Bioethics Discussion Blog: Patient Modesty: Volume 22

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Thursday, August 20, 2009

Patient Modesty: Volume 22


The graphic is a Master and his Slave painted Silician pottery from around 350BC-340BC. I am using this graphic for Volume 22 to represent what seems to be a common thread in the discussions within these volumes of Patient Modesty: A feeling of inequality and perhaps even abuse between the patient (either male or female) (slave) and the healthcare provider (master) with regard to the matters of genital modesty. If I am wrong in this analogy, let me know. Nevertheless, continue on with the discussions. ..Maurice.

Graphic: A master and his slave. Side A from a Silician red-figured calyx-krater, ca. 350 BC–340 BC., Louvre, copied from Wikipedia.

ADDENDUM (August 23 2009):
Here is something special I discovered to add to the current patient modesty discussion. It is a story written by a second year medical student Asrei Beyewitz in Pulse, a medical humanities publication of the Albert Einstein School of Medicine in New York. This and a host of other stories and poems about medicine can be found at this link. I received permission by the chief editor of Pulse and also from Ashrei to publish the story on my blog. Maybe Ashrei will join us here and he can provide us with more insight regarding modesty issues associated with management of his chronic illness. ..Maurice.

Looking for Respect

Ashrei Bayewitz


This may sound strange, but I secretly looked forward to my colonoscopy.

I was excited to see the people in the colonoscopy suite--the receptionists, the nurses and my doctor. I knew that they would like me, because I would be brave and respectful. That's what's always happened since I was diagnosed with Crohn's Disease ten years ago. During my multiple colonoscopies and countless doctor visits and other outpatient procedures, I invariably build up a rapport with someone, be it a doctor, nurse or staff member. I've always been a good patient, and now that I'm a second-year medical student as well, I can understand their work a little better. I expect them to sense my goodwill and to treat me in turn with respect and caring.

This appointment got off to a good start: The woman who registered me seemed nice and appreciated my interest in the pictures decorating her cubicle wall. And I wasn't just being polite--I really did like those black-and-white photos of old TV and film stars. She even had The Honeymooners up there! I also got along well with the first nurse--we shared a laugh about the trouble I'd had finding a quarter to pay for my locker.

But a few minutes later, my interview with the intake nurse took me aback. Staring at her computer screen, she recited a series of questions. Seated facing away from her in a gigantic reclining chair that seemed cemented in place, I couldn't turn around far enough to catch her eye. The nurse's lifeless, monotonous tones conveyed zero interest in who I was or what I had to say. I'd never felt so unimportant.

To make matters worse, people kept interrupting us. The first time it happened, I thought that something serious must be happening--maybe a patient was having difficulties, or the computer system had crashed.

No. It was lunch time. They needed to coordinate their take-out orders, and my nurse, it became clear, was the lunch organizer.

Sometimes coworkers called her out of the room (but not out of earshot); other times they conversed right in front of me. Eventually I got so used to it that I began letting her know when someone was waiting for her.

Still, I felt stung at receiving so little respect. Was I invisible? Couldn't their lunch plans wait a few minutes? Nevertheless, I swallowed my pride, reminding myself that healthcare professionals are people too, with needs of their own. Maybe my nurse had found that distancing herself from patients helped her to do a better job. When she expertly inserted my IV line, I felt I'd taken the right attitude. Our relationship wasn't very satisfying, but at least she had technical skills.

Soon I was called to the procedure room and introduced to my next nurse, who would actually assist with the colonoscopy. She seemed down-to-earth and likable, but that's when things really started to go wrong.

For one thing, she'd forgotten to put a bed in the procedure room. Then, when she did bring it in, she had me lie on it facing the wrong way. After we'd fixed these details, I heard someone down the hall talking excitedly about a "scholar." There must be some talented pre-med students shadowing the doctors that day, I surmised. Feeling a sense of kinship with them, and renewed self-confidence, I hoped that they would stop by my room.

When my nurse brought in the student, I waited eagerly for her to introduce us. Instead, she started helping the young woman to put on scrubs. And while that was happening, I learned that this "pre-med" student was actually a ninth-grader.

My pulse quickened, and my mind raced. Was I some animal in a zoo for children to gawk at? I was having a colonoscopy--the procedure where they stick a tube up your rear end. Couldn't they ask my permission before inviting a spectator?

Struggling to sound calm, I asked, "Does my doctor know that a student will be watching my procedure?"

My nurse didn't seem too pleased: I'd breached the unofficial patient's code of conduct. She blinked and said, "This is a teaching hospital," adding that patients should expect to be observed.

I knew that this was utter nonsense. As a patient and a medical student, I care deeply about the principle that a patient's dignity should be respected at all times. I felt ready to fight for this.

"It's probably okay," I said, "but it would have been nice if you'd asked me first."

"Patients can always refuse being observed if they wish," she retorted, contradicting her earlier statement.

All I wanted was an apology and an acknowledgment that they weren't allowed to coerce or take advantage of me. After some more back-and-forth, my nurse conceded her mistake. But the whole exchange left a bad taste in my mouth.

When my doctor came in and learned what had happened, he told me that I was under no obligation to be observed. Before I'd even finished nodding, the student was taking off her scrubs; a few moments later, she was gone.

Ironically, I still liked the nurse. I felt sorry for her that she'd been making mistakes, and I appreciated that she'd apologized for them. And when she started telling me about herself, I liked her even more.

She'd had a lot of experience in surgery, she confided, but was still fairly new to the colonoscopy suite. She'd felt that she had to let the student observe because her boss had requested it. Although it didn't excuse what she'd done, I appreciated her candor. It was as if we were meeting for the first time.

An hour or two later, I was waking up in the recovery area. Looking across the hallway, which looked blurry to me without my glasses, I saw someone walk by with a friendly wave and a smile. I can't say for sure, but I think I know who it was.


About the author:

Ashrei Bayewitz is a second-year medical student at Albert Einstein College of Medicine and a summer intern at Pulse--voices from the heart of medicine. "I've been interested in writing since middle school, when I composed mock newsletters to celebrate the birthdays of friends and family. I am continually surprised by the interesting and sometimes humorous connections that I make while writing. Around the time that I chose to go into medicine, my love of stories evolved into a special interest in illness narratives. My honors thesis at Yeshiva University showed how these works can help doctors better relate to their patients."

Story editor:

Diane Guernsey


NOTICE: AS OF TODAY SEPTEMBER 8, 2009 "PATIENT MODESTY: VOLUME 22" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 23.

126 Comments:

At Friday, August 21, 2009 12:47:00 AM, Anonymous Anonymous said...

the scope got stuck, I was in severe pain, they gave e something for the pain and WITHOUT removing the scope, turned me onto my back. They were able to proceed much easier for a while before turning me back on my side.

I am not an expert in the procedure, just was wide awake and know what they did for me. Being able to see what they were doing by raising my gown made perfect sense to me at the time and subsequently.

The procedure was uncomfortable and the prep was unpleasant, beyond that, I am glad I had it done for peace of mind.

jw

 
At Friday, August 21, 2009 1:12:00 AM, Anonymous Anonymous said...

Great analogy Dr. Bernstein. Exactly my opinion.

Thanks everyone for the info on prepping. I once heard that you might have to be shaved beforehand. Thank God, there are very few things I can think of that would be more humiliating than being shaved in that area. Especially if they "tried" to send in a woman (opposite gender) to do it. Yeah, they could TRY alright, I would walk out and never return to that place. All that other unethical crap they ambush you with is bad enough.

DD

 
At Friday, August 21, 2009 9:43:00 AM, Anonymous Anonymous said...

DD the important thing is to be proactive, ask upfront and if they can't or won't comply...go elsewhere and tell them why. I just last week was referred to a hospital for some imagining, I called and asked if they could schedule me with a male, they said both techs were female but they were very experienced and do this all the time and I said I am sure they are but I am not and don't. Thanked them for their time and told them I preferred a male tech and would find a facility that had one. It was all very pleasant, no screaming or shouting.......but I spent my money where I got it my way. If BK will make it my way for a 99 cent burger...a $990 image session should be expected to do the same.

the prep and procedure (colonoscopy) is a breeze, you'll be glad you did it.

alan

 
At Friday, August 21, 2009 10:14:00 AM, Anonymous Anonymous said...

DD: men are prepped and shaved all the time in the OR by female nurses. They don't seem to share that info with a patient. Feel it is just their "job". Like nobody has a care one way or the other about something like this! I asked ahead of time and was ambushed and lied to. Trick is they sedate patients and then they have their way to get the "job" done and as alan has written the usual response is "they are trained and do this all the time."
JW

 
At Friday, August 21, 2009 4:49:00 PM, Anonymous Anonymous said...

I find it rather concerning that a
hospital imaging center has no
male techs. wether it be ultrasound,x-ray or ct as every hospital has round the shift coverage for these modalities.
Lets consider for a moment the
manpower required for a 24/7
ultrasound department as an example. That is (21) 8-hour shifts
or (2) 8-hour shifts 5 days a week
with nights and weekends on-call
which is usually done by pool techs. I'll tell you right now few
hospitals in the nation just have
2 ultrasound techs as an example and if they do its only because
the facility is very small. There is enough ob work to keep people
running day and night.
Sounds to me what alan experienced was simply someone not
wanting to set a precedence by not
accomodating someone. It would have
been interesting just for the sake
of the argument to say "ok,you have
no male techs for my procedure so
will I get a chaperone." Then count
the seconds that elapse before you
get a response from that one.
Personally,I'd walk as well and
find a facility that would accomodate me but not before complaining to my insurance company. They pay the bills and I
as a patient was told that I would
not be accomodated. As a sidenote
visit allnurses under general discussion and the thread ,nurses
and affairs. I believe on the second page about a nurse being
fired for having sex with a patient. Seems he was in traction
from a motorbike accident. She
couldn't leave her gender at the door,the patient was behind a curtained area!


PT

 
At Saturday, August 22, 2009 1:44:00 AM, Anonymous Anonymous said...

That's why it's important to find a surgean or other advocate that you can trust. If you can't find someone you can really trust it doesn't matter how many questions you ask or how many requests or demands you make. I've found that medical "professionals" constantly lie because they believe it is part of their job, especially nurses. They think their lie is for the patients own good because what they don't know won't hurt them. Many think that what they are doing is what must be done and if lying to the patient is part of it then it must be done.

I personally never trust what a nurse tells me, whether it's medical advice or what will happen to me when I'm unconscious. Only when a doctor or surgean I trust gives me his word that no females will be around for my surgery, pre-op or post-op (when I'm uncovered) will I consent to the procedure. So far I believe they have kept their word. I'm sure some female nurses or techs have thrown temper-tantrums but I believe in the doctor's leadership.

GL

 
At Saturday, August 22, 2009 11:47:00 PM, Anonymous Anonymous said...

To GL

I wouldn't trust what a nurse tells me either, especially
the ones that call themselves nurse
educator. How can most nurses educate their patients regarding positive health issues when the majority of nurses are grossly obese and smoke excessively.


PT

 
At Sunday, August 23, 2009 11:51:00 AM, Anonymous Anonymous said...

Excellent point PT, I've noticed that too.

GL

 
At Sunday, August 23, 2009 12:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is something special I discovered to add to the current patient modesty discussion. It is a story written by a second year medical student Asrei Beyewitz in Pulse, a medical humanities publication of the Albert Einstein School of Medicine in New York. This and a host of other stories and poems about medicine can be found at this link. I received permission by the editor of Pulse and also from Ashrei to publish the story on my blog. Maybe Ashrei will join us here and he can provide us with more insight regarding modesty issues associated with management of his chronic illness.

Because only 4096 characters are allowed in the Comments section of a thread and also because I think the story is worth putting on the front page, I am doing just that. So if you missed the Addendum at the top of this page, simply scroll back up. ..Maurice.

 
At Sunday, August 23, 2009 1:29:00 PM, Anonymous Anonymous said...

Somehow I really can't imagine a male 9th grader (15-yr-old) being allowed to watch a female getting a colonoscopy. Anyone else think so?

--rsl

 
At Sunday, August 23, 2009 1:33:00 PM, Blogger MER said...

After reading that upsetting story by Asrei Beyewitz, along with the incident Art Stump describes in his book "My Angels Are Come, I have to ask myself: Why do things like this happen. My research has indicated two reasons. This 2 part post covers the first reason:

It goes to the age-old question -- Why do good people sometimes commit evil acts?

One particular book has helped answer this question for me -- "The Lucifer Effect: Understanding How Good People Turn Evil" by Philip Zimbardo.
Now -- before I provide you with two quotes -- I want to make it clear that I'm not equating these incidents with genocide or mass killings or rapes. Modesty violations do not descend to that level, of course. But I believe some of the same principles that apply to the worst of crimes can also be applied to what we're talking about.
Zimbardo defines evil thus: "Evil consists in intelntionally behaving in ways that harm, abuse, demean, dehumanize, or destroy innocent others -- or using one's authority and systemic power to encourage or permit others to do so on your behalf."

The key phrase there is "systemic power." Zimbardo believes that in our culture we don't grant enough credit to the power that settings, situations, and especially systems have over us as human beings. He's not saying that people shouldn't be held accountable. But he believes most of us don't really know who we are or how we would behave in unfamiliar settings and situations controlled by powerful systems.

End Part 1

 
At Sunday, August 23, 2009 1:36:00 PM, Blogger Maurice Bernstein, M.D. said...

I may be mistaken but I assumed the writer is a male student and that the 9th grader was a female. Would that make any difference? ..Maurice.

 
At Sunday, August 23, 2009 1:38:00 PM, Blogger MER said...

Part 2

Consider this quote from Zimbardo's book in terms of what happened to Art Stump and Asrei Beyewitz:

"Aberrant, illegal, or immoral behavior by individuals in service professions such as policemen, correction officers, and soldiers [I would include medical professionals as well], is typically labeled the misdeeds of 'a few bad apples.' The implication is that they are a rare exception and must be on one side of the impermeable line between evil and good, with the majority of the good apples set on the other side. But who is making the distinction? Usually it is the guardians of the system, who want to isolate the problem in order to deflect attention and blame away from those at the top who may be responsible for creating untenable working conditions or for a lack of oversight or supervision. Again the bad apple-dispositional view ignores the apple barrel and its potentially corrupting situational impact on those within it. A system analysis focuses on the barrel makers, on those with the power to design the barrel." p. 10

The hospital culture that allows this to happen, that considers it standard procedure to do this -that's the problem. Of course, we can't just let those who perform these unethical deeds off the hook. They represent what Hanna Arandt would call the "banility of evil," that is, people who are thoughtless. People who don't think for themselves. People who get wrapped up by the setting, the situation and the powerful systems around them that set the moral tone. These other factors have much more influence on us than we care to admit
Zimbardo's book studies the most horrible acts that human beings do to each other and tries to understand why. I'm not equating these acts with these modesty situations. But I do believe there are significant and relevant parallels.
Within the hospital culture, the patient can easily become the "other." The patient is sick, uncomfortable, dying, vulnerable, naked,and powerless. The caregivers are not all of those things.
I know some doctors and nurses shudder at my suggestion that the hospital culture can even be compared to these other horrors. But I stand by my suggestion. It's no accident that nakedness and humiliation are tools, conscious strategies used in warfare, genocide and prison situations -- and that we're talking about bodily modesty and humiliation and sometimes thoughtless behavior within hospital settings.
Medical caregivers have tremendous responsibility because of the trust society has placed in them. They are dealing with people at their most vulnerable.
Zimbardo's book is not the most pleasant read. It's a frightening story, but well worth looking into.

 
At Sunday, August 23, 2009 4:59:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I think the genders of the parties does make a difference from the perspective that even at this age we assume females viewing a male exposed is acceptable, if this is a 2nd year med student we are looking at a 25-27 year old male and a 16 year old female. Would we allow a 16 year old make to observe a 25-27 year old female getting a colonoscopy...I doubt it because of course 16 year old males have only one thing on their mind....that is where it makes a differnce.
I think MER has hit on the heart of the issue....the us and them mentality. There are two sets of rules when it comes to modesty, one for us, and one for them. Because we are them, it is easy to apply rules and procedures to us that they would not accept themselves. They can apply logic that the procedures they subject us to are Ok because we are the patient, and patients don't care...they care when it is them..but then they are not patients. The mentality that allows people to do things to people that they know are unpleasant even harmful to some degree, has more incommon than one would like to admit. The degree, the severity may be vastly different, but convincing oneself that what you are doing is justified, right, goes a long way...thus, when providers such as the female urologist who condemned men for being sexist for not wanting her, but openly admited she purposely chose a female gyn,,,or Dr Orrange who justified the need for womens clinics but could see no need for mens clinics...they can reconcile doing things to people that they would not want done to them,,,,,alan

 
At Sunday, August 23, 2009 7:10:00 PM, Anonymous Anonymous said...

I find it difficult to believe this story when often partners are not allowed to observe procedures but a child is ??? Surely it is illegal if this took place.
NP

 
At Monday, August 24, 2009 4:33:00 AM, Anonymous Anonymous said...

Dr. Bernstein,
My comment (@1:29pm) was pointing out the blatant double standard, not questioning the veracity of story: allowing even a female child such license.

--rsl

 
At Monday, August 24, 2009 5:52:00 AM, Anonymous Anonymous said...

I was happy to read that ultimately the doctor and nurse did the right thing. But how could something so ridiculously unethical get as far as it did? I don't even let female nurses attend my colonoscopies, much less children. I would have been MUCH more upset than he was, especially at the disgusting nurse. I would have told them I would walk if that nurse ever came within 20 feet of me again, and cursed the horrible doctor out for even considering something so ridiculous. Depending on the availability of other doctors or clinics in my area I would have walked out, shunned the clinic and doctor and spread the word about the situation and what others could expect if they go there.

Damn I wish I could do something about places like that other than make sure it never happens to me or my family.

 
At Monday, August 24, 2009 10:08:00 AM, Blogger MER said...

I want to continue my discussion as to why things like what happened to Asrei Beyewitz as described in his story at the top of this thread, happen; and what happened to Art Stump as described in his book My Angels Are Come. And why modesty violations may happen in hospitals and clinics.

Modesty violations like these sometimes happen because of the "deindividuation" process that happens in institutional settings such as hospitals. Deindividuation involves the hiding of one's identity. We can do that by donning a uniform, wearing a mask, not wearing name tags, etc. But once we become anonymous and people we're acting on don't know who we are and we know they can't identify us or we them, bad things can happen

As Philip Zimbardo writes in his book The Lucifer Effect: "I had conducted research showing that research participants who were 'deindividuated' more readily inflicted pain on others than did those who felt more individuated." (p.24)

He also writes: "...conditions that make us feel anonymous, when we think that others do not know us or care to, can foster antisocial, self-interested behaviors." p. 25). This may explain the “self-interest” we see in hospital policy, why they sometimes focus inward and make things easier for themselves.

So -- how does this apply to hospitals and modesty issues. 

First of all scrubs or uniforms. Who's who? They're all dressed the same, so who can tell them apart. Scrubs represent access and professionalism. Secondly, name tags with specific names and titles. How often do we not see them. Thirdly, introductions. How often are we not introduced to those who will be "working" on us, especially intimately. 

Fourthly, operating rooms. Read text books about prepping for operations. When it comes to intimate prepping (testicles, scrotums, genitals in general), you'll often read that the shaving or prep should be done "in theater" to prevent "unnecessary embarrassment." Unnecessary embarrassment for whom? The patient or the staff -- or both? It's the old maxim: What you don't know can't hurt you. Now, some patients prefer this to be anonymous. We're all different.

Under privacy laws, patients have the right to be introduced to and know those who will be working on them. How often does this happen, especially “in theater?”

When it comes to intimate procedures, some medical professionals want to remain anonymous. They don't want to get to know the patient. They don't want to be introduced. They purposely distance themselves for their own psychological safety. As Zimbardo writes: "Any setting that cloaks people in anonymity reduces their sense of personal accountability and civic responsibility for their actions. We see this in may institutional settings..." p. 25 Frankly, as I said above, some patients prefer this strategy. Others don't.

Any solutions? If you're the kind of person who wants to know things, and if you're in for an operation or procedure, insist, demand that you be introduced to everyone who will be in that operating room with you -- everyone. No one who hasn't been introduced to you beforehand is allowed in. Period. Make that clear. Ideally, you'll meet these people before you enter the OR, but that may not be possible. You should at least be introduced in the OR.

Don't let the operating staff deindivuadize themselves. Don't let them remain anonymous. Learn their names, first and last. Let them know your name, first and last.  That connects them to you. You're a person. You know who they are. They know who you are. No games. Some may not like this because they prefer to remain anonymous. It makes them feel more comfortable. Explain that being introduced to them makes you feel more comfortable, and that patient comfort should be high on their agenda.
We've talked about the power dynamic -- how patients are at a disadvantage medical settings. Consider this: Zimbardo writes: "Anonymity plus authority is a recipe for disaster." p. 493

 
At Monday, August 24, 2009 11:02:00 AM, Blogger amr said...

Mer, would you then extrapolate, given the thesis laid out above, that
Deindivuadizing leads directly to the justification of non-consensual pelvic and rectal exams, along with the use of video feeds in the OR? Each are primarily for the benefit of the institution not for the patient. A proviso here would be however that some uses of video does directly benefit the patient. But that benefit is used to justify the deliberate creation of a public space in the OR. Imagine what would happen if public bathrooms had video feeds located in them. The difference is that the institution forces the patient to sign a release to allow the privacy violation as a condition of being treated.


--amr

 
At Monday, August 24, 2009 12:05:00 PM, Anonymous Anonymous said...

MER - Thanks for the info and the great advice.

Dr. Bernstein, thanks again for all the time you put into this. Do you ever sleep?

 
At Monday, August 24, 2009 12:27:00 PM, Blogger swf said...

The theory of "banality of evil" still rests in the belief that there is always a greater evil, and we can place at it's feet the reponsibility of our small parts in the involvement. We have little accountability, as we are conditioned (prefer) to believe. Our small parts in the play are lifted up to a higher or final greater authority who is really the actionable culprit.
I would liken this to the death penalty. Someone constructs the room, but it's up to "someone else" what they do with it. (Not my fault)As is the same with the stadium, the special walls, and even the direct lines that feed the injections. In the end you've simply built, cleaned, or painted a room, and the larger evil is on the head of someone else who uses it. As a society we love to say it's not our fault. Our actions are small and many of which we have no control over. In the example above "The State" has set the moral standard, and we have to trust in their infinite wisdom. Our parts are almost benign...we wash the floors and clean the room because we're told. Try not to think about what really happens there, and your part in it.
The question is: once you understand this flaw in human nature what can you do about it? When something bad happens, our own parts in it are always small...blame the higher being. The higher authority. The higher beings of the authority. Blame....the institution.
Now, as a nurse for example, you can lay the blame of breaking someone's modesty on the moral code of the institution. You can rest at home after laying the shame at the higher evil's feet. What can we do instead to make her/him accountable for themselves?! No one should be off the hook. After all, if you are looking to remove blame from yourself, you have done something wrong.

 
At Monday, August 24, 2009 2:54:00 PM, Blogger MER said...

Zimbardo doesn't excuse the individual. He's saying that we too often disallow the powerful influence that settings, situations and systems have over our individual will. The best way to avoid getting caught up in these influencing factors is to realize that it can happen. If you believe firmly that you could never commit an evil act, even though you've never been truly tested,then you are probably quite
in danger. If you realize that there is the potential for evil in all of us, depending upon factors outside of our control, then at least you have a chance.
At the end of the book, Zimbardo talks about the "banality of heroism." He gives case studies of people who fought the setting, situation and system and refused to submit to evil. Of course, some became martyrs. Zimbardo also gives a list of strategies people can use to help prevent these other factors from taking over.
Zimbardo does not excuse the individual. We all make choices. If nothing else, we sometimes make the choice to place ourselves within a setting and situation and system that is or could turn evil. That's a choice we're responsible for.
As within other systems, caregivers may recognize serious problems within their hospital or clinic. They can go along with it, try to change it, or leave. To ignore it is also a choice.
Considering the two specific cases we referring to, why did these individuals violate patient dignity by bringing minors into a procedure? The system said it was okay. One thing we always have to do is be willing to question authority, think for ourselves, ask questions. There can be great risk involved with this. It's easier just to go along and rationalize that it's okay because we've been given orders. We must realize that systems can get out of control and become focused primarily on their own survival and comfort.
We as patients can do things to help the system refocus. We can remind them of our dignity and modesty. Respectfully educate. Remember, we're talking about good people who can sometimes do bad things. They're basically good people.
In some cases, working conditions, lack of enough or trained staff, lack of proper supervision, contribute to the problem of protecting patient modesty. So we must also depend upon the leaders within the medical profession, the Dr. Bernstein's and Dr. Sherman's, nurse teachers, and hospital administrators to work to change the system. And of course, the those working on the ground, the battlefield of health care -- the floor nurses and cna's and med techs. Many are trying to do this. Some are not. They have individual responsibility. So do we as patients. When we don't speak up, that's making a choice, too -- the choice to endorse the system and let it do what it choses to us.

 
At Monday, August 24, 2009 3:10:00 PM, Blogger MER said...

"Mer, would you then extrapolate, given the thesis laid out above, that
Deindivuadizing leads directly to the justification of non-consensual pelvic and rectal exams, along with the use of video feeds in the OR?"

Usually, our relationship with our personal doctor is close. When he or she sends us to a specialist, we can also perhaps develop a close relationship with him or her and the staff. It's when we get into the hospital "system" that we get this test and that test and this procedure and that procedure and people are coming and going -- people we barely get to know. We go into the OR, not having met some who are working on us, then into the ICU or recover room where we're just another patient to those taking care of us. Perhaps we should all have a photo of us smiling, dressed in our typical clothing doing a job that we love to do (working in our garden or playing with our children) -- and that photo should be pinned to the top of our gown wherever we go within the hospital system so our caregivers will never forget who we are when we're not a "patient," when we're not naked in a gown, sick, frightened and vulnerable.

How we're treated depends as much upon the culture and tone set by the specific hospital as it does upon the individual workers there. If working conditions cause stress and anger, that will affect patient care. If everyone's so busy that they don't have time to develop healthy nurse/patient relationships, that affects patient care and could lead to modesty violations.
It's more difficult to hurt someone, embarrass them, humiliate them, if you know them. Not that it doesn't and hasn't happened. A significant part of genocide involves neighbors killing neighbors. That's where the propaganda machine has taken over and people have become brainwashed, sometimes over generations.
We need to think for ourselves and within reason question authority with any system that takes control of us.

 
At Monday, August 24, 2009 4:22:00 PM, Anonymous Anonymous said...

Mer

Logistics of a busy hospital are not the sole blame
for the privacy violations that
many patients experience. There
are hospitals workers that prey on
this sort of thing as I've seen
my fair share of them. You can have
all the family photos you'd like
adorning the gurneys as many hospitals workers have long ago made the disconnect between patients and people.
For many health care workers
patients are simply the means of
empowerment and opportunity.Sadly,
many nurses hate their jobs with a
passion as one only needs to visit
a few nursing sites to see that
provided you don't work in healthcare. Having a family member
present changes the quality of care dramatically in most every case. Most healthcare workers hate
visitors as you only have to visit
allnurses on general thread "things
you'd like to say to visitors".
Heathcare workers have to put on their best face when family members are present and unfortunately for many patients
they don't always see that best face.


PT

 
At Monday, August 24, 2009 5:36:00 PM, Anonymous Tina R said...

"That's where the propaganda machine has taken over and people have become brainwashed, sometimes over generations.
We need to think for ourselves and within reason question authority with any system that takes control of us."

We have some American women working with us at the moment.
One of them asked me how we arrange our annual checks...do we go to a gyn clinic or see a GP?
A confused conversation followed where I thought she had a personal medical issue and she was totally confused.
I was very surprised to hear that your women have all their reproductive organs thoroughly examined every year starting from their teens.
I explained as a 39 year old woman, I'd never had an exam of that sort...
I'm aware some doctors do a gyn exam when you become pregnant and certainly if you have a medical problems that warrants it...but otherwise we assume we're healthy until we have symptoms.
Cervical screening is offered 2 yearly and I think about 60% of women are involved in that program.
No one sees a gynaecologist for their care...it's a specialist service.
Even though they were reassured by our doctors that these exams are unnecessary...they all became terribly worried and convinced they'd develop cancer as a result.

We also have English and Dutch women on the exchange program. They also reassured them these exams are not done/recommended in their countries.
One woman was sent to a gynaecologist who informed her the exam was of little clinical value and likely to lead to more invasive and possibly, harmful testing. The exam could only provide false reassurance.
The incredible thing...one of the girls is a virgin and still fears not having these exams...our doctors put her straight...she should not agree to any gyn exams or smears in the future.

I thought this was the perfect example of a group of intelligent women who have totally accepted the need for VERY invasive exams and testing every year...and have been so brainwashed they're afraid to depart from the practice DESPITE overwhelming and strong evidence that they are totally unnecessary.
Smears are offered 2 yearly, but some of our doctors now believe that is too frequent and have moved to 3 and 5 yearly testing to reduce the risks of testing.
Even breast exams are not done routinely until you're in your 40's. I rang the GP's association who told me that routine breast exams in the under 40's were not recommended as cancer was uncommon in that group and exams often lead to biopsies for benign conditions in younger women.

Even if all of these exams were stopped in the States...many women would still seek them out...otherwise they live with this totally unwarranted and enormous fear of cancer BUT you have to remember these exams have been aggressively promoted since their teens and all the women in their circle have them as well...mothers, aunts, grandmothers...the message is constantly reinforced...and many have to overcome serious mental hurdles to have these exams.

Brainwashing is a powerful weapon and in the end you have a group of compliant women who ask no questions and have closed minds to hard evidence.
It frightened me really...
I should add all of the women found the exam an ordeal, some took Xanax to manage...but they all felt it was highly irresponsible and reckless with your health not to have them.
One said, "If I don't have the exam and get ovarian cancer, it would be my own fault"...
My Dr said that by the time you can palpate a tumour, the woman would be having symptoms.
The exams are not done here...because there is no good clinical reason to do them and some major negatives not to do them...
The doctor's motto, "Do no harm"...
One thing I noticed...ALL of the women had been put through LOTS of awful follow-up testing...multiple mammograms and biopsies, cervical biopsies, colposcopy, ultrasounds and other procedures. None of them actually had any health problems, but were constantly being examined, tested and investigated...
Curious our healthcare systems are SO different.

 
At Monday, August 24, 2009 7:36:00 PM, Anonymous Anonymous said...

A great example of this is on allnurse.com search whoa inappropriate. It has been cited before, but has special application here. the topic was nurses taking turns checking out a well endowed and unconcious male patient. While the incident itself was disturbing...the turely telling thing was the fact that even among those that acknowledged how wrong this was,,,there was a lot of discussion on both sides of whether to report it. The issue was whether reporting this transgression would be right as it violated the "sisterhood" of nurses and would bring retribution upon the nurse who reported it from the other nurses. In other words while we acknowledge it is wrong...its still about us...and them. We are not a team (patient and provider), the team is them the providers....the institution definately fosters violating modesty for efficency, but the providers not only have to buy into it for it to have an effect...but often embrace the us and them.....alan

 
At Monday, August 24, 2009 8:12:00 PM, Anonymous Anonymous said...

I just got the link to an ad CBS is running on prostate exams for men. Personally I find it offensive, if any one else finds it so, please express that to cbs. It shows a total lack of respect for male modesty concern.

http://www.cbs.com/cbs cares/video/video.php?cid=822112903&cc=26&play=teve

 
At Monday, August 24, 2009 9:10:00 PM, Blogger Maurice Bernstein, M.D. said...

The link in the previous posting, on my sttempt, goes nowhere.. so.. either the link is wrongly written.. or..maybe CBS has gotten the word and took the video off their website! I think most of you would hope for the latter..Maurice.

 
At Monday, August 24, 2009 9:33:00 PM, Anonymous Anonymous said...

Alan

The most disturbing comment
made on that thread whoa innappropriate was from the response that " the patient wasn't harmed so why make a big deal about it."
Based on that response all
peeping toms are harmless as she shouln't feel worried if a peeping
tom pervert looks into her window
at her or her daughter if she has one.
All peeping tom laws in america should be be reversed,how
sick was that!


PT

 
At Monday, August 24, 2009 10:35:00 PM, Anonymous Anonymous said...

Looks like CBS didn't get the message.

Try this link:

http://www.cbs.com/cbs_cares/video/video.php?cid=822112903

Yes, I also think the ad is offensive fr all the reasons already mentioned...Sally

 
At Tuesday, August 25, 2009 7:58:00 AM, Anonymous Anonymous said...

PT, your "peeping Tom" analogy is perfect. That's exactly what goes on way more than anyone thinks, or cares. I've heard and read several accounts about men with priopism. For one guy, over a 2 or 3 hour period of time while in the ER he had as many as 8-10 different female nurses go in to "check" on it. As most people know, that includes wrapping their hand around it for one reason or another.

I went with my mother to the ER once after she collapsed and I don't think I saw more than 2 or 3 nurses all evening. I stayed with her for much of the next 3 days after she got admitted and I don't think I saw more than 3 or 4 nurses there either.

Apparently priopism is much more serious than a heart attack, at least in the mind of all those nurses. He was a very popular guy that night. I've heard about a dozen similar experiences from other guys.

Dr. Bernstein, my question to you (or anyone) is how do you think a doctor (and nurses) in the ER would react if a guy with priopism told him that he wouldn't allow any female nurses or doctors to see or handle his "problem"? I know you can't speak for all ERs around the country but have you encountered or heard anything about a situation like that? What would you say if one of your students asked that question?

LG

 
At Tuesday, August 25, 2009 9:51:00 AM, Blogger Maurice Bernstein, M.D. said...

LG, the issue is a "no-brainer"! Any critical emergency management (which priapism is an example condition)for the protection of life or "limb" will trump any matter of "gender selection of health care provider". If a patient comes into the ER with priapism and refuses treatment by a competent physician present because of gender and has shown capacity to make medical decisions and appears to understand the consequences of rejecting examination and treatment there is nothing further the ER staff can do if healthcare provider of the other gender is not available. Certainly, if there is a competent physician of the gender selected by the patient who is readily available, it would be also in the best interest of the patient for the ER to provide that physician. But if one is not evailable then as they say "tough!" ..Maurice.

 
At Tuesday, August 25, 2009 10:21:00 AM, Anonymous Anonymous said...

The correct word is "priapism".

No where did I see that the treatment of choice was for a female nurse to 'wrap a hand around it'. Do a search and you will find the recommended treatment options for priapism.
JW

 
At Tuesday, August 25, 2009 5:18:00 PM, Anonymous Anonymous said...

Dr. Sherman has posted a link under the media thread on his site to the ad. I did recieve a response from the American Cancer Research Assoc. they seemed like a very sincere organization. I did not get a reply from ACS or CBS, the first surprises me.the second doesn't....I wish i would have noted the advertisers and written them...I am getting to the point of doing it for me, not that it will nesecarily change anything...but its something I can do.......alan

 
At Wednesday, August 26, 2009 4:33:00 AM, Anonymous Anonymous said...

Refering to LGs comment - Obviously doctors can't force patients to do anything. What I wonder is how do nurses react to men refusing to allow them to see and touch their member or any related problems? I know everyone is different but do many nurses at least pretend to understand modesty and dignity? Do they get offended and throw temper tantrums or try to belittle their patients? Any experiences?

 
At Wednesday, August 26, 2009 7:51:00 AM, Anonymous Anonymous said...

The problem is no is suppost to mean no. Once you say you don't want her to touch youit's out there. She can say I can't find anyone else and now you have lost and she has won. You are thinking how painful it is to be humiliated and she is thinking that she has just humiliated you and she won. But even though basicaly you have been molested hte law wants to stick by her because "it's diferent" if it's a nurse. I don't like to sue but if that is the only way to get them to stop molesting us I will.

 
At Wednesday, August 26, 2009 10:42:00 AM, Blogger MER said...

This discussion about saying "no" is so theoretical and lacks real context.
First -- If it's an emergency, a life-death situation, you of course can say no and accept then, if they have no substitute, accept the consequences.
Second -- If it's not life or death, you can say you want a male nurse, and if the female nurse says she can't find anyone else, you can say you'll wait while she does find someone. If it's not life threatening you can wait as long as it takes. If it means you have to cancel or reschedule a procedure, then so be it. They don't want to do that, so, within that context, they'll most likely find someone.
Third -- You can be proactive and try to make your needs known ahead of time -- explaining your feelings and values to your personal physican or your surgeon. You can ask about staffing at the facility you're going to, the mix of male and female help.
Fourth -- I believe most female nurses understand this situation and work to solve it. They trade off with male nurses. This, of course, depends upon staffing situations and the size of the facility.
Fifth -- Much of what we're talking about is theory, what would happen if? We do get some valid stories about the double standard and they're always negative. We rarely get the good stories of how this problem has been solved. One exception is Alan. He's told us how he's worked it out. If we could actually do interviews with patients about this issue, we'd find at least just as many (or more) men who found caring and sensitive nurses who helped them through these embarrassing and awkward situations by find same gender care.
Sixth -- The more I get actual experiences within the healthcare system, the more I see that in most cases this modesty problem can be solved if people communicate. I'm not saying there aren't "bad apples" within the system, or that some "systems" help create those bad apples. I'm also not saying we don't need to work on this issue, this double standard.
I'd like to see more posts here that talk about how things have worked out for men regarding modesty and the double standard.

 
At Wednesday, August 26, 2009 1:31:00 PM, Anonymous Anonymous said...

I am onboard with MER on this one. I do not think the overwhelming issue is evil providers who are looking to humiliate patients. For the most part I have found when communicated upfront they will either provide a solution, or respectfully tell you they can not accomodate....to be perfectly honest I have never run into one that said they can but won't. I think we take the obvious road from our side...they HAVE to know so why don't the do something. I still frimly believe they know, but 1. if you don't ask they are not going to vol. assuming that either even though it matters it doesn't matter THAT much...or if you don't ask they aren't going to because if they do they have to deal with it. and 2. they system they work in tells them not to, the system tells you this is how you handle these situations...and that instruction is to try to convince you to accept what they have always done, the status quo, that works to the benefit of the system. The gender nuetral concept allows the facility to cut the number of staff, if the facility added staff to accomodate gender, it would cut the providers work load....I don't think they would mind at all. But the system does not want that extra cost so, the easiest solution for them is gender nuetral and keep the number of staff down.
I recently contacted a local hospital out of curiosity and asked them if I needed an ultra sound would they be able to provide a male tech. They said they used a service that provided their imaging needs and they had a male in the rotation so I would have to give advance notice and would have to schedule on that day...as I indicated earlier I called another local who said they only had females on staff in imaging but the radiologist who read the results was male and could be there but a female would be conducting the actual test...I said that wouldn't work I was going to have to look elsewhere and they were very respectful in wishing me the best in finding an acceptable solution. Two different responses, both respectful.
Now go to allnurse, you will find some really nasty nurses who have this God complex that it is all about them and how dare anyone intrude in their world becasue they are NURSES, but the vast majority recognize the issue as being valid and recognize it is about the patient....so the bad ones are out there...but the vast majority that I have seen have been respectful and atleast on the surface...seem to understand...alan

 
At Wednesday, August 26, 2009 4:29:00 PM, Anonymous Anonymous said...

You the patient should report to
your insurance company any facility
that cannot accomodate you,wether
they were respectful or not. Is it
your fault they don't have a minimum male staff or is it that they don't want a minimum male staff?
Should any facility tell me they
were not able to accomodate me due
to lack of male staff would most
certainly prompt the question,why?
After notifying my insurance
company I might even be inclined to
write a brief letter to their HR
director stating my concerns. I'd
certainly write a letter to the EEOC stating to that agency that
this is a medical facility that has
no male staff,do you have a complaint history for this facility.
My goal is to raise eyebrows not
blood pressure and to further my point one needs only to look at
L&D staffing. Never ever have I
seen a male nurse working in L&D
and I've visited many over the years. These facilities might just
be respectful to your face but you don't hear the comments that are made behind your back.
If they truly wanted to accomodate everyone they most certainly would STAFF for everyone.


PT

 
At Thursday, August 27, 2009 3:59:00 PM, Anonymous Anonymous said...

To annon 8-26: from my limited expereince nurses act completely surprised and shocked that modesty would be an issue. They will also defend their 'right' to do intimate care by saying that is just who works in that area, they don't have male staff, or the best one, "is that a problem?" You've got to be kidding me! They feel they have every right and this shouldn't in any way bother people. Just like going to the market to get groceries and being checked out with a female clerk! No difference.
JW

 
At Friday, August 28, 2009 12:04:00 PM, Blogger MER said...

JW wrote "from my limited expereince nurses act completely surprised and shocked that modesty would be an issue."
Some responses:
1. You can't group all nurses together. There are many different kinds of nurses who do different jobs -- some of those jobs have nothing to do with intimate care. This is where I completely disagree with you -- most of those nurses who do or supervise intimate care every day, know fully well about this issue.
2. Some may be actually surprised, depending upon their background. We can't assume that this situation doesn't ever exist. Look into her eyes as she acts surprised. It's a true that the eyes are the mirror to the soul.
3. Some may be consciously using surprise as a strategy to get the patient to comply -- that is, making the patient feel as he is asking for something that no one ever else asks for. Thus making the patient feel not normal. We all want to believe that we're normal.
3. Some may be unconsciously using this strategy to protect themselves. Deep down they know, but by denial helps them get through an embarrasssing encounter.
4. And yes,some nurses may actually feel entitled, believe in the gender-neutral stance, and are annoyed that the patient even asks. Their focus is ideological and on themselves, not on patient comfort.
5. Finally, if the nurse acts surprised -- So what? Let them be surprised for whatever reason. That gives the patient an opportunity to "educate" the nurse as to why she shouldn't be surprised. Just as it doesn't really matter we a man might want same gender intimate care -- so to it doesn't really matter why the nurse acts surprised. It's about patient comfort and respect for patient dignity. Patient and nurse need to delve into each other's psyche.
6 As human beings, we can't control how other people think. We can only control how we respond to what they think or say or feel. We need to respond by letting the nurse know that it doesn't really matter whether she's surprised or not. What matters is how she decides to deal with that surprise -- whether she will accommodate the man or not.

 
At Friday, August 28, 2009 3:20:00 PM, Blogger MER said...

In item # 5 above, the last sentence should read: "Patient and nurse need not delve into each other's psyche.

 
At Friday, August 28, 2009 3:35:00 PM, Anonymous Anonymous said...

MER, respectfully, I must comment on your take on my statements. I prefaced my comments with: "from my limited experience." What more do you want from me? I was stating my direct experience. I am fully aware many, many nurses do not do initimate care. There are many different areas of nursing and many do not include doing intimate procedures. I was not lumping all nurses together. I said from my experience. It was several experiences involving nurses that do intimate care in several facilites over many years. The nurses I was referencing worked in areas of nursing that deal with intimate care daily. OKAY? enough said.
JW

 
At Friday, August 28, 2009 4:43:00 PM, Anonymous Anonymous said...

I'd like to add that since when should the patient "have" to educate the nurse or female provider about anything! It's all
about me the patient in the first place. What if she went to her gyn's office and I greeted her there at the door and stated,"I'll
be observing you exam today.
Should I be surprised if she said no? How quickly can I put on
my stupid fake surprised look!


PT

 
At Friday, August 28, 2009 5:57:00 PM, Blogger Maurice Bernstein, M.D. said...

On the other hand PT, if your presence was unexpected and your presence there was not part of the professional examination of course the patients "NO" would be an expected response to you. But if the nurse was a professional participant in the examination of you, your "NO" would certainly be perhaps a surprise and a concern to her and your "NO" response might be questioned and you would have to explain your negative response to her. And what is wrong with explaining? ..Maurice.

 
At Friday, August 28, 2009 6:41:00 PM, Blogger MER said...

JW: Sorry if I seemed to go after you. I didn't intend that. It's just that, who cares whether the nurses is surprised or not? Or why. So what. That's not the issue. The issue is making clear our expectations. Pointing out the double standard, fairness, gender equity, etc.

PT: Call it education, call it discussion, call it debate, call it discourse -- call it what you like. The nurse has a expectations; the patient has a expectations. If they don't match up then some type of communication should take place. I call it education. You'll often hear doctors and nurse talk about what they learn from their patients. Many of these professionals are open to learning new perspectives. I believe it's part of our jobs as patients to better educate them in areas that we may know more about then they do -- that is, our feelings and our bodies.

 
At Friday, August 28, 2009 7:15:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, may I say here that I have always been open to education by the patient. From "tell me why you came to see me" to "tell me about your concerns" to "tell me why you are continuing to smoke" or even last Friday "tell me why you didn't buy that home blood pressure machine that I advised you need to get." And the anwer "I couldn't afford it."

In fact, what I teach my medical students, that the work of a medical student and later as a physician is to listen to and be educated by the patient. I'm sure that many doctors still follow that teaching. Yes, even when the patient is about to exit the office and with a hand on the door knob provides an exit symptom "Doctor, I have one other thing to talk about..", we listen. Maybe the issue is such that the concern can be delayed to be handled at a later time or maybe not but we listen. There is no reason that a healthcare provider cannot listen and be educated by the patient. What is necessary for this to take place is for the patient to take the initiative, if not prompted by the doctor, to speak up. Obviously, the suggested "power" diffential may be the cause of the hesitance. But doctors are not mind readers and the only way for the doctor to be educated about the patient's concerns and desires is for the patient to communicate.
That's the beginning. What happens next..well, that is another issue. ..Maurice.

 
At Friday, August 28, 2009 7:37:00 PM, Anonymous Anonymous said...

Whether and how a patient explains a NO depends on how the nu, you rse presents the why?. While none of us are mind readers including providers you can sometimes read the other person. If the why is an indignant why would you not want ME, its one thing, if its a sincere what is the problem and maybe I can address it thats another....if its an indignent how dare you question me......the heck with you, you either don't don't deserve an explaination or you may not like what I have to say...the tone of the "education" may depend on the tone of the question...I am still mystified that a provider would not have a clue as to why a patient would say no when they bring outside people ie students or student nurses in to observe intimate exams. Would any one question a female at her gyn if a male nursing student in a a female said NO?........if its obvious why,,,questioning why can be more than just the quest for knowledge....of course its not always easy to see which it is, and common curtosey would be to explain unless absolutely sure...alan

 
At Friday, August 28, 2009 9:45:00 PM, Blogger MER said...

If you haven't seen it, you must see the 2009 documentary called "Money-Driven Medicine." I saw it on PBS.

It covers much of what we're talking about here but in the context of the big picture -- today's culture of medicine. There are even a few subtle references to the modesty issue. It talks much about the poor communication patients often face. It talks about the patient not being the focus or center of a system that is "money-driven," a system that engages in competition as if the product being sold were hot dogs, or television sets.

This modesty issue we're discussing is part of a much larger picture, an attitude, a world view, a philosophical foundation. When the system works, everyone is accommodated and respected as best as can be done. When it isn't working, we have to fight a system, a culture that is extremely powerful.

See this documentary. It is quite enlightening.

 
At Friday, August 28, 2009 10:36:00 PM, Anonymous Anonymous said...

It's irrevelant what the level of intercommunication that transponds
between patient and provider,but
rather the posturing suprised look
which is really an act of disguise.


PT

 
At Saturday, August 29, 2009 9:47:00 AM, Blogger swf said...

Modesty is obvious. I don't invite the neighbors in when I take a shower. I don't ask friends to watch me having sex. I don't try on clothes in the middle of the store...I don't walk my dog in the nude....bathrooms have doors... and people have boundaries.
It's just really not that complicated.
People are just people. We want to pick who sees us naked and intimately touches our body. Where is the 'surprise' in that?
Really, let's not confuse surprise with offense. I would guess ,yes, most of them who act surprised are really just simply offended when you say no. People are usually offended when you tell them no anyway.
It's not a big mystery that we don't want to be forced to expose ourselves to whoever whenever.
And for those who are surprised, I would suggest they take the curtains off of their windows and the doors off of their bedrooms and see how long it takes their modesty to kick in.

 
At Saturday, August 29, 2009 11:46:00 AM, Blogger MER said...

I think swf put it quite well. The anger seems to come from what's perceived as the dishonesty in the surprise. I can understand that completely. Why the surprise, we'll probably never know. But if the patient perceives it as dishonest, and responds based upon that perception, then it might as well be dishonest. Perception can equal reality.

This is part of the culture of secrecy in medicine. Let's pretend that these things don't exist and they'll just go away. As patients, let's not pretend. Let's bring up the unmentionable.

I still say that this honest or dishonest surprise gives the knowledgeable patient more control of the situation if he or she decides to take it. How can one respond? As Alan says, it depends upon the tone of the surprise.
"Sorry, but I don't really believe you're surprised at my request. You're telling me that you never see modesty from men (or women)in these kinds of situations? Even though they may not request same gender care, don't you think they would sometimes appreciate it?"
"Let's talk about this. Why are you so surprised at my request? How about you? How would you feel in a similar situation."
"How would you respond to my request if I were a female patient and you were a male nurse?"
"Are you seriously telling me that patient modesty isn't an issue in medicine? Do you believe patients can just switch their modesty on and off when they enter the hospital doors?"

I say the patient can take the upper hand in this situation if the patient recognizes the advantage. Imitate Socrates -- ask questions. Follow up their answers with more penetrating questions. Let them dig themselves deeper and deeper into uncertainty and ambiguity. Put them on the spot.

 
At Saturday, August 29, 2009 12:07:00 PM, Anonymous Anonymous said...

swf, both my wife and I completely agree with your take on this subject. That said, the only caveat to this topic is for some reason the medical world puts a spin on this. They feel I believe that "a patient" comes to them for help and treatment and it IS 'medical'. Therefore, all those things you just stated about what people do and don't do in society -
are out the window and don't apply. Female nurses are experienced, professional, and trained - therefore they should be allowed, permitted and accepted by ALL -
JW

 
At Saturday, August 29, 2009 4:52:00 PM, Anonymous Anonymous said...

A post note to my comment:
The last statement I made about "female nurses are experienced, professional.. therefore they should be allowed, permitted and accepted by ALL.. should have been more clearly stated that it is this they use for the reasoning that the normal rules of society do NOT apply. This is how they justify what they do. This is why they feel empowered to proceed with NOT asking patients or seemingly to not care how this affects people and that modesty issues do not count under the circumstances.
I fully disagree with their take on the subject and how approach it.
JW

 
At Saturday, August 29, 2009 5:31:00 PM, Anonymous Anonymous said...

there are a lot of directions this could go from here. Are they really surprised or is that an act. Are they surprised it is an issue or are they surprised someone stood up. How did we get here, at one times when orderlies were common there was gender specific care, how did we loose it. To me it is fairly obvious gender nuetraling serves providers mainly if not totally. The fact that you will hardly ever find a provider willing to engage in this conversation says something to me. I think they know it, I think they may pretend it isn't an issue, but when they are forced to step up and acknowledge it exits, and forced to defend their position...they can't so they don't, the run for cover. Every provider I have seen confronted with this goes silent. Keagel girl (the female urologist who acknowledged choosing female gyn's but condemned males for not accepting her), Chill, etc. if you go to allnurses there are several threads on the subject, they all end up heated and closed by the moderator.....it leads me to believe that at some level they know, they just don't acknowledge, perhaps even to themselves. How many times have we heard its different when its them BECAUSE THEY KNOW THE PROVIDERS, not just because its them....challenge them, would you accept an opposite gender janitor cleaning the locker room while you shower and change...they act like that is totally ridiculous...but why, who set the rules, who said that providers get to decide they are so special that they can ignore modesty not only when its the only option...but as a matter of daily practice...with all of that said, while I can believe it isn't talked about, isn't acknowledged, I don't believe it isn't known at some level.....if they just focused on the patient...not themselves....alan

 
At Saturday, August 29, 2009 5:35:00 PM, Anonymous Anonymous said...

"Would any one question a female at her gyn if a male nursing student in and a female said NO?" Well yes alan they do. I cannot access the site anymore but in the British medical journal there is an article about male medical students not being giving permission as often as female medical students to perform gyn exams. The whole stance of the article doesn't even question that it is a completely normal response from most women to feel uncomfortable about this. Rather,they state that female patients need educating.
Also whilst most posters here consider female nurses not professional enough to see male patients naked. What about orderlies? They have no professional training and yet they are able to stand around and stare at naked patients.
NP

 
At Saturday, August 29, 2009 6:07:00 PM, Anonymous Anonymous said...

NP I really am not familiar with the UK but in the US the virtual elimination of new male GYN's would indicate it does matter here. The other point is right or wrong we seem to give more lattitude to Doctors and Medical students than we do nurses and nursing students. My point was, if a Gyn brought in a male nursing student, and the female patient said they weren't comfortable with the male assistant...would they question the female patient with the same intensity and degree as they would a male patient rejecting a female nursing student. I would say you are wrong if you say they are the same. Hosptials have gone to court and won cases where they have excluded male nurses from labor and delivery, go to all nurses and read about male nursing students who were kept out of L&D not only by paitents, but by their nursing directors and educators, or the male nursing students who talk about never being trained to cath a female patient because there are enough female nurses to do it, etc etc...while I have not doubt it may happen NP, I truely doubt it is done with the same frequency, intensity, and attitude that males are refused....alan

 
At Saturday, August 29, 2009 7:36:00 PM, Blogger MER said...

In a recent NYT column, Nicholas Kristof writes about a medicaL insurance executive who finally got fed up with the corruption in his industry. He writes: "...he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company's stock price -- which means paying fewer medical bills."

Sound familiar?

Hospital CEO's and those directors on hospital boards, are also removed from the consequences of their decisions -- until, of course,the end up as a patient. Then, they most likely will get special treatment if they request it.

The lesson? -- patients with modesty complaints must go right to the top. Let these CEO's feel the consequences of their policy decisions. Patients must make this modesty issue a public issue so it will threaten to affect a hospital or clinic's bottom line. That will elicit change.

Patients need to play hard ball.

 
At Sunday, August 30, 2009 8:25:00 AM, Blogger MER said...

JW wrote: ""female nurses are experienced, professional.. therefore they should be allowed, permitted and accepted by ALL.. should have been more clearly stated that it is this they use for the reasoning that the normal rules of society do NOT apply. This is how they justify what they do. This is why they feel empowered to proceed with NOT asking patients or seemingly to not care how this affects people and that modesty issues do not count under the circumstances."

I believe this is more than just individual nurse attitudes. Some may feel that way, others may not.

It's an embedded attitude, a philosophy of the institutions, the hospitals. It's further justified by the imbalance of male and female nurses. It's also justified by efficiency and the bottom line.

In some cases it is also embedded in nurse training, but I think their training has become more open to what's called transcultural nursing, being more sensitive to different values.

The attitude you describe is more part of the hidden curriculum than the academic curriculum.

In the "old" days, nurses were expected to do intimate care on men in emergencies. In non emergencies, other arrangements were made. Something happened in attitudes after WW2, grew through the 1950's and came fruition in the 1960's. The attitude change ws more political and ideological than social, that is, the general population attitudes didn't change. But political/social forces decided that their attitudes should change. We see this in many attitude enter into many aspects of society.

 
At Sunday, August 30, 2009 12:05:00 PM, Blogger swf said...

Mer said: "The lesson? -- patients with modesty complaints must go right to the top. Let these CEO's feel the consequences of their policy decisions. Patients must make this modesty issue a public issue so it will threaten to affect a hospital or clinic's bottom line. That will elicit change.

Patients need to play hard ball."

I believe this brings us back to being proactive, and with that said I believe we are at the place to start thinking of names for our website.
For many reasons I believe this should still be an active goal, but the public accountabilty Mer suggests is just one.
I would suggest something along the positive lines of "A Guide To Patient Modesty". It lends clout to the idea that a GUIDE is real, affirmative, and has done their homework.
Also..."Solutions To Medical Modesty Concerns". We project that we have solutions and are serious. The boring stuff about wording hits is covered by these two..but anyone agree that a positive name such as this would gather attention?
These are just examples on direction. Anyone else?

 
At Sunday, August 30, 2009 4:27:00 PM, Blogger Hexanchus said...

MER,

I agree that institutional mind-set is likely a major factor. While we can win individual battles at the provider interface level by standing up for our rights, the worker bees don't establish or change policy. For that to happen the complaint also needs to go as high in the organization as possible - we need to get to someone high enough in the food chain with the authority to modify policy.

As to patient's playing hard ball, maybe we need to start by borrowing a philosophy from DARE and "Just say NO!", and stand firm.

 
At Sunday, August 30, 2009 5:29:00 PM, Anonymous Anonymous said...

As I've said before, I find it impossible to believe that any medical person including receptionists would not REALLY be confused as to why someone says "No" to something that includes opposite gender nudity. They can't possibly be that stupid. So anytime someone pretends to be surprised or not understand, I take it as an insult.

GL

 
At Sunday, August 30, 2009 5:44:00 PM, Anonymous Anonymous said...

I like what MER had to say about questioning those that pretend to be surprised. If I understand right, or I may be taking it a little further, basically you say that when someone pretends to be confused they may be trying to embarrass you into complying by making you sound like a fool. If you question their "surprise" properly, you can actually make that person sound like the fool.

PT, swf, love the comments.

emr

 
At Sunday, August 30, 2009 6:03:00 PM, Anonymous Anonymous said...

NP

My father was an orderly at a large hospital for three years, from 1969-1972. In three years he NEVER saw even one female breast, genital or anything. He never did anything that didn't include nudity but might have been uncomfortable for the female patient, like massage her or help her to the bathroom.

I happen to know that this hospital is still in business (didn't go under for being overstaffed) and patients are still treated with respect. Modesty problems are not an issue because patients are always accomodated (from all I've heard).

I'm sure that some orderlies somewhere have/had the same disrespect for female patients that many nurses today have for male patients, but not everywhere. That's why orderlies were created (at least in my area), for the respect of modesty for both genders.

DG

 
At Sunday, August 30, 2009 7:47:00 PM, Anonymous Anonymous said...

DG that's reassuring. But it just so happens that I used to work with a man in a completely different industry whose favorite pastime seemed to be looking at porn. He often would talk about porn stars and films he saw etc. He left that field of work to become an orderly. He also has gotten married and had children so I do hope he has matured.
From what I have heard about different hospitals is that some treat you with dignity and others will leave you lying there when you are unconscious naked and spread eagled.
NP

 
At Sunday, August 30, 2009 8:29:00 PM, Blogger MER said...

emr wrote: "...basically you say that when someone pretends to be confused they may be trying to embarrass you into complying by making you sound like a fool."

Could but, but it doesn't really matter what they're trying to do, although if you perceive that they're trying to embarrasses you that could affect your tone. Just react to the surprise. Patients often get the cliche: "There's nothing to be embarrassed about." or "It's perfectly natural."

If that's the case, than an open, frank, blunt discussion of the modesty issue should be just fine, right? We shouldn't be embarrassed or uncomfortable talking about this, right? So let's talk.

Go with the questions. My guess is that some will just not want to engage in any discussion or debate. They may leave and just get you a male nurse to avoid a conflict. If they bring back the supervisor, question the supervisor. Others will engage, and I would find that delightful. I have a thousand questions, and dozens of arguments, many of which I've posed on this blog. I'd like to hear their answers.

I've determined that there are very few good arguments against accommodating patients. Most of these "good" arguments go to what's best for the institution and the profession, not what's best for the patient. Learn to recognize these.

And caregivers know they don't really have good arguments against protecting modesty through accommodating. By continuing to question, like Socrates, you let the caregiver dig her/himself deeper and deeper into a murky, embarrassing pit.

Of course, you've got to be prepared -- have a good basis of the arguments we've discussed on this thread. But don't get angry. Don't be rude. Just ask questions and let them answer the questions. Don't interrupt. But continue questioning all their misguided premises.

And to DG: Would you repost? I'm not sure what you're saying. It's not clear.

 
At Monday, August 31, 2009 12:17:00 AM, Anonymous Anonymous said...

To the uninitiated,a hospital
experience is a tall hot cup of
reality. Hospitals by nature have
a secret culture that changes from
day to day mostly dependent on who
the staff is and from which agency
they are from. When a patient suffers a hippa violation,sexual
assault or sexual boundary violation by staff that garners attention from administration,the
guilty parties are quickly terminated.
The next day its business as usual with no lectures and no fanfare.In fact,the less attention
the better as hospitals are very
good at keeping problems quiet and
contained. Occasionally, these
incidents are picked up by the news
media as a result of a police
investigation. In most states,taking a cellphone pic of
a patients genitals without permission is a class B misdeamenor
and a hippa violation.
Sadly,in my state this has occurred for the fourth time in less then a year here all involving
male patients. To the general public these may appear as isolated
incidents. Fact is it occurs more
frequently than many realize as
many simply are no caught.


PT

 
At Tuesday, September 01, 2009 12:17:00 AM, Anonymous Anonymous said...

The comment was made

"They may leave and just get you a male nurse to avoid a conflict. If
they bring back the supervisor,
question the supervisor."

If they brought back the supervisor I would find that very
disturbing. I would consider that
a hippa violation as her supervisor
(charge nurse) is not assigned to
my care.
Unless a facility has electronic charting anyone who has a need to
know must sign off after looking through a patients chart.
To look through my chart
would mean she signed her name in my chart which is something every facility is now doing which would
further implicate her. Lets for a
moment reverse the roles and if
I,the patient were female and the nurse male. I refused intimate care
from a male nurse and he went and brought back the supervisor. Does
it sound ridiculous? Rightfully
so in both cases.
Returning to my argument,the
charge nurse has no business in my
room. She dosen't know anything about me as a patient. Wether she looks through my chart or not,she has just made a big mistake.What would administration think about those two if I complained about both of their behaviors. They both came into my room and began verbally abusing me,telling me
what I need to do.
Questioning my rights and what
makes me comfortable as a patient
and furthermore verbally abusing a
patient is a violation of the nurse
practice act which I would ask a
patient advocate to relay my concerns to the on-call administrator. You see, the question would be brought up to
the nurse. Why did you get the charge nurse involved and why did
you bring the charge nurse back to
the patients room?


PT

 
At Tuesday, September 01, 2009 6:33:00 AM, Blogger swf said...

"They feel I believe that "a patient" comes to them for help and treatment and it IS 'medical'. Therefore, all those things you just stated about what people do and don't do in society -
are out the window and don't apply."
JW: I absolutley agree with you that this is a tactic they use.
However: I wonder why it works on so many people.
Perhaps it's because from the very first day that 'caregivers' decide to go to school, that this is how they want to earn their living, they have already decided that modesty violations will be alright with them. In short, access to our bodies equal a paycheck.
Day one. They have entitled themselves, without our permission, and quite frankly: we have no idea who these people are. All we know is that they passed some tests.
There are THOUSANDS of nurses and tech's out there, who have simply assumed that whatever they want to do is O.K. and we will just have to deal with it. Now my point is, can they really expect us to think that at any time all of these thousands of people can do whatever they want to our bodies? The entitlement is staggering....we are to trust ALL of these people? If not, how many? And how do you choose who to expose yourself to? Some...all? When you look at the numbers even they have to agree that we need some sort of choice. Some way to put the trust odds in our favor. If gender is our marker then a few thousand of them will have to understand. After all, we didn't come to "them". We came to the facility. And "medical" or not,they are not the sacred divine. They are just people who don't want to lose their job to gender preference. Making sure they have a job is really not my concern. My body is my concern.

 
At Tuesday, September 01, 2009 11:56:00 AM, Blogger MER said...

Part 1

At the risk of being annoying, I want to stress what I brought up in some earlier posts.
I don't think we should underestimate the power of setting, situations, systems -- and how easily human beings get into role playing. We all play roles in society, and if we really watch ourselves, we can observe ourselves switching into these roles. This switch may involve a change in our clothes, our stance, or voice, our tone, or a setting and place.
Doctors and nurses get into a role-playing mode, too. That is, there are certain societal expectations associated with these roles and they learn them. But we forget, "patient" is role as well.
When we get into a doctor's office or a hospital we play the role of patient. We learn this, I think, mostly from the media and from stories we hear or read, or from past experience. The system guides us to some extent in this role, often not outright telling us what we're supposed to do but suggesting,implying it -- or forcing it. Most people just go along with the role -- because, in the right setting, in the right situation, with a power system -- most people comply with authority. Some people don't accept that. That would never happen to me, they say. I'd never do that, they say. People who say that, who deny the power of settings, situations and systems, are most likely the fastest compliers under stress.
Look at the recent kidnapping in California, the 11-year-old girl, now 29. Look how that kind of extreme setting and situation and authority can brainwash someone. That's an extreme situation, but don't think that couldn't happen to most of us -- the Stockholm Syndrome.
So -- what am I saying? Why do doctors and nurses assume what they assume? They believe those assumptions are part of the role they are playing. Why do most patients just comply -- they assume that's part of what it means to be a patient. Keep in mind that this role playing isn't all bad. Most of it is good and necessary for any society or system to work.

 
At Tuesday, September 01, 2009 11:57:00 AM, Blogger MER said...

Part 2

How do we break away from the bad aspects of this model? It won't be easy. But it starts with individual people -- doctors, nurses and patients -- first, being willing to recognize what's happening and what's wrong; secondly, being willing to start changing and accepting the risks involved.
As a side note, I just talked with a nurse who was extremely frustrated with how hospital admin was forcing her to spend less time with patients thus not being able to form any kind of professional relationship. We talked about the modesty issue. That frustrated her, too. She wanted to do what was best for the patient but the "system" didn't allow it -- through staffing problems and lack of time.
Now, I'm not excusing this nurse. We all have to make individual decisions. At the same time, when you find yourself within a faulty, broken system that doesn't allow you to do what you think is ethical, when you have to work to bring home the bacon to keep a roof over your head and food on the table, etc., it takes a certain kind of courage to break away or force change from within. You may become a martyr.
I'm not making excuses for people. I'm just saying that most all of are very reluctant to challenge a powerful system when the safety and welfare of ourselves and our families are at stake. Does that make it right? No. But that's just the reality of life as I see it -- why quite often good people do bad things.
Want an extreme example? Watch the documentary "Shoah" or read the book which contains the entire transcript of the program. You'll observe the frightening process of how everyday, ordinary, some educated, caring people comply or ignore or rationalize their involvement with the Nazi Holocaust. Don't think that you couldn't become part of an evil system. We all could.

 
At Tuesday, September 01, 2009 6:15:00 PM, Anonymous Anonymous said...

MER I agree with you to a large degree as would I think Art Stump from his my Angels are come book. Though A, rt gives providers more of a pass than I. A tech who does an intimate imaging procedure does not usually do the scheduling nor do they set the policy of how scheduling is done. That is admin. BUT, how many techs have ever gone to admin and say...I think the patients are uncomfortable with this and it might be a good idea to ask....its easier to not have to deal with the issue, its easier to follow the rules right or wrong set forth by the admin...the boss. So while it is understandable, does not mean its right. If I am told to do it, that relieves me of the responsiblity...and toss in the fact that the system tells me from the day I enroll that its ok, the rules of society do not apply...its ok...I can ignore what i see ain practice....I agree with MER the system sets the rules...but providers have to follow in order for it to work....alan

 
At Tuesday, September 01, 2009 8:09:00 PM, Blogger MER said...

I realize that some medical professionals reading this thread are upset that I'm using extreme examples like the Holocaust and war crimes. I do this not because I disrespect the medical profession, but rather because I am in awe of the great responsibility they have.

We are all only human. Doctors and nurses and only human. But because of their great responsibility, when they go bad the horrible results rises to the level of their special status in our culture.

In his book, "Oath Betrayed: Torture, Medical Complicity, and the War on Terror," Steven H. Miles (professor of medicine and bioethics)writes, referring to Abu Ghraib and Gitmo:

"Medics and nurses often were guilty of not helping victims in distress, of observing brutality and looking the other way, and worse. They signed off on false death certificates and lied about the nature of wounds and broken limbs. They violated their Hippocratic oath and 'sold their souls for dross.'"

As our health care system becomes bigger and bigger and more money-driven, and run by CEO's who are not doctors -- those medical professionals working within this system must become vocal and take a stand for patient dignity where it isn't respected.
Because they're dealing with bodies with people inside, because they need to get people naked to serve them, doctors and nurses must never forget how nakedness has been used historically to demolish human dignity and individuality. It bothers me that, as Dr. Bernstein admits, many if not most doctors don't see medical modesty as an issue, and are not taught much about it.
Doctors, nurses, techs, cna's who read this post and see absolutely no connection between the above quote and what can go on in hospitals, may be in the most danger of getting caught up in systems that put money and what's best for the system ahead of patient modesty/dignity.

 
At Tuesday, September 01, 2009 8:45:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, issues of patient modesty are definitely taught to medical students but in more general terms particularly stressed is the need for students and physicians to be professional and consider misinterpretation by the patients of the doctors actions as something other than professional but perhaps sexual. However, the specific concerns that have been expressed on these Patient Modesty volumes, I suspect have not been part of the student education either by myself or I suspect by other teachers. As I have previously said, only since reading these volumes have I learned.

But I would disagree in comparing physician misunderstanding and subsequent behaviors about patient modesty with Steve's valid disclosures of physician awareness of what was happening and, despite that awareness, the unethical, unprofessional acts as part of their participation. They are not comparable.

I would compare physician behavior to patient modesty similar to misunderstanding psychologic,
cultural or socio-economic issues that patient's may bring with them where physicians may look at those patients wrongly as lacking intelligence, unreasonable or non-complaint. ..Maurice.

 
At Tuesday, September 01, 2009 9:43:00 PM, Blogger MER said...

I think I understand what you're saying, Doctor, and I don't disagree with you within that context. But I'm trying to see this issue from the patient's perspective -- the feelings of embarrassment, even humiliation that some patient's might experience because of what they perceive as doctor/nurse lack of...what? Consideration? Knowledge? Empathy? I'm not sure how the patient perceives this. It may be just misunderstanding, but I don't think the patient perceives it as such. And even if it is misunderstanding, that doesn't change the seriousness of the patient's feelings. The more common response from the patient, it seems, would come later and could be characterized as anger, frustration, rage. Reread Art Stumps's response(in My Angels Are Come) to his experience. Part of him shut down. It reminded me of the trauma torture or rape victims describe, how the mind just shuts down for it's own self-protection. Another part of him wanted to jump up off the exam table and hurt someone.
I think medicine may underestimate the trauma some of these modesty violations may cause some patients. And then later comes a definite mistrust of the profession and/or system.

 
At Tuesday, September 01, 2009 10:22:00 PM, Blogger Maurice Bernstein, M.D. said...

Just to give everyone on this thread an sample idea of what we teach our second year students regarding patient modesty and concern for the patient here are some actual examples at my medical school.

With regard to elevating the female breast to examine beneath it, students are instructed to have the patient lift her breast herself or if that can't be accomplished to elevate the breast with the top of the student's hand rather than cupping the breast in the student's palm. In addition, with regard to genital exams, there is concern about what words should be used.

GLOSSARY OF APPROPRIATE LANGUAGW
*Things to remember:

Purposeful Touch – touch the patient only to garner information: if the patient can perform a function without your assistance, let him/her do so – getting on the table, etc.

Instruct the patient to notice changes to what is healthy and normal for his/her body – use this instructional tool in lieu of describing the pathology you might be looking for.

Words carry many meanings, and improper or non-specific terms can lead to mistrust, confusing information and/or embarrassment.
APPROPRIATE LANGUAGE
“Table” instead of “Bed”
“Please disrobe” rather than “get undressed, please take your gown off, etc.”
Be certain to say “thank you” if the patient has just performed a task you requested – as a sign of respect.
“I am going to touch you now” – lets the patient know when you are going to touch them. Each time you touch the patient, indicate so verbally. This may lessen anxiety.
“Parts of this exam may be a bit uncomfortable, but nothing should hurt. I will alert you to the portions of the exam that might cause a bit of discomfort; if at any time you feel pain, please let me know and we will see how we may remedy it.” This is very important and is the way all exams should be started. Pain is an indicator of 1) something being done improperly or 2) a problem that should be examined further.
“This might be a bit uncomfortable” – to alert the patient to sense of pressure or momentary discomfort
“Palpate or examine with my fingertips” rather than “feel”, you may qualify this term by saying, “Palpation is using fingertip touch to check for...”
“Footrest” instead of “Stirrups”
A speculum has “Bills” not “Blades”
“Insert” rather than “stick in”
“Remove or withdraw” rather than “pull out”
“Please relax your knees” rather than “open your legs for me; spread your legs”
“External genitalia” rather than “down there”
“Penis, scrotum, testicle, buttocks, rectum, genitalia, vagina” – please refer to anatomy by the proper name, never use “it” in place of the correct term, as in “please move it to the side”.
“Please cradle or hold the testicle (or penis)” rather than “grab your testicle or penis”
“Place your feet shoulder width apart” rather than “open your legs for me; spread your legs”
“Please turn to face that table and rest your elbows on the table” rather than “turn around and bend over” – for male exam, the act of placing elbows on the table will automatically provide for the best positioning in the rectal exam.


I hope this copy of the instructions the students actually receive will give my visitors some better understanding of what doctors should at least know to begin their careers. ..Maurice.

 
At Wednesday, September 02, 2009 6:11:00 AM, Anonymous Anonymous said...

I’m not sure if this has ever been referenced or if anyone else has read it but I found that it should fit in the discussions on pelvic exams for contraceptives. This topic has been mentioned many times and I found this site by accident but thought someone else might find it informative. With all that has been posted, I really can’t remember if it’s been referenced at any point here. I don't want to start a debate here on this subject, I just never saw any formal documentation or references before finding this. Jimmy

http://www.law.harvard.edu/students/orgs/jlg/vol27/dixon.php#Heading124

 
At Wednesday, September 02, 2009 8:34:00 AM, Anonymous Anonymous said...

this blog has gone on an amazingly long time. Therefore there is bound to be duplications but given the time I would assume we have new visitors so at the risk of rehashing....I don't disagree with you Dr. Bernstein, but there are two big issues with the approach. One is it focus's deminishing the effect on the provider, what the provider can do while not truely acknowledging the issue, it allows them to do minor things that are easily accomplished by the provider without causing them (the provider) inconveniences. While this may all be good suggestions they do not eliminate the issue itself like offering the choice of gender might. There is no way to eliminate completely the problem, there is no way I can "put my elbows on the table" and not be embarressed or uncomfortable....but I am a lot less so with a male who has been through the same thing, thats just me. Taking the steps listed allow providers to give themselves some justification for doing this....making the patient uncomfortable. I did my part, did what I could.....instead of addressing the patient really wanted same gender but I said relax your knees so it made it better...even ok...when the reality is it might have just made it slighly less traumatic. Simply asking what kind of accomodation the patient would want could get you a a better idea of how to accomodate....but that is patient not provider focused and if they said I want same gender...you have to accomodate or admit you didn't do what was best for the patient.

Then there is the issue that while some may not, many providers acknowledge they have preferences and seek accomodations that go above the steps you layed out above...they know these steps are not enough for them....I still fail to see how they can not connect the dots to the conculsion that patients feel the same. I think it is very much an us and them...and while the laws of war and peace are different...the mind set that we can do this or that and not be prosecuted because of our status....give way to not feeling the need to do everything you can for the patient, I have yet to see any provider or publication say....ask the patient what would make them comfortable....alan

 
At Wednesday, September 02, 2009 8:58:00 AM, Blogger Maurice Bernstein, M.D. said...

Jimmy, interestingly, the Harvard Journal of Law and Gender is strictly "devoted to the advancement of feminist jurisprudence and the study of law and gender." Is there an equivalent journal for the male side of the law and gender fence?

The topic of "unnecessary" pelvic exams as a requirement for birth control pills has been already discussed here but certainly this article is detailed and highly referenced. Thanks for the link. ..Maurice.

 
At Wednesday, September 02, 2009 10:49:00 AM, Blogger swf said...

It seems that one thing is very clear with all of the above posts: There are many forms of modesty.
Dr. B speaks of trying to mitigate modesty issues with appropriate words, professional jargon, and abbreviated touch. Some people will be eased with this, and feel that if curtains are pulled, doors are closed, and only those who "need to see them" will see them then their modesty is protected.
Then there are those who feel that the very nature of modesty is within the opposite gender issues, and only same gender can satisfy this modesty need. Words, curtains, doors: all won't matter if the opposite gender is the one touching them or even in the same room. This seems to be harder for the medical community to admit or accept.
I'm not sure if it's because this makes the caregiver feel as if they are inappropriate or immoral in doing what they are doing, or offended that you tell them no. I suspect both to some degree. If you acknowledge the problem, you become part of the problem.
The first example, everyone seems to try to accomodate. The second everyone seems to pretend should not exist. But, this example is where the greatest amount of damage exists.
I could go into the dynamics of why so much damage, but unless or until the 'caregiver' cares what is in the eye of the beholder, it won't really matter.

 
At Wednesday, September 02, 2009 11:41:00 AM, Blogger Maurice Bernstein, M.D. said...

swf, I think that most physicians would make what I think is a reasonable assumption that in view of the fact that a patient comes to the physician this would indicate that the patient has decided to have this physician diagnose and treat the symptoms by at least taking a history and performing a physical. Of course, further diagnostic procedures or treatment would require the informed consent of the patient who was educated regarding alternatives which were available and whether there were significant benefit differences or significant risks involved. If this simple assumption by the physician based on the presence of the patient is in error then it is the responsibility of the patient to inform the physician otherwise.

You call the plumber to come to the house to fix the leaky toilet. If the plumber arrives and is found, contrary to your wishes, to be smoking a cigar, you would say something to the plumber. If the situation or behavior of a physician is contrary to your expectations, the patient must say something. Otherwise, the physician will continue to assume that your presence and continued presence represents your assent to his or her actions. ..Maurice.

 
At Wednesday, September 02, 2009 12:15:00 PM, Blogger swf said...

Dr. B.
And I absolutely agree with you. Perhaps I should qualify again that we have the choice of the gender of our Doctors. (Most of us) I agree my female doctor my need to do things that, while not making me jump for joy,I will agree to. And yes, that is why I am there, and I can always leave.
"Caregiver": you do not always have the choice in facility setting. And yes, you can still leave if you not confortable.
Perhaps I should have qualified "caregiver' more..so the two examples still exist.

 
At Wednesday, September 02, 2009 12:37:00 PM, Blogger MER said...

Doctor:

Let me explain why your plumber analogy fails relative to the modesty issue.
-- With a plumber, you are on your own turf -- in your house. Now, you may say that one's turf is one's body. That's true. But the context of where your body is located makes a big difference. Your body (your turf) is not on your own turf in a clinic or hospital.
-- Both of you and the plumber are dressed. This must always be part of the picture. And it's often ignored.
-- The plumber is not touching intimate parts of your body. He/She is dealing with a true "object." The patient is more than object. I can understand, actually, why a doctor might in some way see the problem as a "leaky toilet." The organs are "objects" in a sense and follow rules of mechanics.
-- If the plumber brings in a high school student to observe, would you care? (assuming you weren't being charged for the student's time). Would you care about the gender of the student?
-- In fact, what role does gender play in your analogy at all? None. You have selected a gender neutral analogy.
-- Finally -- these kinds of mechanical analogies have their uses -- perhaps when focusing on the mechanical aspects of the job. But these kinds of analogies are insufficient for use in dealing with the whole human being -- body, mind and spirit.

 
At Wednesday, September 02, 2009 1:04:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, my analogy was not between "fixing a toilet" vs "fixing a human body". I wanted to show that a patient just as a home owner, despite the fact that the individual selected that person to provide the service and had entered their office or clinic vs allowed the service person to enter their home, still has the right to reject service despite their initial acceptance into the office or the home if there is some discomfort with the service individual's behavior rendering the service: the patient finds that their modesty is ignored, the home owner did not expect a smoking plumber. The reason for rejection by the patient or home owner is then explained to the service provider.

Of course, the location (office/clinic vs home) makes a psychologic difference as does the relative "power" relationships to the service provider in terms of how easily it would be for the patient vs home owner to "speak up". ..Maurice.

 
At Wednesday, September 02, 2009 1:08:00 PM, Anonymous Anonymous said...

My GP's that I choose are male as
are all my specialists. I believe one of the most predominant issues of victimization that men face are
these intrusions into examining
rooms by female staff wether they
be the clerks, ma's or nurses.
Lets reverse the roles for a moment and say that I am female
patient at my gyn office while
during my pap smear the office boy
(clerk) walks in on my exam.
Appropriate,absolutely not and
whose fault is that. Returning to
my argument that for male patients
this is a common occurrance not
only at physicians offices but in hospitals as well.
No one should tolerate that kind of behavior and should that ever
happen to me I abruptly end the exam process as everyone is fired.


PT

 
At Wednesday, September 02, 2009 2:34:00 PM, Blogger MER said...

I understand the comparison doctor, but as PT says, the modesty issue isn't just about the doctor/patient relationship. I agree with you basically, assuming one can choose his/her doctor. That's not always the case. It's about all the other hospital/clinic personnel that may be involved with the doctor or after the doctor sends the patient off to a specialist and then to a hospital. The patient can attempt to choose in those situations, too, but the request may either become a battle or be refused. That's where you're analogy fails. And that's a significant part of where the modesty problem exists -- outside the office of a persons trusted, personal physician.

 
At Wednesday, September 02, 2009 4:08:00 PM, Anonymous Anonymous said...

""Then there are those who feel that the very nature of modesty is within the opposite gender issues, and only same gender can satisfy this modesty need.

Words, curtains, doors: all won't matter if the opposite gender is the one touching them or even in the same room. This seems to be harder for the medical community to admit or accept.""
swf your right. Doctor why dont you except this? do you feel it isnt true? Can you decide what other people feel isnt true?
eoe

 
At Wednesday, September 02, 2009 6:00:00 PM, Anonymous Anonymous said...

The medical community likes to use the scenerio of life hanging on a thread in the ER to discuss everyday modesty issues. The plumber anology is the opposite. The emotional state of someone with a leaky toilet vs a leaky heart valve are completely different. Then there is a history of the hyerarchy of a Doctor vs a plumber. We have historically held providers at a higher level of authority than plumbers. It sort of like comparing a policeman to a plumber or doctor. If a cop yells freeze...you freeze, if a doctor yells freeze...you think whats your problem, if a plumber yells freeze....you call the cop. The point here is when you enjoy an elevated level of respect, you also assume a higher level or responsiblity. If we place that higher level of trust in you as a provider, you owe it to us to give us a higher level of concern and responsiblity. If the plumber says strip...no way, once again I am calling the cop....providers can not say they deserve a higher level of trust, then say patients have the same ablity to excercise self determination that they excercise with the plumber...can't have it both ways. Either we place more trust in you and you accept the responsiblity with it when it comes to realizing we have compromised some of our autonomy to do that....or we treat you like the plumber and trust you with the pipes but nothing else...alan

 
At Wednesday, September 02, 2009 9:47:00 PM, Anonymous Anonymous said...

Dr Maurice,
I have only had one male Dr perform a pap smear on me and although he was completely professional and used all the correct terminology, I still felt so completely embarrassed. I do not in any way feel that he had any inappropriate thoughts but some of us just cannot change how we feel about Drs of the opposite sex performing intimate exams. Maybe it is irrational, whatever it is, it still doesn't change how we FEEL. So you can intellectualize all you want, we can't change ourselves.
NP

 
At Wednesday, September 02, 2009 10:12:00 PM, Anonymous Anonymous said...

MER said

"I realize that some medical professionals reading this thread are upset that I'm using extreme
examples like the Holocaust and
war crimes.

"That jews were stripped naked
before going into the gas chamber"


MER,THAT IS GOLD,PURE GOLD.

Now I know how they must have looked at me when I hade my military induction physical at
Ft Knox with female clerks leering at me while completely nude along
with about 40 others. Were on our
way to the gas chamber. Lovely!


PT

 
At Thursday, September 03, 2009 6:48:00 AM, Anonymous Anonymous said...

I'd like to share this abstract I found online titled "Making fun of patients-Derogatory & cynical Humor in Clinical Settings. It discusses how medical students especially when in the O.R. ridicule and gossip about some patients, especially those that are what they refer to as "Unusual or Different." How they are reduced to body parts, I found this article very disturbing. I already had fears of exposure amongst opposite gender staff, this article made me wonder what is being said about me while laying naked on the operating table. Am I the topic of discussion for everyone's amusement? It shocking this is allowed to happen. The statement is made that they make sure the patient is OUT before these inappropriate discussions start, how nice of them. Anyway, I'll just provide the link; you can read it for yourselves. I realize not every one of these people are bad, but being the professionals they are supposed to be, this should NEVER BE ALLOWED TO HAPPEN. Someone in authority needs to be trained to stop these infractions dead in their tracks when they happen...like would happen with sexual harassment in the workplace.
It seems like there's no oversight no one to take responsibility to say, STOP THIS, this is inappropriate and won't be tolerated. This is not hospital administration here, these are our caregivers, please someone, have the courage to stand up and say, this is wrong, stop this, this is a person on this table. Someone needs to be the patients advocate while there under anesthesia. Just because there OUT doesn’t make it right to ridicule them, it is corrosive and can lead to a bad work environment and ultimately affect the patients care.

http://www.healthsystem.virginia.edu/internet/bio-ethics/MakingFunofPatients.pdf

Lefteddie

 
At Thursday, September 03, 2009 9:06:00 AM, Blogger swf said...

Mer:
I'm curious...
"But we forget, "patient" is role as well.
When we get into a doctor's office or a hospital we play the role of patient." and "The system guides us to some extent in this role, often not outright telling us what we're supposed to do but suggesting,implying it -- or forcing it. Most people just go along with the role"

From your own interviews would you find that:
A. Most people find comfort in the passive role and don't seem to mind the gender situation.
B. Most people are uncomfortable with the gender situation but are not the type of people to force change.
C: Most people would rather not talk about it.
D: Most people will actively seek change.
Is there even a 'most people' response?

 
At Thursday, September 03, 2009 9:29:00 AM, Anonymous Anonymous said...

To Lefteddie


Here in Phoenix about 12 years
ago there was a complete page about
this behavior in the newspaper. The
subject though was devoted to an
inadequate amout of anesthesia being given to the patients.
These patients were physically
paralyzed,yet could hear and feel everything. One male patient and
rather obese could hear two female nurses standing over him laughing about the small size of his genitals.
One female patient heard the
anesthesiologist making comments about her breast size,making further lewd comments about them.
She also could feel the scapel
tearing into her flesh. After the
surgery was over she asked to
speak to the anesthesiologist. She
mentioned to him that she felt
everything throughout the surgery.
The anesthesiologist stated to her that was impossible. At that
point she recited to him everything she had heard including
the comments he made about her
breast. He was stunned.It was stated in the paper that this woman sued the anesthesiologist.
These behaviors occur equally
well and more frequently in neuro-
intensive care units where patients
are in barbed coma,s and post-op.To
be honest they occur in any intensive care unit where the patient is comatose.
I will say with honesty that comments like these are extremely
rare in the OR between say the
surgeon and anesthesiologist. The
worst thing I ever saw a surgeon
and anesthesiologist do during an
open heart case was step out of the OR suite and engage in a fistfight. True story.
Patients that are intubated and
unconscious are at the greatest
risk for physical abuse.

PT

 
At Thursday, September 03, 2009 10:01:00 AM, Blogger MER said...

from Anonymous: "Now I know how they must have looked at me when I hade my military induction physical at
Ft Knox with female clerks leering at me while completely nude along
with about 40 others. Were on our
way to the gas chamber. Lovely!"

You seem to just accept the fact that female clerks leering at you completely naked as fine, just okay, just the way it is. Apparently, out of fear or intimidation, you just went along with a truly unethical situation. What would you say to male clerks leering at completely nude female recruiits being examined? You consider that ethical? Medical professionals need to be very careful about who they grant power to assist them. Doctors and nurses have been granted special priviledges in our culture that allow them to see people at their most vulnerable. To just allow unprofessional "assistants" access to that priviledge is completely unethical. Sorry you can grasp that.

If you're one of the medical professionals who think you're immune to the pressure of powerful systems, you'll probably be one of the first to join the gang. You may have tremendous technical medical knowledge, by apparently you lack a good historical perspective about the role nakedness plays in war and prison situations,
All of you on this blog, if you haven't read them, you need to read the posts, especially the latest ones, on Dr. Sherman's thread, second volume, dedicated to the discussion of Art Stump's "My Angels Are Come." You'll read some disturbing incidents that show just how debilitating and shattering what you might call just carelessness in dealing with naked patients can be for those patients.

And Anonymous, you need to read how historically some doctors and nurses have gotten themselves involved in some of the most horrific war crimes and human right's abuses. We can bring this story right up to date with the War on Terror. We hold doctors and nurses to higher standards than we do many other professionals. That's why is especially disturbing to seem the go along with such illegal and unethical practices.
But apparently you don't see that. To bad. Maybe you'll wake up if you find yourself treated the way some patients are treated.

 
At Thursday, September 03, 2009 11:52:00 AM, Blogger MER said...

PT -- My last post. I didn't realize it was you writing that anoynous post. Now I know you were being ironic. Sorry. I was responding to what I thought was a serious attitude.

 
At Thursday, September 03, 2009 6:25:00 PM, Anonymous Anonymous said...

Anon re your post about them ridiculing us, they will use the excuse that they under a lot of stress and it is an outlet.
PT who decided that these female clerks could watch? Was it orders from above? Even though you seem to blame women for everything, most people in charge are men making the decisions. At my local women's hospital nearly all the top positions are still held by men.
NP

 
At Thursday, September 03, 2009 6:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Lefteddie, thanks for the link to the Academic Medicine article. This issue of the degrading of ethical and humanistic behavior as student progress through their third and forth years of medical school and on into residency is as well known and well discussed..as actually at our medical school faculty meeting this morning, this very issue was discussed. The only way to attempt to restore ethics is for the student who first observes the wrong behavior to notify people in the medical school setting who have enough clout to enter into the clinical environment and remind those who abuse others with their jokes that this is not a laughing matter. At our university there is a department ready to investigate the details and determine if any patient has been shown disrespect and discriminated against by words or actions. But the department staff needs to be informed since they don't wander the wards as some sort of "anti-discriminatory police". ..Maurice.

 
At Thursday, September 03, 2009 7:41:00 PM, Anonymous Anonymous said...

NP I think the issue is just becasue you can...doesn't mean you should. The clerks had the ability to choose right or wrong. Of course they are to blame, even if someone could have stopped them but didn't, it in no way relieves them from the decision they made, they knew it was wrong, they chose to do it...they were at fault, someone elses sin did not in anyway diminish theirs. You can't blame men for everything, both genders equally violate modesty in these situations, in this case men are just as often or more often victims. While that isn't the case for most cases in society...for the issue of respecting modesty it is
.
Unfortunately as the article and the Whoa inappropriate thread on allnurse. Providers look out for each other, it truely is an us and them scenerio, a person who would turn another provider in would likely suffer repurcussions. The grateful patient would move on, their co-workers will be there. Thats a tough thing to deal with. I think the scenerio is common in most professions, cops aren't suppose to ticket cops, etc...the thing that makes this really bad is the level of trust a patient is suppose to...needs to put in providers...makes it especially troublesome...once again that trust is a double edge sword for providers...for those who recieve much, much is expected. You can't say you deserve a higher level of trust for compromising modesty, then betray that trust or not hold the line in insuring the patient gets it from you...or those you work with...it really is tough....providers are truely just human...but they say otherwise when it works for them...alan

 
At Thursday, September 03, 2009 9:21:00 PM, Anonymous Anonymous said...

Its OK Mer

Actually, your comment about the
holocaust was an excellent comment
and PERFECT analogy to military induction physicals performed in
this country. Many do not realize
that for years female clerks at
many afees and meps centers made
themselves present for males
recieving nude induction exams.
I joined the military at the height of the vietnam war,I was
17. My brother was already in
vietnam, appreciate the fact that
we joined and were not drafted.The
female clerks were civilian employees of the union type. I've
done much research on this subject
and finally in 2003 the commander
of mepcom issued new rules about
observers during military induction
exams. It seems there had been enough complaints.
These kinds of privacy invasions
happened to literally hundreds of
thousands of people. Its irrevelant
who was in charge of this,the fact
remains that these clerks could
not appreciate the word privacy,
especially for many young men this may have been their last medical exam!
Visit mepcom.com and appreciate
that if you made an interference
or disturbance in any way you were
kicked out. Rules for women were and have always been the same,in a
private room and no observers.
There are mep centers in almost
every state including puerto rico and in 1973 these afees centers changed their name to meps. Why did the military and sometimes civilian physicians allow these women to come in and observe. You
tell me! Some say it was a way to
control people. I disagree in that
many of us had volunteered in the
military at a bad time in the
world. Don't forget Pat Tillman
and his contribution,I knew him personally.


PT

 
At Thursday, September 03, 2009 10:12:00 PM, Anonymous Anonymous said...

mer,swf,alan,pt,gl,jw etc
you complain but do nothing
why is this blog still even going

 
At Thursday, September 03, 2009 10:36:00 PM, Blogger Maurice Bernstein, M.D. said...

I, too, would like to see some "action" and perhaps the group that apparently has come together via e-mail or on Dr. Sherman's blog can tell the rest of us how things are progressing. Nevertheless, I think these Patient Modesty volumes can continue to be therapeutic if not the means to a desired end therefore I think I will continue the threads. In fact, I already concocted an interesting graphic for Volume #23 when it comes due to put it up. ..Maurice.

 
At Thursday, September 03, 2009 11:19:00 PM, Anonymous Anonymous said...

I'd venture to say that many are
ashamed of what comes out on this
blog. What makes you think I'm
not doing something about it,as well as the others you've mentioned. There are many folks
who've been reading these blogs very closely as I've asked them to do so. I assure you change is coming.

PT

 
At Friday, September 04, 2009 12:37:00 AM, Anonymous Eve said...

NP,
I could never allow a male doctor to perform any sort of intimate exam...even a breast exam.

The pelvic exam...
I think that exam puts women in a very exposed and vulnerable position.
I don't think any man could understand just how bad it is...
The power dynamic and the vulnerability/maximum exposure/indignity means I would point blank refuse a male doctor.
Fortunately, it has never been an issue for me.
Our doctors do not recommend routine gyn exams.

I've only needed one pelvic exam in my 45 years and went to a female doctor.
I'm sure many men feel the same way about a rectal or genital exam.
Why should we go through a LOT more than absolutely necessary?
These exams are difficult enough....why add another HUGE layer of embarrassment, humiliation, anxiety, fear...
It serves no point...much better to see the doctor of your choice.

I think these issues are much more difficult for American women due to the pressure to have annual routine gyn exams. You face far more tests and exams than other women, far more...so this would be a big issue for many of you.

 
At Friday, September 04, 2009 5:21:00 AM, Blogger MER said...

Let's remember what this thread is really about, in my opinion. It's not just about the double standard -- men who prefer same gender care; it's aboutwomen too. Maybe it started out as just a discussion about the right to same gender care. That right is important.

But what's more important to me is what this thread has turned into -- It's just as much about the traumatic experiences patients have during unclothed exams and procedures, about inconsiderate, unethical treatmen -- unwanted assistants and/or chaperones; doors and curtains open; unwelcome students and observers; unnecessary exposure; and an overall attitutde of entitlement without establishing, in some cases, any kind of relationship at all.
Dr. Bernstein returns to the doctor-patient personal relationship and what goes on in that context. That's his area. But many posts go beyond that to talk about experiences in clinics and hospitals with strange medical staff.
Just wanted to point this out. What's being done? I think many on here have and are taking personal actions -- writing letters, being more clear with medical staff in making values known, etc. And patients are learning techniques they can use to get what they want, or how to deal with hostile responses to their requests.
Some day, someone is going to write a book about this issue and this and Dr. Sherman's blog will act as a tremendous source. At one point I was hoping one or both of the doctors would do this, but apparently they're not interested. There's not just personal unsubstantiated anecdotes here. There are substantiated sources. And I'm sure some if not many on these blogs will be willing to make a personal contact (give their real name and email) with a serious researcher working on a book.
So these modesty threads have much more than therapeutic value.
They represent perhaps the only major source of information about this issue collected anywhere.

 
At Friday, September 04, 2009 8:16:00 AM, Blogger Maurice Bernstein, M.D. said...

MER, I don't intend to write a book on the issues presented on these threads on patient modesty. In fact, to me personally, as a patient, I am not particularly personally affected nor distressed by the issues presented here. As I have written previously, I look to the healthcare providers to do their professional job to get me well and that trumps any modesty on my part. Therefore, I really don't feel as motivated as you or others to become activistic about this myself except to provide a forum for discussion since I obviously see that there is a real concern by others. These are medical practice issues and as a doctor, irrespective of my personal feelings, they are of importance to other patients and that is what matters to me. So even though I don't specifically sit down and write a book, I suppose you could say that a "book" is actually being written by those contributing to these patient modesty volumes. ..Maurice.

 
At Friday, September 04, 2009 8:59:00 AM, Blogger Hexanchus said...

Dr. Bernstein,

Correct me if I'm wrong, but I believe the article referenced by Lefteddie, in addition to addressing the issue of derogatory humor, also provides am interesting window into at least one aspect of how the "hidden curriculum" you have oft mentioned actually works. Interestingly, a co-author of one of the references directly cited in the body of the article is a long time family friend - someone I've known for over 30 years.

MER,

You wrote "What's being done? I think many on here have and are taking personal actions -- writing letters, being more clear with medical staff in making values known, etc. And patients are learning techniques they can use to get what they want, or how to deal with hostile responses to their requests." I couldn't agree more!

 
At Friday, September 04, 2009 9:54:00 AM, Blogger MER said...

I agree, Doctor. A book is being written in a sense with this thread. We're all grateful to you and Dr. Sherman for providing a credible forum.
But the point I really wanted to make in my last post is this: This "problem" of patient modesty isn't a patient problem that necessarily requires therapy. We've discussed this in past posts. That doesn't mean this blog can't be therapeutic for some people in that it helps them deal with the issue when they have to face. This problem isn't emerging from outside the profession.
The issue isn't just about patient modesty. The issue is also about the medical system and individual caregivers violation of patient privacy and dignity. And it's about why this is happening and what can be done in educating caregivers about this.
I think this is also about patient advocacy. Teaching patients to be their own advocates and not be afraid to make their values know and complain if their values are violated. That's a key. Patients owe it to the profession to give them feedback, unpleasant as some it may be.
But this isn't just a patient issue. It's a professional ethics issue. I know you're fully aware of that and are one of few doctors consciously working to improve this. But I just wanted to make my view clear.

 
At Friday, September 04, 2009 9:57:00 AM, Blogger MER said...

One more item, Doctor. You write: "to me personally, as a patient, I am not particularly personally affected nor distressed by the issues presented here."

I'm sure you don't mean you're not affected by the many, many examples of privacy and dignity violations narrated on your and Dr. Sherman's blog. Although you've stated you don't mind opposite gender care, I assume you would be upset or even outraged if during that opposite gender care you experienced violations like some described in these threads. Am I correct?
That's the issue I'm most concerned with.

 
At Friday, September 04, 2009 11:09:00 AM, Blogger Maurice Bernstein, M.D. said...

Hexanchus, yes, of course, what was described in the article is exactly what is part of the "hidden curriculum" and which is very frustrating for those of us who teach the students in their first and second years in medical school the ethical and humanistic way to relate to patients and then they get dumped into a pot of perhaps unprepared responsibilities, extensive tiring hours at work (not the usual 8am-5pm school period), uncertainties about their own skills, concern about how they will be graded by their superiors and more and then this entire pot is stirred by unprepared residents who have had no experience and training in teaching, who have developed their own bad habits to facilitate their work along with attending physicians some of whom retain their bad habits from their training years and see nothing unethical or unhumanistic in the way they perform their duties and who will certainly reject criticism from a 3rd or 4th year medical student or even a young conscientious resident. And the end results, the soup that comes out of that pot, well, it can be terrible! ..Maurice.

 
At Friday, September 04, 2009 11:28:00 AM, Blogger Maurice Bernstein, M.D. said...

MER, you write "I assume you would be upset or even outraged if during that opposite gender care you experienced violations like some described in these threads. Am I correct?" You are absolutely correct since we teach treating patients as subjects, not objects and to respect general modesty issues and the specific issues that patient reveals. But remember, our mantra (if that is the right word) is "The goal is to perform an effective examination but be aware of and take into consideration patient modesty while carrying out the exam" and it is NOT "Modesty must trump an effective examination". It is all where the doctor and patient place the emphasis. ..Maurice.

 
At Friday, September 04, 2009 2:02:00 PM, Blogger swf said...

swf psycology 101:
"you complain but do nothing" implies omnipotence (which nobody has)or familiarity(I doubt you know all of us)or percieved familiarity leading to frustration.
So you can either tell us what your expectations of us were that we somehow didn't meet or in the future ask what IS being done.
And by the way,,,,are you doing anthing or just complaining.

 
At Saturday, September 05, 2009 10:53:00 PM, Anonymous Anonymous said...

Its been mentioned that some actually don't care about opposite
gender care as long as that person
is competent.Many of these comments are made purely for
politically correct reasons which
is ok,however,consider the preparation in choosing say a surgeon.
Only about 40 states have websites giving background information on physicians as far as disciplinary records and behavior. We can do this research
and ask friends and relatives
before choosing. But what about
nursing care? Very few states
give out that information.
Consider the state of N.Y, with the listed site.
www.op.nysed.gov/rasearch.htm#month
Visit on this site May 2008 and
under nursing, take a look at some of the violations as you will be
shocked. Personally, I wouldn't want a nurse who has a previous
violation of drug diversion or a
felony conviction,let alone the
female Lpn convicted of rape.
I've always said that good care
begins with respectful privacy
considerations. Dosen't matter
where you go,how are you going to
know about the nurse assigned to
you. You don't get to do any valid
research and am I expected to trust
a hospital that provides me with
a female nurse just after i've had some reproductive male surgery and I'm simply expected for her to leave her gender at the door, provide absolute trust and respect
for me as a male patient.
Despite the fact that she may not
be a hospital employee,but rather
a temp from some agency across
town or from another state. She
certainly wouldn't know or probably
care less about the core values of
the institution I'm paying and putting my trust in.


PT

 
At Sunday, September 06, 2009 9:03:00 AM, Blogger MER said...

Some good points, PT. There was a recent program on NPR about the fact that it's almost impossible for patients to learn about nurses who commit crimes or loose there licenses. There is supposed to be a national register but it hasn't been completed or near completion. The nursing unions and leadership organizatins are all for the register and want patients to be able to learn this information. This is one of those issues we can all advocate for -- not directly related to the modesty issue but for the general betterment of health care in this country.

 
At Sunday, September 06, 2009 12:21:00 PM, Anonymous Anonymous said...

"At my local women's hospital nearly all the top positions are still held by men."

NP - Do those men inflict unethical practices on you? Do they send unnecessary men, or ANY men in to gawk at your nudity? I guess it's possible but from your obvious opinion about men I really doubt you would tolerate it if they ever tried.

I do agree with part of what you said though. The men in higher positions do allow if not order those women to be in there unethically invading the mens' privacy. I imagine there are some women in those higher positions but if so and if it is them that allow the women to be in there the men in higher positions SHOULD be sticking up for the privacy of the "lower" men. So I agree that men often have or share the blame for those unethical practices.

GL

 
At Sunday, September 06, 2009 12:37:00 PM, Anonymous Anonymous said...

"mer,swf,alan,pt,gl,jw etc" are some of the very best contributers on this blog, "anonymous". I truly appreciate their contributions as well as everything that Dr. Bernstein does. They don't have to be out protesting with signs in front of hospitals and clinics to be effective in helping people deal with these unethical problems. Dr. Bernstein doesn't need to go on strike or put his job on the line to help people either.

"Anonymous" sounds like a ticked off medical "professional" that refuses to accept how unethical he/she is to his/her patients.

DG

 
At Sunday, September 06, 2009 1:04:00 PM, Anonymous Anonymous said...

Maurice, you say you have no problems with compitent healthcare workers and your nudity, which is perfectly understandable and probably most people in the world agree with you. But there have been many issues presented here which go way beyond that. Unnecessary audiences including high school kids, ridiculous privacy violations like doors left open and nurses allowing other hospital employees to enter and watch genital shaving or urinary catheter insertions. As well as many, many other similar violations. I don't imagine you would tolerate those kinds of things during your care would you?

These are the kinds of things we should all take personally. I assume those nurses, etc wouldn't allow the same thing to happen to them. I can't see "Nurse Ethel", who invites her friends from a different department to go in and watch her shave a man's genitals would invite or allow men or even women to enter and watch as a man shaves her genitals. Why does her modesty, and maybe her co-workers modesty and dignity matter when nobody else's matters to her?

SLO

 
At Sunday, September 06, 2009 1:34:00 PM, Anonymous Anonymous said...

Eve,

I agree that you shouldn't tolerate a man being involved with your intimate exams or care, but disagree in that pelvic exams and other things are much worse for women than so,e things are for men. For one, shoving tubes down a man's penis while others watch can be just as humiliating, and it's done so ridiculously often.

I know it's been mentioned many times before, but the fact that women can most often CHOOSE the gender of the doctor performing a pelvic exam (if they want), and the fact that it's almost unheard of to have a male assisting or observing the procedure gives women options that men just don't have.

When men have tubes shoved down their penis they hardly ever have any choice on who does it and who watches. I'm not talking about emergency situations as much as normal caregiving and pre-op and post-op situations. When female nurses and even teenage CNAs are sent in to shave a man's penis and scrotum while other women "assist" or observe, how can anything be mire intimate than that? When a teenage girl is moving her hands all over every square centimeter of his penis and scrotum, grabbing and maneuvering her hands everywhere while another teenage girl watches and often participates in the "fondling", and then get upset and offended if he gets even slightly erect while this is going on, it is extemely intimate, invasive and humiliating.

I know it's not unheard of but not very commen that a man will participate in the shaving of a woman's genitals. And if they try to be involved or observe and a woman objects to it, most often he leaves without a problem and the woman is not condemned or insulted for wanting him out.

I totally agree it's completely out of line for a man to be involved with anything you described Eve, but women most often have much more choice and say in the matter than men in similar situations and it's much more common but just as intrusive and humiliating for a similar thing to happen to a man.

It's not more humiliating or unethical when it happens to a man, just much more common.

GL

 
At Sunday, September 06, 2009 5:28:00 PM, Anonymous Anonymous said...

Dosen't it say alot about the fact
that our own federal government had
to step in and establish HIPPA,to
protect patients privacy. Seems
hospitals and medical facilities
just couldn't or wouldn't!
Seems these days you can't pick up the paper without reading yet
another cellphone pic violation.Yea
I know I've brought this cellphone
pic issue up before,however,I've
printed every single one I could
find on the internet along with
the rememberance of each one I know of that was never reported
and guess what? They all involved
male patients,that's right.
Now female celebrities often have their privacy violated by
someone snooping in their medical records such as the famous actress who passed away recently in California. The person who violated her privacy was a female records clerk who is now serving
I believe 10 years in prison. I've
numerous printouts of those as well. Yet this is the trend and
a very disturbing one to me.
Do the percieved entitlements of
the typical female provider some
how transcend culpability on their
part.?


PT

 
At Sunday, September 06, 2009 6:05:00 PM, Blogger swf said...

http://www.nursingboard.state.nv.us/dactions/discacts.htm

I found this for Nevada. Is this similar to what you were speaking of PT?

 
At Sunday, September 06, 2009 7:28:00 PM, Blogger MER said...

Consider this: These modesty violations men have reported on this and Dr. Sherman's blog -- they happened to men who for one reason or another permitted a female nurse access to them for a private procedure. Maybe initially they had no problem with opposite gender intimate care. The incident may have changed their mind. Maybe they reluctantly agreed to the female nurse. Perhaps they were too embarrassed to protest. Regardless -- they allowed access.
So we begin not with protest or complaint, but with a large degree of trust. And that trust is damaged. Let's remember that.
It's not as if these men were looking for trouble. The system was given the benefit of doubt, was trusted, as the contact with the male patient and female nurse began.
The same is true, of course, for female patients.

 
At Sunday, September 06, 2009 10:12:00 PM, Anonymous Anonymous said...

To SWF

Yes,thats is for neveda,however,
the information is often difficult
to obtain for any state if at all
possible. As an example,visit
www.docboard.org and that site will
make available all physician boards
in the u.s.
There is not one for nursing and
just seems to me that like its a kept secret. Look at what happened
to the state nursing board in
California. Arnold,the governor
had the heads of that board removed
for lack of investigation.
Excessive delays in following
up on complaints that sometimes took years.


MER

Essentially, I agree with
you but in my case I've seen hundreds of privacy violations, sexual assaults and just plain unprofessionalism as a healthcare
worker. But then I became the
patient and experienced them
first hand, unprofessional behavior,privacy violations and
intrusions.


PT

 
At Sunday, September 06, 2009 10:27:00 PM, Anonymous Anonymous said...

GL, it seems to me that PT's experience in the military was some kind of bastardization orders from above. I cannot see how some young women had that kind of freedom to take it upon themselves to watch when this happened 40 years ago in the military.
Regarding my comment about the hierarchy at the hospital. It was just a comment about power in general not about modesty. I would have thought that perhaps at a women's hospital, female doctors might have the top positions but it seems that men are still taking charge.
BTW I am pregnant at the moment and I had some sudden bleeding. I went to this hospital and was seen to by the doctor on duty - a junior male doctor. He wanted to insert a speculum to see where the bleeding was coming from. I was saved in the nick of time by my doctor who said she knew where it was coming from.
NP

 
At Monday, September 07, 2009 11:43:00 AM, Anonymous Anonymous said...

I filed a formal complaint with the BRN of CA. I was told by the agency that they had over 1000 complaints in just the first three months of the year with a staff of 3!
You can see from those numbers how long the process takes! Little to nothing is done for the complaintant. It is a complete farce and waste of time. My complaint took nearly a 15 months at which time I received a one page form letter stating they could not validate my complaint!

Two issues causes great concern for the BRN: 1. A nurse working without a current license. 2. or a nurse using drugs wrongfully.

Other issues are basically of no importance to their limited resources of staff.
JW

 
At Monday, September 07, 2009 8:13:00 PM, Anonymous Anonymous said...

I'm sorry NP. My post to you was a little more harsh than I meant it to be. I don't think it's right that they would have a Jr. male doctor at a woman's clinic. Thank God your regular doctor arrived in time. Have you requested that he not be present during any future appointments regarding your baby?(Congratulations by the way)

I'm just upset at the fact that I've never seen or heard of a Men's clinic.

GL

 
At Tuesday, September 08, 2009 3:16:00 PM, Blogger MER said...

Here's an interesting blog entry by a medical student/doctor. It's titled "The Amazing Power to tell people to get naked." It demonstrates some of the experiences Dr. Bernstein has related here. Notice the use of the word "power." Apparently, this medical student did learn something.

"That day I went home both excited and chagrined about my superpower. I was amazed that I could tell people to do something that left them so vulnerable. "Take off your clothes!" They did! I internalized my smack-down. With great power comes great responsibility. Poking and prodding might seem like nothin' to the young med student, but they're a whole lotta something to the patient."

Apparently, some doctors and nurses forget what this student learned. I wonder if this student still remembers this lesson as a doctor?

Here's the site:

"http://www.medmarg.com/2009/05/amazing-power-to-tell-people-to-get.html

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

NOTICE: AS OF TODAY SEPTEMBER 8, 2009 "PATIENT MODESTY: VOLUME 22" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 23. ..Maurice.

 

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