Patient Modesty: Volume 17
NOTICE: AS OF TODAY MAY 31 2009 "PATIENT MODESTY: VOLUME 17" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 18.
Much has been written here over the past years about how both genders feel about the knowledge and behavior of physicians and the medical system regarding patient bodily modesty. Particularly written about is the patient's need for physical privacy during exams and procedures and the provision of emotional comfort through allowing and following the patient's request for gender selection of the healthcare provider. So NOW IS THE TIME TO SPREAD THE WORD!!
..So we will begin on that theme. How can we entice physicians, nurses and others in the medical profession to visit this blog, educate themselves about the concerns and provide their opinions on these topics? How can the word of patient concerns be spread to physicians and the medical system? The words have so far been defined by the visitors here and now they should be spread! ..Maurice.
Graphic: Spreading the Word: The Street Preacher. A Photograph by Coba.
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.
posted by Maurice Bernstein, M.D. @ 8:22:00 PM
136 comments
136 Comments:
gve I do not argue at all that one of the benefits of this blog is venting. I think that perhaps its even helpful, I thought I was the wierdo until I read this blog and realized there were others who felt as I did. That empowered me to start asking for what I wanted, and I was amazed at what you can get if you just ask. I never asked in the past nor would I probably today if not for finding this thread.
That said, one also has to remember the purpose of this blog. This really isn't our blog, its Dr. Bernstein's blog, and while I am sure he understands and appreciates the theraputic value of venting, he has stated several time the purpose is to open dialog and discussion, to exhcange ideas. My personal feeling is providers are self serving on this issue. The concept of gender nuetrality servs their needs not those the patients. There is no reason for them not to ask about patient comfort, and there certainly is no reason for them to not accomodate patients when they can. To not do so is saying your comfort is not as important as my agenda and what I think, or at best..I know best which is condecending in my view...The question becomes what is the purpose of this thread and how can we achieve that. If the purpose in addition to venting is to get some positive gain in this area and or exchange ideas and engage in conversation...you need two sides to do so. I personally think on of the biggest problems is providers do no WANT to engage this topic. They have their minds made up, the have their thoughts and feelings on this, and some even take it as a personal affront that you would challenge that, in doing so you are challenging them. Starting from that point I think the odds of getting a provider to post here after reading these posts is slim since they know they are wading into the lions den. BUT, when we get the occasional brave provider to step in, we should do everything we can to keep them as long as we can just to get the other side. There is an outside chance we can have a convert, For all the respect we have developed of Dr. Bernstein he says he was oblivious to the issue for most of his career in health care. The other part of this is the old saying "know thy enemy", not that providers are our enemy, but if we know their thinkin we have a better chance of addressing the issue in a manner they may understand better. When Dr. G posted, had we challenged her in Dr. G as a paitient if I was in that situation I might submit to the exam but I would not be open with you due to embaressment or I might submit just to get it over with but I would probably avoid care in the future. Are you aware....etc. You can say I would be very upset with this approach as I would feel you were putting yourself infront of my comfort...etc etc....instead of your a terrible person, you don't care about your patients, I hope you loose all of your paitents and die....what do you think they are going to do, they are out numbered 100's to 1 and being attacked. Dr. Alex was a provider who came Dr. Shermans and this site after going on the web and asking for help and suggestions about whether she had to do hernia exams on sports physicals as it embaressed the young men....now, could be there be a better example of a provider who understood the issue and was trying to do somthing to mitigate it...none the less we climbed all over her and chased her away...some said she should refuse to examine males and accused her of being a pervert....I have been as outspoken as anyone here, I have taken this thread and put it to action, but....two points still stick out, this is Dr. Bernstein's blog, his time and effort, his purpose is not soley to provide a place to vent and attack, and if we chase providers away before we can engage in conversation all we are doing is bitching and preaching to the choir.....IF we get a provider to join in, if we at least temper our comments and put them in a non threatening way...we might actually learn something or teach them something. I understand frustration, I am so frustrated with Dr. Orrange on her dailystrength posts, I truely think she is just plain sexist..but if we jump on them out of the gate, before we give them a chance to explain....we gain nothing, not even insight into their meaning.....alan
I am involved in birth and pregnancy circles so am particuarly interested in modestly in that situation. Most woman do not know that there is little advantage to have your 'area' constantly checked by various people. I want to spread the word that even if you are pregnant and/or laboring that does not give any and all medical personal rights to check constantly and without cause. Particuarly in this situation many couples feel any refusal would immediety be faced with accusations of "putting baby at risk", "do you want your baby to die?" etc. It is a nerewracking powerplay in many situations and is very violating to have people threaten you to get access!
Alan,
Well said!
I do not purport to speak for Dr. Bernstein (he's quite capable of doing so quite eloquently on his own), but I believe his intent is to provide a venue where these issues can be discussed openly and candidly, with the minimum goal of at least understanding the various sides of the issue, and maybe in some cases act as a catalyst to effect change. I, for one, am grateful for his efforts.
Hexanchus (formerly TT)
Thomson Reuters 100 Top Hospitals was announced. Noted was:
If all medicare recipients rec'd the same level of care as pts treatment in winning hospitals
* more than 107,500 additional patients would survive each year.
* nearly 132,000 patient complications would be avoided annually.
* Expenses would decline by nearly 6 Billion dollars a year.
the prospects of converting the mind of the vast majority of provides is NIL. We are wasting our time worrying about their opions, it is their mind that needs to change, not mine.
Ok,folks.. I got a survey job for any of my visitors (or as a group job) who really want to contribute facts to this discussion on patient modesty and gender selection.
I went to the website of Thomsonreuters.com and I found the comments noted by Anonymous here earlier today. But I also found the list of hospitals which I have copied and pasted below.
Now, all my visitors have to do is send a form letter to each hospital, identify yourselves, explain your concerns about patient modesty that you have described here and ask those questions to the hospitals that I know you would want to ask. And then sit back and wait for the return mail. Then, communicate the survey results here as a formal presentation. Even if not all reply, I am sure we will get some sort of an idea about what is the interest and views of the institution with regard to patient modesty and the availability of obtaining caregivers of the gender selected by the patient.
I want this project to be devised by my visitors and not by me. I would suggest some of the visitors get together by e-mail and settle on a consensus on what and how to express the questions. (Remember to be civil and clear in your questions.) You may also use this thread as a forum too regarding how to create the survey. After all, the motif of this Volume is "Spreading the Word" Here is the list and good luck. ..Maurice.
Major Teaching Hospitals
St. Joseph's Hospital and Medical Center — Phoenix, AZ
University Medical Center —Tucson, AZ
Northwestern Memorial Hospital — Chicago, IL
NorthShore University HealthSystem — Evanston, IL
Advocate Lutheran General Hospital — Park Ridge, IL
Beth Israel Deaconess Medical Center — Boston, MA
University of Michigan Hospitals & Health Centers — Ann Arbor, MI
Providence Hospital and Medical Center — Southfield, MI
Mayo Clinic - Saint Marys Hospital — Rochester, MN
Duke University Hospital — Durham, NC
University Hospitals Case Medical Center — Cleveland, OH
The Western Pennsylvania Hospital — Pittsburgh, PA
Vanderbilt University Medical Center — Nashville, TN
Scott and White Memorial Hospital — Temple, TX
University of Virginia Medical Center — Charlottesville, VA
Teaching Hospitals
Rose Medical Center — Denver, CO
Cleveland Clinic Florida — Weston, FL
Mercy Medical Center-North Iowa — Mason City, IA
St. Luke's Boise Medical Center — Boise, ID
St. Vincent Indianapolis Hospital — Indianapolis, IN
Saint Joseph Regional Medical Center-South Bend — South Bend, IN
St. Elizabeth Medical Center — Edgewood, KY
Union Memorial Hospital — Baltimore, MD
MidMichigan Medical Center-Midland — Midland, MI
Munson Medical Center — Traverse City, MI
Metro Health Hospital — Wyoming, MI
St. Cloud Hospital — St. Cloud, MN
North Mississippi Medical Center — Tupelo, MS
Good Samaritan Hospital — Cincinnati, OH
Riverside Methodist Hospital — Columbus, OH
Hillcrest Hospital — Mayfield Heights, OH
Providence St. Vincent Medical Center — Portland, OR
Bryn Mawr Hospital — Bryn Mawr, PA
Hamot Medical Center — Erie, PA
Lancaster General Hospital — Lancaster, PA
Robert Packer Hospital — Sayre, PA
Avera McKennan Hospital & University Health Center — Sioux Falls, SD
Gundersen Lutheran Health System — La Crosse, WI
Wheaton Franciscan Healthcare-St. Joseph — Milwaukee, WI
Waukesha Memorial Hospital — Waukesha, WI
Large Community Hospitals
San Antonio Community Hospital — Upland, CA
Memorial Hospital West — Pembroke Pines, FL
Mercy Medical Center-Dubuque — Dubuque, IA
Advocate Good Samaritan Hospital — Downers Grove, IL
Silver Cross Hospital — Joliet, IL
Central DuPage Hospital — Winfield, IL
King's Daughters Medical Center — Ashland, KY
Baptist Hospital East — Louisville, KY
St. Mary Mercy Livonia Hospital — Livonia, MI
St. John's Regional Medical Center — Joplin, MO
Missouri Baptist Medical Center — St. Louis, MO
Saint Elizabeth Regional Medical Center — Lincoln, NE
Alegent Health Bergan Mercy Medical Center — Omaha, NE
Southwest General Health Center — Middleburg Heights, OH
Memorial Health Care System — Chattanooga, TN
Saint Thomas Hospital — Nashville, TN
Centennial Medical Center — Nashville, TN
Doctors Hospital at Renaissance — Edinburg, TX
Citizens Medical Center — Victoria, TX
Providence Regional Medical Center Everett — Everett, WA
Medium Community Hospitals
West Anaheim Medical Center — Anaheim, CA
Middlesex Hospital — Middletown, CT
Riverside Medical Center — Kankakee, IL
Columbus Regional Hospital — Columbus, IN
St. Francis Hospital-Indianapolis — Indianapolis, IN
Memorial Hospital and Health Care Center — Jasper, IN
Marion General Hospital — Marion, IN
Saint Joseph East — Lexington, KY
Gratiot Medical Center — Alma, MI
Holland Hospital —Holland, MI
Rutherford Hospital, Inc. — Rutherfordton, NC
Mercy Hospital Clermont — Batavia, OH
Union Hospital — Dover, OH
Sycamore Medical Center — Miamisburg, OH
Licking Memorial Hospital — Newark, OH
Wooster Community Hospital — Wooster, OH
Memorial Regional Medical Center — Mechanicsville, VA
The Monroe Clinic — Monroe, WI
Aurora Sheboygan Memorial Medical Center — Sheboygan, WI
Aurora West Allis Medical Center — West Allis, WI
Small Community Hospitals
Chambers Memorial Hospital — Danville, AR
St. Elizabeth Community Hospital — Red Bluff, CA
Desert Valley Hospital — Victorville, CA
Sacred Heart Hospital on the Emerald Coast — Miramar Beach, FL
Meadows Regional Medical Center — Vidalia, GA
The King's Daughters' Hospital & Health Services — Madison, IN
Major Hospital — Shelbyville, IN
Saint Joseph-London — London, KY
Mercy Hospital Cadillac — Cadillac, MI
Central Michigan Community Hospital — Mount Pleasant, MI
Saint Joseph Mercy Saline Hospital — Saline, MI
Douglas County Hospital — Alexandria, MN
Lakeview Hospital — Stillwater, MN
Parkland Health Center-Farmington — Farmington, MO
Jamestown Hospital — Jamestown, ND
Duncan Regional Hospital — Duncan, OK
St. Mary's Jefferson Memorial Hospital — Jefferson City, TN
St. Mary's Medical Center of Campbell County — LaFollette, TN
Lake Whitney Medical Center — Whitney, TX
Castleview Hospital — Price, UT
I looked through the list of hospitals listed above and found
4 hospitals that I've worked at in
the past. The one listed in tuscon
was recently investigated by the
adult sex crimes unit. Nurses and
patient care techs were fired for
taking pics of patients with their
cellphones.
Certainly not the first time this
has happened there. As far as the
other facilities I've nothing good
to say about them. Just because they make the top list at reuters
means absolutely nothing. Take a
look at the surveys by Press Ganey
and see what the top 10 questions
posed to patients.
1) Did your doctor take the time
to answer all your questions.
2) How promptly did the nurse respond to your call light button.
3) How did you find the quality of
the food.
Not one question posed had anything to do with privacy. The
questions are CAREFULLY constructed
and chosen. How do you know it was
a nurse who answered your call light.
Maybe on that month of the survey the Petite Papier club was
on a trip to France.
Maybe it was mexican month
referring to the food served in the
cafeteria. Everyone loves tacos.
People need to realize that the ceo's of these hospitals are just
business people. They don't care
about the quality of care patients
recieve,they are only trying to create a name for themselves. That
data is easily manipulated and I
assure you that you'd never see the
ceo,cno of the hospital as a patient there and neither their families as well.
Hospital ceo's are a dime a dozen and at one facility they went
through 5 of them in 2 years. I'm
certainly in favor for this proposal to writing them a letter.I
would be very surprised if you get a response back as what they say is
one thing and how patients are treated there is another.
What I will do is write a letter
to Press Ganey and ask this, why
don't you ask patients whats really
important. How about asking each
patient how they thought each and
every staff member at the hospital
treated them. Did they seem caring
and respectful?
In the final analysis it always
seems to be the ceo and the management team that gets the pat on the back,never the staff. Put the credit where its due as this
would truly root out bad caregivers. Finally, not every
patient at the hospital gets a survey to fill out. This is just
one more example of how the data
is manipulated and I assure you
the selection is not random.
PT
Although I agree with the basic idea of a survey, Doctor, I don't agree with the method you're suggesting. My reasons:
-- This is a particularly sensitive topic within medicine and needs to be handled with more care.
-- Unless directed to the precise office within the hospital, the survey will most likely be disregarded and thrown out.
-- Surveys from unrecognized, unafflilated, non professional sources, even if directed to the correct office, will be regarded with suspician and most likely ignored. From my experience working with various agencies and organizations -- a survey like this, especially these days and especially with all the medical privacy laws -- would be unwelcomed.
-- Unless done professionally and represented by a professional or academic organization, a survey like this may be perceived as from a group of fanatics. It may do more harm than good.
-- Most studies like this are done by a team usually including a doctor and a sociologist or psychologist. They come out of medical schools, hospitals or universities and have the authority of recognized scholars or other professionals.
-- Hospitals will want to know who is doing this survey, why, and how the information will be used. That's a sensible reaction.
-- I would suggest those interested use this forum to create a series of questions, as Dr. Bernstein recommends, but not jump immediately into sending it out. It would be a better idea, I think, to get a medical professional to stand behind this, or an organization to represent it.
MER
I agree with you to a high degree, where the problem comes in is this takes organization and organization requires partcipation. I touched base with Jimmy via his site got his e-mail, got leemac's and we touched base with Dr. Sherman about using his organize section to get the ball rolling. I have posted here several times asking people to touch base in that area so we could start putting together a group to spear head the effort....that noise you hear are crickets chirping...because that is the response. I agree 100% the best approach would be form a group, perhaps a web site to give it 1. a little ligitamacy and 2. a tool to sign up members. That way you can have a little ligitamacy when you approach them...alternatively you approach them as an individual who may need care so you aren't threatening. You ask the questions from a personal perspective....I really feel the most impact wold be a organization and as you say perhaps recruit a professional to present it...but, people are going to have to do more than just post here....so I toss the challenge out there again, go to Dr. Shermans site, go to organize for patient modesty, lets try to get some direction and go from there....alan
MER, I would agree with Alan. It all has to do with the approach, the way the request for response is written and that this request is to survey an issue of concern to a number of potential patients. The letter should be sent to the chief operating or executive officer of the hospital--so it goes to the top. Be careful on referring to a specific blogsite or forum because I am sure that if the COO reads any uncivil comments there, referral will be unproductive. My suggestion would be, after working out together an acceptable request, just send out a few such requests first and see what responses you get. If that list I copied really represents the top 100 hospitals including in terms of "mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care". they certainly must contain "aware" hospital administrations who are tuned to listen to and attend issues regarding their hospital's functions toward patient care. Give it a try. ..Maurice.
I like your idea Dr.Bernstein. A little over a year ago I actually suggested to doing the same thing (just with your surrounding hospitals) but didn’t get much support on that front. I think if you have the right wording and keep it civil, you might get some good responses. What do we really have to lose? It’s not like we can do any worse than we are right now….. I’d like to suggest that we all (or at least a group of us) agree to one series of questions and pick out the first twenty or so hospitals to send the questions to and wait for response. I think it would be more effective for each of us to send the same letter to the same hospitals so they know that’s it’s a group concern, not just an individual. Then after getting (or not) those responses we start with the next twenty and so on. That of course would be my approach, what do you’ll think? Jimmy
Jimmy, I would say "get started". Nothing is going to be accomplished in terms of education and changing the system by simply writing to mine or Dr. Sherman's blog. Yes, reading the responses of some visitors to the challenge seems to be of benefit for others experiencing the same challenge but beyond ventilating the frustration and anger, not much more is being accomplished. So don't delay with the project you describe. One other thing you might discuss in the preparation is whether the survey should be representing patients of both genders simply to show that the provider gender selection issue for patient modesty is not just the idea of male patients. You might consider inviting women visitors to this blog to the planning discussions. OK? ..Maurice.
Male nurse may be more sensitive to the male modesty issue than female nurses. But there's more value to having more male nurses in medicine that just the modesty issue. Read this thread on allnurses -- male nurses talking about the kinds of things male nurses can provide patients that female nurses can't or done want to. The modesty issue comes up.
http://allnurses.com/male-nursing-forum/male-nursing-moments-385815.htm
Also, we've pretty much just passed over H.R. 2115,that's up in the 111th congress which will amend the Public Health Service Act to establish an Office of Men's Health.
Section 2 of the Bill, Findings, is filled with stats that show how men's health is so much at risk in our society. Great material. Item #17 says: "Establishing an Office of Men's Health is needed to investigate these findings and take further action to promote awareness of men's health issues."
This is it, folks. This is where we can get some serious research done into the affect of gender choice of men's willingness to get checkups. With research like this behind the issue, changes will happen.
For example, Item #15 reads: "Over 8,000 men, ages 15 to 40, will be diagnosed this year with testicular cancer, and 380 of these men will die of this disease in 2008. A common reason for delay in treatment of this disease is a delay in seeking medical attemtion after discovering a testicular mass."
Why do men delay? Some of us are suggesting is that men quite often don't have same gender choices available for the embarrassing exams and procedures involved with this diseas. This Office of Men's Health can investigate this, do some surveys, examine gender choice availability, and come out with some findings.
The same is true for prostate cancer and other specific male diseases which this bill addresses .
The bill's full title is the "Men and Families Health Care Act of 2009." There is significant emphasis on the "families" part of the bill because most often, when fathers die, it affects the whole family not just emotionally and socially, be especially financially.
I mentiont bill because, frankly, I think getting behind it is more important right now than the survey. Let's do the survey with care. But we should all notify our congressmen and women and our senators and request they support this bill.
This is what we're looking for, what we need to get the ball rolling for more research into why men don't seek medical help as often as women. Under Findings, Item 1D reads: "Studies show that women are 100 percent more likely than men to visit a doctor, have regular physician check-ups, and obtain preventative screening tests for serious diseases."
Why? This office will delve into this question and we all know they'll find that male modesty is at last an important factor in why a significant number of men avoid medical care.
Get out and support his bill.
Awesome work Mer.
PT
I've been checking out some texts in nursing. Interesting results. From "Professional and Ethical Issues in Nursing" by Philip Bernard, Christine M. Chapman, and Duzan Smallman.
"The relationship that develops between a nurse and a patient or client is unique. Unlike the relationships in which an individual normally becomes involved, this relationship is one in which neitehr patient/client nor nurse has any real choice."
Interesting, isn't it. The way the system is set up today, this is often the case. Although I wonder what an "unreal" choice is.
"Apart from the situation where the individual engages a specific private nurse, the patient has no say as to who is selected to provide care. Equally, the nurse is rarely able to choose the patients allocated to her care or to opt out of involvement."
Again, true to the current system. But it disturbs me that a book on nursing ethics, stops at this. the patient has "no say" in who cares for him or her. I would think a book on ethics would discuss what should be the ethical standard, not what is the current standard. Basically what the authors are implying is that, if you have the money to hire a private nurse, you can get the respect and dignity you feel important. If you don't have the money, well, beggers can't be choosers.
The book goes on.
"So the situation is one where two individuals who may have little or nothing in common socially (or in any other way} find themselves in an intimate interaction."
"...in society it is not normal for an elderly male person to be seen naked by a female, except in a close family relationship. Older male patients who say wryly that 'the nurse is young enough to be my daughter' often remark upon the uniqueness of the situation."
Notice three things. First, the older male remarks "wryly." That word suggests a lot about how these authors think about male patients in these situations. Secondly, notice that the male patients is simply "remarking" in what appears to be a cold, unemotional, wry, clinical way. Is that how embarassment works? I doubt it. It's as if the male patient is just shrugging his shoulders and laughing it off. How untrue. Thirdly, the authors limit this norm to "elderly" male patients. I don't understand why. Younger male patients wouldn't "remark wryly" if the female nurse doing intimate work on them is their age or younger? Where are these authors coming from?
Finally: "Similarly, the female patient is often embarrassed to be examined or cared for by a male doctor or nurse. The discomfort may not only be felt by the patient; some nurses feel uneasy in some situations, find it difficult to separate normal social expectations from the interatctin not only permitted but expected in intimte patient care."
(pp. 89-90)
This last quote just goes to show that there is a significant role playing, game playing dynamic going on here. We've wondered what goes on the the doctor or nurses mind in these situations. The texts often admit these are awkward moments for medical professionals, too -- but doctors and nurses rarely write or talk about this. The response, "We're all professionals here," or "You've got nothing I haven't seen before," are often coverups for very uncomfortable situations for nurses and doctors.
You see, this is the attitude we're up against in medicine. This is often how doctors and nurse are taught about this issue: choice doesn't exist for either nurse or patient; males react "wryly," and this only really bothers "older" males; it's expected that you nurses and patients will just bite the bullet, accept this situation because that's just the way it is.
No mention at all about how patient comfort may influence the treatment and ultimate outcome. No mention at all that the nurse might, just might seek out a same gender caregiver to deal with the uncomfortable, embarrassed, stressed patient. Or that the doctor will ask the patient if he/she'd prefer same gender care.
Nurses do learn to accommodate, but this is more often part of the "hidden curriculum" that they learn on the job. But only if they work in a facility that is staffed properly and open to same gender care.
It's clear to me that, with the exception of a few physicians like Dr. Bernstein, this is the message that both doctors and nurses are still taught in medical school.
This book can be found at: http://books.google.com/books?id=ssaR4Gu9mYAC&pg=PA90&lpg=PA90&dq=nude+male+patient+nurse+embarrassed&source=bl&ots=DOoLTx-KpM&sig=-YUyKyUA1buHK_SoAOLrFsxRxcg&hl=en&ei=MdkRSvGTAqfEtAOQ4tHmAg&sa=X&oi=book_result&ct=result&resnum=2#PPA90,M1
All of what you write, MER, comes right back to what has been written here so many times. The words "they are professional" encompass the mindset and rationale of the doctor and nurses. That term is the sole reason they feel a patient should accept cross gender care no matter what. They are "trained and professional"; therefore they should do the job even if the patient is uncomfortable and unaccepting of it.
JW
MER..thankyou..we often hear those things, but seldom have the documentation that the book provides.....I agree that the authors seem to carry their ideas only so far...and leave out a large segment of the population....so their writing is obviously not as in depth as they might wish to portray to their readership. ( I am assuming that it is written towards nurses primarily and maybe doctors or lawyers to a degree)
leemac
MER,
Thanks for the reference.
I find the statement "The relationship that develops between a nurse and a patient or client is unique. Unlike the relationships in which an individual normally becomes involved, this relationship is one in which neither patient/client nor nurse has any real choice." interesting, considering the patient does have the absolute right to decide who they will allow to provide care.
Ever notice brochures in hospitals
or nursing magazines that picture a
nurse often posing with their patient. The nurse is always a female and the patient is usually a
female often older and rarely a
male, but never a young adult male!
Are they trying to tell us something or rather not let us see
something or be too suggestive!The notion of gender neutrality to me is meaningless and I challange everyone to read articles written by R. Douglas fields,neuro and cognitive scientist at University of Maryland. This month he contributes to scientific american on human sexuality.
Recently on this site someone
mentioned that it would be only a
matter of time before er techs
insert foley caths. Sorry, they've
been doing that for years now,but
picture a 19 years female that is
120 lbs overweight with the words
sexy tattoed on her neck. In the
er supply room she makes a joke
about the size of a male's penis
she just cathed to another er tech.
I doubt she knows what a moral
compass is if it hit her upside the
head at mach 1 let alone gender
neutrality. I've just created a
new term and I've labeled it
Gender Perfect. This makes the
assumption that men and women are
intectually capable of equally
performing medical tasks and equally important of getting the
appropriate grades to enter medical
school.
The notion of Gender Perfect
fails the logic test as does gender
neutrality in that affirmative
action was needed to get more
females and minorities into medical
school. This essentially meant that
some males with higher gpa's were
bumped to allow for passage of females and minorities. Now gender
neutral makes the assumption that
an opposite gender caregiver can
leave their gender at the door.
By essentially teaching their brain to overcome the biochemistry
of human sexuality one is able to
do this, despite the fact that maybe,just maybe affirmative action
got their feir feet in the door with their 3.2 gpa which is the minimum allowable to enter any medical school in the US. In this
equation nursing dosen't even count
as some nurses were on the 10 year
plan. Their biggest worry was to
get past basic algebra and human physiology as I doubt concepts like gender neutral ever crossed their mind.
PT
Hexanxious...there are many people who have no choice but to accept what is offered to them as they cannot afford private hospitals or nurses. If you are in that postion..you may get to reject a provider or two for cause....but teh hospital may just tell you to go elsewhere as they can not accomodate you...If you are sick enough or injured badly enough..you may not be able to make much of an issue of it....as you are left with no options but not have care at all....
The uniqueness of the relationship between patient and provider is that it is one of function and nothing more until each has had a chance to form an opinion of each other...then it is amicable, adversarial, or neutral in nature.
leemac
Helo all,
I thought some time ago a post about federal regulation for patient privacy/modesty. Can anyone provide me with that information?
I am in the process of fighting the Worst hospital located in Rockledge Florida.
It is extremely difficult to view this blog... I tried to kill myself twice, in part, because of the abuse suffered in that place...
I have spent hundreds of days in hospitals since 2004, I have severe neurological problems which at times cause terrible pain.
I will try to read through some of these posts and see if I can find someone who is trying to do something about this...If you are or know someone who is please let me know..
PT,
I have to play devil's advocate here. Would you have the same issues if your nurse was a homosexual male. That same gay nurse could be ..."19 years old, 120 lbs overweight with the words sexy tattoed on his neck....in the supply room making jokes about the size of your penis with another male nurse/tech."... Is a gay nurse "gender neutral" enough for you? If not, would you add gay caregivers to your reject list, along with females? After all, their agenda with the male body is the same as a female's.
Doctors and nurses often write, or I hear them say, "We're taught to be gender neutral," or "We're taught to ignore patient nudity," or "We're taught to control how we feel when we view naked bodies." Or we hear the cliche that medical professonals are "taught" to deal with this.
I question the truth those statements. I question whether they are actually "taught" these as skills in medical school or as part of the internship or residency. I don't deny that they may "get used to" the nudity they see all around them. I don't deny that it becomes "routine" for them. I don't deny that they may teach themselves to deal with this. But there is a danger in this routinization and self-learning which is part of the hidden curriculum. The danger is that they may become numb to patient feelings or learn unhealthy strategies. The focus becomes on how to make themselves get through these embarrassing situations, not on how to help the patient get through them.
As part of their training, do doctors and nurses read articles like: "NOT JUST BODIES: Strategies for Desexualizing the Physical Examination of Patients" by Patti A. Giuffre and Chriistine L. Williams? Both of these women are sociologists. The article can be found in a publoication called "Gender and Society," 2000; 14; 457.
As I read this, all of the strategies they discuss are not necessarily good. They may be "successful" for the doctor or nurse, that is, helping them deal with this issue. But they may actually make the patient feel more objectified or humiliated.
Or, do nurses read articles like "Crossing the boundaries -- experiences of neophyte nurses" by Ann Seed found in the Journal of Advanced Nursing 1995; 21, 1136-1143? Or do they read books like "Behind the Screens" by Jocelyn Lawler?
These are not rhetorical questions. I don't know the answers. But this is what I would consider "teaching" about this subject. Reading, discussing, questioning, and then applying this to the practice. As classroom work, looking at the status quo and discussing the ethics of that. Doing role play exercises with these different strategies and then discussing them. Observing doctors and nurses at work and trying to determine the kinds of strategies they use. Doing this as guided learning, not as something they're just supposed to pick up on their own.
I do question whether any serious "teaching" takes place. My concern is that doctors and nurses are just left to struggle with these issues on their own. And books like Dr. David H. Newman's "Hippocrates' Shadow (which I've mentioned in previous posts) back up my concern. Newman outright states he was not taught these kinds of things in medical school.
We, as patients, cannot have much influence on what is taught in medical schools, except through enlightened blogs like this. But we can act as teachers when we come into contact with the medical community. We can influence, communicate these ideas, even instruct. We can be come unoffical standardized patients. Now, this may not be the most pleasant experience we will ever have. Doctors and nurses don't always want to change. Some don't think patients have any business "teaching" them anything about their profession. The old cliche about "learning the hard way" is so true. And confronting an enlightened patient may be an unpleasant experience for some doctors and nurses. I say, so be it.
But rather than get angry or upset, as patients we can go into these situations with our eyes wide open and with little pieces of paper. We can become rational, educated, confident "Petite Papiers."
Don't expect to be thanked for this. That will probably be rare. But if this "teaching" is done with respect and openness, with consideraton for the professionalism of the doctors and nurses we work with, then we should expect respect and consideration in return. That may begin to open up some real dialogue.
MER, I would say that the most experience interns, residents and fellows get in their post-medical school training is in the context of the hospitalized patient although surely there is a lot of outpatient work too. But it is the hospitalized patients which causes the sweating. And I mean sweating! Think of this.. (going back to the pilot analogy), a pilot has the responsibility of his or her crew and a plane load of passengers butt it is only a super rare occasion when the pilot is challenged with a life and death situation and where a wrong decision or some lack of control will cause death. The responsibilities of the in hospital physician is not as routinely casual as a pilot and many times during the day the death or rapid decompensation of a patient is challenging the physician. The orientation of the intern, resident or fellow becomes one of repeated serious consideration of a problem with serious consequences. It is in this context and environment that leads physician to attend to the problem at hand and at the time disregard the patient as a sexual object. In that regard, the physician becomes "genderless". Unfortunately, prolonged exposure to these experiences may lead doctors to see their patients as diseases rather than as humans and be attuned to the values and desires of their patients, thus in this way appearing to ignore them. This is even more challenging and stressful since they are all being scrutinized by their superiors with impact on their future careers not mostly in terms of doctor-patient interaction but in terms of doctor-disease-diagnosis-management issues. Thus causing a separation of the disease from the very human patient who has a gender and who has their own desires and concerns.
MER, you would really have to go into the midst of medical training to understand what doctors in training go through. ..Maurice.
Mary,
I know your comment was not to me but I have to answer the devil's advocate...
Thanks for using the "HOMOSEXUAL" Card...Look out there's one over there. That card was used on me by a couple of female Nurses. Oh you don't want a Male Nurse ...as they make a face at me like, oh your lucky I told you about them..
I have had several male techs and nurses and yes....HOLD ON, THEY WERE GAY..the Horror. Several of them were wearing a rainbow wrist band...You know THAT RAINBOW.
To a one they provided me with competent and Professional Care. I know Men are supposed to be uncaring and not capable of providing care with compassion..seen that on some nurses sites.
I just don't see how they say that and ignore all the male doctors who provide care with compassion . They are out there I have seen more than a few...some real dogs also but not all..
Yeah, MER, on Allnurse under the thread of patient modesty their is discussion that "nudity" or "nakedness" is not sexual. So the nurses are stating that a patient being nude or naked has absolutely no sexuality to the healthcare providers (I think the lines were referring to the OR).
Interestingly, a nurse wrote about her husband who went to a urologist for a procedure and he requested a drape to cover himself to some degree because he had to be completely naked from the waist down. She said the MA looked at him like he was nuts and went looking for something that could be used as a drape for him! Another nurse commented -- That is horrible! Guess they themselves haven't experienced much.
JW
TO MARY
I am so glad you asked that
question. Truly I am! Personally,
if it boiled down to a straight
female nurse vs a gay male nurse
I would take the gay male nurse
as the caregiver. Why,because its MY way of payback for all the years
of unprofessional behavior I've
been subjected to by female providers while a patient.
Don't forget I have walked both sides of the tracks not only as a patient but as a healthcare worker as well.
As usual I'm quick to point this
out and bear in mind the example
I cited with the 19 year old er
female tech making the comment about a male's penis she just cathed actually happened. I was in the er supply room and overheard it.
Keep the statistics in mind that
92% of nurses are female and 8% are
male. Over the many years I worked
in healthcare I've known many male
nurses. I don't recall any who I
thought were gay or at least gave
me that impression.
Additionally, and most importantly there seems to be a distinction between the behavior
of male and female nurses and how
they verbalize and express comments of the derogatory regarding their patients. Male nurses know that to verbalize and
make sexual expressions only paints
their picture as a pervert.
Female nurses seem to do it without impunity almost as if they are immune. It's almost as if they have the right or authority. State nursing boards consider this unprofessional behavior and in this
regard comments are often made to
coworkers,not to patients. You read
comments on nursing boards of nurses or nursing students bragging
about how many male penis's they
see.
To the completion of your question my reject list is anyone who can't treat me in a respectful
and caring attitude. Unfortunately,
I've been down that road and if and
when I do need any kind of personal
care it won't come from a female
provider. They had their chance!
Making references that male caregivers or perhaps the patient
is gay seems to be a common excuse among female nurses
whose care becomes rejected. I've
heard it a million times on other
boards! Its a quick and simple
excuse that female providers use
but notice that is their ONLY
excuse. Isn't it funny that any other time women seem to be very
open to male homosexuals in that
they are not threatened by them. Public programming (television)
is very apt at displaying this.
This mentality seems to transcend
many aspects of our lives. I can't seem to pick up a motorcycle or car
magazine without some female nudity
in it. Its almost as if someone somewhere belives that I want to
see this all the time. The mentality seems to be that I as a man need to have some female in
my business 24/7. The notion that
sex sells has permeated every aspect of our lives.
It is my opinion that this is partly the blame when female providers question why male patients reject certain care. Trust
in healthcare sets the foundation for all other care to come.
PT
After having interviewed a few more patients about some bad experiences they had, I've come to believe that most patients don't complain about these modesty violations. That's why many hospitals and clinics don't think much about this modesty issue. Their perception is that they're doing just fine, and when the odd patient complains, well...they're the odd patient, so their opinion doesn't really matter. And the exit surveys they do don't contain any specific questions about modesty of privacy. They're not getting the feedback they need.
One patient said that his experience doesn't seem as embarrassing now as it did when it happened. It still bothered him. I could see he was still upset. And when he first told me about the experience, he was almost in tears, obvously traumatized.
But I think our memory works that way, that is, we tend to ratonalize traumatic experiences or push them into the back of our minds -- for our own psychological survival. We don't want to accept that they really happened. I think there's evidence for this in studies of people who go through traumatic experiences. But these experiences stay with patients and affect other aspects of their lives -- and their attitude toward healthcare workers. The other reason this man didn't complain in writing is because he had to have more surgery in a few months at the same hospital and didn't want to ruffle any feathers.
Another item re the following book: "Social and Behavioral Science for Nurses: An Integrated Approach" by Gaetan Bephage (Churchill Livingston, 2000) a British publicaton.
There's a chapter on "Men and Women's Health." The women get 18 pages and the men 7 pages. There are other references to women'shealth throughout the book in other chapters, but no other references to men's health. I estimate that men get about 1/4 of the amount of attention as do women in this book.
I mention this because I think this is still a trend in medical and sociological texts -- although things are certainly changing. There are actually some books out now on men's health. But this is why it's important to support that bill, H.R. 2115 that would create an Office of Men's Health in the U.S.
To Dr. Bernstein. You're correct. I don't pretend to know what it's like to be trained as a doctor. I can't walk in those shoes. But I do note that in your last post you quickly moved into the life and death, emergency mode when it comes to modesty and objectifyng the patient. That I can understand. I may not like it, but as a non doctor I can see how that can happen. It's more difficult to understand the lack of attention to modesty and this objectification during routine exams and procedures, at clinics, during non emergency situations.
Sorry for the random thoughts.
TO MER
MER Can you view my profile and send me an e-mail. I just saw your post about the Bill H.R. 2115, I would like to speak with you about it.
I was going to contact Senator Nelson here in Florida about the Worst hospital here. I have this idea that we need to take the men coming back from the service and train them in health care. Now the medics want need that much training but there is a shortage of jobs right now and with the influx of able bodied men returning, Something could be done with them to help the Nursing and Tech shortage.
Some may scoff at this but I have seen in material my brother got when he went to a military (people who just got out actually) only job fair. Ads telling about all the good paying jobs in heath care and they showed male nurses and techs. I don't know what to think, that the government was on the same wavelength as me....HAHA
I want to tell everyone that I have MS and sometimes have problems making things sound right when I speak and type but typing is much better for me. When I talked about the male nurses that have taken care of me...I did not mean to suggest that they were all Gay...Some were, some were not that is just a fact..
Thxs...
JJ.
MER, what I was trying to explain is that this daily critical disease management environment that the intern, resident and fellow experience in their hospital training contributes to this "hidden curriculum" which then may affect their attitude toward patients as persons later their in practice, even in routine care. ..Maurice.
Keep posting PT, I like hearing what you have to say.
I know what you're talking about JJ. I'm very close to my mother and she has had M.S. for 25 years.
Dr B
Should one care to look,there
is considerable literature which
tends to debunk the notion of
gender neutrality.
PT
My workplace just started random drug testing and my number was again called this week. We started this a year ago and I’ve been picked twice already (just my luck) but when I retuned the other day a co-worker asked me point blank “did she stay in the room with you while you filled the cup?” I looked at him and told him NO, that the door was closed and I was alone. He said that she stayed in the room the whole time with him and he thought it was strange that she would do that. Now that he knows she doesn’t have to be in the room with him, he said the next time he’ll ask her to leave. Does this all sound familiar? Much like what MER stated, men and women are probably more times than not uncomfortable, but they don’t speak up during that time. They’re a hundred reasons why this gets ignored but if you’re honest, none of them have to do with the person that it happens to. For me, I think it has more to do with these providers getting trained in this manor. They see these indiscretions everyday and soon that becomes normal and routine. I’m also beginning to think that these are nothing more than shortcuts to get the job done quicker without any extra effort or hassle. This issue needs to be addressed from the top and let it filter down or it will only get worse. Jimmy
Jimmy:
Incidents like the one you describe need to be reported. I doubt if it's policy from the top to have her in the room. If it is, then that's another problem. Too much training doesn't come from the top, from those who make policy. Much of it comes from others who haven't been trained or have adopted the hidden curriculum rather than what they were originally taught.. It's a circle of confusion.
But you're right about routine. I found the following quote on allnurses, then check the source to make sure the quote is accurate, which it is.
"In his book, "Customer Service: Career Success Through Customer Satisfaction," Paul R. Timm talks about what he calls the "Takla Syndrome." He writes:
"Early in my career, business took me to a pulp and paper mill in Takla, a small community in the interior of British Columbia.
"As we approached, I was hit by a distinct and overwhelming odor, which I subsequently discovered was sulfur. As discreetly as I could, I asked my client, a longtime resident, how people put up with the smell. His response. "Smell? What smell?"
"He was quite serious. After a while, people who lived in Takla simply became inured to the smell -- they didn't notice it anymore. In fact, for them, it didn't exist.
"And that, I believe, is what's happening when we encounter those nonresponsive employees. Often, they've lived with the smell of poor customer service for so long that they don't notice it anymore." (page. 115).
This is routinization at its worst. And it happens in all occupations and professions. But, if these employees get no feedback, if they're continually allowed to pretend the smell doesn't exist, the situation gets worse. Those who don't complain about these incidents contribute to the problem and make it more difficult for everyone else. I must assume that most good people want to know what they're doing wrong and improve.
That's why incidents like the one you write about, Jimmy, need to be
reported. At the very least, the employee needs to be retrained. At worst, fired.
My pockets are stuffed with dollars, health care dollars. The
implication is I've got money to
spend on health care and the card in my wallet implies that as well.
My reject list is long enough to
reach the moon. I'm a consumer and
being a wise consumer I don't buy
gmc,chrysler nor eat at Mcdonalds
although I've heard the coffee is
great. As a paying consumer I decide whom I choose to provide
the service to me. If I want to
visit a nightclub I decide whom I
dance with! If I choose not to
dance with obese women or perhaps
she has a big tatto on her neck
and I ignore her,its my business.
When I need a haircut I choose
who cuts it. Its all about choices
and my comfort zone. When I need
health care its REALLY all about
me and not about you. Actually, its always about me. I'm paying
for it, who cares if someone ends
up on my reject list,stand in line!
There are many of those that believe that I as a patient would
have to accept personal care from
whomever is there to deliver it.That fault lies with the uninformed. I've heard many female
nurses say off camera that if they
ever need a foley cath that it would only be done by another nurse
and that nurse would have to be female. Thus the responsibility falls on you the patient to make
your choices known. Believe me,when
they're a patient they make their
choices known and so should you.
Trust me, they won't give you a
choice unless you ask. You as the
patient can decide who delivers
healthcare to you.
PT
Re: workplace drug testing:
I would have thought that all urine testing would have a witness. Otherwise it could be easy for the person being tested to bring in a container of "non tainted" urine and substitute it. It's the same when a patient views their medical records. At least with me, I could only go through my records in the presence of a hospital employee. Otherwise I could have easily altered or removed pages if I was so inclined.
We have random drug testing for our drivers. Over the past decade(s) we have used several different companies. none have observed the collection of samples. They have protocol such as a chemical in the container that detects dilution and chlorine, it has a temp strip on the side, etc. And it is pretty accurate. The called after a testing event and questioned a sample pulled a surprise and caught him....I don't know of anyone in our industry that has been watched during the collection...alan
Urine testing for drugs is so blase
and antiquated. Generally, one can
buy over the counter compounds that
after being consumed can mask most
illicit drugs. Furthermore, most
labs immediately check the temperature of the urine as it will
closely resemble body core temp.
Lets reverse the roles and see if
its OK for a male to watch a female
urinate. Its not appropriate in
either scenario. Certainly any
company in america has the right to
have you submit to drug testing and
personally I'm all for that. But to
violate you personal privacy I am not. This is where you should be
talking to an attorney.
PT
Dee, a patient is rightfully entitled to his/her medical record. Period. It is important to always obtain all lab results, all surgical records, all tests, xrays, scans, MRI's, etc. from each and every medical visit or hospitalization.
You and you alone are responsible for your own well-being. To accomplish that you absolutely should obtain every medical record.Keep all records by year in folders.
The medical profession sure likes to itimidate, don't they?
JW
The following is from JJ. ..Maurice.
This is something I have been working on lately. I saw something like this on the web from a female Doctor, talking about what she did, when her husband was inpatient.
I would invite anyone to add to this letter, I don't think we will get far with asking the powers that be in health care to change...I say,We need to tell them what we expect from the people who are taking care of us.
JJ..
I want people to realize I am not saying all females in healthcare are bad. In fact I have had female nurses that provided excellent quality of care. They have saved my life more than once and not just from disease but from the ignorance of some Doctors. I have had infections where they didn't think I would live very long and I know it was because of nurses diligence to my care that I survived..
Ethics and Morals need to be instilled in all employees. In the rush of the need for Nurses and Techs the quantity of people has overtaken the quality of people. Whom you accept into these positions.
This is the first thing you need to focus on, because without a strong foundation of these qualities, you are assured of failure, in the care and protection of those who seek your help.
These next items should be preceded by a questionnaire asking people if they care whether their caregivers are Male or Female. You can not ask this question verbally because the stigma of verbally answering a preference for a male is to great, for a male patient. Especially if it is asked by a Female.
There should be at least one Male Tech and Nurse on every shift. The duties of helping male patients bathe or the insertion of a urinary catheter should be preformed by a one male Nurse or Tech who does nothing else until those items are done. This is already being done in large teaching hospitals that I have been inpatient ..
Patients should be told that they do not have to wear the pathetic gowns that are used in healthcare. That they can bring clothing from home.
All patients should be woke up at night when blood work or vitals are taken as to elevate any concerns or fears that they may have.
Employees having access to patients should not be allowed to carry a personal cell phone with a phone camera. The potential for abuse is to great.
All employees should have there Id information on both sides of their badge...There has been numerous times when they turn them around, so people can't see there Name.
Dee,
There are so many ways of administering a urinalysis to someone that there is no excuse for invading their privacy and causing unnecessary humiliation.
Anything from immediately checking the temperature to allowing him/her to change into a gown before the test. Even if it comes down to having someone observe, there's no excuse for not sending in a same-gender observer. Being observed isn't a necessity, it's a punishment.
Like PT mentioned, the easiest way to cheat is to take something internally to mask whatever drugs you have in your system. I know some people that have successfully cheated the drug test that way. One guy had a surprise drug test when his probation officer showed up at his house one day. His girlfriend (my sister) lied and said he wasn't home. The idiot asked her when he would be home and then said he would return the next day. The junkie went out and got some kind of masking agent (I don't know what it was) and the next day when the probation officer arrived he was able to hide the marijuana and Meth he had in his system.
As upset as I am about the double standard and the complete lack of medical ethics, I'm about to the point where I sometimes don't even feel sorry for abused people anymore. If they don't have the guts to stand up for themselves maybe they deserve to be abused and wrongly humiliated.
The best method I can think of to help people not have to go through that unethical BS is to educate them. If more people could learn that they don't have to accept opposite gender nurses, assistants and techs maybe more people will begin to stand up for themselves. It's like PT said earlier, if you keep your mouth shut they will very often treat you unethically, but if you say something, let them know how you feel and request same-gender intimate care they will very often accomodate you. If they refuse or try to belittle you, stand your ground. They will quite often lie to you and tell you there's nobody else available, but if you refuse any help or threaten to leave they often say "OK, there is someone else but you'll have to wait for ten minutes".
If people learn they may have a choice but still don't say anything then I guess they make the choice to allow themselves to be bullied and humiliated and we shouldn't feel sorry for them.
AT
Dr.Bernstein, Please post this one and not the one before..I made corrections to this one.
Anonymous- Sorry about your mothers M.S. having the Monster is not fun.
AT - Why I agree people have to speak up about what they want that is what the letter above is trying to do. We need to take something to the providers and tell them what we expect.
Now when you say" I sometimes don't even feel sorry for abused people anymore. If they don't have the guts to stand up for themselves maybe they deserve to be abused and wrongly humiliated."
That is a wrong headed statement nobody DESERVES abuse,humiliation. I don't know your story but you probably know how difficult it is personally to actually speak up.
I have and believe me just like you would think you hear them say your Crazy, gay, he wishes. you know the usual BS. I find it much easier to write something out and give it to the person who is the highest up in the situation your in...Charge Nurse,Case Manager,Nurse manager. Make them aware of your feelings.
Now another thing that has happened to me is they get someone I will accept. THEN THEY SWITCH THE PEOPLE WHEN I AM ASLEEP. I say that a female Charge Nurse is ok to take care of me. Not that I think they are anymore less likely to do anything...I know they have the most to loose if they do.
Then there is the tranquilizers I have had nurses call my Doctor and tell them I need to be sedated.
Now again you will probably say , why did you let them. Well when you can't see because your vision has gone out and you can't move your legs, You get so dizzy that you think your in a washing machine. Not to mention that your brain feels like there is a dense fog, that you have to fight through to do anything. It becomes clear that it isn't as easy as it sounds....but now I have something down on paper. So again, I would tell everyone to put something together on paper about what you expect from caregivers.
As the last volume ended, I posed some resolutions for debate regarding patient modesty in general and male modesty in particular. I challenged a debate, especially from members of the medical community. No one has responded. I'm beginning to figure out why.
Recently I had the opportunity to meet socially and professionally with many members of the medical community. I either brought up this topic with several of them, or, if the conversation leaned in that direction I gave it a push that way. What I found is interesting.
There was no middle ground. Either they agreed that this was a problem and discussed it with me. Or, they clammed up. They had no answers to the questions I posed. The impression I got is not that they were oblivious to the problem. My impression is that they are very well aware of the problem, know it needs to be fixed, but don't have any rational answers to the questions I posed about the basic issues of gender equity, respect and dignity.
In summary. My thoughts. Medical professionals mostly are not oblivious to patient modesty. They know what's going on. Some will admit that it's a problem. Others won't. But neither group seems to want to debate the issue. Why? Because I believe they know they can't win. Some may not believe in patient choice of same gender care -- but when you tie that opinion into the issues of individual patient respect and dignity, they have no answers. They can make no case for their point of view. You either respect patient dignity or you don't. And you don't get to decide what dignity means for the patient. Doctors, nurses and other med professonals know that. They also know that most people won't challenge hospital "policy" or later complain. So, the odds are that they can just continue to do things the way they have been doing things.
I don't think most patients realize how close they are to turning this problem around. Most hospitals have mission statements that use the words patient values, respect and dignity. If patients are clear about what they want regarding gender care, and if refused, force the institution to confront its mission statements and/or code of ethics -- the insitution has no ethical response. They may have reasons -- but their reasons for refusing you are institutional reasons, systemic cultural reasons, efficiency reasons, gender discrimination reasons. They can only justify their polcies by arguments about what's good for them, not what's best for you.
That's why it frustrates me when people don't make their values known and complain if their dignity is not respected. We're right on the edge of getting changes done because the system knows what their doing is not ethically justified.
Now, if I'm wrong about this, then let's have a debate. Any med professionals out there who want to engage? Remember, though -- that what's in the best interest of the patient, physcally, psychologically, and spiritually, is at least as important as what's good for the institution and the medical profession. That last sentence is at the base of this argument. Of course, if you don't agree with that statement, then we can debate that, too.
Any takers?
MER, I would agree that most doctors do not ignore patient modesty, surely they don't examine patients who are in the nude (though full body skin exams by dermatologists are seemingly standard with exceptions which I have already written about). What they are uneducated about is that the gender selection issue for the patient is really to some patients "a big deal".
Think. Most doctors feel they themselves had years of education and medical experience and they feel they themselves are competent in their area of their specialty or practice, they have functioned well with little in the way of significant errors and have followed strictly requirements of professional ethical behavior and it is inconceivable that a patient would not select them because of their gender. Yes, there might be other factors the patient might not want them (maybe the location, maybe the office management, maybe the doctor's personality, maybe a misconception about skills but certainly NOT because "I am a man or a woman." I have felt the same way. I have followed professional standards of behavior. I have attuned myself to attend to patient modesty as I exam a patient therefore I think to myself "I am a doctor." If that is being "gender neutral" then I admit it. And that is why, through these threads, I have been educated that to some patients, I am not gender neutral. Now it's time for the other doctors to also be so educated. Keep up the good attempts to do so! ..Maurice.
Doctor:
You wrote: "...what I was trying to explain is that this daily critical disease management environment that the intern, resident and fellow experience in their hospital training contributes to this "hidden curriculum" which then may affect their attitude toward patients as persons later their in practice, even in routine care. ..Maurice.
That makes perfect sense to me. That explanation and your recent post really helps me understand where doctors are coming from. This shows, to me, clearly, where an important disconnect occurs between doctors and patients. That's why patient-doctor dialogue is so important. But with time so short of visits, how does this happen. I think we need focus groups between doctors, nurse and patients. Sounds ideal, but I'm sure it's happening somwhere.
Here is an interesting quote I recently found that presents this issue from the perspective of what's sometimes called the theology of the body. Since it covers our topic exactly, I've briefly quoted from this speech and provided a like to the entire text. Many hospital mission statements come close to saying something like this, though not necessarily in a religious or theological sense.
Selection from a dinner address to the National Colloquium for Catholic Bioethicists sponsored by the John Paul II Institute for Marriage and the Family, the Order of Malta and the Catholic Doctors Association of Victoria, Melbourne, 31 January 2006. S
Speaker: Most Rev. Dr. Anthony Fisher op
"Nudity is not only an issue in the marital bed: it is also one in the hospital bed. The intimacy of the relationship between health professionals and patients raises all sorts of complexities about trust, boundaries, modesty, dignity, privacy and confidentiality. I imagine that it is easy for health professionals to say “you’ve seen one, you’ve seen them all” and to become rather blasé about the bodies of the people they are seeing and touching. It is not, after all, the nudity of spousal love and self-gift that is offered – a gift which spouses can take too much for granted. While spouses are properly in the position of freedom and equality, patients are, as it were, stripped naked by forces beyond their control, exposed to veritable strangers, nude both physically and emotionally. Those who see the human body as a revelation of a unique person and a vessel of the divine, are likely to touch or gaze upon patients with a reverence rather different to those who see the body merely as dysfunctional plumbing and wiring.
http://www.catholicdoctors.org.au/TheologyoftheBodyandMedicalPractice.htm
MER, I must say that if a doctor's goal was only to "see the human body as a revelation of a unique person and a vessel of the divine [and] are likely to touch or gaze upon patients with a reverence" and not as "dysfunctional plumbing and and wiring" most symptoms and diseases for which the patient comes to see that physician would not be relieved. By the way, even some of the Catholic priests, by their sexual abuse of children, are really not seeing the child as "a vessel of divine" but really as some sort of "plumbing". I apologize to those who are upset with what I just wrote but I do want to emphasize that even Catholic priests as with physicians do not always view those who trust them with that high religious goal quoted from Rev. Doctor Fisher. ..Maurice.
MER wrote today:
Frankly, Doctor, I was surprised at your reaction to that quote -- sort of gut reaction. The quote and the issue are not about the Catholic religion. And the scandal in the Catholic Church isn't relevant either. Just because doctors and priests don't live up to the ideal, doesn't negate the ideal or make it less valid.
It's a religious perspective on this issue, which has as much validity as a non religious perspective. Again, you push this to the extreme. It's not an either or attitude. It can be both.
Although, as you say, a doctor's goal isn't "only" to see the human body as is stated in the quote, that doesn't mean that perspective isn't part of the picture.
I'm not offended by your remark, I'm just disappointed that you reverted to an ad hominem style attack rather than considering the issue and statement more objectively.
And I believe you stated at one point that you were associated in some way with [a Catholic hospital] system. Reread their mission statements, and you'll see that they follow this perspective closely. MER, I was simply expressing my disappointment with those Catholic priests who deviate from the path of looking at a person as a human being, a subject and a "vessel of the devine" just as I am disappointed with physicians who wander into a mindset of looking at a patient as an object to be fixed rather than always looking at the patient as "unique" human person subject. By the way, this loss of humanistic thinking and behavior by physicians is part of the "hidden curriculum" turning some, unfortunately, into simply technicians. ..Maurice.
I think some doctors are aware of gender - male gynaecologists are finding many patients are now choosing to see the ever increasing number of female gynaecologists. Previously, women had no choice...now that we do, many women will choose a female specialist and even wait months to see one.
My SIL works in a practice and has noticed the male gyn's have less work - I could see one of the male gyn's this week, whereas I'd have to wait 6-8 weeks to see a female.
The male doctors have expressed concern to her about this increasing preference.
I don't think it's surprising - gyn exams are probably the most invasive exams in the book and many women will feel less embarrassed, vulnerable and exposed with a female doctor.
I have only needed to see a gyn. twice in my life and I saw female doctors both times.
I imagine with the emergence of female urologists, they will have issues with male patients. It actually amazes me that doctors seem surprsied by these preferences...when I would have thought it was obvious.
I have also noticed that US doctors seem to be EXTREMELY thorough...full body exams do not require nudity in Australia.
I've had two skin exams and on both occasions, you undress down to your underwear.
I've also noticed Americans have very thorough exams every year.
An American friend was telling us about the battery of tests she and her husband have every year...it seems totally unnecessary to me.
We're all doing fine down here without the need for all the checking, testing and examining...
We compared notes around the room and the Americans all had LOTS more routine exams and tests. (& had them done frequently) and we're talking about healthy people!
The English and Australians had similar medical experiences - basically see your Dr if you're unwell or concerned about something...
People adopt different attitudes to preventative medicine depending on their age and medical/family history - whereas the Americans didn't see these tests or exams as optional - they assumed they were compulsory...it made your medical sytem sound almost militant. Like patient choice/views/preferences are irrelevant....(no offence)
Just my thoughts...
Dr.B-
You state that it is inconceivable that to a doctor a patient would not select them because of their "gender".
I don't know how you can state such a thing in 2009!!!
It is well documented and known that patients - both male and female - will choose a same gender physician when entire body procedures are involved. Such as women insisting on female GYN's or female dermatologists. Same goes for male patients. Most male patients will choose a male urologist, a male dermatologist, a male GP, and/or a male surgeon.
A female GP my wife went to told my wife she had no male patients! The male patients saw the male physicians in the practice.
To a patient, the majority of the time, there IS gender attached to the provider, no matter how a doctor wants to look at it- GENDER does definitely exist. A physician that thinks otherwise is NOT in touch with reality- they are kidding themselves!!
JW
I agree with you, doctor. I'm disappointed with priests, ministers,rabis, and any religious leaders who don't live up to their vows or ideals, especially when it comes to sexual abuse. It's difficult to even quantify the damage that's done.
Doctors and nurses, too. I think it's no accident that we're talking religion and medicine in the same connection. The kind of trust we place in the medical community is similar in some ways to the kind of trust we place in religious leaders. And when that trust is lost, it creates a significant trauma. Our core values or schemas can be challenged or even lost.
I wanted to provide that quote just to provide a religious perspective that I think generally represents the Judeo/Christian philosophy -- generally. The issue of religous modesty comes up, but more often in terms of Islam, not so much with the Judeo/Christian tradition.
Hi in response to Sam. I am from Australia and Sams comment at least as it applies to Australia that:
"The English and Australians had similar medical experiences - basically see your Dr if you're unwell or concerned about something..."
Is actually more complex than that.
Some examples:
Regular prostate checks- There is actually a debate about this with some authorities eg Cancer Council basically saying its up to the patient and their doctor others, others saying it should occur for all men over a certain age.(EG Prostate Foundation)
Testicular exams- not recommended unless some reason.(EG Family history) Self exams not generally recommended for all. Doctors do not generally do these exams on annual visits.
Breast exams- Are recommended and there are special free mamography clinics set up for this. Breast self exams are not generally now recommended.
Pelvic exams- for women over a certain age for the purpose of a pap smear are recommended. Not required for other reasons eg. to gain birth control pills
colon exam. For all over 50 is recommended. In fact the government has funded a program of sending fecal home tests to all when they turn 50.
Just some examples. The point is that I understand (not being medically trained), that all are based on the evidence that is the best approach and of course any patient is able to request, or not request, tests according to their wishes. Nothing is compulsory
Regards
Chris
JW, you write "You state that it is inconceivable that to a doctor a patient would not select them because of their "gender".I don't know how you can state such a thing in 2009!!!"
Maybe this is part of the wandering of a physician's mindset from the patient as a subject to the patient as an object, as I was discussing with MER. Again I say, physicians generally have confidence in themselves and when they are called upon to demonstrate their skills (mental or with their hands) they may not consider that the patient is interested in their gender but that the patient is interested in how well the physician can provide relief of their condition. As I have said attention to patient modesty during a physical exam is taught and emphasized to students but emphasis on patient's need for gender selection of physicians is not but I, myself, have started to bring this to my students' attention since being educated here. ..Maurice.
Dr B - I honestly think it is quite obvious to most physicians that patients are choosing a gender of the physician when they make appointments. Many male OB/GYN doc are well aware of this situation (and many don't like it). Most derm doctors are well aware that patients mostly prefer same sex physicians if they most disrobe.
JW
MER I want to thank you for posting the info on Bill H.R. 2115. I went and got a copy of the Bill and now am taking it to all the Hospitals around me.
I also included your Quote " Why do men delay? Some of us are suggesting is that men quite often don't have same gender choices available for the embarrassing exams and procedures involved with this disease. This Office of Men's Health can investigate this, do some surveys, examine gender choice availability, and come out with some findings. " now should I just put MER after it or MER then this website address?
The first Hospitals Supervisor of Nursing... Tim was his first name. He turned a interesting shade of red when he looked through my letters and the Bill.
This is interesting , as we walk into the conference room he picks up a magazine that was laying on the table it was all Male Surfers and Beach Volleyball. on the cover...with almost nothing on, not the surfers wet suits.
Tim picked it up shaking his head like, I can't believe they left this in here. Maybe that's why he turned red...
JJ...
To JW
You said that " a female GP that
your wife went to stated that she
has no male patients and that the
male patients go to the male physicians in the practice."
I can't help but wonder how the
discussion even came up. Was it that perhaps the GP is complaining
and if it ever came necessary of
which gender would you think the
GP would choose if she needed to
seek a specialist.
What would it matter to her as a
patient is a patient right. I mean
if she is gender neutral than what
would it matter if she dosen't get
male patients. See my point! Why
should it matter to this female GP.
Obviously, its a concern as it
became a topic between two women
and lets reverse the roles. What
if it were a male patient and his
male GP that were discussing the
fact concerning why he dosen't get
female patients. If you were the
male patient would you think it odd
to be in such a discussion. I would!
PT
"full body skin exams by dermatologists are seemingly standard"
Why do they have to be standard? First of all the patient should always be the one to decide how thorough a dermatalogical exam should be. Aren't even somewhat intelligent people able to see if there is anything strange or new on their private areas? Especially with the help of their spouse. If there is anything odd or new in that area then it's probably best to have it looked at, but if there is nothing there it should be pretty obvious to the patient that there's no reason to humiliate themself by allowing at least one other person to verify that there's nothing there.
Another ridiculous fact is how common it is to have an assistant, almost always a woman, there to "assist". What the hell???
Like any other unethical exam or procedure the patient has to step up and defend himself. Just use your common sense and don't let the doctor or his "assistant" tell you what to do unless you understand the reason and believe it is necessary. You won't go to jail and usually won't get kicked out of the doctor's office just for standing up for yourself.
Sam,
I'm an American and am extremely proud of my country but I agree with you 100%.
Thanks for your thoughts.
DG
JW - I loved your last comment and agree with you. I don't understand why so many doctors and/or their staff claim to be shocked when someone asks for a gender preference. How could they possibly not understand that? With so many experiences we've heard about how a medical professional (or a nurse) demand their own preference when they themselves are the patient there's no way they can possibly think that everyone else is different and doesn't have a gender preference. When anyone else requests the same thing they pretend to be shocked as if they never heard of that before. They're not really shocked, they are just liars.
Receptionists are trained to pretend to be surprised when a patient requests a preference but they, more than anyone else know how common preferences are and are even bigger liars than anyone else. They are trained to belittle and insult those patients and unfortunately they succeed way too often.
JJ and MER
Keep up the good work. I wish more people would put as much effort into educating those people that can possibly make a difference in the fight for medical ethics and against double standards. You have my respect.
LT
My wife and I both request "doctor only" in the exam room when we see the derm doc. What is interesting is that the medical assistant (females- all of them naturally) get very twisted out of shape and very much take it as a personal affront. They look at you with distaste and the body language and looks on their face definitely shows insult. Like how dare you refuse my presence in the exam room to take notes on the computer!!! This has happened several times on office visits. I don't disrobe even down to my underwear. I wear shorts and remove my shirt. Another family member went to a different office and the doctor wanted everything removed. The patient refused to completely disrobe and left his underwear on. The doctor made a big deal out of it. The patient left them on.
In response as to why the question of a female GP doesn't have male patients - my wife asked her directly. I don't quite know what they were discussing but somehow it came up in conversation.
JW
"full body skin exams by dermatologists are seemingly standard"
I don’t at all believe this to be true. My wife has a case of EB which is a disorder of the skin cells. Her case is very mild compared to most but while the doctors were trying to figure out what it was (even at Vanderbilt) she was never asked to remove all clothing. She’s been to several doctors and never had to do this. Since it was only apparent on her legs, she just wore a gown and that’s what they examined (even the students). I myself have had some moles removed and others looked at and again, only removed what was needed to get a view. I though this was the standard? I’ve heard of older men doing full body exams but it was always by choice. I don’t think any doctor male/female can hold you to removing all your clothing.
My department had a mini team building a few weeks back. The first question that was asked was why my company had the policies that it had? There were several well thought out answers but the correct answer was one that everyone was thinking of, but couldn’t say. It was because a few people who started the business came up with these policies not based on anything more than what they saw fit. No research, no input, no data, just a thought. That reminded me of this discussion. So many standards but no data to back them up. Our company is finally making changes and thinking outside the box, maybe providers aren’t that far behind? Jimmy
"full body skin exams by dermatologists are seemingly standard"
Yes, at sometime particularly when there is a reasonable suggestion that there may be more than one skin cancer present somewhere on the patient's skin. With skin cancers, if there is clearly one present, there may be more and not necessarily at the same anatomic location. Therefore all skin areas should be visualized.
However, as written here on these threads by visitors, they have experienced this full body skin exams in a fully nude examination. As I have mentioned previously, full nudity is not necessary for a thorough and accurate exam. The dermatologist at our medical school teaches the students and residents to examine sequentially in segments of exposed skin with the areas not examined at the moment to be fully covered by movable drapes. Concentrating inspection on a small exposed area has been found to be more productive in picking up small lesions than inspecting a patient with all skin areas fully uncovered (nude). But full body skin inspection is standard to be sure that no additional cancers are missed. I hope this explains the statement. ..Maurice.
Doctor:
You write: "The dermatologist at our medical school teaches the students and residents to examine sequentially in segments of exposed skin with the areas not examined at the moment to be fully covered by movable drapes."
What does the dermatologist teach about assistants in general and opposite gender assistants in particular (or chaperones? Is there a standard? Is there a policy? Is the patient asked?
What does your dermatologist teach about notetaking? Who takes the notes?
This is one of major areas of complaint from men regarding dermatology exams -- the apparent "need" for the dermatologist to have a female assistant to take notes for him while performing an exam on a male patient. What is taught about this at your medical school?
MER, good questions but I honestly cannot answer them since I have not been involved or experienced that teaching. The faculty who teaches the first and second year students how to relate to patients, take a history and perform a physical exam had a didactic lecture by the dermatologist that teaches the students and residents and he only described and demonstrated to us the technique of examination but didn't mention anything about the other issues you noted. I can tell you, however, that he indicated the rationale for the sequential exposure was not only it was more accurate, as I have already noted, but also this method was taking into consideration the patient's modesty and comfort. Therefore, I suspect the other issues you mentioned would be considered by him in terms of patient modesty and comfort. Beyond that, I can't answer you. ..Maurice.
After reading all volumes I have to say that I am most grateful to all who have so aptly expressed my concerns....many times much better than I could have myself.
What surprises me is the legnth we have to go to get others to undertsand our point of view. (I always thought it was obvious to WANT same gender care although a fight to get it.)
However, my question has never really been answered.
To those of you who DON'T care who views, invades, or touches your body.....why?
swf
re: the necessity of an assistant in the exam room with the doctor:
It's my understanding that in addition to actually assisting the doctor by handing him instruments, etc. the assistant is also there as a potential witness to what the doctor said or did in case of a dispute or accusation. In the case of male gyns, shouldn't this be a necessity?
Doctor:
You write: "he indicated the rationale for the sequential exposure was not only it was more accurate, as I have already noted, but also this method was taking into consideration the patient's modesty and comfort. Therefore, I suspect the other issues you mentioned would be considered by him in terms of patient modesty and comfort."
That could be the case, but I don't think we can assume it so. The attention to draping may be because there "is" (most likely a an assistant (most likely a female) with him so he's taking more precautions for modesty. And I'm very curious as to whether he would assume a male patient just didn't if he didn't speak up -- or, if as practice he specifically asked the patient about his comfort level. These are the kinds of questions we need to get out front in medicine. Many patients want to know how doctors handle these situations. Many patients don't want to have to get into the exam room to find out -- and my experience is that most doctors don't want to talk about this.
Is there anyway you could ask these questions of him? I think it would be a good indication of what's being taught. But these are the areas where the profession needs clear standards. Newman indicates as much in his book. The article "Naked" in the 2005 New England Journal of Medicine says as much, also.
I'd really like to know what's taught. And I'd also like to hear why so many dermatologists have all female staffs I(besides the economic and female chaperoning reasons, if there is one). Are they not thinking about male modesty, do they think men don't care, or have they just become desensitived to the whole issue when it comes to me. Is it strictly a business/legal decision?
Generally, they're not that way with women because they is to much at stake professional and legally.
Perhaps you could convince that dermatologist to post here and explain his philosophy.
swf, to those of us who have been reading the threads gradually as they progressed over the past over 3 1/2 years, I think we all would give you great credit for reading through all the volumes, if in a brief time.
I agree that, unfortunately, there hasn't been much input on your pertinent question "To those of you who DON'T care who views, invades, or touches your body.....why?"
As I have said previously, my answer personally for your question is that I am far more interested in having things done well for me when I am sick and I remain attuned to the skills of the provider rather than the gender of who does it. But that's me and as a physician that's the way I would expect the patient to think of me. OK.. I know.."gender neutral physician". Anyway, that's my personal answer. I await for others to answer your question. ..Maurice.
"re: the necessity of an assistant in the exam room with the doctor:
It's my understanding that in addition to actually assisting the doctor by handing him instruments, etc. the assistant is also there as a potential witness to what the doctor said or did in case of a dispute or accusation. In the case of male gyns, shouldn't this be a necessity?"
I find that particularly irksome for two reasons. 1. It protects the doctor more than the patient and I am unaware of many false accusations. And it still doesn't protect against inappropriate thoughts which I would say is what happens in the majority.
2. It assumes that there is the possibility that something inappropriate could happen. Now if doctors are truly gender neutral this notion should not even enter anybody's consciousness.
NP
MER I also have noticed providers tend to head for cover when confronted with the question of modesty. I still don't know whether it is arrogancy or associated mainly with this issue. Dr. Orrange's posts on dailystrength were paticularly telling. What I find paticularly telling is many have their own preferences, and even more who claim gender nuetrality for them selves do not recognize it in other professions when they are the one exposed. Like Physcians are some sort of special person or have some sort of special abilities. This becomes apparent as the medical community extends this to nurses, cna's, techs, etc who have in some cases very little training and can be 18-19 years old.
I have had two dermology exams. In both cases I went down to my underear, was given a paper sheet which was a joke as it was so flimsly...but the Dr. did the exam and then asked...do you want me to check the rest...since he had don the rest of me I knew what he was saying...that is what I call respecting patients...
Elaine
I think your post is indicative of part of the problem men face. Please don't take this as an attack on what you said. Frequently when the topic is addressed it goes to protecting female patients from male providers. The number of providers who would do something unethical is very small, and would the situation be anymore acceptable with a male assistant. In fact most would say it would be even less acceptable to have two males observe this intimate proceedure, but think nothing of having a female "assist" a vasectomy or DRE...even male physicians use females to assist when they could do intimate exams and procedures without them. The truth is the biggest part of the issue is what is more comfortable for the paitent...yet the concern for males is not seen as a big issue..
Dr. Bernstein, I find it interesting that Dr.'s would make this about them. Supposedly the patient is the focus of the scenerio..not the Dr. Now I could understand it if the patient was saying no based on gender period, but the patient is saying no to a specific situation and how they feel...I don't think these conversations usually say anything about the Dr's ability, but how the paitent feels about the opposite gender situation....Another thing I find interesting...providers say they should be seen as gender nuetral, yet they wear jewelry, make up, etc that have not only gender implications but sometimes sexualtiy as well....alan
You never see male nurses nor
assistants working at a female
practitioners office nor at male
practitioners office for that matter. Next time I need to change
the oil in my ferrari I'll ask my
girlfriend to hand me the tools.
That should boost my ego big time
and elevate her status to ferrari
assistant. As if my ferrari has
concerns about its internals being
seen. Don't expect to see sports,
car and driver nor mechanics illustrated at that female practitioners office waiting room.
Magazines like cosmopolitian and buffy the vampire most likely will
grace the tables. If you tend to
dab some of your favorite expensive
colonge on expect to be asked what
it is,however,if you ask what they
are wearing you will be given that
oh he's hitting on me look!
Finally, what does it matter if
someone is remotely gender neutral
as they claim when the receptionist is a 19 y/0 and taking notes on a computer?
PT
Gee Maurice can there anything more humiliating than that photo on page 16? It is very disturbing.
NP
NP, all I can say in answer to your question is "not really". This photograph was, according to Wikipedia, taken over 100 years ago, I would hate to think this is happening in some clinic today.
MER, I'll try to see how I can contact the dermatologist and try to get a response. ..Maurice.
My husband and I went overseas last year and found ourselves on a foreign beach surrounded by people wearing next to nothing...men and women of all ages and sizes wearing all sorts of g-strings and tiny tops (often topless)...we felt like we were bearing trench coats in comparison...
We were seated away from the water...near a grassy area and were dismayed when a middle aged and very overweight couple started to shower in front of us - took off their tiny bathers and then bent down to wash their feet - we left very quickly!
This couple were definitely aware we were seated behind them.
It seems modesty and bodily privacy varies between people and between nationalities. I can't imagine that couple having an issue with full skin checks...although perhaps, a medical setting might be different.
Even at the gym, I notice some people are happy to walk around naked in the changing rooms, others undress in cubicles and wear bathers into the steam room. (and that's an all female area)
We all have a different level of modesty...some people don't seem to care at all, others care around the opposite sex and some people are modest full stop.
Doctors and nurses need to be mindful - you can't assume because someone is male, female, young, middle-aged, old, slim or overweight that they are more or less likely to be modest.
I used to be afraid of doctors and felt they had the power.
I basically avoided them for 20 years. I think my fear started as a child with a gruff family doctor who was a master at man handling you...
I stopped seeing him when I was about 16...I hated sitting there wondering what would happen next -I felt powerless. (not suggesting he was a predator, just frightening, abrupt and rude/gruff)
I've become more confident with age. I do my reading and stand up for myself...
I make it clear what I will and will not agree to...
Gradually, the power base has shifted and I now feel comfortable seeing my Dr for most things.
I refuse to have unpleasant exams and tests that are unlikely to benefit me...I prefer to carry a tiny to small risk.
I really believe if all people took the time to do their reading, they'd feel more confident around medical people.
I found medical academics were very helpful and more likely to give me an honest assessment of the need and benefit of some testing and exams. I work on campus...so had a ready supply.
Armed with the facts, you're better able to stand up for yourself.
Personality is important...sometimes you know a working relationship will be difficult - it's the same with the doctor/patient relationship.
I have never been asked to completely undress for a skin exam - just down to my underwear and given a brochure to look for changes elsewhere...which suits me. I assume if you asked, she'd check everywhere.
Personally, I'm a very private person and don't like going to the doctor at all...but I've managed by standing up for myself...if a Dr doesn't like it, I'm happy to find someone else.
It's worked for me.
Doctors just seem to make "a note on the file" and move on...
I've recently decided not to have mammograms (nothing to do with modesty) and once again, armed with the facts...a note was made on my file and my decision was accepted even though my Dr believes mammograms are a helpful screening tool.
I think it's the loss of control and vulnerability that creates fear and no one likes being exposed and embarrassed. I really believe a lot of the exposure and embarrassment is unnecessary or could be minimized or better managed.
It's also finding the right doctors.(for you)
Is he/she right for you? Will he/she respect your wishes and decisions?
A female friend was having an ECG and a female tech walked out and left the door ajar...her breasts were exposed and she was embarrassed that she may have been on view for a couple of minutes (then she noticed and asked that the door be closed) I helped her draft a letter to the hospital and to the Minister of Health. (State and Federal) She also advised her GP, who sent a letter of complaint to the Hospital.
I think they'll be more careful next time.
I can't quite understand the thinking when you'd walk out and leave someone exposed...can you imagine doing that in any other setting?
If we just take what's dished out, nothing will change...but if we change our thinking and take charge, complain, refuse, demand...what's the expression, "the squeaky wheel gets the oil"....
I know if I discussed something confidential with a client and left my office door open, it would be unprofessional - equally, IMO, it's unprofessional not to consider patient modesty and comfort.
I think doctors and nurses who don't consider patient modesty - leave doors open, ask you to undress unnecessarily or don't respect your wishes in that regard are unprofessional.
Simple as that...
"The dermatologist at our medical school teaches the students and residents to examine sequentially in segments of exposed skin with the areas not examined at the moment to be fully covered by movable drapes."
Here we go again. If your genitals are exposed at one time or another you have been seen naked. If the perverted assistant sees your genitals what difference does it make if the other 90% of your body is bare?
"Many patients don't want to have to get into the exam room to find out"
No matter how he likes to conduct the examination the patient should take it unto himself to dictate how it will be done. Patients shouldn't be afraid to have an exam wondering if it will be conducted ethically or not. Medical "professionals" like the patient to be surprised because if they know ahead of time that they'll be forced to be exposed in front of their worthless assistants or nurses they might cancel the appointment or try to take measures before the visit to ensure that no assistant will present during "naked time".
Doctors know that when patients are put on the spot by just taking an assistant in with them they are much less likely to refuse the presence of the assistant.
My question is, it is so obvious that assistants or nurses are of little or no help during countless examinations and procedures, why do doctors hire them and pay them to stand around and do nothing? (other than to be chaperones because of the fear of being sued, which I understand is a fairly new concept)
It's obvious that the most important reason for doctors offices, clinics and hospitals to be in business is for the money. Are there State or Federal Statutes that require a certain amount of support staff? I can't envision these greedy doctors hiring people to do nothing more than vitals, handing the patient a gown, passing them a tool every now and then and jotting down a few notes. Maybe one nurse/assistant for a decent sized office or clinic but any more than that seems a waste of their profits.
"In the case of male gyns, shouldn't this be a necessity?" (chaperones)
Elaine, I haven't seen many complaints about a nurse assisting (chaperoning) a male gyn. That appears to be a standard that not many women complain about. The vast majority of complaining I've seen and heard is to have a female chaperone with a male patient (with a doctor of either gender). That's when it becomes unethical. Even putting a man on the spot by mentioning the use of an assistant or nurse with the assistant standing there is unethical because the doctor knows darn well that most of the time a male patient won't object aloud with the assistant standing there, no matter how humiliating and unfair it is for him.
Alan, your dermatologist sounds like a keeper. It's a pity all medical professionals aren't that respectful to their patients.
To the last Anonymous regarding inspection of the genital area: there has to be a rational limit to modesty arguments. And that limit is separating the "good" and the "bad" of genital examination in a dermatologic exam. The "bad" would be exposure of a modesty sensitive area of the body without specific understanding by the patient of the reason for the inspection and without the specific willingness of the patient to expose him/herself. The "good" is the necessity to discover lesions, both neoplastic and infectious, which can have a profound effect on the health of the patient if missed. Being critical of exposure per se is being uneducated as to the purpose. I can't speak for "perverted assistants" within the room. If there are such in common dermatologic practice they should be specifically identified and removed. If there is a need for an assistant and to me it would be truely unnecessary unless it came to a biopsy procedure of a skin lesion or unless you want to argue the need for a chaperon.
Yes, there is no doubt that patient modesty is an important issue in medical practice that all healthcare providers should be educated about and aware and responsive but also those who espouse the need for modesty need also to be educated and aware of the personal health benefits of allowing modesty to be tempered under specific conditions. ..Maurice.
I wonder if female RN's and CNA's know or care how disturbing their conversations are to other women. Not long ago three women at the gym I own decided that their second careers (ages 40-50) were going to be CNA's. Now,coffee clutching about their new-found entitlements during workouts seemed to be their newest hobbie, and honestly from the conversations none of them are up for the Florence Nightengale award.(And by the way these woundrous beings refer to me now as a civilian. How quaint) And yes, I did attempt to guide the conversations away from where they were, but enough is enough and eventually I had to let them know that:
You chose this career,not my husband or me. I never got the call asking if he were placed in front of you was it alright with me if you saw or touched him intimately. Future reference...the answer is no.
As far as being a professional? 12 months ago you were all professional something elses, so how does this reassure or make a difference to us in any way?
Jealous? Perhaps as jealous as I would be of any other woman who claimed the "right" to veiw and fondle my naked husband.
Society bestowed this honour upon you? I am society. Perhaps you meant the legal and medical society who currently do not seem to be speaking well on my behalf anyway.
Forgive the rant, but seriouly:can't we all keep in mind that we are all just people? These women are just other women to me.
swf
swf hit a very important part of this. While physicians may feel they have the right to play the the "professional" card or say the extensive training makes them different in terms of observing nudity...the fact that they extend this right to support staff all the way down to and through CNA's and techs who have very little training seems to contradict that. In doing so they devalue their argument that medical providers have this special status by way of their training and position that make the behavior less of an issue to their patients. If indeed one accepts the arguement that training and education are the defining criteria then would have to assume that those with less education/training are less capable of being gender nuetral. Yet, by using these people for assistants and duties that cause patients to be exposed to them the medical staff is not differentiating. Now, if you want to go the nesescity route, what about all the times they are there for minor reasons with minimal roles such as one I related where a female nurse "assisted" a vasectomy and all she did was hold his penis to the side. Likewise the occassions where there is no attempt to assign support by gender seems to discount the role education and training play in patient modesty in the medical setting. Now if we go the last route of job duties require this...could we not make the same arguement for janitors and trainers....so while Physicians may claim special privledges including the right to claim gender nuetrality...how do you justify extending that to people with a very minimum of what Physicians claim make their assertations valid.......and since to a large degree doctors are in charge.....while this may or not be exagerated...is it more of a stretch than claiming a male or female is niether by profession and is in reality gender nuetral...how do we navigate those
waters?.......alan
Br. Bernstein,
You made the statement "but also those who espouse the need for modesty need also to be educated and aware of the personal health benefits of allowing modesty to be tempered under specific conditions".
In basic principle I agree, but would state it as "Those who espouse the need for modesty need also to be educated and aware of the personal health benefits of allowing modesty to be tempered under specific conditions as well as the realistic potential risks of not doing so". This is the principal of informed consent, or you could also call it informed refusal. Ultimately it is the patient and only the patient who has the right to make the decision, and once they do the health care provider should accede to their stated wishes.
"those who espouse the need for modesty need also to be educated and aware of the personal health benefits of allowing modesty to be tempered under specific conditions."
I think most reasonable people agree with that statement in principle. A key word is "tempered."
And what we're debating here are those "specific conditions" and who is in de facto control of them. "The patient is in control" is a cliche. It perhaps represents the de jure,the ideal. But we all know, patients and medical professionals alike, that this is not how it works in the real world of the clinic or hospital. The system generally, at least historically, has been designed to make the patient powerless so that the system can deal with a body and not a person because it's easier for the system that way. Bodies just need fixing. They can't talk back or request preferences or claim values or cry. Human personalities can do all that, and more. I'm not saying individual doctors and nurses don't care. They do. And they do wonderful things. But the system, the culture of healthcare moves in a different direction.
Granted, things are changing for the better. And some doctors and nurses are behind these changes.
I think it's rare for a patient not to allow any medical professional under any conditions to see or touch any intimate part of his or her body. We're not talking about the extreme.
We're talking about average, ordinatry, everyday people who are fine with oppostite gender care under certain circumstances and are not fine with it under other, more intimate circumstances. This is a perfectly natural perspective. Some of these "other circumstances" are ethically questionable -- like suprise chaperones or assistants. Simple economic fixes. Others may be part of the medical culture and recent tradition but not part of gender norms in the dominant population.
There is a certain politeness in asking permission in our culture, a tradition of civility. "Do you mind if I sit here?" "Do you mind if I smoke?" "Do you mind if have one of your French fries?" "Do you mind if I go first?" Maybe we're losing this, too.
"Please." "Thank you." "Pardon me." "Excuse me." "I beg your pardon."
It baffles me that we consider these civil statements basic courtisies, and for such simple actions. Yet in medicine, it's not considered standard policy to ask patient gender choice for the most intimate, embarrassing, perhaps humiliating procedures. It leans toward a not uncommon entitlement culture of medicine, rather than the ideal culture of priviledge and service.
Bravo, MER. And AMEN.
Cate,
I like your perspective. That is exactly the same reasoning I have. It just seems like common sense to me.
DG
My wife and I agree with you, "swf" ..they "are" just other women. I think if most wives knew or could see what goes on in the procedure room, exam room or surgical suite, they would NOT like it one bit and would be angry and upset. Just the way many men don't like their wives been touched by male OB's or male nurses. Intimate procedures should be handled by same gender providers.
JW
I believe if you examine the patient bill of rights it so states
that you the patient are encouraged
to make choices and decisions.
It's not just about agreeing to the procedure but deciding if that is the best course of action and
most importantly giving your
permission. I believe the patient
is in control and should be given
the opportunity to ask questions.
This is more about empowerment
and education on the patients part
as far too often patients just assume they are along for the ride.
They most often don't question let alone know about the procedure
they are about to recieve. They
mistakenly make the assumption that
their interests are looked out for
and if you know anything about
healthcare that is the farthest thing from the truth. Hospitals are
not in the business of taking care
of people. They are there to create
wealth just as any other business.
At the end of each month graphs, bars and calculations are done with
all beans counted. Welcome to for
profit hospitals as new technology
gets abused for the sake of
revenue. Sadly the blame needs to
be shared by both parties as the
term "bad patients" is a relatively
new term on the horizon. In the
Dallas/Ft worth area from 2003 to
2006, 9 patients accounted for
2600 emergency room visits. Why,
because 8 of them were known drug
abusers.
PT
Dr.Bernstein's post made me think about the balance between the providers viewpoint that patients need to be aware and balance the benefit of compromising ones modesty or perhaps the cost of not, with the right of patients to self determination. The question becomes who has the right to determine what is the proper balance. While the obvious answer is the patient has the right to determine that balance, with the provider controling so much of the interaction it seems Providers or perhaps the medical community have assumed or imposed their opinion of where that balance is on patients, In my opinion that decision is more for their benefit than the patients. In a majority of the cases compromising a patients modesty is not an absolute nesecity as much as it is an convenience for providers. So while in theory the patient has the right to set that balance, in reality providers more often than not set that balance with policy and process.
while Dr Bernstein indicates the patient needs to be educated and aware of the consequences and benefits of being willing to compromise their modesty...providers choose to not inform and educate patients on the other side...when they will compromise the patients modesty and what options there are....so while I whole heartedly agree with Dr. Bernsteins contentions that patients should be informed as to the benefits and consequences of their choices on modesty....it also should follow that providers should provide the whole story including choices and the fact that ultimately it is the patient...not the provider who has the right to decide that balance....alan
Alan, I have no disagreement with everything you wrote. The doctor has the responsibility to listen and to suggest approaches to mitigate the concern to the overall benefit of the patient. BUT, the patient has the responsibility to INFORM. I say again and again, based on my experience, I suspect that in our "American culture", most physicians do not have it as their first thought that the patient has marked and sincere concerns about the gender of the physician when they appear for an examination or procedure. They, as I, have considered as the first thought, that the patient is thinking " can and will the doctor relieve me of my symptoms and disease and can I tolerate the procedures or treatments." The fact that the patient is present, to the physician, is evidence that gender is not first on the list of concerns. So..therefore it is the responsibility of the patient to INFORM. ..Maurice.
I informed my doctor that I didn't want certain tests and was patronized and chastized...
It was an awkward situation.
I prefer to avoid doctors.
I haven't been able to find one who'll listen and respect my wishes.
As a result of bad experiences, I suffer acute anxiety when I feel out of control.
There doesn't seem to be room for us in the system.
It's their way or go it alone.
I just can't stand the fact it's impossible to confine a consult without it spiralling out of my control and every part of my body is then up for grabs and if I object, I get the lecture and attitude.
It means lots of people avoid the doctor whenever possible or altogether.
The thing is...perhaps, we're better off taking that approach in the long run. Many healthy people end up unhealthy after an exam ends up a fishing expedition.
Dr. Bernstein
I could not agree with you more. Just as the process of women getting providers to recognize modesty and comfort in gyn exams were something not to be taken lightly, this also will be a process. We are changing a historical perspective and way of doing things including evolution from the patriarcal models to more interactive.
I think one of the issues we have not dug into as deeply as others in the role of support people. For males, this is paticularly an issue given 90% of nurses are female and given nurses conduct or assist in some of the more embarassing procedures. Your point of a physician assuming since you are there you are OK with them is easy to understand other than the cases such as referral, ER, hospital stays, etc. Almost all of the problems I have had have been with support staff. I think often we hold the physician responsible for these instances since we see them as in charge. This is paticularly true when we percieve their presence as no absolutely required but more just for the convenience of the provider. While most people understand the crunch on a Doctors time and are fine with assistants for most proceedures, we might question how much a Doctor cares if they have an assistant of the oppossite gender doing what we consider trivial duties, the value of which do not outwiegh our embaressment. I think this falls in line with you frequent suggestion of communicate communicate communicate. I can see where a physician could assume if you were comfortable and or choose them it transfers to the staff...which of course it does not. From a personal view I see the issue as more supporting staff than Physicians but the physician is "guilty" by being responisble to a large degree in charge.....alan
Lee and others regarding a patient refusing tests... A patient needs to seek out another physician if they are chastised, harassed or belittled for refusing tests. A patient has the say so as to what they will consent to. A physician/patient relationship should be a back and forth exchange on a equal footing. The old "parent- child" relationship and the "doctor is GOD" thing should be a complete way of the PAST. If you can't talk to a physician on a level playing field - get another physician. I wouldn't tolerate a patronizing attitude at all. It is time to move on from those kind. All the physician does to cover his a*s is make a note in the medical file -- "patient refused". No big deal.
JW
JW, I agree, except under life-threatening emergent medical conditions of the patient, changing doctors should be the first order of business if the patient can't get the services desired.
Of course, when you write "All the physician does to cover his a*s is make a note in the medical file -- "patient refused". No big deal." you may be overlooking a patient concern that I set as a topic "Ethics of "Blacklisting":Should Negative Comments about a Patient be Transferred to a New Doctor? If So, How?" back on June 3 2006.
Perhaps you might want to go back to that topic on the above link and post your view there. ..Maurice.
I think exactly the same way Alan does. I know that for the vast majority of health problems or injuries I may get, I can choose my doctor, including the gender. Seeing a doctor doesn't really worry me. Of course for any intimate exam or procedure I will definitely be embarrassed regardless of the gender and how well I know him, but I realize that is a sacrifice I have to accept in order to be healthy. I don't lose any sleep over that.
Like Alan, what really bothers me and worries me is his supporting staff. If I have to be naked for some reason I don't give much thought to what the doctor sees and thinks, it's the nurses, aides, techs, assistants and sometimes even receptionists that really bother me. I feel that opposite gender staff have no right to be there when I'm naked and like Alan I put a lot of blame on the doctor for bringing them into the exam room, especially without my prior permission.
I know it can't be possible that nearly all doctors could be so blind that they think using opposite gender staff for very intimate and embarrassing exams and procedures won't bother the patient. Alan also mentioned the fact that a very large percentage of them aren't even necessary.
Doctors HAVE to be aware that their gender is an important factor for many people who choose him or her as their doctor. How can they not understand that? The fact that almost all Urologists are men indicates that gender does make a difference in society. Whether or not they want to admit it most men are relieved to have a male Urologist, but what's the point if all their nurses, assistants and techs are women? If men have the dire need to see a Urologist I think most first-timers don't worry too much because he's a man and has the same stuff all men have under their clothes so this shouldn't be too much of a humiliating experience for them. They don't anticipate having 1 or more women in the room gawking at them throughout their visit, and they REALLY don't expect those women to do the majority of the "hands on" work.
It blows my mind! I know those elegid "professionals" aren't stupid enough to not understand how horrible that is for most men. It makes me conclude that they just couldn't care less about patient feelings and humiliation. Doctors deserve the most blame for that but I also don't understand why female nurses even apply for jobs that they know will include gawking at naked men all day. They should also realize how horrible that is for the men. They are just perverts that enjoy dominating and humiliating helpless men. If men don't start defending themselves from this unethical humiliation they will continue being treated this way by those perverts forever.
Anonymous from 8:13am today, can you defend the terms "gawking" and "perverts" as you describe virtually any of the employee staff of a physician? How do you know that this class of employees all deserve the terms which are defined as "observing stupidly" and "deviant from being ethical, usually in a sexual sense" respectively?
Yes, I am sure there are individuals who will gawk and there are those who find sexual pleasure simply by looking without performing or contributing any significant value to the patient. But to paint an entire class with the same brush seems unfair and insesitive to the host of employees who are contributing value to the diagnostic or treatment process.
Think, no doctor wants someone who is simply gawking or is a "sexual pervert" in his or her office or is considered as such by his or her patients. Why not simply complain to the doctor but also provide the doctor with some idea as to how you came to your conclusion?
As I have written previously, I find painting entire groups in negative terms with the same brush based on experience with group outliers without some proof is not helpful in discussions. Should we call all Catholic priests perverts or all police insensitive toward killing innocents? I should really start a thread on "painting all unethical with the same brush: Is that ethical?" Maybe everyone in a class of persons deserve the negative opinion of the public referring to certain members of that group. Maybe every group has a responsibility to weed out all the bad outliers or else face the common painting by the public. ..Maurice.
OK, I just created a thread where visitors can discuss brush painting in ethical terms. The thread is titled "Painting Groups with the Same Brush as Outliers: Is That Ethical?" Just click on the link, read and then write. ..Maurice.
Dr. B,
Stating a doctor should make a notation of "patient refused" this test or that test I don't feel falls particularly under the category of being a difficult patient and "blacklisting" is in any way involved. If my wife saw a doctor and she refused a breast exam or a pap smear...why would she be labeled a difficult patient? Or if I refused a DRE, I am now a difficult patient? No, this does not fall under that category. And by the doctor making that notation he is protecting himself legally.
I might also again add that ALL patients are entitled to their medical file and records. If you relocate it is important to request and sign a release to receive your entire medical file. Everytime I get a test done, no matter how trivial or routine, from lab to xray to scans, etc. I get a copy of the test and the report for my files.
Don't you get a record of everything done to your auto when it goes into the shop?
I just wanted to mention a few E-mails that I have received from diffent facilities regarding the same gender preference. I realize that I am relatively new to this blog and have much catching up to do,so the info may be of little relevance.
To the places that offer a "safe and friendly" women's only environment, I briefly thanked them for offering this service and asked if they could direct me to similar male only services for my husband. No responses.
However, I did get two responses from general facilities which were directed by men. They may not have been everything that I wanted, but I give them alot of credit for even taking the time to answer...and each small step is a step nonetheless.
They both told me that they had both male and female doctors, but all "secondary" staff were women. They gave me the "private nurse" suggestion for my husband although neither would accept that at his facility. They did wish me luck however, and stated they would keep my e address should staffing change to accomodate both of our needs.
I guess the interesting part of this is that males did respond and in a non-judgmental way.
I wonder if I would be amiss in assuming the lack of female response is in fact a judgmental statement. Perhaps not. I'm sure they are all very busy.
The quest goes on.
Special thanx to MER and Dr. B. for the reminder to keep inquiries
professional and unemotional...
swf
In the medical world there are two
important concepts, non-compliance
and ama. If you agree to your physicians advice for treatment
but are negligent in following his
terms and conditions then you are
non-compliant. As an example, you
present to your orthopod with a
boxers fracture. Your hand/wrist
are placed in a gutter splint and
told not to use your hand for any
grasping or lifting,but you do anyway.
In that case you are non-compliant, the bones don't and will
not heal properly which leaves the
only alternative,surgery. They won't tell you that you're non-compliant,however, the clue is
when you are referred to pain management.
Ama,against medical advice often
paints patients with a negative
brush. You as the patient have every right to refuse any care
providing you are of sound mind and judgement. Patients often are
ama to persue a second opinion or
just simply to stew on the alternatives for awhile. Maybe they
don't feel comfortable with the
provider,however,no one should be
belittled or chastised for refusing
treatment.
More patients need to be empowered and above all educate
yourself about medical procedures.We were never given an
owners manual about our body but
we are the keeper of it and if you
don't want something done say so.There needs to be more assertiveness regarding these issues.
PT
"Non-compliant" is often used in a derogatory sense and should be not used since as I have written, compliance by the patient is based on education and facilitation by the doctor and psycho-social factors facing the patient. Non-compliance does not necessarily represent a negative behavior on the part of the patient.
"Against medical advice" (ama) is purely a descriptive term of a decision and does not necessarily represent something negative about the patient. Remember, advice is simply advice and the ethical principle of patient autonomy permits the patient to make informed consent or as some people forget "informed dissent"! . "ama" merely indicates the advice was not followed but as it stands, nothing more. I was just trying to clarify any unnecessary negative appraisals of the patient who is so-called non-compliant or decides against medical advice. ..Maurice.
swf,
In your research are you searching for a place that will have male support staff for "intimate" exams or procedures only or for a place where male support staff do everything. What I mean is, do you want males for every aspect of your husbands care or do you only worry about who is assisting during intimate exams?
Thanks for telling us what you've learned so far. I find what you've already learned very disturbing. If I can't find a place where I can have an intimate exam or procedure without women standing around and trying to get "hands on" with me I think I'm finished with the medical world. My health just isn't worth constantly putting up with nurses. If a doctor can't help me by himself or with a male nurse then he is worthless to me.
To ANON 5:35 AM
Small clarification: My husband and I both want the same things as far as intimate care. (male/female repectively) I just happen to find myself in the position of family advocate.
I can tell you what he wants for himself......same gender intimate care.
What he accepts from the "woman of the day" in the doctor's office in general care? Blood pressure, pulse, and basic questions as to why he is there. (renew meds., think I have the flu, my neck hurts, etc.)
Anything personal waits until he is in the (male) Doc's office.
He does think that men's comfort level would be greater if a male nurse were there instead of a sea of women, but these small things he will concede.
I live in a relatively small town, so I gave myself a 300 mile radius to start researching. Have you had any luck at all in your search? If not, do you plan on continuing the effort?
swf
profiling is another concern of mine.
historically naked models have come from the ranks of prostitutes and may not have enjoyed the same levels of respect as other members of society.
for example, in many places we are expected to change in the institution's public washrooms, or in storage rooms.
because of my refusal to give in to the profiling, i have very early on in my "career" as visual arts model, decided to change right in the drawing studio.
though there may have been some who were offended by this, i have yet to receive any complaint.
another matter of my curiosity has been the way in which young adults are dealing with the naked male, especially if that male is old enough to be their grandfather.
i have seen young female students relocate their easels when they were initially facing me head-on.
also, often i have been portrayed without genitals...........so the issue here might well be not my modesty, but that of young females and perhaps even some males
Unfortunately, ama in the real world carries a negative connotation as that represents
99% of patients walking out of the
emergency rooms once these drug
seekers get their fix.
PT
Edo, I thank you so much for coming to this thread and I am sure many of our persistent visitors will thank you too. As you know from my e-mail to you, we have had at least one naturist here giving his view of patient modesty both personally and in the naturism culture. I am so glad to have you as an representative of the nude model profession.
I am pleased that you started with your personal concern about "profiling". Why do you think this happens and what does this mean to you? Beyond your interest in the how your presence in front of students is met, I wonder if you could tell us about how you feel when subjected to a medical examination or procedure in terms of the behavior of the physicians or their assistants. Do you think they are in any sense "profiling" you. Do you feel uncomfortable particularly if your genitals are exposed in the medical context as compared with your professional experiences?
Again, my thanks for coming here and I hope you will stick around a bit to respond to the questions and views of the other visitors who don't do the work you do. ..Maurice.
re: profiling...i suppose this begs the question: are the homeless, the prostitute, the skidrow drug addict less entitled to having their privacy and modesty respected than the owner of a $3.5 million ocean-side condo?
would that same condo owner readily agree to sit naked on an old easy chair for her/his 45-min. pose? (many pieces of old furniture are donated to art departments by former students or their parents)
recently a 19-year old female friend of mine did just that...it was just taken for granted that she sit on the same surface so many (naked, or otherwise) had sat on before her.........the irony here is that she complied, no questions asked.
she now carries a clean sheet with her whenever she models.
now, with regards to any treatment by professional health care providers, i cannot recall any disrespectful attitude (digital rectal prostate exam, examination by a female nurse re: "honeymoon itch")........but remember, i am an exhibitionist and i am not a prude - especially in the summer i traipse naked through the house.
and, no, i am not "hangin it out the window"
Maurice, why don't you ask your colleagues how hard/easy it is for them to hire male nurses. I don't think it's a matter of them not caring so much as finding it difficult. Also I would imagine that many male nurses are just not interested in working in a small practice but would rather be in a large hospital.
NP
"Yes, I am sure there are individuals who will gawk and there are those who find sexual pleasure simply by looking without performing or contributing any significant value to the patient."
How are we as patients able to know which are the pervs and which are sincere? Although my body probably isn't very desirable to look at, I have to assume that any nurse or tech or whatever that is seeing and even possibly touching my private parts may be someone who is getting a sexual thrill out of it. Very few "professional pervs" out there are going to say something or act mischieviously while seeing and touching a naked body, so there truly is no way to know.
My solution, when the boxers come off every woman is out of the room and the door is locked. If a male caregiver is getting a kick out of seeing me naked I'll probably never know.
Naturally, it is a very uncomfortable and humiliating experience to have a man see me in the altogether, but I don't consider it unethical or immoral.
anonymus,
i am somewhat perplexed by the last sentence in your recent post:
"naturally, it is somewhat uncomfortable and humiliating....."
swimming pool change rooms, locker rooms come to mind where men often appear "in the altogether" for other men to see.
if they choose not to be seen, they can change in a private cubicle.
and how has that changed since female sports reporters are now given access to locker rooms?
i once applied for a job as recreation therapist in a group home for developmentally challenged adults.
during the interview i was asked how i would handle a situation where a male was pleasuring himself in full view of everyone else (a very common occurrence with that type of resident).
i responded that i would reassure the resident that what he was doing was perfectly fine, but that he should be doing it in private and i would help him to his room and tell him to enjoy himself and when he'd be finished, to come join the others again............
yes, i was offered the job, but i had already accepted another.
as well, though i am an exhibitionist, i consider myself a "professional" patient and would never compromise the comfort of any health care provider, at least not until i had clear evidence that
my dignity was compromised in a situation.
By the way Edo, what do you think is the difference, if any, between what you call yourself as an "exhibitionist" and what CSM had in earlier postings defined himself and his nudism culture as a "naturist"? I just wanted to know if you saw any difference and if so how would this be related, if at all, to the concerns of some regarding patient modesty. ..Maurice.
NOTE: I have discovered why the attempted postings of some of my visitors never was sent to me by Blogger.com for moderation and publishing: TOO MANY CHARACTERS! If you write more than 4096 characters (I presume that includes spaces) when you think you are posting the message--your aren't. There is a notice in the posting window just below your text that explains that you have overwritten 4096 characters. This limit is seeming set by Blogger.com program. This means you need to edit your posting and retype. Remember 4096 chararcters..NOT WORDS. ..Maurice.
Here is the first of two postings which JJ attempted. They are both slightly edited by me. Recall that JJ has informed us here that he has MS. ..Maurice.
This first letter is a letter I wrote to the hospital and the last letter is a letter I received from the hospital. I walked (OK I got in a wheelchair) out when I was inpatient because they said there was no Male in the hospital, that could help me. I told them that is unacceptable and left ...You should have seen the look on there faces.
I thought they would never answer me because I was so up front with them....but they did,. The person at the hospital said something that did not seem right. Concerning going out and trying to get men to work as Nurses and CNA'S that I hope to get the opinion of everyone on.
Hello Ms. (name removed),
I Apologize up front...I am in no mood to play PSY-101. Have you read my letters? Please tell me if you know, Will the Chaplin or whatever they are called there ..receive the letter I ask to be given to them?
I am contacting surrounding health facilities and One. warning them to be weary of hiring [hospital name] rejects. Two. To actually think about what the individual patient / person needs...I know they like to call you by a bed number or room number. but there are real people in those beds and rooms. With unique concerns and beliefs.
It is better for me to send e-mail. If I think you might actually offer something other than to try and placate me . We might talk in person.. I have problems talking on the phone...from the brain atrophy I think.
My concerns are for others...there is not much left of me emotionally but what is.. I will keep going for the fight. I don't want others to go through the Hell of illness and having to defend yourself against abuse. So please tell me what has changed at (Hospital Name) since the time I walked out of the Hospital?
Have they worked on getting males into the system? You have to go out and actively recruit ..just like the military. They can't sit back and do nothing and then bemoan the fact that no males want to be a Nurse or CNA.
Tell me what is the protocol for new hires, in regards to Sexual Harassment... besides someone talking about how all the male patients will try something at one point....Who tells them the Ethics and Morals that they are expected to live up to. and the consequences if they fail to follow them?. How do the Nurses/ CNA's ascertain the preference of patients in regards to intimate care?
I am coming down hard on all the local Hospitals because there might actually be a chance someone might do something...(Hospital Name) is a lost cause and I will never stop warning people about them..
Please look at the following Blogs and forward them to others in the Hospital.
http://patientprivacy.blogspot.com/2008/09/male-modesty-violations-special-case.html
http://bioethicsdiscussion.blogspot.com/2009/05/patient-modesty-volume-17.html
JJ
Continuing on, here is the 2nd post submitted by JJ which starts off with the letter from the hospital in response to his letter. Again, this response has been slightly edited. ..Maurice.
Mr. JJ
I have read your letters. I forwarded the letter to (name removed) our chaplain. Healthcare is an industry predominately female. However, the trend is changing and more men are becoming nurses and CNAs.
Whenever you are a patient here at (hospitals name) please ask for a male care partner and if one is available we will have them take care of your healthcare needs. Mr. JJ I am sorry you have had difficulties with this issue in the past, we will help to make your visits as comfortable as possible.
The badges have information on the back of them.
I have spoken to our recruiter and she ---states we are unable to recruit specifically for male nurses and CNAs, that is discrimination.---
Let me know how I can help you.
Sincerely [signature]
WHAT !! Anyone else think that is Odd about the discrimination deal..
The badge quote is from where I say all employees should have there name on both sides. She says they have information on the other side ...what numbers so small you have to be right up on them to see...
Anyone want me to ask or say something to them?
JJ
Sometimes the importance of modesty vs morals gets lost in the eye of the beholder. Asking me to suspend my modesty, through my eyes, is what I do with my female provider. Expecting me to do something similar with a male is asking me to suspend my moral values. Not a small request because our morals are who we are, what we stand for, and the solace that makes our own spirit unique and whole.
If we suspend these issues simply because someone suggested we should, then we stand for nothing. Because this is our essence, our fiber, our mental trust in who we are. Compromising this is what leads to the personal rifts of depression, anger, resentment, and sometimes the darkest parts of what our human nature can be.
In any other arena, when was the last time someone asked you to hand over your beliefs only to be returned when they are through?
Not likely it happens often, and most likey you would say no.
We ARE the keeper of our own moral ground, and coersion thereof from society.. medical or otherwise..should be considered a dangerous undertaking.
swf
ah, maurice, if only i had started these comments as another anonymus;
there is so much more i could add here, but i am afraid that my writing style would give me away, even if i were now to become an anonymus.
with regards to your question between me, the exhibitioist and csm, the naturist, i am reminded of an episode of m*a*s*h, in which hawkeye claims to subscribe to the nudist mags only "for the volleyball scores"
and of course we all know why men buy playboy mag, right? for the articles, of course.
call me a skeptic
perhaps you are trying to define (patient) modesty too narrowly.
for me, human dignity is of the utmost importance, whether that is in the art studio, the hospital ward or in the doctor's office.
i am appalled, for instance when a young female friend who models in holland, tells me that there is snickering and joking going on when she appears naked on the platform.
in all my extensive experience as a naked model of around the age of 62, i have never, never experienced that.
in the institutions where i have been posing naked, at times people other bthan the ones who "have business there" show up....it is always cleared with me first, as is the taking of pictures.
it is just a matter of courtesy and respect....now, i always say "yes" (the exhibitionist, right), but i would be offended if it was just taken for granted that i had no problem with it.
and drawing that further into the physician's office, i would expect to be asked if i had any objection to the presence of,say, a medical student.
so, even though i have no problem being naked in front of people, i do expect those people to adhere to certain values we have come to expect in our society.
even though in the drawing studio it is very much frowned upon for the instructor, or students to touch the one who poses naked, i have had two instructors who did just that - very innocently, mind you.
now, you tell me, would you touch a patient, say, on the shoulder, when he/she were in a state of disrobe?
maybe it's just me, but don't people generally wonder sometimes what goes on in the minds of certain professionals?
to be rather graphic here, does every gynaecologist leave behind all those vaginas he saw in his office, while he is making love to his wife at night?
and, come to think of it, what exactly drives a guy to specialize in that field?
there was a post earlier about catholic priests.....why are we so surprised that all that "stuff" went on? are priests, artists and physicians above human nature?
studies have shown that a sexual thought occurs to the human male mind every 5 minutes, just not to the aforementioned groups??
i had a cousin who was a monk in a benedictine monastery in france;
he said monasteries and cloisters were hotbeds of homosexual activiy.
yet, we seem to have closed our minds and eyes to that as "they" were "men and women of the cloth" and therefore above human temptation...balderdash!
and that oes for doctrs and nurses as well.
we are all sexual beings, those of us who transgress must face the consequences.
and what exactly constitutes transgression?
when my dignity is compromised. oh, and that goes two ways,: as patiens we could also be offending the health care provider's dignity.
for example, i suspect i would offend a nurse if i asked her to masturbate me, but if she were to offer such a service, i would not be offended, i'd be most grateful, in fact.
Edo, you don't know how much I appreciate the fresh views that you and CSM and some of the new female visitors to these threads have contributed to the discussion. And by writing this I am not trying to downplay the importance of all of my long term writers since they have been important in setting specific issues for the discussion and without them we would remain ignorant as I have said has been the problem in the medical system so far. But I and I'm sure these long term writers are also pleased to have you come here and provide us with your view. Thanks. ..Maurice.
NP there is no doubt the gender disparity in nursing contributes to the issue for males seeking same gender, esp in doctors office. The question that we should be asking is why when there is a catostrophic shortage of nurses looming are we not trying to bring males into nursing when they make up less than 10% of the profession. I just had a conversation with my sister inlaw (a nurse) about the practice of bringing nurses into the state from the Phillipines. She said they paid flights, gave them gaurenteed three year contracts, paid all the fees, etc....yet even when we are seeing high unemployment, job loss that was 80% male....there is no effort to bring males into nursing. And why is it that the judicial system will uphold a hospital refusing to hire makes into labor and delivery because they are male, we will make efforts to bring women into firefighting and other professions...but it would be discrimination to try to hire male nurses where we have none........those are the questions we should be asking....alan
Anonymous wrote: "To the places that offer a "safe and friendly" women's only environment, I briefly thanked them for offering this service and asked if they could direct me to similar male only services for my husband. No responses."
Make no mistake. You got an answer. When someone asks you a controversial, sensitive question and you ignore it, that's an answer. The problem with that is, by not answering, you leave open all kinds of answers that can be assumed by those who asked the question. This is an example of poor communication in general, and the not uncommon kind of poor communication we patients get from the medical establishment.
To be continued...
Continued from last post...
Newman's book, "Hippocrates Shadow," focuses on the "secrets" of medicine. The modesty issue is one of those huge secrets. Many medical professionals don't want to face this issue. Certainly, they don't want to discuss it with patients. Most certainly, they don't want to debate it, because, I'm convinced, they don't have a case and know they don't have a case. They know it's an ethical problem.
Remember that fairy tale The Emperor's New Clothes? Too many medical professionals are strutting around naked, figuratively, and they think they're dressed in the garbs of professionalism. But many patients see thorugh that. The nakedness patients see comes out in much of the negative attitude we find from patients about doctors and nurses. And the major source of this is the lack of communication coming down from health care.
In the case mentioned above, as "nice" as it was for the men to at least reply. But their answer, "They did wish me luck however, and stated they would keep my e address should staffing change to accomodate both of our needs."
They wished you “luck? That is an answer, too. And for me it reads, "Thanks for your concern, but this just isn't an important enough issue for us to really do something about it. If something just happens to happen we'll let you know."
To be continued...
Continued from last post...
Staffing in healthcare to allow equal gender intimate care doesn't just happen. It is made to happen. And isn't made to happen unless there is the will to do so. It isn’t a question of “luck.”
We as patients need to take it a step further. We need to ask follow up with questions like:
-- Why don't you have any male staff?
-- What do you think that says about your regard for or respect for male dignity and modesty?
"On, well," they may reply, "We've tried to get male staff but we just can't find any."
You can reply: "Whether you can find any really depends upon how much value you place on respect for your male patient's dignity. If you really cared, you'd be able to recruit. This is not an impossible task. There are male staff out there. If this were an important issue to you, you'd find some."
With the all-female clinic, their answer to your questions is:
-- We don't want to discuss this?
-- Or, We know this is unfair, but so what? Women have had to put up with this problem for years, now it's men’s turn.
-- Or, You asked for a referral where men can get gender equity as far as medical modesty is concerned, We can't give you a referral because these places don't exist. But we don't want to tell you that because we know it isn't right and the last thing we want to do is to admit that, especially to a patient.
-- Or, get lost lady! We're a women's clinic. Our focus is on women. Let the men worry about themselves.
-- Or, any one of a dozen other possible answers.
Now, some of you may say that those answers I'm suggesting are unfair. How can I know what they're thinking by not answering. Maybe they were just busy.
Let me give you an important principle of communication. When you don't communicate; when you hide behind a no answer; when you ignore difficult questions; when you make believe that if you just ignore it, the question will go away -- When you do that, you're digging yourself into a huge pit. You're allowing the questioner to open up his or her imagination as wide as it can open, and you can bet that they will imagine the worse possible answers to their question.
Ask any experienced politician about this. We all watch the news. Many scandals begin with the attempt to hide a truth. Most often, what's being hidden isn't as serious as is the scandal that results from the attempt to hide it. The hiding becomes the story, not the original event or incident.
My point. Don't stop at "thanking" these clinics for what they're doing. Put them on the spot. Make them face their "nakedness." Let them know you can see through their excuses, that they really have no ethical argument for their position -- and if they do, then you'd like to hear why men don't deserve the same kind of respect and dignity that women are granted. Go for it. Put it in writing.
Become a real patient advocate, for both yourself and others.
LJS erroneously wrote the following comment on Volume 14 which is no longer accepting comments. Alan, I think LJS was referring to your comment on 4/21/09. ..Maurice.
To the poster on Tue 4/21/09 that referenced the "Embarrassing Exams" video's from the U.K. I saw that testicle exam by the female doctor. I looked at a few of the other videos on that site, I noticed there were no male doctors examining naked female privates. I'm not bashing women in any way. I know they run into the same problems as us men. I think this really does go deeper in our culture as to the belief that men arn't modest and don't care. These videos sure reinforce it. I care, it bother's me.
LJS
I think it's more to do with there being a longer history of women having their own specialty (ob/gyn) that this issue (modesty) has been addressed more so than for men. I also attribute it to feminism. I don't think it's because people think that men do not have modesty issues. Gyn/ob has been around for at least 100 years. How long has male urology been around for as a specialty? Men didn't live long enough in the past for prostate and other issues to surface. So this area is in the early stages where women's health was say 40+ years ago.
NP
Edo --
I really appreciate your posts. You bring some interesting perspectives here. You wrote: "but remember, i am an exhibitionist and i am not a prude." I'm trying to figure that out. You're not suggesting that people who don't want opposite gender care are prudes, are you? Please explain.
Also, you write: "studies have shown that a sexual thought occurs to the human male mind every 5 minutes "
I've read that before, but I've never been able to find these so-called studies. Could you reference one for me? I believe that statement is one of those urban myths that help perpetuate stereotypes about men. Frankly, I don't believe it, and until I see an actually study that demonstrates it reliably, I'll claim that it is just part of our culture's contemporary attempt to demean and marginalize masculinity.
There's a new show on Showtime called Nurse Jackie, you can watch the first episode at the link below, its about 28 minutes long.
Count how many ethical and modesty violations you see in 28 minutes...Sally
http://www.sho.com/site/order/preview.do?source=m_nj1_home_may09_sampg#/nursejackie_s01_ep01
MER, this question of sexual thoughts every 5 minutes would be just the appropriate neuro-behavioral study for the fMRI (functional magnetic resonant imaging)technology. Who knows.. maybe that "5 minute" notation is based on science. ..Maurice.
p.s.- 125 Comments: It's getting time to begin to think of going on to Volume 18.
As always MER,,,thanx for your input.
I have no illusions that the female clinics have my best interest at heart. In short: they blew me off. I'm also sure that they are happy raking in the millions of dollars women are now spending on these proceedures and do not consider men their problem.
The 'interesting' part about the men replying was just that...they bothered to respond. Is that much? No, but I'm not finished yet.
swf
I get the feeling male and female nudity is viewed very differently.
My friend is a nude model at a women's art class.
She had no problems, gained confidence and agreed to a mixed class.
She felt uncomfortable to see a large number of men present... more men than women...male responses were very high when female models were available (she was told later)...there was staring and little drawing, snickering, laughing...she felt so uncomfortable, she ended the session.
Her male model friend hasn't experienced this sort of thing.
The teacher tried to reign in the behaviour unsuccessfully.
She's back to all female classes now...where she feels the participants are interested in art and not just having a perv...
I've also heard that male strip clubs attract women who laugh and enjoy themselves...whereas female strip clubs can be very seedy. Male strippers seem to be viewed differently to female strippers.
A young sportswoman recently said in an interview, that after winning her event, she was apporached by 3 mens magazines - she was offended that flowed from her success - that she'd be happy to pose naked...the male athletes were not approached...
You see it in movies as well - full female nudity and men in long shorts. In "Open Water" the woman is completely naked and the man in large boxer shorts...it seems female nudity is often included and expected...whereas male nudity is not as common.
Female actresses are often expected to disrobe, whereas most of the top male actors refuse to disrobe and have stand-in actors for some scenes.
It seems very one-sided...we do see more male nudity today, but still way behind female nudity.
The "Open Water" scene was a glaring example of gratutious nudity and the males in my family all agreed, "What man would go to bed in huge boxer shorts when his girlfriend is naked?"....
Just my thoughts...
To SWF,
I thought your comment about modesty vs morals was very powerful. It gave me a lot to think about. Hope you write more.
RDM
I've just picked up the latest Reader's Digest (Australian issue). It caught my eye because of the cover "35 secrets your doctor would never tell you". And here is the gem; "In most branches of medicine we commonly deal with old people. So we become much more enthusiastic when a young person comes along . We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time."
So much for "gender neutrality".
NP
"And why is it that the judicial system will uphold a hospital refusing to hire makes into labor and delivery because they are male, we will make efforts to bring women into firefighting and other professions...but it would be discrimination to try to hire male nurses where we have none........those are the questions we should be asking."
alan, I don't get what you are saying. When is it discrimination to hire male nurses where there are none?
NP
The key word there, doctor, is "maybe." These kind of "studies" get bounced around and pretty soon they become "facts" that people just assume are true. Even if you can find a study like that, I'd like to analyze it. Just think of the implications of results like that for how men and women interact. After a while it doesn't even matter whether it's true or not. All that matters is whether people believe it.
Sammi wrote: "You see it in movies as well - full female nudity and men in long shorts. In "Open Water" the woman is completely naked and the man in large boxer shorts...it seems female nudity is often included and expected..."
The history (in Western culture)of how the naked male and female body is viewed, is complex. I've written about it briefly in past posts and provided sources. But essentially, the Greeks were more open to nudity, both male and female. Judeo/Christian culture viewed (and still does) the female nude as dangers because she tempted men. She was beautiful, seducing, dangerous and would be the downfall of man. The male nude since at least the early Middle Ages (maybe earlier) has been viewed as dangerous as well, but in a different sense -- wild, uncontrollable, lacking in reason, savage. The Greeks and Romans saw male nude statues as symbols of power and strength. Nobles would have nude statues of them created. That changed, probably influenced by the Church and Christianity, at least that's one theory. The meaning of the naked body changed.
Today, we still view female nudity as beautiful, seductive, even dangers. But we more often view the male nude as lauaghable, powerless, dangers, ugly, savage.
You'll find this information in may books about art history of the nude. It's also covered in the book "Privacy" that I've mentioned in past posts.
This philosophy is still carried over into our contemporary culture, especially film.
I couldn't agree more with the mention of female nudity vs. male nudity on screen in movies. It is so commonplace to see full frontal nudity of a female on screen but maybe a slight shot of the backside of a male. My wife has voiced this observation for years.
Are the male actors too embarrassed by their size? What is with the one-sided nudity? Why should only females be naked?
I must also add to "swf's" comments on morality vs. modesty. When a man enters a healthcare faciltiy for something like a surgical procedure, all morality and all modesty is OUT THE DOOR. He must then succumb to three or more females viewing and handling his genitals. I went through this and my wife and I were not HAPPY with what you must endure. To my wife they were just other women. It was not my choice that which transpired. The only excuse a patient receives is "that is who works in that area and they are trained and profesional." Do any of them really give a care? NO.
JW
"It is so commonplace to see full frontal nudity of a female on screen but maybe a slight shot of the backside of a male."
Apparently you haven't seen the "Watchmen". Dr Manhattan (the blue guy) is nude 99% of the time and you see him full frontal, over and over again. Someone said if you drew a picture of a penis, colored it blue and stared at it for 3 hours, you pretty much the equivalent of the movie.
JW wrote: "my wife and I were not HAPPY with what you must endure."
As patients (male or female) we must stop accepting that we "must" endure procedures and exams that offend our dignity. Granted, sometimes that may be the only choice for a variety of reasons. Then we must endure -- but not silently. We must communicate our displeasure at the lack of respect/dignity afforded us or the gender inequity that forces us to endure opposite gender care. We need to put this in writing to the provider, the hospital, the clinic and to medical ethics and licensing boards. Get it in writing. Don't neglect your health. If you need the exam or procedure, have it done. But you don't have to make believe that everything is just fine. Make sure providers know that you're being forced to endure and you don't appreciate it.
But I think we would be surprised how much accommodation may be granted us if we make our values known, and are willing to halt exams, reschedule, or find other providers. Some providers are more open to same gender intimate care than we realize, but won't offer it for their own reasons unless requested.
Without knowing it, MER by his last post created a segue into Volume 18 which is up and starts out with a graphic of two paths that the patient could take. One is to the misery of "false modesty" (obviously, this term will be debated) or taking the path of "good health" which leads to "happiness".
Yes, patients should complain to the healthcare providers about their concerns but not take the wrong path and sacrifice their health or their lives. ..Maurice.
Now for the NOTICE:
NOTICE: AS OF TODAY MAY 31 2009 "PATIENT MODESTY: VOLUME 17" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 18.
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