"Things I Don't Want to Tell My Doctor and Things My Doctor Shouldn't Have Asked!"
A visitor to my thread on patient bodily modesty wrote in part the following:
"..a few months ago my male doctor brought up my periods. He was completely comfortable talking about it but I wasn't. I wasn't blushing embarrassed, but would I have preferred to talk to a female doctor about it. I'm not saying he has to experience it to know about it, but to me it is a sort of female camaraderie issue. It's hard to explain, but it really feels like an intrusion of my privacy when a doctor brings up something personal that I did not plan on discussing.
LH"
With the title of this thread and the introductory comment as stimulus to discussion, let's see what my visitors think and say about the subject.
By the way, I hope my visitors will take no offense to the above graphic. It was to communicate a visual point and in no way did I intend to imply or picture a patient as a monkey. Even monkeys may have modesty issues too. Whenever I see a monkey on a TV show, I see them in diapers!
..Maurice.
posted by Maurice Bernstein, M.D. @ 9:06:00 PM
11 comments
11 Comments:
Hi, I've been reading your blog for the past couple months, but this is the first time I've posted anything. My name is Alex, and I am a physician-in-training with a Masters in Bioethics.
The quote, to me, reflects how different the sides of the doctor-patient relationship can be. For me, asking about a patient's periods, while perhaps initially embarrassing, is an essential part of taking an appropriate history. A physician cannot properly care for a female patient if he or she doesn't know about certain aspects of her period. For example, if a patient has particularly heavy periods, a physician may be motivated to check the patient's blood levels and iron.
I wonder what the age of the person who posted this is, and if that has any effect on our discussion. From my experiences, most women know that they will be asked about their periods by almost every doctor. I was surprised to read that something that seemed so routine to me was disturbing to a patient. I'm also confused how the sex of the physician plays in to her reaction. The physician isn't asking questions to empathize with the patient about her periods, but to gain important clinical information. If the poster is still reading, I would be curious to know what exactly she means by it being a "female camaraderie issue."
However, I think this illustrates an important point that physicians often miss, and that's making sure patients are comfortable with divulging private information. Some physicians can tell, by small gestures and voice tone, when patients are uncomfortable, but some are less perceptive in that realm. In this case and other similar cases, it's appropriate for the physician to express what kind of questions he or she will ask, why it's important to the visit, and ask permission to continue with the interview. In practice, I think this is more often done with sexual history and other more intimate aspects. Physicians, for the most part, view periods as a normal body function that needs to be asked about, just as with bowel movements and urination. Because of this, I doubt there are many physicians who ask permission to discuss periods in the same way they ask permission for a sexual history.
I think it is critical for a ptient to be completely open and honest with their physician for there to be a constructive and positive patient-physician relationship. Both sides need to be able to overcome private biases or beliefs for this relationship to work. What if a white supremacist patient asked to only speak to a white doctor? One has the ability to choose their physician in elective situations for the most part, but in emergencies they "give up" this luxury, and they must decide before seeking care whether or not they are willing to give this right up. If they feel somehow uncomfortable in the relationship a mutually acceptable solution should be sought. To withhold "uncomfortable" information sets up the relationship for ultimate failure in my opinion.
Oh, please if I hear one more time the equation of patients seeking a doctor of the same sex or (in my case) comfort with a doctor in my age bracket, with "what's next, racist patients demanding white doctors?" I'm going to scream. That reply is just a sham tactic with the intent to taint the opposing side of this argument with the smear of bigotry.
As for the patient's story as presented in the thread,
I feel she has a right to request a same sex doctor if available with the simple explanation of comfort level issues. If the doctor of choice isn't available, then the burdon is on the patient to seek care elsewhere. And if the patient's insurance doesn't provide the luxury of facility selection, well, that's a dilemma the patient will have to work out for themselves.
Not everyone trusts doctors!
Alex brings up a disturbing point; doctors are trained to take (even demand) a complete history from a patient without bothering to find out if a patient wants a doctor to have their complete history.
The example of asking about a patient's menstrual cycle in order to find out if there may be an iron deficiency leaves out the part about the patient perhaps not having any wish to know about or treat an iron deficiency.
Not everyone believes that prophylactic health care is in their best interest. I personally choose to avoid screening tests unless I am showing symptoms. Even then, I may choose to avoid the screening simply because I find the nosy questions and embarassing tests to be more uncomfortable than the condition could ever be. This is my choice.
When I do see a doctor, they sometimes display irritation or seem to be insulted that I choose this route. The last time I went to a walk-in center for a weekend bout of Bronchitis, the doctor wanted to know if I'm having my 'annuals' or if I have had my eyes checked lately. I tell them that I'm not there for an 'annual' or an eye exam. This was met with annoyance, as though I was out of line to put up a personal boundary.
I don't know why it bothers them. It's my body, and my history. It isn't their business to hold me to their standards of what they consider to be healthy. It's their business to help me to treat or manage whatever condition/illness that I choose to treat/manage.
If I come in because I have brohchitis, I won't answer any questions about my cycle or sex life. I didn't ask the doctor to become custodian of my health. All that I ask is for a prescription to allow me to buy a bottle of antibiotic capsules to treat bronchitis.
If you would like to offer me more services, offer me more services, but don't start asking for my history without finding out if I even want services that would make the extra questions pertinent.
A patient is still an individual with the right to be treated with dignity. A need for medication does not equal checking my right to privacy at the door.
Suzy
Suzy, all I can say is that there are a number of questions a thoughtful physician can ask which are pertinent to evaluating your symptom, some of which you would never understand the connection unless you were trained as a doctor. Most doctors, I think, feel that these questions are standard and usually not of an unusually personally sensitive nature and therefore they will ask the question without going into a discussion with each question as to the rationale why it was asked. Some questions, such as dealing with sexual activity and are sensitive will usually be preceeded with some explanation. It should be emphasized that establishing a diagnosis is most often related to taking a complete history and usually the physical exam and even lab tests are of lesser importance for most diseases. If a patient is concerned about the significance of a question, my advise is "just ask". If the doctor is considerate beyond being thoughtful, you should get an informative answer without any sign of annoyance. ..Maurice.
Hello, Maurice. Nice to hear from you.
Case in point: every time I go to a new doctor, and I mean every single time, there is a check box on the form asking if I am married, single, divorced, separated, or widowed.
Evaluating my bronchitis cannot possibly be linked to marital status. One doctor told me it was to 'gauge stress levels'. You can't gauge stress levels from marital status! It varies according to the situation at hand; being stuck in a miserable marriage might be more stressful than being happily single. Someone widowed for 20 years may have less stress than the joyfully divorced.
Suzy
i could not agree more with the idea of a relationship between patient and doctor be a completely honest one, ON BOTH SIDES. however,i would like to add two related questions. the first is when, after examination, physician then recommends the patient needs to have a procedure having the potential of being both terribly uncomfortable and embarrassing. assuming that physician feels very strongly that if he makes the patient aware of this he may refuse to have it done, WHAT AND HOW MUCH do you tell your patient? if the procedure is, say urinary catheterization and the patient is scared and anxious, and he requests to be sedated where he would be unaware what is happening, again what do you tell your patient, especially if sedation for this is very rarely, if ever done and patient will refuse if you do not agree? secondly, a lot has been written on medical blogs about consent and in what instances patients may forfeit this right? the medical staff in a trauma situation, can override patient objections and treat accordingly, if they feel this is necessary. while i cannot quarrel with this, it still creates the possibility of the patient ending up intubated on a ventilator, nasogastric tube through his nose, and a catheter in his bladder, all terribly uncomfortable procedures, even if they are necessary. the patient has lost control of his world. surely there have been investigations and studies done to see if this complete loss of control and the fear of it reoccuring, has any effect upon the willingness of the patient to seek medical care in the future? thank you very much. please continue these blogs as they are very educational and informative.
I don't know if this blog is still active or if anyone may ever read this, but here goes:
In my experience with medical visits (countless) I have learned one fact that is undeniable; Doctors are more interested in protecting themselves from mal-practice suits than acknowledging patient concerns, patient privacy, or actually helping their patients.
Doctors have become egotistical, controlling, insensitive and uncaring. It is really sad, but our medical system has completely disintegrated over the last 20 years.
Doctors and Doctors-in-training need to realize that, despite their desire for it not ot be true, THE PATIENT IS THE BOSS!!! They are paying your salary and without them, you would be selling burgers at McDonalds.
If a patient does not wish to discuss an issue, tell them why you need to know. If they still don't want to discuss it - move on to the next question.
Seems simple to me - but seems to be to complicated for the highly educated Doctors.
CS
CS, thanks for your comment. By the way, since visitors come to my blog mainly from a Google Search or other search engines looking for a specific word or topic, most all of my currently 700 threads periodically get reviewed by a visitor despite whether they were written first in 2004 or later. ..Maurice.
Here is my point the patient every right to see the same sex doctor. Regardless!!! Not the insurance job maybe however the patient does have that right. Understanding the doctor side, there is moral and values issue here. I am a male and totally agree with suzy.
I don't choose a doctor based on age, race or sex, but a surname that is familiar and pronouncable is important to me. I have difficulty understanding an Arabic accent, and many doctors in my area seem to be ESL.
The sexual history questions are invasive and unnecessary. Periods? Sure, ask, but it would be much easier to asked if I am interested in HIV/STI testing, than to try an acertain my 'sexual history'. Questions about previous pregnancies and abortions are medical. Questions related to my relationships are none of Your business!
Post a Comment
<< Home