Bioethics Discussion Blog: Patient Modesty: Volume 21

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Tuesday, August 04, 2009

Patient Modesty: Volume 21



Reading the comments and appreciating the concerns expressed within the comments of both men and women visitors to these Patient Modesty volumes, it is clear that all would want the healthcare system to give patients this healthcare provider gender switch to use. Flicking, the patient could turn off one gender and turn on the one they want to do the more bodily intimate procedures and examinations. This switch, in many cases, is not readily available and that is unfortunate. But, at least, the switch available on this blog, if flicked may turn on a light onto this, previously unlit to many, issue. ..Maurice.

Graphic: The Healthcare Provider Gender Switch. A photograph by me and digitally modified by Picasa 3.

NOTICE: AS OF TODAY AUGUST 20, 2009 "PATIENT MODESTY: VOLUME 21" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 22.

132 Comments:

At Tuesday, August 04, 2009 10:09:00 PM, Blogger Maurice Bernstein, M.D. said...

GL wrote the following today to Volume 20 after I closed it for further comments. Here is the text of the comment. ..Maurice.



"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."

I'm sorry Dr. Bernstein, I wasn't very clear. When I said "doctors don't normally need my permission to do what they need to do, but any support staff does", I was just stating my personal opinion, not the legalities or what society in general thinks. I believe that doctors have the "OK" to do what they need to do to me but I personally don't grant permission for female support staff to do anything I'm uncomfortable with, conscious or not. Their assumptions and sense of entitlement for a backstage pass to any area of my body doesn't fly with me.

GL

 
At Tuesday, August 04, 2009 10:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is another comment, this one from Anonymous which was written to Volume 20 after I closed it. ..Maurice.


"They have your signature and there is nothing you can do about it afterwards."

Maybe not afterwards but any time a perverted nurse tries to take advantage of you during your vulnerable situation you can refuse her gropefest and when she throws a temper tantrum you can do whatever you need to do to defend yourself. If I found out that they lied to me and took advantage of the fact that I was unconscious there would definitely be hell to pay.

If you don't care that they lied to you and took advantage of you while sedated that's fine. But many don't agree with you anon.

 
At Tuesday, August 04, 2009 10:34:00 PM, Blogger swf said...

Dr. B.
The graphic is clever....and the words are greatly appreciated!

 
At Tuesday, August 04, 2009 11:17:00 PM, Anonymous Tim W said...

I have had a number of examinations either naked or almost naked for some or occasionaly alll of the visit by both male and female doctors includiing several where they were specificaly examining my privatesand a colonoscopy which was done by a woman without ever worrying or caring if the doctors or nurses were man or woman. One female doctor after thoroughly examining me everywhere else while in my underwear called in a male doctor to examine my privates though for me that wouldn't have been neccesary. I went back to thatsame doctor the next time a year later and that time she examined my privates herself. The only time I have ever had a problem I was in the hospital after surgery and needed to urinate and was not yet ablet to get out of bed so had to ask for one of those tall things they give you to urinate in. They brought me one fine but then when I needed to use it all of a sudden for no reason I couldfigure out 3 or 4 lady nurses came in and were watching me try to urinate. Only one seemed to have any reason to be there asking me questions regarding the surgery. Theothers at least it seemed to me were just standing around looking at me with my gown up attempting to urinate. Not being used to having women stare at me while attempting to urinate I was iunable to do it until they realized the problem and left. It may or may not seem strange to be embarrassed about having nurses watching me attempt to urinate but not at any other time but that is the way it is for me.

 
At Wednesday, August 05, 2009 12:43:00 AM, Anonymous Anonymous said...

If you were unconscious the doctors and nurses would have no way of knowing your feelings on gender care because you wouldn't be able to tell them. Of course who is assigned to you is going to take care of you and try to stabilize you whether they are male or female. That's their collective job.

Most care wouldn't even center around your genitals in the ER unless that part of you was injured. They would examine your body and insert a foley as needed. The rest of your care wouldn't revolve around your private parts.

 
At Wednesday, August 05, 2009 12:44:00 AM, Blogger swf said...

I've been noticing a disturbing trend among women that I have been sharing 'choices in intimate care' conversations with. While many of them have told me they have become braver in stating their modesty concerns, they do not seem to give their spouses the same respect. How can men expect to be taken seriously with their concerns if (at least) the women in their lives do not respect their choices or support their concerns?
I know each of us has to stand up for our own modesty issues, but how can these women have so much respect for their own bodies and so little for their spouses? I don't expect these women to 'blog for equality' but at least show the men in your life the same respect you show yourself.
I wont go into detail because the stories still disgust me: not because of any gross content, but because they were cruel and heartless. When these men were weak, sick and tired,obviously humiliated at certain proceedures with female caregivers, the wives called them silly...and "little boys." (It got worse, you can fill in the blanks)
I was pretty much spring loaded and launched. How can you not???
I'm not saying I'm proud of how I reacted, but they certainly showed no pride in themselves.
Can anyone please help me understand how these women can be such cruel hypocrites? I will never respect them, but I would like to dredge something useful out of it.

 
At Wednesday, August 05, 2009 4:52:00 AM, Anonymous Anonymous said...

Where did it say that I didn't care about being lied to and taken advantage of while sedated? Talk about reading between lines and making incorrect assumptions!!

I depised and hated what happened. My point is -the healthcare profession covers their a*s everyway from Sunday when it comes to consent forms. "Hell to pay" well, sounds good and you can make one hell of a stink to everyone - which I did, but the fact remains "it happened" and it can't be undone. You can made yourself heard loud and clear but I can tell you they don't change their ways and all you get is the 'ol brush off. They chock it up to one in a couple of hundred patients that had a bad experience and didn't like what happened.

No where did my statement say I didn't care!

 
At Wednesday, August 05, 2009 7:30:00 AM, Blogger Maurice Bernstein, M.D. said...

Tim W, by error, had posted earlier on Volume 20. Here is that commentary. ..Maurice.


about the earlier posts about wearing underwear or not during surgery. In the last few years I have had 2 surgeriesin 2 different hospitals, 1 was a wrist surgery ,the other being a nasal surgery. for both I wore only a gown, no underwear though I do not know why it would be neccesary for either. I personaly had no problem with that. As part of getting ready for both surgeries I was told to remove all clothing including underwear and put on the gown and I never worried about or bothered to ask why.

 
At Wednesday, August 05, 2009 8:10:00 AM, Blogger Maurice Bernstein, M.D. said...

May I remind our new visitors that they, while still remaining anonymous, should end their commentary with some consistent pseudonym or initials so that we know which Anonymous is writing what view. It is very confusing for those who are tying to follow the direction of the arguments. PLEASE, PLEASE REMEMBER TO IDENTIFY YOU POSTING WITH A CONSISTENT PSEUDONYM OR INITIALS!

Here is a current comment from an anonymous visitor that arrived this morning but I can't seem to get it directly published. ..Maurice.


Where did it say that I didn't care about being lied to and taken advantage of while sedated? Talk about reading between lines and making incorrect assumptions!!

I depised and hated what happened. My point is -the healthcare profession covers their a*s everyway from Sunday when it comes to consent forms. "Hell to pay" well, sounds good and you can make one hell of a stink to everyone - which I did, but the fact remains "it happened" and it can't be undone. You can made yourself heard loud and clear but I can tell you they don't change their ways and all you get is the 'ol brush off. They chock it up to one in a couple of hundred patients that had a bad experience and didn't like what happened.

No where did my statement say I didn't care!

 
At Wednesday, August 05, 2009 12:01:00 PM, Anonymous Anonymous said...

My wife doesn't get it anymore than you do, "swf". How can a woman have no feelings when numerous female healthcare workers are looking at and handling their husbands genitals? If a wife at a cocktail party or in any social setting saw a woman hitting on their husband they would no doubt become irrate. Yet, in the medical world it is suddenly okay for numerous women to enter your intimate marital space and there is absolutely no concern or reaction? This makes no sense to my wife and I.
JW

 
At Wednesday, August 05, 2009 4:18:00 PM, Anonymous Anonymous said...

To swf regarding your comment at
12:44 AM.

You've made a good point although something I've known and wondered about,nonetheless,men in
general are not respected especially as patients. Should there ever be another sinking of the titanic I assure you the death
toll for women will be much higher.
Automotive and plumbing books
for women should be best sellers,
and the door swings both ways.Women
can start opening their own door as
I quit holding it open for them a long time ago.

PT

 
At Wednesday, August 05, 2009 6:50:00 PM, Anonymous Anonymous said...

I think what has also been overlooked, as far as men here perceiving that women have been receiving more a more accommodating response in regard to same gender care, is that women are much bigger health consumers than men. Where I live for example there is a women's hospital. (Interestingly the hierarchy still has the top positions at the hospital dominated by male doctors). I haven't really understood how huge ob/gyn is until having had my children at this hospital. So it boils down to financial clout of women en masse, which I think health care providers have become aware of.
NP

 
At Wednesday, August 05, 2009 7:15:00 PM, Anonymous Anonymous said...

there has been a lot of ground covered here over the past couple days.

Dr. Bernstein as much as i respect you and what you have done here I have to challenge your statements that providers are just totally unaware. You and other providers have stated gender isn't an issue for you but having providers you know is due to the familiarity. Do you have a problem with those same familiar Dr.'s giving you vacinations in the arm, looking at your elbow, setting a broken arm? Yet, when providers are exposed they admit having concerns when they know the other providers...so what is the difference, the exposure...the same as when patients have concerns about procedures, its the exposure that makes the difference in both cases. Then there are the providers such as the female urologist from one of the earlier threads who admitted choosing female gyn's and would not go to a male gyn but called a male patient sexist when he didn't want her as his urologist becuase she was female. Then lets look at your comments "Exceptions would be those in ob-gyn where gender selection has become easily recognized by the specialty". I am sorry, but I believe the reality is more providers choose not to recognize or acknowledge vs do not realize. Providers are intellegent people, Dr.'s are assumed to be among the most intellegent of all, they they can not make the connection between their preference and embaressment of being exposed to people they know, and patients exposure as having the common thread of exposure. There have been numerous posts of providers having preferences and asking for accomodation for procedures yet they do not connect the dots for paitents. And what makes ob-gyn so much different than urology that we would recognize females would want same gender providers since it is so intimate, but not think males would want same gender for prostate exams, vasectomies, and erectile implants and problems...how can that be rationalized. I would suggest that the issue is not one of not knowing as much as not being willing to acknowledge it, as acknowledgement would mean they would either have to change protocol to address it or in some cases not be able to accomodate OR it would mean they would have to admit they were not willing to do something that make the experience better for the patient.....if they see it for themselves (even if they change it to familiarity), if they recognize it for ob gyn...how can they not recognize the issue in general...we can fool ourselves if needed...hostages identify with captors (the stockholm effect) soldiers dehumanize the enemy...is this a milder version OR is it what I would call medical arrogance...to insuinuate patients demean providers by discriminating against providers is ludicrous...do providers discriminate when they prefer someone they don't know for intimate procedures, would they discriminate if an opposite gender janitor came in to clean the shower while they were using it or the toilet.
Go to allnurse or other blogs and read how angry nursing students were when they were asked to come in bathing suits to practice bed baths on each other...why do medical schools need to hire practice patients for intimate exams..if it isn't a big deal why not practice on each other...because it is a bigger deal when it is the provider being exposed than when it is someone else...don't know or don't want to admit or acknowledge..even to themselves...I have my opinion...alan

Then there is

 
At Wednesday, August 05, 2009 8:39:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, I can't argue with you since the only doctor I know about is myself. I have never heard nor spoken to other doctors about their own personal modesty and whether they have issues about it. Doctors, in their everyday conversations with other doctors, just don't talk about this subject. Yes, they talk about professional familiarity with other doctors and the issue of having these doctors as their own personal physicians. Most of the concerns has to do with intimate history information rather than intimate physical exam and the other has to do with the issue of VIP treatment. There is concern that a familiar doctor treating another doctor may skip essential exams (including intimate exams) because of hesitations on the part of the examining doctor related to his or her embarrassment about doing the exam or that the exam or procedure might be considered by the examining doctor as uncomfortable to the doctor patient. A slipshod exam and workup is not to the physician patient's benefit. This is about all I can say. ..Maurice.

 
At Wednesday, August 05, 2009 9:39:00 PM, Blogger MER said...

Doctor, you wrote: "I have never heard nor spoken to other doctors about their own personal modesty and whether they have issues about it. Doctors, in their everyday conversations with other doctors, just don't talk about this subject."

I think this speaks to the special sensitivity of this topic, and gender politics in medicine, rather than the fact that it isn't an issue among doctors. It's an uncomfortable topic, even for doctors. I would suggest that especially in today's cultural political climate, it would not be good form, especially for a male doctor, to admit he had same gender preferences, especially to another doctor of either gender.
Does it surprise you that most doctor's don't talk about this with each other? It doesn't surprise me. Most non doctors don't talk about this subject. It's a taboo topic. I've found, though, that once you can get some people to open up and feel more comfortable, they are anxious to talk about it -- like many taboo topics. Others just refuse to open up or become quite defensive. For a male doctor to say in public that he does not want female nurses or doctors for intimate care, I would suggest, might be professional suicide in some circles today. The same would probably not be true for female doctors expressing their preferences. Is this another double standard.
Alan makes some excellent points in regards to familiarity and exposure.

 
At Wednesday, August 05, 2009 10:04:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, aren't you and the others here glad that patient modesty and the conversation about gender selection of healthcare providers is not taboo on this blog? I'm glad since it apparently is a vital subject for discussion. ..Maurice.

 
At Wednesday, August 05, 2009 10:44:00 PM, Anonymous Tim W said...

somewhat off topic but earlier their had been a discussion of doctors becoming friends with their patients. Last week mty aunt died of cancer. The cancer doctor who had cared for her at the end attended the funeral. He was asked if he attended the funerals of all his patients that died. He said no, he never attended funerals butbecause my aunt was a pecial lady who he had become close with while caring for her he wanted to attend hers. As doctors personaly do you try to avoidbecoming close with patients like that. Would you or do you attend the funeral of a patient you had spent a lot of time with like that. Of course the doctor was welcome at the funeral along with anyone else who knew and wanted to remember my aunt who sadly died a terible death.

 
At Wednesday, August 05, 2009 11:12:00 PM, Blogger MER said...

Doctor: I believe we're all glad you've opened up this topic. But where else on the web will you find such a discussion. Is it on any medical blogs? Do any hospital websites have pages devoted to it? Do the even mention it? How many articles have we found about medical modesty, besides the one you wrote and a few others that we've referenced here? Can you cite us a medical text that does justice to the topic, one currently used in medical schools (or a chapter from a book)?
As you've stated a few times, you're not the typical doctor in terms of acknowledging this topic. Maybe the word "taboo" is too strong. But the topic is certainly under the radar. But I think it has an active life under there -- it's just not acknowledged.

 
At Thursday, August 06, 2009 5:13:00 AM, Anonymous Anonymous said...

I have also noted that young doctors right out of school at about 30 years of age have not experienced much in the way of medical procedures. Until they are 50-ish most screenings are not recommended. At 50 is when most exams like colonoscopy, DRE, etc. are recommended. I personally have asked many a doctor when they are recommending a particular procedure for me, "have you ever had this done?" The answer is almost always, "NO." So for the physician/surgeon they for the most part have not been a patient.

 
At Thursday, August 06, 2009 10:40:00 AM, Blogger swf said...

"So it boils down to financial clout of women en masse, which I think health care providers have become aware of."
NP :Isn't this the perfect opportunity for women to use this clout on behalf of men? Sounds odd at first, but if finances are behind it, preferences can shift.

MER:" I think this speaks to the special sensitivity of this topic, and gender politics in medicine, rather than the fact that it isn't an issue among doctors. It's an uncomfortable topic, even for doctors."
Absolutly..And just think how quickly things would change if doctors did talk about it.
And we may be politicaly ready. RX advertisements are now showing women going to women, they speak openly about ED, STD, bladder control, colon/prostate cancer,and myriad of other topics that have traditionally been to embarrassing to talk about. We now accept these issues into our homes through the media. Think how influential it would be if just one add for a facility had a male nurse taking a man's blood pressure.

 
At Thursday, August 06, 2009 1:37:00 PM, Anonymous Anonymous said...

MER, great observation. We as patients sometimes forget we may not be the only one who is uncomfortable. We do not talk to our providers about it as it is uncomfortable, its a sensitive issue so we suffer the consequences rather than talk about it. On the providers side it is probably uncomfortable for a different reason(s). They may be uncomfortable in the begining with our exposure but I think they get past that fairly quickly, they may also be uncomfortable with the fact that their main purpose and goal as providers is care for the patient, to heal them in a compassionate manner. Their identity involves compassion and making it better for the patient. It might be hard to reconcile the fact that in reality you are causing the person you are helping mental anquish that they may or may not be able to do anything about. They are also caught what I would consider peer pressured status quo. It is the medical community who has decided that providers majically become gender nuetral when they get a degree and put on scrubs. It is a self serving concept with no real benefit to paitents. Whether that concept evolved from the administrative side or from providers themselves, most likley a combination, it has become deeply engrained in the medical community. For a provider to stand against that is to stand against the institution as a whole. To acknowledge that providers are not gender nuetral, they are male and female providers does two things, it puts them in a position contrary to their mission of patient care and doing no harm, and pits them against a concept that has become part of the foundation upon which they have built the delivery of their services. Can you imagine the chaos if suddenly every patient was by law given the right to choose the gender of the provider for certain intimate exams...it just couldn't be accomodated even if only 15-20% of patients made a request/demand. It's easy to see why it isn't discussed. We as a society tend to avoid discussions that make us uncomfortable. The civil rights movement started almost 5 decades ago, and the topic is still uncomfortable for many, paticularly in racially mixed settings....how many of us discussed the "teaching opportunity" presented by the Gates arrest...how many discussed it accross racial lines.....every time I think we are beating the dead horse....someone opens the door to something new...great observation....why aren't providers discussing this, the concept of modesty isn't foriegn as exemplified by proper draping and protocols as well as accomodations such as womens clinics and ob/gyn efforts...yet we and providers don't talk about it....interesting.....alan

 
At Thursday, August 06, 2009 2:07:00 PM, Blogger Maurice Bernstein, M.D. said...

I want to report here that I am "spreading the word" regarding patient modesty issues to the medical students I teach.

Today was the first class meeting of my group of 6 second year medical students who are beginning to learn how to perform a proper and productive physical examination. And I started right out with the need for the students to understand patient modesty issues. I mentioned my blog threads and they are certainly invited to come and write anonymously here if they desire.

I may have mentioned this previously but modesty may be a personal issue of various degrees even with my students. Since they have to be undressed to an extent as their they perform heart, lung and abdominal exams on each other colleague, there is always the possibility of modesty concerns by a student (it's very rare). We try to provide and tell them options for them to carry out their learning requirements but with attention to their special modesty concerns.

As I have mentioned previously, I haven't found gender selection concerns expressed by patients regarding the student at the hospitals, neither at the county or private hospitals. But, then again, perhaps like the patient-physician relationships discussed here, patient don't talk about it. ..Maurice.

 
At Thursday, August 06, 2009 4:31:00 PM, Anonymous Anonymous said...

Don't forget that physicians can for the most part treat themselves
and as such avoid medical intervention in most cases. I've
seen a number of physicians in the
hospital over the years that had
become ill in their later years and
some were not treated well from a
modesty perspective.
Irregardless of who you are the level of respect should be the same. Many physicians who need a procedure seek out colleagues who offer the utmost respect for them.


PT

 
At Thursday, August 06, 2009 6:52:00 PM, Anonymous Anonymous said...

Dr. Bernstein I would like to make a suggestion. Tell you students you are going to practice pelvic and testicular exams, that you will not be able to use outside parties so they will need to practice on each other and watch the reaction. Obviously, no one expects this to happen...but see what their reaction is when they are on the other side of the situation...once again, I can not express my appreciation for what you have done here, I can not imagine the hours you put in this and your "day job"

NP, Erin, Ursala, lyn I don't recall anyone saying this was not an issue for women, if they did they were wrong. Women have suffered oppresion and discrimination for generations. It is easy to understand why some might assume the victim role. There are still many areas where women are struggling for equality and equal opportunity. There are many areas where women get the short end of the stick...medicine is not one of them. While this is a challenge for both genders, men face certain challenges that women do not. Those challenges come from two areas: the first is the gender disparity in staffing make up and the second is the perception that male modesty is less inportant than female modesty. Currently slightly over half the graduates from medical school are female, over 90% of nursing students are female. As patients we have the ability to choose our doctor based on gender. We do not have the ability to choose their support staff. While females can choose a female PCP who will in all likley hood have female receptionist and nurses, males can choose a male PCP who will almost certainly have female support staff. Same with specialist, females can choose a female gyn and it would be really rare to not existing that they will have a male nurse assiting, males may choose a male urologist but will almost certainly have female receptionist and nurses assisting. Same with the hospital, for every Dr there are 10 nurses 90% of which are female. The second part: male modesty is not given the same value as female..think that isn't so lets look at some facts..female repprters in male locker rooms while showering acceptable, male in female locker rooms while showering not acceptable, female prison gaurds pat and strip legal in all states, male pat searching and strip searching females..not legal in all states. In some states discriminating against male nurses in obgyn..legal, against women in urology or other not. Womens clinics common, mens nearly non existant. There are many areas where women still have a long way to go for equality, medicine is not one of them..one last point..the federal budget for womens health issues 3X that of male issues, women and childern health have a office at the federal level, men...not

Last point, you say men are liars if they say they don't enjoy it, men talk inappropriately but never heard female dr.'s. go to dailystregth.com and read 10 reasons men don't see dr's. A female Dr feels comfortable about using slang like balls and sticking fingers up guys butt, a male Dr. doing so would be roasted. Go to allnurses.com and search whoa inappropriate where the topic of female nurses taking turns checking our an well endowed unconcious male isn't the issue, the issue is whether they should report it...if these were males checking or a female would this being debated....females are not the only victims of the double standard and discrimination,...alan

 
At Thursday, August 06, 2009 7:56:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, as I may have noted in the past, not so long ago nursing students were required under threat of consequences to perform and allow pelvic examinations on each other in their nursing schools. Teaching under threat is no way to learn. Better teaching is currently done with teacher-subjects both male and female. ..Maurice.

 
At Friday, August 07, 2009 12:07:00 AM, Anonymous Yvonne said...

I agree it's easier for women to find female doctors BUT we are blackmailed/coerced/pressured into unnecessary and potentially harmful testing and exams every day.
Only the strongest and knowledgeable women are able to avoid the abuses forced onto us.
We are largely trapped as doctors control reliable birth control and they will often refuse us unrelated drugs unless we agree to these exams and tests.
We cannot see a doctor for anything without the threat of major intimate violations.
We basically are strong enough to fight back, give in or stay away.
I do the latter....
Haven't seen a doctor in 12 years.
I refuse to have unnecessary violating exams and unreliable tests that lead to more harmful tests.
I won't live my life like that....
My focus is on life, not cancer and death.
So, we have problems...having female doctors hasn't lifted the severe abuses that occur every day across this country.
Men are better able to avoid doctors - at least until you're older (in many cases)
Also, I'm not sure...but I've never heard of a doctor saying to a male patient..."No antibiotics unless you have a rectal exam"....
That happens every day to women in this country - you see a Dr for a virus and they demand you have a full gyn exam before you get your script.
Correct me if I'm wrong...are men coerced in the same unethical way?

 
At Friday, August 07, 2009 2:00:00 AM, Anonymous Anonymous said...

Dr. Bernstein
I do not disagree with you at all. The patient-teacher can bring an aspect of teaching to the process that practicing on each other could never do in that they would gain experience and perspective to pass on to students over time....my point was not to make them do it....it was to tell them they were going to have to do it, and then ask them what emotions that brought up in them. Ask for a volunteer in class one male and one female to act as a patient for a rectal exam or to strip for an head to toe exam...see how many step forward....ask them why....if you tell me they all immediately stepped forward I will have to give you providers don't think about modesty or gender being an issue...but more likely you will have to admit they had a high level of anxiety which would seem to back our contentions that providers know, they may not discuss it but they know deep down...they just may not be able or perhaps willing to admit it even to themselves...please don't take this as condemning them, I wouldn't either in their position...it would take a special person to do so....just still having trouble believing providers are not aware at some level...alan

 
At Friday, August 07, 2009 4:44:00 AM, Anonymous Anonymous said...

Tim W,

You make it too easy for them to take advantage of you. Even if you don't care who sees you naked don't you get ticked off at the fact that they show you so much disrespect? Suppose you didn't want to be seen naked by females, you know they would disrespect you and do it anyway. It's not as much the nudity as the way they forced you to accept everything they felt like doing to you and you had no choice in the matter.

Many things were not only disrespectful but also completely unnecessary. 4 women to watch you pee? What the hell? Naked for nasal and wrist surgeries? Ridiculous! Purely unnecessary exploitation. If you don't care about nudity at least stand up for yourself as a man. You know those nurses were taking advantage of you and you just let them. Coward.

LRY

 
At Friday, August 07, 2009 5:00:00 AM, Anonymous Anonymous said...

swf you are freakin' great! I wish there were more women like you.

LG

 
At Friday, August 07, 2009 5:33:00 AM, Anonymous Anonymous said...

Dr. Bernstein,

I may be mistaken but it sounds like Alan suggested that you say that to your students just to see their reactions, but not actually doing it. It sounds like a great experiment.

Alan also mentioned the string on allnurses.com where nursing students are in an uproar because they don't want to wear bathing suits or sports bras while practicing on each other. Some even said they may consider not going to nursing school if that had to happen. How can that possibly fit in to the discussion that medical professionals don't understand gender issues? Also, why isn't it common for med students to give each other full physicals (gender neutral?) or other exams or procedures involving opposite gender nudity?

Tim W described a situation where 4 nurses entered his room with no other reason than to watch him try to urinate. First of all, how could their presence have been anything but voyeurism? It was perfectly obvious that at least 2 couldn't have possibly NEEDED to be there. But more importantly, I would bet my life savings that none of the 4 would ever be OK with 4 completely unnecessary male nurses doing nothing but watch her pee. In cases like that it's nothing more than power, ego and voyeurism.

Tim, would you consider yourself a good looking or well endowed man?

LG

 
At Friday, August 07, 2009 6:51:00 AM, Blogger Maurice Bernstein, M.D. said...

With regard to healthy medical students not wishing to expose themselves to their colleagues for examination, I don't think that their decision would be in the same context as an ill medical student in an emergency room being examined by a unfamiliar doctor. The context of how the bodily modesty issue arises in also important to understand. In any event, it has been very rare for two women students (only once in my 23 years) to want to practice on each other in a room separate from the men. Virtually all take the repeated experiences in stride and understand their role in the education process. ..Maurice.

 
At Friday, August 07, 2009 9:48:00 AM, Anonymous Anonymous said...

Dr Bernstein I agree with your statement completely...however. The vast majority of our interaction with providers do not involve the emergency room, rather they are with PCP's, specialty clinics, out patient clinics and proceedures, and especially later in life hospitals. These are much more similar, we are expected to disrobe for routine physicals and rightly so. This is little different, they could be told they were going to do a routine head to toe physical exam including a complete skin exam. Most here have acknowledged certain scernios change the dynamics especially the ER. Providers seem to feel at liberty to bring accessory people as well as themselves,(if you have not read Art Stumps my angels are come you should..there is a thread on Dr. Shermans on it) they feel they should be able to include these very students as observers and student doctors to further the students education and we as patients should not have an issue with their presence during exposure or intimate exams...yet these very same students would not be comfortable with their own exposure for the same purpose...educating their fellow students or even themselves....the only real difference between a student dr. shadowing or assisting for the purpose of furthering their education and them learning on each other...is which side of the gown they are on. There is I believe an us and them mentality in medicine. Don't mean that malicously, its probably normal in most other areas. But, providers seem to have two different standards for these situations one for us and one for them. It contributes to what MER touched on, WHY don't providers talk about it....I think pleading ignorance is an easy way out. My daughters used to play selective ignorance on me all the time...I didn't know....you didn't tell me...how was I supposed to know I wasn't supposed to drive 80, you never said don't drive 80...there are things you should know without being told.....

I might also point out how quickly providers blend into the woodwork when they are challenged by this...I know there are more than a few providers who have been sent here....not to many join in and when they do they run for the hills when they face the opposition. Granted some posters I think get over aggressive and might frighten me as well...but chill wasn't scared..he got his feelings hurt when challenged....I think that is telling....alan

 
At Friday, August 07, 2009 9:59:00 AM, Blogger swf said...

Dr. B:
It's great that you are introducing your students to modesty issues. This may be the perfect time, before anyone STOPS believing that it is an important issue. Thanx....

Also, I believe that men and women need to work together on these issues. I have walls to tear down. Men have walls too. I would hate to see genger issues get in the way of ....well, gender issues. I think we need to remember to advocate for each other.
As a woman, yes I feel more accomodated, but I'm not happy with just that. I would like to feel that each step forward I can take, the men in my life..on this blog..and around the country can take an equal step forward.
I am sure that most men here feel the same regarding the women in their life.
Maybe we could all join the patient modesty group started my alan and Jimmy and help advocate for each other?
I am now stepping off of my soapbox..

 
At Friday, August 07, 2009 10:46:00 AM, Blogger swf said...

Dr. B.
I would be interested in the ratio of male to female in your class.

 
At Friday, August 07, 2009 11:20:00 AM, Blogger MER said...

The sad thing about this is that, like all hush, taboo topics, if it were opened up, some would become free of it. It's the secrecy that gives this issue power. Take the secrecy away, talk about it, face it, express your feelings, accept other's feelings -- it begins to lose its power. Some men and women, for whatever reason, will always prefer same gender intimate care no matter what. I respect that. It's their wish. Many I think are on the fence, and which direction they go depends upon how they're approached and whether they feel they are afforded proper respect. Ambush them and they become defensive and mistrust the system. Some of these patients may feel more comfortable with opposite gender intimate care if the whole issue comes out of the closet and they can talk about it with a caregiver who is not afraid to bring the topic up -- up front. No ambusing.

Several volumes back, I mentioned a book called "A Taste of My Own Medicine" by a doctor who faced cancer treatment. It was made into a movie called "The Doctor." The movie ends with that doctor forcing his medical students to wear gowns and go through the same kinds of tests that they require they patients to go through. These medical students are, of course, young, and normally wouldn't be going through tests like this. I would have also forced the medical techs, those doing the testing, to strip into a gown and go through the same tests they administer. That's what needs to be done. Young doctors, nurses and techns need to develop empathy be actually going through what their patients go through. That should give them great insight, and may change the way the see modesty issues. Don't psychiatrists have to go thorugh psychotherapy themselves? Well, medical doctors should have to go thorugh the same process some of their patients go thorugh -- in a hospital where no one knows them and they are not known to be doctors. It would be a good reality check.

 
At Friday, August 07, 2009 11:29:00 AM, Blogger Maurice Bernstein, M.D. said...

Each group of 6 students contains virtually 3 men and 3 women {my group currently does) so the overall school population is about half and half. ..Maurice.

 
At Friday, August 07, 2009 12:04:00 PM, Blogger Joel Sherman said...

Dr B said:
... not so long ago nursing students were required under threat of consequences to perform and allow pelvic examinations on each other in their nursing schools.

Really? Never heard of it and more importantly my nurse wife who was also a nursing instructor for a few years, never heard of it either. She was trained in the Midwest. You're alluding to California?

 
At Friday, August 07, 2009 12:08:00 PM, Blogger Joel Sherman said...

P.S. I meant to add, that as med students, we never examined each other. Rarely an instructor would call for a volunteer to examine in front of the others, but this never included intimate exams. In my day, female med students were about 5%.

 
At Friday, August 07, 2009 1:05:00 PM, Anonymous Anonymous said...

I came across an article from March 2005 titled "Are you man enough to talk about your erectile dysfunction with a bunch of nurses?" and aparently this Boston Medical group did try to set up a mens clinic (for ED treatment) that didn't have female nurses and this nursing association threw a fit.

http://www.nursingadvocacy.org/news/2005mar/bmg.html

 
At Friday, August 07, 2009 5:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Joel, the instruction behavior was throughout the U.S. and not particularly in California. I will get you and the thread the resource information about my recollection. ..Maurice.

 
At Friday, August 07, 2009 6:22:00 PM, Blogger MER said...

"...nursing association threw a fit."

Anonymous: You need to read carefully yourself the link you provided us. The nursing association was angry becuase:
-- The expression "a bunch of nurses." That does carry disrespectfun connotations.
-- That expression implied that all nurses were women, which they are not. They didn't want the term "nurse" to necessarily imply a specific gender. I can understand that. There are male nurses and their numbers are growing.
-- Instead of saying "a bunch of nurses" the ad could have just said that men could talk with other men, male nurses if they wanted.
-- That somehow these men needed to speak only to doctors. They claim, and validly, that nurses can take on this role, too, if the men are agreeable.

Read those articles carefully. The female nurses were not against men talking with men if they felt comfortable. That wasn't their issue.

This is where some people bash nurses when they don't deserve it. The female nurses were not against men having choices. Read these articles carefully.

 
At Friday, August 07, 2009 8:44:00 PM, Anonymous Tim W said...

Due to a medical problem I have I have in fact had a discussion with a female doctor about whether or not I have a problem with being unable to get an erection which I aswerd there is no problem. I had no problem with that discussion but could understand why many men might not want to discuss that with a woman. In my case the doctor treating me for another problem was a woman andthe question was relevant to the other problem so I had no problem talking about it.

 
At Friday, August 07, 2009 9:30:00 PM, Blogger Maurice Bernstein, M.D. said...

Joel, I haven't found yet the professional literature discussing the practice of nursing students doing pelvic exam on their peers. But for individual experiences on the subject, go to AllNurses and here is a concern from a nurse researcher listserv back some 12 years ago. ..Maurice

Should nursing students be asked to undress for fellow students to perform
exams?

This dilemma is now being discussed in our MSN and Nurse Practitioner program
>at SUNY Utica, NY, could use your thoughtful comments and helpful
>suggestions. Our lab for advanced nursing assessment includes lecture and
>then practice on a lab partner. Later this semester we will be studying
>pelvic and rectal exams. I am very uncomfortable with this exam on lab
>partners. I have spoken to several students who, like me, dread it. Two broke
>down in tears when I raised the subject. We all were SILENT in class when we
>were asked to sign permission to participate in that lab. (silence is not the
>norm for these graduate nurses!) We later agreed that the way it was
>presented -- this is part of the required curriculum, sign it and do it. I
>have begun approaching the faculty who have a variety of responses.
>In past semesters, I've heard that studetns who refused were pressured to
>allow an exam on themselves, not allowed to examine a willing volunteer, and
>not offered alternative experiences.
>Personally, I think it is inappropriate to ask this of student peers. a few
>students are not uncomfortable, but for those who are unwilling, is this
>acceptable? I am very interested in learning the exam but is this the only
>way? Is it the best way? How have other schools handled this?
>Will we learn the procedure well enough on a lab partner to make it a useful
>exercise?
>Is there anyone else who would feel violated as a student to be asked to have
>a pelvic and rectal exam by a classmate?
>My son is an art student and he has nude models for his drawing class. Their
>choice, paid position, not a classmate. He asked me if I thought it would be
>"appropriate" for him and his classmates to take off their clothes and sketch
>each other. Intersting perspective :-)
>If anyone has paid models/professional patients, how did this go?
>Please hurry, the semester is swiftly approaching pelvic and rectal exams!
>thank you
>Judith Webb RN,
>Nurse Practitioner Student

 
At Friday, August 07, 2009 9:34:00 PM, Blogger Maurice Bernstein, M.D. said...

Oops! The link to AllNurses from my previous post didn't get published, so I will try again with this link ..Maurice.

 
At Friday, August 07, 2009 9:40:00 PM, Blogger Hexanchus said...

Joel,

You posted:
"Dr B said:
... not so long ago nursing students were required under threat of consequences to perform and allow pelvic examinations on each other in their nursing schools.

Really? Never heard of it and more importantly my nurse wife who was also a nursing instructor for a few years, never heard of it either. She was trained in the Midwest. You're alluding to California?"

Both my wife and sister did their BSNs in the late 70's/early 80's and this was not a requirement in their program either. The students never did any exams on each other requiring any type of intimate exposure.

 
At Friday, August 07, 2009 9:48:00 PM, Blogger Hexanchus said...

Doctor B.,

The reference you posted is from a NP student, not an RN student - I don't think the programs are directly comparable.

 
At Friday, August 07, 2009 10:50:00 PM, Anonymous Anonymous said...

I have seen the article regarding the Boston Medical group and the
site nursingadvocacy.org. But stop
and think for a moment about what
the Boston Medical group was doing,
accomodating men.
Did anyone ever think that maybe
men had complained that perhaps they would be more comfortable talking about these problems with
other men.
That site nursingadvocacy.org
should spend more time advocating for patients first before they advocate for their own.

PT

 
At Friday, August 07, 2009 11:54:00 PM, Blogger MER said...

Doctor: I read the info and link you provided about medical students and nurses examining each other. I'm not sure what point you're making.
To me, these represent evidence that modesty is an issue among medical professionals. It isn't just about familiarity. I think Alan made a good case for that a few posts back. These student don't want to expose themselves. There is a fear from some that men could possible be involved. This isn't just about familiarity and the student context. It's more than that. To me, this seems to indicate that modesty is more the norm in our society than we like to admit, even among medical professionals.
We all see things from our point of view. We like to think our case is special, our context is different, our sensibilities can be rationalized. No so with others. Do these students have a difficult time transferring their discomfort in this context toward patients? Some do. I think most make the connection. Depending upon the staffing and the ideology of their workplace, they may or may not be able to accommodate patients the way they would like.
What's your main point with these postings, Doctor? Besides the fact that you seem to be saying that students shouldn't be forced to do this (I can see your point), what does it suggest about their attitudes toward the body and modesty that they need to be forced?

 
At Saturday, August 08, 2009 6:26:00 PM, Blogger Joel Sherman said...

Dr B,
As pointed out already, the examples of nurses possibly doing pelvic exams on each other is referring to graduate nurses, nurse practitioners or midwives. They are trained to do physical exams and the scenario is at least possible.
But years ago, before advanced nursing degrees, nurses weren't trained to do any thorough physical exams and certainly not invasive ones like pelvics. The suggestion that undergraduate student nurses were mandated to do pelvics on each other is unbelievable.

 
At Saturday, August 08, 2009 6:54:00 PM, Anonymous Anonymous said...

Here is a question that I am not sure how to word...it makes sense in my head but when I write it...not so clear. Do providers not really understand modesty...or just patient modesty. They understand modesty when it applies to them as they do not seem themselves as patients...however when they are dealing with our modesty...they have dehumanized if not us..our modesty. We are not people, we are paitents, much in the same way soldiers dehumanized the enemy which allowed them to do what they needed to do. These normally kind and gentle men were now forced to become violent killers to survive. They enemy became japs, gooks, krauts, etc...maybe we become patients, it makes it easy to do things that they know cause us great anxiety...thus, they choose not to talk about it, and ignore it even happens...modesty is a natural trait in our society for people...for paitents...not so much. Obviously they are forced to recognize a certain degree in certain cases....if look at the as paitents..not people..and don't talk about it, it avoids a lot of complications...but we know we are people...so when it is us....how else does a student Dr or nurse justify having such strong feelings against being exposed for teaching purposes...but expect others to partcipate for their benefit.....alan

 
At Saturday, August 08, 2009 6:58:00 PM, Blogger Maurice Bernstein, M.D. said...

Joel and MER, I am still trying to find the references regarding teaching RN students the pelvic exams by peer examinations. Hopefully, the technique is now out of style but I know from reading in the past that this was not an isolated tutorial behavior.

For whatever it is worth in this discussion, here is an Abstract of a recent study comparing the responses of graduate nurse practitioner students to learning pelvic examination either by a standardized patient teacher or by means of voluntary peer examinations with a supervisor educator standing by. From the Journal of American Academy of Nurse Practitioners Sept 2006. ..Maurice

"Graduate students' experiences with standardized patients as adjuncts for teaching pelvic examinations."
Theroux R, Pearce C.

Graduate School of Nursing, University of Massachusetts Worcester, Worcester, Massachusetts 01655, USA. rosemary.theroux@umassmed.edu

PURPOSE: To explore graduate nurse practitioner students' perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs). DATA SOURCES: Surveys with open- and closed-ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course. CONCLUSIONS: All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates. IMPLICATIONS FOR PRACTICE: Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost-effective, voluntary peer examination was a less effective teaching method.

 
At Saturday, August 08, 2009 7:26:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, you raise a good point regarding how a doctor looks at you: a patient or a person or both. I can tell you that one of the most important concepts we.as teachers, try to impress on our first and second year students from the outset is that they are interviewing and examining not an object but a subject, not simply a patient or someone with a symptom or a diagnosis or even just a disease but a full human person. This the concept of humanism that we spend time talking to the students about and watching how they interact with their persons and how they write about them in their write-ups. That means that modesty is just a part of the person as the person's heart, lungs and the disease. So the concept is there at the beginning of their education but much can happen later to affect how they scale the importance of patient modesty when time is limited, resources limited, the pressure is on to make a diagnosis and start treatment..and so on. But, if doctors start to wander away from certain aspects of humanistic thinking because of these factors, it behooves the patient to remind doctor. That is why these threads have been so educational for me.

But rest assured, we do our best, at the beginning, to supply the students with a humanism concept and a need to apply it to their patients. The patient is not just a "patient" but a human person. ..Maurice.

 
At Sunday, August 09, 2009 9:27:00 AM, Anonymous Anonymous said...

The area I am in has their nursing students use a "professional patient". The medical school in Tucson also uses them I believe.

The medical school in New Mexico(doctors) had to pair off in opposite gender pairs and perform hernia and breast exams on each other..as I was told by two doctors who attended that school.
There was an article in Readers digest about the one in Tucson I think..
There was also an article by a patient having open heart surgery where the surgeon was female. The guy was not out, but was paralyzed by drugs.. he could hear and feel everything... If I could find if there was a link, I would post it.. most unprofessional conduct by the surgeon.
leemac

 
At Sunday, August 09, 2009 12:41:00 PM, Anonymous Anonymous said...

I also remeber reading about an elderly male "professional patient".
He said he was doing it because it was something he could do that he felt was usefull. He seemed to have no problem with students of either gender. I think there have been and maybe still are, a whole series of these articles in readers digest... Remember " I am Joe's body" or something like that?
leemac

 
At Sunday, August 09, 2009 1:57:00 PM, Blogger swf said...

After reading the comments from student nurses everywhere on the net,the point of 'having a choice' is quite clear and universal to all human beings. I don't think any of us are shocked or surprised. Perhaps indignant over the hypocricy, but not surprised.
Some choices may be slightly different, but the core issues are the same. Some students may care about colleagues,peers, teachers, opposite gender, or just the right to say no. Isn't that the point all of us here are trying to make?
What is the difference between their right to their own bodies and ours? We are all just people.
For example:I don't want to be a guinea pig for a bunch of student nurses. As it turns out, they don't want to be either. They speak of hiring professionals so they don't have to undergo embarrassing exams. They hope someone will volunteer to be exposed when they don't want to be exposed themselves.
In the end it's still the same...I don't care what I do to YOUR naked body, but I want the right to choose what/when/why/ and by whom when this happens to mine.
Same thing we all want?
Everyone knows that we all have modesty/privacy/moral issues with our body in some form. And in the end, we all care about those and we all know it.
I don't believe anymore that it is so much about us being dehumanized, as it is devalued.
Their comments make us look like worthless creatures, while they are the special and skilled elite.

 
At Sunday, August 09, 2009 4:45:00 PM, Anonymous Anonymous said...

SWF, well said, I have struggled with your comment devalued or dehumanized...and I reconcilded them to a large degree as the same. We veiw humans on one plain, all other living creatures on another, they have less value. While I think providers may value us as humans, they devalue the importance of our modesty....we are important as people but our modesty has been devalued. The question to me is why-how. I truely believe the issue has a lot to do with the fact that they have a job they Want-need to get done. Accomodating modesty slows that process, therefore it is in their benefit to discount the importance of modesty to patients. In order for this to work, we need to go along, to get us to go along they need to project this concept of gender nuetral....however, it is a projection that I believe deep down they know is merely a way to get things done....thus when they are the ones facing it, the truth comes out.....one has to ask, who does the concept of gender nuetrality really serve, the patient could be perhaps best served by accomodation...the providers are the ones who benefit most, and perhaps the business side of medicine benefits most....I have found a reasonable amount of success just making my wishes known...it thinks its an indicatoin they know, many are not willing...wanting...to fight the battle....perhaps a battle they know is right but aren't able or willing to acknowledge...alan

 
At Sunday, August 09, 2009 5:20:00 PM, Anonymous Anonymous said...

Perhaps the hypocracy stated bys swf is a golden opportunity. The obvious feelings of student nurses relegates them back to being human.. and could be used to convey that patients are human as well and that there are going to be patients who want or prefer one gender or another because of their feelings... That gender preference of the provider by patient is not a slam at them... and has validity. And that it is not an issue for one gender only, but one for many in both genders..
leemac

 
At Sunday, August 09, 2009 5:23:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, I think you are touching on what is the real mechanism of physicians' ignorance of all the permutations of patient bodily modesty. I think we have talked about this before--but it is simply this: "getting the job done". They believe the patient comes into the office, comes to them and that the patient's motivation is for them to diagnose and rid the patient of the symptom. Whatever modesty issues beyond the ones which the doctor has previously heard from their patients about is only theoretical, even if considered, should not interfere with the physician's goal to diagnose and treat. Yes, spending more time in discussion of modesty and attempting to mitigate the issue for the patient is time consuming, diminish income and awkward and just philosophically inconsistent with the purpose of the visit. So the doctor thinks as a technician who has a "job" to do and to satisfactorily complete but not as another human who may have similar personal modesty issues.

Change the concept in the doctor's mind as to what the patient expects the doctor to professionally do and you may find some resolution of the modesty issues described on these Volumes. ..Maurice.

 
At Sunday, August 09, 2009 5:38:00 PM, Anonymous Anonymous said...

I want to further elaborate on the
nursingadvocacy.org site and their
opposition to the boston medical
group. I've followed this site for
a number of years and their letters
of concern.
Generally,they are careful with whom they choose to complain to but
typically involves nurses portrayed
in a sexual fashion. Some examples
are holloween costumes that feature
a sexy nurse costume complete with
fishnet stockings. Many of their
concerns have been directed toward
the porn industry and how nurses
are portrayed.
Whats revelant is how nurses came
to bear this stereotype which has been essentially the case for decades born from their behavior
since the early 70's. I'm suggesting that the naughty nurse
nymphomaniac stereotype exists
partly from the manner in which the
entertainment industry perpetuates
such stereotypes which certainly
are derived much from fact.
Furthermore, stereotypes are mostly cast from those that have a
front seat to such behaviors,
specifically male patients. The
internet is a relatively new medium
on the information front and a
thread on allnurses titled dating
a patient only provides further
insight.
What I thought disturbing about
the thread was that not one nurse
stated that it is a violation of the nurse practice act to even suggest to a patient an interest
in dating.
I wonder what the nursingadvocacy.org would think about that.

PT

 
At Sunday, August 09, 2009 7:23:00 PM, Anonymous Anonymous said...

Does anyone else get the feeling from the last postings that stereotypes and lack of recognition that providers and patients are human beings.... might be both the basis for problems and at the same time key to the solutions and remedies sought?
PT
The entertainment industry has stereotyped nearly everyone from nearly all possible angles... You are right about the sexy nurse portrayals causing real nurses grief.. especially by some off kilter patient who takes them to heart... I know I have hated it when somone cracks a joke about "well how do ya like all the cute nurses" or similar takes on going to a doctor or hospital... It is just that it goes for patients and providers of both genders.. and I have no idea how to not interfere with teh first amendment rights of the entertainment industry, yet make them accountable..
leemac

 
At Sunday, August 09, 2009 11:58:00 PM, Anonymous Jan said...

I wonder how many student nurses and doctors dropped out of the course.
If I were faced with having a fellow class member perform any sort of intimate practice exam on me...I'd leave the course immediately and lodge a formal complaint.
I wanted a job a few years back, but the pre-employment physical was so comprehensive, I decided I'd take another position that only required a basic exam with the company nurse.
These things do affect some people's behavior...it's just that in many cases, nothing would be said, people would just disappear.
I imagine those who felt compelled to submit, might suffer afterwards.
I think exposure is difficult for many people, but to a class mate (female would be bad enough but opposite gender is horrifying) it's beyond belief.
It makes me wonder at the intellect, motives and sensitivity of those who came up with the idea.
There was a drama teacher in our State pressuring his female students to do a shower scene totally naked or topless....if women objected, they were basically told they had no future.
These people are opportunists and deviates...
I think a good rule is to walk away from anything that makes you uncomfortable. If it feels wrong, it usually is...

 
At Monday, August 10, 2009 9:54:00 AM, Anonymous Anonymous said...

This is how they feel when they have to get undressed......

http://allnurses.com/gastroenterology-nursing/dreading-my-first-118141.html

 
At Monday, August 10, 2009 5:03:00 PM, Anonymous Anonymous said...

After reading PT's post, I too got to thinking about the "nurses" raunchy depiction. Maybe it derives from the mere fact that "females" are doing very intimate procedure on male bodies. This in itself brings some degree of 'sexuality' inspite that it is in the name of medicine.

Do the same pictures of sexy nurses show up with the nurse working on a female patient - NO! Enough said.
JW

 
At Monday, August 10, 2009 8:55:00 PM, Anonymous tim w said...

I do not recall if I made this clear in my earlier post but I was most definitely not happy about hhaving several women watch me urinate. There is a difference between being seen naked for a reason by any medical person and having several people watch you try to urinate for no apparent reason, something I prefer to do in private. I did not complain at yhe time though perhaps I should have but I was most definitely not happy about it

 
At Monday, August 10, 2009 9:01:00 PM, Anonymous Tim W said...

as to the other question if anything if the nurses were staring it might have been because of the unusualy small size of my privates for an adult male and no I am not good looking.

 
At Monday, August 10, 2009 10:50:00 PM, Anonymous Anonymous said...

Tim W said

Has it dawned on you that your privates has an incredible hypnotic
effect on the nurses. That it somehow partly shuts down their
brain function. For your sake,don't
let the x-files find out about your
powers.

PT

 
At Monday, August 10, 2009 10:52:00 PM, Anonymous tim w said...

WQhen i had a colonoscopy last yaer I was awake for all ofit with full memory afterwards. It was in fact perfomed by a woman. I do not know what is more common for a colonoscopy, to be fully awake or asleep or somewhere in between.

 
At Tuesday, August 11, 2009 1:27:00 PM, Anonymous Anonymous said...

I would wonder why so many nurses too, Tim.... it is very reminiscent of my waking up from anesthesia when I was 11 to find my self naked on a bed with 3 nurses hovering around me.. and one commenting about my becoming like my dad..(he had had two surgeries in the months before me).. There was absolutley no doubt, even to an 11 year old, what they meant... what they were talking about was plain.
leemac

 
At Tuesday, August 11, 2009 4:02:00 PM, Anonymous Anonymous said...

Tim W.. the vast majority of colonoscopies are done with sedation. Propofol is usually given today. This is the drug that you've been hearing about on the news that Michael Jackson supposedly succumbed to. It is given IV and in 20 seconds knocks you to sleep for usually 20 minutes. No memory of anything. An anesthesiologist or nurse anesthestist must give it and monitor the patient. Oxygen is given thru nasal canula.

Colonoscopies are uncomfortable as the air causes cramping and the docs ususally like to do the thing without worrying about patient comfort. They can get the "job" done easily and quicker if a patient is OUT.
JW

 
At Tuesday, August 11, 2009 9:24:00 PM, Anonymous tim w said...

about colonoscopies I know all about how uncomfortable they are since I was awake through the whole thing. It was amiserable experience.

 
At Tuesday, August 11, 2009 10:11:00 PM, Anonymous Anonymous said...

I guess the solution to all of our problems would be if whoever was providing intimate care should be required to be naked as well. Then maybe more men would WANT cute young female CNAs instead of despising them. Sounds fair to me. Then the "power dynamic" would be equal. Caregivers won't be so full of themselves and the patients won't feel as intimidated or completely powerless. I'll bet that particular office or hospital would get plenty of business.

 
At Wednesday, August 12, 2009 4:41:00 AM, Anonymous OPT said...

How much exposure is there with a colonoscopy?
Are your genitals exposed?
Just wondering whether I take opposite gender appt next week or wait 9 weeks for same gender...
If there is exposure, I'll wait the 9 weeks.
Also, how many people are usually in the room.

 
At Wednesday, August 12, 2009 8:08:00 AM, Anonymous tim w said...

I can obviously only speak for myse;f. I do not know what is usually done or if it makes a difference if the patient is asleep or not but in my case my privates were covered at all times. they had me get in position mostly on my side while my fromt was covered by a gown and blankets while they obviously went in from the back. I was awake the whole time and it waas a miserable experience.

 
At Wednesday, August 12, 2009 8:14:00 AM, Anonymous tim w said...

Almost 5 years ago I spent several days in the hospital after an astma attack. I spent the whole time in pajama pants and underwear. Nudity was not necessary for astma and I do not think anyone saw me naked during that time. I would not have been comfortable spending that entire time naked with everone including visiters coming in and out of the room and it wasn't necessary of course.

 
At Wednesday, August 12, 2009 8:21:00 AM, Anonymous Anonymous said...

So is it ok to expose evrything from the back to the oposite sex, just not everything in the front???
We need to rate the importance of our parts here.
I'll start. My exposed and spread butt is up there with my genitals.

 
At Wednesday, August 12, 2009 8:25:00 AM, Anonymous Anonymous said...

for a colonoscopy u wear a gown. once u r sedated, if there are any problems, the gown is pulled up and your stomach will be massaged to help move the scope. Exposure would be total and prolonged.

There are usually 3 or 4 people in the room, usually at least 3 of whom are female nurses.

 
At Wednesday, August 12, 2009 9:00:00 AM, Anonymous Anonymous said...

colonoscopies usually have the doctor, a nurse to assist and hand the doctor instruments,& a nurse anesthetist or anesthiologist if sedation is given. Patient lies on left side with right leg bent at knee and pulled up.

A large flat screen video monitor is above the head of the bed on the right sidev visible for all in the room to view. The instrument is lubed and the doctor inserts their finger to examine by feel the anal and rectal area then inserts the tube. As the tube is moved into the area for isertion the entire gential area from the backside is completely viewed due to the fact that the tip of the instrument has a fiberoptic lens.
For a female her genitalia is viewable. For a male his scrotal area is viewed.

 
At Wednesday, August 12, 2009 9:03:00 AM, Anonymous tim w said...

It is obviously up to each person if they want their rear end exposed to the opposite sex but since that is where they stick the thing at the very minimum that can not help but be exposed.

 
At Wednesday, August 12, 2009 9:50:00 AM, Blogger MER said...

The details of how a colonoscopy is done certainly may vary. I recall doing a lot of research before I got mine -- and finding much misinformation on the web. As with other procedures, there's a significant amount of information you may not be told if you don't ask. I think this is what contributes to all this misinformation out there.

But I must say that as far as exposure goes, I was covered appropriately and I felt my privacy and modesty was respected. I did mention my thoughts about this to the doctor ahead of time and got the impression that he was in touch with the issue.

A few items to consider:
-- I was awake and alert during most of the procedure. I wanted it that way and my wishes were respected. It got more painful just before it was over and I agreed to a little more medication that helped. I watched the screen for most of the time and asked questions. Decide whether you want to be alert or not.
-- Ask ahead of time exactly who will be in the room. If I hadn't asked, I would have been confronted with a medical student at the last minute. Normally I would have agreed to this, but it was just assumed that this was going to happen and they were planning to ask my permission at hte last minute. Becuase of that I declined. This is sometimes not mentioned to you up front.
-- There were to male doctors and two female nurses. I had no problem with female nurses. Frankly, everyone was extremely busy during the procedure. And it was obvious that the nurses were looking out for my comfort.
-- You're often told that you'll be on your right side, but rarely told that they may have to move you on your back. Because I had researched that I knew what to expect, but no one told me.
-- Someone wrote: "if there are any problems, the gown is pulled up and your stomach will be massaged to help move the scope. Exposure would be total and prolonged." That's just not true. There's no need to pull the gown up to do the massage. There's no need for either total or prolonged exposure. My stomach was massaged with my gown completely on. At no time did I feel I was overly exposed.
-- Talk this issue over with your provider and let your wishes be known. Most will go out of their way to protect your modesty. There's a lot of competition in this field and they want people to have as good an experience a possible. My doctor told me direclty that this was my procedure, they wanted me to have as much control over it as possible, and they wanted me to feel good about it.
There's no reason why this kind of experience can't be (or indeed isn't) the norm.

 
At Wednesday, August 12, 2009 11:05:00 AM, Anonymous Anonymous said...

I have had direct involvement/experince with about 7 colonoscopies. Immediate family and myself. Facilities do vary on procedure and physical set up of their facilty. MER is right in that you should try to ask a lot of questions prior. Most people just go in and "go along."

From my first hand experiences they do prefer to sedate patients.
I asked for little and talked with the anesthesiolgist ahead. She was somewhat bothered and I think offended that I persisted. They just like to put people completely out. I made my desire and I was ignored. I won't go back to that place as I was completely out for a good 30 minutes against my stated desires. They did what they wanted.

 
At Wednesday, August 12, 2009 11:59:00 AM, Blogger Maurice Bernstein, M.D. said...

We are getting here a bunch of interesting personal experiences by a bunch (I presume) of separate Anonymous(es)or mostly the same??? Anyway, again I want to remind all Anonymous(es) to end your comment with a consistent pseudonym or initials and if you have written previously, identify yourself with the date and time of the original. It's so confusing to decide on who wrote what without some identification. ..Maurice.

 
At Wednesday, August 12, 2009 12:31:00 PM, Anonymous Anonymous said...

Mer but it didn't bother you to have opposite sex people in hte room?
is it because you don't consider this intimant? just curious.
eoe

 
At Wednesday, August 12, 2009 4:11:00 PM, Blogger MER said...

To Anonymous: Good question. First of all, as we've discussed before, it's not always easy to explain in words why patients have the kinds of feelings we're talking about. People's feelings, within reason, must be respected. You don't have to agree with them to respect or accommodate feelings. Remember, there are some men and women who prefer opposite gender care. We can't always explain why we feel what we do.
Secondly, personally, I try to examine each medical contact individually. I'm not going to make a blanket statement saying I'll never accept female nurses for intimate care. Remember, there are degrees of intimate care, some less intrusive than others. I have three bottom lines in this area:
-- Choice. I believe patients should have the choice of gender for intimate care. An institution that doesn't or won't hire and staff to accommodate this choice, in my opinion, is not showing respect (or making it of less value) for the dignity of their patients.
-- And that's my second bottom line. My expectation is that I'll be treated with dignity and respect. These are not qualities or conditions relegated to gender. I'll may go either way depending upon the context.
-- Honest and open communication. I want this issue out in the open. If I need an intimate procedure, and there's no male nurse available at that time, and I don't want to or can't wait, and I feel the female nurse is open and honest with me, and treating my feelings with respect, I may trust her. I don't want ambushes. Let me know what's going to happen and ask me whether I have any questions or problems with it. It's about trust, too.
For the colonoscopy, I was dealing with professionals who were honest and open, who listend to me, who demonstrated trust and treated me with dignity and respect. Within the context of this procedure, all this was more important to me than the gender of any one of them.

 
At Wednesday, August 12, 2009 4:58:00 PM, Anonymous Anonymous said...

Essentially, a colonoscopy does not
require full sedation. The lights
are often turned down so the monitored can be viewed. Those
present are the endoscopist,a nurse
and an endo tech who could have been a housekeeper just last week.
In some facilities the endoscope
can be brought to your bed and
certainly occurs in icu's.
Personally, I think this issue
regarding endoscopies are somewhat
blown out of proportion here on
these threads. As far as an endoscopy is concerned I would never have one and never will despite the fact I've been involved
in several thousands of them. The
biggest risk is a perf which
means surgery and a colostomy bag.
There are much better ways of evaluating the colon these days
and as far as evaluation is concerned many a disease process
such as irritable bowel is not
picked up by endoscopy. Many facilities have a very poor record
of proper sanitary control of
endoscopes. If you feel the need
that you must have one though stay away from the very busy endoscopy
centers. Ask revelant questions such as,how well trained are the endo techs? Are the endoscopes hand cleaned or automatic. The
solution that is used to clean scopes is one of the most corrosive solutions I've ever seen.
It will take the paint off an automobile in a few hours. Imagine
if that solution is not thoroughly flused out of the scope. Hand cleaning is prefered for safety reasons. I've seen scopes come out of an automatic washer with feces
still in the cracks and crevices
of these devices.

PT

 
At Wednesday, August 12, 2009 6:19:00 PM, Anonymous Anonymous said...

I had one because I turned 50 and my grandfather had colon cancer which he survived. It went in expecting the worst and it wasn't as bad as I antcipated. Yes it was a little embaressing, drinking the cleansing solution for the prep was the worst, and getting rid of the air wasn't that much fun....but not as bad as I thought it was going to be...and when it was over, i had the peace of mind. To each his own, but PT I think I trust the staff to be careful and feel the risk of colon cancer is worse than the risk of complications.....and again while I know some don't feel the same...but since I was out before they started so...I could accept it...just my experience....alan

 
At Thursday, August 13, 2009 3:11:00 AM, Anonymous Anonymous said...

MER, you said "I had no problem with female nurses."

Did you mean they weren't able to see your privates or you didn't care that they saw them?

Where exactly are all those people situated in the room. Is anybody other than the doctor able to see any of your private parts (from behind or anywhere else)?

alan, you said "getting rid of the air wasn't that much fun...."

How is that done? Were you exposed to anyone during that time?

SLO

 
At Thursday, August 13, 2009 6:17:00 AM, Anonymous OPT said...

In Australia, I think everyone is sedated for a colonoscopy.
Certainly all the people I know have been sedated...
It sounds like your genitals are exposed if you have a raised knee and if you're unconscious, you'd have no control over the situation anyway.
I'll speak to the Dr and see how comfortable I feel with the environment.
I'm against most cancer screening...it seems to cause more problems than it's worth...but I was told recently I have a slightly elevated risk because my mother has bowel cancer - she's 77 so it's only a slight risk - if she were 50...it would be a high risk.
If I'm not happy, I'll pass...
It sounds horrible.
These things are VERY difficult when you don't trust the medical profession.
My cousin is a nurse and she told me that patients being prepped for surgery are often fully exposed (prepared with the ease of the staff in mind and not the modesty of the patient)and that there are very few controls over who enters the surgical suite.
I think it's totally unacceptable to ignore someone's privacy because YOU CAN, because they're not awake to object....

 
At Thursday, August 13, 2009 6:18:00 AM, Anonymous Anonymous said...

OPT - oh, and thanks for all the information.
Much appreciated....

 
At Thursday, August 13, 2009 9:58:00 AM, Anonymous Anonymous said...

SLO

The staff for my proceedure was a female antest. who was on the front side by my head, an nurse who was infront of me helping place a pillow when I went out but I assume was on the back side assisting the Dr. whick would have meant she would have seen what ever you can see from someone laying on their side in the jackknife position, I had a gown, & sheets over me but that would obviously had to be moved to facilitate the procedure. That was it, for me they gave me something to relax me before they wheeled me in, when I was in stayed on the same bed, they hooked me up to the IV and said please turn on your side and pull your knees out slightly and out I went.....one thing that did really bother me was they rolled me through 4-5 nurses standing in the hall, one I know says "have fun" jokedly...they all got a good snicker...I know she didn't mean any harm...but I didn't find it amusing....

Getting rid of the air for me simpley was they offered to let me use the bathroom there,,,,but if I felt more comfortable I could wait till I was home (which I did) and there it was the longest release of flatuant I had ever heard...that I did find amusing...and a great relief...it looked like I was pregnant. I have talked to one guy who woke with a straw like thing in his rear to bleed out the air, and I know others who have said they were not allowed to leave until they did....they said it was a little embaressing as they knew those outside the bathroom could here as one of the nurses says "feel better, that wa a good one"....I really think they mean well, they try to make light of the situation...and to some it may make it better...to others it makes it worse....not sure how you know which is right.....alan

 
At Thursday, August 13, 2009 10:08:00 AM, Blogger MER said...

There was one nurse right by my head acting as the anesthesiolgist looking out for my vitals and condition. That nurse and my doctor talked with me asking how I was throughout the procedure. The lead doctor was by my head on the other side guiding my doctor. My doctor was by my waist with the nurse operating the devise. I had instructed them that I didn't want any coming and going in the room once the procedure started. They had no problem with that. There was also a curtain separating me from the door. I had done all the prep at home, not in the hospital. That makes a difference, too, I think.
I'm sure parts of me were revealed, but within this context it doesn't bother me who sees me. The doctor and the nurse working the divise were very focused on the screen and what they were doing. The focus wasn't on my privates.
There may be other contexts where I don't feel comfortable with female nurses. This was not one of them. I'll deal with the uncomfortable situations in a proactive fashion as they arise.

 
At Thursday, August 13, 2009 12:22:00 PM, Anonymous Anonymous said...

so here is my problem I can't fix anyway.so who cares,right? Me and my husband would be very mad if the other one let hte opposite sex see and touch us naked and I don't care if it's nurse ordoctor.
Just the way we are and noone can help us feel the difference.
Our marrige would really fall apart. Like cheating you know?Maybe we are very different than all here so you can't understand me, but you can't fix jealosy and sorry but we skip things medical. If he had to go do it with them then he have to go but our marriage would turn bad. No one gets it how I feel!!!!
eoe

 
At Thursday, August 13, 2009 1:49:00 PM, Anonymous tim w said...

I believe that all patients whether naked or clothed should be treated with courtesy and respect. As long as they do I do not care about the gender. When they do not that is the problem. Obviously either gender is capable of treating the patient either good or bad. If I can get a lady doctor or nurse who knows what they are doing and is willing to act professionaly and treat me right I am just as willing to have her. with only a couple of exceptions the worst being the one described with the nurses I have gone to a number of different lady doctors who have done a very good job and I have been very happy with the way I have been treated. For various medical problems I have I have had to go to various specialists and it seems like an unusually large percentage have been women. It has gotten to the point where whenI go in to see a new doctor I am almost surprised if it is a man.

 
At Thursday, August 13, 2009 2:49:00 PM, Anonymous Anonymous said...

I have a colonoscopy scheduled for Monday next week.

I have already told them I would not consent to any females being present.

I am not being overly modest, I am just sick of women assuming the right to be there.

jw

 
At Thursday, August 13, 2009 4:13:00 PM, Anonymous Anonymous said...

Most GI doctors are men. The room is darkened once the patient is rolled into the exam procedure room. The patient stays on the same guerny you are on as you enter the endoscopy center. If you want to see what is clearly visible have your husband or wife lie on their left side in a jackknife position (right leg pulled up to waist) and take a look. This is what the people see working on you. The gown and sheet have been moved out of the way giving way to full exposure.

A nurse or assist is standing right with the doctor seeing exactly what he is seeing. Prior to the scope going into the anus the entire genital area is magnified on the flat panel screen due to the camera on the end which is moving around the butt and genital area. I know because I had a sigmoidoscopy and was FULLY alert - no sedation at all. I witnessed the entire procedure.

JW

 
At Thursday, August 13, 2009 5:34:00 PM, Anonymous Anonymous said...

I saw medical modesty pants on the internet. Asked the doc and he said O.K.
Can stay awake
2 people in the room
Woman stays by the head of the table

 
At Thursday, August 13, 2009 9:44:00 PM, Blogger MER said...

So -- what do we learn from all this? People are different. They have difference concerns and different levels of modesty. My contention is that the medical culture needs not only to recognize this, but also respect, and accommodate this. That's where I stand on this issue. All your values should be respected.

Medicine has become extremely competitive in this country. Read the last few issues of The Economist with articles about this. It will become even more competitive if government gets into the picture, or to avoid government getting into this arena. Hospital CEO's do not want to deal with this issue. They don't want any trouble and they don't want to lose customers because of modesty accommodation issues, and, most importantly, they don't want any public publicity about them not being able or willing to accommodate.
So -- make your needs known. You may have to look around. But let them know you'll find another provider if they won't accommodate, and let them know you'll let others know that they don't accommodate. Then do it.

 
At Friday, August 14, 2009 7:48:00 AM, Anonymous Anonymous said...

Thanks alan and MER and others. So it sounds like the anesthesiolgist will never see any naked private parts, huh? I understand (a little) why you don't think the nurses were out of line but I agree with eoe, no females allowed, period. I also see that as being bad for my marriage and frankly, it's just plain insulting.

The way I see it is, how dare those female nurses believe they're entitled to see and even touch me like that? Doctors are one thing but nurses and techs haven't earned the right to see and touch me (or anyone else of the opposite gender), especially when I'm not asked or even warned about it ahead of time.

I can accept doctors (only male for me) seeing and touching my privates if it's absolutely necessary for the procedure but nurses, techs and anesthesiolgists don't have that right. JW's experience sounds like a nightmare.

I for one DO feel exactly like you do eoe. It's just not right.

What specifically do the nurses and the tech do to help you? Are they really necessary if you have a doctor and an anesthesiolgist that watches your vitals? Someone said a nurse helped control the scope, does it really take two people to do that? Many of you have said a nurse was "by their head", is that a position where they can't see your behind (or anything else)?

Thanks again for answering some of my questions. I love this blog. From the sound of it this is one procedure I will never have unless I can be promised an all male team.

One more question concerning dermatologists. Has anyone had an opposite gender nurse or assistant present during a full body scan or during a procedure where your privates were exposed? Did the doctor insist on having her there? Were they really needed? Thanks again.

SLO

 
At Friday, August 14, 2009 10:07:00 AM, Blogger MER said...

SLO -- About dermatologists. Expeiences will vary. Many derms use note takers during the exam. If they do, it will 99.9% be a female -- and 99% not a nurse, but a med tech or asst. These are mostly the large operations. Makes things go faster for them. When I challenged one derm about this he told me with pride how many thousands of patients he pushed through his clinic each year. Move'em in, move'em out. It told him it sounded like a cattle drive.
Why are all these med assts and techs females? It's not just that males are hard to get. As one female derm med tech told me. If we hire a man, he can't assist with a female patient and a male doctor -- because we need a chaperone. But if we hire a woman, she can do both. So -- these med techs, in my opinion, acting as chaperones as much as they are doing anything substantive. It's not ethical.
Derms at smaller operations sometimes work alone and do their own notes or speak into a tape recorder. Others use an assistant, who will just about always be a female as noted above.
I did some calling around a few years back and learned some interesting trends.
-- Most will accommodate you for modesty one way or another. They may want to negotiate, but they want your business.
-- The bigger clinics, espec., just don't want to talk about this issue. You most likely won't get specific answers from the office staff, and, if you're a new patient, the doctors may not be willing to talk with you beforehand. One derm told me he just didn't let his office staff get into this issue, and that since I wasn't a patient of his yet (I had a appointment), he felt no obligation to call me and talk about this.

They will accommodate IF you ask. But because some don't want to talk up front you may get ignored, the run around, or uncertain answers from receptionists.

What often happens is that you get to the office, fill out the paperwork, get led to the exam room by a female med asst., asked to get undressed and put on a gown(some will say you can leave your underwear on if you want), they will leave, then they'll return with the doctor. This means you'll never get to talk with the doctor alone. This is the ambush. What I suggest you do here is, after the med tech tells you to undress, tell her you you want to speak to the doctor alone before the exam begins. When he comes in tell him you don't want a third party in the room during an exam. You may get some flack, or they may want to negotiate,but if you're determined and willing to walk out, most will accommodate you. They don't want to lose you as a patient or have you spread the word. If you let med assist. stay for the non intimate parts of the exam, and then ask her to leave when the intimate parts start, that will almost always happen. But most won't tell you this.
Again -- this is the poor communication we too often see in medicine. It makes it easier for them if they just do what they want to do the way they want to do it -- and, not make any changes unless you request it. Many people either don't care or won't feel comfortable asking once they get naked in the exam room.

 
At Friday, August 14, 2009 12:31:00 PM, Anonymous Anonymous said...

SLO, nurses assisting a GI doctor doing a colonoscopy is not at the head of the guerney. She is at the right side of the doctor for the procedure as she picks up the scope and hands it to the doctor and then she takes it from him when he is finished. Seems doctors now days can't do anything without an assist. I personally think it is pathetic. Used to be you saw a doctor and there was no one else in the room.

MER is correct about the Derm docs. Most offices are now going from paper charts to computer systems. So they enter the room with a medical assist following. I always tell the receptionist when I sign in that I want to see the doctor alone, no audience. When I am called and taken to the room I verify again. The MA's really get twisted when they hear they are not welcome. They seem to take it personally. And, you know what? The doctor functions just fine without the 'twit' in the room! Sorry I just couldn't help myself.
JW

 
At Friday, August 14, 2009 1:43:00 PM, Blogger swf said...

The last few posts (for some)also speak to how closely privacy and modesty are linked to moral values. While it may be possible to accomodate certain issues, moral values by nature are not really negotiable. There are times when the 'caregiver' essentually is expecting a patient to trade or give up their moral ethics for his/hers. And here is where a lot of the anger or indignity comes into play.
As we see, eoe would consider it a breech of her vows to allow opposite gender intimate care. To some, men are men and women are women, regardless of profession. This is certainly where we would see the 'how dare you assume you can touch/see me' defense used, and for them: rightly so. A decision like this could be more than putting aside modesty, it is really a matter of doing something unforgivable or not.
There are a lot of moral dynamics that revolve around our bodies and who feels entitled to them.
Would a 'caregiver' really want to leave a patient feeling as if they had ruined their relationship or broken a vow? I would hope not, but a 'caregiver' will turn just as hostile if they believe breaking your moral code in turn makes them immoral people. We all want the rights to have our own moral beliefs.

 
At Friday, August 14, 2009 2:01:00 PM, Anonymous Anonymous said...

Thanks a lot for the advice MER. I agree, what they do is unethical and we should all not let them get away with it.

SLO

 
At Friday, August 14, 2009 3:05:00 PM, Anonymous tim w said...

because of a skin condition I have I havespent a lot of time visiting dermatologists. In my case at the dermatologists I have always kept my underwear on though frequently that was all I would be wearing sometimes with a gown sometimes not. A number of the dermatologists I have gone to were women and there were always women nurses around. I would not have a problem removing my underwear if it were neccesary but so far it has not been since my skin condition does not affect my private area. The one time I had a pproblem at a dermatologist was a time I was lying on the examination table wearing only my underwear, no gown for a biopsy they were doing when the doctor left the room for a few minutes and left the door wide open so anyone passing by including other patients would see me. I do not have a problem with doctors and nurses coming in and out of the room but would appreciate if they shut the door behind them.

 
At Friday, August 14, 2009 4:31:00 PM, Anonymous Anonymous said...

To SLO

My suggestions regarding assistants during a dermatology exam are this,I don't make my copay up front. I make my copay after the exam and especially when
it regards a new provider or
someone I'm not familiar with. If
they don't like it I leave. If I'm
not happy with the arrangements I
leave and there are NO exceptions
to my rules and in this regard I don't have to ask for my copay back. I go straight home and complain to my insurance company.
There are some people at these medical insurance companies who wear very expensive suits and who have issues in regards to the lack of modesty provided to patients
just like you and I. The medical
insurance companies pay these
providers to take care of you and
I from our payments to our employers or for some,directly.
Our providers are paid in many
cases in advance and as such can from dropped by the insurance
companies if complaints are warranted.


PT

 
At Friday, August 14, 2009 6:55:00 PM, Anonymous Anonymous said...

SLO, I think the key to much of what we discuss here is communication, and communication upfront. I turely believe providers use the fact that most patients just accept what is handed them without protest not only as a sign of acceptance, but as a justification to claim they don't know. From experience if you make you wishes upfront often they will comply, if they can't or won't there are options. I have related here how I had to have an ultra sound, the first time was female,,,it was uncomfortable, the next time I asked for a male, they acted surprised but accomodated, two friends had vasectomies same doctor, one requested the Dr do it by himself and he did, the other didn't and the Dr had a nurse whose only task was to hold his penis to the side.......ask, and you might recieve, if not, call around. You may have to drive a little, but it is worth it...don't avoid medical attention that can save your life, if you look elsewhere and go there, and let the facility that did/could not accomodate you will accomlish numerous things. most important you may save your life, second you will let the first one know they lost business becasue they did not accomodate, third you will reinforce to the second facility their ability to accomodate was a positive thing...and fourth you will find it really makes you feel good about yourself and will give you confidence going forward...as they say in the nike add...just do it........alan

 
At Friday, August 14, 2009 9:04:00 PM, Blogger swf said...

"most important you may save your life, second you will let the first one know they lost business becasue they did not accomodate, third you will reinforce to the second facility their ability to accomodate was a positive thing...and fourth you will find it really makes you feel good about yourself and will give you confidence going forward."
Very good step by step alan. Especially the third, letting the facility who accomodated you know what a positive step they took. These faciliteis need to know how they have played an important role in our and others lives.

 
At Saturday, August 15, 2009 1:52:00 PM, Blogger Maurice Bernstein, M.D. said...

If those on these threads who want to get together to form an activist organization to encourage change in the healthcare system regarding patient modesty, may I suggest a place to go and set up an organization FOR FREE where you can have discussions with those who you accept into your organization and organization site.

Check out Medpedia at
www.medpedia.com

..Maurice.

 
At Sunday, August 16, 2009 10:14:00 AM, Anonymous Anonymous said...

Thank you JW, PT, Alan and swf. I think I have the confidence to stick up for myself now but whenever I hear other peoples negative experiences and think of all those unethical people out there taking advantage of helpless patients it makes me so mad I just can't stand it. It doesn't seem enough to just defend myself anymore, I want to help other people and get back at those terrible medical people that have caused so much misery with their lack of compassion for their patients. I wish there was more I could do.

Many of you along with Dr. Bernstein and Dr. Sherman have really helped me so I guess when I take what I've learned here and take charge of my future doctor visits I can come back here and share my successful experiences. Thanks everyone for all your advice.

SLO

 
At Sunday, August 16, 2009 10:12:00 PM, Anonymous Anonymous said...

To MER

Considering that you are probably
the most articulate on this site my
suggestion would be for you to write a book. For such a book to
be effective you'd have to be blunt,reference examples of ongoing discrimination that men face in health care and place
these issues in some historical
perspective.
I could envision such books being on display in college campus
bookstores,nursing colleges and
free reads found throughout hospitals.
In conclusion, I recently learned that some dermatologists
had conducted military induction physicals on young males with female clerks viewing. I can't help but wonder to call one of these offices and under the
pretense of being a young highschooler ask for an opportunity
to be an observer for a few weeks
in the hope of gaining some medical experience.
Should I be denied I could always bring up the physicians
behavior during military induction physicals.


PT

 
At Monday, August 17, 2009 2:07:00 PM, Anonymous tim w said...

I had an appointment this morning with a dermatologist. In this case all doctors were malr and there were no women in the room during the examination. That was a coincidence how it turned out rather than any request on my part. For the men who do care which I do not it would be nice but depending on the doctors office or hospital not always easy for them to arrange that.

 
At Monday, August 17, 2009 5:10:00 PM, Anonymous Anonymous said...

To Tim

For those men that don't care
they are in essence accomodating
the facility. It should be the other way around!Should they assist
the plumber in repairing leaks
and pay in full. Would healthcare
be different if insurance were
non-existent. What if we paid cash
for all medical treatment for the sake of my argument.
Whats the difference for those of us like myself who pay medical
insurance premiums and copays.I
should expect the same rate of care irregardless should I not?.
Female patients are accomodated
everyday,why is there little or no
effort to accomodate men?


PT

 
At Monday, August 17, 2009 5:28:00 PM, Anonymous Anonymous said...

I just this minute watched a commercial on CBS, short clip, there is this pretty blond woman and she says...what questions do men ask during a prostate exam...can I use my blackberry (picture of a cell phone) you are wearing gloves aren't you (picture of gloved hand) are you done already? Then she says something like...just get screened, it is just another example of how men's health isn't taken seriously, nor is their modesty...imagine that same commercial approach to a pap smear......the uproar would be huge...personally I am writing CBS, not that I expect it to matter, but because I have made a vow not to just be silent about this stuff anymore....alan

 
At Monday, August 17, 2009 10:24:00 PM, Blogger MER said...

As some of you may have noticed, my interest in this subject is as much (perhaps more) academic than personal. Lately I've been researching the history of modesty in Western culture. It's complicated. We can see the roots of where we are today to some degree. I don't think we ever lose those roots, although we like to to think we do. Times have changed, yet issues related to male modesty are still driven to a significant degree by 19th century Victorian myths about sex. I'm not using the term "myth" in the sense of "not true, fictional," but in the larger sense of a cultural narrative. We as a species like to think we've risen above these myths, but I don't believe we have completely or ever will.

To the Victorians, men's sexual desire was considered bestial.A popular theory of the time, "reminscent of Taoist belief," was that "semen was a vital substance and ejaculation a waste of it and to be avoided if possible." Necessary for reproduction, of course, but that's all. Not all men followed medical advice then as they don't today. But that was the popular medical thought. Thus the strong advice against masturbation, and all the myths that developed around that activity.

"As a result, a new myth began to grow up about women, at least those of a certain class. They were now considered to be pure, spiritual beings and therefore quite above sexuality"

Note the photograph above Volume 20 of this thread.

"The ideal women was required to be gentle and submissive, cherished and protected, and under no circumstances was she expected to enjoy so unrefined an activity as sexual intercourse."

Those quotes from "The Mythology of Sex" by Sarah Dening (pp. 180-181)

These intellectual precepts dominated during the Victorian Age, the time that nursing became a feminine occupation for social, economic and political reasons I've suggested in previous posts.

We still hold to this idea today -- that it's okay for female nurses to deal with male patients for intimate tasks. The embedded belief is that they're "quite above sexuality" and have no sexual feelings, or at least can rise above it better than can men. Although we know this isn't necessarily true today, the inertia of this old myth still holds.

Men, on the other hand are naturally bestial when it comes to sex, and women need to be protected from their their gaze which could result in violence. The naked women in art is desirable, sexual, vulnerable. The naked man is bestial, wild, uncontrolled. Consider the picture of Odysseus in Homer when he lands naked on an island beach and needs to deal with some bathing young virgins for help. Also, read "The French Lieutenant's Woman" by John Fowles. He covers some of these Victorian issues regarding sex, as does D.H. Lawrence in some of his novels.

Now, I realize that to some of you all this historical stuff isn't the point. But I think it helps to know where we came from, how we got to where we are today.

 
At Tuesday, August 18, 2009 10:12:00 AM, Anonymous Anonymous said...

Way to go alan. Nice job.

 
At Tuesday, August 18, 2009 11:05:00 AM, Anonymous Anonymous said...

alan, I do not get cbs so I have not seen the ad you describe... maybe you can catch who sponsored the ad as well.. They would be surprised to hear from indignant males... this is much like the article posted a while back by that lady doctor Orrange and is at least as insulting and as far off the mark as can be.. sounds like they are trying to keep doing much of the same things that are so offensive...
leemac

 
At Tuesday, August 18, 2009 3:19:00 PM, Anonymous Anonymous said...

Alan,

I caught that segment as well and found it offensive. First off, why are they using women on all these commercials? I’m guessing they are taking the mother/wife (you know… mother knows best, listen to your spouse) approach to get men thinking about getting screened or could it be to show us that women do these things and so should men? I don’t really know, I just know that trying to be funny about it isn’t going to make me go get screened. Jimmy

 
At Tuesday, August 18, 2009 5:41:00 PM, Anonymous Anonymous said...

Thans MER for your comments.
Now if we move forward to todays environment what does this all teach us? Not sure, but to ad to the discussion.
As has been reported, male sexuality and female sexuality are generally different in terms of what elements of visual stimulation provide sexual stimulation. For men, its often the body, for women the face etc.This doesn't mean that women are not interested in the male body, or its various "parts", they obviously are, its just what motivites them in terms of sexual interest etc. Translate this into a medical setting. Male patient female doctor or nurse etc. Male patient thinks that female nurse/doctor is interested in male body; female thinks I am not interested in this because that element of a person doesn't define my sexual interest. But surely what the male patient thinks is the relevant bit. If a ptient belives that a female is, or could be looking at them in terms of their 'bits" etc, then that is the relevant equation?
Some very basic thoughts anyway.

Chris

 
At Tuesday, August 18, 2009 5:58:00 PM, Anonymous Anonymous said...

Dr Sherman has posted a link under the media section on his blog where you can see part of the ad. The part with the woman making the comments is there, the pictures they posted are not. You can go to cbs.com and go to their contact section, they have shows listed, there is not one for public service but there is one for other not listed...I sent a complaint, and if I do not get a response I am going to keep writing and e-mailing and complaining until I do. It may amount to no more than someone sending a form letter to shut me up...but for my own benefit...I am want some type of acknowledgement....it makes me feel better if nothing else...alan

 
At Tuesday, August 18, 2009 6:12:00 PM, Anonymous Anonymous said...

sorry, I just reviewed the link from Dr. Shermans post...that isn't the current add that is running, that one is in poor taste in my opinion, the semi smirk on her face is a little offensive to me...that one was run around Christmas...the current one is much more demeaning, I will see if it is available somewhere....I have only seen it once....sorry...alan

 
At Tuesday, August 18, 2009 7:39:00 PM, Anonymous Scott said...

We have modesty concerns down here as well but it doesn't come up so often.
I was steeling myself for the prostate check....I recently turned 50.
The GP said we don't do that anymore and ordered a blood test.
My skin checks don't involve my genitals...no doctor has ever asked me to remove my underpants.
My wife doesn't have pelvic exams...her doctor thinks it's unnecessary in a healthy woman with no symptoms.
She's offered a smear every 2 years but follows the program from her home country...the Netherlands. It produces fewer incorrect test results...so she only has tests every 5 years (she started at about 33) and will stop next year when she turns 50.
She sees a female Dutch doctor when she returns to visit her family every 5 years.
Her Aussie GP understands why she's following the Dutch program.
She has decided not to have mammograms when they're offered next year. She's very concerned about the risks.
Between the two of us (so far!) we haven't had a lot of occasions where our modesty and privacy has been compromised...
I think the doctors in the States are far more thorough...probably looking out for the very rare cases.
Our doctors seem more relaxed which usually means we're happy to go and see them.

 
At Wednesday, August 19, 2009 5:08:00 AM, Anonymous Anonymous said...

It is interesting that Scott says that they don't do DRE's and just do the blood PSA test for prostate checks. In the US they insist on the DRE along with the PSA blood check and if the gland "feels hard" then they immediately want to do a biopsy. To me this equates to "money" and biopsies have some danger and are very uncomfortable and embarrassing with female staff present.

 
At Wednesday, August 19, 2009 8:17:00 AM, Anonymous Anonymous said...

I had a colonoscopy today. I was sedated but it did not put me out or make me forget anything.

I had requested an all male team and the hospital (in the UK NHS) obliged.

When the scope became difficult to move around the bends, I was asked to lay on my back and my gown was lifted well up and my stomach was pressed hard to help the scope move. That happened three times. They did NOT press through my gown, it was lifted completely out of the way for their convenience.

Because I had an all male team, I was not in the slightest bit bothered.

All three staff involved were behind me throughout.

I was told straight afterwards that they had taken numerous biopsies (I counted about 15) to rule out any possibility of problems they could not see. The person doing the scoping was very confident there was no problem, it was just belt and braces.

If you don't ask, you don't get.

jw

 
At Wednesday, August 19, 2009 9:11:00 AM, Anonymous Scott said...

No routine colonoscopy either (unless you have immediate family history...a mother or brother etc and then they recommend it from age 50, every 5 years (I think))
Instead the government has started to offer FOT's every 2-3 years. I was offered one this year as I turned 50.
At the moment it's only being offered to people turning 50, 55 and 60 but will be extended if funds become available.
Skin Checks...not everyone has them, but I have quite a few moles and sunspots having worked outside all my life...so my doc thought it was necessary.
Melanoma's kill lots of people down here...
I've heard that biopsies of the prostate are risky and can leave you incontinent and impotent.
Best to be careful...get a second opinion and see someone with a good reputation.

 
At Wednesday, August 19, 2009 11:19:00 PM, Anonymous Anonymous said...

I think I'll move to Australia. They seem to be a little ahead of us here in the States.

jw - Good job asking for the all male team. I think if they had opened up my gown with a woman present I would probably hit someone.

LG

 
At Thursday, August 20, 2009 12:21:00 AM, Anonymous Anonymous said...

Boy jw, your colonoscopy would have been torture if there had been a female involved. Do you think they would have been so inconsiderate if there had been a female? (lifting the gown 3 times, all of them behind you, etc)

I see now why they want people to forget about what happened during their procedures. I've never experienced one myself and probably never will, unless I can also be guaranteed an all-male team. Something I've wondered, if I'm given Versed or any other conscious sedative, will my idea of morality be temperarily suspended? For example, if I don't want a woman seeing or touching my genitals, will I not care if they do while under the conscious sedative or will I continue to defend my morality by any means possible? I'm sure many people might be different but what is the general concensus?

Also, how are you prepped before a colonoscopy?

DD

 
At Thursday, August 20, 2009 5:18:00 AM, Anonymous Anonymous said...

jw's account of his colonoscopy is concerning because when I went in I was completely sedated. A female was in the room with the doctor. When I woke up and taken from the room I was on my back and by rectal area wiped clean. My wife came out from sedation on her side and not wiped clean. So now I wonder what happened when I was in there. Upsetting to me to say the least.
JW

 
At Thursday, August 20, 2009 9:01:00 AM, Anonymous Anonymous said...

DD: there is not prep from the healthcare people. A person does all prepping to clean the bowels out the day prior and the day of the procedure. There is nothing done by the techs or doctors. It is not in any way a sterile procedure.

JW

 
At Thursday, August 20, 2009 9:07:00 AM, Anonymous Anonymous said...

several people have suggested in this blog that there is no need to lift the gown to help move the scope around bends in a colonoscopy. I asked the nurse afterwards and he said it was not possible to identify where to apply pressure unless the skin could be seen. There is NO way that your gown remains down and covering you unless the colonoscopy goes incredibly smoothly and does not get "stuck" at all.

I had researched this procedure when I was told I needed one, I made it crystal clear that it was an all male team or no procedure. I am SO glad now that I did so.

jw

 
At Thursday, August 20, 2009 5:02:00 PM, Anonymous Anonymous said...

DD
The prep is drinking some sort of laxative the night before that causes you to void everything in your colon. Mine was drinking what seemed like a 5 gallon can of this cherry stuff...cherry my a@@.

I am very gaurded about my modesty but the town and therefore the hospital there is very small so the staff is very limited, nearly all female. For me, they rolled me in, I remember them saying turn on your side, we need to put this pillow between your knees and the lights went out. I woke up back in the "room" really curtains in a big room with other curtained areas. For me, the fact that I was not awake for any of the exposure it was much easier for me to accept....thats just me...alan

 
At Thursday, August 20, 2009 5:07:00 PM, Blogger MER said...

"several people have suggested in this blog that there is no need to lift the gown to help move the scope.."

jw -- I suggested nothing. I told you what actually happened. I was alert and awake. Just because you asked one nurse and got an answer hardly "suggests" universal practice. Patients can find out how their "team" will handle this and then act accordingly. But, as we've discussed, they won't tell you unless you asked, and then you'd better be crystal clear about your concerns and what you want.

 
At Thursday, August 20, 2009 5:08:00 PM, Anonymous Anonymous said...

question, jw: how can a person with the scope in be placed on their back and have the gown lifted so that the stomach can be massaged so the scope can move through? This physically does not make any sense. What I had heard is that if the scope gets "stuck" in the colon the doc pulls back a little and manuevers the scope in that fashion to proceed. A patient could not lie on their back with the scope up their butt. Or am I missing something here?
JW

 
At Thursday, August 20, 2009 9:03:00 PM, Anonymous Anonymous said...

Virtually any exam of the colon
be it a barium enema,small bowel
study or endoscopy requires a
prep of mag citrate and ducolax
tablets of which can be obtained over the counter.
No one will get an endoscopy without a bowel prep,period!

PT

 
At Thursday, August 20, 2009 11:43:00 PM, Blogger Maurice Bernstein, M.D. said...

We are now at 132 Comments on Volume 21, so....

NOTICE: AS OF TODAY AUGUST 20, 2009 "PATIENT MODESTY: VOLUME 21" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 22.
..Maurice.

 

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