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Patient Modesty: Volume 23
Kilroy spying on the classic DiVinci figure reflects one of the paths of current discussion on patient modesty. There is concern by patients of both genders that there are onlookers who appear in the patients' medical care environment who just don't belong there and add to the aggravation the visitors describe regarding providers ignorance of patient modesty and privacy. ..Maurice.
Graphic: My construction of Kilroy and image of DiVinci's Vitruvian Man using ArtRage.
NOTICE: AS OF TODAY SEPTEMBER 25, 2009 "PATIENT MODESTY: VOLUME 23" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON
VOLUME 24
155 Comments:
I was away for a few days and got back and read the post from annom back on Thursday. Also Dr. Bernstein asked about an update. So here is killing two birds with one stone. On a personal level over the past month I have contacted CBS, ACS, ACRS, and several associations provided by the American Cancer Research Assoc. regarding an advertisement on prostate cancer that I found demeaning to men protesting and urging them to do something. I have contacted several hospitals in my area and questioned them on the ability to provide me with a male tech if I needed an ultra sound of a private nature. I followed those up with either thanking them and letting them know I would be sure to consider using them since the could...or advising them I would not use since they could not and urging them to do so, I have written a hospital asking to clarify their student provider policy and sent them a copy of Art Stumps book, I have written my state legislators about increasing the number of male nursing students, and written the facility in Art's book and added my voice to his protest, I wrote a local Dr. and informed me how distressed a friend of mine was when he had a vasectomy there and the Dr. brought in a nurse familiar to him to "assist".
To a larger issue, swf, Jimmy, and I have been conversing with another poster her about using her web site as a launching point for a larger effort to organize...we had some discussion as to whether our idiologies and purposes were close enough to join. It was determined while we were working toward the same goal, there were some significant differences that made it more logical to use seperate organizations/sites but support each others efforts. We are looking to choose a name to start with, while it would seem an easy task at first blush...things like web searches, what is the personality of the group, advocacy, information, both? all tie to the title. We were leaning toward something like Advocates for Medical Modesty or Medical Modesty Advocates....anyone...including annom from Thursday is welcome to join in. You can go to Dr. Sherman's site and let us know your opinions under organize or you can leave contact info with Jimmy at medical.privacy@yahoo.com...........alan
Great job Alan
Although I won't go into too
much detail at this time I have
sent letters to a number of high
schools regarding Dr sherman's
thread on group physicals. I've
also invited several attorney's
to read over Dr B and Dr Shermans
site as well. I've other things in
the works as my time permits. At
some point I expect them to respond.
I am currently working on a
rough draft I'd like to send the
staff of these new trauma shows.In
particular ER and I believe trauma
which I've heard some disturbing
things. I'm asking them to exploit
the privacy of a number of female
patients on their shows.Certainly
would drop their ratings rather quickly if they did but hopefully
they would get the point.
PT
'Advocates for Patient Modesty'
I found three male only 'clinics' online that advertise male only staff. I phoned two to ask if that included nurses/techs, and had to e-mail the other for info. So far I have been getting recordings, but here is my point: They can apparently advertise male only staff and not violate any fair hiring regulations. (so far)
One actually had the heading "All Male Staff" in the newspaper.
So for now, it appears that gender staffing violations can not always be used as an excuse.
http://www.sacramentomaleclinic.com
http://www.doctorsclinic4men.com
http://www.cambridgemedicalformen.com/faq.html
I realise there may be a public vs. private regulation, and I'm not saying we can vouch for the clinics, but 'all male staff' is legally being used for now.
'Advocates for Patient Modesty':
I have come to think of it as much "physical privacy" as it is "why" the privacy is important to the pt. Perhaps that can be woven into the thinking and mission statement.
-amr
After describing the issues discussed on my Patient Modesty blog threads to the subscribers to an ethics community in Medpedia, a subscriber wrote the following personal experience. I thought it would be appropriate to present her comment here and also the link to her web site where she presents of list of considerations and behaviors for those who attend to patients. ..Maurice.
Hello Dr Bernstein
This issue hit home recently during a stress echocardiogaphy appointment. As a heart attack survivor, I've had a number of tests but so far not a stress echo - but this incident involving a (male) echo tech and a (female) treadmill stress tech was so disturbing that I lodged an official complaint with the Cardiology Department manager (something that, as I wrote later on my blog, is an action Canadians are known worldwide for NOT doing - complaining!)
The fact that I had to be stripped to the waist for my EKG leads and had a strange man (who had not even introduced himself when I entered the echo lab) pushing and probing and working away on my bare boobs was bad enough. It was made even worse by the fact that neither the male or female techs made eye contact, explained the procedure or made even the slightest effort to make this procedure less awkward, uncomfortable or embarrassing for me. Neither even said "Hello!" to me or introduced themselves,for example.
I don't think patient modesty is necessarily a matter of whether the health care provider is the same gender as the patient. I've had sensitive and considerate care from male docs and techs, and I've had rude, insensitive care from females. What health care staff fail to appreciate is that the person lying on the gurney is not just the 1 o'clock appointment, the factor keeping them from their next coffee break, nor a piece of meat on a slab.
This is about human kindness and consideration - not gender. For heart attack survivors, there is no such thing as a "routine" cardiac test. Patients already come through the door feeling anxious, apprehensive, worried and downright scared stiff.
After the stress echo mentioned, when the department manager asked me for any further input about how her staff might improve their patient interactions (she was surprisingly receptive to my complaint, as mine was the second complaint in less than one week about her staff) I submitted a list that I called: Carolyn's "Top 10 Tips for How To Treat Your Patients" which, I'm happy to say, has been posted in several departments around our hospital. The staff in ICU, for example, specifically told me that in such a high-tech environment, they sometimes forget that high-touch is just as important for both patient and families.
The list is at "An Open Letter To All Hospital Staff: http://myheartsisters.org/2009/07/10/open-letter/
Carolyn Thomas, Victoria, BC Canada
The 3 sites listed involve ED care.
That is very nice and a start, but what about all the other care men need that involves intimate procedures other than ED.
JW
There is no excuse for that sort of treatment or exposure.
My mother had the same test...a female attached the leads privately and then the male entered the room.
You were treated like a slab of meat...a slab of meat doesn't have any feelings.
I guess that makes it easier for some people.
These places should be named and shamed.
In Australia you'd have no problem with all male clinics employing only male nurses etc.
These cases are an exception to the discrimination laws because they deal with situations were people are exposed....like changing room attendants, all female gyms, day spa's for women...
We have many examples in this country...BreastScreen is staffed entirely by women and there are a couple of gynaecological medical practices run by female doctors that only employ female staff to assist in procedures.
If the demand is there, someone will see the gap in the market and grab it...usually means a nice little earner.
JW
That is true,but they are at least advertising an all make staff which is hard to find. And most places will not speak to the issue publically, so it may be a start. I would hope these type of advertisements catch the attention of other facilities and they see the need/market in them. Then perhaps the other types of proceedures will also encompass a same gender choice.
Great job alan, PT, swf, Dr. Bernstein and others.
I guess we could (and should) learn a lot from the people of Australia too.
That there are 3 all-male ED clinics only shows awareness that men are reluctant to discuss ED with female providers. Although it sets a hiring precedent, it still doesn't really address the cross-gender modesty issues that virtually all men endure. Show me a male clinic unrelated to ED (or AIDS) and then maybe I'll celebrate that baby step.
--rsl
You know, that story shows another element of this debate in how these procedures are done. Was bare chested necessary for this procedure? Could women be allowed to wear some type of sports bra (no metal) or something similar? These little things can make a world of difference in my view and won’t cause problems with the procedure so why are they ignored? When I had my last knee surgery, I wore this new type of gown where it had slots cut in it to place the leads so it wouldn’t have to be removed. In past experiences, they just lifted and placed the leads but I was told they went to this type because it was faster and didn’t have to expose the patient. This issue isn’t just about gender, it’s also just about basic human respect which seems to be missing sometimes in health care. Jimmy
I think hte point was they are hiring all men and no one is saying it is a hippa (?) violation si if ED clinics can do it then everyone can???
OK But if thats really true why arent they?
My mother was not exposed...the leads were attached privately by a female and she wore a loose white top with ties to the front during the test.
My mother said it would have been a totally different experience if she'd been exposed...as it is, she has not given the test a second thought.
She said instances of exposure tended to stay on her mind if she'd been made to feel very uncomfortable.
She had a female obstetrician when I was born and all sorts of things were needed during my birth by caesarean section that involved exposure...but they were manageable because my mother had her doctor.
Yet a hip exam with a "creepy" male doctor who was the only doctor available in casualty at the time, still plays on her mind 30 years later. She felt exposed, undignified, vulnerable and afraid.
I agree the way we are treated and the control we have over these experiences makes a hugh difference.
once again I think all of this shows one of the main points, every patient is different, the one post says the issue isn't gender but way they are treated, others say it is all about gender, others don't care, some don't care if they are out, and providers say its about working with or knowing the provider.....all of this says to me the greatest transgression of providers is not this or that...its not asking. the arrogance of one size fits all patient modesty is an indication of the dehumanization of patients....we are all alike, we are patients not individuals....all we have to do for patients is use certain words or provide this or that and they will all be fine..the failure to ask, to just provide what they think we need/deserve vs simply asking what we need/want is the disconnect between patient and provider, it is the great chasim that seperates us...and them......I am not a patient, I am a person who has a specific unique history and specific unique preferences and needs, i just happen to be your patient right now.....which is just a sub catagory of who I am, a moment in time....to who I am....why is that so hard to understand and so easy to forget........alan
I repeat what I have written before. I teach my first and second year medical students that thinking only of a patient as a patient is like thinking of a patient as an object not a subject. There is a human being within that "patient". There is no "gallbladder in rooom 201", there is Mrs. Mary Jones in room 201 who has had cholecystitis and Mrs. Mary Jones has a sole 3 year old son Robert who Mrs.Mary Jones' husband Michael has to care for while Mrs. Mary Jones is a patient in the hospital. Mr. Michael Jones has to be off work for the days that his wife is recovering from her open cholecystectomy since the only other family able to care for the son lives over 2000 miles away and are unable to come and help.
And why does nobody care about Mrs. Mary Jones' modesty concerns?
Well, because she happens to be the "gall bladder in room 201". ..Maurice.
...and a gallbladder just doesn't have modesty concerns!
p.s.- and don't believe that medical practice when under pressure for time, uncertainties of diagnosis and outcome and professional income is particularly thinking about and sensitive to such patient concerns. And added to that, with no voice of these concerns coming directly from the patient.. well, that's why this has become an issue here on this blog. ..Maurice.
After reading recent past posts, and from personal experience, there seem to be some patterns.
-- The current generation of doctors have a better chance of being taught more about modesty, as Dr. Bernstein is doing. They're not perfect, but they seem much more open to discussing this subject. This is not to stereotype the older doctors, but I do think this is a trend.
-- I would say the same with nurses, based upon experience and interviews I've done.
-- The crux of the problem seems to exist with the lesser trained and unlicensed med techs, other techs, cna's, etc. These are the folks who do most of the intimate bedside nursing, sometimes assist doctors (mostly in clinics) during procedures or surgery, or run equipment for testing. Some are more trained than others, but most all are trained in technical matters, not in the humanistic/social or psychological aspects of medicine. There's already an established trend in medicine to replace nurses with medical assistants in private clinics and doctor offices. It's a money issue. Fortunately, due to regs, they can't do that completely in hospitals.
-- Primary care doctors need to spend more effort helping their patients through the system once they refer them out of their office. They may know the dermatologist well. He/she may have an excellent reputation among doctors. But does the primary care physician know the gender preferences of his patient? Does he know whether the dermatologist has only female med assts that assist the doctor during an exam? At the very least, he needs to inform his patient of the situation, if not help pave teh way.
If the primary care doctor recommends a patient for a testicular sonogram or other invasive procedure, does he know enough about his patient to make sure his gender preference for such an exam can be accommodated? Do doctors realize the extra stress opposite gender care in these cases could potentially add to the patient's overall health? To know this information is what caring for the whole person means.
And patients have responsibilities, too.When referred to a specialist or for a procedure, patients must bring up this issue with their primary care doctors and ask them to help pave the way for a successful, less stressful, healthy encounter with those strangers outside of his office. The main problem, I think, is that younger doctors do not have the clout, power, or even the inclination to go to battle with the older generation of doctors still in control of the system. Regardless, the must advocate for their patients, and take some hits if necessary.
The general concensus amongst hospital workers is the vast
majority prefer not to be a
patient where they are employed.
In particular,nurses that are
expecting would virtually never
have their delivery at their facility. Lets evaluate this in
that all L&D nurses at this facility are female. There are
choices for male and female obgyns.
So whats the problem? Apparently,
its the gossip that gets out to her
co-workers about her.Hmmm,so what's
the gossip for male patients that
face an all female nursing unit.
Are they afraid they might experience a mob mentality or that
there would be privacy issues.Why
do you never see the ceo nor the cno as patients.?
Is the suggestion there that if they are patients elsewhere no
one will recognize them.
I think they are afraid of the same thing we are. That they are
afraid but would make demands to
tweek the system for their confort.
PT
GL thanks for your congratulations and there was no need to apologize. Regarding your question : "Have you requested that he not be present during any future appointments regarding your baby?" Unfortunately, as I had a baby last year at this hospital and was assertive and did not treat the male OB assigned to me as a "god", I have a "reputation". I am now trying to be a "good" patient ( i.e. not make waves). Many pregnant patients (unlike me) seem to really worship their OB's. As this pregnancy has become extremely high risk, I just want the staff and doctors to have my and the baby's best interests at heart so I will just grin and bear whatever happens.
NP
Last count I could find is that there are 2.9 million nurses in america. Thats alot of people who want to medicaly molest us just because they want to.
Who can trust 2 million people?
It seems that the modesty discussion can be one of the most volatile conversations I have ever had.(or witnessed) At some point, even religion and politics seem safer subjects.
Those with little modesty retrictions feel as if they are being called immoral. Those with modesty retrictions feel as if they are being called ridiculous. Nurses want exceptions because it is their job. Patients want permission because it is their body. Except for this site, it seems very few people want to even understand the other.
I listened to one woman last week tell another that she no longer can be intimate with her husband because he allowed another woman to 'see and fondle him naked'. (CNA) It broke their bond. She feels cheated on. The other woman divorced her first husband for cheating but told her she was 'bizarre' because "medical women are different". She has no problem with a CNA seeing or touching her husband's body.She was called 'disgusting'. I saw no tolerance or understanding or even empathy for each other. In a way they were saying the same thing just different circumstances of boundaries and tolerance. A fine line that people are either willing to tolerate or can't accept or cross. I thought this example showed how very close we all are in theory, but how far apart we distance ourselves with practicality.
swf -- I think this gets very complicated, as complicated as human beings are. I see a big difference between;
-- People who don't want opposite gender care because they feel embarrassed.
-- People who don't trust the opposite gender for care.
-- People who think opposite gender care is immoral, which could be combined with number 2 above.
Someone who can no longer be intimate with her husband because a nurse or cna touched him intimately but respectfully -- I find that to be extreme. Not only that, I find it to be disrespectful, especially if the husband had no problem with it. To consider that as having been cheated on represents, in my opinion, an extreme opinion verging on the irrational.
But people have their reasons and their religious convictions, and they should be respected within reason.
Those wanting to fight this battle with the health care industry and with the public had better stay within reasonable bounds, otherwise they'll appear like fanatics.
My opinion.
Mer:
I found both of these women to be extreme.....and they would rather call each other names than try to find any understanding. Bizarre and disgusting are BOTH extremes in my opinion. That's where I said things often turn volatile. We all need someone to try to understand our feelings, even if they are extreme or fanatical in our eyes. We don't have to agree with them.
They were both talking about being/feeling 'cheated on'. That should have been some sort of common ground, not grounds for yelling names at each other for their beliefs.
Do I have the right to say she shouldn't feel that way? I don't think I do: nor do I think it would help.
We fight the battle with the heathcare system for everyone, not just the ones we agree with.
And I personally felt sorry for both of their pain, regardless of foundation. I did choose to share their story between all of us for a reason,but does that make me a fanatic? Perhaps I misunderstood.
swf: Of course sharing that story doesn't make you a fanatic. I think you make an important point. And of course these patient's feelings should be respected. Feelings are feelings. They don't emerge from logic. These people deserve dignity and respect like anybody else. They may be much harder or even impossible to accommodate in most situations.
What I'm saying is that in advocating for patient modesty we need to focus on the middle ground at first, not the extremes. We can eventually get to the extremes, like ER's and ICU's and LTC. When I bring this up with med professionals they often go right to the extreme situations -- which makes their argument easier for them. If we focus too much on examples like you cite, we'll lose the most common, frequent modesty violations. I think we need to focus on those first.
I'm not positive about this. Could be wrong.
I know women are often turned off sex with all the cervical and pelvic screening and biopsies that go on in this country.
It called psychosexual issues.
One of my friends lost all interest in sex after going through a cone biopsy. (I would say 80% of my friends have had cone or punch biopsies and quite a few have also had breast biopsies...none of them had cancer)
I think its a defence thing...to protect yourself from further harm.
If you don't need birth control, you can avoid doctors, smears, pelvics and biopsies...
If you don't have BC, sex becomes riskier and may lead to pregnancy.
Some women feel sex causes cancer, so choose not to have sex any more.
My friend has been celibate for 8 years now.
Of course, the cone biopsy confirmed she didn't have cancer, like almost all the other women having the same procedure.
It seems to be a lot of damage for nothing.
As a single woman, I've always refused these exams and tests.
I don't need birth control and so I can't be forced into them.
It has certainly influenced my decision to pass on a couple of prospects in my life.
I really don't want to enter that ugly world.
It looks like I associate a relationship with cancer, undignified and uncomfortable invasive exams and unreliable tests that lead to more undignified and painful procedures.
I no longer see companionship, romance and all the nice things.
Psychological reactions can be strong and life changing...
I've also heard of men being turned off after seeing their wives having gyn exams with a male doctor.
These reactions are individual..no one can say you're right or wrong for feeling the way you do...
That's like the people that say a doctor's sex shouldn't matter...many of us would totally disagree.
Our feelings are no less valid than their feelings on the subject.
Are these extremes any different to the Muslim community? During my pregnancy I see Muslim couples at the hospital. The wives never come on their own and the husbands do all of the talking. Of course no male practitioners are allowed to touch their wives.I wonder what would happen if they did.
Anyway the point is their beliefs are respected. I want to know why can't Western people also be extremely modest without being labelled as abnormal. Just because the media portrays Western society as not being modest, I don't think it really reflects many of us. And I'm not talking about conservative Christians either.
NP
As a mature male I do not get embarrassed if my doctor or nurse is a female but I still get slightly nervous at the surgery as I don't always know what is going to happen.
On a lighter note, if I have to show my 'boy bits' nerves always make me shrink at a time when I want to be at my best, so to speak.
I did recently see a female doctor about a rash around my hips and thighs, pityriasis rosea, and I also had an issuew with some dry and cracking skin on my penis. When I told the doctor how I had been 'self treating' the penis problem she advised me otherwise but at no time did she ask to see it, even when I dropped my pants (with one hand on my genitals, only to keep them out of the way).
I am guessing she was sparing my blushes, or maybe hers.
"These reactions are individual..no one can say you're right or wrong for feeling the way you do..."
I agree, June. Feelings are feelings. We don't always have control over them. I may "feel" I want to hurt someone, but that doesn't make it right just because I feel that way. And it doesn't mean we can't try to control them if these feelings interfere with our lives or our health. But that's another individual decision.
NP -- "Are these extremes any different to the Muslim community?"
There are irratatinal religous extremes, too. Example: People who would rather die then allow opposite gender care. To me, that's irrational. It's a feeling. It may even be a religious belief. And, of course, it's the person's right to refuse care.
The health care system needs to address these kinds of issues and respect these people as much as any others. But I think it's counterproductive to focus on these extreme cases in trying to argue for a patient's choice of same gender care in everyday kinds of procedures and exams.
It's still all about communication, respect and dignity.
On Dr. Sherman's blog, there's a story about a religious man who suffers through modesty violations, and how his religious leader later regrets that he didn't intervene up front to help him.
"The female nurses told this suffering, dying patient, "You don't have anything we've never seen before!" "Don't worry about it, we do this all the time!" and "You'll get over it!" If a male nurse said anything like this to a female patient, he would be suspended, fired, his license revoked, or possibly face a law-suit!"
The difficulty for all of us to perhaps accept, is that these cliche's, these expressions, may not be said with malice. These caregivers may actually believe that what they're saying will make the patient feel better. Why would the believe that? Probably because that's what they've been taught, or observed with their mentors (the hidden curriculum). This belief is then reinforced when the patient doesn't challenge the caregiver immediately or later complain or protest or take some action like writing a letter.
Human pshcyology is fascinating. It's amazing how we can convince ourselves that what we're doing is just fine when it isn't. What we do to protect our own psyches and make work easier for us is very interesting. These expressions are used to end conversation, to prevent a debate, to close the subject. And they most often work.
My points:
-- Patient need to accept that these statements are not necessarily made with the intention of violating dignity or privacy. The caregivers making them often believe they are helping you to "get through" the experience. You must carefully listen to the tone of these statements and look into the caregivers eyes. If these statements are said with sarcasm or ridicule, respond accordingly.
-- When you hear these statements, you need to recognize them for what the are -- attempts to shut down communcation. This is your opportunity to open coversation. Don't let them end the discussion. Challenging these statements and the assumptions behind them. "It's not about me 'getting over it," it's about you recognizing and accepting my values." "It's not about how many times you've done this. I have done this before. It's about how I feel." "How many of whatever you've seen is not the issue. The issue is how I feel about all this."
-- If the caregivers don't accommodate at this point, be prepared for other strategies they may use They usually have a Plan B. This may include new cliches that may become more assertive or intimadating -- "This is how we do things around here." "We have no male nurses or cna's." "So then, you're refusing treatment." "These are the people who are trained to do this." "You're not the only patient I have, so we need to get this done."
"Why do you do things around here like this? What about respecting patient dignity?" They respond: "We do respect patient dignity." You say: "Who gets to define my dignity? You or me?"
If you're in a large hospital -- "You're telling me there's no male nurse or cna in this entire hospital who can do this? I don't believe that?" They say: "Well, we'll have to get him from another floor." You say: "Then get him from another floor."
"So -- if you only train one gender to do this procedure, what does that say about your respect for individual feeling and values? Isn't this gender discrimination?"
"As of right now, this moment, I'm the only patient you have. When you're with me, I'm your only patient."
Go into the hospital expecting the best. Don't go looking for trouble. But be prepared for what could happen. Keep your eyes wide open and your ears alert. Be proactive. And don't be afraid to speak up.
As I go back and read this and previous volumes I am reminded of the wealth of information contained here. There are 'tons' of educational opportunties presented to us here. Not just the importance of what we want, need, expect....but actually how to get it. Anywhere from how to build a respectful letter to how to build a respectful dialog. How to give and get respect. How to inform patients what to ask and what to expect. How doctors feel regarding these subjects. And mostly how to empower a patient.
And the power of venting and releasing is extremely important. Try to get the anger and emotion out so we can move on to a calm means of education. The extremes that we all discuss here do not have to be part of educating and changing healthcare, but the chance to see the best and worst of what we need to accomplish in the end. Moving from zealots to advocates.
Like it or not (and most of us don't) we are where we are until we change it.
MER,
I enjoy reading your posts (and lots of others)
I just wanted to make two points...there are some people who would rather die than allow intimate cross gender care.
I don't think it's irrational.
How many people have been sexually assualted in their lives?
Lots...men and women
I had a couple of very upsetting and damaging incidents in my late teens/early 20's that destroyed my trust in males.
I simply cannot put myself in an exposed and very vulnerable position with a male.
I have successfully avoided all males in my health care.
It is a reaction to MY life experiences and the lessons I've learnt along the way.
It's my minds reaction to a threatening situation...it's about my self-protection and self-preservation.
It may be irrational to other people...but it's very real to us.
I think the fact you may endanger your life rather than face cross gender care speaks to the depth and extent of the psychological and spiritual damage you've sustained by the negative experiences. It changes you in all sort of ways.
I heard a young woman say at a support meeting that she would rather die than allow a man to seize control of her body again.
I understood perfectly....we all did...
I also make the point many men have sadly been sexually assaulted by priests, paedophiles and others.
These men may also act "irrationally"...some refuse all intimate care, others refuse male medical care...it's more complex because their attackers are usually male.
Many of these men have never spoken of the abuse or sought help...I've been told men are less likely to "deal" with the abuse and more likely to turn to alcohol, drugs and tragically, some commit suicide.
There are now more support networks for men, but you still have to convince men to seek help, that it's not unmanly or weak to reach out...
I think there are many "irrational" people in society.
Many of us try to get one with our lives, but the abuse is always with us, no matter how deep we manage to bury it. It becomes part of you.
The other point I wanted to make...I think when medical people make those sorts of comments, "I do this all the time" etc...they has missed the MAJOR point - it is not THEIR feelings that are in issue, it's YOUR feelings and MY feelings.
I would quietly make the point that with respect, this is how I FEEL....
I think given it's my body in question, it's my feelings that take priority.
I think most of the imposition of cross gender care for intimate things is simply about convenience or lack of consideration..."We don't have enough male nurses...or female doctors"...(or it's easier for me not to look for one)
I would never accept that argument, because I simply can't...once it's made clear, it's a male nurse or female doctor or nothing will be happening...they begrudgingly (or sometimes with acceptance or even concern) find someone.
That is what we have to keep doing...it's easy for me and many others...I HAVE to keep doing it.
MER, you stated several posts back about a wife no longer able to be intimate with her husband after cross gender intimate care. You stated you felt that was disrespectful and extreme. All of our feelings are considered "extreme" to many and especially healthcare personnel. On "how husbands feel" blogsite, many men feel exactly how this woman felt. They are turned off completely by having their wife or gf see a male GYN. It destroys some marriages and relationships. It hurts to the core and it destroys a big part of the marital space and intimacy. So how does this womans' feelings differ from many a mans' feelings. To me... nada. Just all the same in reverse.
JW
I stand by my thoughts and opinions. But I will defend a patient's right to choose same gender care for whatever reason. You don't need to defend your feelings and values. Force the system to defend the ethics of its practices. Force the system to defend how its practice corresponds to the lofty ideals of its mission statement and/or core values.
Spouses need to make sure they've discussed this issue and understand each other's wishes. Then they need to advocate for each. But they've got to be on the same page and not back down. Whether I or a caregiver thinks your wishes are irrational is irrelevant. You don't need to justify it. You define your dignity. The system doesn't.
But the point I'm making is the battle needs first to be fought on the ground level, in the clinic, in your hospital room. Letters came come later if you don't get your accommodation. But be firm and make your wishes known to the foot soldiers in this battle. I firmly believe most will try to work with you. If they can't or won't, then decide your next step.
For me the issue of modesty is irrevelent , misapplied and
as such means nothing to me.For
whats important is privacy, equality, fairness , no double-standard and no discrimination.
The other issue of the equation
is unprofessional behavior,boundary
violations that occurs towards male patients and That female providers justify and assume that men often enjoy being seen by the other sex and as such fall into all those categories as seen on the voy forums.
That is what I believe most
men find infuriating. Some typical
comments female providers might say
are to the effect " You don't have anything we havent seen before,or
you'll get over it as we do this all this time. Should the communication degrade to this level
then I've assumed they are not accepting what you want as s patient which to me is verbal abuse.
Those stupid surprised looks should quickly be met with an equally stupid surprised look and
perhaps an equal comment such as
its done all the time in L&D but
without male nurses,right.
PT
"You don't have anything we haven't seen before, or
you'll get over it". I find those and many other excuses so ridiculous they're almost humorous. If I reached over to one of those nurses and pulled her scrub pants and underwear to her ankles I could say exactly the same thing. I have indeed seen plenty of women's private parts and she will indeed get over being pantsed some day, but I would end up in prison.
They might say it's "necessary" to be stripped and fondled by opposite gender medical "professionals" for the good of my health, but it's all lies. It's not "necessary" for a woman to do it when a man can do it just as well or better.
They say "It's OK because I'm a professional". Yeah right, you took a class at the community college for 4 hours a week for six weeks and that makes it OK for you to strip and fondle me? In the case of many MAs they have no education at all. The week before they could have been waiting tables or attending their high school graduation.
What makes it OK for them to gawk at my penis, often with their presence being completely unnecessary while they guard their own modesty and nudity with their life? Guess what nurse, CNA, Tech or MA, I've seen many breasts before so you might as well take your shirt off while you're standing there gawking at my nudity.
Nothing gives them that right except idiotic doctors and nurses that couldn't care less about the modesty and dignity of their patients. They allow their nurses, techs, assistants, receptionists, etc to witness patient nudity just because THEY CAN. Patients don't object because they're too embarrassed and just assume it's necessary because of the blind belief that their doctor would NEVER unnecessarily humiliate them. Most patients have so much to learn and this blog is a great place to start.
SLO
To anonymous who commented about 2.9 million nurses in America. What's your point? Are you being serious or sarcastic?
i read dr. sherman's organize. boy has this thing changed!! options?? what happend to all of us wanting same sex care???
im with you slo. good points!!!
I have just acquired a copy of the
Arizona state board of nursing regulatory journal. It is published quartarly to 90,000 nurses in arizona. On the cover is
a computer keypad wraped with a
large chain and padlock.
The magazine tends to drive home
to nurses the importance of hipaa,
yet interestingly, this subject
in disciplinary actions is not mentioned once as several
hundred nurses this quarter have
been reprimanded for violations
from felony convictions,drug
diversions,failure to cooperate
with board,patient abuse and
sexual abuse. I know of at least
8 high profile cases in arizona
recently regarding hipaa and cell
phones.
In fact, the magazine listd
a website that in Oct 2008 www.renalandurologynew.com
more than 34,000 complaints of
privacy violations had been filed.
What I believe is that those
that are violating hipaa are simply
fired and not reported to the state
nursing boards. A cellphone with
the camera part removed would have
been a better example.
One would think that to improve
and save on the credibility, intregity and professionalism of
their industry they would admit the
indifference to male patients and
increasing lack of privacy in many
facets,instead they seem to go
after other ways of improving the industries image,such as the nursing advocacy website.
PT
Anon 9/13: We need to present choices. Some people go without any care at all because of the gender issue when they might be able to find something they could accept. But, if same gender care is what you are looking for, that info will be there too. These options do not conflict with each other, they allow people more options for care.
Some people want same gender intimate care. I get that. I want it too. The site will have that info.
Some people can have opposite gender care mitigated with a few concessions if neccessary. I get that too. That's not a slight to anyone or sign of giving up on anyone: more an attempt to help everyone get the proceedures done. We really do not all think alike or want the very same thing.
In either case, we all want respectful care.
I really think the two can coexist on the same web site.
Also, I'm not at all sure that the site goals have changed. Jimmy, alan, and others have been seeking this goal for awhile. I'll let them speak to that if they choose.
I agree 100% with swf, me telling someone who doesn't care or prefers opposite gender care they are wrong, they have to or should have same gender care is no better than what is going on now with those who want same gender. Our goal is not to dictate to anyone what they should or should not require, our goal is to do our best to promote a medcial care system that provides every patient a choice of what is right for THEM not what someone thinks is right for them. If you prefer opposite gender or don't care that is YOUR choice...attempting to force a system that forces everyone to have same gender is no better than what is happening now...different but no better. If there is one thing we should have learned from all this is we (patients) are all different, and what we really want is a choice that fits us.......
alan
The goals on the Organize thread haven’t changed; it’s all about choices but mostly about choices for each individual patient. Everyone that has posted here is different and has different views. I honestly believe that you can work with both genders and find common ground. I’ve learned this through my own life experiences. Through four surgeries I had both male and female nurses and never was my modesty or dignity violated. I called ahead of time and requested that my underwear remain on and my gown not to be removed for the procedures and that gave me the piece of mind that I needed. Yes, one nurse asked me to remove them but I politely reminded her that it was okay with both my doctor and anesthesiologist. She just smiled and said that the nurses preferred them off but if they said it was okay, then leave them on. Much like MER, I think if we don’t provide the providers any options, then how are they to take us seriously? How are we any different than them? You find that happy medium for both you and the provider and it’s a win win for all, and there is a medium regardless of what you or the providers say. Our goal is simply recognizing your needs and beleifs. I don’t understand how that’s not getting options? Perhaps someone could enlighten me?? Jimmy
Here is a truly disturbing account of a patient's modesty being violated. (warning not for the faint at heart)...Terry
http://www.healingwell.com/community/default.aspx?f=35&m=1130400
Its apparent that the nursing industry has a lot of dirty laundry
and no matter how many times you wash it,just dosen't come clean.
Consider comments made on many
nursing sites when a thread is started regarding a patient privacy violation. Many nurses will
chime in and state that" well,thats
not how I manage my patients privacy and so forth and so on."
It irrevelant what a few here and a few there say in that you
can't say an industry is a profession when you rely on a few
individuals. You can't just individualize an entire industry
in a desperate attempt to salvage
some honor.
Consider the number of malicious
hipaa violations that occur each
month in the U.S. The peeping and
the snooping and the cellphone
camera clicking.
The fact that We are paying their
salaries while our information is
stolen from us is plain ghetto as
I have more faith in housekeeping.
PT
Terry which particular account are you referring to? I only read the first page. Was it the man who fainted? As far as him seeing the probe having a condom placed over it and being lubricated, there is nothing unusual about that. I have had many transvaginal ultrasounds while doing IVF and during my pregnancies and the probe has always been prepped in front of me. I prefer to see that the probes are prepared properly in a sterile manner. Also regarding the comment of the nurse stepping out of the way when she saw the patient fall, that is a health and safety issue. They are not supposed to risk injuring themselves saving a patient from falling.
NP
The thing that struck me about the healingwell.com thread is the number of male patients that just "suck it up" and never protest, question the young MAs, formerly burger flippers, or wonder if females suffer such wholesale modesty violations.
--rsl
it didnt bother anyone that this nurse let hte MAN run around exposed with no more regard than treating him like a little boy? that's thr real problem. nurses have mommy complexes. humiliate hte little boys and giggle at how silly he is. condensending.
MEL wrote:
"...But the point I'm making is the battle needs first to be fought on the ground level, in the clinic, in your hospital room. Letters came come later if you don't get your accommodation. But be firm and make your wishes known to the foot soldiers in this battle. I firmly believe most will try to work with you. If they can't or won't, then decide your next step..."
This is an excellent point, and reinforces the reality of the PATIENT AS CONSUMER. The commodity we are consuming is health care. If we do nothing when we feel uncomfortable, violated, dismissed, you name it - it's exactly the same as saying that we are wiling to tolerate unacceptable treatment.
When I wrote my "Top 10 Tips for How To Treat Your Patients" and sent it to the Cardiology Department manager after my recent cardiac tests, I was apparently the second client to complain about the behaviour of her echocardiography staff in less than one week. She took my complaint very seriously, forwarding my Top 10 List to all staff, sending out a reminder e-mail about the importance of the 'meet and greet' function, and even booked an In-Service Meeting to reinforce patient care.
Interestingly, her first complainer was also a hospital employee, as I am. (BTW, my "Open Letter To All Hospital Staff" is at http://myheartsisters.org/2009/07/10/open-letter/
The question is: if you are not satisfied with any treatment you are receiving (medical or otherwise) what are you doing to address your concerns?
If you choose to do nothing other than gripe and whine to others (in person or online) about 'ain't it awful?' then you are giving tacit approval for the status quo. Nothing will change.
I don't think that staff (in hospital or elsewhere) are deliberately setting out to be rude or insensitive. But I do believe that many are hugely unconscious about how what they are doing or not doing may be affecting their clients. Our role is to enlighten the unconscious.
And our job as CONSUMERS is to help educate service and care providers and their managers - in an effective, positive way - and then to follow up with the real decision-makers (their immediate supervisors and beyond if you don't get satisfaction there).
Carolyn Thomas
http://www.myheartsisters.org
This one will get the privacy advocates shaking their heads. In
mesa arizona there is a new program
called VISICU or eICU. It is a high
resolution camera placed in the Intensive care rooms of patients.
This camera is manned by nurses
and other personnel from other
locations outside the hospital. The
camera has the capability of zoom
with remarkable detail. I don't know wether recordings are capable.
One can only imagine if these
cameras were used by someone who
was not a patient advocate. There
excuse for these cameras is that
they save lives. I DON'T BUY IT FOR
ONE MOMENT. Where was the nurse. If
the patient pulled out his respirator tube all respirators have built in alarms.
If the patient was willing to get out of bed then he/she should be in restraints. Lets look at the
real reason. About 10 years ago I
visited an icu owned by one of these facilities. I noticed the nurses were wearing some sort of
electronic device on their lapels.
When I asked the nurse what the device on her collar was she rolled
her eyes. Apparently, a patient in
the intensive care complained that
her nurse never came in the room to check up on her. That there were
numerous complaints towards numerous nurses. The device is similar to a house arrest brachlet
that registers each time the nurse enters the room.
There you have it. This is a system set up by the hospital to
compensate for lazy nurses and for
that your privacy is grossly violated. We couldn't keep track of them with a dog collar, lets
try cameras on the patients.
PT
Carolyn,
You are so right except for one thing. People who are humiliated and traumatized are not always able to complain. They feel so powerless, humiliated, upset, angry, outraged that they can't communicate or have the emotional strength to do so.
Thirty years ago I was sexually abused in a hospital. It happened at the most psychologically and vulnerable time of a woman's life; when she's about to give birth.
The treatment was cruel, degrading, involved the public, a mirror and a pediatrician who said he wasn't a pervert but openly told me the day after the horrific experience that he wasn't going to kiss my nipples to make them better as he walked into my room while I was attempting to nurse my baby.
What ensued afterwards was more outrageous than the sexual abuse and it continues to be until this day.
PTSD is considered a disability. One in 6 women is sexually assaulted/abused in this country. These people need special protections when they enter healthcare because of the lack of gender sensitivity in medicine. And, if you have issues, you will be told "yes" and then they will do whatever they want erroding trust even further.
Having researched ptsd, humiliation studies, privacy and torte law and torture I am now putting together the evidence regarding humiliation as a source of emotional trauma together with the physical damage that emotional trauma causes.
It is also disgraceful that when Disability Rights Networks have been contacted, they don't want to get involved due to the opposition they would get from the medical community.
Senator Patty Murray of Washington State recently presented a bill providing for the special needs of female vets coming home from war after sexual abuse citing that their needs are different from the male vets and that when the abuse is perpertrated by those who you trust (like superior officers), it makes things worse. I equate what happened to me as detrimental as the abuses of the Church against children; preying on the sick and vulernable.
If anyone is interested in getting involved in this project feel free to e mail me at: marjoriestar3723@yahoo.com
Marjorie Starr
My apologies to all the men regarding my post. It must be acknowledged that it's not only women who experience severe psychological trauma. It's important to acknowledge that inappropriate behavior and feeling humiliated are emotions felt by both genders.
No one should ever feel unsafe while attempting healthcare. It is my dream to have a hospital that employs both men and women and attends to both men and women with a medical model that puts patient psychological health first. Additionally, people who have been traumatized will do anything to avoid healthcare. It's time that researchers look at what's happening with the psycho social aspects of medical that are causing damage to the patients intead of what's wrong with the patient?
Next post will have to do with the systemic problem of sexual abuse in the disabled, mentally ill, and yes, in our hospitals and some accountability and responsibility to apprehending and support for victims.
Marjorie Starr
Marjorie, I am hesitant to change the main topic of patient modesty which has been going on for years here to another general topic of sexual abuse. Yes, I suppose one could look at ignoring patients' requests for physical modesty a form of sexual abuse, however there are so many illegal and unprofessional actions that can be detailed under sexual abuse that to go into that topic would steer us away from the physical modesty concerns of many of the writers here. Let's keep these threads focused on physical modesty issues of patients and not the general topic of sexual abuse including rape or other criminal acts. ..Maurice.
Thanks Dr. Bernstein. It can certainly be appreciated that you wouldn't want to combine these issues and you are absolutely right. Did you know that previous victims of sexual abuse consider normal standard of practice procedures as perceived sexual abuse? This increases psychological trauma, lawsuits, physician embarrassment and ultimately irrevocable damage to the patient in enough cases that this should matter and I believe the topic is humiliation because of the modesty issue.
The line is thin. Example....15 year old girl brought into the ER from an automobile accident. She's conscienceand has been stabilized to limit her movement until she is assessed. the girl is hysterical and the nurses are trying to calm her down. Any idea why she's so upset? Here's why...the EMT's are standing around, the police are standing around and they are cutting off her clothes.
Without our dignity, automony and sense of self it is catestrophic to heal the body while destroying the mind.
Realizing that the medical issues need to be tended, do it without an audience. They do it because they can. So...I don't see how you can really separate these two issues. Any suggestions?
I had no prior history of abuse and my circumstance did involve misconduct and wasn't perceived and it's one of the things that outraged me the most.
Now what I'm finding outrageous is that nobody wants to touch this. Imagine, I was talking to a female physician who was a rape victim. I said to her, "if I could only help one person". Her reply was...you already have. "Everytime we talk about your work you give me hope' because you're somebody who gets it". The comment really threw me and then another comment was made that showed her fear of saying something out in the open. It made me sad to watch this fine doctor "bound and gagged" by her industry.
Perhaps you might consider another blog??
Marjorie Starr
Yes Marjorie
I've seen those EMT's standing
around in trauma rooms as well as
firemen and the police. I've seen
female EMT's,several policewomen
and female firefighters standing
around when there was a male trauma
patient as well. Yet I can honestly
say that in every case the trauma
nurses were female.
The patient is in the nurses
care and their responsibility yet
every single time privacy is
grossly ignored. I've even heard nurses say " If I'm brought in
here cover me up." That's contrary
to the golden rule but furthermore
not being very patient advocately
like wouldn't you say?
Yes,people like to be an audience even in instances when
they know they shouldn't be there,
therefore,you have to hold the nurses accountable and if you do,
the audience may just well walk away as there is nothing to look at. By the way, statistically more
males are trauma patients than females and fall between the ages
of 17-24 years of age.
PT
Some of you may know, Garrison Keillor recently had a stroke. He writes about it in today's newspaper column. He drove himself to the emergency room, was treated, had many tests, and later then to the Mayo. He writes:
"The nurses, of course, are fabulous. Like many nice 67-year-old men, I am even more awake and alert around attractive young women (though I try to be appropriate). A tall dark-haried beauty named Sarah brings me a hypodermic to coach men on self-administered shots of heparin, and without hesitation I plunge it into my belly fat. No man is a coward in the presence of women."
What he next writes about nurses is not an uncommon perspective. I would say it's quite common:
"Nurse are smart and brisk and utterly capable. They bring some humor to the situation ("Care for some jewelry?" she says as she puts the wristband on me). And women have the caring gene that most men don't. Men push you down the hall in a gurney as if you're a cadaver, but whenever I was in contact with a woman, I felt that she knew me as a brother. The women who draw blood samples at Mayo do it gently with a whole litany of small talk to ease the little blip of puncture and "here it comes" and the needle goes in, and "Sorry about that," and I feel some human tenderness there, as if she thought, "I could be the last woman to hold that dude's hand." A brief sweet moment of common humanity."
I'm sure he doesn't intend it, but Keillor does a real injustice to male nurses here. His thoughts are clear. Men are just not meant to be nurses. Who knows? Keillor may just prefer female nurses. Some men do. And we need to note the he's being treated in St. Paul, his home ground where he is well known, loved and respected. How his treatment differed because of his fame we can only surmise.
He also relates this interesting perspective:
"It's powerful in a hospital. Instead of a nice linin jacket and cool jeans and black T., you are shuffling around in a shabby cotton gown like Granma in "Grapes of Wrath" and you pee into a plastic container under the supervision of a young woman who makes sure you don't get dizzy and bang your noggin."
You need to read all this in the context of a man who is extremely glad to be alive -- to have survived the stroke. I don't thin his is an uncommon perspective.
Here is the link to the Keillor monolog published in Salon. My comment would be "why not consider that some men would be quite comfortable with a female nurse." After all we all like a little "mothering" don't we? ..Maurice.
I agree, Maurice. Just as some men prefer same gender care -- others prefer female nurses for some of the reasons you suggest. This doesn't necessarily have to have anything to do with homophobia. I can completely understand Keillor's point of view. I've experience it myself.
"why not consider that some men would be quite comfortable with a female nurse." After all we all like a little "mothering" don't we? ..Maurice.
I’d actually say that most men are comfortable with a female nurse. That’s fine by me, in most cases I am to. But not when nudity is involved, that’s when I prefer something different. You also have to consider that everyone has a different view on experiences. The reader had in his view a great experience but that doesn’t mean that I would have the same experience or anyone else in the same situation. That is why the same status quo for every patient will never work. Course of treatment should be determined by the patient, which will take care of this problem. Jimmy
Can't tell you how disturbing that mothering comment is. I'm sure it was meant to be. Will need all day to get those little boy patient pics out of my head. Sick nurses wierd patients. Any man who doesn't care if a woman watches him urinate is a freak. They have websites for that.
" After all we all like a little
mothering don't we."
Problem is many of us have had the
wrong mothering types!
PT
I think the issue is Dr. Bernstein that like any group which is a minority struggling for recognition and legitimacy, such commentary can be very damaging. While it may be nothing or affirming to the majority...for minorities it means much more. Just substitute white for female, and black for male....does the same commentary seem harmless....is gender and race so different that it would illicit so much difference....it really depends on the perspective. We have been educated to recognize and despise racial discrimination, we have been educated to have disdain for discrimination and sterityping females....yet we can do the exact same thing against males....and its just expressing a preference....men treat you like a cadaver, men just don't have a caring gene.....women just can't drive and aren't tough enough to lead.........not much difference there is there.....that is what is wrong with the article....we still base the severity of discriminaton based on who we precieve as the victim.....men are not percieved as vitcims..so this is acceptable......alan
I have to agree (in part) with anon. I found the comment a little disturbing also.
I do agree, alan. What disturbed me about the article was Keillor's
notion that men are just not meant to be nurses. He needs to be nailed for that. I do hope some male nursing group calls him on it. He can prefer female care all around if he wishes. Some men do. But his remarks about male nurses were unacceptable.
What we have to do is convince men that REAL men don't cower and give in to the orders of female nurses. REAL men stand up for themselves and their morality. I really don't understand why so many men give in when they're embarrassed and don't seem to be ashamed of the fact that they were ordered around like a Cocker Spanial and followed their master's (nurse's) orders instead of standing up for their convictions. What they should really be embarrassed about is acting like a coward. I honestly will never understand it.
"She just smiled and said that the nurses preferred them off but if they said it was okay, then leave them on."
I wonder why the nurses prefer them off when the doctor doesn't care. What possible reason would they have to want the underwear off when it obviously isn't necessary for the surgery, pre op or post op. Can anyone explain that to me?
Al
Marjorie,
Have you visited Dr. Sherman's blogs?
http://patientprivacy.blogspot.com/
He has many different blog subjects and is always open to new subject suggestions.
LG
I won't even lower myself to read the Keillor monolog (whoever he is). He sounds very homophobic. The fact that he enjoyed peeing in front of a young nurse makes him sound like a real pervert. I agree with anonymous, what a freak.
Alan,
There is a huge difference between gender and race when intimate care is the source. First, in the USA we have privacy rights supported by the constitution. Race discrimmination is not. Second, dignity is supported by the Patient Bill of Rights. Many people (not all) do not want opposite gender care to preserve their dignity. However, what this blog is really about and what isn't spoken about is the human reaction to loss of dignity and that is humiliation. Sometimes the experience is extreme in the medical setting. Sometimes it's traumatizing causing long lasting psychological effects. Whether the experience was an "accident" of insensitivity or outright abuse, the issues are the same. Underlying all of this on this blog are the feelings of both men and women and their opinions about what kind of treatment is acceptable to them and what is acceptable to others. What they are all avoiding is what experiences they would consider humiliating. There is no majority or minority with these issues. As a matter of fact more people of both sexes probably have objections to standard of care practices than do not. I don't believe that male nurses can't be caring. Actually, sometimes they are more caring. As I've said in an earlier post, I was subjected to cruel and degrading treatment when there was sexual abuse while being hospitalized. The perpertrators were both male and female. The traumatic experience left me with a weakened sense of what I would consider humiliating and for me...no strange men for intimate care; no students watching or viewing my body. That's what I need based on my experiences; it's not what someone else needs; it's what each individual patient needs at a vulernable time. However, there is a problem in that so many of us want same gender care. It's about time that the medical profession finally acknowledge what they already know, give us what we want as we're paying for it, and if possible, refuse opposite gender care at the last minute. We as a group would be upsetting the medical industry. They have an issue they will be forced to address and then perhaps our requests or in some cases, a mandated medical qualification will make things better. Talking on this blog or any other one will not change things....only we can.
Marjorie Starr
If anyone is interested in doing something as I'm putting together evidence of emotional damage due to current medical practices, e mail me at: marjoriestarr3723@yahoo.com
But wouldn't a sudden, unexpected vulnerability and contemplation of mortality change a man's perspective of previous control and management of his environment and those who serve him and that he should regress to some much earlier stage, a stage of dependency such as mother in place of father? Anyone want to look up the psychodynamics of such sudden emotional trauma? If this is not pertinent in the case of Keillor then let me know, I am only an internist and not a psychoanalyst! ..Maurice.
'My comment would be "why not consider that some men would be quite comfortable with a female nurse." After all we all like a little "mothering" don't we?'
I'm just saying that as a woman I found the comment odd. Let's change it a little.
'My comment would be "why not consider that some women would be quite comfortable with a male nurse." After all we all like a little "fathering" don't we?'
Would any of you guys find it an odd statement?
Sincerely: My intent is not to take this conversation someplace it doesn't need to go. But....
Fathers can be nurturing and caring people too. However, as an adult, it would not give me much solace to picture a father figure in such intimate situations.
"I won't even lower myself to read the Keillor monolog (whoever he is). He sounds very homophobic. The fact that he enjoyed peeing in front of a young nurse makes him sound like a real pervert. I agree with anonymous, what a freak."
I recall many years ago, before I became interested in this topic, an incident after I had some major surgery (non intimate). I was bedridden for a few days. I needed a bed pan to urinate. The nurse gave me the bed pan and said: "Do you want me to leave the room?" I recall feeling no sense of modesty. Looking back now, I respect the fact that she asked. She walked away from the bed, didn't look, and I urinated into the bed pan. Then she took it away.
The key is, I think -- I felt that my dignity was being respected. The nurse offered to leave the room. Does my behavior make me a freak?
As Dr. Bernstein suggested, our perspective changes when we are very sick and/or when we really feel our dignity is being respected.
I believe that's the kind of incident Keillor may be describing. To say he "enjoyed" peeing in front of a young nurse is an example of what I consider taking this topic and tossing off a cliff. It's irrational. Yes, those who do "enjoy" that kind of activity, although perhaps not freaks, at least have a fetish.
To swf -- I think some women do prefer male nurses. Perhaps not for the most intimate procedures, as some men may prefer female nurses except for intimate procedures. Some females may feel more comfort with male care. They may want to be fathered just as some males like a mothering touch. We're all different.
Why would a man want to become a nurse when the courts have already ruled (Fesel v. Masonic Home of Delaware, Inc) that males can be denied employment as nurses because women patients (half the population) don’t like it.....Jamie
Very interesting reading and observations (especially on page 4) at the link below:
http://www.alsb.org/Proceedings%20Files/2006/Wilhelm.pdf
i have come to the conclusion that Doctors are now ONLY interested in money. ALL other issues have become sidelines to the god of money. Most of the issues we are raising in here revolve around financial convenience for the doctors. If same gender chaperones were not "expensive" they would happen, if same gender nurses in surgery was not a financial issue, it would be a given.
Please doctors, spare us the hypocrisy, just admit, it all boils down to MONEY.
Regarding Mr Keillor's comments I
have this to say. He states that
he urinated in front of the nurse
so he wouldn't bang his head,why?
If he's voiding in a urinal you
can do that on your side covered
in which case why did he void with
the nurse there.Having a patient
sit on the bed to void or stand in
his condition to void is not a good idea, therefore something isn't right here.
If I were a female after reading his story I'd think he's a dirty old man. Lets reverse the roles for
a moment. The patient is a 67 yo
female and prefers male nurses,yet
prefers to urinate in front of the
male nurse! What do you think?
I'm willing to bet he dreamt
about this all week as if they would remember him. Here is my
theory on some folks. Little johnny's mommie kept him in his
briefs while mommie had her high
class female friends over for
bridge. Laughing and drinking in
their stilletto heals and short
skirts playing cards all the while
little johnny was kept in his
briefs. What does little johnny
know and to this its OK.
PT
I reject stereotyping! That includes jw's comment "Doctors are now ONLY interested in money". Yes, in any livelihood whether it is a store clerk or an architect or a lawyer or a physician, money is of critical interest since generally a reasonable life for all cannot be maintained without income. With regard to physicians who under HMO, insurance, Medicare, Medicaid contributions to their income which has been steadily become more limited and with the increasing costs of maintaining a profession including malpractice insurance and frivolous suits trying to provide, adequate income is not some hidden agenda. But, in my years of dealing with other physicians, I find that most physicians are oriented primarily to the proper care of their patients and that is their main interest. It is a taxing job and something more than income is necessary to make the physician feel his or her professional experience is not simply a waste of their life. So don't make doctors and "only" money as a stereotype.
The same goes for the gender stereotypes. Not all women, not all men are sexual perverts. Not all women and not all men reject professional attention by a healthcare provider of the opposite gender. I said "professional attention" and I mean just that,including patient modesty, nothing else. And despite some statistics presented on these threads, most of the interactions between nurses and patients are professional and should not be steretyped as not. By professional If a male patient needs to stand to urinate and some do and if that patient could have even remotely the potential for orthostatic hypotension and possibly collapse in a faint but insisted on standing, it would be appropriate for his nurse to be in attendance, whatever the nurse's gender.
As we try to teach our medical students, to use stereotypes in medicine is irrational since no two patients are the same, no two patient's disease with the same name present or respond identically. Each patient, each disease, each nurse or other healthcare provider of either gender must be looked and acted upon individually and be judged in that manner. No stereotypes. ..Maurice.
"The nurse offered to leave the room. Does my behavior make me a freak?"
From what you said it doesn't sound like your behavior is anything similar to "enjoying being watched".
It is nice to hear you got one of the few respectful nurses though.
What is that supposed to mean?
NP
Patients who have had traumatic experience do not trust the strangers who care for them nor the system that traumatized them in the first place due to the bad behavior that is demostrated on this blog and has people so upset. Trust needs to be earned. Respect needs to be earned.
Based on my experience the medical community, they have earned nothing ; nor would I participate in their sysstematic re-traumatization and abuse that goes under the headline "standard healthcare in theses United States"
Marjorie Starr
Majorie, you miss my point, my point is the process of stereotyping is the same, the flawed mentality is the same the object, person, and reason may be different...but whether you are discriminating against some based on gender, race, or religion...it is just as wrong. My point was while the transgression of stereotyping and discrimination is just as wrong, we do not treat it as equally wrong depending on who the parties are. Our personal perspectives obviously effect how we see this. As a white male I personally feel it is much more acceptable to stereotype and therefore discriminate against me than it would be to do so against say a black female. That is not to say that I am the victim of such transgressions as often or to the degree a black female is, because I do not believe that to be the case at all. My point was if we were to say, females don't make good doctors becasue they are to emotional...all hell breaks loose, we can say males don't make good nurses becasue they aren't as warm and supporting...and a few take exception to the point of protesting...an arguement that has been debated before...we assume prisoners loose rights, we would assume male and female prisoners loose them at the same rate, yet several states actually have laws that prohibit male gaurds from pat or strip searching female prisioners, yet the reverse is acceptable. That was my point, stereotyping which I feel IS discrimination is more acceptable when applied to certain segments of society.
Saying all providers are perverts, evil, greedy, is ridiculous and barely deserves comment. I do not belive many people even on these posts feel that way. I do feel however providers while being taught paitents are all different...the medical profession as a whole practices a one size fits all mentality when it comes to treating patients modesty. From making all patients wear those stupid gowns (which they know we hate) even when there isn't a reason for it to not even asking if gender matters for intimate exams....they ignore the difference in modesty levels that they have to know exist.....that is institutional stereotyping that providers buy into....alan
"Trust needs to be earned. Respect needs to be earned.
Based on my experience the medical community, they have earned nothing..."
Marjorie: I would have to disagree with you, respectfully. I think as a profession the medical community has earned our trust. That's from my experience. Granted -- there are too many exceptions, and too much covering up. Any dignity and modesty violations are unacceptable, and there are too many. But I've found when I even suspect a problem, if I confront the caregivers immediatley, things change rapidly. Respectful confrontation and assertiveness.
I've always believed and will continue to believe that the vast majority of professionals will try to live up to their ethical values. As patients, we need to have extremely high, yet reasonable, expectations. We need to make these expectations clear. Most professionals want to meet high, reasonable expectations and will do so if treated with the same respect and dignity that we expect as patients.
You say: "Trust needs to be earned. Respect needs to be earned."
One problem, I think, are the "strangers" we meet once we're thrust into the system. It's these "strangers," many non licensed med techs, cna's, etc. that do much of the intimate work on patients. Some are better than others. But essentially, the system pushes them to get in there and do their jobs with little time to establish trust and relationships. Sorry, but that doesn't work for many people. That's where the trust and isn't earned.
I'm not impressed with the amount of training these assistants get, either -- it's almost all task oriented. Very little about social, psychological, sexual aspects of their work. Many don't have education beyond high school. These are people I'm concerned with.
I read a story recently about a disfunctinal family -- drugs, etc. They had all kinds of problems. The mother was a former strippoer. As a minor sidenote, the story said she was now going to school to become a cna. Reason: decent money and benefits. This bothers me. And the fact that the reporter didn't seemed bothered by this, bothers me, too.
With the shortage of nurses and nurses aids, we're going to see more and more people hired off the street with less and less background checking going on. I'm not comfortable with this or the kind training and supervision they'll be given. With more and more demand, we've got to be careful about who's hired. Despite some of the problems we read about doctors and nurses, it's still difficiult to get into and through nursing and medical school, difficult tests need to be taken and passed, clinicals and residencies must be passed, etc. Overall, I have reasonable confidence in that system. That doesn't mean it's perfect.
But with the non licensed assistants? No, in general. Another reason why patients need to be told directly who they're dealing with. Caregivers need to ID themselsves, not just with their names, but with their positions and titles. With everyone wearing scrubs, patients often don't know who's who. And some of that is done on purpose.
I don't see how Mr Keillor's comments were homophobic. However, the stereotype that males are not caring and gentle enough to be nurses is wrong. I think that should be addressed to him.
Also, the leap from entitlement to pervert is pretty extreme in my eyes, but we have not all experienced the same things in life.
And..., my comment that it's odd resorting to mother or father figures to get through medical proceedures, and Mer's comment that he could see that as natural only goes to prove that we have all had different experiences in our past to bring us to where we are in life. Not to sound like a broken record, but choices and the educating of those choices is really the only way to get us where we need to be.
Otherwise, are we all going to carry around a journal of personal abuses for our medical records for every care giver to try to understand, find care for, and bend rules to? How can any caregiver understand all of us and the baggage we come with? Dignity, respect and/with options are much easier than trying to understand all of the possible reasons why we need what we need.
Mer,
You hit it right on the head when you said..."based on my experience". Well...my experience has been one that nightmares are made.
Sometimes the violations are so severe and happen so quickly that a patient can be traumatized so much so that they are unable to speak; they are shocked, outraged and numb from the experience. The damage has been done. You can speak all you want afterwards, mostly onto deaf ears, but the patient gets to keep their feelings.
Perhaps it wasn't on this blog where I told of my experience, but I was sexually abused in a very public, cruel and degrading way at the most vulernable time; just prior to giving birth. It happened when my arms were restrained (normal standard of care of C Section). It happened when I was paralyzed from the epidural block given so they could perform the surgery while I was awake.
The people involved were punished but that will never change the way I feel about the medical system nor repair the horror I experienced just prior to the birth of my first child.
When requesting same gender care afterwards, I've been lied to, autonomy taken away, and retraumatized over and over again because of the way the system works.
What are we all talking about here? We're talking about why we all object to bodily exposure when respect and dignity are taken away.Once you lose your dignity, autonomy, there is nothing left.
Humiliation studies are now showing that cruel and degrading treatment and torture are considered more damaging than physical torture.
Those of you who pretend you would know what to do, I can promise you, there might a time when you lost the control, you're humiliated beyond belief and the circumstances so outrageous that in another setting the perpertrators would be jailed for sexual assault and battery or worse...torture.
No hospitals for me thank you...ever.
Marjorie Starr.
I do appreciate you're point of view, Marjorie. I don't question it's validity at all. All we can do on these blogs is give our own experiences and opinions. But we do all agree, I think, that any modesty violation or humiliating treatment is too much. Any, is unacceptable, even if it does represent a minority of professionals. And I agree with you about the potential trauma these incidents can cause. I've written about this in past posts in terms of how nakedness is used in war crimes.
And you're right. We could all come to a point where we have lost control within the hospital system and, unless we have an advocate to look after us, we will be able to do little to prevent whatever happens to us from happening.
One of our main goals should be to educate patients about this issue so they'll have a better chance of standing up for themselves or acting as advocates for their friends and loved ones.
I agree with you completely Marjorie. Keep up the comments.
Larry
I too was lied to with regard to intimate cross gender care. It was a most infuriating experience for both me and my spouse. The system stinks.
I'm not sure enough doctors and nurses realize how these modesty violations and potential humiliating experiences and can forever give patients a negative, almost hateful and suspicious, attitude toward the system and the profession. Professionals need to read blogs like this and study these narratives so they can understand better the potential effects of these kinds of incidents.
These are valid reactions based on the experiences of these patients.
Larry and others...thanks for the support. My incident took place thirty years ago. Twenty four years after the fact I realized I had issues because of this negative experience that eroded trust. After the awaremenss I did a research project on PTSD, humiliation studies, privacy and torte law and torture.
Now I'm advocating for the following at the most extreme end of this issue.
First, recognizing ptsd (post traumatic stress disorder) as a disability and recognizing that one in six women (and some men) will be sexually assaulted at some time in their lives, this first, represents a large segment of the population.
Second, recognizing that traumatic stress can have catestrophic consequences and that forcing opposite gender care to someone who was sexually assaulted (especially in the medical system) is both morally wrong and detrimental to strong mental and physical health.
It should be mandated just as a bad drug would be taken off the market, that opposite gender care for this individuals is harming and forcing the issues causes irreperable harm.
Further, these patients do not currently seek care within the medical system. Therefore, laws should be passed giving them ultimate autonomy to refuse any procedure that will cause them hard. Doing so will give them the autonomy they need and deserve.
My dream is a hospital that employs both men and women but recognizes the psychological issues before the medical. Recognzing that they are treating a whole person and that once loss of autonomy and dignity take place, that an individual has absolutely nothing resulting in the death of the soul. Who has the right to force medical care on someone with that mindset?
Advocacy is fine, but there is no advocate in the operating room; nor the emergency room. They'll let everyone gawk at the patient but kick out the family.
Lastly, anyone who would like join me in my reform effort please e mail me at: marjoriestar3723@yahoo.com
Let's keep those comments coming!!!
And...let's thank Dr Bernstein for his willingness to bring this issue to the forefront; it is matter of life and death to some of us.
The cost of health insurance is up
131% since 1999 while the cost of
healthcare far outpaces increases
in wages by 38%. Whats different,
aside from the fact that more patients than ever abuse the ER'S
and cat scan machines are only a
little faster. More np's and pa's
are working the ER's and its been
40 years since Marcus Welby MD first appeared on television.
The trend is to reduce hospital
stays and move people through the
ER faster while laborotory services
as well as ultrasound and mri
haven't changed.
Is there a trend to be more respectful of patient privacy
considerations despite the fact that hipaa laws have been around
now for 13 years? What if your
favorite resturant became much
more expensive without menu changes
or improvements in decor. Why are
there not more patients demanding
more in the ways of privacy and
convenience? Are male patients
deliberately left out of the equation continually time and time
again.
I recently came across a flyer
aimed at female patients for a
womens imaging center. It says" Don't let wait times and uncomfortable environments prevent
you from scheduling your mammo appointment today."
" Designated registration and
waiting areas specifically for
womens services." Imagine that for
a moment if these kinds of places
existed for men! Urology services
for men. " Don't let concerns of
inappropriate cellphone pics keep
you from getting the exam you need
nor strange female nurses bursting
into your exam room and staring at you. Designated registration and waiting areas specifically for men."
By the way, the ad was created
by catholic healthcare west!
PT
Is this the problem or cause of the gender concerns written here? If it is, what can be done about it?
The following description of common gender stereotypes is referenced in Wikipedia to Niedenthal, P.M., Kruth-Gruber, S., & Ric, F. (2006). Psychology and emotion. (Principles of Social Psychology series). ISBN 1-84169-402-9. New York: Psychology Press:
WOMEN--
# Women are more emotionally expressive.
# Women are more emotionally responsive.
# Women are more empathetic.
# Women are more sensitive to others' feelings.
# Women are more obsessed with having children.
# Women express their feelings without constraint, except for the emotion of anger.
# Women pay more attention to body language.
# Women judge emotions from nonverbal communication better than men do.
# Women express more love, fear, and sadness.
# Women laugh, gaze, and smile more.
# Women anticipate negative consequences for expressing anger and aggression
MEN-
* Men are more obsessed with sex
* Men are overwhelmed by women's expressions of emotion.
* Men express more anger.
* Men control their feelings.
* Men restrain from expressing their feelings.
* Men are stoic.
* Men show emotion to communicate dominance.
What reaction will others in society give to those of either gender who do not demonstrate their gender "accepted" stereotypical behaviors? Some things to add to the discussion on these threads.. ..Maurice.
You are right on PT! Can you imagine how women and their husbands would feel if the woman goes in to the mammogram facility and a "guy" tech comes out and calls the ladies name? Would that be a shocker? Yet that is what men must endure day in and day out. Female everythings for "intimate" procedures.
Is the problem these are the way men and women are percieved or the way they are. I would guess we could find data from the 60's classifying blacks this way or that way. While there are generalities that may be more representive of one gender or race than another, as a society we reject using them to label or classify people. Further, we have ourtrightly condemned using them to restrict people from job classifications or duties. If we were to use those same type of charateristics to say women would not be good police or work as rescue workers becasue they are to emotional, etc.....I have had some great male caregivers....using broad classifications is wrong and that wrong does not depend on which gender it is against. You can find a "Professional" to give you about any opinion to back whatever you want...doesn't make them right and doesn't mean they apply broadly or effect job performance...different doesn't mean worse...the touchy feely may not be everyones preference..........alan
Maurice:
Notice this about those gender stereotypes --
The female stereotypes are all positive. And they are worded in a way that, when you add it all up, implies that women are "better" or more psychologically healthy than men.
The male stereotypes are all negative but for two. Even those positive traits are more mostly neutral. Being stoic can be regarded as positive or negative. The word stoic has as many negative as positive connotations. Men control their feelings? Note that it doesn't say that "Men control their feelings 'better' than women." That would clearly imply that this was a positive trait. By not saying that it becomes more neutral.
There are certainly negative female stereotypes, and positive male stereotypes. But the writers chose to accentuate the positive female traits and the negative male traits. Interesting, isn't it?
This is from a psychology book. I haven't seen the whole book, But Wow! Just goes to show how biased an academic text can be.
By the way, this text seems to promote a general bias about males and masculinity that some feminist and postmodern thought has promoted -- that is, masculinity is a disfunction in modern society. It's a pathology that needs fixing. This line of thought refuses to acknowledge all the positive influences masculine energy has had upon civilization. And it has had extremely negative impacts on how we education young boys in our public school system.
Okay. I saw my error as soon as I pushed the send button. The book is citing stereotypes and suggesting that these views are incorrect.
So, what I'm saying is that these stereotypes represent that concept in some feminist and postmodern thought. The psychologists are just pointing out that they are stereotypes, not truths.
And they're showing that emotionally, women are considered to be healthier than men.
Or if schoolgirls had to contend with pointless pelvic exams conducted by male doctors and assisted by male school nurses. (Or possibly with a male teacher attending to "keep order.")
--rsl
Psychology is an inexact science
but what is exact is that both genders should be treated equal
in healthcare.
PT
There has been much generalization of behaviors of professionals on this and other threads and I wanted to see if we can detail the generalizations a bit further. So I created the following poll. You might want to discuss the significance of this poll or suggest how it could be improved. ..Maurice.
How do you size up the 5 professions below in terms of which of the 5 profession does each quality apply to the MOST and which of the 5 professions does each quality apply to the LEAST?
Copy and paste the following and then fill in the appropriate 2 blanks for each Quality with M for MOST and L for LEAST. Leave the other 3 blanks empty. The categories of medical care providers are:
MP-Male physician
FP-Female physician
MN-Male Nurse
FN-Female Nurse
FOR-Female Office Receptionist
Quality===================== MP FP MN FN FOR
Attractive
Cooperative
Warm
Open,Honest
Friendly
Intelligent
Understanding
Thorough
Considerate
Caring
This is very interesting. There is no way you can categorize people by these characteristics. My experiences have shown me that there can be caring people with any of these mixes; and uncaring people as well. Something I read said that female physicians were no better in the sensitivity department than male because they've all be trained under the same "umbrella".
This blog seems to be a need for reform; a psycho-social mind shift. Did you know that it's in the litereature that doctors and nurses who were humiliated in their training often humiliate their patients? It's alsmost like child abuse in that it is passed down. What we're really talking about here is reform at the most basic level, first giving patients respect and automony, second privacy that every human being needs to protect their dignity.
Choosing your own doctor, the sex may not be very important. However, when it comes to strangers , somehow it's different.
For me, it's all about privacy as I believe there is good and bad in both genders in all of this.
What it's time that medical professionals understand is that while some of us don't have M.D. next to their name, we are every bit as intelligent as they are to make decisions when informed. It gives the opportunity to ask questions and to partner in decisions. This spills into other areas of medical ethics, however, there are times when so many doctors will leave out a little, or not tell you what you need to know. This is a threat to autonomy. This modesty issue is just part of a bigger picture.
What I've learned most from my research is that most medical professionals don't know how to handle a situation when someone has "special" requests. They think they are helping and erode more trust when they don't follow through with requests that are so important or tell a "white lie" treating the patient like a child. The Patient Bill of Rights reflects everything in this post. It was developed for a reason, ignored when it can be and thus, here we are.
Interesting to see these results.
Marjorie Starr
While we are talking about stereotypes....where are the MOR's? (male office receptionist) While in my lifetime I have only seen two, apparently they do exist. Are we being tested on our own prejudices?
"Are we being tested on our own prejudices?" Yes, isn't that what stereotyping others by an individual is all about? ..Maurice.
Of course, but rather ironic that a stereotype survey has built in stereotypes unless you did that on purpose.
swf, exactly! That is what my survey was all about. ..Maurice.
I'm interested in male psychology, gender differences. Why do some many men today go into the hospital and just let things happen to them? Why are they so passive? Now, patients in general are like that, regardless of gender. We've talked about the many factors contributing to why patients feel this way. But I do think women speak up more than men, and because there are so many female caregivers around for them, the have less need to speak up about intimate care.
Here are a few quotes from "The Real Man Inside: How Men Can Recover Their Identity and Why Women Can't Help." by Verne Becker.
After talking about always giving in to women in his life, he writes: "At times my frustration has been so great that I would even say I felt victimized by women. This may strike a few men and many women as a harsh and unfair statement, especially after all the centuries of domination women have had to endure at the hands of men. There is a key difference,however. Most of the men today who feel victimized by women -- including me -- have brought it upon themselves by handing too much of their won power over to women." (39-40)
As I read these blogs, so many men feel victimized by female nurses -- but so many men just don't speak up. So -- what's going on?
"Because we depend on the approval and acceptance of others for our sense of well-being, we are quick to say yes when we're asked, especially by women, to do things. In a way we treat "yes" a lot like "fine," because we so often say it automatically, without stopping to ask ourselves, Do I want to do this? Do I need this? Does this fit me?" (40-41)
In medical situations, men don't say "yes," they often say nothing, or give an indefinite response, or pretend to say "yes" so as to appear fearless and macho.
I think the key to this is in the next two quotes:
"For life to be focused and purposeful, we need to establish various kinds of boundaries around ourselves and within ourselves. These boundaries define the edges of our selves -- who we are and wo we are not, what we desire for our life and what we do not, what we believe and don't believe, what is our responsibility and what is not, what is our feeling or opinion and what is someone else's, what we will tolerate and what we will not...Boundaries need to be strong enough to withstand attack, yet flexible enough to be adjusted if we gain new insight into ourselves." (42-43)
Why don't many patients establish these boundaries when the enter the health care culture? Perhaps they believe it's expected of them that they drop these boundaries. Maybe it is. Perhaps they're afraid, fearful that the lack of approval of health care workers will negatively affect their treatment. That's all true. But I think with many men it's this:
"So many men today have no idea who they are on the inside, underneath the various roles they prop themselves up with. And since Western Culture at the end of the twentieth century has called many of those roles into question anyway, men have even less structure to support their wobbly exterior. More and More of them are resorting to the passive approach to living...'Well, if I don't know who I am, then I'll just be whatever X wants me to be." (44)
Men and boys in our culture have lost touch with their core, with who they are, with what it means to be a man.
With this comes frustration and anger, even violence. Maybe this explains (certainly doesn't justify) the terrible amount of male violence upon women in our culture. Men blame women for their individual, personal failure to be less passive and stand up for themselves. They don't stand up for themselves because they no longer know who they are or what they stand for.
Perhaps this explains some of the extremely hostile attitudes toward female nurse on these blogs. In many cases, they're not doing anything to you that you're not either allowing or tolerating. And when men realize that, it makes them angry and hostile toward themselves, a hostility which they transfer toward the nurse.
Anyway, enough. What are your reactions?
This conversation is delving into a good deal of psychology but I think the bottom line and the reason the majority of men don't speak up is because when they enter a healthcare situation they 'see' the majority of workers of one sex -- female. Therefore, my contention is that the man that becomes a patient sees no choice, no out. He sees healthcare as 'I guess this is what I get, period.'
Until there are more men in all areas of care and even the facilites asking if there is a preference most patients will just accept what is given to them even if it is not comfortable or deep down acceptable.
MER, interesting post, I think what you posted has a lot of application to me personally. My question is, does it equally apply to females. As a male, I find myself trying to figure out just what role a "man" is suppose to follow. By the traditional account, a "man" is suppose to be strong, take adversity without complaining, bite the bullet in pain, all of the things which defined masculinity...now those very traits are seen as all that is wrong with men...yet still has value as what a true man is, my interpatation is women want a senstive man who is strong, very often these are in conflict with each other. How this applies to the medical community is still a little confusing. Part of me still says just take it, act like it doesn't hurt or bother you and say nothing...the result is as MER says, the internal conflict becomes why didn't I exert what I wanted instead of just taking what was handed down....it really creates a lot of anger toward providers and oneself.,,,,for females, is there an equvilant..I would assume society tells them they need to be feminine & strong...again something that can easily be in conflict....I think in my case its as much a concern that should I stand up and request same gender...I will not only risk upsetting the status qou and being deamed abnormal...but being seen as sexist...sort of like the discussion on race that is going on currently.....one fears being deamed racist so we do not say what we think even when it is not racially motivated for fear it will be seen as such..or even for fear it will be used against us,,,I think this has some application in my case...alan
So Dr.B were not really taking the survey?
There is nothing improper in taking the survey I created though on the other hand I may have been premature in its presentation. The professionals are valid groups of individuals. The qualities are commonly used terms for many individuals of all sorts. Yes, I left out many other individuals who are part of the healthcare system. The use of a female office receptionist as a "control" for one who is not involved in intimate exams or procedures can be looked upon as a stereotype though I am sure that few visitors have ever seen male receptionists and thus considered a statistical outlier and thus the female gender of the receptionist might not be considered strictly a stereotype.
The purpose of the survey was to see whether there was a consensus regarding personal qualities attributed within specific healthcare individuals and thus confirm with a survey that actual steretypes exist here. What I left out was identification of the gender of the visitor and whether the visitor was employed or had family members employed in the professions.
On the otherhand, perhaps the survey should be discussed and perhaps better developed before started. I had written "You might want to discuss the significance of this poll or suggest how it could be improved."
Actually, I was awaiting MER as well as others to challenge me on this experiment. ..Maurice.
alan said: "for females, is there an equvilant..I would assume society tells them they need to be feminine & strong..."
Society tends to define feminine strength as demanding what she wants and masculine strength as dealing with what he has.
--rsl
PS: My post on 9/20 @7:10pm looks like a non sequitur because I was addressing the anon comment on 9/20 @5:25pm and the order was shifted.
I did find the format of your survey a bit odd, Doctor. It didn't seem to suit a paper and pencil survey, but would have been better with an interview. But your point is well taken. To some degree we do associate certain of those qualities more with certain genders and/or job descriptions than with others. Some of the qualities tend to be associated with women in our culture more than with men. I just found the survey too vague. But I'm sure some people, not knowing you were trying to uncover stereotypes, would eagerly line up those qualities with certain genders and/or health care jobs.
"While we are talking about stereotypes....where are the MOR's? (male office receptionist) While in my lifetime I have only seen two, apparently they do exist."
A question I have is would female patients accept a "MOR" acting as a chaperone or even assisting a very intimate procedure (as men are often faced with)? How about a "MOR" constantly sticking his head into the exam room while she is standing there completely naked?
GL
GL:
From a female point of view the quick answer is 'no', although your question was probably rhetorical. While the two MOR's I spoke of were in offices where there was no chance of any exposure, I will admit my safeguards are in place in any facility.
I have left offices where I felt uncomfortable, refused gowns when I saw no point, and made sure doors are locked even at my female Dr.s offices. I have never allowed another person in the Dr.s office with me, and the answer to shadowing during any proceedure has always been no.
Like some people here, I found that if you say something is not O.K. with you, you find it can be done your way after all. But you really do need to be the one who speaks up, or they will expect to do things the way they always do.
There may be some here with modesty issues that think even I am too extreme, but I have many black and white views in these areas. That's ME. Based on MY past experiences.
But let me say that alot of my privacy/modesty issues are really entitlement issues, and those are hard (if not impossible)to mitigate. No means no, and at this point in my life it needs to be or I leave.
Perhaps no survey is even needed to attempt to prove the existence of stereotyping of individuals in the medical care system regarding patient modesty issues, if everyone to these threads agree that all healthcare providers' qualities or lack of qualities are strictly related to the individual's own behavior and not some common feature to any particular group. Do we all agree? I will say here.. I do! ..Maurice.
"Do we all agree? I will say here.. I do! ..Maurice."
I agree in essence. But to say that these qualities are "strictly" related to the individuals own behavior and not to any particular group dynamic perhaps diminishes the importance of group behavior. When I say "group," I'm not talking about all doctors or all nurses, etc. But, I am saying that when you put people of the similar education, experience and profession together in a group, a group dynamic can take over and how people behave may be different than what they individually profess to value. When you add gender to the mix, making sure your group is the same gender, I believe that group dynamic can become stronger.
So -- to say all doctors or all nurses of specific genders have specific qualities -- that's stereotyping. But when you take a group of doctors and nurses of the same gender and put them in a cultural context like a hospital and present them with certain situations -- like any group, will they "follow the leader?"
To be more specific -- If the a significant number of staff in a particular institution don't think patient modesty is important or are not aware of its significance, and that group represents the power structure, what are the odds of the other staff (a) following along reluctantly; (b) protesting; (c)refusing to go along; (d)following along with enthusiam.
Individual health care workers have individual qualites and they shouldn't be stereotyped.
But each insitution/hospital/clinic has a culture, too, which manifests and values certain qualities which translate into specific behaviors.
MER, I can't deny that there are cultures developed within professions which originate spontaneously within the group or as part of "a way of doing business" set by the directors or managers of a group. But without observing the behavior of a specific member of the group, it is unfair to anticipate or even label that individual behavior with (and usually negative) attributes of some members of that group prematurely and without confirmation. I am writing, of course, regarding groups who are accepted by society and as a whole contribute to the benefit of society as a whole and to individuals.
For reasons of safety amongst other reasons, criminal gangs warrant stereotyping, known groups of physicians, do not. Period. ..Maurice.
I dont understand why you seem so angry Dr.
lynn t
Lynn t, this is the problem with this blog method of human to human communication. One has to assume from words written without voice or body language to confirm: I am not angry.. I am emphatic. ..Maurice.
I'm not labeling, Doctor. I'm saying you can't always assume one way or another how people will behave within a group setting. They will not necessarily follow their better instincts. Some will. Some won't. This ties in with the theories I've posted before about the importance of systems, setting and and situations upon human behavior. I believe we too often dismiss those factors. This is not to take responsibility away from individual people.
I went to a chiroprater once because my hip hurt. He told me to take off EVERYTHING and put on a gown. He stood at hte end of my table by my feet and told me to rase my legs one a time. I couldnt get why I couldnt have underwear and bra for that. He probably didnt care but I did.
Would you be offended DR.if a woman said no I dont want to do that in front of you? I never will again not bvecause I dont trust you because I dont even know you, but I will never want to be embarassed in front of any man again.
lynn t
Here is some typical hospital behavior. I went to the local hospital to have a test performed. I specifically asked for a copy of the test and I immediately received opposition from the technician stating h.i.p.p.a violations. She said she would check with her boss.
I told her to tell the boss that I'm the consumer, paying for this test and to please mail me a copy (giving written permission)and that as the patient, there is no hippa violation. The tech left the room and came back stating that it would be no problem to mail a copy.
A week went by, no copy (is anyone surprised yet?). I called the hospital, got the run-araound and finally, some kind soul said she would look into it. A call was received later in the day telling me that it was impossible to get anyone to verify that I had requested my result but she would mail it anyway and "take my word for it".
While this isn't a modesty issue, it's a lack of respect issue, it's the mindset to "blow off" the patient. Don't they realize who's paying their bills?
So...Dr. Bernstein, while we may not be able to stereotype groups in the hospital setting, I think we might be able to stereotype typial behaviors in the culturethat are commonplace and infuriating to consumers. The above example is just that.
Marjorie Starr
More on nursing stereotypes from Wikipedia. ..Maurice.
Angel
The image of a nurse as an "angel of mercy"—selfless, altruistic reliever of suffering—is based on the origin of nursing in the religious orders. In modern times, Florence Nightingale was the epitome of the nurse as an angel.
In many wartime movie romances, the hero and the heroine are a doctor and nurse who meet and fall in love while saving lives on the battlefield; Lara and Dr. Zhivago from the novel and film Dr. Zhivago are one example.
However, angels can fall from grace. Nurses such as Beverley Allitt or Kristen Gilbert, who have deliberately killed patients under their care, have frequently been referred to as "angels of death".
Battleaxe
The "battleaxe" is a malevolent authority figure exemplified by the fictional villains Nurse Ratched in One Flew Over the Cuckoo's Nest and Annie Wilkes in the novel and film Misery.
Handmaiden
The "handmaiden" stereotype is that of a person with little intelligence, knowledge, judgment, or autonomy, a person who exists only to assist the physician. The idea of the purpose of nursing being service to the medical profession instead of service to the patient was promoted by physicians in the 19th and 20th centuries. It is sometimes unconsciously promoted by nurses even today—in the Nightingale Pledge, for instance.
Homosexual male
Men in nursing are often stereotyped as effeminate homosexuals because of the concept (in recent history) of nursing as "women's work". The character Jack McFarland on the television situation comedy Will & Grace was a nursing student for several episodes. It was parodied in several episodes of Scrubs by having an effeminate, but clearly heterosexual, male nurse named Paul Flaurs ("flowers"). It was also the basis for humor in the film Meet the Parents.
Matron
The "Matron" stereotype plays on the old concept of the matron as the prim, proper, no-nonsense, efficient and sometimes feared overseer of all nursing activities in a hospital. Respected by doctors, nurses and patients alike. "Ooh, matron!" is a popular catchphrase from the Carry On film series, several of which featured a matron, though this stereotype had an undercurrent of sexuality.
Nymphomaniac
The "nymphomaniac" or "naughty nurse" stereotype has origins in sexual fantasies. Nurses frequently have visual and physical contact with the entire body of their patients, including the sexual organs, in the course of providing routine nursing care. "Hello-o-o, Nurse!" was a phrase used in vaudeville when a "nurse" dressed in a sexually-suggestive manner appeared on stage. This particular stereotype is perhaps the one most frequently used in caricature.
The old-fashioned nursing uniform—white dress, stockings, and cap—is often used as part of this stereotype.
Nurses are often portrayed as a doctor's secret mistress, such as in the film M*A*S*H and in the novel and film The Cider House Rules.
Consider for a moment the role of
statistics in medicine.
1) Brain metastasis accounts for
15-25% of all intracranial tumors.
2)Pulmonary emboli is the third most common cause of death in
hospitalized patients.
3)94% of all nurses in the U.S
are female.
4)10% of the nursing population
has alcohol and/or drug abuse
problems.
5)One in 6 americans engage in
privacy protected behaviors such
as avoiding the doctor to seek
care.
Of those declining to seek care
what are the statistics that they
may have a terminal illness or to
the lesser degree a life changing
illness if gone undetected.
Do we ignore these types of
statistics which are most likely
of the male gender group. Is it one
of those behavioral norms that falls into the stereotypical prejudices towards men. Whose fault
is it anyway? Does anyone care?
PT
The question those nurse stereotypes raise for me -- Why? How did these stereotypes develop? Do stereotypes appear out of thin air, or are there reasons for their appearance?
Accepting that we should reject stereotypes -- we should also accept the fact that this is how the human mind often works. We make instant first impressions when we meet people, mostly based upon emotion rather than reason. These first impressions are not necessarily correct, but we base our following behavior upon those assumptions. So, two points:
-- How/why did those nurse stereotypes develop historically, culturally? I have some ideas, but I'll wait for other opinions.
-- What would a list look like, a list of stereotypes that doctors and nurses have about some patients? What stereotypes do medical professionals have about obese people, diabetics,drug addicts, poor people, Muslims, devout Christians, people whose medical condition they can't figure out our cure, etc.??? That would be an interesting list, too.
Excellent answer swf, I am exactly the same. My question was rhetorical but thanks for the great answer. It's nice to know I'm not alone with my way of thinking.
Have you ever encountered problems with them not wanting to lock the doors or the doors not having locks? In my experience the doctors act insulted when I lock the door or request it be locked. I tell them (when asked) that it's not them I don't trust it's the nurses, MAs and receptionists. (I don't want to tell them I know it's usually the nurses that wear the pants in his office/clinic/hospital) It doesn't seem to help, but I won't let the exam begin until it's locked. Thanks for the answer. Anyone else?
GL
I agree with what your saying Dr.Bernstein, it’s not fair for anyone of us to assume that all male/female caregivers are the enemy. I personally will let their actions determine what I think about them. That is why as a consumer, we need to voice of displeasure with their service when appropriate. Much like others, I’ve found that through communication, you can handle most situations but I still feel like providers should do more in the way of informing patients of their rights and alternatives in any procedure/exam. If we’re not comfortable with a certain situation,,,, leave. See how fast they may change their mind.
I’ve been catching up on previous post and this one has me confused:
As we try to teach our medical students, to use stereotypes in medicine is irrational since no two patients are the same, no two patient's disease with the same name present or respond identically. Each patient, each disease, each nurse or other healthcare provider of either gender must be looked and acted upon individually and be judged in that manner. No stereotypes
Are you just referring to a diagnosis or in general? Would it not be accurate to say that providers assume most patients won’t have any problem with who is assigned to them since they never ask the patient how they would be comfortable? Is that not stereotyping? Jimmy
It seems to me that that the thread has drifted from modesty issues to criticism/defense of medical personnel/procedures. Also loss is the focus on cross-gender modesty violations, which because of staff make up, is primarily--though not entirely--a male issue in the same way that breast cancer is mostly (99%) but not entirely a female issue.
Another casualty of topic drift is the distinction between opposite-sex doctors (usually little problem) and their support staff (BIG PROBLEM)--from being examined by a physician to being ogled by a receptionist.
And sorry, but there is a huge qualitative difference between adult women being subjected to unnecessary pelvic exams (in private) and teen-age boys putting up with hernia exams from a female doctor accompanied by a female school nurse. (Even heard of a case of a female TEACHER observing.)
IMO, the systemic violations should always take precedence over the occasional; we are, after all, talking about reforming a system.
--rsl
Jimmy, the physicians' assumption is based on the observation that patients don't request change in provider gender, closed curtains, locked rooms. The physicians' assumptions include that patients come to them oriented regarding their symptoms and diagnosis and therapy and if the patient doesn't express modesty issues then the assumption is felt to be confirmed.
Yes, we teach the medical students to be aware of patient modesty as they perform examinations and my observation is that the students do explain why a particular exam is carried out and usually are overly cautious about exposing the patient (including as I have written here before, failure to have the patient stockings removed as part of examining the feet). Nevertheless, I am sure a lot of this attention to communication and patient exposure is deminished in later years as time limitations becomes a factor in doctor-patient interactions.
With regard to stereotypes in making a diagnosis or treatment, documented clinical statistics or if not available past experience should be used (if that is stereotyping?) but each doctor should remember that these are crutches for management and that each patient and each cluster of symptoms and each treatment modality has to be looked at also as a possible outlier from the statistics and acting purely on stereotyping will lead to problems. ..Maurice.
rsl wrote: "And sorry, but there is a huge qualitative difference between adult women being subjected to unnecessary pelvic exams (in private) and teen-age boys putting up with hernia exams from a female doctor accompanied by a female school nurse. (Even heard of a case of a female TEACHER observing.)"
I share your concern, rsl, but I also wonder about the frequency of this. We have no real data. We only have anectotes, usually from adults who recall this -- or in one case on Dr. Sherman's blog, from a female doctor who was concerned herself with this. Also, I wonder how frequent today the female nurse is with the female doctor during a hernia exam.
The youngsters don't talk about this, at least to adults. So how do we get real data? I suppose we could find out how many school systems use female doctors for the boys and whether hernia exams are done -- but that won't tell us exactly how much privacy is given to the boys.
What I'm saying is that in some cases we're dealing with "stories" that get repeated and spread around and it's difficult to tell how true they are and to what extent these kinds of cases prevail.
"good one!
I mean, how often in life do you walk into a stranger's room and grab his penis? Never happened to me until becoming a CNA!"
allnurses.com modesty issues.
They do it because they want to and they can. You guys/girls can psyco it any way you want. Ask her before she takes that class what gives you the right to grab me just because you want?
Think guys! Say no! Dont enable them anymore! If you women have a choice so do us men!
GL-
I asked a physician to lock a door and was told there was no lock.
From my observations I do not see locks on the exam doors of the physicians I see. They do not use locks I suppose because a patient could lock the door or a small child could inadvertantly lock the door. I don't know why else for the 'no lock' policy.
JW
they have no locks because it is not their modesty at risk. They couldn't care less. Locks can be put on doors which will open with keys from the outside. The cost would be minimal.
They simply don't care because it does not affect them. Respect cuts only one way and that is most certainly NOT in favour of the patient.
I have found a certain way to protect my modesty and my privacy, I simply do not engage with any health care staff at all any more, period.
More about statistics and its
role in medicine.
1) Incidence of scoliosis in children is about 1 in 333.
Scoliosis is an abnormal lateral
curvature of the spine. If the
condition is diagnosed at an early
age a torso brace is sufficient to
resolve the lateral "s" curvature,
much like braces are for teeth.
If undiagnosed by age 18 than its
too late. Surgical intervention is
required. A simple visual exam of
the back upper body is all that's required for a diagnosis.
2)Incidence of inguinal hernia
is 1 in 544. Restricting to young
adult males is about 1 in 400.
You'd know if you have an inguinal hernia,you won't know if you have scoliosis at a young age.
Why are there so many missed
cases of scoliosis in young people
and where was the school nurse.
Watching young males get hernia exams!
PT
Sorry Dr. Bernstein but your example doesn't hold up in my book. If we go with its not stereotyping patients becasue providers go under the assumption since patients don't say anything they don't care....then likewise patients can safely assume since providers don't ask when supposedly the have been taught to consider modesty they don't care....I in no way feel providers are all evil or don't care, I would hope providers likewise understand that when they act like they assume we all have the same view of modesty....they are stereotyping....and surely they understand, this issue is about us...not them.....alan
If children are going undiagnosed look to the doctors. Nurses can't diagnose scoliosis. It is out of their scope of practice. They can only recommend that the child be looked at by a doctor for a proper diagnosis.
Alan, then tell me..give me script of when and how the physician starts up a communication with the patient about the patient's modesty issues, if any. Does it start when taking the patient's clinical history and covering previous workups or hospitalizations by saying "and when you were examined or had that procedure, how did you feel about having your body exposed?"..or something to that effect. Or would this communication start as the patient is led into the exam or procedure room? When discussing modesty with the patient, how much should be disclosed specifically to the patient as to what parts of the body are to be exposed and whether the patient will accept that degree of exposure? Should the entire procedure be described at one time or should each exposure be disclosed just prior to that part of the exam? Will all patients accept this disclosure and what if the patient rejects exposures. Does the physician have to debate the issue with the patient or simply avoid that part of the exam to the detriment of a thorough exam?
Usually, it is assumed that bodily exposure is part of the implied consent when a patient consults a physician for examination. Should the patient be reminded by the office receptionist that exposure may occur and that the patient bring up their modesty concerns themselves when they speak to the doctor? Would most patients accept this reminder? Would most patients question this reminder?
I need suggestions as to the best way of meeting these patient needs...some protocol to integrate this issue into the standard doctor-patient communication.
Alan, if you or others on these threads can come up with a protocol that is considerate of both the patient and the physician's work and schedule, then I will do my part and bring your suggestions up at our next faculty meeting to discuss there integrating this into the teaching of first and second year medical students at my school. ..Maurice.
To fix U.S. Health care focus on
value,experts say. That was at
least the conclusion from the CEO
of Mayo Clinic,Rochester Minn.
along with others,I couldn't agree
more. Where does it begin and how
does a patient know if they are
recieving quality healthcare.
The average patient wouldn't know
say that for a triceps tendon tear
MRI is the modality of choice versus sending them home with a
script for an anti-inflammatory.
Respectful privacy is the initial
level of care that generally should pre-empt all care to follow. Disrespectful intrusions into exam rooms as well as neglecting patient's basic privacy spells bad care for most.
Without going into great detail
and keeping sentences short and to
the point comments such as " I like
my privacy respected" can make a
considerable impression. Leave the
rest up to their imagination to
ponder.
Sicko Psychpaths are everywhere
and healthcare has their fair share
of those that just take stupid to
the next level. Female clerks viewing military induction physicals, nurses watching hernia
exams, intrusions into exam rooms
by receptionists are but a few
but the lists go on and on.
Many simply couldn't or won't take a few extra steps,alittle work
to make the patient comfortable.
This separates those who simply want a paycheck to fund their ice
cream social time at home in front
of the tv watching er or worse,trauma.
PT
Doctor -- in reference to your discussion with alan:
Let's start with the primary care doctor. I don't think the modesty issue comes up much if there's a good trusting relationship between this doctor and his patient. But -- He/She should know the patient well enough to bring up the topic of bodily exposure and modesty under certain conditions, such as:
-- If the doctor refers the patient for a testicular ultrasound or a urological procedure he/she should at the very least advise the patient of what specifically will happen during the procedure gender-wise and caution that the patient, if this an issue, should request a male tech or male urologist who can do the procedure without a female nurse. I would call that a protocol.
I would go further to say that a good primary care doctor might know enough about the services in his/her area that he/she could help the patient find the kind of situation that would make the patient most comfortable. Don't just refer without knowing the situation at the clinic or hospital.
I would say this protocol might be extended to the next level, that is, to the physician to whom the patient is being referred. If it's an intimate procedure, I would consider it a professional responsibility for the doctor to discuss this modesty issue with the patient. At least be open about how the patient will be prepped, positioned, draped and who will be in the room and who will do what. Confront gender issues honestly. To me, this is true informed consent, good communication, and helps create trust.
We've talked about this before. I also realize some doctors may consciously believe that by bringing up this topic they may be suggesting certain feelings and behaviors that otherwise may not manifest themselves. In some cases this may be true. But I would suggest that the opposite is true, that is, patients who have not experienced extreme intimate care by the opposite gender may just shrug if off and only later, after the fact, may realize that they do have feelings and were bothered by the situation. In cases like that, at least the doctor has been up front from the beginning.
Call these protocols or just good, open communication standards. Honesty. Pretending modesty issues don't exist, ignoring them, or just being unaware, doesn't work in the long run. Some people resent it later.
Dr.Bernstein
You answered my question. It is assumed by the providers that bodily exposure is part of implied consent even though it never gets discussed. I can’t offer any suggestion on how it’s brought up, but I can tell you that me seeing a physician for a knee problem that requires surgery doesn’t mean I should be exposed. Seeing a physician for a shoulder problem that requires surgery doesn’t mean I should be exposed. Just think of all the different procedures that people are exposed when it wasn’t necessary. I guess a good starting place would be to inform the patient that they will be exposed if they choose to have this surgery or procedure? Has anyone here had an experience where this was indicated? Why is it so hard for the providers to open up this channel of communication to the patients? Perhaps more people would be honest if they felt their caregivers actually gave a cent. I have seen it referenced on allnurses, they do it for the good of the patient. To not cause any further stress. Hello… you wake up from surgery and find that you have no underclothes, what is that going to cause to the patient? Just add this to the consent form for people to choose. That would also be a good start. And as far as a thorough exam is concerned, if it isn’t broke, don’t look or touch….How hard is that? Jimmy
The thing is DR B, they don't tell you even when it’s really obvious that:
-this procedure is where a patient is likely to have to be naked and/or
- The patient is likely to be concerned about nudity.
Let me give you an example. I had to have rectal radiotherapy. One of my concerns was how much would I have to undress, who would be there, how would I be positioned etc. I had to ask the female Doctor before the treatment began how much I would need to undress. She couldn't even tell me in words, she had to use her hand in a sweeping motion so that I was to gather from the waste down. Can you believe that? As it was when I protested about that she said I could keep my underwear on, as if it was some form of a concession. (If it’s possible for me why not everyone?)As it turns out, when I talked to a radiographer later she said that she allows most males to keep their underwear on. Again why not tell me and other that?
So my point. When patients are in for a procedure that it is most likely to involve nudity, tell them about this before hand. Explain what will be done, exactly to minimize exposure (Don't use such terms as we do as much as we can to protect your privacy and dignity. What does that mean?)
So I acknowledge that for some situations it is not possible to do things in advance for all procedures, but in hospitals or day surgery or other out patient clinics, it is. And Doctors or nurses could start changing practice there.
Chris
Thanks for the stats on hernia exams PT. Many are about what I expected.
MER, every school athlete I've ever talked to always had hernia exams, the majority by female doctors and about half had an unnecessary and perverted nurse watching.
I would guess a high school athlete has a higher chance of dying of a heart attack on the playing field than having a hernia. (Obviously it's not true but shows how ridiculous I think it is to be required to have a hernia exam)
LG
Dr. Bernstein, in a nutshell, seconding PT, the one thing doctors have absolute control over is the behavior of their support staff.
--rsl
Doctor: I think several posts answered your question. The protocols you're asking for involve good, open, honest communication, which doesn't seem to be happening a significant amount of the time. As we've mentioned before, this problem doesn't always involve close relationships between primary care doctors and their patients. Trust has been established. It's when the patient leaves that office and is thrust into a system where he/she is confronted with strangers and situations where trust hasn't been established. The system seems to assume "trust" exists just because the patient has entered the system. IMO it's a faulty assumption that needs to be challenged. Time is a problem with the system. We all recognize that. But it takes time to establish trust. And it takes an honest, open atmosphere where the patient feels he/she is being told the whole story. If that doesn't happen, and the patient is surprised or ambushed, there goes your trust.
To LG: I don't question your experiences. But this kind of informal second-hand data will just not make the cut. We need the stories from the athletes themselves, and their feelings about this loss of privacy. Problem is, are most of these athletes willing to talk about their expereince? We can't have it both ways, e.g. don't talk about it and challenge it and then just expect it to go away.
Dr. Bernstein,
You wrote: "Alan, if you or others on these threads can come up with a protocol that is considerate of both the patient and the physician's work and schedule, then I will do my part and bring your suggestions up at our next faculty meeting to discuss there integrating this into the teaching of first and second year medical students at my school."
You've had some good responses - the gist of which is patients need to be told ahead of time what to expect. It's a matter of respect. Forewarning them gives them the opportunity to come to terms with it and bring up any concerns or objections they might have for discussion. Many patients find being blind-sided just as upsetting as the actual exposure. The result can be a backlash of anger and resentment - as we've all seen from some of the posts on this blog.
As to how to elicit their preferences from a patient, I'd suggest that direct questioning by office staff is a poor approach. It's too subject to the vagaries of the individual staff member based on their own comfort level - witness the encounter with the female physician Chris described.
I think I have a better approach. Every doctor's office I've ever been to gives you one or more forms to fill out on your first visit - general demographic information, health care history, allergies, etc. My suggestion is to make it part of this form. A few simple questions can elicit this information with a fairly high degree of accuracy, keeping mind that they need to be properly worded - how you ask is every bit as important as what you ask if you truly want a meaningful response. It's simple, has little or no cost, doesn't require any significant staff time, and if done properly can potentially improve the provider/patient relationship.
This might be getting too long - more in part II.....
part the second.......
OK, what kind of questions do you ask.........
First preface it with a simple sentence or two - remember, empathy and respect:
-----------------
"We understand and respect that for religious or other personal reasons, each individual has their own comfort level with respect to privacy and modesty. Please answer the following questions to help us understand your preferences and help us make your visit with us as positive an experience as possible for everyone involved."
Do you have a preference for the gender of your physician or other caregivers (circle one): male female don't care
For your comfort, you may request a chaperon be present during any examination or procedure, especially those requiring any significant degree of exposure. Do you prefer to have a chaperon present during exams: yes no
If yes, do you have a preference as to gender of the chaperon: male female don't care
If you have any other specific concerns regarding privacy or modesty, we encourage you to bring them up with your provider at the beginning of your visit.
------------------------
Yeah it's pretty simple, but it does three important things:
1. Recognizes that privacy/modesty preferences exist and that they understand that.
2. Gets the basic info so they don't unintentionally blind-side the patient.
3. Helps establish a rapport and oOpens the door for further discussion if the patient has additional concerns.
Comments anyone?
Dr. B - you also wrote "Should the entire procedure be described at one time or should each exposure be disclosed just prior to that part of the exam? Will all patients accept this disclosure and what if the patient rejects exposures. Does the physician have to debate the issue with the patient or simply avoid that part of the exam to the detriment of a thorough exam?"
My take is to tell them up front and ask if they have any problem with the required exposure. If they have reservations, ask why specifically, and what could be done to alleviate their concerns. If they refuse exposure, be very careful about debating the situation. A statement along the lines of "You certainly have the right to refuse any part of the examination that you're not comfortable with, but before you do, please let me explain why I think this exam is important for you". Then do so calmly, including the potential risks of what might be missed by not doing the exam. Be honest, forthright, non-judgmental and absolutely factual, especially about potential benefits/risks. If they still refuse, accept it, document and move on. Excessively debating the issue, giving them one-sided information or attempting to coerce or intimidate the patient into complying are almost always counterproductive.
Just my $0.02.....
Hexanchus, only 2 cents? To me what you wrote is $1000! That is exactly what I wanted. I have seen different entry documents for the patient to fill out but never saw this subject noted.. has anyone seen one? Before I gather what you wrote into a format to present to our faculty, let's have a bit further discussion of your suggestion by others. However, even though I would be starting something in one medical school, education approaches do migrate to other schools. Thanks alot Hexanchus.
We will be starting Volume 24 very shortly and we can carry on this constructive theme. Actually, the recent posts emphasizing the need for patients to express their modesty concerns is also a constructive approach and together will facilitate filling out the form.
The next step is to be sure someone in authority reads the filled out form, particularly the part on modesty. ..Maurice.
Hexanchus has some excellent suggestions. A few points:
-- This kind of survey needs to be filled out by patients as they enter hospitals, too.
-- Not just primary doctors, but all doctors need to do this, or at least those who are dealing with intimte kinds of exams or procedures.
-- A good place to start is teaching this to medical students -- but, this also needs to be taught or suggested to hospital CEO's.
-- I've suggested this to a few hospitals, and the answer I got: We don't want to set ourselves up for failure. They realize it's a problem. They also realize that by asking questions they'll get answers. They have a pretty good idea what those answer will be. They know they can't meet patient expectations to the degree they want to. Thus, they don't want to ask.
Let's try seeing if we can get hospitals to use a survey line the one Hexanchus created.
I agree withn the proposal also.I would not however have a statement along the lines for "religious or other reasons". The reasons are not relevant to me. They should not be relevant to the hospital etc. Just say many patients prefer etc
Chris
All of this sounds great and it's a start. However, as a sexual trauma survivor I have asked for same gender care and have been lied to, they forgot or had me sign consent forms while they were sedating me.
These forms allowed for students to watch and for them to video tape; things I never would have allowed. I haven't been to a doctor since and would never go to a hospital under any circumstance; no trust, no reason to trust.
On a previous procedure, it's only after I threatened to leave after pre admission arrangements were made when they forgot that they honored my need and if I hadn't been so insistant they would have tried to intimidate.
Also, there are some medical people who might use modesty concerns against the patient making them even more vulnerable
If possible Dr.Bernstein. After you have finalized the form, could you send or post a PDF copy here on this blog. I'd like to get a copy and send it to each one of the CEO's at the mentioned top 100 hospitals that you listed a few volumes ago. I'd like to find out what kind of respose they'd have. Jimmy
Regarding hospitals and other clinical settings and modesty (physical privacy) concerns: There will be institutional resistance to providing for the pt unless and if there are $$ incentives or disincentives to change the corporate behavior. Anon from last night (10ish-pm) again brings up the point of teaching hospitals, video taping and extra people around. I know Dr. B's position on nudity in the OR: he considers it a "mute point" because the procedure safety trumps modesty. (From the research I have conducted and from personal experiences of blog members, it is clear to me that a lot of the exposure routinely promulgated for the "benefit" of the pt, occurs merely for the convenience of the medical staff.)
Well in this setting, as I have mentioned before, the internet is now integrated into all of the equipment of the OR, including remote controlled camera positioned to view every inch of the OR and patient, inside and out. These cameras are used for everything from OR scheduling ($$ incentive) to Dr collaboration, to teaching of students.
How are we going to effect the behavior of these institutions when the clear attitude is that the compromising of the pt is in the best interest of said institution?
I again bring up the case, which I have mentioned before on these blogs of Stanford University OBS surgery department, who posted a pdf file (link referenced in an earlier entry) on the net describing the protocol residents are to follow for pt intake for ob surgery. Plainly stated in the procedures is notification to the pt that they must sign without alteration, the consent form which clearly states that video will / could be taken of the surgery and that "other" non-essential people will/could be viewing the surgery. The resident is to inform the pt that if they do not agree to these terms, then the surgery will not take place.
HOW COERCIVE IS THAT!!!!
This shows the total disregard for pt rights. I know that UCLA has the same policy. And I'm willing to bet that USC is no different. And speaking of the "hidden curriculum", what message does the institution thus give to the young doctor about respect for patient rights?
When UCLA dedicated their new hospital, Nancy Regan and a bunch of luminaries were pictured in the LA Times being given a tour of the new OR's, each sporting the latest OR technology called OR1 from the Karl Storz company of Germany. This is exactly the technology I mentioned above.
-amr
Dr. Bernstein,
Thanks for the kind words, but to me it's just common sense. I'm a firm believer in the KISS principle, and if we're going to get health care facilities to make changes, whatever we propose needs to be simple and have little or no additional cost impact - that's what I was shooting for.
With regard to making sure someone in authority reads it, I'd suggest that the patient's preferences should be included in their medical record in the same section you'd find other similar information such as "advanced directive on file", etc. It needs to be somewhere where people will see it when reviewing the record.
MER - Your points are well taken and I should have been more clear. The intake interview form I mentioned is something I have encountered the first time I entered any medical care facility, be it primary care, specialist or hospital. Every one I've ever been to uses something like this.
Chris - I'm not locked into any specific wording - what I was throwing out there is a design concept.
Dr. Bernstein - another thought: Have you ever considered having your med students do a simple survey like this with the patients they interact with? Might make an interesting research project for them.......
today I had an appointment with a urology specialist. The nurse who "called me through" then proceeded to sit down as though she was about to stay for the consultation. When I told her quickly that I did NOT want her to stay, she behaved as though i were an imbecile. She "hmmed" away as she left. Why do these people think it is ok to sit and listen to a man talk to a male urologist about urology problems? Are they REALLY so naive that they think men are comfortable with it, or are they simply voyeurs?
All these surveys and no one will take the most importnt one!
B 4 these girls take there very first cna or nurese class give THEM a survey like"
Why do you assume it will bw ok with men that you have decided to do intimant and immodest things to them just cause YOU chose to?? Why do you think you have the right to expose men to you? and why do you want to? find out b 4 they become part of a system of its ok cause we said so.
You wont fix this intil you find out why they assume its ok to mess with our body, go to the problem sourse. Surprse them with the question of why do you even have the right to to do this.
I would want to read there reasons b 4 they even start a class.
To JW
It is a violation with the
AMA to have anyone in the room
while the physician is taking a
personal history.
Additionally, for years I've
said that hernia exams are worthless in group settings.
Here is a Physician who agrees with me and how sports
physicals should be conducted. Men
with men and women with women.
www.mcg.edu/pediatrician/ccnotebook/chapter3/sports.htm
PT
jw:
Just curious. How did the doctor respond when you dismissed the 'nurse'? If he entered later, was he surprised to not see her there? Did he give an answer as to why she expected to remain in the room?
I'm just wondering how supportive he was to your gender preferences.
Anonymous -- those are interesting questions to ask cna's, etc. I'm not sure how productive it would be. They believe those assumptions because they are taught those assumptions in both the academic and hidden curriculum. That message is embedded within the system. And they learn from experience that the vast majority of men go through the health care system like lambs to the slaughter.
Sounds harsh, but I just interviewed a few more men about their experiences. Got some interesting responses. Once they open up, they'll tell you stories they haven't even told their wives. The pattern I find is this: (a) many men have no idea what they'll face once they go to the hospital or clinic for any type of intimate procedure. (b)once they see what's going to happen, they either freeze up, are too embarrassed to speak up, and/or accept reluctantly and perhaps with anger that this is just the way it is. One man I interviewed laughed about it, told about his buddies joking about it, then admitted that the humor was to cover up his anger and humiliation. I asked him if he would be more proactive in the future knowing what he knows now. He said he certainly would.
One major probleme men face today is that the system has gotten used to the fact that, for whatever reason, men just don't complain. Men either accept it as just the way it is regardless of how they feel, freeze up in complete humiliation, or joke about it to hide their humiliation. Many caregivers may assume that it's okay with most men for this reason. Others know it isn't okay but figure that, oh, well, they'll get over it and I just need to get my job done.
We can print out forms until the Kingdom comes, but until men start standing up for themselves, not much is going to change. The system will not be proactive by asking patients if they perceive it's not in their best interests to do so. And by best interests, I mean efficient and easy processing for them.
An idea -- once we get this preference form, why don't we encourage patients to print the the forms off themselves, write above the questions that they want this form to be included in their medical files, make their selections on the form, and then just hand it in with all the other forms they are required to fill in.
Question -- can a patient insist that a form like this be included in their files regardless of whether they system wants it there?
If the system won't ask these questions, that doesn't mean that the patient can't answer these questions and give their answers to the system.
NOTICE: AS OF TODAY SEPTEMBER 25, 2009 "PATIENT MODESTY: VOLUME 23" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 24
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