Bioethics Discussion Blog: Patient Modesty: Volume 16

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Sunday, May 03, 2009

Patient Modesty: Volume 16



NOTICE: AS OF TODAY MAY 13 2009 "PATIENT MODESTY: VOLUME 16" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 17.


With more women contributors to these threads, the women have expressed their concerns about modesty issues related to excessive and presumed unnecessary pelvic exams and pap smears. The men continue the discussion of their own modesty concerns which appear to be ignored by physicians. And the conversations go on.. ..Maurice.



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 of a pelvic exam on a woman circa 1896 (from Wikipedia)and, of course, modified by me using ArtRage and Picasa 3.

134 Comments:

At Sunday, May 03, 2009 5:36:00 PM, Anonymous Anonymous said...

Phil Z I had an testicular ultra sound for a lump I found. I went in and had a female tech, it was very embaressing but I assumed there was no choice. Imagine my outrage when I was signing my paper work afterward and I heard the very same female sonagram tell the woman waiting for hers, I am going on break for a few minutes so the only tech on right now is a male, so if you would rather have a woman do your procedure I will be back in about 10-15 minute...I was stunned, I stared at her she just smiled and walked by. Like you I was furious, at her, at the faclity, and myself. That incident led me to this and Dr. Shermans site...after reading these I knew I had to do something if for no other reason..for myself. I wrote the patient advocate, when I didn't get an answer I wrote to the advocate and cc'd the patient services chairwoman, the head of the department, and to the administrative office and CFO. I think the fact that it crossed departments got some attention. That encouraged me to take more control of my health care. Don't just dwell on it, it will eat you up and cause you to avoid care... sit down, and start with the patient adcocate. If you don't get an answer go up the line and be sure to go to the administration, they pay the bills, if they think it will cost them business they will take it up with the providers who may be using the past of least resistance. You will be amazed at how much better you will feel. Please give this a shot and let us know how it goes.

GH men do not get to pick and choose as you may think. I have had mandatory exams for life insurance, employment, for CDL's, I have had mandatory drug screening, and in every case female nurses have been involved. And when we do need care, you can bet we will have little to no choice as to the gender of the support staff. You mentioned your doctor and said "she", now imagine if she had male staff assisting her. Not trying to downplay what you are feeling...but don't think males have it easy, atleast in most cases you have the ability to have same gender providers and support staff...

I think perhaps the most troubling thing about Dr. Orange'spost is she does seem to care about her patients. The fact that she appears to be someone who has concern and is so oblivious to how inappropriate her post was is very telling. The fact that she felt comfortable using balls, stick a finger up your but, and boner is very telling. The fact that if a male doctor talked about a pelvic exam in the same way he would be roasted regardless of his reasons or intent. The fact that she doesn't see an issue here makes it apparent she doesn't see how males feel regarding this. I tried to post but for some reason could not. Hopefully others here will try to point out her error, if nothing else those going to the site will see this side of it.............It is really important that we respond. Givem she is an assistant professor at USC if we could make her rethink or even think about male modesty...it could impact numerous other future providers...please post a response to her blog...alan

 
At Sunday, May 03, 2009 6:10:00 PM, Anonymous Nellie said...

PT, thanks, the new research shows women having regular mammograms have more breast cancer. My reading suggests it's either the radiation or the squashing of breast tissue or both...
I've read that BSE is not a good thing, it often leads to biopsies for nothing.
I recently read being 'breast aware' is better, just taking note of shape and changes while showering etc...
I'll have to think about MRI, though I'm reluctant to put my hand up for these things.
My grandmothers rarely saw doctors and lived into their 80's....long, healthy lives...not having tests and exams every year or two when they were healthy. In some ways, looking for problems when a person is symptom-free and happy seems to be approaching it the wrong way...why fix it when it's not broken...it just seems to cause more harm than good for the majority of people.
I agree that men's health has been overlooked for years....I must confess though, I thought men were fortunate to escape all the unwelcome probes, useless biopsies and pressure to agree to risky screening. It was like the bully in the playground had overlooked you.
I think men need to be careful or you'll face all the same problems - healthy people being processed and left injured...
I read a very scary report on prostate screening recently. The new blood test is apparently, unreliable and may lead to biopsies. The prostate is deep inside the body and difficult to access, so it's risky. Healthy men have been left incontinent and impotent. There is even a risk of death (not sure how) I suppose puncturing something vital...
Dr McCartney & Michael Fitzpatrick, Scottish GP's are very concerned about PSA screening and it's risks.(& other screening programs as well) Once again, the criticism is that men are not being given all the information....sound familiar ladies!

 
At Sunday, May 03, 2009 9:12:00 PM, Blogger MER said...

As most of you may realize, I'm very interested in the history of medicine, especially in the U.S. All doctors get some background here, but most don't know a lot about it. That's okay. There's so much to learn in medicine, I'd rather they spend their time on the technical knowledge they need to do their jobs. But, perhaps a physician like Dr. Bernstein could put together a course for doctors that focuses specifically on what doctors can learn from not only the triumphs of medicine, but also from its mistakes.

As an example -- I want to tell a story from the history of medicine that shows how dangerous gender stereotypes can be. This story is from a fascinating book called "The Lobotomist" by Jack el-hai. The subtitle is: "A maverick medical genius and his tragic quest to rid the world of mental illness." I recommend it.

It was Walter Freeman, M.D. who saw lobotomies as a solution to mental illness. Some patients actually believed their lobotomies helped them. For many others, though, the procedure was tragic.

But how does gender fit into this? From page 290 of the book:

"Freeman avoided operating on patients incarcerated in prison, but he seemed drawn to female patients. From the late 1940's through the introduciton of antipsychotic medication in 1954, men slightly outnumbered women in the state hospital systems. Yet female patients constituted about 60 percent of those who underwent psychosurgery -- and an even higher percentage of patients who were operated on with transorbital labotomy."

That's interesting enough, but the why is even more interesting:

"Two factors contributed to the gender disparity: a feeling within the psychiatric profession that it was easier to return women to a life at home than it was to rehabilitate men for a career as a wage-earner, and, most importantly, the abundance of women with diagnoses of the affective illness considered most responsive to labotomy."

Now, one wonders how that last factor, that women would be most responsive to lobatomy, was influenced by the then worldview (we might call it a stereotype) that women belonged in the home not in the workforce.

Someone else on this thread brought up other examples of gender differences and how they can affect diagnoses. Some of the women on this thread have told stories and expressed opinions that gender stereotypes affected how they were treated.

Although this is a broad topic, the way men are sometimes treated psychologically regarding their modesty (and women, too), is an example of the kind of blindness that can happen when medical professionals are not able to stand outside of their worldview, their biases, and examine the power of empathy and getting into other points of view.

 
At Sunday, May 03, 2009 10:08:00 PM, Anonymous Anonymous said...

DrOrrange has responded..you need to go to the homepage of daily strength and click on the new article ..
I can not believe that an assistant professor...could be so dense...I would never allow her to attend a member of my family...and certainly not me....she obviously never listens to her patients either..she hears what she wants an dinterprets in wierd ways....all she thinks we want is more mens health centers to deal with prostate troubles and mens health to be a specialty like cardiology.
Dr Bernstein, no wonder you have had such a hard road along with Dr Sherman...your fellow practitoners seem to have selective hearing and one track minds....I am having to leave a lot unsaid because I am at a loss as how to say it without going ad hominem...incredulous best describes my first reaction..frustration came on pretty quick....
leemac

 
At Sunday, May 03, 2009 10:28:00 PM, Anonymous Anonymous said...

One hard lesson that I’ve learned while reading through these posts and reading some of the history of medicine is that there was nothing honorable or respectful about how medicine has got to this point. Did everyone notice the picture above? Could we all really accept this being done to our spouse or daughters? I can’t understand why we gave up respect and dignity for this type of treatment. I may be one of the few on this earth but I can tell all of you that I would suffer and die before anything close to that would ever happen to me. Perhaps Dr.Bernstein could reply but does any modesty/privacy issues come into factor when they created the exams and machines used for diagnostic purposes? Another question I think we could all ask is whether or not medicine is built on any morals at all? From the outside, I’d say NO…Jimmy

 
At Monday, May 04, 2009 5:46:00 AM, Blogger Pickledeel said...

Modesty in the military is an oxymoron is it not? Goes hand in hand with military intelligence etc etc. You can only laugh - in a pre op to have a vasectomy in a naval hospital the bearded male nurse asking if he should shave me or if I wanted to do it (I was so doped up I couldn't hold the razor even it I wanted to) was disconcerting. That was, until I got into the operation itself when the ward sister, a female, spent the next ten minutes running off every male genital joke I had ever heard, and then some, while she tightened clamps and inserted needles that felt like No8 wire. I was number 7 in a queue of 12, and no, modesty was not a high priority at all. But they had just enough drugs in us to hear and see what was going on but enough for us not to care about what was going on!

 
At Monday, May 04, 2009 7:57:00 AM, Anonymous Anonymous said...

Medical care often feels like a form of extortion. If you want to get well, you have to go along with whatever indignities it entails, and you aren't really given any choice.

I was in my 30s when I had radiation to the neck and chest for Hodgkins lymphoma. You are not allowed to wear a gown for the therapy; the treatment is delivered to bare skin. You don't like being exposed that way? Tough; if you don't want to die, you have to submit to it. The techs wouldn't even step out of the room while I was taking off my blouse and bra and positioning myself on the treatment table.

They also took photos to document. They never explained their reasoning, nor did they ask permission. I cannot think of one single reason why they would need a photo of my naked chest, nor why they would need my mug shot. Surely the extent of the treatment field is documented in the record? Those pictures are still in my chart somewhere. Lord only knows who else has had access to them over the years.

Of course I am grateful for the medical care that enabled me to stay alive. But there were many times when I deeply resented some of the things that were done to me. There is an attitude that patients should just shut up and be appreciative for their care, and it makes it very hard for health care providers to understand how coercive this can be.

- PJ

 
At Monday, May 04, 2009 8:18:00 AM, Blogger Maurice Bernstein, M.D. said...

On reading Dr. Orrange's recent response (May 2), it seems that she still isn't covering the issue of potential inequality in healthcare provider gender selection by the patient--women getting a better chance to get what they want. As I understand the issues from all of the posting here, the concern of the men is not that they need a "men's clinic" to attend to the disorders confined to men but what they need is a choice in selection of gender related to their own modesty feelings. And, that I think is the issue that Dr. Orrange is missing and which I have repeatedly said has been missing in virtually all physicians except Joel and myself and those doctors who might read our blogs or those doctors whose patients (more than one) actually spoke up to their doctor. Right? ..Maurice.

 
At Monday, May 04, 2009 8:57:00 AM, Anonymous Anonymous said...

In response to your question on May4..at 8:18, Dr. Berstein, YES, that is exactly what she seems to be unable to wrap her mind around...she dodged the issue and did not even come close to it.
leemac

 
At Monday, May 04, 2009 11:14:00 AM, Blogger MER said...

I think some doctors, male and female alike, feel threatened by this gender choice issue. They're afraid they may loose business or patients if people have a choice. To some extent, that may be true. We've already noted on this blog that law in Sweden, I think, that doesn't allow women to choose the gender of their doctor for intimate exams. Too many male doctors were losing female patients.

The other issue is business. These private medical clinics, (and some doctors in private practice) are businesses, and some of them are doing quite well financially.

I noticed this a few years ago when I called a clinic to find out about the extra staff who would be working with the doctor. All females. The receptionist was not empathetic to a male wanting a male to assist the doctor. The message I got was that we don't really need your business. We're doing well enough without you. So...I wrote a letter to the doctor/owners of the clinic stating my case. I quickly got a call back from the receptionist urging me to make an appointment. No mention of my letter or the or the modesty issue.

Later, at the appointment, when I talked with the doctor about my letter and this issue, he was very defensive. Basically, he said that he was doing well enough financially without having to deal with this issue. The impression I got was that, the only reason he dealt with me was because I had put this whole issue into writing. That, apparently, felt like a threat to his practice if others found out about the way he handeled things. That's why it's important that, at some point in our quest, we put things in writing.

My point -- Physicians like Dr. Orange have no incentive to change their ways. Their practice is doing well. Their male patients either don't mind the exposure or are not willing to bring the issue up. Most likely, she has found the right patients for her, and the patients have found the right doctor for them. And she just doesn't need any more business. She can pick and choose her clients.

There's more competition out there now and that will continue to be an issue. But there are still many private practices and clinics that have no financial incentive to change their ways.

 
At Monday, May 04, 2009 12:06:00 PM, Anonymous Anonymous said...

MER...I suspect your iea about finances is correct...The difference with Dr Orrange is the type of blog site she writes to and her position in a university...this takes it beyond her private practice and makes her responsible for her public comments and commentaries...because it is not her patients she is addressing, but the public at large. This and the students she influences is cause for her to actions to be more measured and balanced...Dr Orrange is the poster child for the doctors that Doctors Bernstein and Sherman have had such a time getting to even acknowledge there is such a thing as male modesty.It seems arrogance, indifference, and possibly fear rule their lives...as much as the money does.
leemac

 
At Monday, May 04, 2009 4:56:00 PM, Anonymous Anonymous said...

A law professor once said " if 90%
of all people treat others with
respect attorneys would be out of
business." Since the individual on dailystrength has little or no respect for men then I'll show her
no respect.
It seems to me at least that considering her particular usage of words that would seem a violation of that sites "terms
and conditions". Arrogrance sooner
or later will get you in trouble
and I'll be interested to see
what USC has to say regarding her
comments. She represents that
institution and as Leemac mentioned, she is addressing the
public at large.


PT

 
At Monday, May 04, 2009 5:08:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, let's be careful in our expressions interpreting the words of another. I think the word "arrogance" is unwarranted with the information we have available. However, I would use the word "ignorance" as the most appropriate and then follow the word with "about the gender modesty concerns of a number of male patients." I see nothing in her comments except for her "man-ish" wordings in her original posting (which I thought was inappropriate and unnecessary) which I would consider out of standards of medical advice that any department of the USC School of Medicine would consider appropriate.

I think that everyone writing to the public on blogs or websites should be particularly careful of how language is used and whether one can formally defend the way it was used. ..Maurice.

 
At Monday, May 04, 2009 7:13:00 PM, Anonymous Kathy said...

I think male gyn's are very worried...they are terribly defensive if women say they won't see male doctors.
Someone mentioned the ObGyn.net website - there are a few discussions on that site between male doctors about women increasingly asking for female doctors. They seem to think it's discrimination for clinics and hospitals to hire females to meet this demand. The also mention the top male graduates that can't get jobs.
I don't see that changing - if you don't think you can make a good living in a certain field, it might be smarter to look at something else. Forcing your services on women is not the answer. One male doctor says he can make a living when women have no choice of doctor like the military and emergencies.
What an attitude!
I know that there is absolutely no way I'd see a male doctor for an invasive exam - I wouldn't attend...
I went to the emergency room with abdominal pain last year and said I wanted a female doctor. I was told the Dr on duty was male and then the male nurse walked away from the counter. The matter was apparently closed.
I called after him that I wanted to speak to someone senior.
Surprise, surprise, they found a female specialist.
The female was VERY busy while the male seemed to have very little to do...I was asked several times whether I was sick of waiting and that the male gyn could see me immediately.
The answer seems clear to me - employ two female gyn's. If the female gyn is rushed off her feet and the male has time on his hands, is it fair to anyone?
Why try to force women to see the available male gyn?
I waited 2 hours to see the female gyn even though I was in pain.
Women are finally making it clear that we're not requesting "if it's fine with them and convenient" - it's not a preference...many women WILL NOT see male doctors for some things.
Male doctors can complain about these changes and that in the past we had no option but to see them and take whatever care was dished out and suffer the extra embarrassment....those days are over, we now have a choice and that's a huge relief for many women.
Even my grandmother sees a female doctor - she has some horrible stories about male doctors from her young years - she loves her young female doctor.
At the end of every consult. she says to her, "Thank you for studying medicine and giving women a choice of doctor"...
I think many women feel the same way.
I can't imagine having no choice of Dr...I too thank the pioneering women who changed all of that for us.
I will also refuse any invasive exams I consider are unnecessary. I agree we're over screened and over tested and that it's harmful.
I should add...men should also have choice of doctor and nurse.
We need to keep reminding the medical profession that we have voices and will reject services that don't meet our needs.

 
At Monday, May 04, 2009 7:23:00 PM, Anonymous Monica said...

There is a group of women that meet in the States that are trying to end routine pelvic exams and the joining of cancer screening and other exams to birth control patients.
I heard about them last year from a US colleague. I have no idea whether they're having any success or whether it's just a support group.
I wasn't surprised to read a much earlier post about US women getting their health care overseas to avoid these barriers to birth control. I also work in Asia and my US workmates all see Asian doctors to access birth control.
It does seem surprising that the current system is unsatisfactory to many US women...but the profession is not responding to that...
These exams are not performed in the UK...I doubt you could argue that our doctors are all ignorant, out dated or careless. When it seems the vast majority of doctors don't regard these exams as necessary, how can US doctors regard them as so important that they stop women getting BC until they have them?
Seems a shaky position to me, one that should be easily broken down if you take a group approach...rather than individuals complaining or getting their health care overseas. You must have womens health groups in the States that take a proactive approach.

 
At Monday, May 04, 2009 8:16:00 PM, Anonymous Anonymous said...

Dr B

If you read the last line of her post, she wants to keep us on a leash. To me that is arrogrance!

PT

 
At Monday, May 04, 2009 8:42:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, Dr. Orrange wrote: "You think we will pick on you for your habits. Drinking a 12 pack on the weekends, not exercising and eating bad foods, among other things. These things are not as uncommon as you might expect. We will put you on a long leash and let you pick and choose the habits to get rid of as needed."

I don't find that in the context this was written that Dr. Orrange was condescending nor arrogant. All patients are assumed to come to the physician for "guidance" with regard to the diagnosis and treatment of their symptoms. Guidance does represent some education and professional advice, so both men and women are necessarily "tied in" to their physicians. Now notice Dr. Orrange wrote about a "long leash" with regard to known harmful habits, meaning to me very little in the way of control of the patient's decision making regarding what to do about those habits. That, I think, is what she means--"make your own decisions about which habits you want to rid yourself from, I'm not going to be pressuring you." That doesn't sound too paternalistic to me. Sounds to be more tolerant of the patient to make their own decisions than arrogant in the sense that "only your doctor can direct you what to decide!" ..Maurice.

 
At Monday, May 04, 2009 8:54:00 PM, Anonymous Anonymous said...

Of course this all comes down to business and many physicians are doing well enough to not treat a few that may challenge their practice. And NO, I don’t have to submit to anything and just like a business; I can call around and find a facility that will treat me like a human being and not an animal. Once I get the treatment, I will then tell everyone I know within shouting distance what I experienced and it will end up costing those more in the long run not to treat me with what I believe is common human respect. I have actually tested this and loosing money even when they are doing well does get their attention, especially when you write down what they’ve lost. We had some problems at a facility last year that resulted in me canceling three tests that I had scheduled there, they all totaled out over $7000. I sent this figure to their CEO and was given a call the day they received my letter. I also made a few employees change their minds about having test done there as a result of my experience. They are still doing well, but they could’ve been $20,000 better off if they had done their jobs. And just for arguments sake, they do make clothing that is fire resistant, hospitals just choose not to give this option to patients based I guess on cost. Shows where their priorities are…Jimmy

 
At Monday, May 04, 2009 9:07:00 PM, Anonymous MC said...

I was offered a great job in the States last year. I noticed a pre-employment health assessment was necessary that included some scary and unfamiliar things. I showed the list to my Dr.
She said screening would not apply to virgins. I should just ask them to confirm I would not be required to have the test.
She also said to refuse the "bimanual" exam which are not carried out in this country.
The medical clinic responded to my email and said they follow the recommendations from the various medical societies and that screening was compulsory for all women 21 and over.
I decided to take up another position. I was asked about my change of mind by the man who would have been my new boss and I said the medical exam was unacceptable to me and my Dr.
He said they'd follow that up, but that many of these things are tied up in red tape by insurance companies following out of date and overly strict guidelines.
Anyway, I was disappointed I missed out on the States.

 
At Monday, May 04, 2009 10:49:00 PM, Anonymous Nina said...

I also needed treatment for Hodgkins and refused treatment by two male techs.
I wrote to the facility and female techs did my treatment.
It's often easier just to force techs on patients rather than change staff...but once a treatment is rejected, they usually find a way.
I'm sorry that added to the ordeal of your treatment.
All patient comfort needs should be considered. Exposure to the opposite sex just adds to your stress levels.
Sick people don't need THAT on top of everything else.
I wrote a letter of thanks to the hospital and mentioned my hope that this courtesy would be extended to other patients.

 
At Monday, May 04, 2009 10:54:00 PM, Anonymous Anonymous said...

Thank you Dr for this great forum.
I thought that I was the only woman on earth to reject cancer screening and routine gyn exams.
I'll sleep sounder knowing so many other women share my feelings.
It's difficult even to admit to other women you don't have these exams because so many have been completely comvinced these things are essential to your health.
I've read some of the Articles mentioned...thank you for some peace of mind.

 
At Tuesday, May 05, 2009 1:08:00 AM, Anonymous Anonymous said...

We looked at screening in one of my Uni subjects.
A satisfactory screening test must pass three tests...
a) the test must be acceptable to patients;
b) the test must be reliable;
and c) the cancer must be common or fairly common.
Cervical screening fails all three tests.
Other screening programs like breast fails two and PSA testing fails one.
The decision to implement these programs is often political - cervical screening was forced onto the agenda by feminists in the 1960's before the test was properly evaluated...

To justify these programs, they must result in a reduction in the number of people dying from the disease. This means with something like cervical screening where the test is unreliable, the cancer is not common and the test is unacceptable to many women...women must be pressured or forced into the program using strategies like paying doctors to reach screening targets, not releasing risk information, releasing misleading information and making it a prerequisite for something like contraception. (which catches lots of women) These measures were necessary due to the extreme invasiveness of the test and figures show that once women are no longer in need of contraception and can avoid screening, the screening numbers (in the older age groups) do fall.
Of course, doctors were aware that many women would have false positives and false negatives...one way of getting around unreliable results, is to test more often...to catch the false negative cases. The emphasis is on catching cancer and not containing harm to healthy women or freedom of choice by respecting the need for informed consent.
This means more women face colposcopies. The justification for this end result is that no one dies from a biopsy, so the collateral damage is necessary to get to the very small number who'll have cancer. Women may not die from biopsies, but they do suffer discomfort, stress, embarrassment, pain, injury to the cervix, sexual dysfunction and some will end up with serious damage to the cervix.

In this way, a reduction in death rates can be achieved...although those figures are often misleading because other factors are ignored...like the number of women who've had hysterectomies these days.
My problem with this approach is that it relies on keeping patients in the dark and to present a one-sided view - screening is always beneficial for the target population and downplay the dangers. It also means, finding ways, some may regard as unethical, to motivate women to have screening. The best patients are those who don't question and are accepting of biopsies for false positives.
It's clear to me, if patients were aware of the full facts, fewer would agree to screening and many of these strategies would have to be abandoned.
In the States, the approach has been taken to an extreme level with no consideration for the majority of women who'll face biopsies...
In a bid to catch as many cases of cancer as possible, American women will face more than 50 tests in their lifetime (some will have even more) and almost all will have biopsies. Extreme over testing in fact, results in the most damage to the healthy population, but doesn't catch that much more cancer. Other countries find a more comfortable medium...catch almost as much cancer without the huge number of biopsies.
I don't think this approach is ethical unless patients are aware of the risk of an incorrect result and it's consequences. Biopsy rates over a lifetime vary from country to country - from 55% up to the high 90's. (Finland & the Netherlands at one end and the States at the high end)
There has been some discussion over the last few years...should they tell women not to be alarmed by a positive test result? - that it's unlikely to be cancer. This has been resisted as it's feared giving women information about the unreliability of the test may deter women from accepting the test or may expose them to liability.
It's actually quite dangerous to come clean after damage has been done.
In the UK, buses display signs saying "One in 9 women will get breast cancer"...
In fact, the figure is closer to one in 65...the one in nine is based on women living into their 90's and is (many believe) an attempt to frighten women into presenting for mammograms by overstating the risk of cancer. This may be because more women are refusing breast screening and it can't easily be joined with another service to force compliance.
I find these sorts of measures totally unacceptable.
I made sure my wife read through my notes and I support her decision not to have cervical screening.

Matt

 
At Tuesday, May 05, 2009 2:26:00 AM, Anonymous Anonymous said...

I don’t remember if this has been discussed but why are procedures/practices so much different in other countries? One would assume that if something is working just as well if not better in other parts of the world that the powers that be would take notice and set the same guidelines. I don’t believe at all it is because of better doctors, maybe it’s revenue driven here and they don’t have the funds available overseas to do the battery of preventative test that we do here in the states? Even here in the states, there is a difference in how procedures/surgeries are done from facility to facility? Why is there not one uniform standard for all to adhere to? Would that not make cases easier to manage? Haas anyone else given this a thought? Jimmy

 
At Tuesday, May 05, 2009 7:52:00 AM, Anonymous Anonymous said...

I think one of the reasons for lack of uniformity..is the quest to find what method is best, Jimmy.
Because of the posts by the ladies here, I think that a patient/provider decision would be arrived at quickly..if lawyers and insurance companies have to stay out of it. Then only exams which work will survive...
The picture at the beginning of this volume.....really jolts ya. I wonder what the purpose of taking it was? I know it is over 100 years old and we can not interview the participants..It may have been state of the art then I guess...
AS treatment/diagnostic advances are made they tend to be implemented...but the "beside" and modesty issues still seem to lag behind...it is as though issues physical in nature are more easily adapted to, while matters of the emotions and mind...are more difficult.
leemac

 
At Tuesday, May 05, 2009 10:35:00 AM, Anonymous Mary said...

I have to comment on the disturbing photo heading this thread. In the "unedited" version (accessible thru Google images) the young woman appears totally naked, not just the part of her body necessary for the exam. The contraption that is positioning her, complete with metal leg locks, could have been designed by Dr. Mengele. She's given the same dignity as a restrained animal.

But I'm sure a hundred years from now, when our descendants look at today's medical images, our methods will be judged just as primitive and barbaric.

 
At Tuesday, May 05, 2009 10:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Mary, I too was impressed by the photograph as published in Wikipedia. I am not sure what was going on. If this was a routine pelvic exam only, there is no need for a nude patient and there is no need for the patient to be in such a inverted position. It looked to me that perhaps the vagina was being lavaged rather than examined. The photograph is clearly disturbing but I though fit the commentaries, particularly those about aggressive examinations of women, which have been written to these modesty threads. ..Maurice.

 
At Tuesday, May 05, 2009 4:52:00 PM, Anonymous Sam said...

Actually when my US classmates talked about these exams that seem to start at about 18...it sounded very similar to the photo at the top of the thread.
Stirrups, being naked under a paper sheet, every orifice examined, probed, scraped and tested and then possibly even more testing and treatment - freezing cells, burning off cells, cutting out cells, it seems there is always something to treat and eradicate...the description of the exam left me shocked and feeling sick.
I can't believe you put your young women through that...
I still can't quite believe it.
It also surprised me that these women are prepared to go for this treatment not once, but every year!....the "need" for these exams seems to have been passed down from their mothers and aunts.
They seem shocked and confused when I say it's not done at home and I would never allow someone to treat me in such a manner....EVER
They all hate the exams, but they seem to be in some internal turmoil convincing themselves they have to get over it for the sake of their health.
One friend said, "How do you know your ovaries and uterus are healthy?"...
I said that I assume I'm healthy until my body gives me a clue there may be a problem.
I also said, "How do you know your brain is fine?" "Is that being scanned and biopsied as well?"
The focus on breasts and reproductive organs is a bit creepy too - like that's all we amount to...don't they know that most of us die from heart disease...maybe there should be a greater emphasis on heart health and living a healthier lifestyle than slicing off pieces of cervix and doing breast biopsies. One of my 21 year old classmates has already had two breast biopsies and cells burnt off her cervix...
It seems to me you're destroying womanhood...physically and mentally. The amount of time and energy that goes into worrying about these exams and talking about them is VAST.
I've told them all...just forget about it and get on with your lives - have more faith in your healthy young bodies....stop concentrating on disease. My grandma doesn't live like that...yet women in the States live like that from their teens.
It makes no sense to this healthy young Aussie woman with her body, mind and dignity in great shape.

 
At Tuesday, May 05, 2009 5:32:00 PM, Anonymous Anonymous said...

Dr B

Wether it be a long leash or a short leash is irrevelant, its the
context in which it was used. The
assumption is that a leash is for
dogs and only dogs have balls in the slang that is.
Testicles are nowhere near round or spherical. Lets reverse the roles for the sake of my argument. Assuming she was a male physician referring to female
patients.
Lets use the word chains instead of a leash which then
conjures up slaves but be sure
to change the vocabulary to match
a female. If you were a potential
female patient would you want to
see this physician. Do you think
shes representative of say a
University in good standing.
" None are more unjust in their
judgement of others than those who
have a high opinion of themselves."

Charles Haddon Spurgeon


PT

 
At Tuesday, May 05, 2009 5:39:00 PM, Anonymous Jilly said...

I'm not sure if it's done another way these days. A friend had a colposcopy about 15 years ago and described something that looked like a dentists chair that reclined to a steep position so her vagina was in the air. She had two male doctors peering into her.
She says it was the most demeaning and humiliating experience of her life. She hasn't been to a Dr since that experience. She still talks about it often and has nightmares.
These things go against the way most of us are raised...sit with your legs together, behave modestly "like a lady"...I'm convinced this sort of experience is deeply damaging. (especially in a frightening environment with two men in charge of your treatment!)
There was nothing wrong with my friend by the way.
Curiously, men seem to be trained since childhood not to be modest. My brothers went to a boys school and there were no doors on the shower cubicles...and in the old sports wing, just a row of showerheads. There was teasing about the size of each boy's penis and competitions - too small, too big, freakish...
One of my brothers enjoyed these games, but my youngest brother is a reserved and quiet person and he was deeply affected by this lack of privacy and bullying.
I guess we all have our demons.
I do think it's the more reserved people who suffer the most...faced with that contraption I'd head for the door to check it was really necessary and whether it could be done another way. Many people though would be overwhelmed and afraid to "make a fuss"...
Sadly, these people are often the victims in our society.

 
At Tuesday, May 05, 2009 6:46:00 PM, Anonymous Anonymous said...

Jilly, don't think "trained" is the right word here, what choice do they have, men are forced into these situations just as females. We are denied the same consideration as females from a young age, most males do not "enjoy these games" they have no choice, what could they do at this age other than go along with it. When faced with a situation that is stressful, uncomfortable, etc that is beyond their control males will often act like it doesn't bother them, they will act like they accept it, doesn't bother them...especially at that age where due to their youth they are powerless. Similar to what women face in these screenings only at a younger age. I had a friend tell me about his urodynamics exam where his urologist had two female nurses assist, another had a female "assist his vasectomy and all she did was hold his penis out of the way (by the way he knew the nurse personally), I had a female tech do my testicular ultrasound and then ask the woman after me if she wanted to wait till she got back from her break so she didn't have to have a male tech, we are supposed to get screened for prostate cancer yearly and the PSA and DRE often end up in biopsy's that can cause serious complications...my brother had one..nothing. We screen we screen we screen, men and women, that is what we do in the US, the part i have the most problem with is if the screening is required for birth control...and there isn't a valid reason....that is extortion, blackmail, and abuse of power....but don't think it is a female scenerio...we just don't recognize the issue for males...alan

 
At Tuesday, May 05, 2009 6:55:00 PM, Blogger MER said...

Jilly writes: "Curiously, men seem to be trained since childhood not to be modest."

In our culture, in the past men were raised not to be modest in front of other men. That's the key. Male bonding rituals involved nudity, but never with women involved. Women were trained to be modest even in front of other women. But it's even more complicated than that. In his book "Privacy: A Manifesto," Wolfgang Sofsky writes about 16th, 17th century Western culture:

"The higher one stood on the social scale, the greater one's right to act shamelessly. The Sun King in Versailles was godlike also becasue, for him, there were no rules of decorum. He could show himself naked, hold audiences while sitting on the toilet {reminders of LBJ}, or change his shirt in front of everyone. Every private act was a state act. Noble ladies and gentlemen were allowed to receive lower-ranking persons while in their baths on on their toilets. In contrast, ordinary citizens had to completely conceal themselves. They were never allowed to appear undressed before a respectable person. It was not nakedness but rather masquerade that showed humility and respect."
(P. 60)

The history of modesty in Western culture is quite complicated.

"A naked woman was the very embodiment of lust," Sofsky writes, "a naked man was a wild barbarian, nearly a madman."

I think we sometines overlook that men's "modesty" was seen more often in the context of female sensitivity. That is, that a naked male might be embarrassed or humiliated in front of women was not as important as the fear, embarrassment or humiliation of the women seeing that man naked. The woman's sensitivity was more important. You can trace that historically in how early nurses were taught. The medical community was more concerned with the female nurses sensibility than they were with the males modesty. That's why early on female nurses rarely performed intimate procedures on men. Male orderlies did that.

The point is, though, that men have never been trained in our culture to drop their modesty in front of women, especially those they don't have an intimate relationship with. That's one of the keys to what we're talking about. To expect many men to just drop their modesty concerns in front of strange women, even in a medical context, is not the norm in our culture.

The confusion here, I think, is that just because men have traditionally not been concerned with modesty around other men, some people think that this applies to all situations for men. It doesn't. Secondly, just because young children, especially boys, don't seem bothered by their nudity even in front of females sometimes, that doesn't mean that when these male children get older they don't feel uncomfortable in these situations.

These misconceptions result in many of the stererotypes about men and their modesty.

 
At Tuesday, May 05, 2009 7:50:00 PM, Anonymous Anonymous said...

Jilly, alan is right...and so are you those of us who are reserved, shy, bashfull get a double dose and it is much harder..we try, but sometimes it seems avoidance is the only option and it almost always leads to bigger problems down the road..You do not "make a fuss" because the last thing you want to do is call attention to yourself and Your modesty issues.
Tomorrow I have to see an orthopedic surgeon...I am not nearly as concerned about the complications...as I am about what pre-op and post op are going to be like.....I am going to press him for any other treatment..if there is one...not based on anything but my desire to avoid....a situation which promises to subject me to embarrassment...

 
At Tuesday, May 05, 2009 8:09:00 PM, Anonymous Jilly said...

Alan, I know men are often silent about this sort of thing - it's unmanly to complain, you should enjoy being handled by a woman if you're a "real" man. We're always being told how we should feel...that because others don't mind, there is something wrong with us if we do care.
Women get more consideration because we spend our young lives watching out for men who might try something...we have to protect ourselves.
This has been a fairly recent thing though...my mother's generation had no choice of Dr. Younger women take choice of Dr for granted.
I agree we're treated badly with risky testing, misleading stats and "strategies" - thanks Matt. An article appeared in Spectrum a year or so ago... basically slamming cervical screening. I know many women talked about that Article and questioned their doctors about it.
The damage control started straight away with the screening program stressing the importance of this "life saving" test on TV.
It just made me more suspicious...the Ads didn't address the concerns raised by Spectrum at all...it was just more "lets scare women into having this test". It frustrates me that they never address the concerns that are raised, just wheel out the same tired old general statements to frighten us.
I disregard these Ads...when they won't even address genuine concerns, why should I trust or listen to them?
I assume if they were on solid ground, they would have something more to defend their position and be happy to meet these criticisms.
If someone automatically says, "you'll die without this test" it makes me think Spectrum was onto something.
My Dr has not refused me contraception even though I don't have smears. If she did, I would speak to the AMA. I think doctors that do that...are just "trying it on", if they see the game is up, they usually prescribe...they would know they couldn't win..if they were forced to defend their position. The test has nothing to do with contraception. (I always wondered about that, thanks again Matt...so it is indeed a strategy - THAT is very poor)
Men need to be careful too...I share your concerns about PSA testing.

There have been some cases over the last few years of priests sexually assaulting boys...many of these cases are old, dating back to the 60's.
The Police found that many men had never mentioned the abuse to a soul, they were so ashamed and unfortunately, some had committed suicide. You wonder whether the abuse led to the suicides or contributed anyway.
I know many women don't report sexual assualt. It also seems true to say that MOST men don't report assaults. I guess it's part of the conditioning...to admit another man got the better of you...that you were unable to protect yourself, maybe you didn't fight hard enough. Hardly fair, when your attacker is older and your teacher or priest. It's never fair to expect a victim to defend his/her position - they are never to blame.
I don't think it's fair to assume men have no modesty concerns. Once again, some men and women won't care and the rest of us will care very much.
Is it acceptable to belittle or ignore those of us who suffer when our dignity and modesty is violated?
I don't think so....

 
At Tuesday, May 05, 2009 9:03:00 PM, Anonymous Anonymous said...

Wow super posts, alan, Jilly and MER...
leemac

 
At Wednesday, May 06, 2009 12:36:00 AM, Anonymous Lesley said...

I think a lot of this makes some doctors uncomfortable. My friend is a GP and is very concerned about the large number of her patients being sent for colposcopy, only to find it was a false positive. She has had terrified and weeping women ready to write their Wills.
She finds she can no longer recommend this test...she's obliged to offer it, but won't go further than that...she couldn't care less about reaching her screening target and is more concerned about her patients.
She believes a screening target should reflect OFFERING the test and not DOING the test to acknowledge the doctor's respect for patient choice and informed consent.

It's difficult for many doctors. The safest and easiest approach is to follow the rules from above...so if something goes wrong or is missed, you can point to those recommendations.
If you don't agree with the recommendations, you're painted into a corner or go out on a limb to protect your patients. There may also be insurance implications as well...
My husband and I were lecturers at an American University for 3 years and during that time, I used the campus clinic. I have never engaged in casual sex and neither has my husband. We both got tired and were a bit offended when every session at the Clinic meant fighting off testing for STD's.
We concluded however, that doctors would prefer to offend people who don't have STD's, than to miss the people who have them...
No harm done offending a few people. The assumption must have been that students are more likely to have casual sex and more likely to have STD's.
I suppose it's the same with screening - if we hurt some people to stop a few from dying. Although I disagree with deceiving and lying to people. We should be asked whether we're happy to accept the high chance of biopsies.
My brother smokes - he accepts the increased risk of lung cancer. If you choose not to have screening, you accept a small risk of cancer. (and it seems very small in some cases) Of course, screening doesn't reduce the risk to zero anyway...
In many cases, you're accepting a high chance of biopsies for a tiny reduction in risk. The only appropriate action in that case is to leave the decision to the patient.

 
At Wednesday, May 06, 2009 2:37:00 AM, Anonymous Stella said...

I wonder whether I might give women some hope.
One woman forced change in the UK...ONE woman.
Her name is Hazel Thornton and she has fought tirelessly for more honesty about cancer screening.
She is now in her 60's and a world expert on screening.
She forced the screening people to send to every woman in the UK, information regarding the shortcomings and risks of screening. The fight continues as she believes, "they were economical with the truth"...
The General Medical Council were eventually forced to act with complaints mounting about improper practices and the total disregard for the need for informed consent. Cases of women being harassed, pressured by one or more doctors, aggressive opportunistic screening (when women see the doctor for something totally unrelated), women being expelled from practices and labeled defaulters, women being asked to sign disclaimers, "if I get cancer, it's not my doctor's fault"...sort of thing AND demanding screening before prescribing contraception.
The new guidelines are displayed in my Doctor's waiting room. (this is the abbreviated version)
1. The Dr has a conflict of interest and is paid to take smears and reach a screening target.
2. You have a low chance of benefiting from screening (uncommon cancer)
3. There is a fairly high chance of an incorrect test result - a false negative or false positive - the latter may lead to colposcopies and biopsies that carry risks. (Unreliable test)
4. The Dr must have informed consent to carry out this Test
5. You are free to decline testing and the Dr must respect your decision. You are free to ask for more information.
WOW!
This makes it perfectly possible for women to decline testing. Previously it was almost impossible...seeing the Dr became an uncomfortable experience if you declined screening.
I had virtually stopped going to the Dr, I was so tired of the subject.
Now, I feel like some sanity has been restored....finally!
Many women have been frightened by the misinformation and scare tactics...many will continue with this risky testing because they've been brain washed...at least though...with the new approach, over time, they may start to feel more confident about rejecting this testing or having it less often...
I believe Hazel Thornton is largely responsible for this massive change.
I'm sure there must be another Hazel Thornton in the States.
jrsm.rsmjournals.com/cgl/
content/full/96/8/409

 
At Wednesday, May 06, 2009 6:10:00 AM, Anonymous Anonymous said...

Great exchange folks. I am begining to think the required pelvic exam without a true connection to issuing birth control is truly blackmail. It is odd that we are looking to make it illegal for a provider to refuse to do an abortoin based on religous belief's....but we won't allow a grown female to make an informed decision on her own. You have the absolute right to choose to have an abortion, soon you might be able to force a physician to perform an abortion...but not give you birth control without a pelvic exam.....not making a political statement, just questioning exactly how providers can justify requiring this procedure.....what the heck?

MER you may have hit the nail on the head with a very simple statement. Men have been brought up with compromised modesty...infront of other men...females are modest infront of each other, apparently we as men fail to recognize the issue of same gender modesty for women as in the pelvic exam context, and some evidently fail to recognize compromised modesty among men and infront of females are two completely different things....simple observation but more complex ramifications....

Several here have read and commented on the 10 reasons as posted by Dr. Orange. I would be interested in hearing what people think of her follow up. Apparently what she took from the comments on 10 reasons was men want specialty clinics....I think she failed to grasp the bigger issue that was being put forth....but even so, when I read her follow up (go to the wellness blog tab on the site) I am stunned. I think we read things and get different intent from them, I would like others opinion of what they get from her post. I read she recognizes the need and validity of womens clinics but challenges if there is really a need for mens clinics. I felt she wrote questions so she could answer them from her view ...I responded, but doubt we will get an answer. It seems to me like when confronted and asked for a reply providers become strangly silent on these blogs similar to keagal girl, to me the sexism is blantant with her posts...but then I am male so I may be reading into this...I would appreciate if some of our female posters would read this and give me your honest opinion....sorry I don't know how to provide the link to the site...its www.daily strength thanks alan

 
At Wednesday, May 06, 2009 6:55:00 AM, Anonymous Anonymous said...

I have been keeping up with the article on daily strength by Dr. Orrange. The responses about mens health needs has been surprising in ways...many including women..have come out fairly strongly on the issue...I wish some of those psters would also read this blog and post here...several of them have very interesting documented statistics.
I am so glad to see the ladies post their views/experiences here. The issue of male modesty/female modesty can not be made separate issues...because it is really patient modesty period...I think a lot of misconceptions are being exposed and knocked down because of this dialogue and maybe collectively are the assembly of substantial information (mostly ancedotal I know) sufficient to get some providers to read this blog and maybe even weigh in here.
leemac

 
At Wednesday, May 06, 2009 9:31:00 AM, Anonymous Anonymous said...

I am new to this discussion so forgive me if some of my comments have already been made, probably more eloquently, by others.

I am a primary care doctor, practicing in a teaaching hospital, and I have often encountered and had to respond to patient preferences for - or against - a particular type of doctors. Sometimes a patient prefers a doctor of a particular gender, sometimes a patient expresses discomfort with a doctor of a particular (visually determined) race or ethnicity. As a woman doctor I've had male patients initially refuse to be seen/examined by me. Only once that I can recall have I actually transferred care to another (male) doctor. I find that with good communication and rapport, immense attention to modesty and dignity (leaving the room while a patient changes, using drapes liberally) using very matter-of-fact language during the history taking, and occasionally even lightheartedness depending on the patient(e.g., "I'm a doctor, not a woman") and extremely professional language and behavior during the exam, male patients become comfortable, or at least more comfortable, with the exam. If a pateitn continues to refuse I will of course not insist, although practically speaking their treatment may suffer a delay. They might even have a male physician who treats them with LESS dignity and professionalism than I do. Which leads to my point: it is the individual professional, not their gender, that matters. There are plenty of competent, caring, dignity-respecting male gynecologists and plenty of female gynecologists lacking in compassion. Personally, I'd rather have the former.

That said, there are some patients, for instance those whose strongly held beliefs prohibit an exam by a member of the opposite sex, or those who have suffered abuse, who shoul have their particular needs (not merely preferences - note the difference!) met. Likewise, while I normally would not accede to a patient who wishes to exclude a resident's presence because of their race/ethnicity, on rare occasions - for instance a history of a violent attack, a veteran who refused an Asian doctor - I have done so. Of course a patient who wishes to avoid a doctor of a particular race/ethnicity can "vote with his feet" and go elsewhere; I just have not been willing in the outpatient setting to collaborate with discrimination of that sort.

Dr G

 
At Wednesday, May 06, 2009 10:21:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is a response to the issue of modesty and "unnecessary" screening which was written to a bioethics listserv. I am not identifying the writer since I didn't ask for permission to post but I thought the response sheds a different light on the issue especially the writer's question "Do we know what the
statistical outcomes are in those cases where modesty wins out?"
..Maurice.

Perhaps "unnecessary" is in the eye of the beholder. Do we know what the
statistical outcomes are in those cases where modesty wins out? If at
age 25 I had allowed such a sense of modesty intrude, it would have
prevented my gynecologist from doing whatever he thought prudent, and I
wouldn't have had an early diagnosed, hence successfully treated,
cancer. That was 30 years ago...today, at least in this little corner of
the world, I find it difficult to get the kind of screening tests that I
think (both in my own case and in many others' cases I've heard in the
course of ethics case presentations) prudent--irrespective of
statistical significance. (If I had demurred back then based on the then
current statistical likelihood of my having cancer...???). Gee, back in
the "bad old days" when I was in practice (RN), the patient sitting in
front of the physician was most decidedly not a statistic.

 
At Wednesday, May 06, 2009 11:13:00 AM, Anonymous Anonymous said...

Dr. Bernstein, very good point, and I think we should really consider that statistics mean little if your that 1 in the 1 in a....HOWEVER, regardless the odds, the provider still does not hold the right of self determination that is the patients and the patients alone. The doctor can not MAKE a patient stop smoking though we all know the patient is compromising their health...so why should they think they have the right to force women to submit to a pelvic exam to get birth control...more people die from smoking, why not withold medical care to them unless they quit, of tell the obese person...no allergy medicine for you until you drop 20...they are providers, they work for us, they are not God with the devine right to dictate our behavior for our own benefit...they can suggest, they can inform, they can do a lot of things...but they do not have the right to demand.......alan

 
At Wednesday, May 06, 2009 12:52:00 PM, Blogger Maurice Bernstein, M.D. said...

I thought, pertinent to some of the discussion here, especially related to governmental differences with regard to population medical screening, is this abstract of a recent study published in the Journal of Medical Ethics September 2008. ..Maurice. Abstract:
Context: Despite much research on informed choice and the individuals' autonomy in organised medical screening, little is known about the individuals' decision-making process as expressed in their own words.

Objectives: To explore the decision-making process among women invited to a mammography screening programme.

Setting: Women living in the counties of Sor- and Nord-Trondelag, Norway, invited to the first round of the Norwegian Breast Cancer Screening Program (NBCSP) in 2003.

Methods: Qualitative methods based on eight semistructured focus-group interviews with a total of 69 women aged 50-69 years.

Results: The decision to attend mammography screening was not based on the information in the invitation letter and leaflet provided by the NBCSP. They perceived the invitation letter with a prescheduled appointment as if a decision for mammography had already been made. This was experienced as an aid in overcoming the postponements that easily occur in daily lives. The invitation to mammography screening was embraced as an indication of a responsible welfare state, "like a mother taking care."

Conclusion: In a welfare state where governmental institutions are trusted, mass screening for disease is acknowledged by screening participants as a valued expression of paternalism. Trust, gratitude, and convenience were more important factors than information about benefits, harms, and risks when the women made their decisions to attend screening. These elements should be included in the ethical debates on informed choice in preventive medicine.

 
At Wednesday, May 06, 2009 1:34:00 PM, Blogger MER said...

Dr. G:

You seem to have a resonable approach to this issue. I would like to point out a few things.
First, I don't believe we can generally compare choice of gender with race/ethnicity. It would be comparable if a man, for example, refused a female doctor strictly because he thought women were not intelligent enough to be doctors. Same with a woman, who may think all male doctors are predators. But those are not the kinds of cases we're taking about. Even the BFOQ laws distinguish between race and gender when it comes to body modesty. We're talking about personal values and emotions which are valid for people with modesty issues as they are for people who don't care one way or the other.

You write: "it is the individual professional, not their gender, that matters." Generally speaking, especially when it comes to knowledge, that's true. But remember, "what matters" is not a definite conclusion. What matters is also the patient's decision.

But overall I think you have a very open attitude toward this issue. And as I've pointed out many times on this thread, communication is the key point in many cases. You're absolutely right about that.

 
At Wednesday, May 06, 2009 2:11:00 PM, Anonymous Anonymous said...

Thankyou Dr G. for your comments. You seem to be a pretty grounded person that can make allowances for reality and not some hard and fast policy. If I may, when a person is embarrassed and insists that they want a provider of a specific gender (ie a male who wants another male) do you take it personally? Embarrassment does not mean rejection of you nor of your abilities. You say you speak matter-of-factly..which is great, but does this mean you stress you are a doctor not a woman? (I have never met a person who was not female or male).
WOW...you all are really coming up with interesting posts.
The Nordic letter to women seems like it should be unethical as it misleads the ladies. Although there is something to the notion some folks just want to be taken care of and not have to make any decisions for themselves.
leemac

 
At Wednesday, May 06, 2009 3:31:00 PM, Anonymous zak said...

Dr G,

you could try an persuade me for the rest of my life that gender does not matter. I am happy for you that you feel that way, I do not.

Educating me will not work, complying with my requests without questioning my motives will.

I really dont care if you feel offended, most female health care practitioners dont care less about Male feelings.

 
At Wednesday, May 06, 2009 3:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac, from what I can understand from the published abstract (I have't as yet obtained access to the original study), it appears to me that this was only a study with women speaking out about motivations for deciding to attend the invitation to have a mammogram at that time and there was nothing mentioned about something misleading in the invitation unless it was they weren't told in advance that they would also be seated in focus-groups to express their opinion what motivated them to attend.

Dr. G., do you feel (or know) that most physicians in general are not aware of the gender preference toward the the healthcare provider by some patients as part of that patient's concern for their personal bodily modesty? This has been my impression since moderating this blog and reading the innumerable comments. This impression is based on the fact in all of my 50 years of internal medicine practice I have never had this mentioned to me by other physicians nor indeed have the patients themselves. Perhaps, if I had been a gynecologist or urologist, I would have been aware of the gender selection issue. ..Maurice.

 
At Wednesday, May 06, 2009 3:52:00 PM, Anonymous Anonymous said...

Of course, we now have some important research from Scandanavia which suggests that women who have regular mammograms, have more breast cancer...they're not sure why...perhaps the radiation.
I wonder whether these women still feel "cared for"...

The old saying - ignorance is bless IMO, doesn't apply to screening.
Sorry Dr, I don't agree with pushing unreliable testing on healthy people without FULL disclosure. If I'm harmed by screening (very likely with some testing) will I be comforted by the handful or the one person who was helped?
In the Law there is an expression, "Hard cases make bad law" - I believe it applies equally to medicine - just because someone was unfortunate enough to get cancer at 20, doesn't mean we should all be tested when the chance of disease is SO small and the risk of harm is high - in these cases, you hurt many, to save one.
That is why cervical screening is OUT for women under 25 or 30 in most countries. If you look at the States, many young women have already had interventions before that age (with no cancer) and many will have problems in life as a result.
Embarrassment is one factor for me declining cervical screening, but it is not the major reason. The top reason is my unwillingness to accept the high chance of a false positive, colposcopy and biopsies, when I'm a low risk woman.
It takes a brave person to dismiss a positive result...if we're being tested and get a positive result, it means moving down to the next diagnostic test and facing more risk.
I've had doctors talk about the one woman helped here and there...
"She didn't want it either...we found cancer and she's alive today, thanks to screening"...
I don't care, I've weighed up the evidence and it doesn't get over the line for me. The ONE grateful woman is not a sufficient motivation for me...in fact, I find it a bit insulting to my intelligence. It's just another "scare tactic".(used by someone above)
Dr, if you believed a test was MUCH more likely to hurt you...would you agree to it simply because another man died of that cancer last week?
If you had the testing and were left injured...and then found out you hadn't received risk information showing your outcome was highly likely...would that be acceptable to you?
I strongly agree with the posters about the absolute need for full disclosure and the decision resting with the patient.
If we're supposed to be grateful for screening and live in blissful ignorance, who takes responsible when we're left incontinent, impotent or with an incompetent cervix? The State? Your Dr? The screening people?
The answer is...the damaged body and life is left with the patient.
IF WE'RE TAKING THE RISK, IT SHOULD BE OUR DECISION.
I also reject mammograms - I heard Prof Michael Baum speak a couple of years ago. Thank goodness, I didn't just attend like a grateful woman!
I don't know whether he's spoken in the States. He helped set up the first breast screening centre in the UK and now believes screening harms more than it helps. He also strongly disagrees with the screening people misleading women, providing scant and biased information, no risk information and using unethical tactics.
He's faced a lot of criticism by the screening zealots, but it's hard to discredit a very senior and highly regarded breast cancer surgeon - a leader in his field. The zealots never address his criticisms...they just produce their skewed results and adopt the moral high ground. Prof Baum has said that many doctors agree with him, but are afraid to speak out and face the fury of the screening zealots. These people do not want to be questioned...they start from the premise that screening is a GOOD thing - it's difficult to debate that sort of arrogance and ignorance.
I'd read all his Articles and interviews - "Screening Wars" & others. Sorry, I don't have the link...just google his name.
Someone used the word "immoral" and it jumped off the screen for me.
Personally, I believe it is immoral and arrogant to push screening without full disclosure and respecting the patient's final decision.
Lily

 
At Wednesday, May 06, 2009 4:06:00 PM, Anonymous Anonymous said...

Dr. Bernstein, the part where it was percieved that amamography had been scheduled already does seem misleading to me.
Doctor G, if I were to be a patient and told you I was just too embarrassed and wished male providers doctors/nurses...what would you tell me?...
leemac

 
At Wednesday, May 06, 2009 4:25:00 PM, Blogger Maurice Bernstein, M.D. said...

I have an important survey question to pose to those visitors to my blog who are reading and writing these volumes on "Patient Modesty". The basic topic of these threads have always been simply patient bodily modesty. The issues of population medical screening are appropriate for these threads if they are discussed primarily in terms of patient modesty itself.

The medical, ethical, economic and political issues involved in population screening of the well is really a separate issue that has been written about in the literature unrelated to patient modesty and is a very important issue to be commented upon on a bioethics blog such as mine---BUT as a separate thread. I recently was reading more about population medical screening and I was thinking of putting it up as a new thread. Now here is my survey question:

Would those visitors here accept a new thread to discuss the innumerable aspects of population medical screening but in a more general context (not particularly related to patient modesty)with a title such as "Population Medical Screening: It's Ethics and Value"? Therefore on the current patient modesty threads we could talk about screening but specifically from the viewpoint of patient modesty and refer the more general considerations to the new thread? I just don't want to dilute the important discussion subject of patient modesty in all of its components with discussion about the general issues of population screening. ..Maurice.

 
At Wednesday, May 06, 2009 4:57:00 PM, Blogger Maurice Bernstein, M.D. said...

leemac, I don't know what was written to those possible participants in terms which would make them interpret the message as a scheduling of a mammogram procedure specifically for them. However, I would assume that there was nothing written that would have coersed them to attend and that each woman could have easily, if desired, reject participation. Therefore, their decision to attend or not to attend, apparently, was based on their own interpretation of the invitation and it's value to them and shouldn't be looked upon as a misleading invitation. ..Maurice.

 
At Wednesday, May 06, 2009 4:58:00 PM, Anonymous Anonymous said...

Yes, Dr. B, you should use a different thread for the screening issues. On "How Husbands Feel" site most of the topic discussion is on "male gyn" and female exams being WRONG. This seems to be a hot topic, Pap smears and gyn exams that most on that site feel are wrong and completely unnecessary.

 
At Wednesday, May 06, 2009 5:18:00 PM, Anonymous Anonymous said...

I see this question as one of gender...
In the UK there was a ready acceptance that men would not accept the DRE and so now they have a blood test.
No such measures have been fast tracked for women. We just get patronizing comments, "Most women get over that...have you had kids yet?"
Of course, recent newspaper articles suggest men may not have been so lucky with the new blood test and the potential for harm is high - even death.
Modesty and dignity are huge issues in the screening arena...many women have been pressured to see male doctors or their request for a female has been ignored..and some male doctors have used opportunistic pressure to force women to have the test when they see them for a cold - they may have been happy to see the male doctor for a cold but not a smear. Many women are not strong enough to refuse...
In Ireland, where there are fewer female doctors, screening has been a failure - less than 30% of women attended for cervical screening. There are plans to abandon the testing. Looking at another site, many women said no female doctor meant no testing. My friend was told to just go into brain freeze, think about a lovely beach setting and allow a male doctor to do the test. She refused...
I find it incredible that anyone would have trouble understanding why a woman would have a problem with a man doing that sort of test.
There are few exams were you're as exposed and vulnerable...not to mention the embarrassment and indignity.
I wanted to mention another side to screening. Sometimes, the discovery of cancer does not add years to your life, you just know you have cancer for a longer period of time.
Also, screening often finds cancers that would never harm you.

My close friend had a mammogram last year and DCIS was found. This is a cancer unlikely to ever harm you.
Doctors push us into screening....when they find DCIS however, they have NO answers for us. About 35-40% of middle aged and older women will have DCIS.
My friend's life has been a living hell since the Test. She can't sleep or eat, has lost weight and is taking anti-depressants.
The doctors say she can watch and wait and keep having mammograms (with the extra radiation and bruising) and possibly, start drug therapy OR they can take the breast off...what a choice!
This is unsatisfactory...
It also means getting insurance will be very difficult in the future.
If doctors have no game plan for DCIS, this should be mentioned to patients before they agree to testing.
The current brochure does not even mention DCIS - it mentions the test is not perfect and may be incorrect in a very small number of cases.
That is a bald faced lie!
I actually think it's wonderful to see such honesty from the female (& male) posters. I suppose this may be a safe haven. Many women don't admit they don't have testing because of the enormous faith some people place on testing. (I've found these women simply don't know of the risks, they have accepted the party line hook, line and sinker or they mistakenly believe their life was saved by testing.)
Most women feel uncomfortable admitting they don't have screening fearing the torrent of judgement and criticism and the patronizing comments and extreme statements from the screening enthusiasts and doctors - scornful stuff - "don't complain to me when you're dying of cancer"....
I don't find those comments helpful at all.
We're portrayed as ignorant, misguided, foolish and reckless women. In fact, nothing could be further from the truth. Most of the women I know who refuse screening, have given the matter enormous thought and researched the topic, not just accepting a doctor's word. They took the time to find the answers that are NOT in the screening brochures.
I fear a separate section on screening will mean many of your posters will retreat...we've heard it all before - these people do NOT welcome discussion and DON'T tolerate any criticism of screening..they are ABOVE criticism and don't need to address our concerns intelligently AND they have NO respect for the individual's right to choose...we're all idiots.
Sadly, we rarely hear the voices that appear on this site. They are swiftly silenced...particularly dangerous posters like these women - educated (generally or on this subject), articulate, well informed and honest...their deadly enemy!
The above posts certainly encouraged me to add my thoughts.
LMac

 
At Wednesday, May 06, 2009 6:16:00 PM, Anonymous Anonymous said...

I think a separate thread for population screening would be great.
The merits of a test/exam/procedure could be discussed for its therapeutic value or lack thereof and keeping the issue of modesty somewhat autonomous.
leemac

 
At Wednesday, May 06, 2009 6:21:00 PM, Anonymous Anonymous said...

LMac..my statement is in no way intended to dimish teh need for reform such as I think you feel is needed also...but eliminating a procedure from automatic to need only would , in my opinion, have a better chance with th epowers that be if a) enough people refuse to take them b) enough evidence and statistics can be assembled to force those who make the recomendations (ie insurance companies) to recognise the value or lack thereof for such things as mamograms and cervical screening.
leemac

 
At Wednesday, May 06, 2009 7:32:00 PM, Anonymous Anonymous said...

Dr. Bernstein I would agree, screening issues are a seperate issue from what we are discussing here. While modesty may play into it...it seems to be a part of the problem not the problem.

Dr. G.
Glad you joined the discussion, we really would appreciate and benefit from hearing from providers. I hope you will stay with us if the conversation gets heated or you feel one sided. Our intent is not to gang up on you. Hopefully we can learn from each other. I hope you are open to our side as we need to be to yours. I am a male who feels very uncomfortable when exposure is involved with opposite gender. I have been through several procedures which required this. After one paticularly event I had made up my mind that I would not go to my follow up treatment. I came upon this site and changed my approach. My question to you is who does your approach serve, the provider or the patient. While you might talk or persuade a male to accept the treatment, if they do so just to get it over with, or because they feel pressured...who did it benefit. I really don't understand why providers feel it is about them. Why do you feel getting the patient to accept you is more important than the patient feeling comfortable and secure in the medical setting. The more comfortable they are, the more open they are, and the more likely they are to seek medical care in the future. Your method may seem to work for several reasons, you may actually convert some who find out they are OK with it once they try it, you may just wear someone down where they do it just to get it over with, there will be those who are not strong enough to say no, there may be those who have no choice due to economic or need. For those who learn to accept you may have done a favor, but for the rest...you may have driven them away from further medical care. I feel providers who make the argument they are "gender nuetral" it is about them being professional ..not their gender are making themselves the center or the focus of the interaction, not the patient whom it should be. You are in your natural environment, you are fully clothed, you are in your routine. The patient on the other hand is in a strange environment, sick or injured, stressed, often scared...should the focus not be on what makes them comfortable not on what the provider wants or thinks they should be comfortable with. To me, this is the arrogance of medicine. Why do you think it is so important that the patient allow you to perform the procedure that it might overshadow the patient being comfortable or getting what they want, maybe even what they need to complete health care. It also occurs to me that medical doctors are making judgements about patients psyhic when they say the recognize the need for patients of abuse or rape..but not others.but how can you make that call? Inevitably whenever they find an alter boy who was abused by a priest...they find multiples who never said a word for decades and just suffered with it....I know I was one who on the outside was Ok, but inside I was tormented, after one incident, I fell off the wagon and started smoking again after over 15 years of abstenence. Left the hospital hit the 1st c-store and bought a pack. You have no idea what you might be doing to your patients. So once again, do you not see this as being self serving and self centered. I don't know that I would or would not cave if someone like you pressured me...and you may not mean to but it is pressuring due to your position the power dynamic is not equal, I may or may not cave, but if I did cave, from experience I would loath you and myself afterward, and I would think twice about coming back....that may seem extreme to you, but I would say its more common that you know becasue your focus is on the physical and getting YOUR job done. You may have the best intentions, you may benefit some, but I would lay money some walk out of there with a totally different experience. Let me ask you, have you ever worked with a good male gyn, have you ever had him do a pelvic exam? Would you feel comfortable allowing a male gyn you work with do a pelvic on you? It may be another day at the office for you...but for your patient....with all due respect, and I mean that sincerely as I detected no malice in your post...I think your seeing things pprety much one sided....alan

 
At Wednesday, May 06, 2009 11:29:00 PM, Anonymous Leah said...

I have never understood why we need to justify our choice of same sex medical provider.
There is a woman in our office who seems to think she's a "normal" person because she sees a male gyn.
"I can't understand women who won't see male gyno's"...
Personally, I don't understand how women can see male gyno's, but I respect each patients right to choose...
Why do we need to justify and explain our choice? Why are we the odd ones?
Then I see there is a 10 week wait to see most female gyn and you could get in the next day to see a male gyn...clearly I'm not the only woman preferring a female doctor. (some of that is because there are fewer female gyn, but not 10 weeks - the ratio is 40/60 now...(in Australia)
I say to those women who don't understand - great, see your male doctors...at least you're not dragging out the wait time to see my doctor to 12 weeks!
BTW I don't just see any female gyn, with that level of exposure, I spoke to three female gyn's before I selected mine.
I don't see the issue any differently for men - you want a male doctor and nurse - fair enough by me, you certainly don't need to justify or explain.
I agree Leemac - the thought of having a gyn exam with a male doctor horrifies me. He may have great qualifications, he may have seen hundreds of women that week, he probably views younger and more attractive women than me (I've heard them all) - how is any of that relevant to how I feel?
I don't care who he is, I won't accept his medical services.

 
At Thursday, May 07, 2009 12:00:00 AM, Anonymous Anonymous said...

Dr.G

I to value your input to this blog. I hope you continue to post and don’t take things that are said personally. Much like others, I’m just not comfortable exposing myself to the opposite gender. I could care less about their credentials; it really makes no difference to me. Fortunately, I have good insurance to where I have access to the care that I choose and yes, I’ve let my feet do the talking before. What bothers me the most is the attitude that is shown when you make these request. I can’t understand how providers say that they stand for dignity, respect, and integrity and then sometimes force a patient to throw all that out the window to get the care they need. They compromise the patient’s mental state to care for their physical state even though, as discussed here, many times that scars the patient for life. I nor anyone else shouldn’t have to explain anything. If it’s requested, it should be honored with no strings attached especially since I’m paying for this service.

Dr.B

I’m not sure if a separate thread for screening would be of value. Much of what has been discussed does pertain to this discussion, not necessarily the statistics but the general push by providers for screening which leads to compromising your modesty/privacy. Jimmy

 
At Thursday, May 07, 2009 6:56:00 AM, Anonymous Anonymous said...

I think a new thread where information, web sites, studies, could be collected could be used to get some exams, tests, or procedures reduced to an as needed rather than standard everyone gets it all the time.. to get such a stance by the AMA and other groups or even our own PCP's it helps to have facts and figures handy to back the change.
leemac

 
At Thursday, May 07, 2009 1:02:00 PM, Anonymous Anonymous said...

Women on this topic are raising how "unacceptable" it is for a male gyn to be doing paps, etc. The same thing happens when a patient goes in for a surgical procedure. Once a patient is sedated it could be a male nurse that invades this area on a woman to prep her. The same in reverse, what makes it okay or normal for a female nurse to handle a mans genitals for a prep? Just because you are rolled into a "special room" called a suite and then WALAA... everything is now acceptable. It would not be so acceptable to everyone if this very same thing was done while the patient was conscious and in an exam room. Why does this go on?

 
At Thursday, May 07, 2009 4:38:00 PM, Anonymous Anonymous said...

Jilly writes

"Since childhood males are trained not to be modest."

Who said so? Is that an excuse
NOT to show,give and provide male
patients privacy in health care.Is
that their excuse. Did you ask my
mother how she raised me?
I believe every manual,procedure
and protocol in patient care states
that the patient must be afforded
privacy. I've never seen it written otherwise.It's not gender specific although somewhere female nurses and other female providers
have it in their mind otherwise.
All patients must be afforded
respect for privacy and take note
that its considered unprofessional
behavior not too.


Dr G

You wrote

" It is the individual professional,not their gender that
matters."

Well how am I supposed to
interpolate that statement after sitting through two hours of interogation with the police and risk management after witnessing a female physician assault a male patient.I am not spock from star
trek and I cannot read minds.
I do make decisions from
experience and my experience says
stay away from female providers.


PT

 
At Thursday, May 07, 2009 5:01:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I am the one confused. I don't know how to interpret the statement you made "after sitting through two hours of interogation with the police and risk management after witnessing a female physician assault a male patient.I am not spock from star
trek and I cannot read minds.
I do make decisions from
experience and my experience says
stay away from female providers" as a response to Dr. G.'s "It is the individual professional,not their gender that
matters." You didn't fully explain this incident, the nature of the alleged assault,your relationship in the incident and the outcome but also how your experience of this incident lead to your generalization. Yes, I don't want you to name names on this blog (that's not necessary nor ethical) but you must be a bit more helpful in providing us with more understanding about how you constructed your point.

With regard to generalizations, though I am well aware about news stories which frequently describe either the unethical or illegal activity of police professionals, I would still call upon the police department to help me in any emergency that happens to me or that I observe.

I am not being critical of your right to make a point on this blog only how you presented it in order to present it better so that we all understand. ..Maurice.

 
At Thursday, May 07, 2009 6:39:00 PM, Anonymous Anonymous said...

Dr. G posted "its the individual professional that matters, not their gender that matters" I think perhaps that may be the very center of this whole issue. Providers see the issue from that basic theory. Whether is it taught in school or through assimilation from interacting with other providers...that seems to be their mantra...unfortunatley they never asked the patients if that holds true. Typically they try to make it exclusive, you can choose professional behavior OR same gender, frequently they present it like it is an either or proposition. Whether this is the result of the residual remenants of the patriarchial days where Doctors were all knowing or the desire of medicine to transition medicine from the patient as being the sole focus (emotional and physical) to effciency/profit driving patient care. In any case that approach once again makes the provider all powerful and able to change patient physic through their behavior and ablities. While I do not think it is done with malice...I think it is wrong in it places the focus on the provider not the patient. Should not the focus be on the patient. After all, a provider pushing a patient to accept their will...how much different is this than they dynamics where society says a prisioner is incapable of having consensual sex with guards because of the power dynamics. The provider is assumed to have an position of power that they claim is granted them by society....using that power dynamic to push the patient into accepting them or something the patient has already told them they are uncomfortable with is similar to "consensual sex" between prisoners and guards....can a patient who is expected to give the provider permission to make decisions over their very well being truely partcipate on an equal basis when pushed by that provider....I find the argument that it is the professional individual not gender that matters to be very self centered...would that provider accept that same argument from anyone else..I am a professional janitor, I am a professional personal trainer so I can be in the locker room while you shower...its a self proclaimed right...one we need to challenge....alan

 
At Thursday, May 07, 2009 7:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Becoming and being a professional such as a physician, lawyer or nurse, as examples, is characterized by a guiding and scrutinizing organization or organizations with duties for establishing criteria toward the professional education with accreditation of the educational institution,certification of the idividual, standards of behavior and codes of ethics that must be followed or else the individual is removed from the profession.

As an example of what is understood as a professional, you might think that those who call themselves "clinical ethicists" or who "do ethics" as a work in the medical environment are professionals. No, they are not. They are, as a professional, no different from that janitor. Why? Because there is as yet no universally accepted standard setting organization, no accreditation of the institutions teaching folks to become ethicists, no universal certification of the clinical ethicist, no formal standards of practice nor code of ethics. Yes, they may be more educated than the average janitor..or maybe not. (By the way, there is hope that some day soon clinical ethicists can look at what they do as a formal profession since there is active discussion and work begun currently to make it a profession.)

Therefore, yes.. there is something special for a physican to be considered a professional. Being a professional goes beyond gender and from the view of the physician, being professional and following the professional standards and requirments trumps being a male or being a female. Of course, that is the mind-set of the physician. If this is NOT the mind-set of the patient, then as repeatedly written on these threads, the patient should "speak up!" ..Maurice.

 
At Thursday, May 07, 2009 8:50:00 PM, Anonymous Penny said...

The information on this website is not readily available to women.
I didn't even realize I had a choice about screening - it was just done or I was told I must have it.
I read the articles mentioned, took note of the statistics - in fact, my BF & I spent an entire weekend looking at screening.
I actually stood up to a doctor!
I refused screening, mentioned informed consent and patient rights & produced that amazing chart together with the VERY HIGH number of biopsies for false positives.
I got my script with no screening.
The chart and information is now being circulated around family and friends.
How disgraceful that I only got to discover the truth about this testing...because I happened upon this site.
This information should be readily available to every woman in the world. (in doctors waiting rooms)
I intend to get the message out in every way possible - the lies, bullying, risk taking on our behalf, ignoring our rights to consent or decline, holding back risk and statistical information and refusing scripts until we agree....MUST STOP.
It shakes my faith in the medical profession to think so many doctors just went along with these unethical practices.
Thank you so much.

 
At Thursday, May 07, 2009 9:11:00 PM, Blogger MER said...

I'd like to present another quote from "Hippocrates' Shadow by David H. Newman, M.D. Remember, the theme of this book is that "Doctors have secrets, and we have lots of them." Newman confronts these secrets and brings them out into the open. Thus:

"When I was in medical school, no one taught me how to keep from gawking openly in front of a patient with a visually striking wound, or how to remain quiet and politely attentive while a patient with a severe stutter speaks, or how to deal with physical attraction (in either direction) during interaction with patients."

Now, why weren't these issues confronted in medical attention, especially patient sexual attraction? I suggest they weren't taught because to recognize sexual attraction between doctor and patient forces one to recognize the power of gender. And within the medical world of "gender neutral," there is no gender -- just "doctors."

Newman continues: "This can be difficult to explain, particularly to laypeople, who understandably prefer to see physicians as persons capable of suspending human tendencies like anger, fear, and physical attraction."

So we see clearly that gender does matter, and sexuality exists, but it's considered "professional" to take the pose that these don't exist. This is a delimma for the doctor. He or she certainly doesn't want to bring sexual attraction out into the open during a doctor-patient interaction. But that doesn't mean it doesn't exist, and when coming from the doctor's side, isn't noticed by the patient. It's the elephant in the room.

Of course, it's not only the patients who "prefers to see physicians" this way. It's also the physicians who claim to be that way (at least publically)-- as we see with Dr. G's reassuring the male patient with "I'm a doctor, not a woman."

At best, with a good physician like Dr. G, this is a pose. At worst, it's a lie. That's not to say that doctors don't use strategies to deal with these uncomfortable, embarrassing situations. But some of these stragegies actually demean or anger or humiliate or embarrass the patient. The stragegies work for the doctor. They make the doctor feel "good" or less embarrassed, but they don't all work for the patient. Of course, good doctors use strategeis that empower the patient. But what strategy works on what patient is situational. The doctor has to really understand the psyche of the patient. One strategy doctors use which can go either way with a patient is posing as completely technical, objective -- objectifying the patient. Here's another interesting quote from Newman's book:

"One analogy I have used in teaching students is that of the bank teller. The first few hours, or even days of handling great quantities of cash may seem personally challenging for the teller, a test o fhis restraint. He may desire or covet the money, or be tempted to divise clandestine methods to horde it for himself. But soon enough (and perhaps from the very beginning for some), professional instincts and routines make such restraint unnecessary. Handling money becomes a part of everyday exisence. While money may be something bank tellers desire, it is soon ingrained in a teller's mind that THIS money is quite distinct from what they desire."

Now, Newman admits that this analogy doesn't work for every student, and some students don't need it. "But the issues are difficult," he writes, "and the complicating factors of taboos, preconceptions, and everyday social repression often compound the difficulty. While learning how to work with and around these issues requires the most directed teaching, medical education instead tends to skip over them entire."

Interestingly, Newman next references The New England Journal of Medicine 2005 article "Naked" that started Dr. Bernstein on this entire thread. Newman writes: "...there's no uniform professional standard for the many 'how-to's' of patient modesty and discretion in the physical examination of patients. For instance, should there be same-sex chaperones present for examinations of potentially private body areas? And which areas -- the wasitline, the groin, the buttock? No standard has been set in medical practice that answers this question. There's no policy, no approved or disseminated guideline, no ethical writ, and no cohesive message is imparted to medical students. As with most nebulous and deficient areas in our field, medical education is only as confused as medical practice."

Two responses to these quotes:

1. Dr. Bernstein talks about medicine as a "profession" with standards, ethics, policies as one criterian that make a profession. This is where medical "profession" breaks down, in the area of patient modesty. This is where the comment some patients get -- "We're all professionals here," is one of those "secrets" Newman talks about. Medical professionals are not all professionals when it comes to patient modesty. There's no standard, no agreement, no professional organize that defines this and sets standards and enforces them. Furthermore, many those healthcare workers who invade patient modesty day in and day out (med. assistants and cna's) are unlicensed, and in no way considered true professionals. Just because they work under a doctor's license, doesn't make them professional.

2. Newman's analagy of the bank teller, though well intentioned, fails miserably. Why? Because there is no possible analogy like this for the unique, personal, special, trusting, emotional, even spiritual relationship that can occur between two human beings, especially the doctor and patient. Notice that Newman's analogy involes a human and an object -- a bank teller and money. The kind of emotional relationship that can exist between two human beings, doctor and patient, can not even come close to the relationship between bank teller and money. Analogies like this perpetuate the myth of patient as object, doctor as someone "working on" or "fixing" or "looking under the hood."

If I may be so bold -- if I were teaching doctors about this issue, I would ask the class to come up with analogies like the bank teller one. Then we would discuss them. The point I would make is that you can't come up with an analogy using a person and an object that is valid when studying the doctor patient relationship. Beware of such analogies. They will push you toward viewing the patient as an object to be worked on or dealt with.

Newman ends this section by writing: "Social and cultural confusion is awkward and difficult, but it can also be dangerous. Beyond decisions about exposing someone's waistline during a medical examination lie broader challenges to doctor-patient communication, and as our country becomes more culturally diverse, this problem will only increase. Where communication is limited, good medicine -- sometimes lifesaving medicine -- is also limited."

From all the reading and research I've done in American medical sources, Newman's book respresents one of the wisest written.

 
At Thursday, May 07, 2009 9:44:00 PM, Blogger Maurice Bernstein, M.D. said...

To Penny and other visitors, I need to emphasize the disclaimer on this page. As the moderator of this blog I must say that information presented here may or may not be accurate and/or fully detailed. Readers accepting this information as correct and basing decisions on it should be aware of this. Furthermore, even if the information is evidence-based, one would have to look at the study producing that evidence and other similar studies to establish the validity of the information. Finally, if the evidence suggests benefit or lack of benefit for a population, the reader should remember there are clinical nuances for each individual such that the significance of that information for an individual may not be the same as for the population as a whole.

Use the information disclosed on these threads, if the reader feels they are worthy, to stimulate further reader research into the subject rather than make medical decisions solely on what is read here. ..Maurice.

 
At Friday, May 08, 2009 2:03:00 AM, Anonymous Penny said...

Thanks Dr, but I'm perfectly capable of reading articles in medical journals and my BF is a mathematician so statistics don't frighten him.
The mistake I made was trusting my Dr.
A big mistake...perhaps, I should also blame the dishonest self-interested people who push these programs...deliberately misleading us with no regard for our health & well-being.
How dare they present a biased and inaccurate upside with no mention of the huge downside.
If I had been provided with these references years ago, I would NEVER have agreed to screening.
This forum has opened my eyes and now I have that awareness, I'll keep researching the topic.
I'll NEVER just accept a doctor's word again.
I'll never allow myself to be railroaded or intimidated by a doctor.
My Dr told me cervical cancer is VERY COMMON - NOT TRUE!
That the test was almost perfect - NOT TRUE!
I could keep going...but basically lie...after lie, after lie....
I could not find ONE article that supported any of these statements -it's all just spin to scare women into this highly unreliable test.
I, like lots of other women, was treated like an ignorant fool....a doctor gambled with my health.

Why should I believe totally unsupported statements by self-interested doctors rather than articles in medical journals by senior and respected scholars and researchers?
Research actually backed up by facts and statistics & the concerns of the General Medical Council.

My Dr went bright red and knew the game was over when I produced this information AND was aware of this research. When I asked for the so-called "facts" to be supported by references...nothing was produced.
I've also been looking at the Nordic Cochrane Institute...they assess screening tests and are VERY unhappy with the brochures released by the breast screening program - misleading with no risk information. They have suggested a total redraft by non-screening people. I've sent them an email asking for more information on a number of screening tests.
The dangerous thing with all of this...most patients don't think of the other side, the other argument - we assume there is NO other argument and end up risking our health and even our lives, blissfully ignorant to the dangers.
Men - beware of PSA testing - DO YOUR READING - don't just accept your doctor's word - there are articles that state that men will die as a result of biopsies from false positives. This huge risk is unlikely to even be mentioned to you.
I've given my Dad these articles...
I would have no objection to these people offering these tests if we're also given ALL the information and are free to reject it, as we see fit.
The way these programs have evolved though is to me...arrogant, dishonest and unethical (maybe even more serious than that...)

 
At Friday, May 08, 2009 4:56:00 AM, Anonymous Anonymous said...

The term professional is over used and to me has little significance. The true issue is that certain jobs or professions are licensed. Go on to any states web site and you can pull up all jobs that are licensed by the state and many require continuing education to maintain an active license. Beauticians, accountants, real estate agents, etc. There are many. Medicine and ancilliary medical jobs are just that jobs that have required training, education and licensure. "Professional" means nothing.

 
At Friday, May 08, 2009 9:54:00 AM, Anonymous Anonymous said...

"I should add...men should also have choice of doctor and nurse."


What??? Which planet are you from? Since when do men get a choice of a nurse's gender? I would love to know what city you live in because I'd like to move there. From all accounts I've ever heard or read there is hardly ever a choice of the nurse's gender for men.

 
At Friday, May 08, 2009 11:00:00 AM, Anonymous Anonymous said...

"many those healthcare workers who invade patient modesty day in and day out (med. assistants and cna's) are unlicensed, and in no way considered true professionals. Just because they work under a doctor's license, doesn't make them professional."

Exactly. They have no right to say "we are professionals". Even others such as other types of nurses and techs that have one or two years of training at a community college seem to believe they are just as qualified to order someone out of their clothes as a doctor is. If an education is what these people think entitles them to be present during an embarrassing exam, I'm sure I have more of an education than most if not all of them. Going to a few classes at the community college doesn't, or shouldn't give them automatic access.

Anybody can be an "assistant". I could go to the clinic where my aunt works and hand her supplies or squirt lubricant on her finger as well as any "educated" CNA, but it's not proper or ethical. Why don't medical "professionals" understand ethics?

Dr. G, I would never be your patient no matter how good or qualified you claim to be, and I would encourage everyone I know to stay away from such a self-righteous "professional".

LT

 
At Friday, May 08, 2009 11:25:00 AM, Blogger Maurice Bernstein, M.D. said...

LT, that should blow Dr. G. away from this blog! What you did was "jump the gun" by your remark about Dr. G. and it isn't fair to her since you are making assumptions without giving her a chance to explain her own remarks, if there is explaining to do. I know the heat is up on the issue of gender selection but this is a discussion blog and discussion requires analyzing all sides not shutting up the opposing discussant by scaring them away with ad hominem remarks. ..Maurice.

 
At Friday, May 08, 2009 1:03:00 PM, Anonymous Anonymous said...

I am not entirely sure what Doctor G thinks about male modesty .....or how she views that that honestly have an issue with opposite gender care...I do think that she believes that gender neutral and professionalism are all that folks should/do feel and that that should make it all better...
This is probably because she has never really been exposed to how many folks feel...they just shut up and gut it out which she may mistakenly think is acceptance...although I do note that she did say comfortable or more comfortable with an exam/procedure/treatment...but maybe she thinks it is usually because of worry about whatever is going on exclusive of modesty issues..I hope she does not go away and will post more in depth thoughts....
leemac

 
At Friday, May 08, 2009 1:27:00 PM, Anonymous Anonymous said...

I have a slightly different question...we have heard what most medical schools teach as to patient modesty, but what do they teach in psychology? What is the teaching on male/female modesty and how folks feel?..I was of the understanding that doctors had to take at least some psychology..is it possible that some ideas or concepts don't make it across to whatever classses are taught in how to deal with patients?
leemac

 
At Friday, May 08, 2009 1:35:00 PM, Anonymous Anonymous said...

I think it's clear why many doctors and nurses would never post on this board. The blatant disrespect and disregard shown to them by a few even when they are trying to explain their take is despicable. What a shame that those we can try and show how some feel about these issues are treated so poorly here that many never return. I can't say I blame them.

TP

 
At Friday, May 08, 2009 2:29:00 PM, Anonymous Anonymous said...

Personally Dr. Bernstein I would be in favor of you censoring comments you find inflamatory toward providers or other posters including mine. It is so rare and so valuable to have the other side. I truely want to know what is the reasoning that makes providers feel patients accepting them is more important than providering same gender. There may actually be some reason in their mind that it benefits the patient. I can't see it, don't understand it, it seems obvious, but then again you have stated several time you had no idea patients felt this way, and yet you are a concerned and open minded doctor so it is possible there is a rational thought that is patient oriented...doesn't mean I will agree if I hear it...but I sure would like to know if its a Dr knows best or if they truely feel they are doing the patient a service where we see diservice..one thing for sure, scare them away and we will never know....alan

 
At Friday, May 08, 2009 2:58:00 PM, Anonymous Anonymous said...

TP,

i agree with you, how dare we say what we think... after all, there is open and fair debate on allnurses, there is no censorship there.

Would you have this blog censored as the allnurses is?

 
At Friday, May 08, 2009 3:29:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, I can't speak for other doctors or can I present their explanations for their views and their behaviors. I do feel, however, based on my own experience both with patients and physicians and the many commentaries written to these threads, as I have previously written, I suspect most doctors are unaware of the degree of emotional upset regarding gender selection of healthcare providers in the context of patient modesty. As I have said, I, now am more aware. But the other doctors have got to speak for themselves. That is why I hate to have doctors who might come here find this blog an uncomfortable place to speak their mind despite the observation that the non-doctors here seem to have virtual freedom to argue their points. It's not fair when the idea is to engage in discussion. ..Maurice.

 
At Friday, May 08, 2009 4:55:00 PM, Anonymous Anonymous said...

Although many express their embarrassment in terms of past experiences, it is not just a matter of the demeanor of the provider not doing whatever upset some. The embarrassment is now inside us and that is where it comes from...I may believe a provider that they are trying to be gender neutral and they may be the nicest person you would ever want to meet...but the embarrassment does not come from inside them...it is our feelings..Assuring me you are a great provider (You may be the best on earth..I won't say you aren't)does not change how I feel...I am not putting you down...I am not even saying you are going to molest or in any way mistreat me (an old guy like me has little to worry about anyway on that score)...I am not biased against female providers because I think they are inferior..if it is a bias..it is solely because my embarrassment is pretty acute.

I do not want providers to avoid commenting here..I think that the reason most of them can not or do not go into any depth is because they have never thought about the subject enough to have any indepth thoughts....Just as Dr Bernstein has often stated...But we will never get any satisfaction concernig our needs if we drive away the ones we need to achieve these goals.
If any are offended, perhaps they will still answer the ones who are questioning rather than be put off by the attacking ones.
leemac

 
At Friday, May 08, 2009 5:39:00 PM, Anonymous Anonymous said...

Well Dr B

There were three of us who all
saw this assault. Now from my viewpoint trust is imaginary. As
children we are taught to trust the
police, the doctor and our teachers
and parents. Yet as we grow older
and wiser we realize that in essence,you can't trust anyone.
As we become adults with experience we are confronted with
this dilemma. We are told as children Santa Claus exists,however,eventually we learn
its just a tale.
You read and see on the news
of mothers drowning their own
children,of police officers beating
the innocent and taking bribes.Of
gross unprofessional behavior within the medical community. The
kind of behavior that is unspeakable.
Dishonesty with even presidents
and on and on. Even Einstein had
affairs while he was married. Now
I'm hearing from some female provider on this thread that says
look I have either a md,do,nd after
her my name and that being said I'm
to assume that makes her gender
neutral, perfect thoughts and squeaky clean based on what she
says.
How long do people have to
listen to this garbage. Reminds me
of comments on allnurses when one
nurse did something very unprofessional to a patient, other
nurses write that well I don't do
that. Personally, I couldn't care
less what they have to say.
Many years ago Myself and several other medical personal witnessed a female resident physically and sexually assault a
male trauma patient. She was fired
from the residency program.But it
was what she did next which was
really disturbing. She relinquished
her medical licence for 5 years
on her own accord. Did she do that to keep from having it revoked.You
tell me, despite the fact of facing
a felong charge.


PT

 
At Friday, May 08, 2009 9:28:00 PM, Anonymous Mac said...

How can doctors not know?
Aren't they also patients or do they self-prescribe or does a medical friend just write a script?
If so, they still might need surgery or do you all change the system so your modesty and other requests are fully respected.
I can't believe male and female doctors and nurses have zero modesty and dignity issues...
I know of one male urologist (family friend) who arranged a procedure at a small private hospital and hand-picked everyone who'd be in the theatre. Very express and written directions sent through his lawyers to the hospital.
Maybe all doctors and nurses do that because they know if they don't, anything might happen....they might be treated like us!
Dr, would you make any special arrangements if you needed surgery? Would you request a closed theatre, no medical students etc?

 
At Friday, May 08, 2009 10:55:00 PM, Blogger Maurice Bernstein, M.D. said...

Mac,I was hospitalized twice in the past decade, once for a myocardial infarction and heart surgery and another time for significantly symptomatic West Nile virus infection. I can tell you honestly, I never thought about modesty even once in either of these admissions. My thoughts were about surviving and walking out of the hospital. There are times when overcoming an illness trumps patient modesty. But, obviously, from reading these threads, this is not always the case.

No, I didn't ask for and specifically rejected VIP treatment by the doctors or nursing staff even though they knew me personally or knew I was a doctor at that hospital. ..Maurice.

 
At Friday, May 08, 2009 11:23:00 PM, Blogger MER said...

Doctor:

I would think the medical community would be as diverse regarding modesty as the general population. But Mac does make a good point. Younger healthcare workers who haven't experienced hospitalization or intimate procedures just don't have the personal experience and lack true empathy. Especially men. It's different for younger women, though, isn't it? They know from a young age about this issue.

But older male doctors must know about this from personal experience. For some, like you, it doesn't matter. Others may be too embarrassed to bring it up, especially because they are doctors and don't want to seem as a trouble maker. Or, they don't want people to think they are expecting VIP treatment. Others, though, like Mac said, go out of their way to get things arranged the way they want it.
This probably isn't an issue male doctors talk to each other about. But what's your take on how male doctors feel about this issue when they need intimate work done?

 
At Saturday, May 09, 2009 1:25:00 AM, Anonymous Mac said...

Dr, would you say that's typical of most people in the medical world?
Do you become desensitized to modesty and dignity issues after years of dealing with the human body?
Perhaps, that's why there is a departure in thinking between patients not used to exposure, ours or other people's and medical personnel who deal with bodies all day, every day....
I had to have an ultrasound after a ball slammed into my groin area a few months ago. I was embarrassed when two young females did the ultrasound - I did feel uncomfortable.
I heard them laughing as I left the outer room (where I dressed)...I have no idea what they were laughing at, but naturally, I assumed it was me...probably because I was the one exposed and feeling embarrassed.
I should add I didn't ask for a male technician or make any enquiry about gender.
I was a little taken aback though when TWO attractive young women entered the room. Maybe the second woman was to protect the operator from me.
I doubt you'd use a chaperone who is the same sex as the operator.
The second girl just watched so maybe, she was a trainee.
I did have to send myself elsewhere mentally during the procedure.
I got out of there pretty quickly.
I would probably ask for a male technician if I ever needed another one - it would just make the procedure that much easier for me.
Call me a prude, but that's just how I feel...it's just a bit confronting and awkward having two women concentrating on your groin.

 
At Saturday, May 09, 2009 3:17:00 AM, Anonymous Anonymous said...

There is a difference between being in the hospital for emergency or very serious situations and non-life threatening situations. I'm sure many people who are usually very modest and moral who are in the hospital for heart surgery or for serious trauma issues because of a bad accident think less about their modesty than if they were having surgery for a torn ligament in their knee. I would guess the majority of patients in a hospital or clinic are there for less serious issues. They are the ones, I would think, that we should be considering most during these discussions.

I doubt there are many patients that write on these blogs that complain much for lack of privacy during a life or death situation, but many want to judge those that do complain as caring more for their modesty than for their life. It's the knee surgery and other elective surgery patients that should be given a little more slack for their modesty concerns. Especially when it's so easy to avoid unnecessary humiliation by planning ahead or ignoring dumb traditions like stripping naked under a gown for a shoulder surgery. Just using common sense and treating patients with common human decensy could also go a long way. Why send a female nurse in to watch a male patient strip naked when there are male nurses around? Why expect male patients to accept female techs for scrotal ultra sounds? Why force men or women to have unnecessary exams or procedures (a very hot topic on this blog lately)? Why not schedule same-gender nurses or assistants, especially for common procedures like colonoscopies or vasectomies? It just doesn't make sense.

As has been said very frequently here, it's all about the medical workers convenience and comfort. It's just a 9-5 job for them and the patients mean nothing. The patients are just an obstacle that must be finished before the medical worker can go home for dinner. Mindless objects that have no actual life of their own. No family, feelings or stress of their own. And they call themselves "professionals".

 
At Saturday, May 09, 2009 7:36:00 AM, Anonymous Jackie S said...

During surgical procedures, it's the extra people that make me feel uncomfortable.
I was being prepped for an emergency c-section.
Call me a prude too...
I didn't want the male orderley and male theatre tech watching the catheter being inserted.
I went to a female obstetrician for a reason. I feel much more comfortable with a female doctor for some care.
I refused the procedure and asked to speak to my doctor. (who was close by)
I asked why these men were permitted to hand around and watch something so personal...she immediately asked the orderly to leave and a sheet was held up screening me from the tech.
Once draped, I was fine...
I just didn't want these men watching while something so personal was being carried out.
I asked my doctor (later) why an orderly would even be permitted to hang around and she said people often don't think about that sort of thing, they're just busy doing their jobs.
It's usually up to the patient to say something.
I don't think that's good enough.
I can imagine some odd people might find their way into that line of work when it means they can view people in an exposed state.
I really think patients should be protected and not exposed to anyone who happens to hang around.
I imagine a younger or shy woman would have said nothing and put up with the audience.
I also worry if I'm ever in theatre again and unconscious this time, whether male orderlies will be hanging around for the view and I won't be able to protect myself.

It wouldn't take much time and extra effort to protect our privacy while these extremely private things are being carried out - catheters and shaving.

 
At Saturday, May 09, 2009 8:10:00 AM, Anonymous Anonymous said...

I have had some conversations off the blog with Leemac and Jimmy about attempting to start putting some of this to action. We have discussed among other things a web site, etc. We want to get some more people involved in if nothing else giving us your opinions of what we should be focusing on, what would the site look like,, etc. we would especially like for some of the females whom have posted here to join us. As a starting point, we would like to use the "organize of patient modesty" section on Dr. Shermans thread as a clearing house for comments and to take a step. If anyone interested in this process would go there and join in with comments etc....it might be the first step toward moving from venting and individual benefit to creating something that can be used as a tool for individuals and possibly be the basis of something larger....hope you will join in.....alan

 
At Saturday, May 09, 2009 10:40:00 AM, Anonymous lady patient said...

Dr. B, If a patient requests on their consent form that no non-essential observers be allowed in the exam room, operating room, during screening procedures, etc., is that request legally bound to be honored?

Or is there better wording than "non-essential" that could not be parsed to violate the spirit of the patient's request?

 
At Saturday, May 09, 2009 10:42:00 AM, Anonymous Anonymous said...

Mac and Jackie- my feelings exactly. I had a surgical procedure and was told a male would do the shave and prep for a groin procedure. I was knocked and I only afterwards my spouse and I learned "it was a big fat lie."
How unethical is that? I was infuriated and upset as was my spouse. This should not happen to any patient.

 
At Saturday, May 09, 2009 2:55:00 PM, Anonymous lady patient said...

Anon (10:42 am) I'm confused. Did you request your preference for a male to prep you via the consent form or verbally? Who was the person who reassured you it would be a man, and who was the person who revealed the truth afterwards? When you expressed your outrage, what was their defense? Please finish the story for us so we can better prepare ourselves in a similar situation.

 
At Saturday, May 09, 2009 5:12:00 PM, Anonymous Anonymous said...

I had a clear and concise discussion prior to surgery with the medical director who was also my anesthesiologist. I specifically asked about the shave/prep. He assured me my male surgeon would be taking care of it.
I learned afterwards from the surgeon this was NOT the case and NOT the routine and normal protocol. My take on this is that I was intentionally lied to for THEIR convenience. They KNOCK you out and do their THING.
Clear all this ahead of time and get it in writing. This will never happen to me again. Once a patient is OUT... forget your rights and god only knows what goes on and who all is there to see and handle your genitals.

 
At Saturday, May 09, 2009 5:14:00 PM, Anonymous Anonymous said...

Sorry..post script to my post. They had no defense. No appology, no answer. I am sure they have lied to many people just like they lied to me. It was "you must have misunderstoo."

 
At Saturday, May 09, 2009 5:50:00 PM, Anonymous Mac said...

The fact remains...you still have no idea whether your wishes will be respected when you're out.
It would rely on someone reminding everyone of your wishes (when you might be patient 4 of 8) and making sure your wishes are respected.
I wonder whether it's more likely you'd just go into the "system" and never know...
Might not they also say, "this patient wanted a male nurse, so don't mention this to him"...the cone of silence theory talked about earlier in this blog.
I think the only sure way you'd be sure your wishes were respected...is to have YOUR rep in the suite - someone being paid by you...someone vested with the responsibility of ensuring you're prepped according to your instructions, other people are kept out of the area.
I'm sure they'd be as welcome as a meat tray at a vegetarians picnic, but I think it's the only way.
Someone looking out for you.
I wonder whether hospitals would accept such a proposal.

 
At Saturday, May 09, 2009 6:58:00 PM, Anonymous Anonymous said...

A record is kept of everyone present during any surgery and of anyone who comes in and out of the room. It is thoroughly documented.

 
At Saturday, May 09, 2009 7:32:00 PM, Anonymous Abby said...

Giving birth in a public hospital is a nightmare.
Women are treated with no thought for their modesty or feelings.
At one point...I had 5 men standing around staring or examining me.
I had no choice of doctor and no control over the people in my room.
How can you concentrate on giving birth when you're the main act at a circus?...exposed and out of control.
I wanted to be left alone with one female midwife and had been told ahead of time...that was fine.
Instead I was taken up in a system that left me feeling distressed and stripped of dignity.
My daughter's birth was an ordeal...it was a normal birth and I didn't need all this medical intervention.
It was an ordeal...not because of the pain...rather the pain that comes from being treated like you're dirt.
I'm normally a reserved and quiet person...but after becoming very distressed, my husband managed to almost clear the room.
When two more men barged into the room, he bellowed at them to "**** off"...he later apologized and was very embarrassed but felt he couldn't protect me and hated watching the way I was being treated.
He said it reminded him of an injured helpless creature being attacked by a pack of wolves....gathered around tormenting, humiliating and hurting me.
I can't deny it...we both hate doctors now and stay away from them. We fear them and their power.
We're people and want to be treated like we matter. My husband wondered whether they'd allow their wives to be set-upon like that...
We now have insurance which will give us some protection in case of an emergency. I pray we never need it.
We are not having more kids. I'll never recover from that dreadful experience and would never risk going through it again.
I didn't survive...it has caused a lot of mental and spiritual damage.
I've typed "I"...but in fact, it should be "we"...my husband was also distressed and still feels angry he couldn't do more to help me and shelter me from the "brutality" of it all.
When did giving birth become a brutal thing and that has nothing to do with the actual birth?...more the medicalization of birth...the management of birth.
My husband thinks medical people have their souls removed when they start working.

 
At Saturday, May 09, 2009 8:02:00 PM, Blogger Maurice Bernstein, M.D. said...

To Abby and others,just to show a potential consequence of all the negative talk about doctors and their work and behavior, I am copying a recent posting on the "I Hate Doctors" thread by MD2B. We all need doctors but I am sure more students than MD2B may come here or on other forums and find that the waters they had planned to enter is not as inviting as they had hoped. ..Maurice.

yes I will be graduating (in 9 days to be exact) from a good school, going to a good residency at a top program after working countless hours with a lifelong goal to get to this point. I did so with what I believe was a naive ideal that I could/would help those in need. Only now at this late hour do I realize how hollow this all is and the depth of hatred the public has for us, how little they want my/our help. I do not want to do this anymore. I do not fear the debt -I just wish I could have my 20s back.
MD2B

 
At Saturday, May 09, 2009 8:04:00 PM, Anonymous Anonymous said...

There usually aren't that many people in the room for a routine birth. Often it is a doctor and two nurses. Were you in a teaching hospital? Why didn't you just ask anyone there you didn't wish in the room to leave politely but firmly?

"I wish to have a private birth with only necessary licensed staff present. I don't want any students or extra personnel involved. Thank you for leaving in prompt fashion."

 
At Saturday, May 09, 2009 9:13:00 PM, Anonymous Abby said...

I don't want to hate anyone.
It sort of feels self destructive to feel hate for any person or group.
I hope we can see past this one day.
Yes, it was a teaching hospital. We thought we'd get the best care at a large hospital and we were unlucky that I got pregnant before we arranged insurance so we didn't really have a choice.
We didn't have the money to pay for private care.
We were using contraception but I got pregnant anyway.
You learn the hard way.
I think we were ineffective standing up for ourselves.
We're both quiet people. (usually)
It was only when things got out of hand that voices were raised and we spoke rudely to people. That wasn't the first step...we were pushed to that point.
I was also very unlucky to get a male midwife and nurse. Just horrible...what woman wants to give birth amongst a crowd of men?
No one else was available...so we were told.
Maybe the other women rejected these men so I got stuck with them...the woman least likely to complain...at the start anyway.
I've been told since by a few people that as a public patient you have to take what comes, you're not in a position to pick and choose with free health care.
I accept that to some degree, but surely we're entitled to some kindness and consideration.

 
At Saturday, May 09, 2009 9:38:00 PM, Anonymous Anonymous said...

I do not want medical students coming in here (or any provider for that matter) and only get that they are hated out of this blog....when that is NOT the case..In most all postings you will see it is a manner of how a patient was treated that they hate nearly all of the time...notthe provider...although they may be pretty ticked off at the provider.
I thik if they will use the postings to see what and why the posters are so angry they might feel better...and get a lesson it seems is not taught so well in teh classroom.
leemac

 
At Saturday, May 09, 2009 10:24:00 PM, Anonymous Sandra said...

Male midwives and nurses...
Why have them in midwifery if they have to be forced onto the women unlikely to complain?
Some women have male doctors and develop a trusting relationship during the pregnancy. I think it's very different when some bloke strolls into the room, a total stranger.
My sister refused a male midwife and after a bit of fuss, a female was found.
She was told that the male midwives are often rejected and other women will reluctantly accept them...so why bother employing them?
If women have clearly expressed their preference...it just seems insensitive to me and unfair to everyone.

 
At Saturday, May 09, 2009 10:40:00 PM, Anonymous Anonymous said...

Cripes...we willnever get thecahnges we want if we drive existing doctors/providers away from the discussion...and we are sure going to be in a pickle if the students who read our comments change majors...one or more of them might be the ones who are instrumental in changing how we are treated...
I hope MD2B was just having a bad day and got the jitters...It would be a shame to run someone off who wants to help people...Maybe he/she will realise there are cretans on both sides of the fence..or that often it is the circumstance and not always the provider folks are mad at.
Sorry you had such a terrible experience , Abby.
leemac

 
At Sunday, May 10, 2009 5:06:00 AM, Anonymous Anonymous said...

Yes, Mac, I will insist on having a "patient advocate stand-in" for future surgical procedures when I am going to be knocked out. You are right, no way to absolutely know otherwise. I too am on the verge of "hate" for the lying medical profession. And as far as documented charting, all I can tell you is that what is suppose to be documented doesn't always happen. It is "s*it in, sh*t out" as they say. My chart was NOT documented properly. Just because they are "suppose to do things this way or that" doesn't mean anything. Dream on. Does anyone really think they are going to really write down every person that has walked into the room? The circulating nurse has the job of charting since she is not sterile.

 
At Sunday, May 10, 2009 7:29:00 AM, Blogger Maurice Bernstein, M.D. said...

AN INVITATION: There are currently 690 thread pages on this blog, of course 17 are specific for patient modesty and a couple each specific for "I Hate Doctors" and the good and mostly the bad of hysterectomies. That leaves 669 threads comprising many different aspects of clinical ethics, the medical system, medical education, politics related to bioethics and much, much more. Of course, these patient modesty volumes bear the greatest readership (but still less than 25 percent of all the visitors), however the most written to.

I suspect many of the visitors to these patient modesty threads have other interests and concerns about the medical system and the ethics of practice or would be interested to learn what clinical ethicists or hospital ethics committees do. Answers and discussions of all of this an more can be found beyond these patient modesty threads.

I want to invite all the visitors here to enter a topic or pertinent words into the SEARCH BLOG field on the top of this page and either press return or click on SEARCH BLOG button and then scroll down to find the topic which interest you.

I think it would be refreshing for your thinking to look at and consider other processes and issues in which bioethics is involved these days and then, if you desire, to write comments on those threads about your views of the subject.

I am not trying to get any of my visitors here to leave the topic of patient modesty prematurely but I did want to inform all that there are here 669 other topics here since when I started this blog in July 2004. By the way, if you write comments on other threads, please use your current pseudonym so I and others can still recognize you from this thread. Thanks for your consideration of this invitation. ..Maurice.

 
At Sunday, May 10, 2009 4:07:00 PM, Anonymous Anonymous said...

Discrimination is without a doubt one of the most ugliest words in the human vocabulary
and yet every day of every year
this is what male patients endure
when seeking healthcare. They are
faced with a lack of respect and
privacy compared with female patients.
What is the point of bringing
female providers to this site and
having their side presented. What
possibly would I want to learn from
these people. There is nothing to
learn, just avoid them!
To clarify my point would you
have a website for blacks who where
discriminated against by other races, to have viewpoints presented
by those that discriminate. This
problem is much more involved than simple modesties issues. They should not be given the opportunity
to make any response.
Furthermore, the problem is compounded by the fact that most
medical facilities work very hard
at covering these things up. It's
called damage control. They don't
want the public to know too much.
But once in a while events get
out to the news media. To the astute observer one must ask, how
often do these things really happen? Some months ago I spoke
with a medical malpractice attorney
and after introducing myself stated
that I have previous healthcare
experience. The question I asked
was "what is the most difficult
part of your job?"
His comment to that question was
extracting the truth from medical
facilities,in other words sifting
through medical records and charts
and discerning the coverups.
I'd like to share something I've
known for some time and that is
this. In the beginning, male physicians were initially the sole
cause of discrimination and privacy
violations for male and female patients. By ignoring one of the
oaths of hippocrates, "I will respect the privacy of my patients."
By ignoring this single aspect of their oath caused hundreds of
thousands of privacy violations during military induction exams for males. They willfully allowed
non-medical female observers during these exams. They have encouraged unnecessary medical exams of women in surgery by residents.
They have set the stage so to speak for all that was to come.By
allowing nurses and cna's as well
as secretaries essentially to stand
and view medical procedures.
There truely are few medical
procedures whereby you really need
an assistant. Just about every
procedure tray from a lac kit to
a lumbar punture to even a hip
prothesis tray is already set up.
Would you really need your wife
or your girlfriend to hand you a
socket wrench to drain the oil.
I once assisted the orthopod in a hip pinning. I didn't need someone to hand me a lag screw
from a mayo stand, I got it myself.
I really can't understand why a
urologist needs an assistant in
a vasectomy. Everything is right
there on the tray, five or six items. It seems everyone likes an
audience. Once I responed to a level one trauma. When I arrived
in the trauma bay I was stunned to
see over 30 people standing there for this one trauma patient. There were 3 or 4 non-medical registration people. Two
respiratory techs, 3 people from
radiology, two nurses from surgery
a trauma anesthiologist. A trauma
surgeon, two residents and 3 er
nurses not to mention a slew of
fireman and ambulance drivers.
There were 3 folks from hospital
security and others I didn't even
recognize. The trauma was by mech,
meaning due to the severity of the
accident the patient due to precautions was brought in.
Now over time nurses and cna's
have taken on more of these responsibilities from the physicians and of course old habits
die hard. Many female providers see
male physicians do things and assume that it is ok. Many of these
behaviors were a learned response.
Certainly not what they learned in school but that the example was
set. Over the last 20 years we are
seeing these same bad habits only
now they are being carried out by female providers. Now the assistants are females as well you
see because the stage has been set.
To bring about change must be done by example as you are not
going to change opinions of female
providers and some male providers
for that matter. To make this
change will require a challenge of the status quo such as a clinic
featuring men for men as an example.
Recently, I saw an advertisement
of a cardiac cath lab at a local
hospital. What shocked me not only
were there 38 employees for this
cath lab, but that they were all
women. You can't tell me that they
could not find one male nurse.


PT

 
At Sunday, May 10, 2009 6:00:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, by what you write you bring up an important point that itself needs to be discussed and to see if others agree with your conclusion. What you are writing essentially is that the issue of gender selection in patient modesty issues is a settled issue and that there is no need for any explanation, excuses, documentation of facts, detailing nuances of practice and so on and so on by those who don't hold your view or by any healthcare provider who wants to make a rebuttal or wants to defend themselves or wants even to take your view. They just need not appear. The story is over. Does this mean that the series of threads on patient modesty are over and nothing further on this issue ever needs to be discussed in terms of the ethics or right vs wrongs or who is responsible? Has all the facts, all the attributions, all the accusations, all the descriptions of the misery and emotional suffering been sufficiently and totally been documented here so that there is no logical reason to accept any contrary view from anyone but particularly a healthcare provider who wanders into this blog?

If I have over-exaggerated your point of view, please let me know. But I would like input from the other participants here whether they think the issue of patient modesty has now run its course in terms of attempting to listen to both sides and, in fact, there is no "other side". Period. ..Maurice.

 
At Sunday, May 10, 2009 6:46:00 PM, Anonymous Anonymous said...

Dr. Bernstein
I couldn't disagree more, I think we may be venting from time to time, I think we sometimes stray from modesty issues...but I think the thread has by no means run its course. The issue is we are so one sided, I have had numerous personal "victories" since coming to this thread. I have also gotten a little different view of the other side...the problems I see are:
1) we can't attract providers into the discussion and scare them off when they do come...to be honest I don't think providers take criticism to well or like to be challenged, coupled with our tendency vent on them vs discuss,,

2)while venting is of value, to doesn't change much...Leemac, Jimmy, and I have been trying to connect without much luck...but we don't seem to have much luck getting this to move to action...we are tryingn to get an exchange going on Dr. Sherman's "organize..." section without much luck...

Still some potential here...just don't know how to tap it....alan

 
At Sunday, May 10, 2009 7:33:00 PM, Anonymous Anonymous said...

My two cents...The discussion has only begun..it is jsut beginning to be a discussion...(Which take two sides..or it is...of no value)
If the "other side" does not appear...it becomes a crying club...not a debate..not a discussion....everyone needs to be heard..WHY? Because that is our biggest complaint on here..(go back and read)...that no one listens to us...well it takes both sides..and if we do not let others of differing postions debate us...we will never achieve any of the things we want nor should we...because we are just like those who will not listen to us...
Because..they won't even know why I want any changes..or what they are. AND I won't have any idea why they do as they do..so I can't offer alternatives.
leemac

 
At Sunday, May 10, 2009 9:31:00 PM, Blogger MER said...

I think PT may be expressing an individual opinion here. Let me know if I'm wrong, PT. As a patient, if he says "no," he means "no," and doesn't really want to discuss it. He doesn't want to hear the other side or to be asked why he feels the way he does. There's no discussion. That's how his feels, these are his values, and he expects that either his values will be respected or, at least, he'll be told outright "no," we won't respect your values.

That's the "rubber meets the road" aspect of this issue for PT, as I read it. I think he's saying that although there is another side, he isn't interested when it comes right down to an actualy encounter.

This is part of the problem with this issue. There is a distinct line between the real and the theoritical. We're mostly dealing with the theoritical on this blog, with the exception of case studies or anecdotes. There are people who have actually had many experiences with this, some of them bad, and others who have had little or no experience with this issue.

The real is how men have to actually, realistically deal with this issue either proactively or at the moment it happens.

If PT is suggesting that there's nothing more to discuss and that any theoritical discussion has no value, I disagree. But we are repeating ourselves a lot on this thread. That's okay and will happen as new people come on.

It seems to me that, although PT may tolerate the other side discussed here, theoritically,he certainly doesn't want, when he says he wants a male nurse, someone to start "discussing" or "debating" or presenting the "other side" to him at that point. For PT, it's decided.

If I"m off base here, PT, let me know.

And PT, I would still like that article reference you mentioned earlier.

 
At Sunday, May 10, 2009 10:09:00 PM, Anonymous Anonymous said...

MER....I do not disagree with PT saying no when he is saying it about some treatment or if he is being issued a female provider when he wants a male....In those circumstances I think we all should be firmer in expressing our preferences. I do think that in our discussion here we need to get the providers to talking..Maybe we will then not have to get so tough when we are confronted with real life circumstances.
leemac

 
At Sunday, May 10, 2009 11:07:00 PM, Anonymous Katie said...

The only way to force change is to speak up, refuse to accept a doctor or nurse you don't want and complain if you face difficulties.
Last Friday I had an ultrasound of my right breast. Over the phone I mentioned I'd need a female operator. Fine.
While I was at reception, a man arrived for an ultrasound...he sheepishly asked the receptionist/nurse (in a quiet voice) if he could request a male operator.
The woman replied, "You want a MALE...that's a strange request"...
The way it was said was IMO clearly intended to embarrass the young man.
I couldn't help myself and said, "what's strange about that?I just asked for a female and got it"...
A short exchange then happened between the male patient and myself...we agreed same sex was better for some things.
It was clear he was pleased to have some support.
The nurse/recep then said, "Okay, fine...you'll have to wait 20 minutes"...
I really believe speaking up is the answer and not backing down.
BTW I had been reading this blog the night before which probably made me more sensitive to the nurses comment and tone.
It also reminds me of the problems women faced years ago when there were few female doctors. It took us a long time to get past having to explain our "strange" requests...it seems your fight is just starting.

 
At Monday, May 11, 2009 8:58:00 AM, Anonymous Anonymous said...

How can we use the current status of health care growth to implement more males being trained and hired for nursing and as techs such as for sonograms etc.
It may be that with health care agreeing to reduce unnecessary tests this is the time for the ladies to get a reconsideraion about the need and effectiveness of breast exams and cervical exams.
A major hospital in my area just recently opened a new ER...all private exam rooms instead of a ward-like affair with curtains...now the concern has shifted from exposure to abusiveness because of the arrangements...it seems there are times when there is no perfect cure..
leemac

 
At Monday, May 11, 2009 9:56:00 AM, Anonymous Anonymous said...

Thankyou Katie...sometimes support as you gave the guy about his ultrasound tech gender preference does more good than just for the guy at the moment...it also makes some impression on nurses and receptionists that not all guys are so eager to have a female view/manipulate/examine/test private parts...some guys ( a lot I really think) want the only female in that postion to be their spouse. Not all of us want to get as many females to see/touch us as we can get.
It is so great to have a female speak up in defense of our feelings instead of laughing /ridiculing us and saying the same old stereotypical cliches.
leemac

 
At Monday, May 11, 2009 11:11:00 AM, Blogger MER said...

Thank you for that story, Katie. These are the "rubber meets the road" incidents where we, as patients need to support each other. As I've said before, as a patient, I could go either way depending upon how respectfully I was treated. But that's the key.

If a patient requests same gender care respectfully and as met with a response like that -- that's blatent discrespect and needs to be dealt with directly.

If I were in the situation that the young man was in, as Katie described it, I would declair war. If a patient civilly and politely requests same gender care and gets a snide remark like that man did, we need to fight back. If we overhear this happening to a patient, we need to join in the fight -- back each other up.

Now, before going to "war," it might be a good idea to engage in a "reeducation" or "resocialization" program with the offender. I'd be willing to try that. But you've got to be ready with some good, rational arguments. Force them to defend their position. Force them to define what patient dignity means and what patient comfort represents. Push it. Force them to confront the double standard. Force them to look at the gender inequity in the medical workforce. Do it openly. As to speak to supervisors. Write letters. Work you way up to the top.

If that doesn't work, and if the unprofessional, uncivil, snide remarks continue, go to "war." At this point, I would not be averse to embarassing publically the offender just as they try to embarrass the patient. I grant, these may sound like extreme measures to some,and each patient individually needs to assess the situation and decide where to go with this. But sometimes extreme measures are necessary. Education is not always a pleasant process. There is such a concept as learning the hard way. Sometimes direct confrontation is the only thing some people respond to. They may be embedded so deeply in their biases that they can't see anything outside of their little world.

But in this thread, we need to discuss strategies, examine case studies like Katie's, and then practice these as they occur -- then report back and explain what happened.

Note that the modesty issue is rarely part of any patient advocacy webpage or blog. I found a few of these blogs and tried to get them to include a page about this. They were very reluctant to do so, In fact, I wrote up a summary for one of the patient advocacy blogs and they edited all the important, direct, straight talk right out of it so the final product was meaningless. Why?

I later learned that the blog was run, not by patients, but by medical personnel. That's the key. We need to create a patient advocacy blog or thread run by patients. Blogs like this, run by Dr. Bernstein (and Dr. Sherman's) are rare in their openness. Ideally, patients and doctors can work together on this issue, as with this and Dr. Sherman's blog, to bring this issue to the forefront.

But eventually, we've got to go public with this into the mainstream media. It will be risky. The world view of the mainstream media is as gender neutral as the medical profession, at least theoritically. But once this issue gets out into the open, into the genderal public mind, the response, I believe, will be astonishing. People will come out of the woodwork, realizing that they are not the only ones who feel this way. The medical field will be stunned and will quicly respond out of self-preservation.

This is the direction we should be heading.

 
At Monday, May 11, 2009 11:42:00 AM, Blogger amr said...

TP, I could not agree with you more (or Dr. B for that matter) regarding the trashing of those we wish to join meaningfully in this dialog. COOL IT !! What makes this blog singularly unique is what is turning into a massive tomb regarding this issue.

Dr. G. I want to personally apologize for LT's remarks. Although I have no idea who this individual is, I too have found your comments invaluable to this discussion, and I hope that you continue to participate. Your comments about working to mitigate the modesty issue means that you are sensitive to the issue and are working to deal with it. That is appreciated.

Anon: May 8, 2:58 pm: Did you forget to id yourself :) Dr. B did not censor. In fact, he did just the opposite, he published the comment and gave a very strong response as to why it was inappropriate. And, he printed your strong comments. It is also the case that LT's strong feelings could have been voiced without attacking Dr. G.

What Dr. B has done is to provide a forum that is beginning to take off with respect to number of contributors. It is interesting and insightful. IMHO, neither of your entries foster dialog that leads to a fair discussion of the issues. Flaming might be appropriate on other blogs - it has no place here. There are clearly strong opinions, and where people say they have found this blog useful in how to better interact with docs, it has been a fine public service. There is room here for strong feelings - not personal attacks. Hopefully it will be these strong feelings and discussions that can be the basis of change in the medical community.

Good for you Katie - Sunday May 10!

I believe Katie's story, Dr. B, goes to the argument that as patients, we see this issue regarding physical privacy and modesty as how the entire set of people within the medical community treats patients. Thus a broad brush of discontent is painted across the entire profession - including docs. It is the case however, because docs are at the top of the heap (if not the institutional managers), the tone of the institution is set there. If the leaders set the tone on modesty, the corporate culture would begin to change. Thus, I hold management responsible for this issue.

---------

Dr. B, you could have a grad student in psychology possibly do a breakdown analysis of this blog, and it could be published.

-------

I remain interested in this issue in that the medical industry routinely sacrificing patient physical privacy for the perceived public good as defined by the "profession". It is the body (asexual) that is after all being treated. The one that keeps coming up in my mind is self-serving cameras in the OR. Either sign away your right to physical privacy, or don't get the surgery. (Doesn't this sound a lot like-- No pap, no BC drugs?) Not being given the choice really gets my motor running.

Take for instance the following site: VTS Medical SystemsIf you click on the picture of the OR, you will get a detailed description of the electronic equipment. Notice that there are cameras with feeds showing the entire OR room (#5), Light handle light (#3), and this setup would allow for any number other camera angles. All you need to do is add cameras. This room is anything but private. This is not the only website. There are many international companies competing to sell this technology world-wide. It is out there, you simply need to look. They are making no bones (pun intended) about this technology deployment. As it is placed into more and more hospitals, more and more of us who need surgery will be compromised. As I have said before, there is a lot of good that comes from this technology - but undoubtedly at a price to patient physical privacy.

Slight change of subject:

Medicine is self interest driven in most cases. Drs today have massive bills to pay from school and are being pinched by the insurance companies for how much they can charge for services.

Thus if a doctor "allows" a patient to gender select per se, it means that there might be fewer patients to be seen and thus less revenue made. It is also taken personally - docs see themselves as providing for humans, not males or females.

Take as evidence the appearance of all female ob/gyn practices that discriminate against hiring male docs. I have also read that male docs today are being guided away from gyn practice. This should inform even the casual observer that gender does matter - to the patient. Thus, I do have difficulty believing that doctors are not aware of this issue.

Self revelation: Although I came to this blog because of issues pertaining to my wife's DCIS cancer surgery, I see a female GP.

I am thinking about leaving her however for a male MD. Besides the fact that she dropped my insurance carrier and she now no longer takes credit cards (both economic choices), I'm not sure looking back that she been as thorough in my examinations as I remember my male GP was. At my next yearly, I plan to discuss this with her.

--------

Dr. B - your May 7 comments 7:24pm "professional"

"Becoming and being a professional such as a physician, lawyer or nurse, as examples, is characterized by a guiding and scrutinizing organization or organizations with duties for establishing criteria toward the professional education with accreditation of the educational institution,certification of the idividual, standards of behavior and codes of ethics that must be followed or else the individual is removed from the profession."

It is, in fact, fairly difficult to defrock a doctor. The very organizations that "frocks" a doctor goes to great lengths to make sure that a doctor remains "frocked" even in the evidence of wrong doing. This is the very same organization that you point to that provides the "profession" credibility. There are any number of examples in the news about doctors who have acted criminally still being allowed to practice medicine. It would also appear from the court cases as reported by the news that the judiciary is overly deferential towards doctors misdeeds. Also there seems to be more incidence of sexual wrong-doing among doctors versus the general population that either goes lightly punished, no not punished at all.

When you put the two of these together, it might be considered that the word "professional" in some cases is a shield rather than a badge of honor.

I believe that the few bad apples, and the professional organizations that protect them are to blame for the sometimes strong feelings of impotency voiced herein.

If we are to hold doctors to the higher standard of "professional ethics and behavior", then the professional organization that certifies said professionals must as well hold its members to that higher standard. But, follow the money - this isn't going to happen any time soon.

When my wife's surgery was invaded by a salesman, and documented in the med-legal docs, her surgeon failed to inform us that a breach of our specific opt out had occurred. Had he told us that it had occurred and he had immediately dealt with it (which he did), the matter would have ended there. But he did not. We found out about it months later after reading the surgery docs. Letters were then written to him and his defense (without apology) was that he was not going to inform us about a breach that he immediately handled. He clearly was counting on the fact that we would not find out. It doesn't take much to begin questioning the "professionalism" of a doctor when this sort of thing happens. The point is that he made a decision to protect himself and the institution rather than volunteer a breach. I believe from a med-legal standpoint, this is common. This is the nature of medicine today and not the competency of this doctor. However, the doctor is tainted by this behavior. There is a well warn tenant in legal circles. If there is something bad that might come to light, it is better for you to bring it up first before someone else does. (I have seen this in practice, and to a large extent it is true - and it works to mitigate the "problem".)

Having to deal with this breach though did effect the relationship. I'm sure he has been taught never to apologize if a possible legal action is possible as a result of the given complaint.

Change of subject (again :)

Lmac - Wed May 6:

My wife was diagnosed with DCIS and ended up with a mastectomy and several cosmetic surgeries. She is a small woman and the DCIS mass was percentage wise large enough such that she was not really offered the choice of "wait and see". The problem with DCIS is that the docs never know when this stage 0 cancer is going to break out and become invasive. Docs want to treat the patient and are taught to preserve life. Thus, often times, absent real evidence, they want to be aggressive in order to preserve life. There is a raging argument about how aggressive to be with DCIS, and it depends upon what school your doc is from that determines how that doc is going to recommend treatment.

But this is true of many types of illnesses - with multiple approaches to treatment. Today, in our world of malpractice law suits, the docs do not want to take heat for a course of treatment that might not turn out well. Thus, we as patients are asked to become the experts in our own care. If we are forced to choose the course of treatment, then the doc is legally off the hook.

Ok, that's enough for now….. :-)

-amr

 
At Monday, May 11, 2009 12:03:00 PM, Anonymous Anonymous said...

I had to have an ultrasound of the pelvis and I called around to several area hospitals only to learn that few employeed male techs. I made an appt but had to wait 6 weeks due to the fact that the only male tech on staff was going out on an extended vacation leave. When I arrived for the appt he was surprised that I waited for "him" to return. His response was -- well, I do female patients. So this was to mean that I should have accepted a female tech and my preference had no credence? Where are these people coming from ..what planet?

I am glad this man spoke up and made his request. If they hear this more and more maybe just maybe they'll begin to "get the message!"

leemac's statement of the new ER is happening even with regard to patient's rooms. Many hospitals now have private rooms where a spouse or parent can stay with the patient overnight. Pull-out couch, linens provided, etc. It's about time.

 
At Monday, May 11, 2009 1:08:00 PM, Blogger MER said...

RE: "When I arrived for the appt he was surprised that I waited for "him" to return. His response was -- well, I do female patients. So this was to mean that I should have accepted a female tech and my preference had no credence? Where are these people coming from ..what planet?"

This is the point where we, as patients, need to respond. I'm not claiming it's easy. We may feel intimidated. But if we can jump this fence, this is where we'll make a difference. Unfortunately, most patients clam up at this point and don't know what to say.

As I've discussed before, there is a conscious attempt in the medical culture to resocialize patients, to push them into accepting, willingly or not, opposite gender care. So -- let's, as patients, start resocializing medical professionals. Don't let them frame the discussion. When they say things like "We're all professionals," or "We've seen all this before," that's them framing the discourse with a focus on them. That's where we need to reframe the conversation and do some resocializing ourselves.

I have to believe that most professionals will respond respectfully and civilly if we remain that way ourselves during this education resocialization process. If they don't, we need to become more assertive. This is where respect for patient personal dignity comes in, and I have to beieve that most doctors, nurses and other techs will at heart understand. If they don't, make them confront the reality of this issue.

Would anyone be interested in some sample dialogues? I'd be willing to start with an examples like the ones I've recently discussed, and create a "script" with how we could approach this issue. It would be a hypothetical dialogue between a challenging patient and a doctor, nurse or medical tec h. Let me know if anyone things this might be valuable.

 
At Monday, May 11, 2009 1:44:00 PM, Anonymous Anonymous said...

amr.. I hope all is well with your wife and am glad that the mass was detected..my point is solely that so many of the ladies are opposed to many tests/exams and think they are used to often...I do not know which side is right, but I have said earleir...all teh information must be assembled and a decision made on therapeutic value and not just a determination by a lawyer (few of whom are versed in medicine enough to have so much say)
I need to have my prostrate med prescription renewed...I know I will have a DRE because my doc does not just renew prescriptions cause ya want him to. When I go in I know what to expect..(implied consent??) as long as it is him or his male PC-A I do not care that much. No, it is not going to be the highlight of my day, but I am more embarrassed by the dribbles than the exam...So I have no problem with anyone of either gender getting gender specific exams...but somewhere it has to be their choice..I am less concerned about the exam than I am who will be giving it..( I do not think it is the highlight of a providers day to have to stick his digit in some old guys stinky butt either).

leemac

 
At Monday, May 11, 2009 4:39:00 PM, Anonymous Anonymous said...

DR B

In no way am I suggesting that
this site and your work has been in
vain. In fact, a lot of good has and will come from this site. This
site will be a springboard if you
will for change. What I've said is
that we are not going to change the
attitudes and perceptions of a few
straglers who happenstance upon
this site. You can never change
the attitudes of those that
discriminate. You've seen it by
their disposition on this and
other sites.
Personally, I don't want to know why they discriminate as it
means nothing to me,therefore,why
should their opinion matter? What
I think matters is that we need to
move this issue forward,placing it
in the forefront of public opinion.
That will require placing this
issue in the public limelight and
letting it fester. I know it to
be fact that many nurses from other
nursing forums frequently peek in
on this site. Not that they are
enlightened, but this forum just
makes good reading for them. They
enjoy the double-standard as it
creates many advantages for them.
Many hospital ceo's will tell you that opportunities are there for facilities willing to change to attract new patients. I am the
customer,the client and the patient. I am seeking a service and
as such I am paying for it. For many of those that contribute to
this forum there contributions too will not be in vain either. I have
some ideas that I'd like to share
with the regular contributors on
how this might be done.

Respectfully,Mer I am digging out
that issue of Discover magazine and
will let you know.




PT

 
At Monday, May 11, 2009 5:13:00 PM, Anonymous Anonymous said...

MER, AMR, Ann, Katie, Jilly and anyone else who feels so lead, we are trying to gather thoughts and ideas on how to move this forward. We are trying to get a core to help design a web site for patient rights/privacy. If you would share your thoughts on Dr. Sherman's site under organize for ...your input would be greatly appreciated. Same with you Dr. Bernstein though I think between this and your day job...you have plenty going....

 
At Monday, May 11, 2009 5:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous, thanks for the invitation but beyond suggestions I have made in the past regarding an activist approach, I have nothing further to add. Though I appreciate now the concerns many have about the aspects of patient modesty as written to these threads, I, myself as a potential patient don't have the same concerns. As I have said previously, I am more concerned about the medical outcome.

As moderator of a discussion blog, I want to personally take a neutral stand and moderate without prejudice and allow views on both sides to be presented here. Therefore, I suggest that an organization intent on speaking out to the community for change should only be comprised of members motivated and unanimous in the same concerns and goals. I am not such a candidate and personally, as I said, want to be neutral in that regard. ..Maurice.

 
At Monday, May 11, 2009 9:55:00 PM, Blogger MER said...

PT’s recent post saying that he wasn’t really interested in the other side of this modesty issue got me thinking. I’ve been contributing to this thread from way back, almost to the beginning. And frankly, I don’t recall any really good arguments posted against protection of patient modesty and gender choice. Let’s look at some aspects of this issue.
All patients deserve to have their modesty and dignity respected. Do we all agree? Any arguments against that?
Patients vary in their attitudes toward their modesty. Some want same gender care when it comes to intimate work. Some want opposite gender care. Some don’t mind either way. Agreed?
One gender should not be granted more dignity than another gender. Both genders deserve the same amount of respect. Any arguments there?
The AMA or other medical organizations do not have definite, specific, objective definitions of “dignity” and “respect,” and “privacy,” especially when it comes to bodily modesty. Perhaps they do, but I haven’t been able to find them. Within reason, the patient gets to decide the definition of these words relative to their treatment. Anyone disagree?
Patients, both genders, have a right to same gender care for intimate exams and procedures. (I’m not including ER, ICU or even some LTC situations). These are the arguments I’ve heard against this premise – (1) same gender isn’t necessarily the best care, medically, probably the best argument;(2) there are not enough male nurses and assts. to give men this choice; (3) the schedule gets in the way; (4) both genders of doctors and nurses need to learn to treat both men and women, another good argument; (5) medical professionals are gender neutral. There may be others. As I see it, the main question is – Do any of these reasons trump the patients rights? Doesn’t the patient have final say in all this, even if the patient chooses not to be treated? Of course, the doctor or hospital can refuse to treat a patient. But who is ultimately in charge? When we defend abortion, we’re quick to talk about the woman’s reproductive rights and control over her body. But doesn’t this body control apply to both men and women? Or is this another double standard.
Patients must be given as much information about exams, procedures, operations, etc. as they request. Patients have a right to request same gender care in these situations. If the doctor or hospital refuses to grant this request, at the very least they have an ethical obligation to tell the patient this, allowing the patient to find another provider. Any arguments against this?
Patients should be asked their gender preferences when it comes to any intimate exams, procedures or operations. The system should try to work with patients who request same gender care. If the system can’t or won’t meet these needs, they need to inform the patient upfront. Arguments against this?
Primary care doctors should know their patients well enough so that, when sending them to specialists for intimate exams or procedures, the primary care doctors know when to help their patients get treatment that matches their modesty level. Primary care doctors should never just send their patients into the unknown, unless they know it won’t bother the patient. Any good arguments against this?
Hospitals and clinics should staff so that both genders have choice (to the greatest degree possible) of gender for intimate exams and procedures. If they are unable to do this, they need to review their hiring practices for gender equity within their workforce.
Arguments against this?
For now, I’ll end here. My point is, in all the 16 volumes of this thread, I have read few if any really good arguments from medical professionals against these issues. Maybe I’m not reading closely enough. Perhaps this is what upsets posters like PT. The lack of good arguments begs the question. Perhaps doctors and nurses are avoiding this thread because they just don’t have any good arguments on the other side. If they do, I’m perfectly willing to listen and take them into consideration. But I would suggest that the arguments be as much patient focused as system focused. There seems to be a great disconnect between the ideals of patient dignity, respect, comfort, and what is too often carried out within the medical culture.
So – any takers? I’m anxious for a good, productive, civil debate.

 
At Tuesday, May 12, 2009 5:15:00 PM, Anonymous Anonymous said...

I've seen and read many examples
whereby female patients have asked
and always been provided same gender care. Yet, when male patients ask they are scoffed at.
This is one form of discrimination
that exists for male patients and
this attitude is often displayed
even when male staff are available.
I'd like to point out a couple of
phrases that can quickly change
this kind of unprofessional behavior. First, simply ask " I'd
like to speak to your supervisor".
Keep in mind that her opinions are
much different than say the core
values of the facility you are
visiting. Most clerks think they are god!
Realize that most of the time the
person who scoffs at you most often
is a clerk or receptionist. Quite
frankly medical clerks, receptionists and unit
secretaries are the scourge of
healthcare. I loathe them almost as much as I do attorneys. They single handedly are the cause of untold mistakes.
Physician calls a verbal order
to a unit clerk for folic acid,
the patient gets a foley cath. The
patient didn't need a foley cath
but now is at risk for urinary
infection or even worse. Physician
writes an order for an angiogram
of the chest for possible pe. Clerk
orders a plain jane chest ct, which
dosen't show a pe and after this
delay the pt expires. Thousands of
mistakes are played out each day
across the nation in physician's
offices and hospitals. I've even
seen surgery performed on the
wrong limb which was traced back
to a mistake caused by a unit clerk.
How do you think they are going
to deal with you when you ask for same gender care? That will be the topic of their jokes that evening at the bar. In fact, a Dr wayne
dyer wrote a book about clerks and
how they want to make your life miserable as well as standing in the way of progress. My second most
popular phrase is directed at female nurses who feel that male
patients are undeserving of any privacy, " Maybe you don't have any respect for my privacy but I do". That one really gets their
attention fast.
Finally, I would like to point out a very important concept. If
you have medical insurance, that
basically says there is an entity stating that they are being financially responsible for you.
That this entity has a selected
network of providers that oftentimes payment has already been
MADE to these providers. Very very
important to appreciate. If you
are not happy with the facility,
complain to your insurance carrier
as they chose these providers under
the impression that they will treat
patients professionally. They pay their saleries out of the payments YOU made to them. They need to be told that you were scoffed at.
Often times this applies to physicians offices but I've seen
payouts to imaging centers and
specialities in advance. I've seen
these providers dropped from insurance carriers due to patient complaints.
Now this begs the question, what
if you don't have insurance. Should
your wishes be respected if you ask
for same gender care. Perhaps, you
plan to pay later or by installments,however, I say that
you do have the right to make
such requests. I say this in
reference earlier based on the fact
that female patients are offered
a choice, why can't you.


pt

 
At Tuesday, May 12, 2009 6:47:00 PM, Anonymous Anonymous said...

A little off the subject but realated. There is a link on Dr. Sherman's blog about a bill before congress that would create a mens health commission similar to the womens heath position that has been in existance since 1990. I would urge all men, and women if so lead to go to his site, there is a link in men's modesty and was one in the first thread to read about it. Please read it and urge your representative to support it....alan

 
At Tuesday, May 12, 2009 7:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is the link to Dr. Joel Sherman's patient modesty blog.

Hmmn..after only 9 days, we are again up over 120 posted comments. I guess I will have to start preparing Volume 17. ..Maurice.

 
At Tuesday, May 12, 2009 10:38:00 PM, Anonymous Anonymous said...

"I was also very unlucky to get a male midwife and nurse. Just horrible...what woman wants to give birth amongst a crowd of men?"


All the female nurses must have been busy inserting men's catheters, giving men their bedbaths and assembling to observe other female nurses caring for men's catheters and giving men bedbaths.

Let's not forget the important jobs of holding a man's penis out of the way during a vasectomy and playing chaperone while a male doctor gives a male patient a full body check.

 
At Tuesday, May 12, 2009 10:50:00 PM, Anonymous Anonymous said...

"We all need doctors but I am sure more students than MD2B may come here or on other forums and find that the waters they had planned to enter is not as inviting as they had hoped"


The Med students should take advantage of a blog like this so they can learn from the other medical worker's mistakes, their incompetence and arrogance and mistreatment of their patients. If they know what bothers those that come here to rant they could learn from it and become much better and well liked and respected medical workers.

If they just lowered their noses and listened to what angry patients have to say they could adjust and become the kind of doctor, nurse, etc. that their patients come to love and respect. Why wouldn't any medical professional want to be the medical person that is loved and respected by their patients?

 
At Tuesday, May 12, 2009 11:12:00 PM, Anonymous Anonymous said...

Great job Katie. I commend you for sticking up for the quiet male patient. I hope I run into someone like you the next time I need an ultrasound. You have definitely learned from this blog and clearly don't subscribe to the male vs. female concept.

DG

 
At Tuesday, May 12, 2009 11:47:00 PM, Anonymous Anonymous said...

Thank you for all the excellent comments on May 11, MER. As I see it you understand to a T what the major problems are with the medical system and embarrassed patients that won't speak up. I also like your suggestion of "sample dialogues".

I also have learned a lot from PT. You certainly have a lot of knowledge about this topic. Thanks for sharing.
DG

 
At Wednesday, May 13, 2009 8:47:00 AM, Blogger t said...

MER,

I also like the suggestion of sample dialogs. Not that I think patients should necessarily used canned responses, but by thinking through potential scenarios ahead of time, it would help them respond intelligently and constructively in their own words.

Katie,

Nice job. By your simple comment, you let an uncomfortable patient know that their request wasn't "weird", and that other patients have the same concerns and desires when it comes to privacy.

.....
Note to all...

Until very recently I hadn't read the "I hate doctors" thread, because I don't hate them. When I did, I discovered someone had posted comments using the same identifier I have been using since I started posting here. To avoid confusion, I have changed my identifier...

Hexancus (the poster formerly known as TT)

 
At Wednesday, May 13, 2009 9:21:00 AM, Anonymous Anonymous said...

Dr> Bernstein, I know you have said you have talked to other providers who seemed unaware of the problem....my question is could you get a feeling of how they felt about it. While I think no doubt we need to temper our responses so as not to chase providers out...we had a female Dr. who did high school physicals looking for help to avoid doing the hernia exam, she ended up here and got roasted...obviously this was someone who cared and we chased her away...on the other hand..there seems to be a lot of providers who want to make their side known but seem unwilling to recognize or even discuss the issue with patients. In some cases it is sort of seems like that God syndrome...I know best for you or even how dare you question me...as soon as the challenge goes down the dialouge stops. Dr. Orrange's post is a little like that, she feels free to make these comments but will not answer questions or challenges to her position. That said the heat got higher and higher on her mainly because she did not respond or responded totally off the subject....I get the feeling providers do not really want to discuss this...all the more reason to be careful with the ones that do and who come here....alan

 
At Wednesday, May 13, 2009 11:44:00 AM, Blogger Hexanchus said...

Alan,

I don't know if it's a matter of being "careful" with the providers who do come here as much as it is being respectful to others and recognizing that everyone has a right to their own opinion.

As I have mentioned several times in the past, I too am uncomfortable with the vitriolic nature of some of the posts. If progress is to be made in understanding both sides of the issue, it needs to be done through intelligent discourse and meaningful dialog. That said, the very nature of the discussion tends to lead towards highly emotional responses, which is where I think it breaks down. Maybe we all need to take a deep breath and count to 10 before clicking on "post reply".

Hexanchus (poster formerly known as TT)

 
At Wednesday, May 13, 2009 2:26:00 PM, Anonymous Anonymous said...

Hex

I agree, I think we are on the same page just using different terms. By being careful I mean how we approach and how we say things not what we say. Don't have to agree, but there is more than one way to say something. To be honest, I still question whether we will ever accomplish that without sometype of intervention from Dr. Bernstein and I hate to put him in that role. I know I get wound up on this and reply a bit stronger than needed at times...I would have no problem if my submission was sent back to me with a please rephrase....but then, I think we are creating quit a burden for Dr. Bernstein as is....alan

 
At Wednesday, May 13, 2009 3:38:00 PM, Anonymous gve said...

I think we need to recognise that there are VERY few outlets for people who feel as we do. The "norm" is that we simply accept what we are given, don't complain and treat doctors like gods. That is not how we have behaved on this thread and more power to it for that reason.

The thread is undoubtedly cathartic to many of us. It serves as a safety valve or way of letting off steam.

Why do we need to be politically correct in here? There are many blogs available to nurses and doctors to vent their spleen, this is OURS.

I rally do think there are many doctors and nurses who visit without posting, they are probably hoping we will go away.

WE WILL NOT GO AWAY OR BE SILENT ANY MORE.

Dignity and privacy belongs to us all, not just doctors or nurses who happen to be hospital bound......

 
At Wednesday, May 13, 2009 7:31:00 PM, Blogger MER said...

Doctors complain about patients, too. I found an interesting website that lists some of these conplaints – 12 of them – most are pretty valid. But one reason in particular relates, I think, quite particularly to this thread. Number 12 reads: “Some doctors just don't want to work with empowered patients. They can't be bothered, or they are intimidated.” It goes on to talk about a notation a particular doctor was discovered by his female patient to write on her records – “petite papier,” which means “little paper” in French. It referred to the fact that the patient did much of her own research and, apparently, the doctor just didn't want to deal with patients like that. See this article at:
http://patients.about.com/od/doctorsandproviders/a/doctorcomplaints.htm

The patient created a site about this where she wrote: “A "Petite Papier" woman is someone who comes to a doctor's appointment, armed with notes and "little papers" (petite papiers in French). Her site is called The Petite Papier Club, and you can find it at:
http://thyroid.about.com/cs/publicawareness/a/empowered.htm

Not all doctors are like this, of course, Some are. And in fairness, patients need to be careful about researching medical subjects they don't know in depth. Patients need to be reasonable. Some aren't. But I think this anecdote highlights the nature of some doctors who just don't want to deal with patients who don't comply with the whole nine yards. They just don't want to bother with it. They expect to be obeyed and don't really want to enter into a partnership with the patient. These doctors probably fall into the group that may not accept a patients attitude toward his or her modesty. Or not. I'm just tossing this out as a thought.

Also, I presented some debatable premises in my last post, hoping some doctors or nurses will present an opposing view. Now, some may not like me framing the premises, so feel free to create your own premise. I've put them in the affirmative because that's how debate premises should read.

No responses so far. This is what I'm talking about. We've had few doctors or nurses give well-reasoned arguments against these premises. They talk about gender neutrality, about lack of male nurses or assistants, problems in the system, scheduling. All reasons, but hardly good arguments when you're dealing with patient autonomy, respect, dignity and values. So...I'm still waiting for some good arguments against those premises.

Once we get to the new volume, I'll try posting a sample dialogue just to see how it goes.

 
At Wednesday, May 13, 2009 9:18:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY MAY 13 2009 "PATIENT MODESTY: VOLUME 16" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 17.

 

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