Bioethics Discussion Blog: Patient Modesty: Volume 18

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Sunday, May 31, 2009

Patient Modesty: Volume 18




NOTICE: AS OF TODAY JUNE 14, 2009 "PATIENT MODESTY: VOLUME 18" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 19.

Continuing on with the discussions of patient modesty, I want to add to the mix the consideration, as expressed in the above graphic, of whether there is such a thing as a "false modesty", a path which if followed could lead to late or inadequate diagnosis and treatment and misery, if not debility and death. On the other path, the direction is that of "good health" ignoring modesty and leading to the goal of "happiness". Just something to think about, put in a graphic form. ..Maurice.


Graphic: "Which Way Will You Choose", an illustration from an old sex hygiene manual, taken from Wikipedia and modified by me with ArtRage. Instead of the path "sex hygiene" I substituted the words "Good Health".

124 Comments:

At Sunday, May 31, 2009 4:27:00 PM, Anonymous Anonymous said...

Some people don't have a choice.
You avoid abusive situations...if you've been assaulted by a doctor or other male, then you avoid putting yourself in harms way again.
I have avoided doctors all my life.
It might be rational to say...modesty means poor health OR see a doctor equals happiness.
That simply doesn't always follow...
Many people are traumatized and harmed in a medical setting. We often feel exposed, vulnerable and powerless.
I will only respond to symptoms and even then, find it VERY difficult. I have one female doctor, a gentle and kind woman, who understands...it took me years to find her.
I fear ever needing surgery.
I couldn't put myself in a situation where I was unconscious and unable to protect myself - whether that be an assault, someone taking advantage or being ridiculed. I know there would not be one person in that room who would take responsibility for my safety - as long as I came out breathing, they would be satisfied there work was done.
I disagree...
My doctor has said arranging an all female surgical team would be difficult, but she would try and sort something out if I ever needed surgery.
I would only accept that situation if she accompanied me into surgery...I simply don't trust anyone in a medical setting.
I was a member of a support group for a few years and many members knew they would probably die rather than place themselves back in the hands of their abusers. It's human nature to stay away from a previously bad situation.
We would rather die on our terms than risk being abused again.
I don't believe we are uncommon...many people leave a medical setting with some degree of trauma - I guess we're at the extreme end.
MM

 
At Sunday, May 31, 2009 6:00:00 PM, Anonymous Anonymous said...

The first point I'll make is regarding qualifications as to
who has the right to question why
we want same gender care. Maybe
they've never experienced unprofessional behavior from providers, no one has the right
to decide what others want.
The second point I'll make as
to why should you have to call around to find same sex provider
for any specific procedure. Thats
like calling your executioner asking if they could please use
rubber bullets. Just show up and
see whats in store, if they don't
accomodate you with a same sex provider then refuse the procedure and leave. Complain to
the head of the facility and your
insurance company. You could say
simply that the person made you
uncomfortable.
Lets look at some examples for
instance. Suppose you are a male
and need a testicular ultrasound,
which might be for reasons of torsion,epididymitis or rough sex
resulting in penis fracture. Yes
there is such a thing,look it up!
The ultrasound tech can ask you
to remove your trousers and cover
yourself with a sheet. The tech can
then ask you to place the transducer on your right testicle
and they can angle the transducer
through the sheet. If they say they
cannot they are lying to you. If a
female needs a pelvic ultrasould with a transvag that involves placing an ultrasould probe into
the vagina and moving the probe
in various positions. This is all
done WITH the patient covered and
the tech moving the probe in various positions,through the sheet. If they say they
cannot again,they are lying to you.
I am not an ultrasound tech,however, I have used an ultrasound machine to locate arteries on patients for HD catheter placements,PICC lines and
other vascular procedures.
If they really want to maintain
your privacy they can,you need to
insure they do. For radiology
procedures such as cystogram,voiding cystourethrogram
or barium enema you the patient
can remain covered for the ENTIRE
procedure. For the cystogram and
urethrogram you will need a foley
catheter. Radiology will need a nurse to insert, surprisingly every
radiology nurse is female. At this
point ask for a male nurse from
the er to place the catheter. If
they refuse then leave,but the other option is to ask the radiologist to place the catheter.
As far as a barium enema, you can
insert the tip yourself. That covers just about every procedure
I can think of without the exception of a uro procedure at
a urologists office. Again, vasectomies can be done easily with
only the urologist in the room. If
you are a patient through the er
the triage nurse does NOT need to
examine your genitals. If they say they do ask for the charge nurse.
That should stop that kind of behavior right away! I see it as
empowerment by maintaining your
privacy and happiness,why can't you
have both? You can!


PT

 
At Sunday, May 31, 2009 6:13:00 PM, Blogger MER said...

MM -- Your story demonstrates a major reason why patient choice for intimate gender care needs to be the default position in medicine. People who are victims of sexual assault or other previous traumatic experiences deserve accommodation. But, does such a person need to show proof of assault? Are they required to tell their doctor this? I say no. A significant number of abused people have never told anyone. Why should they have to reveal this information, especially for an intimate, non-life threatening operation or procedure.
As far as all male or all female operating teams -- if that is allowed, it must be allowed for both genders.

 
At Sunday, May 31, 2009 6:23:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, I would disagree. As a general internist, I would want to know, taking a sexual history as part of a complete initial history and physical, whether the patient had a history of sexual abuse. If a patient hasn't communicated this information to anyone, they should, at least, talk about it to their trusted physician. This, along with other talk about modesty concerns should alert the doctor to the need for special considerations for the patient as they continue under the physician's care. ..Maurice.

 
At Sunday, May 31, 2009 6:53:00 PM, Blogger MER said...

Doctor:

I don't disagree with you in principle. But that communication represents one level of the healthcare system. Once the patient gets out of their trusted physician's office, they will be dealing with unknowns -- specialists, all kinds of assistants, techs, nurses, cna's -- people the patient may not trust because there has been no time to establish relationships. Is the patient expected to reveal this information every step of the way.

Ideally, their personal physician should pave the way for a smooth transition. What are the odds of this happening? In my experience, the communication web of most hospitals isn't good enough to assure the message will remain attached to the patient.

And if the physician or some advocate isn't with the patient every step of the way, what's to assure the patient that his or her wishes will be granted? Too many opportunities for miscommunication and mistakes -- especially for patients who have concerns about what will happen to them when they are unconscious.

I don't think it's as simple as confiding in your personal physician. Am I wrong?

 
At Sunday, May 31, 2009 8:04:00 PM, Anonymous Anonymous said...

You're correct MER...
I didn't tell my doctor for years.
She picked up on my body language and anxiety. I eventually told her some of it.
I don't feel safe outside her medical office (and even that location causes me anxiety)
A hospital horrifies me with so many people I don't know, let alone trust.
If you're attacked while walking home from the bus station, you'll probably stop doing that in the future...get home some other way, travel with a friend...your conduct changes.
If a doctor or other medical person is involved, you're supposed to just put yourself back in that situation, "you'd be very unlucky for it to happen again" is not good enough...
Avoidance behaviour is perfectly normal after a traumatic event.
I see a difference between priests and doctors who use their position to assualt...they claim to be something they're not...they use their position to take advantage. The man in the park or lurking in the forest is at least open about his intentions....he's not masquerading as a trusted professional.
I found it VERY difficult giving my trusted doctor any information. I simply would not put myself in a position where I had to negotiate nurses, unknown doctors, orderlies and others...just impossible.
MM

 
At Sunday, May 31, 2009 8:54:00 PM, Anonymous Anonymous said...

MM brought up an interesting point and I’ve read it several times on Allnurses “it doesn’t matter as long as you are breathing.” I don’t agree with this at all. This is what providers specialize in and sell. How could that be the response from these professionals that are there to support you? Like many people, I would choose misery because I couldn’t live with myself knowing what happened to me when I was a sleep. What’s the point of being well if you can’t even look at yourself in the mirror? I’ve said it before; you could actually do more harm and hamper a recovery if this is forced onto a patient. That’s why the patient should choose, not the provider. Jimmy

 
At Sunday, May 31, 2009 9:26:00 PM, Anonymous Marg said...

MM's bad experience reminded me of a recent change to the law.
In the past, decent doctors covered for the suss doctors or looked the other way.
That's dangerous now...and doctors can find themselves in trouble if they choose "not to get involved" when they see or hear of an assault or unprofessional conduct.
Lots of doctors are now being dobbed into authorities after a particularly nasty case of a male gynaecologist who sexually assaulted and mutiliated the genitals of numerous patients. He was allowed to continue for many years until he was finally halted by the Police.
Graeme Reeves or the Butcher of Bega is the man in question. The rules were changed after this case...making it an offence if doctors failed to report misconduct. There was evidence of lots of people observing his conduct in theatre and elsewhere and being very concerned...and doing nothing.
It's because of cases like this...that patients should always be able to ask for same sex doctor. It doesn't matter that it's uncommon.
I'd go further...if you feel more at ease with same sex, so be it...
It's about self protection, a basic instinct...whether from harm, discomfort or embarrassment.
I don't swim in the ocean because I'm afraid of sharks, it doesn't matter that attacks are uncommon. I live in an area where there are lots of white pointer sharks and I choose not to take the chance and swim in my pool instead...same thing.
I chose female doctors - I prefer not to take a chance and it protects me from extra embarrassment and discomfort.

 
At Sunday, May 31, 2009 9:28:00 PM, Anonymous Anonymous said...

Re: the changes to the law requiring doctors to report misconduct or they themselves can be prosecuted.
http://www.news.com.au/couriermail/story/0,,24794611-5003426,00.html
Marg

 
At Sunday, May 31, 2009 10:02:00 PM, Anonymous Anonymous said...

I am wondering how the feeling of extreme embarrassment would be construed as false modesty....I understand many different contexts of the use of false modesty...but in case of body exposure I do not see how it could be used...as a description of the persons feelings.
leemac

 
At Monday, June 01, 2009 12:00:00 AM, Anonymous Anonymous said...

edo,
When I said "Naturally, it is a very uncomfortable and humiliating experience to have a man see me in the altogether..." I was talking about a medical situation. If I hadn't mentioned that I thought many people would think that I hate being in nudity situations in front of female "caregivers" but really enjoyed being naked in the company of male doctors or nurses, which I don't, but is nothing compared to having females around while I'm naked.

In the situation you refered to I would have a choice whether I wanted to be in the "alltogether" in front of other men in a locker room, so I wouldn't have to feel humiliated and could just use a stall or something. With medical care you have no choice but to be naked sometimes if you care about your health. So in that case I couldn't hide my nudity in a private booth. I have to accept that I'll need to be exposed sometimes, no matter how humiliating it is for me. But to be humiliated in front of a man or men is nothing compared to how it would be if a woman or women believe they are "entitled" to look at or touch my privates.

Anon

 
At Monday, June 01, 2009 12:38:00 AM, Anonymous Anonymous said...

swf - I loved your comment about not "suspending your moral values". I feel exactly the same from the male patient's perspective. Please continue posting.

Sammi - We get it, women=good, men=bad. Have you thought that maybe women are more eager or willing to get naked on screen? Have you noticed how many women started successful careers by going naked? Or how many careers have been rehabilitated after a woman, previously successful or not, decided to appear naked? Often the only way a woman can be given her opportunity in Hollywood is to go naked somewhere, and many women know that.

I admit that when I'm watching a movie and am surprised with an experienced actress getting naked I take notice. I also admit that when I see a male actor get naked I lose respect for him and often don't want to watch his movies anymore. But I would expect the same thing to often happen from the female side.

MER - excellent posts as always.

 
At Monday, June 01, 2009 1:18:00 AM, Anonymous Anonymous said...

Thanks for your comments mm. You make your points very well and I totally agree. Nobody should have to be put through a personal hell just to get medical help. I'm also the type that wouldn't share a lot of personal horrifying experiences with anyone, even a trustworthy doctor (if they actually exist).

People that want same-gender caregivers aren't wrong, clinically insane or homosexuals. I, like many others I've read about here don't think we should be REQUIRED to discuss with our doctor the reasons why we want same-gender care. We should simply make it clear that this is how we feel and our opinion and preference should be respected. No questions asked.

PT made some great suggestions about how many of us could tolerate putting up with opposite-gender nurses and techs during many horrible but often necessary exams and procedures. I don't understand why his suggestions are pretty much unheard of in reality. Shouldn't those be common methods in the medical world? The fact as I see it is that it is too inconvenient for the providers so they won't tolerate it, even if the patient suggests or demands it. Do they believe that the patient's modesty, dignity and morality aren't worth the extra 3 or 4 minutes it might take?

DG

 
At Monday, June 01, 2009 5:21:00 AM, Anonymous Anonymous said...

Sammi/JW no doubt female nudity is more common in the movies. This is paticularly true of exposing the breasts of women, however when was the last time a females genitals were shown in an R rated movie. Society seems to have established a "degree of exposure" with female breasts & both genders rears being more acceptable than showing genitals. I think in general we accept this ie topless beaches vs nude beaches. The different anatomies make a full frontal shot of the actors different in what they show. Just looking at recent movies Forgetting Sara Marshal, Walk Hard, Sex in the City, the Reader all included shots of male penis's...these were all R rated..can you name one where female gentitalia was shown in an R rated movie. I think a more telling scenerio is how we deal with cross gender exposure in locker rooms and prisions where females are given far more leaway and accomodation than males. Actors/actresses choose to be in these movies for pay...different...but not totally different than strippers, but locker room reporters and prisions gaurds are imposed on the people without their choice, much more similar to the issue of gender choice of providers than movies.

swf my point was why are hospitals afraid to take affirmative steps in hiring male nurses for fear of being labeled discriminatory but have no problem with womens medical centers staffed by women or accept without problem...even fought to be able to keep male nurses out of the delivery rooms....why is one easily accepted but the other not...did I make my intent any clearer?

 
At Monday, June 01, 2009 10:27:00 AM, Blogger MER said...

The concept of supply and demand applies to all economies. In our healthcare system, there is a demand for female caregivers. Many women seem to prefer females for intimate care and are not afraid to make that request request. Plus, since nursing is dominated by women, these females have more of an empathy for their women patients. I think that's natural. Most men don't make their preferences known and thus the system assumed female intimate care doesn't matter to them, even if they show embarrassment. Men can create the demand by making it clear what they want and turning down care, and finding places that will accommodate them. Making a sound business decision, the system will go out of its way to accommodate men. If enough men did this the system would get the message.
The hidden message in our culture is that women are better at nursing and make better nurses than do men. That is never spoken openly, and is often denied. But it seems to me that is perhaps the only explanation, along with supply and demand, that allows a system like healthcare to be so unbalanced gender-wise. The system just accepts the gender inequity, and because men don't complain, the supply and demand formula isn't allowed to kick in. Nursing is no longer the low paying job it used to be. It's not economics that keeps men out of nursing. And with the emergence of a new class of workers, cna's and other assistants, many nurses are no longer doing some of what might be considered the unpleasant jobs associated with bedside care. There are other more cultural, political, and power-oriiented factors that keep men out of nursing.
Don't expect the situation to change because people in the system are concerned with this problem. There is a power dynamic here. When one race or gender gains power, they are reluctant to give it up. That's human nature. Women accept a small number of male nurses in their ranks, and even praise their presence. But that's only as long as their jobs are not in danger. If we get to a quota system,where affirmative action requires more men be hired, you'll see attitudes change.

 
At Monday, June 01, 2009 12:13:00 PM, Blogger edo deweert said...

afew years ago there was a story in the local media about a resident/patient in , i believe, a mental hospital having been sexually molested by a caregiver.
someone (amember of the public, or a loved one, i cannot remember) had apparetly witness the patient being masturbated by the caregiver.
health offcials scrambled to quell the story admitting that this was a service occasionally provided quietly and that such a practice is quite common in a number of such institutions and that the media were totally insensitive to have made such a fuss over it.

talking about movies and such, i just love "nip/tuck", it's so trashy that it is good, much like john waters' "pink flamingos"
the two plastic surgeons seem to treat their patients' privacy and dignity with a great deal of respect - in their face; however, when they are amongst each other they use evey crude word under the sun referring to the anatomy of those patients.
i know, i know, it's only a tv show, right>
well, i challenge even one doctor in the land to deny that this may be going on in real life.

as a naked fine arts model, i experience an almost indescribable sensation of eroticism and vulnerabiliy - it's like living on the edge.
anyway, i am of the opinion that also vulnerable when people look at a painting of me when i am not even there in the room with them

i am not finshed

 
At Monday, June 01, 2009 12:29:00 PM, Anonymous Anonymous said...

Dr.
You have no idea how frustrating it is when a provider gets the facts and events backwards. The original issues become invisable and you are never taken seriouly again. I will never share my "history" with a provider again.
To be clear:
I have always believed in same gender intimate care, long before any experienes in my life. Therefore, to give a doctor the impression that this may be why I feel the way I feel is extremely misleading. But once you bring it up, the original issue gets lost in the ferver and the fact that you've always felt this way gets tossed aside. This also does an injustice to people who haven't faced abuse, men who have but are not taken seriouly, and the family in general who shouldn't have to fight for their basic beliefs.
I don't want "special" treatment, I want repectful treatment.
We all deserve same gender intimate care...for many reasons that are our own. I don't believe it is a mystery that needs to be unlocked.
swf

 
At Monday, June 01, 2009 12:44:00 PM, Blogger edo deweert said...

as a naked male fine arts model i have been tracking my experiences and observations in a blog, i have also visited many college and university periodicals in which some models describle their experiences and feelings.

as a reasonably intelligent and informed human being, i hold that we are all sexual beings.
i have always been very suspicious of those who vehemently deny that sex is not part of the equasion in some areas of our sociatal sojourns.
thus, when people tell me hat they are coming to the figure drawing sessions to celebrate the beauty of the human body, istrongly refute that.
there is no intrinsit aestetic quality of the human body as art object; it's ugly, i formless blob, from which some appendages protrude.
ok, ok, read on....we, as a species, have however, asigned standards of beauty to each and every part of the human body and those who display and meet those high standards, are said to be ggod-looking or beautiful.
beauty = desirability = sex = survival of the species.

though i am an artist, i have gone into naked modeling believing it has nothing to do with art, really, but everything with sex.

art instructors who claim students must learn to become good artists by learning how to draw the human figure are deceiving us....it takes just as much skill to draw accurately that old gnarled oak on the corner.
i mentioned in an earlier post in vol 17 that i find it hard to imagine that where there is nudity there is no degree of sexuality,
even though there is no actual sexual activity taking place.
i simply do not believe that the gynacologist can wipe all those vaginas from his meory and mind when he goes home......if they do not leave their imprint on his libido, then he is absolutely superhuman.
and when the guy who joins a nudist colony tells me that seeing all those naked breasts and buttocks has no impact on his libido, he has lost all credility with me and it reminds me of an episode on m*a*s*h, in which hawkeye claims to subscribe to the nudist magazines for "the volleyball scores"

ok, i am finshed.........for now

 
At Monday, June 01, 2009 1:55:00 PM, Blogger edo deweert said...

i do not want to sound flippant, for i am not.
but i cannot help but wonder is anonymous would be very specific, there would be ways in which we could collectively help him on an inner healing course.
there is always the possibility that we feel comfort in being the victim.
as a former street youth worker, i always took the position that until we addressed the source of the pain, we would need forever painkillers (alcohol, coke etc., etc.)
please do not assume that i am in sensituve, for i am not, but, still in my view the road to better health is in finding a way to heal the inner self.

 
At Monday, June 01, 2009 3:07:00 PM, Blogger edo deweert said...

and today marilyn monroe would have turned 86.

(incidentally, i have a problem with my keyboard...it seems at times certain letter are not appearing when i touch the keyboard...i apologize.)

 
At Monday, June 01, 2009 4:12:00 PM, Anonymous Anonymous said...

edo:
"there is always the possibility that we feel comfort in being the victim" is not just "flippant" it is offensive.
If there is any comfort at all it's knowing that we survived and moved on.
swf

 
At Monday, June 01, 2009 4:55:00 PM, Anonymous Anonymous said...

Apparently, medical facilities such
as hospitals,surgeries centers and
physicians offices don't report
hipaa violations. I believe they
should be held to the highest standards of trust.
Lets take for example an article
appearing on Dr shermans site regarding some female nurses who
took innapropriate pics of a patient. What is simply amazing to
me is the comment from a Michael
Robinson,spokesman for the U.S. dept of health and human services
office for civil rights. He said,
" its hard to say if an incident
such as this is common." Oh come
on michael, where did they find
you? Perhaps if medical facilities
were required to dutifully report
these unethical behaviors, michael
might realize they are common
occurrences indeed! But then he's
just a spokesman,what does he know?
I remember this kind of behavior
occurring in the late 80's which
of course was before there were
cell phones with cameras. I recall
several female nurses and respiratory techs were fired for taking a pic of a patient. They
brought an instamatic to work with
them. Technology marches on and
rest assured Michael will be getting a letter from me soon
highlighting the occurrences and
those fired in my city alone over
the last few months!


PT

 
At Monday, June 01, 2009 5:24:00 PM, Anonymous edo deweert said...

sorry, man, surviving and moving on would not be enough for me.
and if what i said, offended you, so be it, i have offended plenty of people in my lifetime, when i felt the only way to get through to them was to be assertive and blunt (are they two synonyms for offensive???)
here is a story for you:
way back in the mid-early part of the 20th century here in the province of alberta in canada there existed a public body named "the eugenics board".
in fact , right up until the 195os that body decided whiche "feeble-minded" individuals would be sterilized so they would not be able to procreate.
one of its members was hailed as a true fihter for women's rights as she was also a suffragette.
there is a statue now in honour of her.
one of the people who was thus sterilized was an individual who had been institutionalized as a
feeble-minded" in dividual, even though many years later she was released as nothing seemed to be the matter with her.
she sued the government which not wanting to go to court over this, reached a multi-million dollar settlement with her and apologized to her as well.
if we delve into the history of most "civilized" nations we will find gut-wrenching injustices commiitted...for many individuals simply suviving and moving on it a betrayal of the strength of human nature.

 
At Monday, June 01, 2009 5:34:00 PM, Anonymous Anonymous said...

I agree we have to find a way to move on...otherwise, it eats us from the inside out and destroys us.
I'll never forget though and will continue to protect myself from harm for the rest of my life.
I agree with Edo...how often are women told that male doctors don't even notice? I find that the greatest insult to my intelligence. I firmly believe male doctors enjoy the opportunities presented by their work. I have no idea how many take advantage in some way...my guess is...that it's pretty high.
If every male doctor looked into an honest heart...I wonder how many could say they never taken advantage in any way at all.
One of my friends had a male doctor ask her to remove her bra to listen to her heart. She refused. I'm sure he could find a "medical" excuse for his conduct...but the fact remains...in her 29 years, no other doctor has made this request. Also, when she challenged the doctor, he just moved on...
You can't help but wonder how many times that worked out for him and the patient just complied with his direction...and whether he asks 60 and 70 year old women to remove their bra's so he can listen to their hearts.
I think doctor's are aware they can "get away" with this sort of thing in most cases and if a tempting patient appears...they may try to maximize exposure or even talk her into routine exams requiring maximum exposure.
He can hide behind his profession, but HE knows his conduct was motivated by things that are NOT medical.
I can't speak for female nurses and their conduct toward male patients...but I stand arm in arm with any patient, male or female, who has suffered at the hands of doctors or nurses...people who take advantage with the help of their profession and when we are at our most vulnerable...are very low people in my opinion.
MM

 
At Monday, June 01, 2009 5:54:00 PM, Blogger edo deweert said...

here is another thought:
do we really know what goes on in the minds (and loins) of those stoic-looking pious-faced detectives, scouring cyberspace in search of kiddy-porn in their attempts to catch the "vilest-of-vile", the pedophile?

 
At Monday, June 01, 2009 6:26:00 PM, Anonymous Anonymous said...

MM I can speak for female providers, I had a female do a testiclar ultrasound on me then tell the woman right after me if she was uncomfortable with having a male tech do her ultrasound she could wait and she would be back from break shortly, never occured to her to see if I cared. Go to allnurses and read whoa inappropriate about a nurse complaining about other female nurses taking turns checking our an unconscious male patient....the issue is not gender specific....however it is seen as less of an issue when it happens to males....as MER said, until we start making ourselves hear like women have it won't change...alan

 
At Monday, June 01, 2009 6:32:00 PM, Anonymous Anonymous said...

It is precisely the "strength of human nature" that allows many women to survive....edo if you judge that to be inconsequenial then so be it. But at least I'm still here to fight the battles that are presented to me, which should hopefully bring us back to topic.
The original point was, I shouldn't have to dredge up my whole life just because someone thinks it's why I want same gender care.
swf

 
At Monday, June 01, 2009 7:15:00 PM, Blogger MER said...

part 1

I believe what we're reading in recent posts (and we've seen it in past posts, too) is a reaction to (among other things)the "secrets" of medicine and the generally poor communication within the system to patients. Hospitals must communicate not just intellectually, but emotionally, too. I don't think that's happening. You get the technical details about your case and the operation or procedure, but rarely do medical professionals confront the patient with the emotional issue of modesty or body privacy. And if they do, they don't let patients know ahead of time that they will. Patients need to guess what will happen to them when the get in the gown and in the hosptial.

As I said in a previous post, when you keep secrets, when you don't communicate openly, when you sometimes take the attitude that we know what's best for people and just do it without telling them or asking permission -- you dig yourself into a pit. Now,as we can see, people wonder about what's going on in the minds of doctors and nurses, whether they feel sexual urges or have those feelings.

Of course they sometimes do. Why deny it? Being a sexual being and having those feelings doesn't mean you can't control them or act professionally. I personally believe most doctors and nurses have these feelings and have learned to deal with them. What they need to be taught, actually taught (apparently they're not) is the different ways to handle these feelings and thoughts and the difference between healthy and unhealthy strategies.

 
At Monday, June 01, 2009 7:28:00 PM, Blogger MER said...

part 2

But in fairness to the profession, these are not the kind of topics that are best talked about with patients in the exam room. But doctors and nurses can give signals and show respect in ways that put people at ease about this issue. Most do. But because most hospitals and clinics don't discuss the modesty, body privacy issue openly, don't confront it on the websites and in pamphlets and brochures, don't ask patients how they feel about same or opposite gender care and give them choices -- they leave patients open to come to their own conclusions about what's going on, as Jocelyn Lawler says in her book, "Behind the Screens."

So -- below is a sample text I wrote for us to send to hospitals and clinics urging them to post it on their websites in a prominent spot. If hospitals refuse to post a notice like this, challenge them to justify their reasons. Demand to know where patient respect and dignity stands on their list of priorities. Here's the text:

"We, at _____ Hospital, are as much concerned about your personal privacy as you are. And by privacy we don't just mean your medical records. We also mean your modesty. We realize that this is a topic that often isn't talked about openly. You may have had some negative experiences in hospitals or clinics with your modesty in the past. We want to assure you that this won't happen at _______ Hospital. We realize that patients are often hesitant to bring this issue up with their medical providers. Patients may feel intimidated or too embarrassed to discuss it. We urge you to discuss it with us.

Some patients prefer a caregiver of the same gender, especially for intimate types of exams or procedures – showers, bed baths, or any procedures involving the genital area. We will try to ask your preference, but if we forget do not hesitate to state your preference. If you're having a planned surgery or procedure, let us know ahead of time how you feel about this issue and we will work with our schedule to see that your request is granted. We are dedicated to respecting your privacy and dignity. It is a priority for us.

There may be times that we may not be able to grant your requests. If that's the case, we will work with you to see that your modesty is protected to the utmost. If we can't accommodate you, we will even help you schedule the procedure somewhere that can accommodate your needs. We regard you as a member of our team and your feelings and values are important to us."

 
At Monday, June 01, 2009 7:31:00 PM, Blogger Maurice Bernstein, M.D. said...

MER with regard to what you wrote in "part 1", the only thing I can tell you about how our school's medical students are taught in the first two years is about the "seductive patient" (either male or female) and the necessity to understand how to confront the situation if and when it arises. The response deals with understanding the patient's motivation, the need to reject the seduction and the need for the student's self-control regarding any sexual response to the patient. I believe the students are also taught about their sexual feelings and control when doing either male or female genital exams (I am not involved in those sessions). Beyond that, except for knowing the professional limits to sexual behavior, I don't know if in psychiatry they learn techniques for keeping their sexual urges under control as the student participates in interaction with a patient. ..Maurice.

 
At Monday, June 01, 2009 7:32:00 PM, Blogger edo deweert said...

i took the original topic to be patient modesty and i stretched the term patient modesty, because in my stop-overs on the human journey there are many instances where our dignity and modesty can be and are compromised.
yours is but one such story and in the context of human modesty and dignity... genitals are but one area where such transgression can occur.
it's not my place to judge how the things you have experienced have impacted your entire mental and emotional being; we are after all the product of every moment before now....and now is already past.

nor is it my place to apologize for the thoughts and questions i have and express in a measured manner following the reading of these posts.
i am 65 years old and have lived on three continents...i have been a patient and i have a spouse who has been a patient many times over.

 
At Monday, June 01, 2009 7:40:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, as for the Hospital Statement in part 2, I look forward towards some hospital CEO or COO to come here and explain whether such a statement could be created and any limits, if any, to what is promised. Such an visit from an administrator of a hospital would be much welcomed by me and I am sure other visitors to these threads. ..Maurice.

 
At Monday, June 01, 2009 8:00:00 PM, Anonymous Anonymous said...

As a student who had to do two nude art classes as part of our course, I would like to offer my perspective. We had to draw both a male and female on different days and it was not at all sexual. Not because we were "professionals" but because our models were older and both not the slightest bit attractive. If we had young, good looking models I am sure that I could admit that there was a sexual element. I think that it is the same with doctors. I cannot believe that a young,good looking patient is not preferred over an old or obese one. I just cannot.
NP

 
At Monday, June 01, 2009 9:58:00 PM, Blogger edo deweert said...

yet, anonymous, art instructors bend over backwards to ensure that "all ages (over 18), all body types, either gender" are welcome.
a friend of mine in holland tells me that when she was recruited to pose for drawing classes, the instructor was looking for "young females with long hair".
and yes, i started modeling at 58, by sheer chance.
may i suggest you check out the 25 may 2006 issue of the eugene weekly, go to visual arts and finde the painting by dean smale titled "ode to edo" (he said he just couldn't resist the title).
now, be sure to read the accompanying critique by the arts reporter.

there is alsoan interesting favorite pose instructors want their female models to strike: on their side, lying down.
it does really accentuate the buttocks.
no, there really is nothing sexual going on during these sessions, but......

 
At Monday, June 01, 2009 10:21:00 PM, Anonymous Anonymous said...

I once heard a female ultrasonographer say that testicular ultrasound exams are
her favorite. Draw your own
conclusions. I once visited a
patient in an intensive care unit
at a large county hospital. The
wallpaper in the nurses restroom
was covered with nude male layouts
from playgirl magazine. The nurses
there in the unit were all female!
Imagine if you accompanied your
wife to the gyn office and entering
their bathroom you noticed the walls covered with nude women foldouts from hustler magazine.
Not all ultrasound techs are
licensed. Some may have the
crendentials of ARDMS which is
certification from the american
registry of diagnostic medical
sonographers, but many do not.
Previously, I mentioned that any
intimate ultrasound exam performed
on a male or female can be done with the patient covered. If you
need an intimate exam with ultrasound ask the tech how will
they provide you with privacy.
Should they not seem to motivated
to your satisfaction ask them do
they carry the ardms certification.
If they don't you can refuse on the basis that they don't have the
appropriate credentials, but if they carry the ardms certification
you can make the comment such as
great not only will I get a very
good exam but my privacy concerns
will be met as well.
If they are licensed I doubt they
would want a letter sent to their
licensing agency complaining about
the lack of concern they had for your privacy. That agency , ARDMS
located in rockville Md 1-800-541-9754 has the right to issue and revoke licensure.
Finally,the single largest cause
for the lack of male nurses at medicals centers can be attributed
the that person called the director of human resourses.
I have never seen a male humsn resourse director.Since they are
allways female I suspect they set
the tone on gender hiring.


PT

 
At Tuesday, June 02, 2009 1:19:00 AM, Anonymous Anonymous said...

MER,

I can tell you that such a policy wouldn’t be posted in a hospital. There are many reasons why but the most important is that they don’t want to draw attention to this issue that we’re discussing here. It’s to their advantage not to even mention it (remember the power dynamic is in play). Would be interesting to see what the response would be for such a policy, perhaps we should each forward it to some people we know and ask for their feedback? I’ve asked my wife for her opinion as she was a CFO, I’ll post what her response was. Jimmy

 
At Tuesday, June 02, 2009 2:39:00 AM, Anonymous Anonymous said...

"how often are women told that male doctors don't even notice?"

I think, not nearly as often as men are told that female nurses don't notice their nudity, especially erections. I agree though, and I have never had any respect for male gynos. I think any woman who has the opportunity should see a female gyno, and I also believe there should be no male nurses in a gyno section or facility. I understand that it isn't always possible though for a woman to be able to see a female gyno. In those cases I feel really bad for them and don't think it's fair to them. But for those women who CHOOSE to go to a male gyno, I don't really have any sympathy for them and don't want to hear their complaints.

Same goes with men. If men have a choice and CHOOSE to go to a female Urologist or other penis doctor I don't want to hear their whining. But the nurse, assistant and Tech situation is very different. How often can a man CHOOSE a male nurse, assistant or Tech during humiliating exams or procedures? Even if a man chooses to go to a female Urologist it doesn't mean he is comfortable with other women in the room. There's a major difference between a very educated and experienced woman doctor and female nurses, assistants and techs that often (usually) have very little education or training. Nobody will ever convince me that a 20 year old female nurse or tech that is shaving off a man's pubic hair or giving him a bed bath is a "professional" that doesn't take any notice to a man's penis, especially with an erection. Same goes when anyone says that most men truly don't care about having a woman do to his privates what I don't even allow my own wife to do, or that men could usually have their choice if only they would ask.

It has been mentioned that it is impossible to tell if a "caregiver" of either gender and any occupation is truly a pervert, and to what degree. Any provider, from a gyno down to a CNA or "assistant" can be a pervert and even his/her own co-workers and even spouse may never know. That's always what I think about every time my wife or I need to have an "intimate" exam or procedure of some type.

Anon

 
At Tuesday, June 02, 2009 2:56:00 AM, Anonymous Anonymous said...

Great ideas MER. It seems so apparent to me that if a medical institution made things like that clear, they would be the most popular and successful institution in the area. Many people, especially men, who have always refused healthcare because of the unethical and irresponsible practices like disreguarding their gender and modesty may finally visit a doctor. If they (both genders) know they won't be confronted with opposite gender support staff and know that they can have all male/female surgical teams there could be a whole new market out there. If medical institutions could figure that out then that alone would make it a priority, since obviously money is the most important thing for them.

 
At Tuesday, June 02, 2009 3:04:00 AM, Anonymous Anonymous said...

http://www.eugeneweekly.com/2006/05/25/visart.html

 
At Tuesday, June 02, 2009 7:15:00 AM, Anonymous Anonymous said...

"how often are women told that male doctors don't even notice? I find that the greatest insult to my intelligence."

Any medical "professional" that told me that would be forever considered by me a liar and I would never trust him/her again, especially female nurses.

If they lie about that, what else are they lying about?

LT

 
At Tuesday, June 02, 2009 7:33:00 AM, Blogger edo deweert said...

the patient: a female,
the procedures:
two births,
removal of cyst from breast,
implant of intra-uterine device,
tubal ligation,
numerous pap smears,
hysterectomy,
three-day coma following episode of ventricular fibrilation,
insertion of device to push kidney stone back into the kidney, so it could be blasted.

these were done in different parts of the country.

not at any time did this patient feel her modesty/dignity had een violated by any of the caregivers.

correcton: once she felt violated, when a member of the custodial staff came into her room and proceeded to clean with a feather duster while she was having her dinner.

on to your other point, anon.:
to ask any caregiver/technician prior to the precedure to what extend he/she will ensure your modesty is upheld, is rather loaded in my opinion and can lead to the wrong conclusion being drawn and if i were that caregiver i would be offended.

and thank you for posting "ode to edo" i am very proud of it, even though i did not paint it.
it's a perfect example of artist and subject being on the same wavelength. and it's not a pose i could have done at the age of 20, or 30, or even 40.

 
At Tuesday, June 02, 2009 7:42:00 AM, Blogger edo deweert said...

anonymous:
you seem very concerned that a male patient's modesty is compromised when a caregiver is aware of his erection.
could it not also be that there are caregiverswho might be offended and feel violated by that very sight?
or, could not be that the caregiver might become aroused?

oh and while we are looking art art, check out odd nerdrum. a fine painter, originally from norway, but now living and working in new york.very disturbing!
and what do you think of his "selfportrait in golden gown?

 
At Tuesday, June 02, 2009 11:48:00 AM, Blogger MER said...

Jimmy: You wrote: "I can tell you that such a policy wouldn’t be posted in a hospital."

I don't disagree with you. But I think we need to send statements like this to hospitals and ask them to post them. If they don't, we need to ask why? Force them to justify. Force them to consider how they are implimenting their mission statements regarding patient dignity and respect. Notice that the statement I wrote makes no promises. It says the hospital may not be able to meet a patient's requests. But it also says, if that's the case, they just won't abandom the patient. They'll help them find accommodation. That's not just good customer service and ethics, it's good medicine and good business.

Doctor: I agree with Jimmy. I don't think we'll find any hospital administrators who really want to talk about this. I may be wrong. If I am, I hope they'll explain why they would be willing or not willing to post such a notice.

This isn't so much about patient modesty as it is about integrity, honesty, and open communication. Hospitals say they values these ideas but they too often don't practice what they say they value.

 
At Tuesday, June 02, 2009 2:00:00 PM, Blogger edo deweert said...

further to my post about that "sexual molestation of patient": i came across this on the net, the site is www.vrouw.blog.nl
the story, though, dates back to 2007.
there is a charitable organization in switserland that is (was) looking for people interested in having sex with the disabled.
it is not entirely clear if they offered money for this, but a number of people offered their services for 92 euros per time (appr.US$125)
the story went on to say that the organization has already been providing erotic massages to their clients and had decided to get into the (i guess one could say) sex brokerage provision.

 
At Tuesday, June 02, 2009 2:08:00 PM, Blogger MER said...

Edo wrote: "not at any time did this patient feel her modesty/dignity had een violated by any of the caregivers."

The connection between how any individual patient feels and what specifically is being done is not a universal. Different people have different feelings and each may have a different level of toleration for what bothers them. You seem to be implying that there's one level of response for everybody. You make that point when you write: "once she felt violated, when a member of the custodial staff came into her room and proceeded to clean with a feather duster while she was having her dinner." I would suggest that that event would not bother most people.

You also write: "to ask any caregiver/technician prior to the precedure to what extend he/she will ensure your modesty is upheld, is rather loaded in my opinion and can lead to the wrong conclusion being drawn and if i were that caregiver i would be offended."

Frankly, a patient shouldn't have to ask. Ideally, the technician should assure the patient that his or her modesty will be protected. That's just called good communication. If that doesn't happen, the patient surely has the right to tactfully either ask or make clear his or her expectations regarding modesty. Again, it's about honesty and communication. If the technician doesn't open up the communication lines, the patient should. Finaly, as far as the technician being offended -- if the patient asks respectfully, civilly and tactfully, and the technician is offended -- that's the technician's problem, and that tech can just learn to deal with it. We have no control over how people react to us. That's up to them. All we can control is how we communicate with people.

 
At Tuesday, June 02, 2009 3:19:00 PM, Blogger edo deweert said...

MER,
first....excuse me!!!???not being offended when a cleaning lady comes in to clean when a patient is eating is offensive (i guess i must finally use capital letters, so against my persona) IS offensive, the absolute, if you get it.?
this in the midst of all the furore over superbugs
i can tell you are not a care provider in the health care system.

as far as that question you refer to, sorry, dude, we take for granted that our dignity is being observed and respected, we do not need assurances from the care provider.....having been on this thread, i am beginning to finally understand the difference between the american and canadian health care system and the mentality of its providers.....that's why, when canadians, when asked to characterize their national identity, the response often is :"we are not americans"

 
At Tuesday, June 02, 2009 3:41:00 PM, Blogger Maurice Bernstein, M.D. said...

On the other hand, Edo, Canadians and Americans, we can all get along and most of the time we do! ..Maurice.

 
At Tuesday, June 02, 2009 4:07:00 PM, Blogger edo deweert said...

we can get along, and we do........the point is that obviously there is a huge difference in the mentality between the two national identities and the way we react to and interact with each other.

from some of these posts i get the distcinct impression that your health care providers are a bunch of uncouth, insensitive individuals
even though that may not be the reality.
i have been astounded, for example by the kinds of insensitive treatment one of the contribtors seems to have encountered and seems to want to share with us .
the list of procedures (and in hindsight it wasn't complete) i mentioned in anoyher post stretch over a 40 some year period in two candian provinces.
we all know there are exceptions to every rule, and perhhaps your contributor simply has been unlucky, but from our perspective here....no, that is not the norm; therefore some of the solutions suggested here may sound downright absurd and offensive to me.
to downplay the huge health risks in unhygenic practices is downright offensive to me, especially in light of the SARS and H1N1 experiences.

and how come nobody appeared to wonder if i was offended by the posting of "ode to edo"
the original post was directed at anonymous....in the business i have been in for the past 7 years, i have always been asked for my permission to have photos taken of me....even though this may be considered a public forum, there is still the matter of etiquette.
don't get me wrong... i am delighted with the post, but either you, maurice, or anon should have asked me if i had any objections to having the url posted. (one could almost say that my dignity has been violated by not having been asked my permission, even though, i suppose such permission is implied in the participation in these forums.
i have come to the conclusion i have little more to add to it...i have said it all; if i did not get the message across, well, so be it. amen.

 
At Tuesday, June 02, 2009 4:22:00 PM, Blogger MER said...

edo: Re your first paragraph -- no, I don't get it. Re your second paragraph -- you might want to check out Dr. Bernstein's other thread listed at the right top of this page. It's titled "Painting Groups with the Same Brush as Outliers: Is That Ethical?"

 
At Tuesday, June 02, 2009 4:31:00 PM, Anonymous Anonymous said...

In Medical ethics there are subjects called respect for patient
autonomy,safety and nondiscrimination. All patients have the right to fair and equal
delivery of health care services regardless of gender. Patients have
the right to complain about the
quality of their healthcare.
Personally,in these trying
economic times I can't imagine
a healthcare facility turning a
patient away simply because they
can't accomodate someone who requests same gender care.
Over the last several years I've
looked into the state nursing boards across the country and have found the criteria essentially the same throughout regarding what constitutes a valid patient complaint.
Verbal and physical abuse as well
as not providing privacy to patients. Next time some nurse wants to argue with you as to why
you don't need same gender care might well be reminded of these
state board nursing guidelines.
Additionally, alan brought up
the thread from allnurses regarding
whoa inappropriate,a thread of which I am very familiar with. That was clearly a case for exploitation of a vulnerable patient. Just one more case file
of double-standards.


PT

 
At Tuesday, June 02, 2009 4:33:00 PM, Anonymous Anonymous said...

I don't understand how providing sex to the disabled fits into patient modesty, unless
A) They are forced into sex against their will
B)Or it's "everybody gets to watch" day.

 
At Tuesday, June 02, 2009 6:18:00 PM, Anonymous Anonymous said...

EXCUSE ME edo, but I would suggest that someone coming in and dusting would not be offensive to most people as they would not automatically think of the action in terms of "the superbug", where as caregivers might think of it in those terms. Which is exactly the point that many have been trying to make, offensive is in the eye of the beholder. In this case the focus of the interaction is the patient, they are the one whom is sick, they are the one whom is in an unfamiliar environment, what the caregiver does or does not think is appropriate consideration for the patients modesty is really secondary if not irrelevant to the patient. The patient has a responsiblity to be respectful to caregivers, other than that if a provider finds a patients request for accomodation for their modesty offensive perhaps they need to spend some time with introspect on their compassion and choice of profession.

So are you saying Canadians have no concern for their modesty because of a complete and total faith in their providers and system...I find that strange since I know several Canadians who have come to the US for health care. Once again I am amused by what appears to be judgment of the larger part of society by a small fragment of society. We see this frequently where that segment places their view of normality society at large and almost has contempt for their beliefs instead of the other way around. And as far as national identity....I am American, proud of it, we as a country and people are not perfect no country is, but the advances that have come from this country in science, medicine, and other areas that have benefited the world are second to none. I love Canada, and America, and a lot of others countries and people....modesty is not defined by boundaries, it may be infuenced by culture...but it is defined by the individual. What is right for you...is just that..right for you...not me.....alan

 
At Tuesday, June 02, 2009 6:55:00 PM, Anonymous Anonymous said...

The Crux of the situation is...What constitutes protection and what constitutes modesty?????
Each individual has their own particular feelings and each has a greater or lesser degree of comfort in many situations ...especially those involving exposure of certain body parts.
I have a good friend who is a nurse in the Canadian Health system...and know from her that it has its share of problems the same as ours...
My question remains...who is to dictate what degree of modesty is ok or not ok... and exactly what constitutes false modesty as to the discussion on this blog??????
leemac

 
At Tuesday, June 02, 2009 8:30:00 PM, Anonymous Anonymous said...

I don’t think the discussions here has anything to do with Canadians or Americans. It has to do with individual preference on the subject. If others are comfortable with opposite gender intimate care, more power to them. I’m not going to judge them by that. But that does highlight why this needs attention because we all have different feelings and reaction on the subject. I respect their point of view, I hope I get the same in return. I do feel that if this was a requirement and providers were upfront with you, we wouldn’t be the minority. And yes, we can all get along…..

Here’s the response from my wife:

“Anything like that goes to corporate to ensure compliance on legal and licensure issues. In theory it would be fine.”

As I said, it’s in their hands to decide just like everything else. If it doesn’t help their bottom line, it won’t happen unless (as has been said) enough people suggest. Jimmy

 
At Tuesday, June 02, 2009 10:20:00 PM, Blogger Maurice Bernstein, M.D. said...

Edo, yesterday you posted a message including the following: "may i suggest you check out the 25 may 2006 issue of the eugene weekly, go to visual arts and finde the painting by dean smale titled 'ode to edo'" Then someone posted the link to the Eugene Weekly. I wouldn't publish a painting of one of my visitors on this blog without permission of the painter and visitor. Since you referred to the article, I found nothing unethical in allowing the link to be posted. I hope this explains my actions.

With regard to contrasting the behavior of Canadian medical providers vs U.S., it could well be that because of the different financing of the healthcare system, the attitudes of Canadian physicians or their patients are different that those in America. ..Maurice.

 
At Wednesday, June 03, 2009 9:28:00 AM, Anonymous edo deweert said...

maurice:
if i had wanted to offend the sensitivities of your readers and anyone else for that matter, i would have posted "ode to edo" myself.
out of consideration for others i did not feel i had the right to wave no nakedness in anyone's face; so by suggesting to go to the site, i left it up to everyone to access it, or to just move on.
there is on this blog a huge double standard: anon thought it was pwerfectly ok to wave my nakedness in everyone's face, having little regard for consideration for common courtesy and you compounded that by apparently following the same line of thinking :"after all, he is naked anyway, so i am sure he wouldn't mind if we show the picture to everyone.
i have received several private e-mails from you, how much work would it have been to drop me one line:"dedo, anon posted the url, i believe it would be great to share it with everyone on this thread, do you mind if we go ahead and post it?"

now, actually there an a propos reason for suggesting anon go to the eugene weekly: the one line in which the writer entioned that "the subject was treated with dignity"
come on guys, you have just given me proof that the lack of common courtesy, respect and safeguarding of modesty is systemic in your society.
it's precisely that arrogance and self-righteousness that we canadians loathe so much in americans

 
At Wednesday, June 03, 2009 12:10:00 PM, Anonymous Anonymous said...

I used this information and invitation...did not need or use the link someone else put up..may i suggest you check out the 25 may 2006 issue of the eugene weekly, go to visual arts and finde the painting by dean smale titled "ode to edo" (he said he just couldn't resist the title). This was posted by edo at 9:58 PM June 1,2009.
I fail to see where this violated anyones modesty or privacy as the subject issued the site and invitation.
I have found his commentaries on nudity and sexuality (libido)interesting..but a bit confusing...and am still trying to determine what level and nature his comments on modesty mean as to his personal feelings..
I think feather dusters are forbiden in many instituions beause they only scatter dust and germs reather than clean them up.
leemac

 
At Wednesday, June 03, 2009 4:45:00 PM, Anonymous Anonymous said...

One of the most disturbing trends
I've seen in years is the abuse
of the emergency room. It's bad
enough that patients use it as
a substitute for their doctors
office,worse that its an avenue
for drug seekers.
On any given day 20% of all er
patients are drug seekers with
a fabricated illness,tying up
critical services meant for real
emergencies and costing billions
annually. Representive of the
spiraling healthcare costs passed on to the paying consumer.
Many er physicians are nicknamed
the candy man as they are known
amongst the community drug seekers
and in fact many will call the er
just to see if their favorite
candy man is there. Many physicians
have simply caved into this out
of frustration. I heard many er
physician say " I know they are
here for drugs and I'd just as well
get them out of here by appeasing
them." You can always tell these
patients apart, they are allergic
to everything except dilaudid or
"I can't take toradol, I'm usually
given morphine."
Sadly, many "fake" patients can
get their fix, yet a real paying
patient is often denied basic human
dignity,privacy!


PT

 
At Wednesday, June 03, 2009 6:21:00 PM, Anonymous Anonymous said...

Edo, Dr. Bernstein did not post your picture. You invited people to go look, someone sent the link, Dr. Bernstein posted the link. None of the three of you posted the picture. You invited, I had the same opportunity to follow your invitation to look for it as I did to click on the link. I chose to do niether as I have no interest in seeing it. I fail to see how you could be offended by the fact that Dr. Bernstein did little more to show the picture than you did yourself. That said, it does point out the fact that what is and isn't acceptable is very subjective and in the eye of the beholder, a fact that providers do not seem to recognize. And edo, not trying to make this personal, but most of the Canadians I know don't have a problem with American People, they have issues with our government as we often do...but not the people, especially considering Americans provide a big portion of the GNP in Canada. One might ask also, what would both societies think of your life style and belief's....a 65 year old man that likes to pose naked and puts sexual conotations in most interactions....personally I could careless, as long as you don't hurt anyone, if it makes you happy...more power to you..but loathing the people of a country, people you don't know....

Back to the topic, I went to visit a friend today in a local hospital. He suffered a heart attack late last week. They did a cath, could not do anything with the blockage but told him he would be OK as the heart had formed a new channel for the blood....guess what bothered him the most...the fact that he had to stay in bed for over 2 days and could not get up and use the bathroom, he had to have the nurses bring him bed pans. Not the heart attack, not the cath, not the blockage or the new path,....the bed pan. While this is all so irrational to not only providers, but to us patients....strangely I understand. I agree its crazy, he could have died...but he didn't and his modesty and the embaressment was what bothered him...that is how deep this issue runs. The nurses reassured him that they were trained for this...his answer...I wasn't...I was struck by how this was so reflective of what we discussed here. Rational has nothing to do with it....he liked the nurses, knew they were trying to make him feel more comfortable....still embaressed him and made him hate being there....go figure.
Something else I have been looking into. I got to thinking about the truely disturbing post by Dr. Orrange on the 10 reasons men avoid medical care, so I googled it. There were numerous articles on it, several studies, many cited the "feminization" of the system, several even mentions the lack of mens health centers similar to womens health centers. They also recognized the embaressment of men as patients as contributing. I found it interesting and I agree, another interesting thing...with these studies indicating these issues contribute to males not seeking medical attention and contributing to shorter life spans....the medical community seems to be ignoring it or at least doing nothing about it.....alan

 
At Wednesday, June 03, 2009 7:06:00 PM, Blogger Maurice Bernstein, M.D. said...

I have tried a number of times to reach Edo by his e-mail address (which is available on his Blogger Profile) but have repeatedly got the word from MAILER.DAEMON that the e-mail was now undeliverable.

If Edo is reading this posting, I hope he understands the rationale for my response and those of the visitors here who wrote. It may not be satisfactory for Edo but that's the reality.

Since I appreciate all points of view--because as I have said again and again "this is a discussion blog" and not a blog broadcasting the views of the owner--- I truly hope that Edo would return to participate again. ..Maurice.

 
At Wednesday, June 03, 2009 11:22:00 PM, Blogger MER said...

Those who haven't read Dr. Bernstein's Bioethics Discussion Pages -- I highly recommend them. Some good basic philosophy. At one point, there's a discussion of the 4 principles approach -- principles that should ground doctor-patient relationships. Here are the 4 principles:

Respect for Autonomy--respect people’s decisions/values

Beneficence--help people

Nonmaleficence--don't harm people

Justice--treat like cases alike; distribute benefits and burdens fairly

As I read more about these in other sources, I saw how they applied to our discussion here. They seem to strongly support the medical profession allowing modesty accommodations for patients. The last principle seems to cover the double standard we're discussing. I'm curious as to how others see these principles applied to same gender intimate care. I'd especially like to hear Dr. Bernstein's reflections.

 
At Thursday, June 04, 2009 4:57:00 AM, Anonymous Anonymous said...

"to ask any caregiver/technician prior to the precedure to what extend he/she will ensure your modesty is upheld..."

I don't know where you came up with that but I will comment anyway. I don't see at all why that's an unfair question. You might be pleasantly surprised to have a nurse walk into the room and pull the sheet off you without an explanation but I and many other people don't like surprises. Even if I thought that question would offend them (which I don't), who cares. It's their job to explain those things to you and if they ever did act offended I would tell them to get the hell out of my room and send in someone who will do the job right.

I appreciate the fact that you would be the perfect patient during intimate procedures but we are not all nude models.

You tell the story of a woman that had many intimate things done to her and did not feel violated. Good for her but that's only 1 person. She was probably a nude model too, so she may have actually enjoyed the attention.

Anon

 
At Thursday, June 04, 2009 5:06:00 AM, Anonymous Anonymous said...

edo -
Am I understanding you right? Do you mean to say that when a male patient gets an erection during an intimate exam you actually feel sorry for the "caregiver"? If so, that's the most ridiculous thing I've ever heard. Is it possible that a "caregiver" could enter her profession not knowing how often that might happen to her? How could she be a nurse or whatever and fondle a man's penis and not expect to ever see an erection? Even the oldest, fattest and ugliest nurses out there are going to cause many erections when they're fiddling with a man's penis. If they can't handle that (excuse the pun) they should never be working in the medical field. I can't believe you even suggested that.

 
At Thursday, June 04, 2009 5:40:00 AM, Anonymous Anonymous said...

Edo, you gave exact instructions on how to find that picture of you and now you act offended that someone went there and posted the url? You were practically begging everyone on this forum to check it out.

Now you're dissing Americans and praising Canadians? From what I've researched Canadians have even fewer choices of who their providers are and generally have the "take it or leave it" mentallity. And how can you group hospital patients' attitudes by nationality? It's been a long time since I've been to Canada but I'm pretty sure not all of them are ready to strip naked at the drop of a hat for anyone wearing hospital scrubs. I would return your insults about our respective countries but I know many very good people from Canada and have enjoyed traveling through the Yukon territory. I could never group them in any form, good or bad. I think I'm going to start skipping over any post that starts with "edo", as a result of your attitude, not what country you live in.

 
At Thursday, June 04, 2009 12:50:00 PM, Anonymous Anonymous said...

Mer
I have to absolutely agree with the concept that in the "do no harm" promise, emotional wreckage is harm.
The question would be ,unfortunatly, in the doctor's interpretation. (Or nurse, cna etc.) It seems to be random as to the issue of "harm".
That's why we have found that we are responsible for the gaurdianship of our own "do no harm" promise, and sadly many times at the most vulnerable points of our lives.

swf

 
At Thursday, June 04, 2009 2:43:00 PM, Anonymous Anonymous said...

I am convinced that doctors are now solely concerned with money. The care of patients comes a LONG way down their list of priorities. I have complained to my local doctor's practice about their computer system allowing access to my medical records to their administrative staff. Their response is to drive me away from the practice. I realise now how little patient care matters to them. Do no harm - don't make me laugh. Help people - what a joke. Respect for autonomy - yeah right. The only thing they care about now is their pay.

 
At Thursday, June 04, 2009 3:04:00 PM, Anonymous Anonymous said...

Also, as to the discrimination in hiring male nurses/techs....I have found that the discrimination happens long before the applications hit the employment desk. Why? Women recruit women. Ask the female teacher why she just told 15 women that her nursing class lottery was not full and didn't even tell a single male. Ask the female cna teacher why she recruits from the female pool of hospital volunteers and not the male.

There has to be a way to break up this "girl's club" mentality, or else enough males will never be available for same gender care.

swf

 
At Thursday, June 04, 2009 5:48:00 PM, Blogger Maurice Bernstein, M.D. said...

I notice a "bunch?" of anonymous writers. Please let me remind those who want to post anonymously..and you certainly can..please either sign on to Blogger.com with a pseudonym or some initials. If not, then when you end your posting use a consistent pseudonym or initials. It is so important to understanding a point of view to recognize who says what.

I hope Edo returns but if not I would like to enter a point of discussion here and I am not trying to point any fingers but just to have us all think about why we seem to lose those visitors who come here (remember "Chill" et al)and present a different view than what is generally discussed on these threads. Are we misbehaving or uncivil in our responses? I think to understand this is important if, as I have for a long time suggested, the need for activism in making change in the medical system. But that activism presentation must be tempered in a way so that others DON'T just turn the issue off and walk away. Any suggestions? ..Maurice.

 
At Thursday, June 04, 2009 5:50:00 PM, Anonymous Anonymous said...

just wanted to share something with you all. I needed to see a specialist this week. They hospital he was associated with sent me preregistration including consent forms. On the consent it contained language about them using students and giving consent for them to partcipate. I know they have a lot of high school students shadowing which is ok other than certain situations for me. I e-mailed the patient rep. to ask if I could cross it out and or how if they notify patients if someone is as sudent etc. I liked her answers she said they ask the patient if it is acceptable etc and went so far as to say I could cross that out on the form and just make a note we had talked. This opened the door for me to have a discussion about the whole issue of modesty, gender, etc. great opportunity to exchange with a patient rep and reinforce what they probably know but sometimes forget.....just wanted to share something that was not intended to be advocacy but ended up so.....alan

 
At Thursday, June 04, 2009 6:31:00 PM, Anonymous Anonymous said...

Administrative staff that handles billing and insurance will always have access to your records whether it be in a doctor's office, clince or hospital. It's unavoidable as they need to send the necessary information and documentation as required and requested. The key is that only essential personnel see it.

-sm

 
At Thursday, June 04, 2009 8:05:00 PM, Anonymous Anonymous said...

Dr. Bernstein
Good question, I think for quite awhile everyone let Edo express himself without challenge. At the point however where he made comments derogatory to others and or the country he opened that door. That said, I think perhaps what causes the biggest issue is the feeling of being ganged up on. Now the fact that a majority of the people on this page share a common concern(s)that is understandable, however as stated loosing those with opposing opinions does nothing for us. I think if we could perhaps expresssing agreement with opinions expressed vs rehashing them toward the person might make it a little more tolerable, and as always the tone and way we address this is a factor......I still have no issue with your censoring or sending posts back for rephrasing the post if you so feel. I don't know what else would work. Someone coming here with an opposite view is going to be in a minority.....but we really need them.....alan

 
At Thursday, June 04, 2009 8:21:00 PM, Blogger MER said...

Doctor: You wrote: "why we seem to lose those visitors who come here..."
I've thought about that too. Some visitors have been treated perhaps a bit too harsh. I hope I haven't alienated any. But I am a fierce debater and I don't apologize for that.

And I do see this as a debate. I'm interested in all opinions, but I expect people to be willing argue the point. Including myself. I've always tried to separate my opinion from other opinions I quote, and I've always tried to back up as much as I can with sources. Frankly, I expect that of others, too. Some people just expect that the way they see things is the way things are and don't want to be challenged. They don't want to debate. They don't want to quote sources, or use lines of argument. They just want to shoot and run, express and opinion with the assumption that that's just way things are. I'm not like that. I expect to be challenged. I want to be challenged. But I expect people to do their homework just I do mine. Some of our visitors just don't want debate their point of view. To them, it's not a point of view. It's just reality.
Note that I've never gotten any debate about the premises I proposed a few volumes ago. I'm sure there are some doctors and nurses occasionally looking in. Why no debate? Why no professional response to the text I wrote for a hospital websites? Why so little response to the recent 4 principles theory. Why no responses from professionals. If I'm way off, the let me have it with a good argument. It's like we're all preaching to the choir here. I'm beginning to believe that their is no true ethical case against giving patients a choice of same gender care, or against being open and honest about it, or against hiring more male nurses and recruiting if necessary, or against many of the other issues we're debating. Where are the arguments against these view points?

 
At Thursday, June 04, 2009 8:30:00 PM, Anonymous Anonymous said...

I have to agree with you doctor but I’m not sure what we could’ve done differently in EDO’s case but for sure we ran away Chill and a few others. The conversation sometimes gets heated but most of us are still here posting while others have said their peace and leave? Maybe they know we’re right? Maybe they have better things to do? I don’t know, I just know that I’m not just going to go in my shell and hide from the issue. As I’ve said, I respect their points of view. But, it is their point of view, not mine. I don’t live by their rules and values. I have my own just as they do so don’t expect me to just take it in the A**. In each heated exchange it has been them that have left, you’d think if they believed in their point of view so much that they would at least defend it but I guess it’s just easier for them to just sign off.

MER, that’s absolutely right. In every principle you read from providers they actually do support what we’re all wanting here but it’s like once you enter the facility or go under, you’re playing by a different set of standards/rules. I to would like to understand how they could put all this in writing knowing that’s not how it’s going to be done. Jimmy

 
At Thursday, June 04, 2009 9:03:00 PM, Anonymous Anonymous said...

Many facilities have standing policies as to who can view
patient data within the facility.
This represents a hipaa violation
and if you suspect someone has
accessed your data without a need to know then by all means complain. Data systems now have the capacity to track intrusions within the system regarding who is accessing data via logons. Folks, this is a bigger deal then you realize.
Additionally, regarding consent
forms patient reps are clueless as
to what happens to you once you
become a patient as they deal only
in the arena of paperwork.
Facilities need to be very careful as to who is allowed in
patient care areas. Just because
it is a patient care area simply
dosen't mean anyone can walk
through. I would question the facility as to why high schoolers
are shadowing anyone. If they are
not part of the heathcare team
they have no business being there.
I'll stand by this comment as
accepted fact. Many facilities such
as hospitals are using volunteers,
however,their access to patient care areas are highly restricted.


PT

 
At Thursday, June 04, 2009 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, I don't have time to perform the moderation you suggest and also I think every writer should have responsibility for the words that he or she writes, responsibility not only in civility but also responsibility to make clear to others what point the writer is trying to bring out. This does require a bit of thought before typing out the comment. Sometimes, instead of clearly contrasting views between the writer and the other, the result may be an almost ad hominem remark reflecting personally upon the other instead of separating out the two views.

I think that if we had on these threads a few others of the opposite view than the majority opinion and together would stick around, they might be more comfortable to stick around rather than remain a sole defender of a view. ..Maurice.

 
At Friday, June 05, 2009 12:21:00 AM, Anonymous Anonymous said...

Something interesting I found...

"In seventeenth-century China, no lady would have endured the indignity of a hospital johnny. It was improper for a physician to see her body, much less conduct a physical exam. So on a house call to a woman of rank, he would pull from his pocket a palm-size diagnostic doll."

“The lady would be lying in a four-poster bed behind curtains, and the doctor would hand the doll to the maid, who would hand it to the lady,” explains Sidney Brody, a retired professor of medicine who recently donated his collection of antique medical instruments to Brown. “She would point to the place where it hurt, and he would make his diagnosis based on that.”

[...]

"Diagnostic dolls were typically nude except for their tiny feet, which were covered with drapery or shoes. Foot-bound as toddlers, ladies never exposed these, their most erotic and private parts. Even in bed with her husband, a lady would cover her feet, reports Strait. For a stranger—even a doctor—to see them would bring disgrace." Jimmy

 
At Friday, June 05, 2009 5:04:00 AM, Anonymous Anonymous said...

I completely agree with your statement and opinion MER and "swf" regarding "do no harm" promise...emotional wreckage is GREAT harm to the persona of a couple when cross gender care is given without a patients consent and a healthcare facility ignoring a patients' preference. They fail to recognize how much HARM this does to individuals. Not until one experiences this can one fully understand the damage this does. Hypotheticals do not count.

JW

 
At Friday, June 05, 2009 5:06:00 AM, Anonymous Anonymous said...

MER, I think people such as "chill, edo" etc. have strong viewpoints and opinions and when they are bombarded with opinions on this site they can't take the heat and so it is just easier to Not Debate and leave the site. Afterall, none of the blogger here that have modesty, cross gender care issues are going to change their minds. It's easier for them to just move on rather than listen.
JW

 
At Friday, June 05, 2009 8:25:00 AM, Blogger amr said...

Edo and Dr. B

(This was written a few days ago - on Wed June 3)

First of all, I want to echo what has been said about your (Edo's) contributions to this blog. I have found them most enlightening. I think what has happened with the posting of the link and Edo's reaction is most interesting. The theme that Edo has brought to this discussion is one of "asking permission". The modesty breaches (oops.. Physical privacy breaches) that I take umbrage with are those where the institution forces its agenda upon the patient wrt cameras, video, observers and "teaching". Asking permission and getting active agreement says to the pt that they matter and that they are truly being consulted. I will never forget how my wife's doctor asked permission to examine her in the hospital room. It meant a great deal.

Edo, over the course of many years now and what is many thousand pages of text from this blog, there has been an informal tradition whereby a citation is oftentimes "cleaned up" or made easier for others to access. Many times a web address that is not set up as a link, is made so by another contributor for the benefit of all the bloggers. I truly do not believe that anything other than that, in fact, occurred. And thus I buy Dr. B's assertion that he saw nothing wrong with the entry.

However, I absolutely get your anger. It is clear that you could have provided the link just as easily as how you chose to "provide it". You had a reason (well explained) for doing it how you did.

Current comments: It is my impression - and clearly I could be wrong, but there seemed to be a "break" that took place with Edo. One minute we were having a great discussion, and the next he became angry - presumably over the posting of the "link". Remember, Edo at one point made the comment that he wished that he had made his comments as anno, so without realizing it, we may have stepped into personal space. However it is hard to understand what really took place because he is no longer around to explain. "Chill" on the other hand is another matter. He basically came onto the blog with a chip on his shoulder that was clearly responded to. (This chip was better explained in another of Dr. B's blogs - I forget which at the moment. He stated that he is suffering burn-out.)

--amr

 
At Friday, June 05, 2009 5:41:00 PM, Anonymous Anonymous said...

For me it is simply beyond reason
as to why this subject even needs
debate, all issues regarding patient privacy should be
assured. For those visitors who
have left I've the suspicion that
they don't like what they hear and in essense fear change.



PT

 
At Friday, June 05, 2009 9:20:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, nothing but nothing in this life is assured except death ("and taxes"). ..Maurice.

 
At Friday, June 05, 2009 9:47:00 PM, Anonymous Anonymous said...

PT,

I enjoy your posts. You are obviously very knowledgeable and have done a lot of research. Some people may not like how you "tell it like it is" but I enjoy it. Keep it up.

Anon

 
At Saturday, June 06, 2009 9:17:00 AM, Anonymous Anonymous said...

One other thing is almost assured...It is that change will seldom be for what you want if you do not take the effort to get your input included for consideration....otherwise it will be for those who do make the effort...and that may not be what you want to see...and may result in status quo..or change further from your wants/needs.
leemac

 
At Saturday, June 06, 2009 12:45:00 PM, Blogger swf said...

I have a question please:
Same woman..(conversation edited for space)
Same proceedure
My concerns: She understands my needs and can accomodate me in this facility and bingo all is well.
My husbands concerns: (among other things)I am now a ridiculous, petty, jealous wife.
On the surface I get it...women care about women and not men. But seriouly, how can the same people blantantly throw their own personal discriminations in your face and not feel petty and ridculous themselves???
This leads me back to something I tried to post a few days ago regarding discrimination with hiring male staff and where it really starts, but I'll move on to my second and final question:
When the men here try to advocate for your wives are you guys called ridiculous petty jealous husbands?
And, has anyone enountered any blogs where the jealousy issue is dicussed?
I am certainly beyond caring what they call me and think of me, but it does present yet another wall of communication hurdles.
swf

 
At Saturday, June 06, 2009 3:01:00 PM, Anonymous Anonymous said...

I agree with PT's remark that this subject should not need debate. I think the issue and problem lies with the fact that females have been doing this intimate care WITHOUT being questioned so long and so much that they look at a patient that does object with puzzlement. That sure doesn't make what they have been doing "RIGHT".

JW

 
At Sunday, June 07, 2009 9:22:00 AM, Blogger MER said...

To swf: You write: "how can the same people blantantly throw their own personal discriminations in your face and not feel petty and ridculous themselves???" I think many of them do feel petty and ridiculous. Those that don't are either emotionless or they, as JW has pointed out, have just done intimate care so long without complaint that they have become numb to what they are doing. When we get into routines, we don't even see anymore. Have you ever gotten up in the morning, taken a shower, brushed your teeth, then while driving to work said to yourself, "Did I brush my teeth today?" You can't remember. Routines are like that. We're not even thinking about what we're doing. Historically, hosptitals have developed a culture that is extremely inward looking. The culture looks out for itself, for what's best for the profession, the scheduling, etc. I provided a quote about this in several volumens past from a book on the history of hospitals. The medical culture too often focuses, maybe not in training, but in reality on what is in its best interests. The assumption is that if it's in our best interest, it's in the patient's best interest. Hardly a scientific position and one that they just don't want to research.
Because many health care workers see the double standard, see the general modesty issue, when they are approached with this issue they become defensive. They know what they're doing isn't right, that it doesn't meet with their mission of patient care and comfort, with patient respect and dignity. But many of them are stuck within a system, or working for a supervisor who won't tolerate accommodation. I've interviewed a few nurses about this issue and a commen response I get, when I ask about accommodating male patients is that they don't what to bother a male nurse. If female nurses keep asking male nurse to take over these intimate care situations, in some places (depending upon the culture and the supervisor), the lose respect. They are are not considered doing their jobs.
You also write: "When the men here try to advocate for your wives are you guys called ridiculous petty jealous husbands?"
I think they are. It depends upon the individual culture of the hospital or clinic, or of the specific supervisor on duty. I can't get hospitals to state publically their policies on accommodating same gender care. They won't talk about it. I'm left to believe that the policy is left up to individual supervisors based upon the gender make up of the staff on each floor or in each department. No one's in charge. If I'm wrong, someone please show me a hospital that will openly state how they deal with this issue.

 
At Sunday, June 07, 2009 10:47:00 AM, Anonymous gve said...

I have been pushing the issue in the UK for some months. When faced with the facts of double standards and threatened sexual discrimination cases, they have without fail bent over backwards to accommodate me. I have also followed another avenue and got a helpful nurse educator/researcher to apply for (and at last WIN) funding for research into the way men feel about intimate procedures being carried out for men by women. I think the answer is undoubtedly to use the same avenues women have used for years to gain "equality" and turn them back on the establishment.

I will keep you posted of the outcome of the research.

 
At Sunday, June 07, 2009 3:09:00 PM, Anonymous Anonymous said...

swf writes about men and how they are perceived if they advocate for their wives not receiving cross gender care. There is a blog titled "howhusbandsfeel" and mostly what is discussed is male doctors in OB/GYN. There are male and female posters but the moderators and most of the posts are from men truly objecting to their wives going to a male doctor having intimate exams. It upsets these men beyond words. One might call them obsessed with the subject. Are they called jealous, petty and controlling? Don't know. But it is ALL they discuss and how much it upsets them and sometimes even ruins a relationship.

 
At Monday, June 08, 2009 4:18:00 AM, Anonymous Anonymous said...

Great job gve. I'll stay tuned in for your results.

GL

 
At Tuesday, June 09, 2009 10:19:00 PM, Blogger Maurice Bernstein, M.D. said...

I notice that the commentary has slowed down here a bit. Could it be that all has been said that needs to be said? Or now there is no one poster who now presents a view about which the majority of posters have a conflict? ..Maurice.

 
At Tuesday, June 09, 2009 10:53:00 PM, Blogger MER said...

Perhaps all has been said.

I just had some communication with some higher ups in the medical/hospital system. We discussed this issue. They admitted the problem but didn't seem sympathetic or empathetic. I asked why more studies were not being done about how men feel about this issue. They told me that the studies wouldn't show anything that they didn't already know.

The higher ups know the problem. They just don't want to talk about it or deal with it. With no incentives, they will do nothing about it. It's really not an ethical issue to them. It's a financial and a political issue. Having many women in these positions is both cheaper and politically correct. Getting more men in nursing will cost more money; men will demand more money and will not put up with much of the garbage nurse have to put up with. Ironically, more men in nursing will improve the profession in many ways. I think some nurses see this but don't want to be displaced. Can't blame them. Plus, challenging the female powers within nursing is not politically correct for those men in the high positions.

Most hospitals will try to accommodate if they can, but they can't always, and in some departments, rarely can they. You won't get most hospitals to discuss this openly before getting into the hospital. They want you in their world before the conversation begins, when they have the advantage, so if they can't accommodate you'll be in an awkward position. I hate to put it that way, but that's how I see it. Bottom line is they want your money, and don't want you going anywhere else. Note all the advertising in the media for various hospitals. There's much competition.

Perhaps someone should send off letters to all those hospitals Dr. Bernstein listed. My guess is that you'll either get no answer from most of them, or a vague, generic answer that will in essence say nothing. They want you to go away. And they've learned that most people will go away if ignored. When you get to the point that you need medical help you'll feel helpless, need those who can help you, and accept whatever comes your way. That's how most people behave.

What men have on their side is that the worst case situation for these hospitals is bad publicity about this. They'll go out of their way, bend over backwards to avoid bad publicity or a public discussion of this problem. They know that once this issue goes public it will be like opening Pandora's Box. They'll be forced to deal with the accommodation more openly.

That's why it's important to put your complaints in writing and copy ethics boards and licensing boards. And perhaps write an op ed piece about this in your local newspaper.

Change can happen but the more I research this topic the more I believe is that change will be painful and require much advocacy and hard work. It won't be a pleasant experience. Those publically representing the points of view expressed on this blog will be demonized and ridiculed. They'd better be strong and know who they are and what they stand for.

 
At Wednesday, June 10, 2009 9:03:00 AM, Blogger Hexanchus said...

MER,

Sad to say, you're probably correct in your assessment - at least in a worst case scenario. I agree that adverse publicity, or at least the threat of it, is probably the only thing that will get them to do something. They want to keep it quiet, so how do we blow the lid off of it?

I do think we need to attack on two fronts:

1. Get it in the public eye as you suggested. There appears to be more than enough evidence to make a case of possible discrimination (preferential treatment) based on gender. Might even be able to make a case for the possibility of coercion/intimidation and willful violation of patients constitutional rights of privacy and self determination.

2. Take action from a personal standpoint. Patients need to make their feelings and preferences known to the facilities and providers they deal with for health care and insist that they take those concerns seriously.

As you stated, both requests and complaints should be made in writing so there is a documentation trail. There's an old saying in medicine, "If it isn't written down it didn't happen".

It would also be nice if we could find a facility or two willing to honestly and proactively address the situation. They could be held up as a positive example, i.e.: "these folks get it, why don't you?"

Just my $0.02.......

 
At Wednesday, June 10, 2009 12:49:00 PM, Anonymous Anonymous said...

In reference to the comments MER made above....is it incentives or consequences or a mix of the two which will get hospitals etc. to alter their practices???

 
At Wednesday, June 10, 2009 2:24:00 PM, Anonymous Anonymous said...

Once again MER is right on. He has stated this problem succently.

Female nurses are petty, caddy and treat each other with contenpt many times. Males could add alot to the mix and make things more professional. OR nurses are really nasty.

 
At Wednesday, June 10, 2009 3:08:00 PM, Blogger swf said...

Mer

There is more power in numbers, as I feel many times one woman banging on the door doesn't get it opened. I feel that what I do now is only for the benifit of my family and not for all. Dr. suggested a letter/survey. Perhaps some will not respond, maybe most, but we could start. Has anyone here started to collectively work on it, or are people doing their own mailings?
I wanted to suggest starting a place where people could go who need local information on same gender care. Perhaps a web...blog..pamphlet...newspaper listing. I just havn't gotten the legal answers to that yet.
I'm working on a letter to send to facilities regarding this. I believe this might open the idea to them about profitability and need. (supply and demand )or at the very least, see their response to opening that box. Once it becomes a "public" issue, they may want to slide in as open minded, rather than hopelessly selfish and only in the biz for money.

 
At Wednesday, June 10, 2009 4:17:00 PM, Anonymous Anonymous said...

The only time hospitals will change what they do is if they are legally forced into it or it affects the bottom line.

 
At Wednesday, June 10, 2009 6:35:00 PM, Blogger MER said...

Anonymous wrote: "Once again MER is right on. He has stated this problem succently. Female nurses are petty, caddy and treat each other with contenpt many times. Males could add alot to the mix and make things more professional. OR nurses are really nasty."

The way this is written, it sounds like I said or agree with the above. I neither said it nor agree with it. I think I've made it quite clear in all my posts that I have great respect for the majority of nurses, and doctors. I disagree with the above statement. That's neither what I said nor implied.

 
At Thursday, June 11, 2009 3:57:00 AM, Anonymous Anonymous said...

I'm with you MER and Hexanchus.

Next week I begin as a participant in an acid reflux study to test two new medications. It's at a Gastroenterology clinic. I'm not exactly sure yet which tests will be performed but if any involve my nudity you can bet I'll stand up for myself, at the risk of being booted out of the study and my thousands of dollars worth of free study related healthcare. I don't consider nudity bad, only if female nurses or techs are involved do I get upset.

I imagine I won't even be put into that position though because it probably only involves Upper GI tests. Also, since my community seems to be more conservative than most others maybe they are more concerned about morality and ethics. If not though, I'm ready to make a stand.

GL

 
At Thursday, June 11, 2009 4:38:00 AM, Anonymous Anonymous said...

swf: I have been in the same position. I have been doing things on my own but feel the true advances will be made only when there is a unified effort. There is strength in numbers. There have been a couple of small efforts to get this rolling. I will toss this out there once again. We need a central place where a core of people could share idea's and combine efforts to get something started. There is a poster here named Jimmy who started a spot for people to come to organize. It is just an e-mail address to start with, but if you have interestt you and anyone else who might have interest in working to that end could email him, he would put you in contact with myself and others who have indicated they are interested in forming a group. From there we might have a start. Dr. Sherman has also indicated he would have no problem with us using his "organize" section of his blog to share. The e-mail address is medical.privacy@yahoo.com....alan

 
At Thursday, June 11, 2009 5:14:00 AM, Anonymous Anonymous said...

So what are your opinions about an openly homosexual doctor, nurse, etc. concerning chaperones? If a gay male doctor or nurse was performing an intimate exam on a female patient would he need a chaperone? Would you guys that don't want a female nurse or assistant present during an embarrassing exam accept a lesbian nurse? Would modest women accept a gay male nurse?

GL

 
At Thursday, June 11, 2009 5:41:00 AM, Anonymous Anonymous said...

A discussion posters here might want to enter is going on at

http://www.boston.com/community/moms/blogs/moms_are_talking_about/2009/06/very_intersting_conversation_g.html

regarding should male nurses be allowed in labor and delivery.

--rsl

 
At Thursday, June 11, 2009 8:18:00 AM, Anonymous Anonymous said...

I think it all comes down to the same thing we have been discussing for some time. It is an individual preference, personally I would feel more at ease with a gay male Dr. than a lesbian female for intimate or exposure. I suppose that goes back to the issue of upbringing. I was brought up to conceal my nakeness from women..but not males, the issue of gay wasn't even on the radar screen back then. For me this isn't really a sexual attraction issue....I don't think the 22 year old female nurse is attracted or turned on my this 50 year old guy...but its still embaressing.....alan

 
At Thursday, June 11, 2009 1:23:00 PM, Anonymous Anonymous said...

I second Alan in feelings...It is NOT that I think anyone (gay male or straight female is going to make a pass at me) it is just there are times when males are not going to embarrass me..but females will.. no matter how nice they are or how indifferrent they are... it is not about how Whoever feels.. it is about how I feel.
leemac

 
At Thursday, June 11, 2009 4:17:00 PM, Anonymous Anonymous said...

Architecture and how it is used
to deny male patients privacy.Ever
notice the structural design of
emergency rooms and how some of them are curtained off partitions.
Patients on both sides of you know all about you,who comes in to see you and whats been said. The fact of the matter is female patients are more often given a
private room when their medical condition dosen't warrant it. I've
seen them recieve a private room
for a broken nail wheras a male
patient with a possible appy is
placed in a curtained off partition.
Ever notice they ask you to pee
in a cup and they come back in the
through the curtain one minute later.


PT

 
At Friday, June 12, 2009 1:41:00 PM, Blogger swf said...

alan: thanx. I emailed my e-address to the site above.

With respect to some of the posters above about female nurses/techs: Somewhere in between absolute hate for all of them and respect for most of them is (cautiously) me. My experiences in interviewing (and listening to )them always results in much different outcomes than that of a caring women stuck in a broken system. I wonder if that is the difference between women talking with women vs women talking with men. There has to be a bit of a difference as I have yet to have one tell me she began in the profession to help people. If you ask about inimate care, the entitlemnt issue always rears its head. "I paid my dues" "I went to school" "this is my job" "I have the right".
Try to tell them that the stories they tell could someday be my husband, brother, eventually grandson and they fail to relent. I have come to the definate opinion that this is certainly a "girls club" mentality, when they say that they "get" to do things most women in society can't. (interpret as you wish)
Do I view them all as sexual perverts? No. More like power addicts with the "bonus" of being able to humiliate people.
I don't know when ES (entitlement syndrome) begins..whether it is in the beginning of education or after a few years but I believe it can not be denied. Even knowing how I feel, they still try to recuit me, which leads me to believe that again they miss my point. Do I care about people? Of course. Do I like to help people? yes. Do I find the human body offensive? no Could I perform intimate care on a man without either running away horrified or becoming sexually aroused? yes.
But JUST BECAUSE I CAN, DOESN'T MEAN I SHOULD.

 
At Friday, June 12, 2009 8:18:00 PM, Blogger MER said...

Swf makes interesting points. I think the answer perhaps lies somewhere in between. As you suggest, and as I've said in past posts, power is an important element in this modesty issue. Power itself is neutral, and is often necessary. Decisions must be made. How one uses power is what matters. It can be used for good or evil.

But I don't think we can talk about why many women in general and why some nurses and nursing assistants (doctors, too) in particular have become so emboldened when it comes to intimate care for men – we can't talk about this without talking about how men have changed in the last generation or so.

I refer to the book “Emasculation of the Unicorn: The Loss and Rebuilding of Masculinity in America” by C.T.B. Harris, Ph.D. On page 7 he quotes Andrew Samuels, “The Father: Contemporary Jungian Perspectives (London, Free Association, 1985, p. 3):

“Analysts are beginning to meet a new kind of man. He is a loving and attentive father to his children, a sensitive and committed marital partner, concerned with world peace and the state of the environment; he may be vegetarian. Often he will announce himself as a feminist. He is in fact a wholly laudable person. But he is not happy – and bids fair to stay miserable until either the world adjusts to him or he manages truly to integrate his behavioral and role changes at a level of psychological depth. Otherwise this man, casualty of a basically positive and fruitful shift in consciousness, will stay a mother's boy. He is a mother's boy because he is doing what he is doing to please women.”

I believe this man continues to exist and his numbers have grown. Too many men today are afraid to challenge any feminist thinking. They don't want to perceived as anti-women. They want women to like them. One man told me he just went along with female intimate care despite his humiliation because he wanted to be a gentleman. Another humiliated man told me that he just bit the bullet because women have had to put up with this for a long time, so now it was men's turn. The real reason they just went along with it despite their negatives feelings? They were afraid. Afraid to upset these women. They want to please women. Now, there's nothing wrong with wanting to please women, or men for that matter. But a significant number of men today do not know how to be a man, how to stand up for what they believe it, how to take the hits for what's important to them – especially when it comes to their relationships with women. I realize how this must sound to some people, people who throw around the word “sexist” liberally, except when it comes to sexism and the double standard against men. When men stand up for their rights, they're often labeled or secretly suspected of being misogynists.

Men are treated the way the often are in health care, not only because of the normal fear and vulnerability associated with hospitals and disease, but also because too many men are still mother's boys and want to please women at the expense of their own psyche and mental health. When they face these all these women in health care who have become routinized and emboldened, they are afraid of not being liked.

Anyway, that's a theory that's bound to annoy those on both sides.

 
At Friday, June 12, 2009 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

I think that the goal of a healthcare provider at any level to the patient is one of providing effective health care. I think the goal of any patient under the care of that provider is to come to a satisfactory conclusion of one’s symptoms and disease. Any wavering from this goal either in practice or thought is not in keeping with the responsibilities of each. That is why I personally feel that both as a doctor and also as a patient these goals are the ones to meet and that though patient modesty should be dealt with on both sides, modesty issues and concerns should not trump the goals I stated above. That doesn’t mean that modesty should be ignored but it should be weaved into the process of the goal of getting well. Yes, gender inequalities in healthcare management should not be ignored and mitigation of inequalities should be attempted and systems changed as needed to resolve inequalities. But if inequalities do exist, and perhaps as written here they do, the goals of effective healthcare and a satisfactory conclusion of symptoms and disease should not be sidetracked by most of the modesty concerns written to this blog. Any deviations from those goals due to specific behavior issues by either the healthcare provider or patient should be promptly attended and corrected. This is the way I look at the patient modesty issue from my two perspectives. ..Maurice.

 
At Friday, June 12, 2009 11:22:00 PM, Anonymous Anonymous said...

Dr.Bernstein

After all these post, I still have the feeling that you just don’t get it.

Some could care less about the symptoms and disease. The fact is in most cases treatment can be performed while respecting modesty but it isn’t even give a second thought. Stripping a person nude and leaving them on display for all to see while prepping for abdominal surgery? There’s nothing dignifying about that process. This is a good example of when a person male/female can remain clothed without causing harm or getting in the way and yet there they lay, on a metal table nude and in plane site? And what’s the point of getting a good diagnosis if you kill that person’s soul? You have then hindered the recovery process and scared that person for life. I hope that wouldn’t be the sacrifice most providers are after.

My satisfactory conclusion: If it’s not getting worked on… keep it covered up. That’s my compromise to any provider and I could care less of the repercussions. Modesty fears for some do trump the goals that are set above, is that not obvious yet? Keep in mind, these conclusions that you refer to are also dictated by providers so really, who is right in this situation? What choice do patients really have? Jimmy

 
At Saturday, June 13, 2009 6:04:00 AM, Anonymous Anonymous said...

As much as I respect you and your opinion Dr. Bernstein I think your opinion shows to some degree the problem. Many providers act like this is an either or proposition to a large degree. You can have focus and thus positive medical outcomes or you can have concern for modesty but not both. They act like concern for modesty must by its very nature in some way compromise the medical care. The medical community as adopted this theory to such a degree that the modesty side has not only become to a large degree discounted, it has become in their view and is treated like a hinderence. Providers want to use the extreme and obscure to justify the violation of modesty in the day to day. Examples such as the ER are applied to the routine such as imaging. Look at the ritual of requiring a patient to be naked for proceedures such as shoulder or eye surgery. It is justified by the possiblity that the patient may arrest and they may need to get into the femeral artery. Now look at it realistically, is the odds that a patient will arrest X the odds that they will not be able to get into the main artery X the odds that the time it will take to move or remove shorts to get to the femeral have a real effect on the outcome greater than the odds that the patient will be effected by a provider who hasn't recieved enough sleep, or might carry VERSA or other infections and cross contaminate as they go from patient to patient? The thought is compromising patient modesty for such a long shot is justified but focusing on an equal or greater risk on the provider side isn't justified. Is the care patients recieve measurably better since providers did away with male orderlies to bath and do other intimate care for males? Is a patient in the hospital for observation, testing, or any number of procedures any markedly safer becasue they have those ridiculous open back "gowns" instead of one that overlapped and covered their behind. While there is no doubt there are cases where modesty has to be compromised to insure or increase the probablity of a positive medical outcome, it should not be used as a blanket excuse to justify all cases. Many of the things we object to are driven by economic benefit to the provider pure and simple. It has little to nothing to do with patient safety or outcome. It is however much harder to justfy compromising a patients modesty, and therefore their emotional well being for financial or ease for the provider reasons than it is for safety and health, so providers use the patient health/safety explaination to justify nearly all cases whether it is truely the case or not. Once again, I understand the can't, but the just won't or don't really ticks me off. The other thing that comes into play here...its still my choice, providers do not have the right to determine what risk I am willing to bear for my modesty. They are not my God, I should have the right to make that determination. The other side is I should not hold them liable for my choice. This doesn't in most cases have to be either or.....alan

 
At Saturday, June 13, 2009 7:56:00 AM, Anonymous Anonymous said...

Great post MER. It's about time we say what we think without being afraid of not being politically correct. I used to be a woman pleaser too, no matter how humiliating it was for me. But it has gone far enough.

There's a time when we should be chivelrous to female attendants who we believe really care about us and do everything they can to not take advantage or embarrass us. But for those that are on an obvious power trip (the majority in my experience) we can't be afraid to get up off our knees and stop worshiping them. We can't be afraid to remind them that we DO have a mind of our own and there are some things they do to us that just aren't right.

swf - it seems like my words are being typed onto your keyboard. That's exactly how I feel.

alan & leemac I'm with you. Gay or not, I'm comfortable with men for intimate exams/procedures and uncomfortable with women. It doesn't matter which gender they go home with at night.

AD

 
At Saturday, June 13, 2009 9:10:00 AM, Blogger Maurice Bernstein, M.D. said...

Jimmy, "after all these posts", I do get it and encouraged those who feel like you and the others writing here to do something about changing the system. What I can't get is changing my view of the professional goal of practicing medicine which I feel is to do the best in relieving the symptoms of patients and to recover from their illness. Yes, patient modesty is important and we teach students that patients should not be exposed unnecessarily or for gratuitous reasons. It may well be that some standards of undress which have been long accepted in medical/surgical practice need to be changed.

The other day, I talked with a physician internist, board certified, about this patient modesty thread and the general views of the writers here. He was thoroughly surprised about the concerns I told him about. He said he never thought about the gender selection issue and the intense emotions expressed. But then, I suspect, as I have previously noted, most physicians would have the same surprise.

Yes, that is what you are dealing with. Regardless of my personal views, I still encourage my visitors to make their views known and make a concerted effort to change the system as necessary. ..Maurice.

 
At Saturday, June 13, 2009 7:37:00 PM, Blogger swf said...

I know this is a place for rational arguments and the exchange of tools and ideas to help us all. And tommorrow I may be sorry that I didn't stick to my origianl plan of dicussing MER's interesting post or telling alan and Jimmy and all who posted their hearts here: Thanx
But sometimes.....
some times my heart just says "My God: it's just wrong. It should really be enough to say it's bizarre and it's just wrong."
I've read of people who are too humiliated to even face thier spouse again and a marriage is ruined. How immoral is that?
I've read of spouses who feel betrayed and cheated on because their partner allowed it to happen, and a marriage is over. How immoral is that?
Ive read of people who feel broken and beyond redemption because someone thought they had the right to strip them of their moral beliefs. How immoral is that?
We fight through or lives to keep people away who have no right to touch our bodies other than "they want to." Now we have to fight a system that believes the same thing. Does anyone in that systam ever go home at night feeling accountable for the broken marriages, broken hearts, or broken spirits? Does anyone in the system really want to change it's devastating cycle of personal destruction? Anyone.......
Here alone there are pages and pages of painful words that just scream "enough". Words that are riddled with such sadness that you wonder who could have possibly done this to them. Is all of this enough proof that in the most simple terms: it's just really not right.
Tommorrow I'll be rational and professional, and the fight will go on, but tonite.....I just can't get past how bizarre it all is and how cruel humans are to other humans.

 
At Saturday, June 13, 2009 8:16:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I am curious as to if the physician you said was surprised at the patient modesty issue made any further commentary... Do you think he may read some of the responses posted in this blog..and perhaps go to the blog of Dr. Sherman...
leemac

 
At Saturday, June 13, 2009 9:27:00 PM, Blogger Maurice Bernstein, M.D. said...

Leemac, the physician, I believe, has my general blog address available and knows I moderate the blog but it didn't appear that he has visited here. Interestingly, he is a fellow "ethicist" as myself. That might tell you something.

Just to make you feel a bit more frustrated, though I think you all are frustrated enough, I can state that in all my 20 plus years of watching and participating in medical ethics, I have never seen the issue of patient modesty generally or related to healthcare provider genders vigerously discussed or debated. I have tried to bring up these topics on the bioethics listserv to which I subscribe. The misbehavior within the operating rooms was felt to be rare but when present represented something that needed attention by Administration on the one who misbehaved and perhaps looking at these behaviors as a patient safety issue that needs fixing. Looking back at the listserv responses since 2006, I can't find discussion of gender selections and modesty and yet discussions extending from the ethics of using the sperm of the deceased to maintenance of a pregnancy to delivery in a deceased mother have been discussed! Frankly, I do believe that patient modesty is not high on the ethical agenda. ..Maurice.

 
At Saturday, June 13, 2009 10:48:00 PM, Blogger Hexanchus said...

Alan,

You said:

"The other thing that comes into play here...its still my choice, providers do not have the right to determine what risk I am willing to bear for my modesty. They are not my God, I should have the right to make that determination. The other side is I should not hold them liable for my choice. This doesn't in most cases have to be either or..."

I agree, and this is the bottom line from a legal, and in my opinion a moral and ethical standpoint: Ultimately it is the patient and only the patient who has the right to decide. Providers have no rights, but only those specific permissions that we, as patients, choose to grant them.

As MER and others have pointed out, power is an important element in this issue. Traditionally, health care institutions and providers have been perceived as having the power and being control - an illusion they'd like to perpetuate. In reality, the real power is actually in the hands of the patient, but only if they stand up and assert it instead of ceding it to the providers.

Yes there obviously needs to be an effort to "enlighten" the system, but nothing will change until the patients revolt and refuse to accept the status quo. Patients concerned with this issue ned to assert their rights of privacy and self determination. If you ask for accommodation and they say they can't, ask "why", and make them back up their answers with documented facts, statistics and evidence based study results.

 
At Sunday, June 14, 2009 9:13:00 AM, Anonymous Tim said...

Usually when money is involved - things change...
An all female ob-gyn clinic....and the place is packed...
My wife went to this clinic and was assured of all female care for her pregnancy and the delivery. My wife was relieved and impressed with the sensitive care.
All female surgical teams are now available in some hospitals...but it seems to be kept fairly quiet.
I think it's because male gyn's are really feeling the heat these days and don't want patient preference to be easily accommodated or they may find themselves out of a job or struggling...a male gyn. (friend of the family) refuses to believe it's an issue for women BUT is very sensitive and defensive about the topic which suggests he's WELL AWARE of the issue and patient preference.
It's like - stick your head in the sand - if you can't see it, it's not happening....
I suppose they feel...if you don't make it easy for women (don't cater to them or acknowledge it's even an issue) a percentage of women will "put up" with a male, feel unable to make a fuss etc...
It amazes me...that it took two months for my wife to get into the Clinic - we needed to be on their books BEFORE she got pregnant to be assured she'd be accepted as a patient.
The doctors stop taking new patients from time to time when they get too busy.
What does that tell you?
Why haven't more all female ob-gyn clinics been opened to cover the demand?
The consumer has spoken...the waiting room is full to overflowing...
Reading through this blog - why not open an all male urological clinic?
Again, you'd make a fortune.(not to mention make many men feel more comfortable)
When money seems a HUGE motivator in the medical world - pushing every dodgy test on us - how could they have missed the obvious cash cow?

 
At Sunday, June 14, 2009 11:27:00 AM, Blogger MER said...

First, you all need to read an article by Atul Gawande called "The Cost Conundrum: What a Texas town can teach us about health care" in the June 1st New Yorker. Dr. Bernstein has established a thread about this. I'm the only one whose responded there. The article can be found at
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

The thread is at: http://bioethicsdiscussion.blogspot.com/2009/05/soured-on-cost-service-and-value-of.html#comments

We've got to understand how much money is a factor here. Just recently I read an article that pointed out specifically how much member of Congress and their families have personally invested in health care businesses. I have little confidence that the Congress of the U.S. will tackle this problem. They have too much at stake personally. The only way we'll get Congress to deal with this is first, to strip them of their business investments in health care; second, the take away their health care and don't give it back to them until they solve this problem.

Second, if any one still doesn't think that power and money are not essental factors in this modesthy issue, then consider this:

What if the President of the U.S. or any member of Congress needed an intimate procedure and wanted same gender care? Do you think that would be a problem? Most definately, no. They would most likely send ahead a front man to negotiate the terms of care demanded, and they would be immediately accommodated. Is there anyone out there who doubts this? The same goes for any wealthy or powerful individual. Modesty accommodations are a fact of life for the wealth, rich and famous if they desire it. It's only the poor, average, powerless, or in many cases, middle class males who are confronted with this double standard. So -- the double standard isn't just about males and famales; it's also about the rich, the powerful, and the middle class and poor. Make no mistake about that.

As Dr. Bernstein has pointed out, this issue isn't discussed with the ethics community. It isn't an ethics issue to them. It's a question of who has the power and/or money to demand and get the kind of modesty accommodations they want.

 
At Sunday, June 14, 2009 12:04:00 PM, Anonymous Anonymous said...

Tim asks:
"When money seems a HUGE motivator in the medical world - pushing every dodgy test on us - how could they have missed the obvious cash cow?"

Probably because an all-male ANYTHING (clinic, gym, club, etc.) would result in a discrimination suit by feminist groups, regardless of similar availability to women, few will take the gamble.

--rsl

 
At Sunday, June 14, 2009 1:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Since MER didn't insert the HTML tags, I will do so and then the URL addresses will become clickable links.

The New Yorker article: link

My thread on the article: link

MER, did you read anything in the New Yorker article about gender inequality? There is certainly one gender inequality that is discussed in medical circles and that is the inadequate attention to symptoms and diagnosis and thus treatment of coronary artery disease in women. ..Maurice.

 
At Sunday, June 14, 2009 2:36:00 PM, Blogger MER said...

Part 1 of 2

There are several gender inequities. Generally, though, "men's health" is not a focus. Check out all the ads for clinics. Notice how many list "Children's Health," "Women's Health," "Family Health." Its rare to find any ad from any clinic that refers to "Men's Health." That doesn't mean they don't serve those needs. They don't market to men because they don't perceive men as caring about their health. Their perception is that women care about men's health and women decide for the men.
Also, there's a new book out called "The Secret Lives of Boys: Inside the Raw Emotional World of Male Teens" by Malina Sava in June 7 the New York Times Book Review. The reviewer (Lori Gottlier) writes: "If Google could be trusted, boys were different from girls in all sorts of troubling ways: they were uncommunicative, emotionally stunted, unaffectionate, illiterate, hyperactive, and prone to violence and drug abuse."

These are the stereotypes out there. As I've said before, we can't really address this male modesty issue and the double standard without understanding perceptions of masculinity in our culture. This book is a case study of 10 varied teenage boys. The review continues: "But as different as these boys seem, what unites them...is the very quality boys reputedly lack -- a desire for connection. 'The boys told me straight out that they were not just looking for someone to talk to, but someone to talk with.'"

 
At Sunday, June 14, 2009 2:37:00 PM, Blogger MER said...

Part 2 of 2

This nonsense about all boys and men wanting sex all the time, eating, drinking, sleeping sex, sex, sex. These newer studies are showing that boys and men want more than just sex. They want emotional connection, too. But read how this review ends: "Still, in a voyeuristic way, parents, teachers and especially teenage girls will be fascinated to know that boys care about fashion, cry about girlfriends and have deep feelings. More important, they might see aspects of themselves reflected in these stories and realize, as I did, that boys aren't so mystifying after all."

How incredible! Boys actually have deep feelings. Wow. Perhaps men do, too. See how this fits into the attitude we get about modesty? Males don't have deep feelings. Men don't really care about modesty? Men are just after sex; they don't want meaningful connections. These are the stereotypes that men face when they enter the medical culture. These attitudes, assumptions are embedded in our culture. It becomes clear when a book like this finds it "fascinating" that boys have deep feelings and that, wow, girls need to realize that. Let's be blunt. Men and boys are no more a mystery than are girls and women.
And, do note, that the perspective we're getting of all this is from the female author who wrote the book, and the female reviewer who wrote the review. It's interesting, but not surprising, that the NYT would select a women to review this book. How often do you see male reviewers reviewing feminist books or books about the female psyche? Rarely, because it's not politically correct. I'm not suggesting that we can't get interesting perspectives from both genders. We can. But masculinity has been absorbed into the feminist agenda and defined in terms of feminist frames. Men need to reclaim the concept of masculinity and not let it be defined as an aspect of the feminist agenda.
All this is connected to the culture men face in our current health care system.

 
At Sunday, June 14, 2009 6:33:00 PM, Anonymous Patrick said...

I don't think anyone would have a problem setting up an all male urology clinic.
The law makes an exception when personal comfort (as well as safety) is concerned...
In fact, the cases regarding all female care were NOT so much influenced by the threat of assault or acknowledging the fact many women have been sexually assaulted BUT rather simply because it was understandable that women would prefer intimate care from another woman.
I see no problem at all...carrying that argument across to male patients. It would be discrimination if it didn't apply to male patients.

Personally, I think this is all about power and money. I don't like waiting to check-in at the airport and have reached a point in my life, when I can now afford business class. I'm certainly treated better than an economy passenger - what I want matters, I'm treated as an individual.
I see the same thing in the medical system.
I told my Dr what I wanted for a recent day procedure and said if I couldn't be accommodated, I'd find a place that could meet my needs.
They found a way...it was carried out in a private hospital.
I suspect in a public hospital...it would be a LOT harder. Some of my friends have had the same procedure in the public system and had very different experiences...the few that made special requests were dismissed or it was just too difficult. At the end of the day, they know you have few choices and will accept whatever IF you want the treatment.
It seems to be the same in lots of areas - hotels, restaurants...
Money gives you power, influence and choices - a voice.

 
At Sunday, June 14, 2009 8:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Patrick, it's too bad when it takes money to give a patient's voice some clout.

If it is one thing that the medical system has to learn (obviously as yet fully unlearned in some situations) is that each patient is an individual who deserves equal attention and an equal conscientious attempt arrive at a beneficial conclusion to the patient's symptoms and disease as any other patient.

By the way and just out of curiosity, in view of the current governmental and healthcare industry debate and planning to upgrade the current medical system has anyone on these threads written to their congressman, senator or even our president regarding your desires. If so, can you tell us what you have written?

By the way folks, it looks like it's getting time to move on to Volume 19. I'll be putting it up shortly. ..Maurice.

 
At Sunday, June 14, 2009 9:34:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY JUNE 14, 2009 "PATIENT MODESTY: VOLUME 18" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 19. ..Maurice.

 

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