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Patient Modesty: Volume 20
Continuing on with the general discussion of patient bodily modesty in all of patient concerns including the disregard or inability for physicians, clinics and hospitals to accommodate gender selection by patients (often male patients) of their nurse or technician attendants. ..Maurice.
Graphic: Photograph Russian Nurses at Work (early 20th Century)
From
Beinecke Library via
Wikipedia.
NOTICE: AS OF TODAY AUGUST 4, 2009 "PATIENT MODESTY: VOLUME 20" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON
VOLUME 21.
145 Comments:
The photo introducing this volume poses several interesting questions.
1. Are these really religious nuns, or are they just wearing the uniform of a nun? There is a tradition of nursing among female religious orders. It hasn't been that long ago that British nurses were called "sister." Are some still called that today?
2. Much within the modern history of nursing relates to this modesty issue, especially for males. Modern nursing as we know it doesn't begin until the 1850's, and not until the 1870's in this country were there true nursing schools. By that time all nurses were female.
3. During the wars of the mid-19th century, some early nurses were officers wives. Often they were required to be married, the implication being they had experience with sex and the naked male body. In some cases, the leaders of the nursing movement required that nursing candidates not be pretty or good looking. They needed to be plain looking or even considered ugly. Apparently, they didn't want the men excited.
4. Why did the term "sister" last so long for British nurses, even though they were not religious nuns? Was there something about the symbolic purity of nuns that made that title more fit for the kind of intimate work they did, especially with men?
5. What are those nurses in the photo actually doing and to what gender patient? Is it possible to tell?
In earlier posts, I've written about the history of early nursing and given some good sources -- that is, what I've called the feminization of nursing which began in the mid-19th century. Women have always been nurses and midwives. But so have men, especially in wars. There were male religious orders to dealt with the war wounded in earlier times. Once women got in control of the nursing profession, it became impossible for men to break in. Of course, at that time men most men were not particularly interested. But my understanding is that from about 1917 until the Korean War, men were not allowed to be nurses in the military or join the nursing unions.
It's an intersting photo, and to me raises all kinds of historical and sociological questions that are connected to this topic.
Thanks MER for such an interesting commentary on my graphic. You know, I was struck with with the impressions and questions you expressed (obviously, that's why I put it up) but surely I couldn't express it all as well as you. Again, thanks. ..Maurice.
I think it would be great to see more male nurses as long as they're not forced on female patients.
I personally feel uncomfortable with male anything when I'm feeling exposed...I wouldn't use a mixed changing room at the pool or gym and I don't want male nurses or doctors.
I've always had the option of a female doctor (thank goodness) but know it's more difficult in a hospital setting - even a private hospital.
A female Dr should understand there is a reason you waited many weeks or months to see her....when you could see a male doctor in a few days.
A friend needed a gyn procedure and waited to see a prominent female gyn.
She was upset to find men waiting for her in the ante-room to the procedure room - a male anaesthetist and male nurse.
She asked to speak to her Dr who assured her she would be present the whole time.
My friend was terribly disappointed with this answer.
Sure an attack would not occur...but the primary reason she chose a female specialist was personal comfort and feeling very uncomfortable with men involved in her intimate care.
Her female Dr missed the point completely.
Some women simply don't want men involved in this sort of procedure. Is that so hard to comprehend....even for female doctors?
I see from this discussion...that some men don't want women involved in their intimate care.
My friend did the unthinkable and decided not to have the procedure. A very brave thing to do...most women would have gone ahead albeit anxious, upset and uncomfortable.
Her female doctor offered a few compromises but my friend has lost faith...she doesn't trust the doctor's word once she's unconscious.
She wonders whether in future they'll keep the men hidden until the woman is out...
She has decided not to have the procedure at all.
I can't understand why these terribly intimate procedures for men and women can't be carried out by all female or all male teams.
My friend was very concerned about male nurses present in a gyn ward...she thought that showed enormous insensitivity to the patients.
I totally agree...
Likewise, I agree...having female nurses in urology procedures is equally insensitive.
If I ever need surgery, I can assure you I'll be asking lots of questions ahead of time...
I wonder though...how we enver ensure our privacy is protected when we're unconscious....do we need to go as far as having a personal representative in the procedure room with us?
My Aunt had a caesarean section a few years back and said a male orderly was present while she was very exposed and being prepared...he was permitted to just stand and stare at her.
She closed her eyes consumed with embarrassment and humiliation.
It wouldn't have taken much care to change a scarring experience into a happy event...instead of remembering her son's birth...she remembers the dirty creep staring at her.
She complained to her doctor who said she should have said something and they would have asked him to leave.
Is it really the patient's responsibility to remind the Dr and nurses to ask an orderly to leave?
Surely if orderlies are permitted to stand and stare, this position will become attractive to some very suss men.
This open door policy/no responsibility for those present attitude in operating suites and procedure rooms where patients are exposed and powerless is totally unacceptable and leaves patients very vulnerable.
It seems in these cases we ARE objects or bodies. It must make it easier to knock us out before we get in there...a talking body seems an huge inconvenience!
Stacey
There is a thread on allnurses.com
under general discussion called
male nurse sexism. It involvess a
female patient who is pregnant in
the icu. The patient is assigned a
male nurse who has his assignment
changed because the charge nurse
feels that he should not be involved in her care.
What we don't know is wether or
not the patient requested a female
nurse, or this was simply the opinion of the charge nurse. Would
she advocate in this manner for a male patient? Most likely not as
this type of behavior only sharply
defines the level of ignorance and
discrimination that exists.
PT
The medical work arena is like no other working arena in society. No other business assumes liberties with your body just by walking in the door. (Except for a few brothel counties here in Nevada.
And even there, you choose who does what to your body.)
The biggest fraud perpetrated on society is the "pretend" attitude. Pretend it doesn't matter. Pretend it's not happening. Pretend that we are not just women/men groping the bodies of the opposite sex.
I've still really seen no written legal justification that hospitals and facilities seem to claim that they have. They really only have the theory of compliance, and the hope that no one is going to notice or catch on.
And the new tactic really makes me tired of even thinking of all of this rhetoric anymore. Because no matter what you say, they have a new excuse.
New Tactic: A group of comments I've read lately pulls the old mars/venus card. "Women are not sexually stimulated visually like men are". Therefore a women doing a male F/C is not the same as a male helping with chidbirth.
I'd like to point out here that I'm a woman. A "sexually stimulated visually" woman. My female friends are visually stimulated too.
Who are these non visually sexually stimulated women?
Don't think they exist in this era, or ever really did.
Lies, fraud, entitlement, excuses.
And after all, if it isn't wrong, why so many excuses?
Are we ready yet as a society to say enough?
And the fallout continues,the body
count is rising. Over 25 employees
at a major neurological hospital in Phoenix Arizona have been terminated for snooping into the
medical records of a famous boxer
whose daughter died there. Others
were terminated for taking cell-phone pics of his daughter in the
icu.
Most were nurses and one with over 20 years employment at that facility and among those terminated all were female with the exception of one male.
This is just all too commonplace
in healthcare as no ones privacy
can be assured. Many people who
after working at a hospital all
day will retire to the front of
their t.v. sets only to watch
more healthcare like the show er
or scrubs. It's as if they didn't
get enough of it crammed down their
throats
Now suppose If I worked at a target store for 10 to 12 hours days. Do you think I'd have the strength to watch movies of customers walking around in target. Why? Seems to be some
kind of an illness dosen't it.
PT
Hexanchus said "Is it easy to identify the body language of the patient when they are reluctant to expose themselves to opposite gender caregivers? - usually it is now, but wasn't always early on. It truly only comes with experience."
From what I've seen and heard it's the opposite. It seems to me that when a nurse begins her career she notices a patient's body language more because she was likely like that herself or knew others that were. It seems that early on in her career she cares more about pleasing the patient and doesn't want to cross many modesty boundaries.
As she gains more experience she begins to "assume" more and more often and soon becomes blind to modesty issues. Either that or she just stops caring and just wants to get her job done more easily and efficiantly.
Stacey,
VERY well said. I as a guy feel exactly the same about every comment you made, especially with female nurses at Urology clinics and male nurses at gyne clinics or delivering babies. I always wonder the same thing, if men or women intentionally make an appointment to see a doctor of a specific gender why do they think it's OK to have a nurse or tech of the opposite gender? It just doesn't make any sense.
If it were up to me, every kind of intimate exam or procedure would be completely gender segregated. Of course, I think if a patient requests someone of the opposite gender they should also be accomodated whenever possible. But in the majority of cases I've heard the patient either wants same-gender caregivers for intimate procedures or doesn't care. Very few I've heard of request opposite-gender.
Also, what's wrong with assigning male nurses to male patients and visa versa automatically whenever possible? Why make two patients (one of each gender) very uncomfortable at the same time when all they had to do is switch nurses? You make many very good points.
DG
Stacy, you have hit it right on the head. They do just that -- knock a patient out before beginning. And for all the reasons discussed on this site. When a patient moves onto the OR table, they are not exposed or handled prior to the anesthesiologist giving the OKAY to the circulating nurse. At that juncture the patient is OUT and they then disrobe the patient and start the necessary care/prep for the procedure. This way the patient is clueless as to how they are exposed, what all is done, and WHOM is doing it all.
Even in cases where the patient is not given general anesthesia but a regional or local and exposure of the genitals is necessary they manage to give the patient something to sedate them or put them to sleep for a short time so this can be done without their knowledge. A drug such as propofol (Diprivan - Michael Jackson's stuff) or Versed. Both make you sleepy to where you don't know what is happening.
A patient advocate to stand in is the only way to have protection against what you DON"T want to happen. Otherwise, you can be lied to and you never know. Shameful..but they do it.
JW
I believe the "patient modesty" site was originated by a member of the "how husbands feel" site.
JW,
If you are having regional or local anesthesia you can explicitly refuse any form of sedation - been there, done that (twice for a local and once for a regional). I also refused secondary IV access for 2 of the 3. It's actually quite handy - none of that "NPO after midnight" nonsense, since my airway was never compromised, and I was also able to drive myself to and from for two of the three (swelling from rhinoplasty can make it a little tough to see).
Main thing is you need to put it in writing. Keep it short and simple & write it right on the surgery/anesthesia consent form before you sign. What I wrote was:
No medications of any kind, including general anesthesia or sedation, without my specific written authorization. No intubation under any circumstances.
In my experience, if you talk with the surgeon about it ahead of time, most won't have a problem with it. It was the anesthesiologist for the regional that pitched a fit. To her "What if something goes wrong?" my reply was no problem, I'll sign a DNR - it hung her up (love that phrase - Thank You Jimmy Buffet). I then told her I'd already discussed it with the surgeon, who had no problem with it, and if she couldn't deal with it, the surgery was off and she could explain to the surgeon why. I got my way - I think the key is being calm and polite, but firm in not backing down. Being confrontational and raising your voice won't get you anywhere.....
Anonymous July 10 @5:43am, you posted :"From what I've seen and heard it's the opposite. It seems to me that when a nurse begins her career she notices a patient's body language more because she was likely like that herself or knew others that were. It seems that early on in her career she cares more about pleasing the patient and doesn't want to cross many modesty boundaries."
Two comments:
1. Task loading - a new nurse is usually up to their eyeballs learning how to apply their newly learned skills, unit procedures, etc. It can get very harried until they get it all down, and sometimes they lose sight of things like the patient as person. My wife and sister have precepted both students and GN's, and often enough have had to remind them there's a person in that bed, not just a medical condition.
2. Experience - New nurses don't have a lot of patient care experience. While the empathy may be there, they usually don't have the practical experience to recognize the subtle non verbal nuances in body language - especially when they're overloaded due to number 1 above.....
JW or anyone... I wonder if it is possible to limit what kind and how much sedation you are given? or does an anesthesiologist have carte blanche??
I still do not understand why exposure of genitals would be needed unless the surgery/procedure was right there. Can you stipulate no propofal or versed or like drugs?
leemac
Hexanchus, most surgeons and anesthiologists will not accept to perform surgery if a DNR order is in effect during the surgery. If you should die because resusitation was not permitted, as an example, your death, an unnecessary death, would be marked on their surgical record as an operative death. Besides it could be an unnecessary death, there are also humanistic reasons beyond their own record to refuse.
I can tell you that even patients where the surgery is simply for palliative reasons, the DNR order in effect before surgery is deleted during surgery and in the immediate few post-op hours. ..Maurice.
My male Dr (GP) who assists in gyn surgeries complained to me how the female nurses leave the unconscious female patients exposed before the doctors are ready for surgery. He says he is the one telling them to cover up the patients. To me it seems to boil down to respect. And obviously many people in the medical profession don't have any. As a woman I could not feel comfortable allowing another woman to be exposed like that. I suppose I have natural empathy, something that some need to be taught and something that some cannot be taught.
NP
Dr. Bernstein, with reference to DNR/DNI, is it possible to only want and get a DNI? This would allow CPR to assuage the feelings of the surgeon... it is the respirator I have a problem with... it is a machine I do not want hooked up to... I don't know if general anesthesia without paralytics administered still mandates the use of one..I know the use of paralytics such as pancuronium bromide (sp?) is pretty common... is it something a patient can refuse? Or would they have to reject the entire surgery?
The only surgeries I have had were long ago and although ether was the general anesthesia used..I don't think they could have used a respirator and extract tonsils.. not even sure they had them.
leemac
Leemac, I am not a surgeon nor anethesiologist so I don't know all the nuances of intubation and mechanical ventilation during surgery. However, I am aware that such ventilation is necessary obviously if the chest is opened but also it is necessary based on the depth and duration of the general anesthesia. If the anesthesia substantially deminishes the spontaneous ventilation so that there is inadequate oxygenation of the blood or removal of carbon dioxide from the body, intubation and mechanical ventilation is necessary. As an example where it is not needed is in tranient procedures where the patient is lightly obtunded such as in colonoscopy. However, in these patients, their blood oxygen level still must be monitored.
I am not sure that any anesthiologist would accept a patient's request which would violate any accepted anesthesia standard of practice. No anesthesiologist would accept the possiblility of a catastrophe through not following the standard and which would demand an emergency intubation and resusitation by not having control of respiration and blood pressure at the outset of the operation. ..Maurice.
Thank you for your response, Dr.Bernstein.
I know that in an emergency situation where it is felt that the patient does not have presence of mind a patient will have to accept whatever they do, but in non-emergency situations it appears that the choice is limited to having a procedure or not... My living will stipulates that for no reason whatesoever not at any time am I to ever be placed on a respirator.. I understand this would preclude even paliative procedures in that event.. if placed on one because of EMS or hospital being unaware they must remove me immediately (although I am told that a hospital may require tht a court order be procured to enforce the living will as an extra covering for their behinds).. the only thing my pcp said would be entirely unenforceable if I were in an institution, and developed respiratory distress, I would be sedated ( I didn't want to be) as a matter of course.
I can understand the doctors positions, but those postions are only a further consideration for me to determine if I will or will not have a procedure... The less control I have over what happens.. reduces the attractiveness of any procedure... and yes, I know..there are considerations that only the surgeon should be able to make when it comes to the mechanics of surgery.. I say this in order to not even appear to be the surgeon/anesthesiest.. cause I am not... I am just not so trusting and am not anxious to place myself where I have to just grit my teeth and suffer embarrassment if I can eliminate or mitigate the circumstance.
leemac
I had my impacted wisdom teeth removed under a general.
I was told to remove all my underwear and put on the gown.
Just before the surgery the nurse asked me to sit up and undid the ties on the back of my gown.
I was curious about this at the time.
If I had known exposure was about to happen, I would have been more selective with my choice of surgeon.
If I was fully exposed when I was just having some teeth out, that shows a total disregard for my privacy and makes me very angry.
I have no idea whether I was exposed or not, but I did wonder when my ties were undone.
I really think most of this exposure is totally unnecessary...it would only take a bit of care.
I'll be more aware next time. (hope there isn't a next time!)
India
swf, you are the bomb. Nice to have you on our team.
India,
Your gown was undone so that they could place leads and monitor your heart while under general. That's standard and nothing to be alarmed about in this matter. They would attach them and then pull the gown up again.
Often wisdom teeth removal is done under local. If the surgery was in a hospital it is often under general.
India...I had my wisdom teeth removed under General in a hospital in Australia. Not only did I keep my underwear on, I kept all my clothing on. I expected to change into a gown or something but was pleasently surprised to enter and exit the OR dressed exactly as I left the house that morning. Lets face it if resucitation or something was required the OR is equiped with all the appropriate gear and equipment to get your clothing off in record time and for the 1 in 1000000 chance give the patient some dignity!!
Leemac, the standard for the operating room is to give sedation prior to a general and/or anything where there is prepping on the genitals and they don't want a patient to be aware. I guess it is in the name of supposedly saving the patient from embarrassment. This way the patient never knows.
You ask why would a patient be exposed? Most preps are abdominal and prepping is done from the nipple line down to past the genitals. Even when a shoulder or knee surgery is done a patient is naked except for the flimsy gown. When a patient moves onto the surgery table there isn't much privacy and "things are visible". For a man the gown provides little to no covering. For a foot surgery the foot and up to the knee is scrubbed and prepped. The gown is always shifted and moved about and sometimes completely removed. For a hip replacement the gown is removed. Also, parts of the body are positioned/elevated etc. and genitals are exposed in the process.
I asked for a very light dose of propofol for a procedure and the damn anesthesiologist did as he saw fit. I was completely out for over 20 min. This isn't right but it goes on all the time.
Dr. Bernstein & leeemac,
Thoracic surgery without general anesthesia or intubation is possible & safe.
See the following url's for more info:
http://www.scahq.org/sca3/newsletters/2003dec/drug5.shtml
http://www.ctsnet.org/doc/9582
http://www.webmd.com/video/wide-awake-heart-surgery
http://www.youtube.com/watch?v=zPBdSNMnXSc
http://www.wockhardthospitals.net/general/mumbai_jumppg.asp
Lots more out there - do a search on "awake heart surgery".
Hexanchus, you can't generalize minimally invasive CABG in the awake patient to other forms of thoracic surgery. The reason this surgery can be performed on highly selected patients under specific conditions is simply an anatomic trick. If my human anatomy knowledge is still fresh after all these years, the heart is located in the mediastinum and to perform surgery solely on the coronary vessels of the heart does not require the pleural covering of each lung space to be opened.
Therefore the dynamics of spontaneous respiration is not affected if the spinal anesthesia is properly located. Once the pleural cavities are opened, an operative pneumothorax occurs with collapse of the lung and immediate impairment of pulmonary function.
Hopefully, if these heart surgery tricks are popular and safe, it will be for less chance for specific complications, quicker and better patient recovery and reducing the financial cost of CABG surgery and NOT particularly for reasons of patient modesty. If this is what patient modesty is all about, I would reject the idea, even though I find other attempts to mitigate modesty concerns appropriate. ..Maurice.
Dr. Bernstein,
I wasn't addressing it from a modesty standpoint and agree that shouldn't be a primary focus in choosing this approach - it was developed for exactly the reasons you stated, reduced risk to the patient and faster recovery.
My post was in reference to leemac's question regarding intubation and your responses, and simply intended to provide the information that intubation/general anesthesia isn't always necessary anymore - there are viable alternatives, even for major heart surgery. And it's not just for CABG's - this technique was recently used successfully to perform awake bypass surgery with aortic valve replacement.
With respect to opening the pleural cavity and resulting pneumothorax, to quote one of the referenced articles:
"Occurrence of pneumothorax in a spontaneously breathing conscious patient with an open chest had been a major concern by some authors. However, with increased experience in performing CABG in the conscious patients without endotracheal general anesthesia, it had become apparent that, single lung diaphragmatic respiration is tolerated quite well by the majority of patients, given that the pleura is widely open. Air flow through a small opening in the pleura causes tension in the pleural cavity, which results in respiratory distress and mediastinal shift. However, when the pleura is widely opened, tension is relieved without any respiratory or hemodynamic consequence. Hence, the size of the opening in the pleura determines the consequences of pneumothorax, rather than occurrence of pneumothorax per se."
Anonymous of July 12 - 6:06pm,
You posted:
"Even when a shoulder or knee surgery is done a patient is naked except for the flimsy gown."
Not necessarily true. I had shoulder surgery that was done with local anesthesia only (no IV) at my insistence. I was awake and alert the entire time (45 min) and my underwear stayed on. The only people in the OR were the surgeon, scrub tech, circulating RN and me. The gown stayed on as well - the only exposure was to unsnap it at the shoulder & fold it back enough to expose the shoulder being worked on, and very briefly uncover the lower part of one thigh to affix the bovie pad.
Dr. Bernstein,the link I am sending is a male nurse asking on allnurses about becoming a surgical nurse. I thought some of us might offer him encouragement.. and strategies to negotiate a good pay by showing that there are potential patients who want support a male surgical nurse.
http://allnurses.com/men-nursing-forum/male-surgical-nurses-407310.html
leemac
Thanx Hexanchus for all of your posts!
I was told that I definately could NOT have shoulder surg. under a local so I declined the proceedure.
swf,
There are no absolutes - it depends on the surgeon and the type of shoulder surgery. A local can be used for some procedures, but if not, an interscalene regional block can provide effective anesthesia for most types of shoulder surgery, and in some circumstances, general anesthesia is the best option. You might want to consult a different surgeon....
Just because you walk into a hospital, clinic or doctors office doesn't mean you automatically sign over your body's power of attorney to anyone wearing scrubs. You ALWAYS have complete control over your body no matter what the medical staff tries to make you believe.
Only YOU decide what happens to it and who sees and touches it. Don't ever let them bully you into doing something you don't believe is right. If the nurses try to force you into anything tell them to back off, they have no right to see or touch you unless you decide to give them that right.
I personally take what the doctor tells me very seriously but I don't have much respect for nurses and certainly don't follow their orders if I'm not comfortable doing so. Also, I have a strict rule that no female nurses are allowed in the room during an intimate procedure or examination.
Over the years I've had to listen to the nurses whining and their attempts to belittle me but so far no doctor has ever refused to treat me without his nurse and none have ever had any problems doing it alone.
Hexanchus, MOST times for any surgery an IV is started and a patient is asked to put their clothes in a bag, place the bag under the guerney and don a gown. What you insisted on is perhaps unique at best. Most times they don't ask a patient what they want to do or not do and what they want to refuse. It is SOP (standard operating procedures) in place. MOST patients don't know they can opt out or request this or that from the surgical team because it is a new or fairly new experience for most people. And depending on where you go depends on their response to these things you did.
Here is a link to a recent new blog that started in June on the issue of Male Nurses working in labor and delivery, which some of the comments are very interesting:
http://www.boston.com/community/moms/blogs/moms_are_talking_about/2009/06/very_intersting_conversation_g.html
Many ceo's treat your complaint letter like a football. Punted
means it ends up in file 13 or
it might be a lateral to the cno
as most complaints involve nursing.
Rarely,he might just pass it back to you and say "get over it",
in which case your complaint needs
to be presented elsewhere.
Heads of these institutions ought
to be acutely aware of issues
regarding quality but sadly are disregarded. Complaints are often
passed on the the various directors
and assumed resolved.
PT
I am in the process of trying to start a non-profit organization, Medical Patietn Modesty that would promote stronger patient modesty in medical settings. Please look at http://www.patientmodesty.org. Please especially check out the About Us page to see what the goals are. I would need to find a group of individuals and busineses that are willing to donate money for this non-profit organization. Please contact me by clicking on the email address that is on the Contact form. I address both female and male patient modesty. This non-profit organization will target patients who value their modesty and don't want the opposite sex to participate in intimate procedures.
While I am in favor of websites promoting patient modesty and with that intent allowed the posting from Anonymous from today describing and providing a URL to the website, nevertheless, particularly in view of solicitation for financial support, I would strongly advise that Anonymous fully identify him/herself by name and some postal address and other information for identifying and certifying this "non-profit organization". In any event, I would urge my visitors to be cautious. ..Maurice.
The Old Guy-77 submitted the following comment but on inactive "Patient Modesty: Volume 14". As it is pertinent to current discussion, I am publishing it here. ..Maurice.
Some time back while I was picking up medical reports of a couple procedures I had done at the hospital ~ I asked for a blank "Informed Consent Form" ~ I was told, 'they are the personal property of the hospital and she was not allowed to give them out." So much for that ~ ~
To Kevin ~ if observers, tech's, MA's or nurses want to know about 'how procedures are done' and want to see for themselves during a surgery and clogging up a small operating room ~ why don't they go to "YOUTUBE.COM" as I have. There are many 'learning' videos of all kinds there. They can repeatedly 'observe' them for as long as they want without violating a patients privacy ~ ESPECIALLY, how to insert 'various' catheters, cysto's, pelvic exams ~ and the 'ultrasound' of the bladder without infringing on a "patients privacy".
The OR would be far more sanitary and prevent infections without the above crew gaulking at the patient.
As for myself ~ I have already told my ortho & urologist that I would never permit any 'observers' at all at any time.
They didn't seem to mind ~ especially my urologist (since that cysto incident).
Maurice,
I forgot to include my name. My name is Misty. My mailing address is in NC. The reason I've chosen to not include my mailing address on web site is because I am concerned that I might get some hate mail. But I am willing to send people who request the mailing address via email. Just go to Contact Us and click on the email address. I am willing to provide people with phone number & address. I will just need to receive emails from people and determine if they are reliable.
Misty
I looked on utube and typed in male foley catheter and an entire video showing such was displayed. No wonder people don't feel accepting of cross gender care, whether it be male nurse/female patient or female nurse/male patient. Either way NO WAY.
Have a little respect for people. It doesn't matter if a tech/nurse is trained to do something. Dignity and respect and a patients' preference SHOULD always trump any other excuse.
Although this is only tangentially related to modesty, it does have some bearing.
I was just watching a show on PBS.. in it it was shown that tests showed that patients who trusted their doctor could recieve pain relief from a placebo .. the brain released endorphins even though it had no pain medicine in it... It only worked when the patient had a trusting relationship though.. It came down to the doctor taking time with a patient .. enough time that teh patient believed he/she was genuinely interested in the patient. Perhaps the insurance companies might find that running tooo many patients through in a day is counterproductive... in so many ways their bean counters have caused a great deal of the higher health costs because their efficiency really hasn't been efficient at all..
This taking time would be the time when a provider would be able to learn of modesty and any other issues teh patient has. It might also be a time..that should it be impossible to accomodate in all ways at all times those issues, the patient will be more likely to accept things tht they otherwise would not... and not be as stressed out over having to.
I posted this because I do not think that the answer we seek is going to happen from only one thing or another, but a combination of items and changes.
leemac
Please look at http://www.evanhospital.com/services/medical/one-day/default.aspx#day. Look at how you must remove your underwear for any surgery at this particular hospital. That really bothers me. There are so many surgeries such as knee, arm, etc. where you don’t need to remove your underwear at all. Some people say that you must remove your underwear because of germs. You could always put on a sterile underwear.
Misty, that hospital makes no bones that all surgery patients are going to take off their underwear...and the bold type they use for the word underwear gives rise to the fact that is must be a problem with a lot of patients...
I wonder if one of those adult depends plastic pants type underwear would qualify as sterile?
leemac
leemac
"I do not think that the answer we seek is going to happen from only one thing or another, but a combination of items and changes."
Very very well said. Also...your take on the program with the modesty spin is something I would never have seen. You certainly have a knack for seeing opportunities in places that others wouldn't.
My visitor Mattie who writes comments to the abuse of hysterectomy thread today wrote the following but to the current new thread on watchful waiting. However, as a moderator it was my opinion that the context of the comment fit better here under patient modesty. So here it is.. ..Maurice.
For over fifty years the medical industry and gynecologists have relied on a relatively inaccurate tissue test the "Pap Smear" to diagnose cervical cancer and HPV. American women have been subjected to bear their naked bodies to gynecologists and medical doctors to be tested for over a half century. Most women in the "United States Of America" will agree, they have been taught since menstruation they were ticking time bombs vaginally and "must" disrobe to avoid becoming a female organ cancer statistic. Every year women and young girls after menstruation would be subjected to this humiliating ritual awaiting the results of their future fate. Take all of your clothes off and be vaginally invaded with gloved hands and cold medical instruments or die, basically.
There is no medical reason to get naked to be tested for possible female organ cancer anymore. An accurate blood test for the detection of cervical cancer is approved in the "United States Of America". It is called the, "CSA Blood Test".
The simple blood test called the "Cervical Specific Antigen" is almost 100% reliable. The test was patented in the "United States of America" a few years ago, although the accuracy and availability of the blood test has been kept very quiet. Many believe medical doctors, gynecologists and pathologists will be reluctant to "give up" the unreliable "pap smear" test with it's lucrative follow-up industry.
The "CSA" test will end the humiliating and degrading naked tests we women have all endured through OB/Gyn's, Gynecologists, medical doctors and assistants.
Ask your primary health "care" provider for the "CSA" test. Don't disrobe in front of a gynecologist or medical doctor anymore for a cancer screening, it is medically archaic and not medically necessary.
SWF, Thankyou for your kind words, however I can not take credit for my statement. Dr. Bernstein, Dr. Sherman, Yourself and each of the other posters to this blog have, in one form or another, commented on the need for a patient to be able to spend enough time with a doctor for the patient to be able to feel freer about talking to him/her and for the doctor to be able to understand the needs and quirks of the patient. I merely was able to use these statements along with the findings about pain treatment to be able to use the pain show findings to Further substantiate the beliefs expressed by so many others. The findings about the use of placebos in patients who had a trusting relationship carries over into nearly all other ailments ( I think...) from everything I have seen in my life and from everything I have read... It is the human aspect which delivers as much success as it is the science aspect.. maybe in the end they are one and the same.. There was a study in orphans in Central America (if I remeber the place right) where the ones who were held for a few minutes several times a day lived and ones who were just fed and changed died in a very large number.. I think this came out when a study was done as to why some orphanages had higher death rates. Not that I am in any way saying a doctor needs to hold us... but somehow I think the two are related.
I do feel that if you do not trust the doctor and all providers in any treatment.. that no matter how good or appropriate a treatment may be.. its chances of being successful are reduced. The mind and a persons will and beliefs can make the outcome different than it might othewise be.. to the good or to the bad.
I am slow to warm or talk to a person in person.. and real slow to talk about anything personal.. If I do not have a real big dose of trust...what I think will not come out in words.
leemac
Dr Bernstein,
Do you agree with Mattie's comments?
NP
Evan hospital sounds like a pretty bad place, but at least they tell you ahead of time instead of making it a surprise. I wonder if that includes upper endoscopies.
I think I'll put it near the top of my blacklist.
Regarding the question to me by Anonymous 1:25am today, I spent 1/2 hour trying to verify the information Mattie presented and I can't find the statistical studies documenting CSA "almost 100% reliable". Whether the evidence will show that this test is of such sensitivity and specificity to do away with the ancient and admittedly diagnostically wanting pap smear may yet to be established. Appropriate (performed for a specific diagnostic goal)pelvic exams, however, may be still appropriate in the sense of providing potential benefit to the woman. Male genitals are exposed to the outside and can be self-examined, women's genitals being internal are more difficult or virtually impossible for self-examnation. ..Maurice.
Misty, there is on the Evan Hospital site -- under "grievance" an email address and phone number for THE "continuance quality grievance manager." Wonder if she would address the "NO UNDERWEAR" policy.
I attempted to locate info on the Evan Hospital site to see what the core values and patients rights were. All I could find is that a pamphlet was available. Would be interesting to see what they include and if their is reference to "respect, dignity, values".
There are instances when its irrevelant wether your underwear
are removed or not in many surgeries. I know of facilities
where they couldn't care less
depending on the clientele.
Funny but my observations are
the lower down the economic ladder
the patient is,the less likeihood
that the underwear needs removal
and this I've seen.
I can only wonder at what the
core values of this facility might
be with those kinds of requirements. Its similiar to the
lack of common sense used at airport security. A 75 year old
grandmother gets searched by airport security while a young
middle eastern male walks by
unnoticed.
While I'm not suggesting that middle eastern men are all terrorists, I'm suggesting that
it all boils down to common sense.
PT
Dr Bernstein,
If you look around the world you'll see routine pelvic exams are NOT recommended for well women.
These exams can actually harm women...anxiety, pain/discomfort, psychological distress and further unnecessary intimate investigations. (that could also harm you)
Many US doctors are even questioning the need and value of this routine and terribly invasive exam.
My Australian Dr (very senior) said they are of LOW clinical value and unnecessary in a well woman. None of my Australian, Asian or European friends have this exam.
(I read somewhere that Germany is the only other country to push this exam....maybe on this forum)
I'm in my 40's and have never had a pelvic exam and never will (unless I develop symptoms) - if I were a US woman, I'd be up to say, 27 or so by now...
Someone used the expression, "Womanhood is not a disease"...couldn't agree more.
I find it puzzling that US doctors still push this exam as important when medical thinking elsewhere totally disagrees with them.
I think these sorts of VERY invasive exams should be reserved for women presenting with symptoms that require a pelvic exam.
Is the assumption our reproductive organs are diseased until the contrary is proved and every 12 months?
The importance placed on this exam in the States is a complete mystery to the rest of us.
I feel terribly sorry for US women who have been led to believe this exam is very important for their health and part of responsible healthcare.
What a horrible black cloud hanging over your life.
I'll bet those 12 months must flash by very quickly.
Not to mention the way it is carried out - stirrups, undressing before the Doctor arrives...I'll bet adding up to an ordeal for most women.
Love the States...but you can keep your routine annual nightmare reserved for women.
I hope more US women wise up and look at overseas practices and start to feel brave enough to refuse this very invasive exam.
Claire again...
I rang a scientist friend who told me the CSA blood test looks VERY promising.
He's also concerned that the huge sums made from screening and biopsies may delay the introduction of this Test.
He understands the Australian Government are reviewing women's health currently and it will probably be considered soon.
The Govt spends a small fortune on testing and its aftermath...so if a reliable and non-invasive test were available, they'd be keen.
Currently 60% of Australian women take part in the 2 yearly testing program.
If something reliable and non-invasive were available, almost complete coverage of the population would be possible.
As a very low risk woman, I declined to participate, as I have no wish to get caught up having procedures for false positives. The risks of the testing are just too high for most low risk women.
Even some high risk women have departed from the Australian program as two yearly testing does throw up lots of false positives....they have 3 or 5 yearly testing instead.
Of course, most women wouldn't be able to make that call...as very limited and biased information is given to us.
I was lucky to find myself researching screening a few years ago and got the information I needed to make a decision.
This test would be much more acceptable to women and would spare the harm to the huge number of women who face biopsies every year for false positives.
False negatives would also be reduced or gone, so women with an actual problem will receive prompt diagnosis and treatment.
I can't see the point of pushing an inaccurate test onto healthy people.
It has never made sense to me.
A visitor jgj attempted to write the following today erroneously on inactive Volume 3. ..Maurice
I understand that everyone is different, has distinct preferences and perspectives, comes from diverse backgrounds. I share the sentiment of several much earlier in this discussion who said they grew up completely trusting medical professionals and had no problem disrobing or being examined intimately with or without a chaperone. Some of that trust has eroded in recent years, but I still basically have confidence in medical personnel. I have no problem with being examined, and I have had both male and female PHPs. Personally, I don't see the sense in disrobing and then putting on a gown, which forces the doctor to move the gown in order to perform the examination. Again, I understand not everyone would feel this way, but I trust medical personnel and need their expertise in order to reach my goals of getting healthy and staying healthy. jgj
to me it isn't about trust, its about comfort, dignity, and my right to self determination. I could walk naked in front of a bus load of nuns and trust them...but i would still be uncomfortable...alan
Many people submit their complaints
to the ceo's of these hospitals. To
the uninitiated,ceo's are the bean counters supreme with advice from the cfo(chief financial officer).
The cno(chief nursing officer) walks in the shadow of the ceo with
no real direction as to what their duties really are. Nursing complaints should be directly forwarded to the cno and dealt with
appropriately. I'm not sure exactly
what that person does everyday but
I can assure you it has nothing to
do with the improvement of nursing.
PT
I agree with alan. I might trust them, but that does not mean that I would not be embarrassed beyond words... It was not in this vein that I spoke of trust ealier... Just trust alone does not mean I am in any way going to be comfortable in exposing the parts covered by underwear. I do think that developing trust between patients and providers might mean a great lessening of chances you are going to be embarrassed. Otherwise you are going to go into any appointment, treatment, exam feeling Highly Defensive...and that does not make it easier to get treatment in a manner you are comfortable with... because it makes your provider an adversary in your mind ..even before you see them.
leemac
leemac .. alan is okay with full nudity and cross gender care as long as he's unaware of it. Maybe we could all just ask for a knock out drug and everything would then be acceptable.
Patient modesty and privacy covers a wide range of considerations. Slightly different than what we usually discuss here (this may not be the right thread, Dr. Bernstein,, if so please excuse me)
it also covers who gets our information and what choices in care we can exercise in choosing providers, procedures, etc.
With the electronic records and I hear a federal condition that requires all electronic records be submitted to some federal bureaucrat reguardless of payment methods coupled with some of the items that are in the new health care bill, I have some questions.
How do folks think this will impact getting same gender or gender of choice to be recognised as valid? How will this impact how folks ask for consideration to their personal preferences? Will all of the new structuring , as proposed, provide a valid excuse for instituions or others to claim the inability to grant preference in gender care because they can not afford it?
Are the changes being discussed going to leave us with a medical system or a bureucratic snafu? I use snafu in its fullest meaning.. sorry if it offends.. not trying to be vulgar, but.. it is reality.
Can the modesty issues be worked into a workable re-worked system?
Is it more important to spend effort on modesty issues or should more energy be spent on making sure we don't get ripped in a new government mandated way of getting health care? I say some of these things because some of the items in the 1000 page proposed bill... limits many choices a PHP can make.
A lot of these changes have nothing to do whether you are on a government insurance, private insurance , or self-pay.. they are a one size fits all.. and all must adhere to its dictates.
leemac
I also agree with alan. I trust my PCP I have been seeing him for 20 years and he is also a gyn. But I have never had him do a pap smear on me. I would just die from embarrassment. I would rather go to a women's clinic and have it done by a total stranger whom I will never see again. My PCP is just to familiar to me like a family friend. So you see it's a very complex issue.
NP
NP, although the professional relationship of a physician to the patient should be warm, understanding and show willingness to provide attention and care to the patient, both parties in the relationship should not look to turn the physician as a "family friend" (in the usual use of that term) or almost a "family member". Just as it is not wise for physicians to treat their own family, it is unwise for an example you point out for the doctor to appear to the patient as a "family friend". ..Maurice.
Anon, although I am not thrilled by the prospect of the total nakedness and whoever as the provider while I am out, I understand what alan is saying.. being unconcious may be the only way to avoid the embarrassment. I am moving to a small community and I already know that getting a male for anything is going to be difficult at times and impossible the rest of the time. The hospital there (less than 100 beds) haas two male RNs and one of them is not involved in patient care per se as his full time job is to serve as a patient advocate... they have No male cna's.. a balance of male/female radiologists, mostly female lab techs.... ANd the next hospital I could go to is over 100 miles away.. I may have to accept the gender that they assign me. no I do not like it..but it is reality and being unconcious would at least spare me a little.
It is just reality.. I have to accept it for now.
As to doctors getting too close to their patients.. this was in teh place I am returning too.. My dad was saved by a young doctor..and through crisis too numerous to caount he saved him time and again.. as my dad went down hill for nine and a half years.. The last time this docotr came by the house...we all knew it was the end.. as he ws leaving he told my mom and me it was just a matter of hours..and please not think ill of him , but he needed to go out of town..and he would have one of the other doctors in practice with him stand by... He had got too close on a personal level with my dad.. he did not tell us..but he could not be around for the end.. his son later told me it was one of the most miserable weekends he had ever seen his dad go through.. When this doctor died a few years later.. it was hard on my family too.. I think Dr. Bernstein is right.. close relationships should still have some distance.. perspective can be lost as well as objectivity..
leemac
Maurice, I said my doctor is like a family friend not is a family friend. By that I mean I can't see how you could have a relationship with someone for 20 years and not form a relationship of some sort that is more than a strictly professional relationship (which in a sense it still is). But we're on a first name basis, we have jokes, I know a little about his family etc. He has seen me during many of life's major milestones. I don't want a "fake" doctor who has got the empathy act mastered but is an aloof cold fish on the inside that sees me as nothing more than his/her source of income.
Anyway, how would a lone country doctor in a small town ever have any friends if s/he maintained a distance from all his/her patients? What is unwise about forming friendships with patients anyway? I am not talking about sexual relationships,obviously. I think doctors need to get off their pedestals a bit and be a little more genuine and human. And as you can see from your main thread "I hate doctors" many people seem to feel the same way.
NP
NP, I can't titrate here just what quantity of "friendliness" a physician or a patient should show to each other to be humanistic and yet at the same time maintain and effective professional relationship. Obviously, if you find that you are too embarrassed to allow the doctor to perform a necessary pelvic exam on you and yet you are willing to have the same exam by a "new" doctor, the relationship with the "family friend" has now become
non-therapeutic.
Of course you are right that you "don't want a 'fake' doctor who has got the empathy act mastered but is an aloof cold fish on the inside that sees me as nothing more than his/her source of income." Some patients, but I am sure only a few, want their doctor to be simply a "technician" and possibly even be satisfied with the doctor's relating to the patient more as an "actor" if the "technician" role was well done and yielded personal medical benefit.
NP, you have seen and described to us the consequences to both parties for allowing a "too friendly" relationship to develop. Doctors and patients, both being human beings with emotional fallibilities, may not be able to make that necessary titration of "friendliness" and therefore the end result may be what you have described both for yourself and your doctor. ..Maurice.
To anyone,
If I were in a hospital and I or one of my family members or friends put a sign on the door and above my bed saying "Male caregivers only" how do you think it would be perceived?
I don't really care about female nurses doing things to me when my genitals are covered but don't want any intimate things done by a woman or with a woman in the room.
Do you think anyone would take it seriously? I imagine it would only bring on arguments and threats but I still would like to try it.
I've seen signs like that before but only for female patients.
Anon: "alan is okay with full nudity and cross gender care as long as he's unaware of it. Maybe we could all just ask for a knock out drug and everything would then be acceptable."
I still can't find a post where Alan said it was 'OK' with him, as opposed to unavoidable if unconcious. Can you reference it for me?
ANON:"Do you think anyone would take it seriously? I imagine it would only bring on arguments and threats but I still would like to try it."
Good question. I believe that is the whole point of this blog. Yes, it causes arguments:people with entitlement issues are always offended when you say no....and it is not easy to fight for the basic rights of our body, but who cares if someone gets mad because they can't touch our bodies the way they want?
It was THEIR choice as to how to earn a living, but OUR choice to let them. Say NO whever you can!
I would like to see this happen, "male caregivers only". Don't rightly know how it would be perceived by the staff. It would give them something to talk about.
You'd probably get the old routine line, we simply cannot accomodate that as we don't have the male staff to do so. In other words, your request is denied.
Maurice, my wife sees an interist. She does not feel comfortable having him examine her breasts or pelvic area. She sees a female doctor for that. I don't think this dimishes the therapeutic relationship one bit. It is virtually impossible not to build a relationship with a person after seeing them for a service for 20 yrs or even less. How can one even suggest that would be possible. You con't have to go out and have drinks together but after a number of years a relationship builds no matter what.
"Please look at http://www.evanhospital.com/services/medical/one-day/default.aspx#day. Look at how you must remove your underwear for any surgery at this particular hospital."
I emailed the hospital and asked if patients take everything off for an Upper GI Endoscopy, because most places I've heard of don't even make you take off your pants. Angela Brouse, Assistant Director, Public Relations answered my email and said "Patients having the procedure done at Evan leave their underwear and slacks on for the (upper GI) procedure. Hope this helps."
I don't know about other surgeries but the point is she returned my email, so other people could email her with their questions and she may answer.
ABrouse@evanhospital.com
DG
An UGI is a diagnostic procedure
performed in radiology after the
ingestion of a barium sulfate
solution. No need to remove your gown or pants as long as there are no metal objects on the upper aspect of the pants such as metal snaps etc.. An upper endoscopy procedure is properly called an EGD,performed in the endoscopy department. A more involved procedure is an ERCP.
These procedures do not require
the removal of the gown or pants
as the environment is non-sterile.
PT
swf, several volumes back there was a lively discussion about cross gender care and alan stated it did not bother him if he was in the OR and was anesthetized. It only bothers him if he is conscious and aware of it.
To me what the "hell" is the difference. Being conscious or unconscious doesn't change the cross gender care issue.
well folks her is what I mean about being knocked out vs awake during exposure. What I said was while I would prefer an all male team, I understand there has to be a balance between what I want and what the providers CAN REASONABLY provide. My real issue is when they can but don't accomodate. The occassions where I had surgeries or procedures were varied but I had a colonoscopy in a local hospital, male support staff is really almost non-existant. While I don't like it, for ME if I don't have to see them, meet them, they are this unknown entity and while I understand there was exposure..one was to remove a lump on a testicle...for me not being awake and actually experiencing the exposure vs knowing it happened make it more acceptable. It was is somehow less real. To me that is different than having a woman looking at me, talking to me, while I am exposed. I have had it both ways, the more abstract the less real it seems and its easier to accept and put behind. I looked at asking them to provide an all male team as much harder for them to do than asking to be scheduled with a male tech when they have them on staff. My main point was everyone is different, you have to speak up and make YOUR wants and preferences known as we are a diverse group...some people don't care at all. My main issue is anon who seems to think that I am wrong for feeling that way, these things are personal and we all feel different about them, it isn't a general right or wrong...its what is right or wrong for us. I didn't say it was OK, I said I could deal with it...
I also understand what NP is saying. Friend-friendly is different things. It doesn't mean you exchange Christmas Cards and go out to eat. But after 20 years of seeing someone of and on you become much more familar with them. If you don't I would think that is odd. As such, being seen naked or having an intimate proceedure done by a same gender stranger is a whole lot different than having it done by someone you will see again more and more frequently as we age. Familiarity makes it different. Having your nieghbor who is a nurse, friend or not, give you an enema for surgery is a whole lot different than someone you will never see again...seeing your nieghbor on the street reignites that humiliation...the stranger you will never see again doesn't.
by the way did someone post a link to art stump/my angels are come's blog, thought I saw about it but could not find it alan
Alan:
http://patientprivacy.blogspot.com/2009/06/cancer-rx-privacy-my-angels-are-come.html
I hope this works.
swf
"Being conscious or unconscious doesn't change the cross gender care issue."
No, it doesn't change the premise. What is set in motion instead is our choice. Will we allow a situation that could be life saving but crosses our gender borders? Each person has to make that choice.
Sometimes it is because of that situation that makes one fight. Sometimes it is "in case" of this situation that makes one fight. And sometimes it is the fact that everyone deserves the chioce that makes one fight.
In the end, I believe most of us here feel roughly the same....we deserve what our moral standards dictate. Our paths are different, but we hope they all lead to the same place.
A workmate requested all female carers when his young daughter was in the burns unit in an induced coma.
She needed to have her entire body treated and washed every day and she was catheterized...
Their daughter is very modest and only sees female doctors and would have been upset to know males had been nursing her.
They knew it would be unacceptable to her if she were conscious...being unconcious made no difference.
In fact, they felt more comfortable with her being in female care given her vulnerable and exposed position.
It would be very easy to take advantage of an unconscious patient.
It was not difficult for them to arrange but they got the impression they don't worry too much about same gender care in that setting because the patients are not able to complain.
They were told its usually only an issue when people are awake unless their families raise the matter.
In this case, they stayed with their daughter constantly - a family member was around all the time or in the immediate area.
If you were absent, I'm not sure whether they'd cut corners if it were more convenient and they thought they could "get away with it".
If a request was made for all male care...I think it would be respected...every attempt seems to be made to keep the families happy given their loved one is seriously ill.
Franks story is interesting. I do wonder though if 'all male' care would be accomodated for a male patient. No doubt the hospital would say they do not have enough male caregivers to insure that request. Key in this story is his comments about 'getting away with it' and 'they don't think about gender care when the patient is unconscious'. My feelings are it is a concern with a conscious patient but perhaps an even bigger concern with an unconsious patient.
I feel the same as the previous commenters. I don't worry as much while conscious because I'm able to defend myself, but if unconscious I have no idea how I would be treated and who would be treating me. It really bothers me not knowing what might happen to my body while unconscious because my morals don't change when I sleep. Even if I allowed a female to prep me or catheterize me or whatever at least I would know exactly what she is doing and could object to certain things(though that scenario will NEVER happen), but while unconscious I would have no power over myself at all and who knows what she (or they) might do. A good example of that would be that if I were awake I would make sure there are no other unnecessary females watching the procedure but while unconscious I could have an audience watching and believing they're not doing anything wrong and I could do nothing about it.
I'm sure there would also be times when there really wasn't any unethical behavior going on while I was unconscious but afterwords I would still assume there was. So I always play it safe and make everyone clear of my demands before they render me unconscious. I assume the majority keep their word but I'm sure there is always the possibility that a nurse or two might do something they promised me they wouldn't. It's impossible to trust every medical person involved with my "care" though, so I will always wonder.
Just a reminder again. We are getting a number of Anonymous writers who are not identifying themselves with a consistent pseudonym or initials at the end of the commentary. Please remember to do so, since it really helps preserve continuity and enhances our understanding of your individual views. Thanks. ..Maurice.
I was doing an internet search of the term “double standard” and came across an interesting (and long!) article written by Susan Sontag. I thought that many of the points she makes may explain why women’s modesty is respected more than men’s in a medical setting. The article starts off explaining why women sometimes lie about their age, then goes on to state they do this because as men and women age, society judges women much more harshly than men. She states that society views “old” women not only as unattractive but downright disgusting and that “old” occurs at a surprisingly early age for women and women know this. Men on the other hand age far more gracefully and who a man is has more to do with what they do for society, which improves with age, than what they look like. Good looks is just a bonus.
Nurses, who are predominately female, also know this and naturally go to extra lengths to shield other women from the anxiety that poor body self image causes them. They offer no such concerns towards men because society thinks men don’t need it. ---Leslie---
http://www.mediawatch.com/wordpress/?p=33
Leslie, thanks for the link to this most interesting article. Actually, it would be great if others to this thread read the entire article and discuss the relationship of the concepts set by Ms Sontag to the concerns described on these threads both by the men and by the women.
To facilitate, here is a clickable link to the article. ..Maurice.
Sorry Leslie
I don't buy this excuse and thats what this article tries to
do and that is to make excuses for
the inexcusable.Everyone should treat both genders equally. I can
think of hundreds of privacy violations of men where this subject has no bearing at all.
Consider the military induction
physicals of men where female clerks made themselves present. Why
is it that at many level 1 trauma centers female patients young and
old are immediately covered up
whereby male patients are left uncovered.
PT
As I interpret it, one of the keys to the Sontag article is connected to the fact that nursing is dominated by women. Female nurse have more empathy for female patients than they do for male patients. That's not a condemnation. I think it's the norm for people to have more empathy for those they have more in common with. Female nurses relate to these issues of aging, body image, vulnerability, sexual assault, etc.
And yes, it's assumed in this society that males don't possess the same kind of modesty women do. And frankly, that may be true for some men, but not all. But I think some nurses (and other medical professionals) slip down the slope from their belief that most men are not as modest as women, to the position that men shouldn't be as modesty as women. That then makes men who express modesty the exception to an assumed rule. And these other "rules" are interesting.
Nurse have some reason to believe these stereotypes because of the unnatural relationship situations that are thrust upon nurse and patient. Most patients don't speak up, but nurse have more empathy for members of their own sex so female patients don't often have to speak up because the nurse will sense the non verbal signals. They may even sense the signals in men, but may not have the choice or providing a male nurse.
There are, of course, "rules" to these embarrassing (mostly for the men), potentially humiliating situations. But the "rules" are never expressed or set down. Of course, the person who has the expectation of certain rules yet never let's the other person what the rules are, always has the advantage. It is a power and control factor
Can you imagine playing a board game with someone when they know the rules and you don't? And they won't tell you the rules but just expect you to pick them up as you go along? Do this and do that, they tell you. Why, you think? Do I have any other choices? Move this way, move that way, take that off, put this on, role over this way. Now, some med professionals are excellent communicators and tell you why they're asking you do do something. They may even tell you some of the rules. But I don't think that's what generally happens. That's one of the "rules," that you just do what you're told without asking too many questions.
The Sontag article is excellent and I think it does much to explain the why of the double standard. From what else I've read of Sontag, I think she would have agreed, though, that men have as much right to same gender care as women.
You sure are right about not knowing the rules. It's just "shut up and do what you're told". And I do believe women medical "professionals" take care of their own, while older men, with the possible exeption of young boys, are treated the worst. In every retirement home I've ever visited or heard of the men are nothing more than children to the nurses and are treated that way. During bath time it doesn't seem like they are treated much different than farm animals. Move them in and move them out with no regards whatsoever for their feelings.
When my sister was a 16 year old high school student she was in some kind of nursing program and would spend time at a retirement home in the area. The way she described bath time was that she and other high school students would literally hose the old folks down, and then laigh their heads off when they could cause some of the old men to get an erection. It was just a cruel game for her and the other young girls. I lost a lot of respect for her, the program and nursing homes back then.
GL
I essentially agree with Sontag's points. Women are held to a different bodily standard than men are. I have never understood why the feminist movement doesn't protest this more actively. Why do they accept for instance that women media commentators are expected to be beautiful to a much greater extent than men? That is not anywhere near as true in other cultures such as the UK. Let us see a female sideline reporter who is not beautiful but actually knows sports.
But Sontag does not take the age problem far enough. The most devalued of all people in our society are really old men, so called 'dirty old men.' There have been studies that showed that the least valued of family members are old men who are no longer independent. (Sorry I no longer have the references.) Women are still valued as caregivers, home keepers, baby sitters etc. But old men have no value at all as suggested by some of the nursing home comments.
Unfortunately, I have seen and feel the same as GL when it comes to nursing homes... all too oftennone of the residnets aare really treated like human beings with men faring the worst... perhaps the article by Susan Sontag gives some insight as to why vulnerable males are too often seen as a way to get even.. Much of the things the lady says are true.. there are double standards that are not right.. but that does not excuse or justify taking it out on guys.. many of whom do not subscribe to the inequities described by Ms.Sontag.
leemac
I am so glad that the double standard issues were brought up again because we often gloss over some of the thinking behind them. The female thinking to be specific. If Sontag made viable points then consider this: The attitude of female 'techs' toward men is a disgusting attempt to take control and balance the power over their traditionally disempowered lives. An attempt to say "this is my arena of control, and I have very little respect for your body, and can treat you as I please."
Before assumptions are made that I am about to condone this, I will say before hand that this is part of the attitude that angers me about female 'caregivers' and I am woman enough to admit it.
Consider....the female body has been treated rather commonly and disrespectfully for ages. Dozens of porn magazines, frontal nudity in art and film, uniforms, billboards, and prostitution.
Men's nude bodies have traditionally been held in reverance, protected, and been displayed selectively when someone is bold enough to expose them. Men respect themselves.
If society treats women (aging or not) so cheaply then we as women have to share the blame. However, the medical field is the one approved area removed from general society where women can manipulate their own surroundings as they choose.
Consider also how many times female caregivers goad other females: pointing out that at any given time they and a few hundred cohorts have access to their husbands bodies in the most intimate of ways. Bravado? Power?
Whatever the motive it is clear that many seek to invade even the assumed sanctity of relationships held between lovers and spouses for the purpose of turning the power tables.
If these statements are hard to prove, it is because there is a difference between what people say and what they will go on record as saying.....
As the moderator, I am most favorably impressed on how the discussion here has changed from mere expression of emotions with some explanations to more of a deliberative analysis of possible mechanisms behind the cause of the patient modesty concerns. I think that the structure of a problem needs to be thoroughly analyzed before one goes on to mitigation. I think that Sontag's article brought out elements of the structure which was never discussed here previously. Continue on.. I'm learning. ..Maurice.
I have just read about a woman's experience on a another forum which I think you will find interesting. She said that she needed to go to her GP for a exam of her pelvic area. After the doctor looked at it he turned to her baby and said "My relationship with your mother will never be the same again."
NP
NP, I need to make this point about your last posting. What you wrote is hearsay with no documentation at all in either the context in which it was originally written nor of the relationship to the current discussion on this thread. What is more constructive is to avoid hearsay comments of others as some sort of examples and attempt to stick to insightful and deliberative discussions. Otherwise, what is written here will turn out to be like a garbage dump where the readers are then attempting to sort through the trash and find some meaningful pearl. I am open to discussion here and now on my philosophy of the method of rational and productive discussion. NP, excuse my use of your posting for these comments but I just had to present my view. (..and I think I already wrote about this in some distant past Volume.) ..Maurice.
I think women are CONSTANTLY judged on our bodies and looks....from childhood to old age.
When we hit puberty, we're judged fat or thin, large breasted or flat chested...
The male attention we receive may often be unwelcome and even frightening.
Being ogled at, whistled at, grabbed, propositioned and feeling threatened and afraid (flashers, drunks, voyeurs, attackers)makes you on guard around men and trust becomes an issue.
When I was 24, I was attacked by a man as I walked back to my car after a late meeting. I managed to escape...but it was the most frightening experience of my life. His mutterings as he closed in on me made clear his motives were sexual assault.
After all of this, I'm afraid I became uncomfortable exposing myself to men, so sought out female doctors.
At a certain age, the pressure starts to look at ageing products and cosmetic procedures...ageing women = a very bad thing.
So, we're judged as young/beautiful/sexy/attractive and sought after in a negative and positive way or we're judged as old/unattractive/fat...
but we're always judged on our appearance.
I think this has resulted in some accommodations to protect us when we're vulnerable and exposed...from people taking advantage OR from ridicule when we fall short.
I think this judgement and focus fuels a lot of disrespectful conduct.
At University, the male engineering students regularly held a "KFC and porn party"...which was perfectly acceptable. (so it seemed, it went on for the 6 years I was on campus)
There were many problems with the conduct and attitudes of these students toward female students.
The NRL here in Australia has been pulled up severely after revelations they engage in group sex activities - numerous NRL players were recently shown to have participated in group sex with ONE 19 year old girl.
It caused a HUGE reaction here with attitudes ranging from, "she asked for it" through to outrage that a group of men could treat a young girl so shockingly...that it was immoral.
The evidence in this case suggested to me the girl had been "set up"...she agreed to go back to a hotel room with 2 players (so many people immediately dismissed her as a slut deserving of everything that followed) and when naked she found herself confronted with approx. 10-12 players (they had all silently entered the room)...6 had sex with her while the others touched her, hit her in the face with their erect penises or masturbated while watching...
It was also revealed that strippers and sex toys were present in the club rooms...to help with "bonding"...
The very poor attitudes toward women and the protection provided by the Clubs....dealing with Police, covering up shocking conduct and paying off victims ensured the conduct continued...the players felt "safe" to do as they pleased.
The poor attitude seems to go to the very top in the NRL organizations.
Several sponsors withdrew their support.
What is the answer?
It's certainly complex...but at the very least our society needs to stop the gratuitious nudity and disrespectful conduct toward women. We need to help change the focus to achieve a better balance....and dignity, values and good manners need to be maintained.
Women of a certain age apparently become invisible to men - because their physical looks have faded.
Female politicians, newsreaders - anyone in the public eye, are often judged on their age, weight, clothing, fashion sense, looks, hairstyle or appearance generally....
Julia Gillard, our Deputy PM and her hairstyle has been the subject of many news stories.
I'm not suggesting for one moment that ALL men are perverts or disrespectful...
I'm just relating my experiences and impressions and the trends and focus in society that seem to fuel and feed the problem.
Can you blame us for preferring a female doctor for intimate care?
BTW I agree that male modesty is important and that men are equally entitled to same gender medical care.
Maurice I thought you would react like that to my posting. I could have easily pretended it happened to me. However, I will direct you to this forum where people have written about the appalling behavior by the medical profession in Australia. http://www.essentialbaby.com.au/forums/index.php?showtopic=704143&st=0
NP
I agree with Dr. Sherman about broadcasters (especially women) having to look 20 something and like they are competing in a beauty pageant...Wlater Cronkite passed away las tweek... the most trusted man on tv..He decried the celebrity journalism..I want someone who gives the facts and I am not terribly interested in looks as they have nothing to do with th etruth... except most cons seem to have smooth voices and great looks... male and female...
The looks thing does elicit a lot of sympathy for females from me.... it is a part of our culture that needs to go out the window with lack of consideration for all persons modesty.... Looks do not equate ability. Hang in there ladies... not all men are so shallow.. just as not all females are any one thing or other either.
leemac
Although I agree with much of what Sontag wrote, I think things have changed somewhat since she wrote that. It's not old, elderly women who are despised or discriminated against in this country today. It's the elderly in general. Age is the great enemy in this culture. Getting old is the secular sin of today. I will grant that even today older women do get it worse. But once a person passes a certain age, becomes physically helpless in certain ways, ends up in a nursing home, especially if they're poor -- once this happens, it doesn't matter too much whether they're male or female. Getting old is the sin here. Much of celebrity culture is about today is, at its core, is the denial of death. In the 1950 film Sunset Boulevard, a character comments: "There's nothing tragic about being fifty. Not unless you're trying to be twenty-five."
It's old age that's the enemy in our modern American culture.
MER, you might to be interested in the similar vein to your comment is what was published today in AOL Politics Daily online in which I as well as some more well-known ethicists including Art Caplan were interviewed and written up regarding the ethics involved in any new healthcare overhaul in the U.S. especially in relationship to the elderly. In the reporter's case, his father, an outlier with numerous medical complications but managed with recurrent expensive medical treatments at 91 still has a quality of life which is worthy of him still being kept alive. ..Maurice
Julia:
"I think this has resulted in some accommodations to protect us when we're vulnerable and exposed...from people taking advantage OR from ridicule when we fall short."
Do you mean "We" as women or "We as people? If we are accomodated as women it is severly unfair to men who are also "vulnerable and exposed..." and somtimes ridiculed when they "fall short".
Dr. Bernstein:
I've been reading about what it takes to become a Patient Advocate.
Some of the Ethics and PA comments state that the main drawback to the field is that many times you wind up doing what is best for the institution and not the patient. What then would be the point?
My question is ...do you work with PA's, and is it a valuable field? Or is it just a legal attempt to appease patients and their families?
Excellent article, Doctor. And I agree with your basic philosophy regarding quality of life. I think this denial of death has, in some cases, infiltrated patient attitudes. Some patients just don't want to die, ever, and expect the system to keep testing and testing and operating and testing. Some doctors don't want their patients to die, ever, and want to do everything to keep them alive. They key word here is "ever." It's not an easy problem, but this article covers it quite well.
Although this article isn't on topic, I recommend it to all on this thread. As we discuss modesty issues, it's worth considering some of the other major ethical issues that the medical profession faces. Patient dignity is always foundational, and modesty can be directly connected to dignity -- but we need to look at the big picture, too.
Julia,
You said "Can you blame us for preferring a female doctor for intimate care?"
I don't remember a single comment on this blog that disagreed with what you said. Most of the comments I've read here have discussed the importance of everyone having their choice of gender for any intimate care. I think most people here agree with you.
You also have to realize that many men have had bad experiences as well. But bad experience or not, everyone deserves respect and dignity regardless of their reasons. I think nearly everyone would sympethize with you after hearing your experience, it must have been terrible. But even people that haven't had an experience like yours deserve that same respect.
I know you understand the importance of same-gender care for everyone because you said that "male modesty is important and that men are equally entitled to same gender medical care", but there are many other reasons that both genders have besides a bad experience and they are ALL valid.
You have a very good reason but you shouldn't have to tell anyone your story before receiving the respect and dignity you deserve. They should give you that choice simply because you are a human being, not to mention you're giving them a lot of money.
LG
OK let me first say I fully understand and antcipate I am am about to open the door for a firestorm of criticism when I say...what a crock. Is there a double standard as Sontag relates, yes and no. Much of what she writes is true, but what about the other side, why is it ok to tease and ridicule the bald man, those jokes are pretty funny right, and if I had a dollar for every time a guy with a beer belly was taunted in a public setting I could retire, yet I have yet to hear a woman be taunted for thin hair, a guy making fun of a woman for being fat would be deamed and ass. Showing the male penis in movies seems to the the in thing now, tell me a movie where the female genitalia was shown. Then there is something more to point recently a female sports reporter named Erin Andrews was covertly filmed naked while dressing, the out cry was tremendous as her privacy had been violated, not one article brought up the irony that she entered male locker rooms routinely when the same activities were being undertaken by male atheletes (yes I understand the legality and moral issues of covert illegal behavior vs legal, and I think the act was awful and the perps are scum), the double standard is out there everywhere. How much attention is being given to the fact that 80% of the current job loss has been male...none of this makes the double standard against either sex justifiable or acceptable. If anything one would think one who has been the victim of discrimination would be more aware of just how wrong this is. Doing the same thing you complain about only provides validity to those who commit it against you. Yes women are discrimianted against, but so are men, and elderly, and young and hispanic and whites and blacks.
Sontags comments are not as much wrong as they are self serving, each segment of society could write the same article on the paticulars of what their segment of society experiences. None of which justifys anything. Women are some of the harshest critics of other women (Sara Palin comes to mind). male doctors brush off male modesty with the same irreverence as females in medical settings. That said, I agree that a big part of the issue is it is natural to have empathy for those we associate ourselves with, as our newest candidate for the supreme court would attest....yet...I think the issue is a factor in our debate in a more significant way. We have come to feel not only that it is acceptable to discriminate against people whom we normally label as offenders or beneficiaries of the double standard as a pay back, we do not as a society believe that those "priviledged" people can be discriminated against. There is an interesting article by a female Dr. Orrange on a web site called daily strength, she says there is justification for womens health centers but not mens health centers as women have special needs that males do not have...but it apparently doesn't even dawn on her that males have just as many "special needs" that do not apply to women testicular cancer, prostrate issues, erectile dysfunction, etc. This obviously intellegent Dr. actually did not see the falicy of her statement...this is the double standard that is not acknowledged or recognized...so while it may explain some of the discrimination against males, what about when women ignore the modesty of other women...the discussion on Dr. Shermans site with Art Stump the author of My Angels Are Come has a lot of validity...the business of medicine has put effiency and profit at the top of the priority lists and trumps modesty and caregivers fall in line with the process....alan
I get it swf. You hate female nurses.What I think of my male patients is none of anyones bizness as long as I GET THE JOB DONE. And I do. I agree with Alan what a crock he said. DO YOU HATE MALE NURSES TOO? Double standard.
Thank you Alan.
cnakelly
Excellent post, Alan. I agree with you. Add to this the political climate today -- it's such that many men are afraid to say the kinds of things you say lest they be labled as women-haters. Women are taking over in some fields. We've talked about nursing. About 60 percent of college students are women. Fields that emphasize communication skills are dominated by women today. I'm not making a judgment about this, just bringing out the facts. In may fields, men are not well represented. In the most dangerous occupations, where life and death are involved, men are overly represented -- which has always been the case. I have some more interesting stats that I'll post later. Things are changing in our society, cultural changes, and gender plays a significant role in this.
Patient satisfaction scores are at
an all time low according to Press
Ganey. Unless you are offering male
patients some choices then no you
are not getting the job done.
One only needs to look at what the governor of California did to that states board of nursing only further indicates the sad state
of affairs that exists in nursing
today.
The are many articles recently
that suggest that misconduct is
ailing health professionals. One
such article is on www.mlive.com
I've always said that if you can't think positive for your patients then you can't do positive
for your patients.
PT
To cnakelly: I take it you're a cna. I'm glad you've come on this blog. We don't seem to get many nurses or cna's here. (Of course, some of the anonymous postings may be from them). I would like to hear more of your responses to the kinds of opinions expressed on here. Not just the extreme ones, but the more rational ones.
To cnakelly: What I forgot to say in my last post was, although I would enjoy hearing more about your views, your last post was unclear, confusing to me. I'm not sure what you were saying. What is it that Alan said that you agree with, specifically? What is your attitude toward the supposed double standard toward men in healthcare? Do you think it exists? When you say "Get the job done," what do you mean? The task at hand? How do the patient's feelings fit into the task at hand, especially if it's an intimate task with a male patient? Do you think that how caregivers feel about their patients can be hidden all the time, or do you think patients can pick up on those feelings? If one of your patients does pick up on your feelings, positive or negative, doesn't that make it his or her business?
I ask these questions respectfully. I'd like to hear more from you.
Here is the specific link to PT referred article. ..Maurice.
I agree with MER cnakelly that I don't get the point you are making. The tone is quite harsh. If I read some of your comments correctly it is all about getting the JOB done and it is your right and duty...nothing else matters?
Not all men want female caregivers and I think 'swf' has stated her opinion of 'some' female caregivers. Nursing at all levels should not assume intimate care done by cross gender caregivers is acceptable to every patient. Whether it be a female or a male patient. For nursing to have no insight on this very personal matter shows something is severely lacking in the healthcare industry.
JW
For the record I never said that I "hated" anyone. I did say that people who feel entitled to do things that we don't want them to do "anger" me.
As to equality, this would apply to anyone....male or female.
As to profession,it doesn't matter if you are a bookkeeper/bartender/cna/cpa/
cocktailwaiter/housekeeper/hooker/
hairdresser/mailman/medical tech/nanny/nurse/or zooligist. We supposedly have the right to say yes or no to anyone who wants to touch our body.
I see no double standard here.
"Not just the extreme ones, but the more rational ones."
htey all seem rational. Some are more emotional though and some have facts. Does it matter?
If the patient has a problem with opposite gender care the patient needs to state just that. If you don't the staff won't know and will continue with their job.
"Not just the extreme ones, but the more rational ones."
htey all seem rational. Some are more emotional though and some have facts. Does it matter?"
Well -- I think some people go into these intimate care situations looking for a fight, rather than assessing the situation, making one's wishes known, and trying to deal rationally with health care workers. They go into the situation assuming that "nurses are perverts" (I would call that an extreme opinion), assuming that they will be treated with disrespect, assuming that they won't get what they ask even if they ask civilly, assuming that the world is against them. That's what I mean by extreme positions. I don't think most people on this thread are like that, but I perceive some to be. I still believe that most of the time caregivers will try to work with patients if you let them know ahead of time. And "Does it matter?" To me it does.
"If the patient has a problem with opposite gender care the patient needs to state just that. If you don't the staff won't know and will continue with their job."
I agree with your first statement. I disagree with your second sentence. Staff know most of the time. I can't believe they don't. Female nurses know if a man is uncomfortable, embarrassed, even humiliated. In fact, they're taught that embarrassment is just part of the process and to deal with it. They know. If they continue the job it's not necessarily because they don't know -- it's because they need to get the job done and move on to the next one and that it's easier to ask forgiveness than permission.
I can understand that there may not be a male nurse readily available. But the question of a main mission of nursing comes into question -- patient comfort. If you know your patient is extremely uncomfortable, and don't try to alleviate that discomfort, then you're not focusing on your mission. Now some will say they do things to alleviate discomfort and embarrassment, and maybe that's sometimes successful. Maybe not. But I don't think you'll often hear a female nurse say this to a male patient: "I see you're embarrassed, uncomfortable. What can I do to help with that? I can do this procedure and I'm willing to do it. But would you prefer a male nurse?" I'm not saying that never happens. I think the best female nurses may do that, but only if they work in an institution that staffs so that these choices can be made. I think you'd hear that more from male nurses working with female patients. Why? Because male nurses are a minority, and minorities learn to see and read things better than the majority culture around them. They need to in order to survive.
Anyway, interesting discussions.
Mer
The scenario will essentially emcompass an inpatient facility
such as a hospital. There will always be a male nurse available
that can accomplish the procedure.
I seriously doubt that any female
provider would have the insight to
ask the patient,let alone seek out
a male nurse. Its only when the patient states his wishes and
adheres to this that the female provider will succumb to the wishes of the patient as the procedure will take on presidence.
PT
To expand on what you wrote MER, male nurses are also taught to ask female patients if they’d prefer a female nurse for intimate procedures. That may not be formal training, but I’ve both seen and heard that they do this to make the patient more ‘comfortable.’ This should cut both ways but the assumption is that men don’t care. That is what gets me so fired up. They recognize that this is a valid issue for some and ignore for the rest. As I’ve stated in the past, I speak to them upfront, long before the procedure not to have the issue come up when your there. It’s worked for me with only the exception of one female nurse but once I explained to her that the surgeon didn’t care and that I’ve had procedures done here in the past, case was closed. That was also very odd to me because the female nurse that I had for my first knee surgery (at the same facility) not only told me I could leave my briefs on, but asked if I wanted some surgery shorts? Then, I go back six months later for the second surgery on the same knee and that nurse asks me to remove everything and put on a gown? I don’t get it… Consistency would go along way in helping this issue. My guess is that there are surgery teams and each beat to their own drum. More the reason to speak up in advance and communicate your wishes in the beginning. Jimmy
MER
"I think some people go into these intimate care situations looking for a fight, rather than assessing the situation, making one's wishes known, and trying to deal rationally with health care workers"
I wonder if the difference between the two is really the comfort level that one feels in standing up for themselves. Someone who feels more at ease with it might be matter of fact or perhaps even polite about asking for such care.
Someone who finds standing up for themselves difficult may dwell on it and maybe even play out the battle in theirs heads to build the courage to face it. Many times these are the people who come out of the gate already combative.
I see these two extremes in small ways everyday.
Anonymous from 8/2 is handling it perfectly. Make your needs know prior so they can prepare. See if there is staff available to meet your request so if there isn't you can go elsewhere. Ask if the male nurse assigned to you calls in sick or has an emergency if there is a back up for him always available. Don't assume anyone knows how you feel or what you are thinking. Speak up.
I think you're right on, swf. I think it also depends highly on past experiences. If patients have been mistreated in the past, they may be more proactive (which is a good thing), but they may assume they need to begin by being aggressive. It's generally better to begin by giving caregivers the benefit of the doubt until you learn otherwise.
On Dr. Sherman's blog there's a thread about how the media treats patient modesty, especially males. It's worth reading. Remember, these blogs are the media, too. Mostly the bad stories get reported in the media, and it's not difficult to get jaded, to think that most people get treated like those who have told the bad stories. I don't think that's true. I think that's a product of the media stereotyping and just plain human nature to focus on the bad. Granted, there are too many modesty violations in medicine today, too many. And we, as patients, need to be proactive and work with the medical community to correct this. But I don't think this is how it happens most of the time. How often on this blog do we read cases where people were treated with great respect and dignity, granted same gender care, etc.? Not very often. But I believe it happens most of the time. That's why Art Stump's book My Angels Are Come is so valuable. It's about the most balanced account you'll get of intimate care in a sensitive cancer case. Art doesn't hedge in describing a terrible modesty violation. Yet he is extremely grateful for the respect show him by his other caregivers. And he's alive. Sometimes we, who theorize about all this, don't think about how it must feel to face your death, and how modesty fits into those feelings. If you haven't, read Art's book and pass it on especially to doctors and nurses and techs.
What bothers me most is that the medical culture won't talk about this issue publicly, and reassure patients on public forums that this is an issue they're aware of and are willing to accommodate whenever possible. This is a great mistake medicine is making by not addressing this issue. They leave it to people's imaginations as to what will happen to them. And the human imagination is very creative.
Call any surgery center and ask about same gender care for a pre-op prep that would involve the groin for a man. Interestingly most times the female nurse or whomever you speak with sounds unbelievably surprised and shocked at the question. One tends to get,"oh, is that a problem?" They totally act like they have never before been confronted with this issue and that the issue doesn't even exist. Try a few calls, it might just surprise you.
"Try a few calls, it might just surprise you.
I'm not sure what your point is. That they act surprised? The reality probably is, as we've discussed here, that most men don't ask, so it's no surprise that they may be surprised when a man asks. What really matters is how the man requesting same gender care responds to that surprise. What matters then is how the nurse or receptionist responds to a reasonable, rational explanation of why the man wants same gender care. If the man isn't satisfied, the he should ask to speak to a supervisor. My contention is, with the specific case your bring up, you will more often than not, find people who will work with you -- if you remain civil, use good reasoning, work your way up to the top, and remain polite. I'm not saying this always works. And when it doesn't then you need to take action that will make those at the bottom regret that your request had to go so far up the ladder. At some point way up top, someone is going to ask those below: "Why did this matter have to get to me? Why didn't you solve this several steps down? Why can't we just give this guy what he wants? Can't we just schedule him so there's a male nurse available? What's the big problem?"
Because the nurse or receptionist acts surprised, are you assuming that your request won't be granted? Let them act surprised. That's okay. What matters is what happens next.
MER, I would toss this out there, if a female asked for same gender would there be a surprised response? Is it more likely that providers including the receptionsit are surprised men get embaressed or have preferences or is it more likely they are surprised a man would ask....while I think it is a mistake to go in guns blazing without even giving them a chance, I think it is appropriate to point out the double standard, if a woman were to ask for same gender would you be surprised. I have a hard time believing it isn't just easier to pretend providers don't know than it is to acknowledge they do and be faced with the choice of openly ignoring patient comfort or undertaking the effort and expense to deal with it. I really question how many times the "first time a male has asked" are really the first time they were asked much less first time they were aware.....
swf, I think you are very tuned to peoples feelings. I know for myself, if the situation is such that I have a hard time standing up for myself i will "work myself up" for the task and go in a lot tougher than I normally would. If I antcipate resistance I go prepared...I never took anything you wrote to be I hate female nurses...rather I felt you were stating that there needs to be a balanced and equal treatment between the sexes, which I agree with and truely appreciate your comments and throughts especailly when you are not standing for yourself, but others.
CNA Kelly, I am glad you joined in and hope you do not become offended and leave the blog. The majority of posters here have modesty concerns and feel they have been violated in one manner or another. We are presenting things overwhelmingly from our side so it probably seems like you are being ganged up on, your views and thoughts are very valuable. That said I think you misread my post, my point was I do not find the arguement that women are held to a different standard for body image therefore it is somehow understandable that they empathize with other women in settings like healthcare. My point was every segment of society could make similar claims, none of which justifys a double standard or discrimination. I also am trying to understand your post, if I read it right you are saying you have a job to do and just need to get it done, the modesty issue, double standard, whatever is a hinderence to you getting that job done so it isn't discrimination or a double standard, its just you getting your job done. I have to take issue with this, you aren't on an auto assembly line, these are people and people have feelings, while it may be a job to providers and the mechanics of the job may take priority, the patient has multiple things going on and are focused on themselves, it is a stressful situation that revolves around them as the center. You may look at the list of patients you need to get through...they see what they are going through, modesty, embaressment, humiliation, shame, and unpleasant proceedures are part of that, and they look different from our side of the picture....alan
"I think it is appropriate to point out the double standard, if a woman were to ask for same gender would you be surprised."
Alan: I think that's a good response, and it can work best if it's said in a calm, polite, civil tone. On the one hand, it doesn't really matter whether the nurse or reception is really surprised or is faking it. What matters most is how the male patient proceeds with his request. Certainly, point out the double standard, but I wouldn't get aggressive at this point. I don't think it's constructive to argue with the receptionist as to whether she is really surprised or not. Get to the point. This is what I want. You would do this for a women, so you need to do it for me. Gender equity and all that -- but all this said calmly and politely. Now, if you get rude responses, there's no need to be rude yourself -- but you can certainly be clear and adamant that you will not tolerate rudeness, that she is being unprofessional, and that your expectation is that you will be treated with the same respect that a woman would be treated in the same situation.
Conflict resolution. These are my needs. What are you needs? These are my assumptions. What are you assumptions? Let's get to where we want to go. This is what I want. What do you want? Can we work this out. Be polite. Be calm. But be firm.
I may have written this before but it seems appropriate to emphasize again. It is my belief just from being in the healthcare professional environment that I am sure that most healthcare professionals feel they are competent to do what they are trained and have experience to do. They are expecting if patients come to them the goal of the patient is for the healthcare professional to provide the services to get them well. Yes, they are expecting modesty and professional behavior in examinations and treatment.. but (and this is a big BUT) they are not expecting the patient to discriminate the healthcare provider because of the provider's gender. This is an important point to make and I will repeat it: Healthcare providers do not expect the patient to discriminate against them and their skills or behavior simply based on the healthcare providers gender. And in a sense when a provider is told otherwise, it will appear as a humiliating and denigrating behavior on the part of the patient.
Is this behavior on the part of the patient fair? Is the reaction of the healthcare provider fair to the patient where the professional standards are to minimize self-interest and attend to the best interest of the patient? Whether it is fair or not for both parties standards, I can't say but I want to make clear to all that this is the issue that needs to be mitigated.
I have been one of the professionals in the past who was ignorant of such views of patients regarding my gender. No patient has ever and I mean ever informed me. My education to this has come entirely from these 20 volumes. And I am sure most healthcare providers whether physicians, nurses or techs are equally ignorant. Exceptions, presumably would be those in OB-GYN where gender selection has become easily recognized by the specialty.
So please, with all the advice to potential patients written here, everyone should bear in mind of the ignorance of all of us in the healthcare profession except a couple of us blogger moderators. When you talk to the doctor, nurse or tech, stay calm and take the role of an educator.. because that is exactly the role which is required at that point and not one of a demanding consumer.
With that said, let's get back to the discussion.
Looking at the number of posts on this volume, it looks like we will be moving on to Volume 21 soon in keeping with our decision to limit the number of postings to a little over a hundred so so. ..Maurice.
I think it's easier to TELL them politely that you want a male or female tech/nurse/doctor.
I won't see men when there is the possibility of exposure - in fact, I MUCH prefer women for everything.
I had a couple of bad experiences when I was young...affecting my trust and comfort level with men.
Some of my friends go into brain-freeze to get through...this makes no sense to me...why do that to yourself?
One friend was lumbered with a male tech for a mammogram - she is very reserved and was too embarrassed to say anything - she got a severe stress rash on her body and the anxiety caused an asthma attack...
While she was sitting in the reception area with a female nurse looking after her...she mentioned the extreme embarrassment probably caused the attack.
The nurse was sympathetic but said they were short staffed so women who didn't point blank refuse a male tech, got the male tech.
It has made my friend stronger and I think she'll be better able to make a stand in the future.
There have been very few occasions requiring exposure in my life (thankfully) but I won't hesitate in the future to make my wishes known and leave the facility if they can't accommodate me.
If you're short-staffed, sort it out...don't compromise people's privacy and comfort levels.
Can you imagine any other facility getting away with that statement? (gym, pool, sauna)
You'll have to get changed in a mixed room today...we're short staffed!
Why do they think they're different to the rest of the world and the rules of the civilized world have suddenly changed?
Is it arrogance, ignorance, misuse of the "power dynamic"?
I shared a house with several doctors for a year in 1997 - three male doctors and one female.
It sickened me to listen to the male doctors open-up after a few beers...talking about their female patients...ones they "enjoyed"...their "favorites"...the "ripe" ones and the "gross" ones.
Never believe that men change when they become doctors.
They may remain professional, but they're still taking advantage in my opinion...still using their professional access for their enjoyment and amusement.
I never heard the female doctor speak in that manner.
She admonished them when this talk started in her company.
I can't comment about female nurses.
I don't see male doctors...it's all female care for me.
Any man who says he doesn't notice, doesn't enjoy viewing and touching some of his patients is a liar. It seemed to me this talk was accepted as normal...certainly their friends engaged in it as well.
I think they may be more careful when non-medical people are around...
In my case they simply forgot I was sitting in the next room trying to study.
I note your comments about female nurses.
Sadly, nothing surprises me anymore...
Hi I posted this link from a from 2000 in discussing sexuality in the context of cancer treatment for men and women. Look at the difference of approach in relation to discussion of men and womens wishes to opposite gender care. Male dismissed and woman acknowledged! Also the approach is relation to whether partners should be involved or not. (Do they realise how patronising some of the comments about male patients seem?) This is the link:
http://theoncologist.alphamedpress.org/cgi/content/full/5/4/336
Chris
That surprised response is purposely calculated to disperse
guilt. The matter has presented itself to them before. I don't
feel that inclined to educate
them and shouldn't have to.
Ask for the supervisor, ask for
their mission statements,which you
know in advance. Remind them you
are paying for the service. They
are well versed in the art of the
double-standard and as such I
shouldn't have to bring it up.
PT
That's an interesting article, Chris. For me, this was one of the most revealing parts: "Patients often have unvoiced concerns and agendas, and the social and psychological context of the medical dilemma profoundly influences how patients cope. Indeed, under stress, both staff and patients may limit how much information is exchanged"
Isn't this what we're talking about? Getting this whole subject out in the open. As the professional with the knowledge, as the one with the real power, caregivers are obligated to open up this discussion with their patients.
Doctor, you write: " Healthcare providers do not expect the patient to discriminate against them and their skills or behavior simply based on the healthcare providers gender."
First of all, I don't think skills or behavior really have anything to do with this. It's a comfort issue, psychological and/or cultural issue. Secondly, the use of the word "discriminate," although correct, tends to place this issue beside racial and sexual discrimination,which it isn't. Same gender choice for cultural, psychological, personal comfort reasons, is not the same as sexual or racial discrimination. As I said above, the skill of the caregiver usually isn't the issue.
What many of don't understand is this: At least some healthcare workers have personal preferences about the gender of caregiver they see for intimate procedures. Certainly some female doctors and nurses prefer female doctors. And I'm sure some male doctors prefer male care -- and may indeed have the professional clout to make special arrangements. Therefore, why wouldn't they then make the logical leap that some of their patients prefer same gender care for intimate procedures? When doctors and nurses become patients, the literature that some of them produce clearly demonstrates that they are quite aware of modesty issues. I've referenced a few books in past posts.
I can believe that healthcare workers get so busy and routinized that they shut out gender issues, or that they shut them out as a defense mechanism -- but I can't believe that many of them are not aware that gender plays a role in patient comfort. They may need to be reminded. But they know. They may not like being deselected. They may resent it. But they know some people are more comfortable with certain genders. I think it's this perception of game-playing, supposed ignorance, that may annoy some patients even more than the the lack of choice.
I am not sure that most doctors would have or display gender preferences for their own healthcare provider. I think most doctors, however, would prefer not to have one of their close colleagues as their personal physician or have colleagues or nursing staff from the hospital where the doctor attends to them. I doubt the gender of the provider is an issue for most physicians. I have never heard of it in my 50 years of practice.
I only wish we had more physicians come to this blog and honestly give their views of the issue. Has anyone out there actually brought these threads to their own physician's attention? If every visitor here would do that, perhaps we would begin to get some insight from the other side of the doctor-patient relationship. ..Maurice.
In response to the comment by Dr. Berstein about discrimination against providers... I do not see it quite as discrimination.. when my insurance decided to choose my PHP they gave me a female doctor.. I ws fortunate that th same practice had a male doctor and the front desk staff said it did not matter if I saw him instead.. I explained that I was in no way disparaging the medical abilities of the lady.. but that I was uncomfortable enough about opposite gender care.. that I would just not go at all. I am not putting that lady down at all... modesty is not discrimination... That office seemed ok with it.. (they did laugh a bit when I told them, but they did not ridicule me or try to get me to see her anyway.. and as I knew that the reason I was going to a doctor anyway was over an issue that was going to involve intimate parts and would be tooo embarrassed to even mention it to a female doctor.. I feel I did nothing wrong. Had I not been allowed a male physician, I would have sought alternative treatment.. even though I was not sure exactly what was wrong. I am happy with my choice , but another guy going there said the lady was better than the male doc.. about the same issue.. he told me months afterward.. but not even that gives me second thoughts.
leemac
I just read the article at the link provided by Chris... wow... talk about bias and double standard.. they start off with some truths and procede to loose it.. That urologist is in for one big surprise as I do not think guys are gonna quit saying lady doctor in the next few years...
My thoughts are probably ad hominem so I won't say more...
leemac
I was shopping for a "get well" card for my male friend yesterday. I saw one that had a photo of a sexy young "nurse" with the caption "time for your sponge bath". Now who, I wonder thought up the idea of that card? A man or a woman? Perhaps this is why men's modesty is not taken as seriously.
NP
I am a male. I would not see a female doctor for any ailment whatsoever. If I arrived at an ER without a male doctor, I would leave.
This may sound irrational but I am absolutely clear in my mind that I do not want to discuss any aspect of my health with a female doctor (or nurse) at any time.
I have encountered deliberate nastiness in response to my position.
I am not looking for sympathy or understanding, just male care.
Doctor, you said: I am not sure that most doctors would have or display gender preferences for their own healthcare provider.
We don't know. As we've discussed, the studies are just not out there, thus no stats. But I would suggest that it probably would not be politically correct in today's cultural climate for a doctor, especially a young doctor or medical student, to say publically that he preferred a male caregiver for intimate procedures. That may be why male doctors don't even talk about this among themselves, as to their preferences. Too risky.
I've suggested this blog to a few physicians, but the impression I get is that it's just not an issue for them, at least that's what they say in public. Until it comes to a head, until they they have to face a series of patients who make their modesty levels clear to them, they have too many other issues to deal with. They don't seem interested. That doesn't mean, I think, that they don't recognize the issue exists. But because enough patients don't complain, especially men, they think that even if patients don't like it they tolerate it -- and most probably do just that.
Notice leemac's recent post -- "they did laugh a bit when I told them" -- that's ridicule with a condescending attitude. This where education can come in. We can respond: "Do you think my request is humorous? Would a woman asking for a female doctor be funny, too?" Be polite, but put them on the spot. You'll find it was either nervous laughter, not intended to be insulting -- or else, they don't have a leg to stand on for their subtle contempt.
"Healthcare providers do not expect the patient to discriminate against them and their skills or behavior simply based on the healthcare providers gender."
While I can not dispute what you feel as a healthcare provider, I have to say this is a little odd.
We are not a Uni-Sex society. In all honesty, as long as I have genitals that define me as a woman and others have genitals that define them as men I will always have a gender modesty issue. This should be no surprise or cause any offense to any human being no matter what they do for a living.
I just personally have a preference as to who sees and touches my body.For those who don't care, that is their choice.
I do not see preference as discrimination. After all, I am not talking about refusing to order iced tea from a male stranger. I am talking about refusing to lay naked in front of a male stranger.
One may argue that it is the purpose or intent of the nudity that makes a difference. But we also must remember that all of that 'well meaning intent' is inside the head of the 'caregiver'. What's happening in real life is that I would still be laying there naked in front of a male stranger.
Can anon who posted on August 3 tell us why he would not use a female Dr for anything? Nearly all of us here only want same gender care for intimate issues. Anon seems to be discriminating for purely sexist reasons.
NP, Have you seen the movie "Patch Adams" - the mock up of a woman with her legs spread and the entrance to the Hall is her vagina - this was to welcome gynecologists to the hospital.
The movie "Knocked Up" where the gyn looks under the sheet and says, "Oh, now I see the similarity with your sister"....
Every woman in the cinema cringed and many of the men thought it was tasteless and definitely not funny.
The woman with her legs in the air and a man between them has been the source of great hilarity for many years.
It disgusts me....
BTW my female doctor sees female doctors and said that all young women should see female doctors.
She understands why many women (all ages) prefer female care and this was one of the reasons she chose medicine. Her patients range in age from babies to age 93!
Why would I not use females for any procedure?
If you are attended to by anyone, they get to see ALL of your medical records. They have access to everything (relevant or not to the current condition).
You lose all privacy by simply coming in to contact with them. Your "private" conversation you had with your GP about deeply personal problems becomes "public" domain.
I would not have such conversations with women in the room, so why would it be ok for them to read about it afterwards?
I'm sorry but I find it impossible to believe that medical "professionals" can be unaware of gender issues. Absolutely impossible. Am I to believe that every medical professional that I ever come across has never had a single patient mention the fact that they are uncomfortable being naked in front of the opposite gender? Should I believe that every one of them has never been uncomfortable themselves in front of the opposite gender at any time in their life? If even one person mentions it they should then become aware.
I'll bet the majority of those nurses or receptionists that pretend to be astounded at hearing a gender request from a man at least once refused to go to a male obgyn or allow a male nurse to observe or assist in an intimate exam or procedure. It's not just a double standard, it's a major hipocracy.
I understand though how Dr. Bernstein (in the past) and others like him would not be as aware of the problem. I regard doctors much differently than their support staff. I could understand tolerating an opposite gender doctor for intimate things because they are a doctor. Nurses, techs and assistants on the other hand are much different. To me, they haven't earned the right to see and touch the private parts of opposite gender patients with no regard to what the patient thinks about it. If a doctor needs to work on me they don't normally need my permission to do what they need to do, but any support staff does. For me, a (female) nurse doesn't have the right to do or see anything intimate to me just because she's a nurse. She may feel entitled to my body but I don't see it that way. If she ever feels the need to perform, assist or observe anything of that type she needs to ask my permission, and most if not all of the time permission won't be granted.
GL
cna kelly is the perfect example of what I've experienced (if I understand her comment correctly). All that matters to many of them is that they "do their job", no matter what the patient thinks about it. As I see it patients are the clients so her job is what we say it is, not what she wants to force on us. Her six weeks at the community college doesn't give her complete ownership of my body.
Good for you Lottie. I feel the same.
Lyn, I agree with what you say but it DEFINITELY happens on both sides. Just because your female friend didn't talk that way about male patients in front of you doesn't mean others don't. Have you ever spent time in a nurses break room? Many men can be very cruel but so can many women.
swf, thanks for all your great comments and understanding.
I have a difficult time feeling sorry for Erin Andrews. Maybe now she might understand how men feel when she invades the men's locker rooms. She obviously is not happy about the situation so how can she think the men she violates don't feel the same way? Maybe if even one women's sports organization begins to allow male reporters into the women's locker room they might give this double standard a second (or first) look.
"Anon seems to be discriminating for purely sexist reasons."
Does it really matter what his reasons are? I have to admit that for almost my entire life I didn't care at all if a female doctor or nurse treated me for anything that wasn't intimate but with so many unethical and uncaring female nurses I've seen lately I have begun to distrust female nurses even for non-intimate care. I have never had a problem taking off my shirt in front of anyone while playing sports, swimming or other outdoor activities but lately it has started to bother me doing it in medical settings in front of women. Maybe it's because of a loss of power or maybe because I know that those same nurses feel just as justified to see me completely naked. Whatever the reason, I often ask the nurse to leave even if I only need to take my shirt off.
LG
Anon about the "get well" card..
This is portrayed a good deal. A comic type skit with a nurse "built" really well with a short tight "nursing" outfit on. This portrayal of the "sexy" young well built good-looking female nurse alludes all too well as her care for the male patient being a sexual encounter. Thus, alluding to men wanting and liking a female for intimiate care. This attitude is what prevails among the minds of most female nurses.
GL, I am not aware of any stipulation in the licensing of physicians or nurses where society has denied permission for these professions to examine and treat members of the opposite gender. Obviously, in both professions, the carrying out of procedures without the patient's informed consent, if not battery, would be unacceptable and unprofessional. That means if a patient states "I don't want to expose my intimate body parts to you" that should be sufficient to prevent that exposure, however the professional providing someone acceptable to the patient, within the circumstances present, may not be possible. ..Maurice.
GL and Dr. B, from my experience, signing a consent form for a procedure includes ALL the people assisting the physician/surgeon. By signing the consent form you are giving permission to cross gender intimate care. Even if you never intended for that to occur or if you were told differently. They have your signature and there is nothing you can do about it afterwards.
Erin, I agree with you completely. Even though many of the men that post here seem to refuse to believe that woman ever get humiliated by male Drs anymore and that we woman have won the battle, I was supporting the men to their right to modesty as well. Most of the males here seem to think that women will have complete choice over who sees them naked, but from my own personal experience I have still had to put up with being seen naked by male anesthetists and nurses. I was just pointing out that there is the joke out there that men enjoy being naked in front of the opposite sex. (And perhaps many do). And as you pointed out it, there seems to be the joke out there of humiliating naked women (almost making women feel ashamed of their bodies) - both concepts probably thought up by men.
NP
NP
Female patients are given a gown to
wear when recieving a chest x-ray
irregardless of the sex of the technologist,however,if you are a
male you are expected to remove your shirt and place your bare chest on the machine.
Next time you recieve your chest
x-ray consider asking for a gown
so as not to get contact dermatitis
as its very unlikely they wipe
down the machine after each patient.
PT
I don't believe for ONE second that doctors were unaware of patient embarrassment.
They either didn't care, don't care or accepted it was something the patient HAD to accept if they wanted medical care (in the days before female doctors)
My Gran tells me the standard line was, "Don't be silly, he sees hundreds of women every week"...
Was that supposed to make a difference to the patient?
To her embarrassment and discomfort...
Victims of sexual assault were faced with VERY intimate exams by a male doctor until fairly recently.
Some women couldn't face it and the attacker walked away from his crime.
My grandfather was a policeman and remembers those days very well.
They could offer a female nurse in attendance, but needless to say many women couldn't face a male doctor after the ordeal and some went through with it (some were pressured) and lived with the psychological stress...from the assault and the second assault (in their minds)...
One young girl told by grandad that she felt men were working together to demean and humiliate her.
He advocated for a female police surgeon for many years. He was angered that so many couldn't see why a woman would refuse a male doctor in these circumstances...they heard "doctor" not "male"...
I insist on same gender care for almost everything. You often don't know were a consult might lead...if I'm unsure, I go for same sex care.
I have a female dentist these days...my last dentist was male and had the bad habit of wiping his hands on the bib on my chest...this made me uncomfortable...it was like he was wiping his hands on my breasts.
No other dentist has ever done that...when he started to overservice me...I moved to a female dentist.
I have found a difference between the exam given by male and female doctors. A female dr has never asked me to remove my bra to listen to my heart.....yet two male doctors have asked me to remove my bra...naturally, I refused.
A friend saw a male rheumatologist for hip pain...she kept her underwear on, but had to move her legs about so he could assess her hips. He then decided to check her vaginal area by touching the bones...she was surprised and asked the doctor why that was necessary...he said, "we might as well check everything while we're in the area"...
She was angry and thought he'd taken advantage - if that had been required, she would have insisted on a female doctor.
So many of my friends have now gone over to female doctors to avoid these situations.
I want to get back to cnakelly. She wrote: "What I think of my male patients is none of anyones bizness as long as I GET THE JOB DONE."
I think we see an attitude here that may or may not be significant.
-- Getting the job done. Cna's are basically taught skills, jobs to do. Their training is short and not comprehensive. They're close to the bottom of the power hierarchy so they need to just do as they're told. These days they're doing more and more bedside "nursing" and nurses are doing less. But the point is that their hidden curriculum tells them they'd better just get the job done and move on to the next job.
-- Apparently, cnakelly doesn't want to engage in any discussion about this. Get the job done. That's just the way it is. There's nothing to discuss.
I repeat that I'd like cnakelly to give us her perspective of all this. I'm open to listening to a view from the inside. I'm willing to learn. I could be wrong.
Join us, cnakelly, and give us your thoughts.
NOTICE: AS OF TODAY AUGUST 4, 2009 "PATIENT MODESTY: VOLUME 20" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 21.
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