law.
I told the Dr that I'd contact my Finnish Dr.
My Finnish doctor strongly advised against the test, as testing women under 30 is problematic.
I was told that women under 30 are more likely to return incorrect readings and face extra testing and treatment that can cause problems.
The American Dr forcefully advised me to reconsider.
I provided him with the information sent by my Dr.
With respect, it seems in the States the thinking is something like, we must try to catch even the rare cases, no matter whether it's a negative thing for most women. Whereas in other countries, it's the welfare of the majority that is just as important.
I was uncomfortable with the extreme and emotional way the doctor spoke to me. My doctor does not speak to me in that way. It is more a co-operative relationship and nothing I say is irrelevant or unimportant.
The Dr chose not to provide contraception. I have been able to obtain protection through my Finnish Dr. My Dr was dismayed that I could be refused contraception because I declined screening on my Dr's advice.
I can see why many American women feel so strongly about this situation. I would hate to have this Test yearly from my teens. Most of my American friends have gone through testing since they were 16 or so (even many virgins) and lots have already had cervical biopsies. This is very upsetting and embarrassing for most women.
I understand almost all American women will have biopsies, while few have cancer. In Finland, I understand we catch almost as much cancer and a bit over 50% of women will have biopsies. I think this number of biopsies for a small amount of cancer is still too high and I may choose not to have testing and accept the small risk of this type of cancer. I know my Dr will listen to my concerns about testing. I think many American women would be fearful to raise their concerns with their Dr's.
Biopsies can cause trouble when or if you wish to conceive and some women can't carry a baby if their cervix is badly damaged by extreme biopsies, like cone biopsies.
Finnish women have 5 to 7 tests in their lives (if they wish) and American women will have 50 or more.
I'm not surprised they are unhappy with this situation.
I mean no disrespect, it's just that I understand and share your concerns.

At Tuesday, April 28, 2009 11:32:00 PM, Blogger MER said...

Thanks for providing those links, "Sally." They were interesting. To me, they indicate the following:
1. Gender is an issue in medicine. It always has been and will continue to be an issue as it is in all aspects of our culture.
2. Medicine is beginning to recognize this and study it. Just beginning, though.
3. Other disciplines, such as psychology and sociology and anthropology, have been studying gender issues much longer than has medicine. Medicine has much to learn from these disciplines.
4. The best studies will come out of partnerships between and among medicine and these other disciplines.
5. The studies you referenced focused on communication and other medical skills, but from the doctor's point of view.
6. Little has been done in medical gender research from the patients point of view. More needs to be done.
7. I note that the second article focuses on women's health. Although heart disease is discussed in both these articles (commen to both men and women), most of the other conditions discussed are all women's conditions. Nothing about specific men's conditions like prostate cancer or testicular cancer or male urological problems -- and how the gender of the doctor affects that care. This seems typical of the studies that are out there. More research needs to be done in this area. I think, perhaps, it's "assumed" that the gender of the doctor doesn't matter to men in this situations; and it's "assumed" that doctor gender does more often matter to women. Perhaps these "assumptions" are driving the research to focus more on women's health.
One other thing, "Sally." You write: "I thought about writing another episode of doctor/patient “blindness” but decided to go another route."

" go another route..." This suggests to me that you're trying to convince us of something, you have a specific agenda. That's fine. We all have agendas.

But why don't you come right out and tell us what you think about these articles. What do they indicate to you? How do they fit into your point of view about this issue?

At Wednesday, April 29, 2009 4:48:00 AM, Anonymous Anonymous said...

I would be interested in hearing how health screening in general is viewed in other countries, we have th UK and Austrailia here. My Dr. strongly suggests an annual physical but I have a full every 2 years for my CDL which includes DRE, blood draw for cholestral, PSA protien, etc. On the between years I have a blood draw for PSA and Cholesteral. He also has a standing policy that anyone can stop by anytime for a bp check. I had a "routine" colonoscopy at 50. Are these screening exams suggested or pushed in your countries? It would be interesting to compare the approach to screening in general in different countries.

Ann, from a male perspective, I hope you truely realize what your husband did. It seems our society thinks a vasectomy is an easy answer for men. There is a lot of joking about it when a guy gets one not only from other guys but I have seen it from spouses and other women . In a lot of cases its approached with its no big deal for a guy snip snip and its over. It is seen as much easier than a tubal (which if done independant of delviery I understand it is much more difficult and dangerous) and often its seen as easier than birth control such as the pill or condoms. Men like most medical situations won't vocalize it, we take the if we don't talk about it we can pretend it didn't happen, the cave approach. I am not chastising you. I had a vasectomy after a lot of pressure from my wife including the witholding sex ploy, I really resented her for awhile. It really is a choice, you being uncomfortable or me. Not trying to chastise you at all, for us it was the right decision in the long run. For me it was the wrong time, I wasn't ready at that time, but I felt pressured into it so I had resentment. There is recognition of the emotional/mental aspects that a woman goes through with menopause as she can no longer have childeren. But the male version is a joking matter which is taken so lightly, if we don't want a vasectomy its like we are insenstive or selfish. This seems to be carried into the procedure itself...could there be any more personal, intimate, and potentially embaressing procedure for males...yet many Doctors bring a female nurse in for the procedure who do little to friend had one and the Dr had a female nurse he knew come in and "assist", all she did was hold his penis out of the way....again I am not trying to chastise you, sorry if it seems that way, but from the guys side...I hope you understand it just isn't that easy and is every bit as difficult as an annual pelvic exam.
Not sure why the US would require females to have an annual, if there really isn't a material health reason risk issue that the Dr. could be liable for. I really think the practice is abuse of power if there isn't a definative reason. My opinion is even if there is risk, as long as the woman is informed and knows the risks, it is her choice. She is an adult with full cognative ability, she should have the right to make that decision herself. I ride a motorcycle some of my friends smoke, people sky dive, we are of age we have the right to make these choices though they put us at risk. If a woman wants birth control, and she is informed of the risks, signs a waiver that she understands and accepts those risks...just what gives Dr.'s the right to basically say you can not take that risk. This isn't something that WILL give you complications, it can, the same as driving to the office can get you killed or eating at McD's can give you heart disease. Maybe its time for NOW or some other organization to challenge this.....alan

At Wednesday, April 29, 2009 8:15:00 AM, Anonymous Anonymous said...

Concerning pap smears and other "woman" exams, wouldn't female gynos be more understanding to the humiliation and uselessness of the exams? From most of the posts I've read here it sounds like the majority have male doctors. If a doctor isn't required by law to perform a mandatory exam, I would think female doctors would more likely waive the exam.

At Wednesday, April 29, 2009 9:05:00 AM, Anonymous Anonymous said...

Though I am against forced pap smears and think that is ridiculous, I have to argue that there are also male exams and procedures that are just as "forced" and just as worthless. While most aren't as invasive as a pap smear, there are mandatory tests such as hernia, DRE and prostate. Men, as well as women, should have the opportunity to accept the risks and waive those exams. But like women, we are forced to do them. Not physically forced, of course, but if we refuse to allow them we can be fired or not hired, be dropped from our insurance companies, not allowed to play sports, etc.

Boys in jr. high and high school are never allowed to play any school sport without a worthless hernia check, almost always given by a female doctor, of course, while a female nurse stands there doing nothing more than gawking at their penis. To me it's seems less like an important medical exam and more like a required rite of passage.

Alan mentioned that he can't drive a truck unless someone shoves their finger up his butt first. It sounds like very often the men have no choice but to allow a female to do it. Now I'm not saying that they aren't very important exams that all men SHOULD have, but it just isn't right to have them forced onto them. They should have the choice to take the risk of not doing it, and so should women.

When both men and women decide that it is in their best interest to have the exams done, they should be done under their own terms, not sent to a previously unknown place to have it done by a stranger who doesn't care about gender preferences. They should have their choice of the doctor's gender as well as any nurse or "assistant", and a choice of whether or not they want a chaperone. In a perfect world the medical workers would care about their patients and not treat them like an object and a burden.

I forgot to mention many other miserable procedures, like any procedure where someone (almost always a woman) shoves things down their penis. Things that seem too big to even fit inside their penis. Also testicular sonograms, while not painful or invasive, are done by a female about 90% of the time (I've often heard), and most often won't give the patient a choice of gender.

I don't want to give the impression that I think it's worse for men than women, or that it isn't terrible and unethical for women to be forced into the exams. I just want to remind everyone that women aren't the only ones forced into undergoing horrible and unfair forced exams.


At Wednesday, April 29, 2009 1:17:00 PM, Anonymous Anonymous said...

It’s Sally again with a few observations:
1) The UK, Australia and Finland all have government sponsored/taxpayer funded healthcare systems, what we in the US call socialized medicine. Would it not be in the government’s interest to reduce cost by recommending these kinds of exams less frequently? Are these doctors basing their decision on sound medical data or just telling the patient what the government has decided is the proper frequency? In the US, we have a private healthcare system so it is entirely possible that they are performing these tests so frequently simply to make lots of money.
2) I don’t believe for one minute that any urologist would pay someone say $10 an hour only to hold a certain part of someone’s anatomy during a procedure when a 5 cent piece of tape would do the job. Don’t be ridiculous. You can ask the doc if they can work alone but if they don’t agree, well you can either stay or walk out. But insisting that they work alone, or insisting that you know better than the doctor or surgeon what staff is needed and or not in the OR is downright dangerous.
3) Those two articles indicate to me that limiting your choice of a doctor to a specific gender can result in inferior health care.
4) I think there are good doctors and bad doctors of both genders. The best one out there for you, depending on your condition, may be of the opposite gender. It would be a shame if the two of you never met up.

At Wednesday, April 29, 2009 2:54:00 PM, Anonymous Anonymous said...

Doctor Orrange wrote an article for daily strength called the 10 real reasons men don’t go to the doctor. She gets quite a few zingers in there, especially # 1 and # 2 and actually mentions the feminization of healthcare in # 4. She thinks you’re afraid not embarrassed.

signed Real Woman

At Wednesday, April 29, 2009 3:02:00 PM, Anonymous Anonymous said...

Insurance companies are willing to pay for yearly exams because they are seen as preventative medicine for males and females. The sooner something is found the quicker it can be dealt with and many things found early will cost less money than those found late.

If a patient doesn't want to have DRE or pelvic I don't think they should have to have them nor can a doctor force you to. On the flip side I also don't think the doctors should have to provide BC or meds without them if they aren't comfortable with it. It goes both ways.

At Wednesday, April 29, 2009 3:39:00 PM, Anonymous Anonymous said...

Sally, while the best one out there may or may not be of the opposite gender, it is more of a shame when you will not go to a doctor because you can not have a provider of agneder you are willing to see..or one that you are so uncomfortable with you are not open in your discussion with them. I am not uncomfortable if the exam/tests are non-intimate. If they are intimate, then it will be a male provider or no provider. I have learned (through this blog and that of Dr. Sherman) that I can choose. Mostly it only takes talking to whoever makes appointments so you know if it is a male or female doctor/technician. You can see if they offer a suitable gender or you just go to another facility when you find one that can accomodate you.
As to your response to alan about alien providers you can't see their faces being the same as being unconcious....perhaps it is to the provider, but it is not to the patient...

At Wednesday, April 29, 2009 5:50:00 PM, Anonymous Ann said...

No, female doctors won't waive the exams. It seems it's a silent agreement to force women into their waiting rooms. I think we should be able to buy BC over the counter. I read there is a pilot scheme operating in a couple of areas.
Planned Parenthood offer the HOPE scheme. Hormonal contraception with optional pelvic exam however, most pressure you to have the exams after 6 months or so. I couldn't bear the stand-off, being made to feel like a foolish child for refusing...and then having to give in again.
I felt it was to get you through the door and then force compliance.

I understand what you're saying, Alan. I just could not take another exam, after annual exams since age 20 and two biopsies with no cancer, I could not face any more. I was prepared to give my husband a divorce. There is a limit for all of us.
My husband faced the surgery before he was ready. I felt guilty about that fact.
He felt guilty over the years watching my stress levels rise as the day approached, as the Pills ran out and my anxiety and fear reduced me to tears. I'd call and let them know I was about to run out and could I get a fresh supply until I could get into them and the answer always the same, "No, not until you come in for your physical"...
He also saw the distress and deep humiliation of the biopsies.
I now know mine were false positives. In other words, the test was wrong, as it often is...
In a way it felt like I was being punished for having sex.

My husband felt that the vasectomy wouldn't be an easy thing however, it was one procedure and not required every year.
I do understand what he went through and I think he understands what I went through for many years.
I do understand what you're saying...
We're just pleased this ugliness is behind us and we can enjoy our lives. I'm finally free to love my husband without counting and saving pills and worrying about exams and biopsies. I often avoided sex for months or we'd use condoms to make the pills go further and delay another date with my abuser. (that's what it felt like) All the time worried about an unplanned pregnancy if a condom failed. My husband also lived with those pressures. I'm sure he could sense my reluctance. Sex was always linked with those exams in the back of my mind.
It's no way to live.

At Wednesday, April 29, 2009 5:54:00 PM, Anonymous Anonymous said...

I get the feeling that there are
those on this blog with ulterior
motives when it comes to mens
health issues.
Busy bodies are a dime a dozen
always quick and ready to tell others how to live their life yet
their own lives are so screwed up
Dr Phill refused them.
It's a pathetic joke when some
female provider thinks she knows
why men don't often seek care. Her
thread is just another way of diffusing guilt for her own
gender group.Why would she even bother with such a discussion.
Funny how guilt has a way of
coming back to haunt people, those
that discriminate. Making comments
such as " men are more afraid than
embarrassed." Nice try but it dosen't work. Trying to play on the
fearless man card trick. Whats the
matter, male patients only account
for 4% of your clientile. Reminds
me of that mindless female physician whose medical practice
was failing. With the rampant sightings of ufo lights she decides
to write a book about those ufo
lights seen over Phoenix. Viola,
no shes a cosmologist going on speaking tours.
She knows the secret of those lights or she really wants you to just shut up and buy her stupid book. But then maybe just maybe
some little green men flew all the
way here just to give her a gyn
exam. A taste of her own bad


At Wednesday, April 29, 2009 6:52:00 PM, Anonymous Anonymous said...

Sally, not so sure what you find unbelivable. The Dr.'s I spoke of were PCP's not urologist but I don't think it makes much difference. Dr.'s have nurses on staff, they are on the clock, they are getting paid whether they assist or not, they are already there. Dr's sometimes feel their time is more important than patient comfort. Regardless of whether you believe it or not this is a common practice for Dr.'s to have nurses assist vasectomies, as a matter a fact from talking to other men, unless you state otherwise most vasectomies are performed with a nurse assisting which is a perfect example of what we are discussing here, it doesn't HAVE to be that way, its just easier for the Dr. The practice may be ridiculous but the reality is it is common. I know from personal experience it does happen. One could make the same arguement about nurses assisting pelvic exams, thats ridiclous, why would a Dr. pay a nurse to assist what he can do on his own....

My company uses a Health Reimbursement Plan (HRA). Basically they pay the 1st $2000 of claims 100% then you pay, then you split with them. The idea is to get patients to be more responsible with using health care. They pay 100% of screening but do not charge it to your $2,000. Obviously they feel financially it is cheaper to pay for mass screening than to pay for advanced cases of illness and disease. Insurance companies don't care about you, they care about numbers, they are masters at playing the odds, thats what they do for a living. If they think screening is cost effective...odds are (little pun there) it is. The part that is problematic is where they will not provide contraceptive for women unless they submit to screening. If it truely is the pill provides a serious risk for a significant number of patients without screening, I guess I understand a providers reluctance to provide it, but I am suspect and still question the right of a provider to determine an acceptable level of risk for an informed patient. As someone mentioned earlier, the fact that many of the new GYN's are women...and still follow this protocol...would lead one to question if there isn't more to this than we realize. Hard to argue it is men imposing this on women when female Dr.'s follow it as well..........don't know enough about it to make an intellegent call on it...wish we could get a female GYN's take on this issue...still have to question the right to over ride a womans choice to assume the risk.........alan

At Wednesday, April 29, 2009 8:20:00 PM, Blogger MER said...

I just must comment on Dr. Orange's "blog." Everyone here should read it. It puts into context how this male modesty issue we’re discussing is just one piece of a larger double standard in our society. Her article is a great example of

...the "gender neutral" worldview. Notice that when she talks about why men don't go to doctors, she talks about "us" and "we." Doctors aren't men or women. They have no gender. They're just "doctors." Of course, that' show they see themselves. That's not how many patients see them. In her worldview either men don’t really see gender or, if they do, it doesn’t or shouldn’t matter. the medical profession, and apparently female doctors, don't really understand male psychology. She perpetuates stereotypes in her article. Men don’t really care about their health. Men must be forced to go to doctors by their wives. Men are really stupid – they don’t realize doctors are there for prevention. In earlier volumes, we referenced the research of Dr. Catherine Dube and how she has unraveled this stereotypes. Dr. Orange would probably say she was just using humor. See below. good, caring female doctors (Dr. Orange obviously cares about men's health) use what they think is humor to get their point across. Humor can be a good strategy in the right context. But one must be careful. When does humor become sexist?

…how good doctors can be condescending without even realizing it. One man comments that she’s male bashing. I think she responds that it wasn’t her intent. Some one responds, can’t we all just get along. Can’t we just discuss this without always finding a hidden agenda whenever women talk about men? Please! Hidden agendas? That’s what feminist theory is all about – the hidden agenda. Feminist theory deconstructs all kinds of “paternalistic” texts. She writes about examining men’s balls. A man asks her how she would feel if a male doctor talked about examining a women’s tits. No answer. But we all know that such a comment about women by a male doctor would not be considered funny. It would be considered unprofessional.

…this is a classic example of another double standard in our culture. If you think I’m wrong, just rewrite Dr. Orange’s little essay. Call it “Ten Real Reasons Why Women Don’t Go to the Doctor.” Just replace male anatomy with female anatomy and use the same slang terms for women. Read it aloud to your wife or girl friend and see how she responds. I would strongly suggest that if a male doctor wrote this article about women with the same attitude and using the same language, he would possibly be up on ethics charges, or at least charges of unprofessionalism. If he claimed humor as a defense, his intelligence would also be questioned.

What’s remarkable is that Dr. Orange writes all this on a public blog with her photograph. This demonstrates how “normal” this worldview is considered. To her, this is just humor. It’s funny. Nothing to be angry or upset about. She has good intentions. It’s sad – because she obviously cares about men’s health and wants to help them

The fact that she is also an Asst. Professor of Medicine, begs the question: Does the attitude she conveys in this article get passed on to her students?.

But I do agree with Dr. Orange about one thing. Many men are afraid. It’s not so much the fear of going to the doctor. It’s the fear of challenging women when they make sexist and/or stereotyped comments about men. Men don’t want to appear as if they “can’t take it.” Being masculine today isn't politically correct. We’re supposed to accept the double standard because, as some feminists see it, that’s what it means to be a man. When men see attitudes like this, we need to challenge them without fear. Sexism is sexism, regardless of which direction it happens to be traveling.

At Wednesday, April 29, 2009 9:01:00 PM, Anonymous Ann said...

Alan, I was told directly by a female doctor that the exams and test had nothing to do with the safe use of the birth control pill.
"We hang onto the Pills to make sure you come in for your health checks" were her exact words.
Pelvic exams are not recommended in other countries and screening is a totally separate issue to birth control. One doctor even told me the pelvic exam was of low clinical value. I guess that's why it's not done elsewhere.
If you do some research on the Internet, you'll see more and more senior doctors questioning the ethics of tying together birth control with gyn exams and cancer screening.
One UK article said to link screening with BCP's violates the doctor's requirement to obtain informed consent from the patient.
The only things required for the safe use of BCP's is a medical history and regular blood pressure check.
As Nicole points out...the WHO, USF&DA & American College of OBGYN's all say these tests and exams are not necessary.
So, what's going on? Why are their members ignoring their recommendations and witholding BCP's until women submit?

At Wednesday, April 29, 2009 9:23:00 PM, Anonymous John S said...

You may care to look at an Article by Heather S. Dixon entitled "Pelvic exam prerequisite to hormonal contraceptives; Unjustified Infringement of Constitutional rights, governmental coercion and bad public policy" published in the Harvard Journal of Law & Gender.
Right on point.

At Wednesday, April 29, 2009 9:24:00 PM, Anonymous Anonymous said...

While many of the statements made by DR.Orrange are about what many if not most doctors say, her limited understanding of embarrassment and the fact that it can be an issue of the gender of the provider...either ignorance or arrogance on the part of the provider. As Dr. Bernstein has written repeatedly, providers are mostly ignorant of just how much gender is an issue with patients....especially in men.
I doubt if we could get this assistant Professor of Medicine to update and add male modesty based on gender of provider as another reason to her article

At Wednesday, April 29, 2009 10:07:00 PM, Anonymous John said...

This article includes a chart which shows US and German women face far more pap smears than other women.
Many would say that US women are over-screened and that's why they face more biopsies than other women. (the figure is in the 90's...roughly 95% of women will have biopsies) The extra cases of cancer detected is very small. When you over-screen women you may catch a few more cases of cancer, but also greatly increase the risk of a false positive and interventions.
This should never be taken lightly as false positives cause great anxiety and biopsies are uncomfortable procedures that can cause physical and emotional trauma.

At Wednesday, April 29, 2009 11:57:00 PM, Blogger MER said...

If anyone thinks my rant about Dr. Orange's article about why men don't go to doctors is off base or out of line, check out this this male nurse thread on all nurses. All the comments are negative and bring up some of the same issues I do.

At Thursday, April 30, 2009 4:58:00 AM, Anonymous Anonymous said...

58flyer, who has contributed to our conversation on this blog, has an interesting post to the thread "The ten real reasons men don't go to the doctor" on There are several posts there which have a direct bearing on our discussion here. As this thread is new, I suspect it may have been started by someone who RealWoman's post here.

At Thursday, April 30, 2009 9:37:00 AM, Anonymous TT said...


The behavior by physicians you describe is called coercion - "the practice of compelling a person or manipulating them to behave in an involuntary way (whether through action or inaction) by use of threats, intimidation, trickery, or some other form of pressure or force. These are used as leverage, to force the victim to act in the desired way."

Arguably, if the physician realizes financial or other gain as a result, then it may become extortion - "Extortion, outwresting, or exaction is a criminal offense which occurs when a person unlawfully obtains either money, property or services from a person, entity, or institution, through coercion."

Regardless of the intent of the physician, if the tests involved are not directly related to the care being withheld, this behavior is not ethical and needs to be challenged. Maybe if every woman that was denied hormonal birth control without first undergoing the screening exams filed an ethics complaint with the BOM it would get their attention....

Just for fun I fired off a synopsis of this subject of discussion to a long time friend that happens to be a DA, for comment - will let you know what I hear back.......


At Thursday, April 30, 2009 1:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac, you wrote "I doubt if we could get this assistant Professor of Medicine to update and add male modesty based on gender of provider as another reason to her article". I would suggest: "try it!" Go to her website and state your view (and those of others here) and see what happens. You may be surprised what a bit of education can do. Look what has happened to me and this blog: 15 volumes and a few thousand comments! ..Maurice.

At Thursday, April 30, 2009 3:03:00 PM, Anonymous Ann said...

Thank you TT
I'd be very interested to hear the answer or comments.
This conduct is a problem for women and their men.
I know many women currently managing in other ways to avoid these exams. The unfairness and manipulation is hard to stomach and it's a negative in our relationships.
I think most women don't even think about making a complaint because we're made to feel like silly children and assume it'll be the same higher up...deaf and patronizing ears.

At Thursday, April 30, 2009 3:10:00 PM, Anonymous Anonymous said...

I sometimes wonder whether people lose their sensitivity meter when they enter medicine. They forget they're dealing with individuals.
A male nurse was sent to shower me while I was recovering from a recent operation.
Why would I have a problem with a total stranger helping me in the shower?
It's something I do every day!
I wonder whether people become a bit sadistic when they have power over others.
How could anyone assume a young woman would be happy for a man, a total stranger, to wash her in the shower?
I do feel for men, it would undoubtedly have been harder to find a male nurse if a male patient had my complaint.
Although, in this case, you could have taken mine, he certainly wasn't showering me!

At Thursday, April 30, 2009 4:25:00 PM, Anonymous Anonymous said...

Dr B

Previously, you provided a link
to the transportation board regarding whole body imaging and
airport safety. Millimeter wave
technology as its called for
screening. I'm well aware of this
as there was considerable concern
about its use several years ago.
Many potential passengers questioned its use and of course
the concern for privacy. They claim
the operator never sees the passenger associated with their
image and claims zero storage
capability. Hmmmm, how then could
the image and therefore "the proof"
be maintained should someone have
a concealed weapon?
There is abuse in every kind
of technology and its only a matter
of time before there is abuse with
this machine. This apparatus in my
opinion is no more sophisticated
than a metal detector. One can
conceal a metal ignitor in a fake
tooth crown and a strip of semtex
in their shoe and this device will
not pick it up.But then neither would a metal detector.This technology is very expensive and provides only a limited measure of safety.
Does it provide a measure of
safety at the expensive of passenger privacy. Time will tell!


At Thursday, April 30, 2009 5:17:00 PM, Anonymous Anonymous said...

Ann I understand why you feel so strongly. To me, if the pelvic exam and BC pills are truely not related, requiring one for the other amounts to blackmail or extortion. I find it paticularly disturbing that women who have been through this do not attempt to change it. Perhaps it shines the light on another issue, the brother/sisterhood of providers is tighter than their identification of gender. Surely growing up these female doctors felt the same way...yet when they become providers that "code of the providers" becomes thier primary identification....thanks for the insight....glad it all worked out, I like your husband got over it, but I was resentful for awhile..I have gained new perspective on the issue, I never stop learning from this blog

Realwoman, seems like the use of afraid and embaressed aren't that different in the context she used them. It did as MER stated provide an example of the double standard we complain about. If a male provider made light of females having pelvic exams with the 10 reasons women hate Pelvic Exams and made comments about getting a finger up her...and used one of the slang terms for vagina, or as stated above yes we will handle your t*ts....would anyone here think it was appropriate humor....the fact that she doesn't recognize the issue and felt comfortable making those statements in wrtiing on the net shows how lightly the issue is taken by providers.......alan

At Thursday, April 30, 2009 5:46:00 PM, Anonymous Anonymous said...

I did not post allnurses, I swear, but the timing is interesting, the allnurse post is about 4 hours after mine. Looks like a few of the allnurse people have been checking out the discussions over here.
signed Real Woman

At Thursday, April 30, 2009 6:12:00 PM, Anonymous Anonymous said...

Well, it appears that Dr Sherman beat me to comment on her site, but I also left a comment...We will see if there is any response...if not I will try to send her a personal message.

At Thursday, April 30, 2009 9:04:00 PM, Anonymous Anonymous said...

Ann is right.
All of this ended my engagement. My boyfriend got tired of using condoms after I went off birth control pills. I felt nervous using condoms as well...fearing an accident.
I found those exams made me very unhappy...sick to my stomach...sometimes I'd vomit or cry...and the year would go very quickly and I'd be back there again.
I'd rather be single and happy.

At Thursday, April 30, 2009 9:13:00 PM, Blogger Maurice Bernstein, M.D. said...

It is interesting and ?"refreshing"? to begin to get more viewpoints from visitors of the female gender as we did originally in the first thread "Naked". I don't want to diminish the value of the male visitors comments to this discussion. But to have the opportunity to consider the similarities and differences of the concerns in women is also of value. With this posting, I just wanted to thank the women for their participation here. ..Maurice.

At Thursday, April 30, 2009 10:25:00 PM, Blogger MER said...

I agree that it's good to get more female points of view on this thread. Since there have been several posts about the questioned necessity of some procedures and exams, especially for women, I thought I'd give a reference and ask Dr. Bernstein to explain it.

In his book "Hippocrates Shadow" by David H. Newman, M.D., the author talks about the "NNT" in Chapter 8. "NNT" stands for "Number Needed to Treat." Newman explains: "The NNT measures the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person." In other words, statistically, for doctors to know that a treatment will affect one person, they may have to treat 2 or 3 people, even if they know it won't affect all those they treat. By the way, the title of Chapter 8 in Newman's book is "You're a Number (The "NNT").

Maybe Dr. Bernstein could address this use of statistics and whether this is what might be driving what many of the women on this thread consider unnecessary exams or treatments.

At Thursday, April 30, 2009 10:28:00 PM, Anonymous Anonymous said...

Doctor Bernstein, I am new to your
wonderful series of PATIENT
MODESTY blogs. It's taken me
three weeks to read all the comments on "PATIENT MODESTY:
A More Significant Issue" --
May 11, 2006 to Feb. 26, 2007
and "NAKED" (which seems like it
was a patient modesty-type blog of
yours) Aug. 22nd, 2005 to Nov. 24,
2006. PATIENT MODESTY, Volume 2
(the first of the numbered volumes)
starts on December 15, 2007.
Question: What happened to postings between Feb. 26, 2007 and
December 15, 2007? Almost ten months seems to be missing(?) I'd
love to read these, too. Where/how
do you have them listed? Many
thanks for moderating this great
patient service. I'm feeling
really fortified by it. The next
time I meet any medical staff
they're going to face the new me!
Let's say, "I'M MAD AS HELL AND I
- Phil Z.

At Friday, May 01, 2009 4:03:00 AM, Anonymous Anonymous said...

A friend was in rehab after hip replacement surgery. He too endured a female nurse showering him! He was mortified, embarrassed horribly and yet did not speak up! Why do caregivers NOT have sensitivity that people -both male and female - are NOT comfortable with this? It is beyond words. Can they really think for one moment that this is comfortable just because they've had a surgical procedure? Come on.

At Friday, May 01, 2009 4:19:00 AM, Anonymous Anonymous said...

I agree Dr. Bernstein, it also opened up my eyes that modesty goes beyond gender. I always assumed if I had gender choice for providers the issue would be addressed, apparently that isn't nesecarily so. I assumed pelvic exams had to be problematic for many women, but I assumed being able to choose a female provider who would have a female assistant would address most of that....apparently that isn't so....likewise we often seen the division along gender lines where I felt often men got a quit whining "women have to"...argument that indicated a lack of recognition that there was a problem for males. This seems to be a little more of a universial problem with recognition and empathy by some on both side of the gender devide.......great exchange, now if we could just get more providers to wiegh in....alan

At Friday, May 01, 2009 4:19:00 AM, Anonymous Anonymous said...

Thanks to the medical profession I now HATE being a woman....there is no celebration in the female body, we are to be compulsorily checked for disease....we're treated like we're disease ridden whether we're diseased or not and it's all for our own good.
I hate my body.
These exams are degrading, humiliating and slowly destroy your soul and enjoyment in life.
I will be single for the rest of my is the only way to actually enjoy your life as a woman.
I won't let these people make me feel like a dirty science experiment and strip me of dignity, self-respect and modesty.
I'm a person and not a collection of organs to be treated whether I'm diseased or not.
Being female amounts to being diseased in this country.
At one exam...I asked the Dr to cover my face, I'm just a body anyway, the person doesn't really matter or exist...I'm just a statistic to be prevented....I'm a disease to be caught in time.
Having read some posts from Australian and English women, it gives me hope...I'm going to try to relocate...maybe other countries value and respect women...and will allow me to live a normal life.
If you take away self respect, dignity and modesty, you have nothing left...absolutely nothing that matters anyway.
What's the point of catching every rogue cell if you kill the soul in the process?
The same Anon...

At Friday, May 01, 2009 7:58:00 AM, Anonymous Anonymous said...

While I do not know if she will respond on the blog site, I did get a response by email from Dr Orrange. To be honest I was really surprised. I guess that in order to understand her article, you have to understand what the entire site is about and read other articles and postings. Her intentions are far different than what the single article seems to across as...I had suggested that she go to the article on, Dr.Shermans' blog, and to come here are read Dr Bernsteins' blog...
If the ladies are excluded from our discussion here we not only miss out on experiences and concerns they have, we also become the same as those who ignore our feelings...and we loose their support...I think its called mutual respect and joining forces for the benefit of both genders...Many of the experiences they have described here could be avoided by the same mechanism that would help males avoid the situations we find so bad...allies that by their numbers increase our voice geometrically..and is heartening to see many of them sympathetic and not derogatory of our feelings.

At Friday, May 01, 2009 8:08:00 AM, Blogger Maurice Bernstein, M.D. said...

Phil Z. congratulations for attempting to read all the postings to these threads. Because of some unexplained idiosyncrasy in the posting mechanism, 900 postings from "Patient Modesty: A More Significant Issue" suddenly disappeared from the thread's Comment page and could not be recovered. However, it turned out that they all were still present within the pop up window where visitors can write new comments. I copied all of the missing comments and put them in order on two new threads "MISSING COMMENTS FROM PATIENT MODESTY THREAD (A)" amd "MISSING COMMENTS FROM PATIENT MODESTY THREAD (B)"

Since then by limiting the number of comments to 100 or so on each thread, there has been no recurrence of what happened.

Click on the above links and you can read all the missing comments but don't try to write comments there since they won't be published. ..Maurice.

At Friday, May 01, 2009 10:09:00 AM, Blogger Maurice Bernstein, M.D. said...

MER, with regard to NNT (numbers need to treat) you wrote "Maybe Dr. Bernstein could address this use of statistics and whether this is what might be driving what many of the women on this thread consider unnecessary exams or treatments."

My response,MER,is that there is a lack of readily available statistics or simply lack of use of statistics that are readily available by physicians and that the average doctor makes screening or therapeutic decisions based on informal experience or advice in the literature or conferences. According to the University of Texas Medical School on Medical Informatics
"There is currently an information gap:

* About 50% of indicated care is provided (McGlynn, 2003) while up to one-third of care may not be indicated (PMID: Fisher, 2003).
* 20% of primary care visits have a guess being made by the physician (calculated from Ely, 1999)
* 14% of medical inpatients may have improved principle treatments if literature searchers were provided to the physicians (Lucas, 2004)"
(Go to the site to access the reference links.)

Here is the link to the Clincal Calculator so if you have the statistics on the incidence of a disease or the benefit or harm of a screening test or procedure, you can determine by the calculator the NNT yourself. ..Maurice.

At Friday, May 01, 2009 4:09:00 PM, Anonymous Anonymous said...

Eight staff members at the University Medical Center in Tucscon Arizona were fired yesterday for taking cellphone
photos of a patient without their
permission. Four nurses and four
patient-care technicians were
involved. The family of the patient
and the police department were
I don't need to tell you what they took a picture of although I'm
sure you know the anatomy of the patient involved. Is this a trend and where do they find these people. I know now of four hospitals in my state alone of this
occuring and you can say with
certanity that it occurs with much
frequency as many don't get caught.
If this isn't a wakeup call I
don't know what is!


At Friday, May 01, 2009 5:49:00 PM, Anonymous Anonymous said...

Dr. Bernstein, thanks for the links
to the 900 missing comments. I had
read into them for a couple of
hours when I came across a situation strikingly similar to something I experienced a month ago. I hope you don't mind, I'm reposting it here.

The only key difference is that
the female sonographer was having
trouble with her equipment so
one and then another technician, both women, joined her to literally
experiment on me. I was morified
but like many men I've read about
on your blog, I said nothing. It's
made me angry for a month. I found
your blog as a kind of therapy to
try and get beyond what happened.

(REPRINTED from Aug. 31st, 2007)
Anonymous said...
Dr. Maurice: I once had a medical plan that allowed me a choice of seven urologists. Six of them employed female sonographers for scrotal ultrasound procedures. The
sole doctor with the male tech was always three times harder to book an appointment with. Perhaps his fellow urologists saw more female patients or they didn't want to deal with the need for an extra
staff person to act as a chaperone. It would be cheaper to inform male patients they
had no choice and ask them to suffer through any embarassment. Afterall, their female ultrasound tech was a "professional" (who had a right to be insulted by such
same sex requests). This is the kind of thinking I've found throughout the medical services world. The first time I had a scrotal ultrasound, I never thought about the gender of the sonographer and was actually
shocked when I was introduced to a woman. I had elected to go to a male doctor. I assumed this obvious choice would follow through technical care. Live and learn.
Her ultrasound room was a small suite off the inner-office corridor. A half-dozen
female administrative staff wandered along it, continuously. I asked the lady tech to
please close the door or screen the examining table as we
were in clear view of the door.
She said she couldn't without another female staff member present. In other words,
if I wanted any privacy, I would have to tolerate a double assault on my modesty! Even a woman who finds herself with a male sonographer always gets a female
(same gender) chaperone. Who came up with these rules and why do they think they're even remotely fair? It's time men started raising their voices.
Very loud, guys!
Friday, August 31, 2007 9:12:00 PM

Perhaps your current readers would
want to re-comment about this. It
would be a help to me if they
were to share their opinion. I'm
amazed at how much this has
troubled me. I don't know how to
fight back. I took it all as if
I were a child. I actually feel
less of a man for having let this happen to me.
- Phil Z.

At Friday, May 01, 2009 7:03:00 PM, Anonymous TT said...


The news report from two different sources says 8 employees were initially suspended and four of them subsequently fired. Apparently it is the result of a photo taken by one staff member, & the police investigation continues.

No details of the incident have been disclosed, but I agree this type of act is deplorable and the perpetrators deserved what they got.


At Friday, May 01, 2009 7:38:00 PM, Anonymous Margot said...

The emphasis is totally different in the States.
It's test everyone, as often as possible, regardless of risk, for the sake of better figures and to cover the possibility of very rare cases - like the doctors who still push screening onto virgins.
It doesn't matter whether we hurt 500 people to save one person.

In the Netherlands, the approach is totally different. I was stunned when a doctor asked me whether I wanted screening.
I looked at her and said, "I have a choice"...
She went on to explain one in 126 women will get cervical cancer and one in 55 to 60 will get lung cancer and breast cancer, so I understood the absolute risk of these cancers. She also mentioned the test was far from perfect and gave me a chart showing the number of false positive and false negative results. I could take this information away and think about it. The test does not reduce your risk to third of women who get this cancer have been having smears, but the test misses the cancer - a false negative.
I was shocked by the honesty of my new doctor.
The numbers are so small, I'm very happy to live with the risk.
The risk of a false positive is MUCH higher than the risk of cancer.
My Pills were prescribed without an exam, except for a blood pressure test.
I had assumed cervical cancer was everywhere and not having the test was dangerous. This isn't the case and we've all been deceived. It was like she was talking about a totally different disease...a US doctor would go into a frenzy if you refused testing.
This has opened my eyes. I feel angry that doctors lied to me for years - blatantly lied...
I won't be having further testing.
My husband is Dutch and we'll probably make our home here, the new approach to medicine is a huge bonus in my eyes.
Anon, think about the Netherlands - no testing before 30 and then only every 5 years to keep down the number of incorrect results and you are entirely free to refuse testing and still get your Pills. The weather might be better in Australia though!

At Friday, May 01, 2009 9:21:00 PM, Blogger MER said...


You wrote regarding Dr. Orange's article: "I guess that in order to understand her article, you have to understand what the entire site is about and read other articles and postings. Her intentions are far different than what the single article seems to across as..."

Explain to me how knowing what the entire site is about can excuse the tone and diction of this article?

I don't question her intentions. I don't question that she's a caring doctor. But if you can think of an acceptable context for this article, please let me know. In the last few days, I've show her article to several women and they can't believe a woman doctor would write something like this. It doesn't matter that her other articles are different. This article shows an error in judgment. Can it be forgiven? Certainly. But I haven't read on her blog an regrets she's posted about the way she approached this topic. If I've missed her comments responding to the outrage posted on this and other blogs, let me know where to find it.

At Friday, May 01, 2009 10:33:00 PM, Anonymous Anonymous said...

I am not happy she posted what she did the way she did...and I do not think she is going to put any disclaimer or change it....Perhaps Dr Sherman got a longer explanation than I did..but I think she wrote the article for a different audience....and that perhaps enough folks will visit the site...and explain that while we all need some levity and not to take ourselves so seriously...she obviously is lacking in common sense and her sense of decency is questionable...but she wrote it (I think) to cheer up wives of men who are experiencing health problems but won't go to the doctor.
I also feel that she must have felt she had a rough time becoming a doctor because she is female. (gut feeling). It is probably a sense of insecurity that led to her coarse language and inapropriate joking.
Perhaps enough can leave her a post and maybe send her a message via the sites message system so that she will see just how offensive it really is.

At Friday, May 01, 2009 11:35:00 PM, Anonymous Anonymous said...

MER to be succinct..Her personal response to me was that she is considered huggable by all who know her....I suspect I would like to arrange for her to be interviewed by PT and several others here for an hour or so...perhaps she would understand
why she would make a poster provider for a major reason why men do not go to the doctor...her danger is...that she really thinks she is helping..

At Saturday, May 02, 2009 4:49:00 AM, Anonymous Anonymous said...

US women are told pelvic exams are a life saving exam and should start at 16 or so, even for virgins.
Others countries DON'T recommend these exams at all.
I went to a Dr in the UK for some Pills and was expecting a pelvic exam.
When I asked whether I should undress for the pelvic exam, she said,
"Is there a problem?"...
I said, "No"...
"So why do you need a pelvic exam?"...
"We're told they're essential every year to make sure our reproductive organs are healthy"...
"We DON'T agree with that practice."
I got birth control with no pelvic!
I was euphoric...think I'll stay in the UK for a long time. can our doctors say they're essential exams when the rest of the world say they're not even recommended?
It doesn't make sense.
Women need to refuse these exams and if you're refused birth control, make a complaint.
When I return to the States, I'll be taking this matter further. I'm not having any more completely unnecessary invasive exams. I'm even prepared to speak to my Uncle, an attorney, to see what can be done to break this unethical stranglehold on our birth control pills.
This has to stop...

At Saturday, May 02, 2009 8:48:00 AM, Blogger MER said...

Thanks, leemac, for your response. So, Dr. Orange is considered "huggable" by everyone? As you say, that kind of remark either shows that she really believes that there's nothing wrong with the way she's putting things; or, it means she isn't willing to own up to a mistake. That's too bad. It's like that sexist male saying that his wife and children and even his dog loves him.

And, if she really believes that the way she's communicating with "many" men is in that article, it's almost frightening. The fact that some men took the article well perhaps indicates to her that that is how "all" men should be responding and that there's something wrong with those who don't respond. If she really is looking inside herself and examining her worldview, she apparently isn't willing to share her insights with those who disagree with her.
Has anyone asked her specifically how she feels about the double standard and the availability of male nurses and aids to work with men for intimate exams or procedures? It would be interesting to get her specific take on that. My wife went to a women's clinic for an exam. I asked her to ask her female doctor about gender issues, especially for men. Her female doctor said that men just need to get over that. My wife and I both laughted at her response. You see the irony? Here's a female doctor working in a female clinic telling men that they just need to get over the kind of service that she's providing. It's amazing how we humans can be so blind sometimes.
Unfortunately, I'm beginning to think that, Dr. Orange, as good a doctor as she is, may represent the embedded medical culture that we must fight.

At Saturday, May 02, 2009 2:22:00 PM, Anonymous Anonymous said...

The thing many of these folks really think they are doing what is right...unfortuantely...the their way or no way...attitude is given the idea..that their good works...makes everything ok...
The old saying about just reaching a goal justifies the means...and makes the means the ruling idea....
I have no idea how to get them to see that they are defeating themselves....
I am going to try to see what Dr Sherman has learned.
I have no problem with keeping a sense of humor...I have no problem with the good Dr Orrange does....I just do not see how to get her to see how much anger is caused by and harm that humor

At Saturday, May 02, 2009 3:56:00 PM, Blogger Maurice Bernstein, M.D. said...

I was rereading Dr. Orrange's commentary "The 10 REAL Reasons Men Don't Go to the Doctor" on and it seems to me she was just expressing the usual public health dictum that doctors and others in the preventative health field say to the public. I do think, however, that for emphasis she was using "men-talk" if that is the right word. For that, I think was a bit too much just as those governmental video ads showing men walking about in gowns as their clothing to encourage men to get physical checkups.

It is my view, based on my clinical experience, that health education for patients is better in a one to one discussion with the patient's doctor and tailored to what the individual patient NEEDS to know based on their own history and clinical state AND what the individual patient WANTS to know based on their own concerns and questions. It is in this relationship that the back and forth communication will achieve the best compliance and health results rather than broadcasting generic or threatening information to the public. To emphasize again, what each patient needs to know is an individual matter.

What should be broadcast regarding healthcare is that everyone should get themselves a general physician with whom they feel comfortable, the rest is up to "you and your doctor". ..Maurice.

At Saturday, May 02, 2009 4:45:00 PM, Anonymous Anonymous said...

"I don’t believe for one minute that any urologist would pay someone say $10 an hour only to hold a certain part of someone’s anatomy during a procedure when a 5 cent piece of tape would do the job. Don’t be ridiculous."

Sally, you obviously haven't talked to too many men about their procedure have you? Haven't you been paying attention to many of the posts here that have described exactly that? (Alan was one I think)

leemac, PT, GREAT comments!


At Saturday, May 02, 2009 5:26:00 PM, Blogger MER said...

Oh, I agree with you Dr. Bernstein. Doctor Orange was trying to emulate a stereotype of male locker room talk. But it's a stereotype. It's not how most or many men seriously talk about their health. And we can't ignore the double standard in this case; that is, a male physician would never get away with trying to emulate "girl talk" using language like that.

Frankly, I think many male doctors are afraid to challenge physicians like Dr. Orange when she writes like that. It's not politically correct. Just like men who want same gender care, they may be called "silly" or told to "just get over it." And they don't want to deal with this issue. There could be too much professional and/or social ostrocism involved.

You also write: "What should be broadcast regarding healthcare is that everyone should get themselves a general physician with whom they feel comfortable, the rest is up to "you and your doctor".

Although I agree totally with that statement, the fact is that, once you leave the familiarity of your personal physician's office and go to a specialist and then off to another clinic or hospital, all bets are off. Most personal physicains (family doctors) neither feel comfortable nor do they have the clout needed to advocate for a male who wants same gender care. Some might. I don't believe most would or even could if they wanted.
Even those who have hospital priviledges to do surgery -- most must fit into that hospital culture, accept that hospital's scheduling, go along with whatever the policy is at that hospital. Most, in my opinion, will not risk pushing these issues by advocating for the patient. As with all cultures and systems, people who go against the grain must pay not only a social price but sometimes an economic price and definitely a professional price in this case. I don't think most doctors will fight for their patients in this regard.
Look at a common example we've talked about here. Your trusted personal male physician recommends you go get a testicular ultrasound or some type of urological procedure/exam. First of all, they probably are not even thinking that the whole staff working for the male urologist will be female. Secondly, if they do know that, will they even tell you? I doubt it. Thirdly, if you ask them to help you find a clinic where you can find a male sonographer or a male urologist who has a male assistant -- will they help you by calling around or using their influcence? Some may. I don't think most will.

Maybe I'm wrong about this. But, as you've so often mentioned, most doctors don't have a clue about male modesty issues. And I don't think they want to take professional risks by pushing this issue. Especially professional risks like challenging the judgement of physicians like Dr. Orange who perpetuate male stereotypes in articles that verge on sexism.

At Saturday, May 02, 2009 5:50:00 PM, Anonymous Anonymous said...

Thanks John for the great article.

At Saturday, May 02, 2009 6:01:00 PM, Anonymous Anonymous said...

Glad to hear from you Phil Z. I feel the same way.

Careful Dr. Bernstein, you're going to have all the talk show hosts inviting you onto their shows pretty soon.


At Saturday, May 02, 2009 6:03:00 PM, Anonymous Anonymous said...

I agree with you, Dr.Bernstein, about the need for a one to one relationship with a doctor.
The fact that the lady doctor resorted to "man language" does come across as a shaming mechanism though...made especially acute because of the gender of the writer...and it does ,as Dr Sherman said, demean men...Yet it is also the approach and words combined with gender that have kept men from going to a evidenced by numerous posts here on your blog.
I understand wives frustrations...and the need to have some humor injected for them...but the article should be prefaced that it is written for the benefit and edification of everyone Except the men it addresses. If I had come across this article first last year, it is not likely I would have gone to a doctor last year when I did....but I found this blog first..I am sure Dr Orrange has the best of intentions...but her article is as paternalistic as anything the coming here have complained of..I sincerely doubt if she looked at your blog here ( I did privately tell her she should) nor do I think she looked at and the article review there...if she did you might have heard from her..

At Saturday, May 02, 2009 6:38:00 PM, Blogger Maurice Bernstein, M.D. said...

DG, do you know, I am fully not in favor of anyone with specialized knowledge going on a "talk show" to broadcast that knowledge to the public in that format which can be misinterpreted and incomplete because the interview is limited in time and limited by the approach the talk show host uses to ask questions. Therefore the one interviewed may be limited in the ability to fully and properly convey his or her information to the public. How should information by conveyed to the public? In a written article on hardcopy or on the internet. Also, another medium would be a half or one hour presentation on TV such as "Frontline" where issues can be detailed and carefully explained to the public. Even threads like on this blog would cover more aspects of an issue for the public than a 10 minute talk show interview.

Part of the reason by the high cost of medical care including the costs of drugs and the premature and erroneous spreading of medical news to the public is due to the frequent one or two minute medical snippets presented on TV news and then the public's hasty reactions.

No.. leave me out of any talk show interviews. ..Maurice.

At Saturday, May 02, 2009 6:58:00 PM, Anonymous Anonymous said...

Phil Z.
I hear exactly what you're saying. I've been a bit of a rebel throughout my life with the gender issue in medical ethics, even before I understood what ethics are. I have always avoided medical "care" for that reason and have been very lucky so far.

After researching the subject here and on Dr. Joel's blog and reading so many experiences I'm ready to get some much needed exams done and now I know what I have to say in order to stick up for my rights. In an emergency or if I had obvious health problems I couldn't avoid having addressed I would have always fought tooth and nail and would never have allowed any female to invade my modesty, but I never imagined what might have happened when I did. I always thought that EVERYBODY would have argued with me and called me a fool but it wouldn't have changed my mind.

Now that you and I know we are not alone we have an argument that some medical professionals might pay attention to.

If I were in the situation you described, I NEVER would have let it happen and would DEFINITELY have told everyone in that perverted office what I thought about them. But that's me, and I haven't met many people that will endanger their life for their principles like I would have done. I would have been crazy, but I still would have done it. You most likely weren't ready to put your life on the line, so there is no shame in what you and seemingly what most other guys would have done as far as I'm concerned.

But now you know. Now you can make sure that injustice never happens again. Now you know what to expect and what to ask before they have a chance to get their cruddy hands on you. If one office still follows those barbaric procedures you can go on to the next. With enough guys like you that care enough about their modesty, dignity and morality beginning to defend themselves, things will HAVE to change. Great job Phil.

What's really pathetic is that I have never been forced into that indignity you've faced, yet I stay up all night letting other guys' bad experiences keep me from sleeping. All I can think is, HOW DARE THEY DO THAT? Thanks for reading all the way through my rant guys. Phil, you know now that you're not alone.


At Saturday, May 02, 2009 8:01:00 PM, Anonymous Anonymous said...

AD, many men can avoid invasive exams until they're middle aged (most not all) but women are pressured from their teens. Once they need birth control, they get the lot and it's almost impossible to avoid.
My BF has had a vasectomy.
My BF has two kids from a previous relationship and we've decided not to have more kids.
I consider myself one of the lucky ones...I can avoid doctors like most men.
I have no problem seeing a Dr when I'm sick or for general checks...but I don't wish to have "just in case"..."to be on the safe side" checks.
I have a doctor who accepts my views....if however, I needed birth control, the power would rest with her.
When did the doctor/patient relationship become a power struggle?
I read that article and strongly disapprove of the language used to describe the male one poster said, "very disrespectful"...I also hate the way doctors speak down to patronizing...why do they all do that? Is it another tactic to scare us or does it make it easier to treat us dispassionately...dealing with bodies, numbers and guidelines rather than people.

At Saturday, May 02, 2009 8:42:00 PM, Blogger Maurice Bernstein, M.D. said...

GH, you write "I also hate the way doctors speak down to patronizing...why do they all do that?" I don't and I am aware of how I talk to my patients. I am sensitized to this kind of talk and watch my medical students carefully to pick up any sign of patronizing communication with their patients. Actually, for these students, as I think I have noted previously, they are hesitant about lecturing and not as likely to speak that way to patients.

You will find that if a doctor has a very limited time to communicate with a patient (10-15 minutes to do everything), the doctor will speak giving advice, expecting to be understood but not waiting for the patient to respond or question the doctor. This can produce what the patient may interpret as a "talking down" patronizing attitude. It's all part of the system within which the doctor and patient are participating. ..Maurice.

At Saturday, May 02, 2009 8:44:00 PM, Anonymous Anonymous said...

Previously I mentioned the story of
8 employees at University Medical
center tucson arizona taking innappropriate cellphone pics of a
patient. TT has mentioned that 4
of those 8 employees have been
Apparently, the tucson police
dept adult sexual assault unit is
investigating as well. Here is the
site that the story can be found.
Whats disturbing to me is that this happens more to patients than people realize. In my state this is
the fourth time this has happened
that I know of in two years. Keep
in mind that often it occurs without the perps getting caught.
Now extrapolate that occurrence out to every hospital in the nation
and one can realize the extent of
this problem. I recently learned
that emt's and ambulance drivers
frequently take numerous cellphone
pics for their own personal use of
severe auto accidents that display
mangled and gruesome bodies.
These unfortunate victims become
patients once an ambulance arrives
at the scene and is no different
than if the photos were taken innappropriately at the hospital.
A trauma nurse recently told me
that some emt's have thick scrapbooks filled with pics that they proudly display at parties and so fourth. Now for a moment
consider that you work say perhaps
for animal control.For the sake of making my point say that you drive
around looking for road kill of
I'd consider it gruesome and
certainly Jeffery Dahmer like if
one took pics of dead carcasses and kept them in a scrapbook. Ever
notice that many uniforms of emt's
resemble more of a paramilitary
uniform than a healthcare worker.
Oddly thus far all innappropriate
cellphone pics taken at hospitals
in the last 2 years here were the
genitals of male patients. Is this
becoming a trend and just something
that only male patients risk when
becoming a patient at a hospital?
Do many health care workers
simply enjoy the means and the technology with the advent of cellphone cameras to invade the privacy of patients even more so now than say 20,30 years ago.


At Saturday, May 02, 2009 9:13:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, taking those pictures without the patient's or surrogates approval would be against the federal HIPAA rules and could subject the employees and their employers to penalties. As long as a therapeutic relationship has developed between the patient and the EMTs, the pictures, used for personal interest, would be against medical privacy laws in contrast to a news photographer who might be free to take a picture of an accident scene in a public place. ..Maurice.

At Saturday, May 02, 2009 9:34:00 PM, Anonymous Nellie said...

PT, we had a very bad case in Australia last year.
Most male doctors don't use chaperones here.
We had a male dermatologist arrested after several female patients made complaints to the Police. The police also raided the Medical Board.
This man had lots of naked photos of female patients on his phone. He told the patients he was taking photos of their moles.
He was convicted of the digital rape and sexual assault of several patients.
How often are women told not to be silly, male doctors wouldn't study for years just to abuse them...and then you hear shocking things like this...and sadly, it's not a rare thing.
We've had some horrible cases down here. It doesn't affect me as I only see female doctors.
Naturally, these cases outrage me as they do everyone - a man taking advantage of his trusted role as physician.
You may like to read the following about Dr Kevin Tong

Like the other posters, I refuse cancer screening as well. My brother is a pathologist and gave me information to hand to my doctor.
If you're prepared, doctors have to accept you have the right to refuse cancer screening. I've never been refused contraception, to hear that happens, shocked and surprised me. The evidence against mammograms is very frightening - they may actually CAUSE breast cancer.
I hope you can change the "system"'s unfair to push any healthy person into tests that carry risks...particularly when doctors conveniently forget to mention the risks.
I shopped around and have a young female doctor...she's a gentle and kind woman....she doesn't speak down to me. I know what you're saying though, most doctors shop around.
Maybe, younger doctors are more aware because of a greater emphasis on communication and sensitivity in medical schools today. Dr, did you get this instruction when you trained? Do some doctors forget about it when power goes to the head?

At Sunday, May 03, 2009 10:34:00 AM, Anonymous Anonymous said...

Dr Orrange posted her view of the women’s health versus men’s health double standard.

She only addresses the gender double standard from a medical study/research/funding point of view and doesn’t think men’s issues are underrepresented. The modesty issue many men feel when dealing with an overly female healthcare system is not addressed at all. It simply doesn’t occur to her that many men may have the exact same reasons women have in seeking same gender intimate medical care. Is she clueless or is this deliberate based on the genderless doctor world view?


At Sunday, May 03, 2009 10:37:00 AM, Anonymous Anonymous said...


The number one leading cause
of childhood leukemia is background
radiation. Background radiation is
environmentally produced such as from concrete,the foods you eat and
the air you breath. Were being bombarded with it from distant stars and our own star,the sun.
If you are on a jetliner you
are bombarded even more and its
cumulative. Yes mammograms can cause cancer although the new mammogram x-ray machines have mostly been switched over to what
is called xeromammography which
delivers an even lower radiation
There is something in biological radiation physics called the threshold dose. This is
a dose low enough that causes no
biological response. This is what
mammography has sought to achive
while acquiring state of the art
There are risks in driving to the convenience store and when a
physician requests a mammogram those risks are weighed, of having cancer. Of course it is projected that I believe one in 1.8 million patients will acquire cancer from a mammogram.
The data is currently inclusive though and perhaps background radiation and genetics
plays a big part in these statistics. If you are concerned
about acquiring cancer from a mammogram consider BSE (breast self-exam) and/or an MRI. An
MRI scan is actually better at finding cancer than a mammogram
although much more expensive.
Since you brough up this
subject what similar procedure in
imaging technology is there present
for the prostate. If you guessed
none you are correct. Men get cancer too yet there is very little
fanfare about that affliction.
There is breast cancer awareness month, breast cancer walks. The susan G.komen breast cancer foundation and on and on. Do you know what awareness exists for prostate cancer. I've seen or heard only one comment all month
and that was from a Dr. Orange in Santa Monica Ca.
She wants to stick a finger
in my butt. That is very encouraging news for me to say the least.


At Sunday, May 03, 2009 11:36:00 AM, Anonymous Anonymous said...

Dr. Bernstein, I said that they might want you to go into a talkshow, not that I think you should.


At Sunday, May 03, 2009 3:11:00 PM, Blogger Maurice Bernstein, M.D. said...

I guess it's time again to go on to a new Volume.



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