REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD
Patient Modesty: Volume 25
To many of those posting on these Patient Modesty volumes, there appears to be something "broken" in the United States medical care system that is not really being discussed in all the current public commentary about healthcare reform issues. The broken part is what should have been an attention, concern and resolution of patient physical modesty but where, according to the posters, there is generally none or if present it is very limited. We will continue with discussion of approaches to fix this broken part. ..Maurice.
Graphic: Photograph by me of a broken pot composition.
NOTICE: AS OF TODAY OCTOBER 24, 2009 "PATIENT MODESTY: VOLUME 25" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON
VOLUME 26
149 Comments:
What's broken includes giving meaning to the purported institutional values, the core values. I'm not convinced that once these core values are established by committee -- that they are regularly reviewed. And, I'm not convinced that managers sit down with ground floor supervisors and caregivers to figure out how and evaluate whether these core values are actually being implemented on a daily basis, specifically. By the way, these meeting should include patient representatives.
Most core values include the words dignity and respect. How do we define a person's "dignity" within a medical context? Who defines it, the patient or the system? Sounds basic, but this needs to be discussed. What does respect mean? How is it connected to dignity? Again, patients need to be involved in these discussion and the creation of policies and protocols.
I believe many hospitals have discussed this and implemented some things -- curtains, knocking on doors, better gowns, etc. But they need to get more patient feedback and review some of the issues discussed on blogs like this and implement further protocols that address modesty issues that they have neglected -- asking patients about their preferences (a form of respect?); being clear about observers during exams or procedures, etc. These protocols should be included in patient surveys: Where you asked about gender preference for this exam?
Will this take more time? Maybe. But that's where medical professionals need to weight the importance of human dignity next to time factors. Will this cost more money? Perhaps. How does this fit into our core values? If they are "core," then we need to build around that "core."
It's not impossible for patient activist groups to get the ball rolling on this -- but it really needs to come from the inside.
To eoe
Are you still with us,I hope
so. Decades ago when I first started working in healthcare I
began in the morgue. I hated it
beyond words seeing what human beings did to other human beings.
All the lost souls,all the
john and jane does,then one day it
didn't bother me anymore.
To Marjorie
Good point and I've mentioned it several times previously. You can't discuss patient modesty and privacy issues
without the subject of sexual abuse/assault. For some one betrayal is enough.
To Edo
For me there is no comparison between nude models and
patients in the realm of modesty/
privacy issues. As a nude model you sir are being paid. Patients are paying. You are well while
modeling,patients are not. There
are risks of being a patient,what
are your risks? I could go on and on.
Mer
A few points I'd like to make on the allnurses thread
regarding accomodating which as you know was referencing racism
for the most part,not referencing
intimate procedures per say. I will
draw your attention to the most
important comments I thought were
made on the thread. Those being
"What I want from my job is an
income,not every patient thrilled to have me as their nurse.People
are too screwed up to expect
everyone to love every nurse. Who
cares if they do or not as long as you get your check."
I'll have to admit thats not the
first time I've read or heard that.
PT
It's too bad it takes "religious or cultural reasons" for many in the medical industry to think about accomodating. While they of course are very important reasons, why should patients need to have a particular reason to be treated with respect? Why do people of a particular religion or culture deserve more respect and dignity than the "average" patient? Why do, for example, people from the Middle East deserve to be treated better in American hospitals than Americans are treated?
GL
Ask all male Dr.s to volunteer a day as a patient so female nurses and cna's can practice intimate care on them. Do it at another hospital so no one knows who they are. While your at it, make the hospital boards volunteer to.
If they expect patients to let students watch and practice on them then they should be willing to do the same. Then we'll see how far 'male or female doesn't matter' really goes. Until they experience that real humiiation, things on the 'inside' wont change.
The real problem is, like prison, hopitals treat you like once your in your body belongs to them. So, they don't really care about humiliation till it happens to them. You guys will never change how they feel because they don't care until its them.
Thank you PT. It should also be noted that not only is the male model being paid but, more importantly, he disrobes with his full consent and not only tolerates the invasion of privacy; but enjoys it. One could argue that there is no privacy invasion at all, for to be an invasion it has to be against one's will or common sense of modesty for which there is none.
I would like to note that my relative is an illustrator. She never felt like life drawing courses were sexual at all.
Would appreciate a blog on the issue of assault and abuse and modesty issues that come out of that regardless of where the abuse occurrec. The statistics are so high, I too, think this is a warranted topic.
Marjorie Starr
I've taken care of male doctors several times and it has included intimate care. All had student participation involved. None complained or had issue with it. Not all males have an issue in this area.
Lisa
Doctors do get a chance to look at life on the other side of the bed railing when they get sick, need procedures or are hospitalized. As I may have previously noted, I have been hospitalized twice and was in conditions where nursing care was necessary, they were all provided by woman nurses, some of whom I knew since I was a hospital staff member. And I was fully comfortable with their service.
But, I think (and you may say that is my error in thinking) when a patient is ill and needs assistance, for most of us, modesty goes out the window!
Again, I must caution all readers to these Patient Modesty threads, that whereas most everybody has some physical modesty issues, nevertheless in the context of medical diagnosis, treatment and nursing care when one is ill, the proportion of the entire population in our society that would agree with most of the concerns written here, may actually be in the minority. I think most people who are satisfied are not going to write to blog topics like mine. This doesn't mean that even for this minority (if true) we should ignore their concerns. And I haven't and have repeatedly advised activistic action to mitigate these concerns. ..Maurice.
Interesting. I have a problem with strange men who want to play with my naked wife. And she has the same problem about a strange woman and me. We don't care what you call yourselves. Dr., nurse, just gives you a cetificate to mess with people. How strange if it were to happen outside of a facility. What kind of person would you be called then? Really makes me wonder about all of your morals.
When we are sick modesty goes out the window???? How about morals doc. Really, more people dont want to get naked in front of the oppisite sex than you admit. No matter what your excuse is, you are all just regular women and men. Get over yourselves.
Not wanting to get naked and have oppisite sex strangers play with you is not rocket science for God's sake! Everyone gets it. Stop making excuses. If I don't like it like you do, then I don't like it.
moralman
Doctor: I agree with your basic contention (I know some on here don't) that when people get very sick modesty becomes less of an issue. To say it goes out the window may depend upon exactly how sick one is. At some point, I could see it going out the window for some patients.
However, you and other health care professionals I debate with almost always end up in the ICU or the ER or in LTC. Why is that? Many of the anecdotes on this blog are about basic, non emergency procedures or exams where patients have been unnecessarily embarrassed or humiliated. If you haven't read Art Stump's "My Angels Are Come," you need to so you can experience what it feels like form the inside from the view of a patient who is not a medical professional.Other examples include:
-- Doctors using nurses or med techs or assts as really chaperones.
-- Requiring these "assistants" for simple procedures that they could do alone.
-- Not diversifying their staffs so that men (or in some cases, women) hae a choice as to who assists the doctor.
-- Even if they have diverse staffs, not scheduling in such a way to make accommodation possible.
-- Not paying enough attention to opening and closing doors, using curtains.
-- Not asking patients their preferences in this regard.
In all of these examples, I'm not talking about people flat on their backs, dying or unable to care for themselves at all. I'm talking about people who are essentially healthy but are being tested or examined to see if they are unhealthy.
You're pushing this argument to an extreme, reasoning and then concluding that the extreme represents the normal, every day examples of how people feel about this issue.
That's not the case and I think we all know that.
Of course, you're dealing with some bloggers who are pushing this to another extreme -- all opposite gender care is sexual abuse or immoral. Most health professionals humiliate, use their power unprofessionally, or don't really care about their patients.
This attitude is wrong, too, as far as I'm concerned. We've got to look a this from a reasonable middle ground.
Tell me Lisa,did you survey them
or was it just your assumption?
Would you mind if there were male
students watching you recieve a pap
smear. Would you object? Obviously,
many women do object as there are
no male mammo techs as well as no
L & D male nurses as far as I've seen. Realize that as far as mammography goes we're not even
talking about genital procedures
here. So why so much modesty for
womens issues and procedures?
Why should it matter who they
are or what title they have?
PT
Patients need to speak up. If you don't want a chaperone say it. Most doctors do bring one into the room when an exam with exposure is being done. If it upsets you communicate that directly to the doctor. Many might accomodate you if they realize this is your wish. A lot of people like chaperones and others don't, but don't assume your doctor knows how you feel. We have already established here they don't.
-Lisa
Lisa, I would agree not all males care, however the problem is medical staff act as if no males care....I assume you are a nurse, there have been more than one blog where nurses in training complain loudly about being asked to partcipate as a patient for practice in bed baths and such, medical and nursing schools have to pay for practice students. Male gyn's are an endangered species.....not trying to attack you, but how do you explain all of these situations where when providers are patients they seem to practice do as I say, not as I do. And in all honesty, would you feel comfortable or would you allow a group of male med students watch your transvaginal ultrasound? And please, I am not trying to be rude or attack you, I really would like to hear what you feel, how you explain what appears to be hypocracy to us,,,,,,,,
There really is no way to tell if this is a minority or not. Providers practice a don't ask, don't ask policy when it comes to patient modesty...why exactly is that, why have I NEVER been asked if it mattered....so NO ONE, NO PROVIDER I have ever met thought it might matter, that it might make a difference.....really, none of them, not one? It reminds me of female sports writers, I have heard several female sports writers say I am just one of the guys to them, they don't care....oh really, none of them, do they have a choice? Providers take the same road, they come up with their own assumptions based on what fits their models and needs best and apply that to their paitents mentality.
We will never know how many people care and to what degree if we leave it up to providers becasue they really don't want to know. How many questionaires start with which is more important, the quality of care or your modesty...why not ask which is more important you dying or your modesty....I do not dispute, it is not universal, I don't even dispute the degree varies greatly and people on this blog may be more passionate than most....but don't minimize the numbers until you really make an serious attempt to find out....assuming you really want to know.....alan
I'm a doctor not a nurse. Yes, I have had male nursing and medical students involved in my intimate care several times. I gave birth in front of several male students both times.
I treat both male and female patients, but a majority of my patients are male as I am a urological surgeon. I have a practice with two other doctors both of whom happen to be male.
I do all my exams whether the patient is female or male behind a closed curtain behind a closed door to ensure their privacy. If a procedure is being done it is with assistance as needed. Once the door is closed no one opens it nor would anyone ever dream of doing so. We respect the privacy of our patients.
The key is communication. Let your doctor know how you feel. Don't go home angry and complain. Make your needs known. I would help my patients in any way I could to ensure their comfort. If they requested a male team I would do my best to get it. If I couldn't I would be honest about it.
-Lisa
Interesting moral choice that a woman would choose urology with mostly male patients. Hmmm. And I'll bet your assitants are female. So what if the privacy curtain is closed. YOU are there.
Sad decline in moral values. I guess it is time for woman to pay us back.
moralman
Lisa
All urologists are surgeons!
PT
Moralman, morality or ethics has nothing to do with the selection of a specialty. Yes, it is an element in the professional behavior of a physician. However,I would avoid painting Lisa with your brush of assumptions regarding her as a physician. You don't know her. (By the way, as my long-time visitors know well, it is difficult to keep a physician visitor to these threads possibly because of unthinking and uncivil personal comments made by others instead of entering into a productive discussion even if a different view is presented.) Instead of denigrating a physician who has shown interest in this topic on my blog, let's welcome the physician to learn more about other's views. ..Maurice.
To Lisa above,
It is great to have a doctor on line, especially one whose majority of patients are male. Urologists have been raised as particular interest on this site, as most of the mostly male urologists insist on utilising mostly female nurses to assist. (This is certainly the case in Australia where I come from).
The fact is most of us cannot understand how urolgists who by definition will be dealing with more male patients than females, think that this is an appropriate.
Its also true that males often do go home very angry when our privacy and dignity is in some way breached, but the fact is that many men are not conditioned to say any thing. As an example, in Australia for a number of years there was a community awarness program called "be a man", which was basically about having your prostate checked. (The sub text being that to not have a test and be "concerned" about DRE for example, was in fact not being a "proper" man.) What however this all does is make it not apprropraite for men to raise their concerns re wanting same gender care for example, as this is seen as being something other than a man.(Like a women perhaps?)
What about doctors raising this with patients, rather than waiting for them to make comment?
Finally thanks for joining the conversation though as its good to have that medical input especially a female in the speciality that you have chosen.
Chris
I agree Maurice,however,would you
object to me asking a few select
questions to our visiting urologist?
Lisa
In PKD how would your treatment be aimed at preserving
renal parenchyma?
End stage renal disease occurs in what percent of patients
by age 65?
Considering the epidemiology of renal artery stenosis,hypertension occurs in less than what percentage of patients?
Would you consider radiation and chemotherapy as an
option in the treatment of renal
cell carcinoma.
Would you consider blunt force trauma a cause for a renal infarct and would an embolectomy
be useful and at which stage?
Briefly explain how you
might manage a patient with
angiomyolipoma particularly with
a large perinephric hematoma?
Do you employ males in any capacity at your office?
In conclusion,did you by chance
attend the AUA held in N.Y. in 2004
and if so what is Dr. Glassberg's
favorite tie?
PT
I find it 'interesting' that so many people post using the term 'morals' instead of privacy or modesty. Many seem to ignore the term, as if moral values are insignificant or extreme. I know many poeple who consider this an issue of morals, so why are we afraid to address it? The med profession wants to call it 'privacy' or 'modesty' to keep them safe from moral implications, but some people have deeper meanings to their issues of opposite gender intimate care.
I am not condoning the tone of the above posts, but it does remind me of how the moral issue gets overriden.
Imagine someone asks you to do something against your beliefs because it is inconveniet for them, but afterwards you are free to have your beliefs back when they are through. How ridiculous? Except the med profession does it all of the time.
Obviously to some people "morality or ethics" has alot to do with "the selection of a specialty". Or job for that matter.
We need to see all points of view, not just the ones we agree with.
PT, is this really necessary? It seems like you are trying to establish whether Lisa is really a urologist or a fake. Do you think that I should challenge not only doctors who write to my blog but anyone else who writes without full disclosure of identity so that I can establish whether their personal anecdotes raising modesty or gender complaints are valid. What additional documentation do I need? I have trusted my visitors and have assumed that the stories they tell were not made up for this occasion. My concerns about anecdotes was that we have had enough examples, not that the personal ones were made up.
So PT, let's not make this blog thread a urological boards exam and get down to the business of discussing the elements that lead to patient unhappiness in the way things are now and what can be done to improve the situation. ..Maurice.
Once upon a time I was just as Maurice said. One of those patients who was aware of modesty issues but when needed would go to strange male doctors or technicians referred for necessary exams. Perhaps I was a little uncomfortable but no big deal.
Then, the unthinkable happened in a hospital when I thought I was in an environment with people I counted on, trusted to take care of me. Those feelings were reinforced because my mom was an R.N.
My feelings as most of you know have radically changed. The fundamental business at hand isn't bodily exposure, it's about respecting people; treating them with dignity, informed consent and reasonable bodily exposure. What that means is informing the patient who will be in the room and what will be done.
There have been infuriating instances where people have asked for a same gender team. So...the doctors cooperate and once in the hospital all the doctors and nurses are female and they send in a male surgical tech. It's not only infuriating, it's utterly ridiculous.
Part of the problem is that patients are not treated as intelligent, thinking individuals and I have personally witnessed patients being lied to about what's going in their IV, medications taken and procedures for a test to be performed when questioned. It's this uneasy feeling that causes people to avoid medical care. Those who have trauma issues have their trust eroded and also avoid medical care with a sense of loss and harmful psychological damage.
Trauma survivors value their mental health more than their physical. It's the most important thing to them. When they are lied to, trust erodes. There is no safety net, no trust and the kind of behavior noted above, just destroys their sense of trust and respect for the professionals caring for them.
This is a social problem. We need to look into why it happens, when it happens and to whom it happens.
Until this important research is done, and patients refuse to cooperate making everyone feel it in their pocketbook, nothing will change.
While modesty issues are not important to everyone, when they are, it is extremely important.
Lisa who commented is a perfect example. You can almost think of her as an artist who is used to critique and with her psycho social training of separating sexual issues from medical ones, she is ablle to be a free participant in the medical arena without constraints that most of us have. However, she understands and is interested in what happens here. Thank you Lisa.
This is a huge issue in healthcare and The Patient Bill of Rights has attempted to address it. The laws are there, the medical profession, in it's arrogance refuses to recognize or even approach this issue.
Shortly, there will be a new blog that will strongly compliment this one, examining the psycho social aspects of medical care that are damaging to patient mental health. Many of these issues have to do with bodily exposure.
As noted previously, victims of abuse and torture often have problems with the medical system because some "standard of care" procedures and the degenderization of employees reinforced by Title VII, have created a very difficult medial model in which to survive. Due to the huge numbers of sexual assault/abused, these individuals need their own protocol.
Marjorie Starr
I don't see caring for opposite gender patients as immoral. I didn't become a doctor to treat only one sex. I became a doctor to treat those in need of medical care. I would never for a second have thought prior to reading here that someone would see my choice of specialty as immoral, but I respect everyone's right to their own opinion.
Patients who feel this is immoral should be sure to see only same sex doctors. That's easy enough. The only time you might run into a problem is in an emergency situation.
I'm happy to see Lisa on this blog,too. And what we've all overlooked again is what she said about communication. Myself and others have been focusing on this on volume after volume. It's one thing to recognize that many males feel uncomfortable expressing their feelings. But once you're aware of it then you learn and you change. And you help other men learn and change. This goes for female patients, too. It does no good to sit back and pout because patients aren't asked about their preferences. In a perfect world that would happen. But it often doesn't. So patients need to confidently and civilly communicate their needs and values to caregivers. And, as I've expressed earlier, most will do just what Lisa said: they will either accommodate you are be honest and tell you they can't.
Great comments. I am also one that thinks that being seen or touched in private areas by a "caregiver" of the opposite gender is immoral. I also wonder why someone would pick a specialty like a male Ob-Gyn or a female Urologist. Again, lack of morality comes to mind.
Jer
Marjorie, I hope men are welcome on your blog.
SWF, you say to understand all points view, yet you still felt the need to sugarcoat what I said.I said what I said.
Lisa, good point on same sex doctors. Do you have choices on male nurses and tecs as well?
Dr., People shouldn't take my morals so personally. They are for everyone, not just doctors and nurses and tecs. I feel that way about the lady who delivers the mail and my female nieghbor, and the lady who cuts my hair. Are we supposed to take it personally when you and others ask us undress for you guys?
moralman
It's easy to say "Patients who feel this is immoral should be sure to see only same sex doctors." While true, for men in particular Lisa it's not the doctors we have problems with, it's the nurses and other support staff. You're right, unless men go into a Urology clinic blind and are bullied into seeing the female Urologist, it's usually easy to set up an appointment to see a man.
The problem is, every Urology clinic I've ever heard of uses only or mostly female nurses, and often men have no choice but to have them present for humiliating exams and procedures. To me, having a female nurse (or more) is MUCH worse than having a female Urologist. Why can't Urologists of both sexes understand that? Especially when many male Urologists are perfectly aware that a patient chose him BECAUSE he is a man. It just blows my mind because it is so obvious. And if a Urologist, doctor, receptionist, etc understands that a patient's choice of a particular gender is for modesty or moral reasons, why is the gender of the nurses and techs kept a secret? I just don't get it.
SLO
I don't know if all men chose a certain urologist because he's male. I'm sure some do. Most urologists for quite some time in recent history have been only males so there really was no decision for the patient to make. Same thing for females for years. Most of your female family members had male doctors for years because there were no females to deliver even if they wanted one. They all had males and all had no choice. This has definitely changed in recent years. Choice is good. I'm all for it.
You are all right. Most nurses in hospitals are female. The nursing industry is made up of almost all females. I do believe the recession will help some in this area. Males generally gravitate to more action filled units such as ER or OR.
We do have one male assistant in our office. We could never get a male nurse as much as we would like one so we got an assistant and have them help as within his scope.
None of our exams have a chaperone watching it. We see that as unnecessary exposure. The chaperone is behind a curtain and can see nothing. Some of us in specialized fields relating to private parts seem to have a better sense of coverage. That's been my experience.
It saddens me reading here that some see nurses, techs, etc, being cared for same gender almost as a conspiracy against them. I can assure you it isn't. They hire who comes in for interviews and posiitons and the vast majority of those people are females. The numbers just aren't there for male nurses. That doesn't mean you shouldn't ask.
Communication is key. State your needs clearly and politely. If your needs can't be met search out places where they can be. Hopefully in time the numbers will balance some.
Lisa
The only survey I have seen on gender preferences in healthcare are the ones on Dr Sherman’s blog. Those surveys indicate, for what has been called “intimate care”, about half of male patients prefer same gender care and the other half do not have a preference (i.e. they don’t care). For female patients, slightly over half prefer same gender care and the other half do not have a preference, some prefer opposite gender care. So roughly half of the population will accept opposite gender care and are therefore fine with the “gender neutral” notion the medical profession espouses. I think those who have no preference for the gender of their healthcare provider rarely post here on this blog because well “what’s the problem?”
However those who do have an issue with the gender of their healthcare provider are very active here on this blog. Now many of their reasons are valid reasons like past sexual abuse, it’s my body and I determine who sees or touches it and who doesn’t, the ratio of male/female doctors/nurses/staff is unfair to patients who care. Some posters here attack doctors, nurses and others who accept this “gender neutral” notion and post here. A few even go so far as to call them immoral or perverts or enjoy gawking or being gawked at.
Is this because these same gender care versus neutral gender care ideologies are such total opposites that each side can not and will not understand the other side, much the same as the conservative versus liberal ideologies are such opposites and every election cycle we rehash all these difference with ugly name calling and character assaination?
Lisa – thank you for joining the discussion. Please stay and don’t let the rude and uncivil ones drive you away. From your previous posts you seem to be very professional with your patients and already do whatever is within your power to respect their modesty.
Jer & moralman– shame on you, I think you are way out of line with that comment about males going into OBY/GYN or females into urology do so for immoral reasons. My wife has had 3 gyn, everyone one was competent, professional and male. It was her decision. The second one is a fundamentalist Christian. A finer, more Godly man I have never met. He and his wife would host birth control information classes at their home for the premarital couples classes that the church offered. Many of the women at the church used him, he was always booked up and the ones my wife talked to all said he was wonderful.
Paul
I agree with SLO (10/13 @9:14):
While the discussion keeps drifting back to the choice of same sex doctors, what most men have problems with is the overwhelmingly female support staff. The average male has less of a problem with a highly trained, highly experienced, highly professional female doctor than with the female tech doing his testicular sonogram; or with the cna fresh out of HS who insists on giving him a bath or pubic haircut; or with the receptionist who barges in on his physical to get papers signed; or with the school nurse ogling him while he's getting a hernia check....
By conflating morality with modesty or doctors with support staff, we're obscuring an issue that very well may be keeping a very real silent minority of men from getting the help they need and a silent majority of men from more fully using available health services.
--rsl
Absolutely Sir
PT
Lisa you said: "None of our exams have a chaperone watching it. We see that as unnecessary exposure. The chaperone is behind a curtain and can see nothing."
The obvious question is if they can see nothing, though I presume as per your previous comment, they are most likely to be female, why have them at all?
In addition of course they can hear all of the conversation which to me would be alomst as embarrassing.
Chris
Lets be honest here which no one is really being, because we are too busy saying correct things like 'intimate care'. We are talking about exposing our genitals to the oppisite sex. Nothing more or less. Some of us think that is wrong/immoral/ call it what you want I dont really care.
DR.s all....isnt there anyone you dont want to stand naked in front of? Be honest. The cashier, the loan officer, the vacume salesman? Us? Me? No one? You are fine with exposure to everyone?
Well, some of us see you as 'everyone' just regular people, nothing more nothing less. No disrespect, but there are alot of you guys out there claiming special privildges to OUR bodies. "Dont be embarrassed".. why not?? Who dictates my morals. Me. Why are you 13 million people different from any other 13 million people?
No, you cant help yourself to the intamacy I share with my wife only. SORRY! No exceptions. Your just not that different from everyone else.
Excellent way to put it rsl. Exactly how I feel.
DG
Lisa
My apology for thinking you were a nurse, I do not believe in the doctors are male nurses are female. I really appreciate your partcipation here, and I also hope you will ignore any rude or out of line comments. I also think accusing someone of being immoral for choosing this or that specialty is ridiculous. The vast majority of experiences I have had with providers....doctors and nurses has been very positive. While I believe most are very compassionate and will accomodate if asked...I and most feel they should be the ones asking,,,that said, that is not the way it works. I also agree with the contention that most of the issues are with support staff, and here is where you as a Dr comes in...often I feel Dr.'s place patients in uncomfortable positions just fore their own convenience, for time. I related the example of two different vasectomies...my PCP did mine by himself, a friend's PCP brought in a nurse who was familiar to both whose only task was to hold his penis to the side...he was humiliated. There is no doubt with 90% of nurses being female it is harder to accomodate a male...the lack of effort to accomodate without being asked and the general lack of effort of the medical community is a big issue. I feel there is no right or wrong in how a paitent feels about this, its just the way the feel. Sort of like asking why do you love your kids......I just do. I have so many questions for you...this is really exciting having you with us. I really want to hear the other side. I agree the patient pool is a mixed group of those who care/those who don't. Those who what same, those who want opposite, and no preference.... Do you feel you can accurately identify those who do or don't care from those who care but say nothing? From your experience if I as a male need a proceedure and want a male team, and my urologist can't or won't provide (my urologist is really nice, but as far as I know the only male in the building that isn't male) what are some options....again, thanks again for joining us.
Paul, I disagree, I see very few who express a preference condemning those who don't. Its more of a question of choice, most of those who have a preference back the right of those who prefer opposite or no preference....personally I would probably not go to a female urologist because I don't think I would comfortable and therefore as open....but that is my preference and my concerns and has nothing to do with her. Likewise some males would rather have a female, and that is about them not the provider. I personally find Lisa's open commentary and encouragement to look for what makes you comfortable very positive. not once did she make any comments about personal choice being right or wrong...don't know how anyone could read malice in anything she posted...alan
Anonymous from today 5:35PM (and next time please include a consistent unique pseudonym or initials):
Licensed physicians have been given special permission by society to inspect and examine and perform procedures on a human body of a patient with the consent of the patient.
Unless we are naturists, I suppose none of us want to stand naked to some stranger or friend except our bedmates. For us to do so would be for no interest, no value and might even be socially embarrassing. To expose our body parts to a physician to whom we have gone for consultation, diagnosis and treatment and with our consent is to our benefit and potentially of value which is not in the various viewer categories which you describe.
By the way, even standing naked in front of a dermatologist is not necessary as I have written on these volumes in the past, since sequential small area uncovering of the skin is felt lead to better inspection and more patient comfort. ..Maurice.
No apologies necessary, Alan. If your doctor can't accomodate you I would call other facilities and see if they can. Ask to speak to the person who handles the surgical schedule. They will be able to tell you if there are male OR nurses available. If a procedure is being done in the office I would ask if the doctor would consider doing it solo.
I do all my vasectomies solo as do the other two doctors in my practice. We do offer a chaperone and let the patient know when that chaperone would be female. Rarely do patients want a chaperone. I would say 5% would like someone there and for those that do it's a comfort measure. The chaperone always stands at the head not down by the genitals.
I know other doctors who prefer a helping hand and others that want a chaperone even for same gender patients. Many doctors are afraid of being sued. In the hospital they always want us to have a chaperone because they are afraid of being sued as well.
Our new patients are always told what doctor is female and what doctors are male. A vast majority of the females do request to be seen by me. The males that call seem to be a little more willing to see both sexes, but some do request a male. Mnay agree to see whoever can meet with them first. When people are sick and in great discomfort that often overrides all else. That has been my personal experience.
I would say once or twice a year I get a male who didn't realize I was a female. Usually when questioning them I come to see their wife made their appointment and we have a little chuckle over it. I always let them know they are free to see one of the male doctors and that they don't have to be uncomfortable in leaving my exam room. I've yet to have a male patient leave my office, but I truly would accomodate them at their request.
Lisa
"Licensed physicians have been given special permission by society to inspect and examine and perform procedures on a human body of a patient with the consent of the patient."
I agree completely doctor. "Licensed physicians", who we are able to CHOOSE (of course, gender is involved). That is the reason we go to see them and if that includes something in the "intimate" area it's obvious it has to be exposed, if we CHOOSE.
The problems come with unwanted support staff, especially of the opposite gender, and being bullied or tricked into exposing ourselves to people we're not comfortable with. Usually someone of the opposite gender that we weren't expecting or being bullied into exposing ourselves unexpectedly.
Obviously I personally would feel uncomfortable exposing myself to anyone, but if I needed something taken care of I would go to my male doctor, and him alone. Uncomfortable but necessary. So I agree doctor that bearing ourselves to a Licensed physician when necessary is acceptable, but never with an audience.
(I couldn't get through the second sentence of Paul's speech without skipping over it, except the insult at the end to me)
Jer
I live in the UK and I recently changed medical practices because my former one would not accommodate my requests for confidentiality. On arriving at my new practice, I have now been "excluded" because I requested a male GP. I am now basically left without any medical care for the major criminal offence of requesting a male GP.
I wish all Doctors were as understanding as "Lisa", I have avoided contact with female doctors for over 40 years (basically since I was old enough to make my own decisions). I personally believe that many female doctors are more competent than their male counterparts, and without a doubt more caring and understanding. My issue is with personal modesty, not with any thought that female doctors are less good than men. In the UK Doctors now care about money and little else. It is a major failing of the NHS in the UK that ALL the power now resides with the Doctor and NONE with the customer/patient.
It's very interesting that the gender exception of Title VII that says you cannot discrimminate against anyone's right to work based on race, gender or religion except when issues of privacy prevail. The exception is when someone else's privacy is invaded when performing the job. The courts consider privacy exceptions different than consumer preferance...thank goodness!
Outside of healthcare you would never see an opposite gender person tending a restroom, locker area or other setting. However, in healthcare, there are cna's who tend to bathing and changing patients. So...why isn't the title VII exception seen here? The people administering care are not medical professioals. My feeling is that healthcare blanketed them into one of their own and this is probably the biggest breach of privacy.
Marjorie Starr
It is clear from some posters that opposite gender intimate care is indeed a moral issue for them. Let me be clear though. I said this subject is steered away from "to keep them safe from moral implications." By nature, if you state a moral ground, people of the opposite belief will assume you you calling them immoral for not sharing your belief. I see this all of the time when interviewing people about this subject. I'm sure we all encounter this in life.
Personally I believe this is where the anger comes from that some people share here. Providers get defensive, patients get defensive, and no one comes out of it happy. Yes it is a touchy subject, but one we need to understand in our efforts of communication.
By the way, most posts I have read refer to THAT persons moral beliefs. I don't see most people turning the tables and calling the provider immoral. So although it happens, I think it is rare.
Whether it is modesty or morals, the question is really why more people don't speak up. That is the question I keep asking angry people.
We are in transition in this medical debate. Some people are feeling braver in their needs.
Hopefully people will pass the anger stage and enter the communication stage. But it does have to happen both ways. "Caregivers" need to stop coersion and ambush tactics and practice understanding too.
So, doctors would like to hire male nurses but since no male nurses apply the doctors don’t hire them. Do we need another slogan like “Real men not only wear gowns, they hand them out too!”
Anonymous from today 5:35PM (and next time please include a consistent unique pseudonym or initials):
That was me. Sorry, I just want everyone to be honest. Even poeple here who are supposedly doing things to help advocate make sure they write politally correct comments. Fine, but even they are not honest. Ive read all there comments, and even the ones who are moaning about entitlemnt issues, but wont say how they feel about the"care giver" doing those wrong things to them.
" We need to see all points of view, not just the ones we agree with" ? until they dont agree with you.
Fine. I stated my opinion. You see but dont agree. But dont be upset that I was an honest person. Communication hurts, doesnt it. I see why outsiders dont stay here long.
moralman
Outside of healthcare you would never see an opposite gender person tending a restroom, locker area or other setting.
The exceptions to Title VII have all been decisions upholding women's right to work vs. men's right to privacy. From female prison guards conducting strip searches of male inmates to female reporters in male locker rooms, Title VII has been interpreted in only one direction thanks to feminists jurists using the "abuse excuse." There was a case of a woman demanding the "right" to be a mens room cleaner although the job required cleaning while in use. And though far more common in Europe, there was at least one female mens room attendant in the U.S. (nicknamed Ms. ICUP).
Given these precedents, the only surprise is that in the medical establishment, on rare occasions, the violation sometimes goes in the other direction.
--rsl
I'm sorry to the patient from UK who is running into problems. This shouldn't happen. I don't mean to pry but can you expand on your former office not respecting your request for confidentiality? Thank you.
Lisa
Marjorie:
We discussed some of this in previous threads. As I understand it, hospitals and LTC facilities have demonstrated to the courts that they will suffer economically and financially because a significant number (or majority) of their female patients will not accept intimate care from male nurses or cna's. They also have to demonstrate that they can't simply schedule to accommodate. Apparently, many of these facilities have been able to demonstrate this. Men haven't pushed the issue as women have. Again, as I understand it, the essential exceptions to the law apply to both genders. If men filed class action suits and if the institutions could demonstrate that men wouldn't use them if they didn't accommodate, they would get the same treatment. When you get to the heart of the law about equal rights and gender equity, men and women have the same privacy and modesty rights. Men have just not pushed that far.
That's why it's important to file written complaints about gender choice -- so a paper trail begins.
The Computer system the Practice uses allows full access to all details to everyone who works in the surgery. NOT just doctors and nurses, everyone, receptionists, admin staff etc. I was not prepared to accept this and they would not accommodate me so I left. The next practice was unwilling to accommodate me when I said I did not want a female GP, they had me struck off their list. I have not had a proper consultation with a doctor for almost a year. I have several ongoing problems, not least the pain from a slipped disc and the recent destabilization of acid reflux which had been stable for about 12 years. The destabilization came about due to them witholding medication from me in an attempt to force me to accept "their way or no way". Their behaviour has been nothing short of scandalous, they should be ashamed of themselves, i would not treat a dog the way I have been treated.
moralman:
1. I think we have made it clear that we see your point. The subject of morals was opened for discussion wasn't it? Dr. B. could have easily not posted it, so that was a very 'honest' effort.
2. I said I know many people who feel that way. I do not, however, feel the need to post the actual things they have said. Not because of 'honesty', but because it is harmful.
3. We do not all have to agree that all caregivers are immoral in order to understand your point of view.
4. As stated many many times " We need to see all points of view, not just the ones we agree with" because it is important for communication reasons to understand all points of view including yours.
5. Civil is different than politically correct or sugar coating.
6. The advocates have been open in sharing all opinions and are trying to work for everyone, not just a few. There are some who would accept options (for example) that I wouldn't, but I can not say their opinion is wrong. In reality, niether can you.
I think there are several points that have surfaced.One is consent, for many years Dr's were held up with such reverance I don't think anyone questioned them, not about the diagnosis or modesty. That has begun to change, we question, we seek a second opinion, This paticular issue was less of a problem, hospitals as many had male orderlies to provide gender specific care, the issue of dispairity in the gender make up of Dr's came to light and there was an effort made to address that by encouraging more females into the profession,currently slightly over half of current med students are female. I agree with Dr. Bernstein that we give implied consent to our Dr, however we assume that consent will be respected, not more than needed, , and protected. Protection to many here means not allowing others whom we did not choose to "invade" our modesty. When support staff is just included without any consent or even real need or for the benefit of the patient....we feel betrayed and our trust abused. When others are simply there for convenience of the provider, to speed things along, or chaperone that is abusing the trust the patient puts in you the Dr., and we feel that violation is little different than how you feel about being exposed to the janitor or us. If you were arrested for some crime...say driving someone elses car and drugs were discovered, would the fact that the jailers were just doing their job, protecting other inmates and guards, following the protocol and authority bestowed upon them lessen the embaressment and violation you felt being strip searched infront of others including opposite gender? While perhaps extreme, it illistrates this concept really is open for interpetation depending on which side of the gown your on its not as cut and dried as you would like to think, and this comes to the second item for the Dr's consideration. We place unparrelled trust in you, we put ourselves in your hands, we see you as the leader, your in charge, almost omnipotent, when we feel support staff have been given rights that we didn't agree to, when we feel violated under your care even though not by you, we may hold you accountable, even though some or even much of it may not be warrented. And it goes so far as to perhaps feel that you have a responsiblity to atleast try to influence changes for our benefit such as encouraging a more balanced gender make up. That isn't to say that you can cure issues such as few male nurses but let me ask you, do you know any Dr's who have even tried, even care or see this as an issue of concern. Not trying to turn this into a religous thing, becasue for me its not, but there is a verse in the Bible that says "To whom much is given, much is expected". If you expect us to enturst to you something you admit you would not entrust to others ourside your circle, our modesty, shouldn't you be willing to go that extra mile to earn that trust, to simply accept there aren't enough male support staff doesn't seem like making much of an effort to me. But then perhaps we expect to much, perhaps we desire the emotional concerns we have to take to high of a spot on the priority list.
I must say I have been encouraged by what we see here from Dr's. For every Dr. Orrange or Dr. Keagel there is a Dr Bernstein, a Dr. Sherman, and a Lisa. Lisa, I also say thanks, you seem to be exceptional in the way you address this issue...the only thing I could see that you could do better is try to be proactive, and advocate for bringing more balance to the gender make up of support staff....but then, you already have a full time job don't you,.thanks again for sharing with us....I appreciate your advice and your attitude, it makes it a little less daunting thinking about addressing the issue with my providers thinking they may be as open, supportive and concerned as you and the good Dr's Bernstein and Sherman......alan
Mer,
I suppose it matters what area of the country you live in because where I am, the consensus is that they will try to accommodate gender requests for intimate care if they can.
The law should read that a facility that accommodates both men and women should have to staff both female and male cna's 24/7. Doing so would protect our most vulnerable of both sexes from privacy invasions.
Research I completed had me calling nursing homes asking about the gender question for intimate care. The premises is that if someone needs same gender care and they won't enter the facility without it being in their contract, what woul they do? Ten out of ten said they would not put in in the contract but on the patient's chart and try their best to accommodate....not good enough!
marjorie starr
Thats interesting. In Austrlia whilst Doctor visits are largely subsidised by the government, there is no problem in shifting from one GP practice to the next. You go and make an appointment with your new GP and the old GP is obliged to transfer your file. In addition, as most GP practices these days have more than one doctor, it is usually possible to select the gender of your GP without any difficulty.
Chris
gee, you're gone for a day, building a fence to keep the new pup in the yard.....
yes, as a naked model i do get paid, and yes, i do it of my free will, and yes again, i do get paid and -shift here - no, i never compared myself to a patient needing medical care.
in post after post the main thrust of my argument was to examine why we have these issues, concerns and problems.
human sexuality, i have concluded may well be a strong component of this.
if the disregard for patient modesty were simply a matter of thoughtlessness, how easily if could be resolved.... a simple workshop on a saturday morning would show those who have trespassed how we all would like to be treated.
trouble is- maurice, please indulge me once more - there are those is every profession and every walk of life whose sexual proclivities include infringing upon the dignity of others.
codes of conduct, prior refernce checks are useless in the pursuit of those who insist on pursuing such behaviour.
sure, we can launch lawsuits, pin up posterz, do whatever,
do i really need to remind this illustrious group how immensely complex human sexuality is?
and is it always the caregiver who is the villain?
edo
I couln't agree with you more. This is the white elephant that the medical industry wants to "keep in the closet". My book should be out within the next year highlighting patient abuse in healthcare and what needs to be done to rectify it by making accountability, responsibility and strong penalty the source of ending this outrageous behavior on the part of some.
I do sense though, a degree of hostility in your postings and am curious to why. I've already explained my feelings of hostility with the system but it seems you're hostile to those of us blogging. How come?
marjorie starr
Lisa, I would like to ask you a couple questions and please don't take them as being critical or trying to set you up. This blog has served numerous functions from venting, informing, educating, engaging, empowering etc. One of the problems is the conversation has been 99% from the patient side. Your partcipation, especially with your specialty gives us a rare opportunity to get some understanding from the provider side. I know I feel differently about provider motivation/agenda than I did. I read a lot less lack of caring into their actions and recognize the efforts more. If you would indulge me please: (1) Males who choose you obviously have no or little concern about gender, those who as you say appear surprised when their wives make the appointment...I know I used to give the appearance I was fine with it becasue as a man, at that time it would have been embaressing to say no, latter I would be extremely angry at myself and them. Do you ever get the feeling this is the case with them (2) several Dr's have said they honestly never realized patients cared...you seem to recognize this evidenced by the way you ask, take efforts to protect etc. Do you think you are a minority in that you seem to recognize the gender of a provider may make a difference in the comfort of a patient during exposure.? (3) You stated you had male providers while giving birth....a question..did gender to any degree at all play into your decision when you were looking for providers such as your gyn, is your gyn female or male? I personally see absolutely nothing wrong with your choice of specialty due to your gender. I have a close friend (male) who is a ob/gyn, why he just loves the whole process of bringing childeren into a family and sharing the excitment of a couple during the process...he finds it so rewarding, he once said he has experienced bringing in life, and attending death during his rotation and there is no doubt in his mind which works for him. This is such a rare opportunity to talk with a provider in your position....thanks again for joining us. Realize you probably have a full schedule with work and kids so we understand this is cutting into that speaking for the others I hope you stay with us......alan
alan: I have to say if there was ever a post that I wish I had written, it would have been that one. (10-14/4:55)
What advice would you give someone with body self image issues who is so embarrassed and ashamed of the way they look they don’t want anyone looking at them, not even same gender healthcare providers? ……… Terry
I like Alan's commnentary. One point I would like to add is that you never see males working in doctors' offices or some clinical type areas. What's with that acutally? I realize the pay is usually LOW, but the main factor is that the office has a female office manager who hires staffing. The doctors don't do this. Maybe it should be up to the DOCTOR to say.. hey, lets recruit some males to work here so we have a gender choice.
JW
in europe co-ed washrooms in public venues are commonplace,
here in canada family change/washrooms are common in just about every shopping mall.eight years ago i lay on an x ray bed ...a female technician....i was in too friggin much pain with a kidney stone to care wtf was going on, but i knew enough to know she was the most non-sexual professional i had ever been subjected to.
now, let's turn the clock back to when i was 18
(adult content warning!!!)
i lay in a hospital bed, nurse came to tend to me and bathe me, - that included exposing .....- i tried my hardest to get an erection as i wanted to show of to her....no, the brain, as you all know, being the biggest sex organ, wouldn't cooperate.
before we go hogwild creating bariiers that are so rarefied, we must examine all actions within their contexts.
and speaking of context (and no, it's really not within the purview of this discussion)
i develeoped a work for the theatre a dozen years ago, in which i took away context fro the viewers and placed them in the setting of a long-term care facility with altzheimers patients
you see, we are so sure we can function rationally and we so quickly condemn those who cannot, that we have lose sight of what the human journey is all about.
altzheimer patients live in an environment where context has been ripped away from them, but some remneants of the "former" life still exists in their brains.
so why bring this up?
CONTEXT, my friends....just plain CONTEXT
Majorie- as rsl has pointed out and the link below illustrates, outside of healthcare, men are usually the victims of having their privacy invaded by women but the reverse rarely occurs because the man would be arrested. The Madonna Inn in San Luis Obispo, Ca has a rather unique urinal in the men’s restroom downstairs by the restaurant. It is claimed that it receives almost a million visitors a year and half of them are women! They do warn you if you're a man and need to use this for it's original purpose, be prepared to be interrupted by giggling women with cameras.
http://urinal.net/madonna/
This whole modesty issue is connected directly to a much bigger picture. Please indulge me here. This may sound off topic, but it's not.
In the LA Times, I've been following a story about how the Cedars-Sinai Medical Center gave radiation overdoes (8 times stronger)during CT scans to 206 patients. The hospital learned about their mistake in August -- yet it's only recently that patients learned about this error -- and many of them learned about it from recent newspaper reports.
Four patients said they were called by the hospital last month and "questioned." But no error was acknowledged and nothing explained to them. The hospital said they called patients to learn if they were experiencing any side effects. Didn't want to alarm them.
POINT ONE -- The attitude: We know what's best for our patients. Patients can't handle the truth.
George Annas, an ethicist and lawyer at Boston University said that, from an ethical standpoint, the hospital should have informed patients of the error: "This is part of a trend in patient safety. Whenever you make an error, you tell the patient."
POINT TWO -- This is a new trend? Telling the truth to patients about errors? What's that saying about the standard operating procedure? The SOP is secrecy.
The LA Times interviewed some patients who had been called by the hospital -- one of the five they interviewed said she had been told of the overdose. The others had not. Basically, patients were asked if they had had any side effects. That's all. One patient said his call from the hospital sounded like an "investigation." But he was never told the truth.
By the way, this is the same hospital that, in 2007, did not tell actor Dennis Quaid and his wife that their newborn twins had been overdosed with a blood thinner. Quaid said that he and his wife learned of the problem the day after it happened when they arrived at the hospital and were met by risk managers.
POINT THREE: Risk Managers? This clearly shows that the hospital is primarily interested in protecting itself rather than it is in open and honest communication.
Does anyone see a trend or pattern here?
How common are these errors. It's estimated that up to 100,000 people die every year due to medical errors. That would be as if we had a commercial plane crash (full plane) every day of the year. How do hospitals deal with communication regarding these errors? Are they up front, open and honest with patients?
POINT FOUR: This is the culture of secrecy that patients are dealing with within American medicine. In fairness, many good doctors and nurses are trying to change this. But secrecy is extremely embedded, and has been historically, within medical culture. Medical knowledge is like Gnosticism -- secret knowledge necessary for salvation, and only the professionals have it and they know what's best for everyone.
If the medical culture deals with errors like the ones I've summarized by practicing secrecy and and extremely poor communication skills, how do you think they deal with such a small issue (to them) as patient modesty? For many, patient modesty, specifically gender choices for patients, isn't even on the table. It's off the radar.
This is the battle patients face.
I have visited the Madonna Inn a couple of times and have been in that Men's room though I never have seen a woman with or without a camera there. It is a most interesting place to visit! ..Maurice.
Should you be a female prisioner
in the state of New York you are
given a "Cross Gender Pat Frisk
Exemption Card". You simply show this card and only a female officer may frisk you.
It seems that male prisioners
should be given this card first
as according the the Dept of
Justice female guards statistically
are charged with rape more so than
male guards. That being said I am
now issuing free Cross gender
intimate care exemption cards.
Simply print and present these
cards whenever you are put on the
spot. No questions asked,opposite
gender providers will have to
comply.
***********************************
Good for one same gender
intimate care
Respect must be provided,as in no
students,observers or cell phones
***********************************
PT
Just curious Dr Bernstein, what would you do if you were using the urinal and a giggling female stranger with camera in hand walked in on you ?
edo:
"is it always the caregiver who is the villain?"
While I wouldn't say villian, I would say that if someone is going into the business of taking care of people, they have to expect the whole person, not just a body. The whole person includes preferences, opinions, modesty concerns, fears, etc. Anyone who approaches another persons body with expectations should also be willing to understand restrictions.
To answer the question from Anonymous 5:55am today, I would inform her that she had entered a Men's Room by mistake and her room was elsewhere and then continue on to empty my bladder. What else? When my bladder was empty and she hadn't left, I would report it to the Management. What would a woman do if I entered the Women's Room giggling with a camera? I would expect the woman to do the same. What more can we learn from this scenario? ..Maurice.
there is a differnce between idiots who walk into a restroom and women who want to play with our bodies and go get the states permission. one is dangerous, the other is just an idiot.
moralman
Hi Dr. Bernstein. I had posted a reply to Alan in the wee hours that I don't see as of yet. I didn't know if it was still waiting for approval or had been lost somehow. Please advise. I really enjoy your site. Thank you.
Lisa
to swf:
i keep saying this over and over again:
there are people entering a variety of "people-care" professions and vocations who do not have the noble-mindedness we expect from them, or would like them to embody.
these are the people that are the most difficult to detect and correct since it is almost always after the (f)act that they come to light....and that's when we deal with them in a disciplinary fashion
"ode to edo"...no...no...no, that issue is far behind us....this is new, trust me...
the painting is a work included in a show of works by medicine hat, canada, painter dean smale, entitled "inner sense" currently running at a gallery here in edmonton.
"it explores the relationship between the physical body and the mind, and deals with the transformation imposed by the aging process."
for those of us who think that our bodies are unsightly, or "no longer attractive", or "hideous" due to disease or injury and are thus "ashamed" of it, there are people -mostly artists, i am afraid - who celebrate the human body with all its imperfections.
and yes, there was a precise moment when even mae west had to succumb.
there is a 5-min clip on youtube of the dean smale exhibit "inner sense"
also, check out the work of photographers such as dorothea lange and dianne arbus, the latter famous for her photos of "circus freaks"
then there are the little acts of thoughtfulness, decency, kindness - call them what you will.
and no, i am not a saint - i don't do well with halos, but
years ago, men's washroom, me in a stall; person enters stall next to me.....a woman (woman's shoes, no trousers down, but a bloody sanitary napkin in a pair of panties.....i did not think it fair to have her come face to face with a guy in the "wrong can", so i waited until she was done and had left .....no, i do not need, nor want applause...after all this was the same guy who was trying to produce a boner to impress a nurse at the age of 18.
I would do the same, Dr. Bernstein. I'd tell them they were in the wrong restroom. If they didn't leave I'd report them.
Lisa
Lisa, I checked and I just didn't receive your posting and it wasn't either somehow put into Spam. I have not withheld publishing on these Patient Modesty threads or on any other thread unless the posting is naming names in a negative sense that isn't in the public news or is frankly uncivil and with ad hominem remarks or that the intent of the posting was an obvious commercial with no valuable contribution to the discussion. Lisa, please submit your commentary again, if you remember. ..Maurice.
Thank you for checking, Dr. Bernstein.
Ask away, Alan.
1) No, I really don't feel that way. There are so many male urologists out there that no man would ever have to see a female one unless they were okay with it. There are two on staff in my office. It has only happened a handful of times that the man was surprised. I offered an immediate
appointment with one of the males in my practice and told them they didn't have to feel even remotely uncomfortable about it. They declined. They all came back to me for f/u care as well and remain patients until this day. I'm glad they were comfortable enough to do so.
2) I do think some of us in specialized fields that deal with intimate exams on a regular basis might be more in touch with modesty concerns. The majority of us realize we are dealing with private parts and some symptoms that are embarassing to our patients. While this is par for the course for us many of us realize it isn't for the patient.
3) My gyn is the same one my mother uses. She always received great care so it was an easy choice. The practice is made up of three males and one female. I like all of them. I also had male nurses and medical students involved in my births because I was always so grateful to the patients who allowed me to learn off their generosity. I wanted to return that favor to other students.
I hope this helps. We really are on the same side. I like your approach. It's respectful and open.
Lisa
Lisa, I for one appreciate your input here.
Speaking from a past unpleasant and upsetting medical experience I wonder what your thoughts are on the fact that men can chose the gender of a surgeon or physician but once in the 'system' they are at the mercy of famale nurses doing extremely intimate procedures, i.e., surgical preps, or female staff standing in to view vasectomies, urinary caths, cystocopies, etc.
Seems the patient is 'most times' blindsided with this and only afterwards becomes very angry with what occured. Many times, as in my case, I was directly and purposely lied to as to the gender of the person performing a surgical prep. Why is it that doctors feel it is acceptable to ignore a patients' preference regarding modesty concerns and "how strongly the patient may feel about this?" Can they really be that ignorant on this issue? This crap that nurses see this all the time and 'we are all professional' means absolutely nothing to a patient!
Thanks for your time.
JW
yeah, what is this "professuional" crap....i keep being introduced as a "professional" model...does it mean that i make a living modeling.....geez, if that were the case, i might as well live under a bridge...
i think, though, it ought to put students at ease with respect to my behaviour: so, no boners, no telephone numbers, no innuendo, ....yeah, i get it....professional.
professional means you get paid to do it for a living
amature means you dont. Thats all the diference there is. I kno it doent make me feel better about professionals.
Lisa
I think the approach you use has the little extra step that makes alot of difference. If a male is unaware you are female until you are there a large percentage would not say anything even if they cared, if you asked if they wanted to change still a certain percentage wouldn't admit because we are told men shouldn't care so we feel we are the odd if we do, telling them its perfectly ok to have a preference. You have gone the extra mile and done everything you possibly could, short of developing the ability to read minds. As stated above more often than not it is the support staff that is a problem, sometimes providers do not have choices, sometimes they do but they just don't. I have related two instances one with a testicular ultrasound I had, and a vasectomy a friend had there were options but they were not offered. In my case the female tech completed mine walked out with me and told the woman in the waiting room, she was going on break and the only tech on duty beside her was a male so if she wanted a female she would be back in about 10 minutes....these are the type of things that give patients the impression providers just don't care. Unless one stumbles on resources like this, and discovers there are providers like you three and a Dr. Alex that posted here we just assume we have no choice. For me the biggest revelation for me from the dialouge here with providers like you is we need to communicate. We assume all providers will care and ask like you do...we find even those that care may not ask so its up to us to do so. By and large I have found that when I ask I have gotten some accomodation, or at least was treated with respect not like I was a freak.
Your male patients seem to comfortable having a female provider as you give them every opportunity to change if they choose. Do you sense any difference in comfort when you have to have other female(s) assit in procedures like cystro's etc.? Once again thanks for sharing with us, it not only informs and educates it helps change some of the thoughts we as patients hold/held toward providers....alan
no, anon.; that is not what "professional" means; it means that our behaviour and actions conform to certain standards (usually meant to put the recipient at ease)
so a doctor who is considered acting "professionally" is deemed not to sexually accost his/her patients, for example.
a naked model is deemed to be acting "professionally" if he/she is not using his/her nakedness for purposes other than to be rendered on paper, canvas etc.
incidentally, would you regard shaven pubes (male/ female)acceptable attributes of the naked art model?
Who lied to you, JW? It sounds like the doctor stated he would get you same gender OR care and it didn't happen. Did you speak directly to the doctor? Did you speak to anyone at the hospital about having your needs met? What was the response when asking why the request wasn't met? At what point did you find out your request wasn't met?
Our patients get information sheets before their surgery so they know what to expect. I have seen other doctors do this as well. I find it answers a lot of questions and gives patients a feeling of control.
Lisa
Hi Alan. I have never had a patient ask for a male nurse in office for a procedure or for a surgery outside of it. We give an info sheet for scopes, etc. so they know what it is and who will be doing what during the procedure. I checked with the male doctors in my office and they have never had a same gender request or a complaint about female care either. Our speciality however is different in that they know their genitals will be involved right from the start given the nature of the practice.
If a male is requested and a male is available the need should always be met. If you call and find a male tech is available to meet your needs I would make an appointment directly with that person. If they say they can't do that ask to speak to the manager. Call the day of appointment to make sure the male(s) are not out sick to save yourself a trip.
Lisa
ANY WOMAN who decides its OK to FORCE ME to expose MYSELF to HER is mistakn. Thats not her choice to just do that ITS MINE. You cant just decide to EXPOSE ME because you want!!! That is called molesting someone and its SUPPOSD to be ILLEGAL. Why doesnt anyone admit that?????? Are we insane???
moralman
Those comments made on-line regarding accomodations and who accomodates in the real world are two very different matters.
For me I see right through it as
its just bogus talk. Lets take a
look at the real world for a moment
since we are on the subject of patient modesty. Which gender has as it appears the most issues with modesty concerns.
Women in the united states in 2003 spent 16.5 Billion dollars for
bras.That same year women underwent
280,401 surgeries for breast
enhancements. Total cost spent in
that year for cosmetic surgeries was 6 Billion dollars. In the late
1980's a chinese surgeon by the name of Long Daochaio perfected the
art of penis enhancement surgery.
Since 1989,only 18,000 such
surgeries have been performed as
there are only 30 surgeons in the
us at this time capable of doing
such surgeries. Approximately 2300
of those surgeries were for vets
or others who had lost part of their penis in war or accidents.
It seems that the bra is
constantly evolving with extra
padding and foam for that even
larger look. Many in the fashion
industry state that women are more
in competition with each other more
so than the looks they hope to get
from men. In the state of arizona
there are (0) male mammographers
employed.
I've never seen a male nurse or
medical assistant at any physicians
office I've ever been to,let alone
a urologist! What if women on average had a 50/50 chance of a
male mammographer. Those are still
much better odds than men face as
94% of nurses are female. Would
attitudes be different then among
the female population? Would the
problem be more recognized for the
male patient? How can anyone
appreciate discrimination if you've
never experienced it? I really doubt they even think about it after all why should they!
PT
Lisa, JW here. I had surgery at a free standing surgery center. I'll never do that again. I asked prior and was told by the anesthiologist and medical director (same man) that I could be assured that a male would do my prep. Lied to point blank. Found out afterwards that normal protocol was female nurse did prepping after I was under with Propofol and given a general. Very convenient for them. I was furious.Their excuse was I "misunderstood". Good excuse when they were actually caught in a blatant lie. I am sure they did this habitually. The place was so low they never had the decency to respond to my complaints.The doctor never had the decency to even respond to me. I went to all levels state and otherwise with formal complaints and basically at the end of the day, a patient has NO recourse. It's a lost cause. Their ass is covered legally and it is a no win situation for a patient with a complaint as this. Yes, it is morally and ethically wrong and extremely upsetting (beyond words for some people as us) but there is not a damn thing you can do about it. The damage is done and you have to live with it. It took a long time for me and my wife to recover from the damage. They go on their merry way and do the same thing to others.
JW
Something Lisa posted has been stuck in my mind for a couple of days. Basically she said due to her specialty she/they were aware it was just another day in the office (par) but it was not for patients, that relatively simple statement strikes close to the heart of the issue for many. There have been numerous posts here about providers using such techniques as saying "I have seen/done this many times its no big deal, etc, The problem seems to be often providers either do not, or are precevied not to recognize that just because they are comfortable does not mean the paitent is comfortable. And while Lisa seems to equate it to the fact that she is in a specialty that requires this and may be more aware...I would question the opposite, if a provider whose specialty requires exposure realizes this, that patient who walk in knowing this will be part of the deal....are still uncomfortable...how can those who deal with patients who may not come in expecting this not think about it. I think it comes down to the provider not the specialty...Lisa and her group seem to get it....the issue of comfort isn't about the provider its about the patient...what the provider is confortable with has little to do with how the patient feel. A provider that recognizes and acknowledges it will find more acceptance that those who don't and make the issue about them. The question becomes if some like Lisa's group get it, why don't others. I fear soemetimes/often its because if they acknowledge it, they have to do soemthing about it which will likely cause extra work & or money, or admit the patients comfort isn't priority one.
PT I have to be honest I find many of your post to be overly aggresive for my taste, but I have to agree with you, the ridiculous dispairity in gender of support staff makes it really difficult for males. I also have never seen a single male nurse or tech in a doctors office, specialty or not. What i find even more troubling than the issue itself, is the apparent lack of concern by anyone to do anything about it...even in the face of a potentially catastrophic nurse shortage....alan
When male patients in large numbers start to refuse opposite gender care, the same thing will happen as did with women's issues. There will be more male techs and nurses hired to accommodate. The practices will be losing money until they make the necessary changes.
Seems like I may have cancer. The biopsy will be done in the MD's office.
If needed, I refuse to have the surgery unless an all female team administers care. What would the ethics committee say when a patient who has been sexually abused in a hospital pleas not to be re-traumatized by forced exposure by the opposite sex? Can't wait to see how this fiasco works it's way out. No wiggle room for me.
Marjorie Starr
Alan
You and I have different
styles,however,we want the same
thing do we not. My goal is to try
to get people to see the whole
picture and with that becomes more
understanding.
Keep up the good work,I like
your comments and your activism.
PT
In 2003,detainees of world
terrorist figures were held at
guantanamo bay while awaiting
trial and interrogation. As you
may recall many were subjected
to torture techniques which later
were shown to the world. The world
was shocked to learn of these cruel
treatments that our military has
used as tools to gain information
from the terrorists.
What I thought similar with
the experiences of terrorists that
basically parallelled what american
males had experienced here simply
as patients. Consider that young boys were subjected to hernia exams
with female nurses and teachers
looking on. Enter the military to
simply serve your country and find
your self getting a full medical
physical in front of female non-
medical clerks.
If you've developed a medical
condition requiring hospitalization
then you are in for more experiences as well. Just don't get
an erection. You could be looking at the end of a heavy spoon.
PT
PT
You are absolutely correct. I came across a comment made by a Ca. politican that said something like, "We treat our hospital patients worse than the detainees at Gitmo". Somebody "out there" got it.
Contrary to Dr. Bernstein, I believe that in order to change policy, unless some harm can be proved, the policy will take a lot longer to change. Examination of antecdotes, thereby over time, showing the sources of psychological trauma are just what we need to research what needs to be done in healthcare. While everyone is different, there are certain things that upset nearly everyone to one degree or another.
Victims of trauma and sexual assault need special care. Example...Blood pressure. Someone who was subjected to previous trauma and have high blood pressure at the time of an intimate exam (whether opposite gender there or not). So...what do you suppose would happen to this same patient if they were forced into a position similar to what traumatized. They could absolutely "stroke out".
Also, continued exposure to traumatic events tampers with the hormonal system in the body and degrades the mental health of patients. That's why many sexual assault victims and those with PTSD have problems with cardio/vascular issues, pulmonary and gastro issues as well. The added stress impedes the immune system causing these illnesses.
So...when thinking about what we patients go through, it's time to examine the psycho social aspects of medical care that are harmful to our mental health. This will forced the medical industry to re-think "to do no harm'.
marjorie starr aka bjmd
Here are 2 comments written to my e-mail today by a visitor who is having trouble writing directly to my blog. ..Maurice.
Several things Dr.Lisa shared on this blog I find to be problematic. Conferring with the male doctors of her urological practice, none of them, ever had a male patient who revealed a disinclination for an intimate exam, procedure, and care by females! Not one guy! Ever! Why am I reluctant to accept this statement? It is apparent that none of the upset men on this blog have been among its patients.
Also, Dr.Lisa indicated that because her speciality is the genital region of the body, the patient must know that he will be attended by a female nursing staff. Imagine that I am a female patient with an appointment at a gynecologist's office, am I to presuppose that if I needed a pap smear or some other vaginal procedure that an all male nursing staff would attend to this matter? Much of the discussion on this blog gravitates around the male patient denied options related to intimate care by same gender providers. Why does Dr.Lisa not employ male nurses? If I were a patient with one of her male associates, and needed an insertion of a foley catheter, and disallowed a female nurse from doing the job, how would I be accommodated? With the information presented, I could never be a patient with this urological team; I could never recommend the practice to other men, and if I found myself in the office to be "ambushed" (as it has been termed on this blog; I label it "Bush-whacked"), I would fail to make monetary renumeration for a partial service. What is being given to us men, is the usual, "take it, or leave it". -REV.FRED OF PENNSYLVANIA
As a Protestant pastor, I infrequently find congregants contact other clergy for weddings, baptism, and funerals. These actions are not viewed as an affront to my competency, credentials, and commitment to ministry. For any number of reasons, parishioners have decided to move in another direction, and owe me no explanation. Church membership is not church ownership. I learned a long time ago, no one can be all things to all people,all the time. For a female medical worker to assert that her education, experience, and certification entitles her to give me an intimate exam, procedure, scan, or care, which I decline due to my religious beliefs and moral outlook, is not only an offense to my values, but would supply me an additional reason for the rejection of her services. Such an individual is lacking in professisonal reflection and emotional maturity--no one I want working on me!Also, for forty years, voices in the feminist camp have declared loud and clear, that a woman has the right of self-determination over her body! Does not a man have the right to exercise autonomy over his anatomy? I find it astounding that some female doctors, techs, and nurses will fight to defend their freedom, but disallow male patients control over his manhood! Do not bash me as a chauvinist, because women participate at every level of decision-making in the congregation, and in the classroom and from the pulpit I have upheld gender equality. My commitment to religious holiness and sexual integrity supercedes my advocacy for gender equality. -REV.FRED IN PENNSYLVANIA
I've been reading Lisa's comments and the responses. I have to agree somewhat with Rev. Fred. I find it hard to believe that professionals like Lisa claim that they have never or rarely found a man who doesn't feel comfortable with opposite gender care. Of course, they don't use the words "feel comfortable with." They often say "complain" or "refuse." As humans, we often see what we want to see, interpret other's responses to us based upon our set beliefs or stereotypes. So -- just because some men don't verbally complain, everything's just fine, apparently.
The question I've not heard Lisa answer is this: Do you have male nurses or male assistants available in your practice. If yes, fine. If not, what choice does a man have? It's easy to rationalize by saying that you never hear them complain. Rev. Fred is right. Just because Lisa works in a field that deals with genitals, and men know that's the case, doesn't mean they know that if they choose a male urologist they'll have female assistants working with them.
Rev. Fred, I think the issue is not that Lisa said no one had concerns with it, she stated what Dr. Bernstein did, that patients do not speak up. I was one of those, I had numerous procedures-exams and just sucked it up, pretended like I was fine with it, got through it and never said a word to anyone. I have related the incident that set me off and on a different path involved a female tech not providing me choice during an intimate exam but did so with the female waiting. We had been chatting nochalantly during the procedure and walking down the hall as if we were coming from an ice cream social, inside I was full of anxiety but I would lay money no one would have known. When I saw the obvious double standard right in my face and the fact that they didn't even seem to see the hypocracy I really became upset and happened across this blog and it changed my whole attitude. I was convinced I was the only one like this, I was the one with the problem...not them. So I really don't doubt what Lisa said is true...but it doesn't mean those men were OK with it, just they didn't speak up. And that, is the problem X 2, we don't speak up and until we do nothing changes. How do we get the word out that it is ok not only to feel uncomfortable...but to make it known and request accomodation. Women get it, they do a better job at making their wishes known and walking if they don't get what they want.......we need to do so as well.......
PT, as you say, same goal, different approaches and I also appreciate and respect your efforts and the passion you put into it.
An even more obvious example of disregard in this country for male modesty. A court rulled against a muslim inmate who filed a complaint because a female gaurd was frequently subjecting him to strip searches and watching him as he showered. The actions of those in war, while agreed more extreme were punished at Abu but upheld in our own court system. In another case a male prisoner lost a case against two female guards who strip searched him and stood and made derogatory comments about his naked body pointing at his genitals, the court ruled since they did not touch him it was neither cruel and unusual nor sexual harrassment.....
I have to stick up for Lisa's group to a large degree. while I think it would be proper to seek males to help the situation, males who would work in that paticular area are few, while we can hope providers will get involved in recitfying this...that isn't really their job, and it appears they are atleast aware and doing something...it now falls on us to push this and hopefully enlist some help from people like them along the way....alan
I agree with most of what you say, alan -- except " while we can hope providers will get involved in recitfying this...that isn't really their job,' This regards finding male help for assistance with exams and procedures.
If a patient tries to hide the pain he/she is in, do caregivers ignore it or ask the patient if he/she's in pain? If patients look like they may be feeling dizzy, but don't say anything, do caregivers ignore it? If patients look hungry or thirsty, but remain silent, do caregivers just say, oh, since they're not speaking up everything must be fine. Or, do they ask? These are physical symptoms. There are also psychosocial/sexual behaviors, too. One of those is how comfortable patients feel with opposite gender intimate care. You can't convince me that caregivers don't notice patient discomfort in this area. But do they ask. Most often, no. Why is that? They are commissioned to take care of the whole patient, not just the body.
As professionals, the nursing and physician organizations are obligated, as far as I'm concerned to try to help mitigate any kind of staffing problem that gets in the way of helping patients. And they're still bound by "Do no harm," which they can do to some patients who may have ptsd from past abuse. The medical professions can't completely solve this problem on their own, but I don't see them doing little if anything to help solve it.
Yes Marjorie
I recall that comment that the
politician made. I'm also condeming
the actions and behaviors that
terrorists have done around the world. These techniques of
humiliation and torture were used
to break the will of the terrorists
to get them to talk.
Some of these techniques parallel how many male patients in this country are treated by our healthcare system and that is what
concerns me.
Additionally, I've known
several women from afghanistan
who have told me about how they
were not allowed to attend school
in their country and must remain
completely covered from head to
toe. That the terrorists groups
are responsible for killing thousands of men,women and children
and displacing 2.5 million people
to take shelter abroad,however,
techniques of torture and humiliation should never be used
against innocent people in healthcare.
PT
MER, I agree with your post, I should have said advocacy for this issue it not their primary purpose. Providing for their individual patients needs is their primary focus. Most of us agree the physical comes first, but the emotional should not be discounted. Practices such as Lisa discribes go beyond what I see as normal. I have to commend her for letting her patients know its ok if they feel more comfortable with a male Dr., one has to wonder if she and the other Dr.s do not mistake failing to protest with acceptance or approval of additional female staff present during procedures.
Lisa, how do you see the fact that males have not protested or asked if there were alternatives to female staff assisting, do you think they don't care, that it doesn't make them uncomfortable....or do you think it may simply be that they don't think they have an option so there is nothing they can do about it....has anyone ever asked if they had a preference for....while none may have expressed discomfort with the additional female staff...have you ever sensed patient(s) discomfort when additional female staff was present....alan
Rev Fred, wrote me the following e-mail this evening and "by golly!"..he may have presented to us an entirely undiscussed approach to furthering the goals of many of those who are writing here. Though typically an Advance Directive sets the guidance for healthcare providers when dealing with a terminally ill or end-stage illness though I don't think that there would be a legal problem for using the Advance Directive to setting other standards which the patient desires for medical care. It would be an important legal declaration for the physician to follow. It very well could be considered ethical and legal for the physician not to accommodate if truly impractical. But in that case it would be required for the physician to acknowledge the request, discuss with the patient and help the patient find another clinic where the AD could be followed. What do you think? ..Maurice.
Dr. Bernstein, thank you for your graciousness, and including my posts on the Patient Modesty blog. I see that I have generated some discussion. Perhaps, my third contribution, may prompt comment. Last week, I visited my attorney to revise my Medical Declaration. with directives related to life-support, organ donation, and hospital choices. I added a new provision; "As a religious professional and due to my religious beliefs and values, if any intimate examinations, genital-rectal procedures and/or scans, perineal care, etc. are required and/or necessitated as part of my medical care, then I specifically REQUEST same gender (male) doctors, male technicians, male nurses, and/or male medical treatment providers." This Declaration has been witnessed and notorized, filed with the attorney, and carried in my possession at all times. Copies hae been presented and discussed with my surrogates (co-executors). The lawyer said that he had never written this language into a Declaration, but was certain that it would not be is last. He suggested that I substitute "REQUEST" with "DEMAND". I sought not to be so heavy-handed. Are any of the posters aware of a provision written into a Declaration? I recommend this course of action, in order to individually. send a message to the medical world, as to the seriousness with which some of us, attach to this issue. -REV.FRED
I found an interesting website titled HISTORY OF THE ARMY NURSE CORPS with lots of pictures dating all the way back to the US Civil War. Does anyone think the wounded soldiers cared what gender the medical people were?
http://history.amedd.army.mil/ANCWebsite/slpr/slpr.htm
while this may not be a consolation for some on this blog, it is an historically documented fact that humankind has been very preoccupied with and fascinated by having power over other people's sexuality and sexual matters.
just think of the american torture and degradation of iraqi prisoners of war.
then there is circumcision - male and female (yes, i know the difference; female circumcision really is total mutilation, whereas male is "only" partial mutilation ) and please don't get me started on this subject as i am an avid, if not rabbid crusader of thgis barbaric practice.
it seems, if we want to degrade someone , we go for the genitals.
war, hospital room, dr. clinic and the jokes we all tell at the office cooler.
will it ever change?
are we here on this blog going to change it? how?
surely the discussion has been going on for a hell of a long time.but you know what? i have no solution and would endorse some that have been suggested.
those solutions, however, might help the odd patient, but the fact remains: we will continue to aim at our opponents' genitals long after we have expired
I have been away from this blog for several months, and I see that the themes are largely unchanged, but thought I'd chime in on a couple things. First, I think the "advance directive" is a splendid idea. In my case it of course would read something like "As a naturist, and in harmony with those beliefs and values, I specifically DEMAND that the doctors, technicians, nurses, and/or other treatment providers attending to my medical needs are, without reference to their gender, simply chosen on the basis of being the best in their field of expertise." Second, as a point of information, having followed the advice here and expressed my preference, I successfully completed my annual physical this year without once having to suffer the indignity of those open-backed paper gowns! :) Third, much to my surprise, both my nephew and my son are studying to become nurses/PAs. Finally, responding to an earlier comment here, my work as a journalist has taken me into locker rooms for interviews with athletes of both genders without incident or fuss, making me think that the medical community will become adequately sensitized to gender issues just in time to welcome a generation of patients who profoundly don't care. That of course doesn't make sensitization to personal modesty less important, but it may help with allocating staff resources in response to those whose "advance directive" still specifies a gender preference. -CSM
"Does anyone think the wounded soldiers cared what gender the medical people were?"
"attending to my medical needs are, without reference to their gender,"
Here we go again. Now we're on the battlefield and dealing with advance directives within an ICU. Again, extreme examples used to say exactly what? That people in dire conditions don't care about gender? Only the most extreme don't agree with that. Of course badly wounded, dying soldiers are not concerned with the gender of their care. That's a no brainer. But once they get better and need intimate care, what then? Does it matter then to some?
But this seems to be a strategy, poor strategy, but one nonetheless -- push this issue to the extreme. Talk about dying patients, in pain or unconscious and imply these situations are representative of the problem.
They are not representative. I hope I don't have to repeat the kinds of situations many people complain about -- situations when they are conscious and not dying, situations when having a choice isn't such a big deal for the system, more a matter of attitude political correctness than even staffing.
Here's a survey that I will bet we will never see the results of.
"How many men who feel humiliated, emasculated, abused, embarrassed, and defiled by female medical staff leave angry and revisit that anger and abuse in their personal life?"
If anyone actually cared what happened to people after they were coerced into humiliating circumstances, they would find this kind of data out there. Not that this is a new point of awarness or advocacy, but it clearly shows 'harm' and continuing damage in a person's life due to bad and careless treatment. Anger is powerful, especially when we believe someone has taken the rights to our own body away.
I do not condone violence, or excuses for abuse, but if it is happening then it is happening. If people leave physically 'well' but mentally 'ill', who is going to admit any responcibility for that? If 'caregivers' know that they are causing emotional harm and depression, how responcible are they for doing it? It seems to me that no one cares what effect they have on people, as long as they maintain the right to do it.
I believe the real hurdle in changing the system is to overcome the egos of females/males who fight at all costs for the rights of entitlement to our bodies. And at all costs means....we are the costs.
What I hear on this blog boils down to this. "Tell us all about your feelings of embarrassment and we will 'try' to accomodate. We probably wont because all of our staff are women and we are not actually inclined to do anything about that but we will be very honest about saying no. Feel free to go someplace else because we are not willing to do anything about a problem we know exits, but maybe someone else is willing to do something about it. Otherwise deal with the humiliation or leave.
I absolutely believe that if you know perfectly well you are part of tramatic circumstances then you are obligated to help work on the solution.
I find this blog interesting, but at times disturbing because of people like moralman. I am a male who just happens to have a female primary care physician. I really have no preference either way on the sex of my doctor. I just happened upon a medical office close to my apartment at the time when I was a young man in need of care for a viral infection(in my mid 20's). She seemed like a good, forthright and sensible doctor and I was in need of a primary care physician, so I have had her ever since (around 20 years). Obviously, she has seen and handled my privates and I have never had an issue. For someone like moralman to equate that with immorality is ludicrous. The only time I have ever had an issue with a female presence in medical care was recently when I was referrred again to a urologist (who just happens to be a male). One of his nurses, a female, prepped me for a cystoscopy-which included picking up my penis and giving me a shot to numb it. Again-not a problem-didn't give it a second thought. However, unlike the only other time I have had this procedure done-the nurse stayed in the room when the doctor was inserting the scope. For some reason, for the first time in my life-I thought I really don't particularly need this nurse standing here seeing my genitals in this particular setting. I am sure I would have felt the same with a male nurse and a female doctor. I just thought there was no need for another person to be there-wasn't the end of the world or a major invasion-but it did occur to me.
I guess the bottom line is all medical professionals should ask if there are concerns and try to address it appropriately to each patient. However, while I am a religious person-I do not need an ultra righteous person telling me it's in any way immoral to let a female examine me in a medical setting. And the person who more or less stated that they may rather go without care than get care from the opposite sex is just downright disturbing. I guess my bottom line is respect the patients modesty and accomadate them as much as possible. And if they decide to risk their lives in order to satisfy their irrational fear of being "immoral"-that's up to them.
Dean
Dean, I most appreciate you joining the discussion here. Frankly, we really have not had many visitors expressing your overall degree of satisfaction from your experience and a more temperate view of the issues presented here.
I would look to Lisa to tell us the need and standard of practice for an assistant to stand by during a cystoscopy procedure. The urologist may need access to tools while holding the cystoscope in place. ..Maurice.
ok MER what exactly is the difference? 1) Emergency situation, life or death, minutes count, gender doesn’t make a difference and its ok for them to look and touch, as needed, to save lives. 2) Routine medical care to determine if you have a condition or disease that won’t kill you today but may kill you a few years down the road, now its not ok to look and touch, as needed. Why is the first ok but the second not ok?
Moralman or Rev Fred would accept, assuming you are conscious, any gender care in situation #1? If yes, why #1 but not #2?
BTW I totally agree with Dean. Doctor skill, caring and intelligence trumps gender. Goes for nurses too so long as they are doing something required by the course of treatment.
I would like to ask a question of moralman and Fred. Is having a doctor or nurse of the opposite gender examine you a sin? Can you support your position with Scriptural refences rather than this is just how you feel?
Larry
Marjorie:
I was re-reading some posts..did you say that you may have cancer?
I don't know if it's appropriate here, but good luck with the biospy, and truely hope all is well.
Our nurses do the prepping as well. Dean. If I need an assistant I try and have them stand away from the genitals as much as possible. Even though the assistant is the one that prepped them I still try and give them as much privacy as I can in an uncomfortable procedure. We also have all our exam tables facing away from the door and we put a sign up so everyone knows the room is in use to avoid anyone intrusions. It's a shame that in reading here this isn't always done.
Lisa
I'm so sorry you were lied to, JW. I'd be curious to know if there even was a male nurse or tech available to help you out or if none even existed. Lying is never the answer. It adds insult to injury.
Lisa
Urology seems to be a particularly hard field to get males, Alan. My guess is it has something to do with the false and hurtful homosexual sterotype that exists in nursing. Urology just might be too much for some. My experience has been men go into more action oriented fields.
I do think you are on the right track as far as action needing to be taken. The only way the situation every really improves is if more males get involved in nursing and that could start at home.
If all the people here spoke to their sons, nephews, uncles, and friends about entering the field it could get things moving in the right direction. If anyone knows a man looking for a new career in the recession this could be a great time to bring up nursing as an option.
Nurses make good money and there is a lot of flexability in regards to their hours. They also could go into many other fields versus hands on care should they see fit. Talking about these things with the males in your life could start to change the way nursing is viewed.
I would also urge everyone to call their local high schools and colleges and see if they emphasize nursing for males. If they don't see if they will start to do so in the future.
Ask your hospitals if they highlight nursing for men in their job fairs or seminars. You might find more support out there than you think. Just a few ideas.
Lisa
Alan,
I disagree that the physical should come first. Both the mental and physical states must be looked at simultaneously. People who have suffered through torture, sexual abuse lose their dignity, autonomy and after that's gone there is nothing left. Their world is shattered. It is traumatic emotionally for these patients when they need healthcare. Setting the emotional needs aside, let's look at what happens medically to these patients if their dignity concerns are not met. First, it is re-traumatizing and second, it can be construed as a violation is such is done against a patient's will. It becomes another sexual assault. Third, medically here's what's happening in their body. Blood pressure skyrockets, cortisol is released impeding the immune system. This is why trauma survivors very often have pulmonary and gastro issues.
Therefore, I would rather refuse medical treatment if I could not have my gender issues resolved rather than be re-traumatized and suffering the dibiltating effect of mental health deterioration. You can be you with a physical illness. You are never you when your mental health is at risk from re-traumatization. Nothing is worth that. What good is a fixed body when a soul is destroyed?
Marjorie Starr
"ok MER what exactly is the difference? Why is the first ok but the second not ok?"
Nothing personal, anonymous, but you need to reflect more on this yourself. If you can't see the difference I'm not sure I can explain it to you. Note that I'm not saying that patients shouldn't be treated respectfully and with dignity in emergencies. Of course they should. But life and death is an entirely different situation. I think most people understand this and, even if reluctantly, accept it.
By the way, check out this "Caregiver Preference Guidelines" from the University Health Network at Toronto General Hospital. It clearly makes a distinction, that is often missed on other blogs, between patients who openly discriminate because they just don't respect people of a certain sex or race, and those who feel uncomfortable or embarassed.
I would ask Dr. Bernstein -- do you know any American hospitals that have guidelines as detailed and specific as this regarding caregiver choice? This is a model that should be adopted by all hospitals. It seems pretty realistic. They make no promises, but they recognize the issue and try to deal with it. This is part of what some hospitals call patient-centered care.
Here's the URL:
http://www.uhn.ca/About_UHN/corporate_info/reports_statements/docs/Caregiver%20Preference%20Guidelines.pdf
Larry
Certainly religion has nothing to do with it unless your Muslim.
That in dire conditions people
don't care about gender. How do we
know,have we asked them? Have there been surveys? Where are they?
Simply because you are on your
death bed and dying makes no difference to nurses and/or ma's.
Perfect example with the University Hospital in Tucscon Az
a few months ago. There were 8
nurses and pct(patient care techs)
fired for taking cell phone pics
of a male patients genitals. The
patient died 2 days later.
The Army nurse corp,means nothing to me.It was an army
female nurse who started the idea
to assault males with a steel spoon simply for having an erection.
It was male medics on the
battlefield who really cared for the wounded under machine gun fire,
while the army nurse corp was behind enemy lines. Don't believe
everything you see on mash,not true.
Don't expect everyone in healthcare to advocate for you,
dissapointments are around every
corner. Where are the surveys
regarding these subjects,there are
none. I recall a meeting with a
hospital ceo regarding reimbursements for nosocomial
infections. Medicare and medicaid
will refuse to pay for such
infections while in the hospital.
All while the entire nursing staff refused to believe that
a big percentage of infections are
a result of poor and/or no hand washing. They'll believe it when
the dollars stop flowing.
PT
man you guys just dont get it. expose yourself to who you want. if you and your spouse really dont care what you do with the oppisite sex , great. have fun. not married? knock yourself out.
not me. just cause a woman wants to play with my genitals dosnt mean I have to let her. you really want a scripture for that?
htey are so used to men who will strip for anybody and anything that its hard for guys like me now to get treated with modesty respect.
This message is for those visitor who are Anonymous but DON'T post with a consistent pseudonym or initials: Please start posting with some sort of identification (keep it "G" in classification, not "X")so that we all can follow the discussion with more continuity. ..Maurice.
p.s.-Thanks to all those who DO post with "some sort of identification".
Lisa:
Isn't it odd that male urology doctors are fine, but male urology nurses have a stigma? Very hard to understand.
Have you spoken with any of the male doctors at your clinic about this subject? If so, do they see the harmful circumstances men are asked to put up with and are they perhaps willing to make a greater effort to help men through these devestating situations by earnestly trying to find just one male nurse/tech?
Dean
There are some great "Voy" forums I know you would enjoy. There are other people that feel the way you do and like to brag about their experiences. There are also many female medical "professionals" that comment on their love of exploiting male patients. I know you would get a kick out of it.
Male nurses in general seem to have a stigma, swf. Urology however might come with a bit more of one given the body parts involved. It's unfortunate.
We have one male tech as I stated earlier in this thread. They will leave us at the end of the year to go into trauma nursing. They help us on the infertility side of things at present.
We can only hire who applies and the last listing we had bought in 0males. We have reached out to many nursing schools and men just don't bite for this field. We would be happy to hire them if they were qualified and interested.
Lisa
To moralman- you can feel however you like on this issue. However, where people have trouble with your line of thinking is when you say something like this:
"just cause a woman wants to play with my genitals dosnt mean I have to let her. you really want a scripture for that?htey are so used to men who will strip for anybody and anything that its hard for guys like me now to get treated with modesty respect."
A female care provider is not "playing with your genitals". She is simply inspecting them in order to provide you with competent medical care. I would certainly not want a doctor of either sex that would abstain from doing necessary exams because of the situation having the possibility of making either the patient or care provider uncomfortable. That, my friend, is the person to stay away from-because such thinking could lead to an unnecessary premature death.
So, moralman, just admit that you have an issue with the opposite sex (very likely that could use a professional doctor in the psychiatric field). Your name is not very apt-because it has nothing to do with morals or morality.
Dean
A MAJOR ANNOUNCEMENT! PLEASE READ AND FOLLOW:
If Lisa is the origninal Lisa and if there are visitors here who are actually performing an unethical act on an ethics blog by using someone else's pseudonym, then the whole value of discussion is degraded into uncertainty and simply noise.
I strongly suggest that ALL writers (including the original Lisa) to this blog make an important decision: Formally become a Blogger member by registering at www.blogger.com
It is free and takes only a minute to do. Then, like MER has done, when you want to contribute your thoughts to this blog, you simply log in, you identity is still hidden but your anonymous name and password are safely yours and no one can assume your writing identity.
You will lose nothing by registering and then signing in to write but it surely make all these important comments more coherent and honest and particularly for an ethics blog---more ethical!
Please go to: www.blogger.com and get started! Thank you, ..Maurice.
p.s.-By the way, after you originally register, if you allow Cookies on your computer, you don't even have to formally log in for a visit but just come and you will be welcomed.
Oops..in the first line of my last post I meant to say:
"If one Lisa is not the original Lisa" ..Maurice.
Rev. Fred wrote the following e-mail to me today. ..Maurice.
Dr.Bernstein, Permit me to make a few replies to comments on my posts. Thank you, SWT, for challenging Dr. Lisa's explanation that a lack of male nurses in the urological department is due to the stigma of homosexuality; but at the same time exempting male urological doctors from the same suspicion. Good point. Why not bring back the orderlies? Anonymous and Larry questioned if my position is Scripturally based or a personal conviction. I am almost certain that Dr. Bernstein does not want to convert this blog into a Biblical symposium. Judaism and Christianity, with Islam have beliefs and values related to modesty for the male as well as the female. Failure to recognize this fact, is to be grossly misinformed. I am grateful for Marjorie's agreement that there are issues which may take precedence over the physical care of the body. Both of us might affirm with Steven Covey, "we are not human beings on spiritual journey; but spiritual beings on a human journey!" Making a careful scrutiny of my previous three posts, never once did I make the assertion that a medical provider and patient giving and receiving same gender intimate care are guilty of immorality! Recently, I had a consultation with an out-of-town hospital CEO about modesty, he shared that another hospital had bent over backwards to accommodate a Hasidic rabbi with a same gender surgical team, for an inguinal hernia operation. Dean, would you designate this Jewish rabbi, as exhibiting an "irrational fear" (as you termed it), or is it possible, that his commitment to his spirituality, is something of which you know little or nothing, and do not understand? Is it not also, possible, that my faith tradition, shares a similar viewpoint? I am not being sarcastic with you, but if your religion has granted you a liberty, where all this is no big deal, do not permit your enlightenment to cause "the weaker brethren" to stumble (First Corinthians Chapter 8). - REV.FRED
dean inspecting, examining, playing with , groping. call it what you want. all depeds on which side of the penis you are on.
moralman
Rev. Fred, I was actually commenting on the posts of "moralman" more than anything you have posted. I do believe that he has some issues entirely unrelated to your concerns.
However, since you brought it up, I will discuss. I am a Roman Catholic who takes my religion seriously, however, I do understand and respect if your views preclude having someone of the opposite sex examine you in a medical setting. Please do not question my spirituality in any way, Reverend. Just because I do not agree with your line of reasoning on this subject does not make me an atheist who is incapable of understanding a spiritual persons viewpoint. I can respect your view while still beleiving that such a viewpoint is not supported by what I believe. While I do believe the Bible and other spiritual works are helpful in our path to God, I think that people tend to use it according to their empirical needs in furthering an argument rather than common sense. Please remember, these words were written by humans that were trying to replicate what God was trying to teach them. It is therefore fallible. That is why I can continue to believe in my religion despite the fact that there would be proofs contained in the bible that would allow slavery of a person as long as that person is treated with respect. I do not mean to go on too long, but I wanted you to understand that I do know quite a bit about spirituality, despite your concerns. At this point-I would think we can agree to disagree-don't you ? You can obtain your medical care in any manner you wish and I the same. It does beg the question that has been raised though about emergency medical care where no choice is available (accident on freeway with first responsder being of the wrong sex). Would you rather die than receive care from the opposite gender ? From my perspective, though-my God would not want that for you, whther you want that or not.
oops, i menat to add my name to that last post.
Dr. Bernstein-please add if my name to the last post if possible. If I decide to continue to post on this subject-I will sign up as you request.
Thanks,
Dean
Fred, are you saying that beliefs and values about modesty that exist in society (whether religiously based or not) apply everywhere and there is no exception when needing care from a physician? No exception for emergency medical care? If you are unconscious, is modesty still required? Isn’t it also immodest for anyone, except your spouse (see there are exceptions) to see your nakedness? If opposite gender care is wrong because of heterosexuality then wouldn’t same gender care be wrong because of homosexuality? When you get a colonoscopy isn’t that sodomy?
Larry
I believe it is important to try to see the black and white of this issue. Within this comes the ability to try to understand the entire spectrum of grays.
This is how I understand the initial points of this spectrum:
Those who see medical personel as
technicians: lab coats, scrubs, trained personel. People not as male/female, but persons with training that sets them beyond an ordinary male/female role. Exposure is within the context of necessity and therefore warrents access.
Those who see male/female as a commodity that by nature can not be set aside. It is naturally and obviously who we are, and training in any field is the secondary componant. Scrubs and lab coats contain these men and women. Exposure is given with permission and should never be expected as a clinical right. They can respect training and vast experience, but no one is really set beyond traditional male/female roles.
**Those here can feel free to correct me if I have not stated the basics in an unbiased or logical way.**
From here we get the questions of grays: the levels of acceptability, the implications of hypocritical mixed messages, the judgements of not seeing with the holder's eyes of either black or white points. Do we really know why one has the view from either side? Are we here to convert those to either side? There are many shades of opinions and experiences that color how we feel now, or ever felt about this subject. And perhaps touchier than any other, because some do not just want, but need, others to understand. Why? Because how often in life do you need to justify exposing or not exposing yourself to someone/anyone.
I think we toss out subjects like morals and beliefs as a means of understanding, not to be turned to accusations. Holocost, war crimes, punishment: all examples of how humans treat other humans. A means of understanding the universal dilemas.
Most of us are not going to agree on everything. Even the ones who advocate for choice have alot of gray in between agreement.
It is yet to be seen if so much spectrum can be encompassed into a respectful solution for everyone.
Hopefully we all agree: What ever your definition of respect is what you will recieve. Whatever your definition of choice, is what you will be offered. What ever your definition of morals, is what will be abided.
" We've reached out to many nursing
schools and men just don't bite
for this field."
Fact of the matter is male nurses
are simply not hired at physicians
offices. I've heard them say this
and simply because a physician cannot utilize them 100% of the
time. Fact of the matter is most
physicians don't hire nurses,they
hire ma's. Rarely do you need a nurse at a physicians office.
Many physicians offices use pa's
as it is more cost effective in that the pa's can see post-op
patients and write scripts.Further
more the pa can see patients if that patient cannot get an appointment in a reasonably time
frame with the physician.
I know of no urologists that
employ nurses. Most urology offices
that have more then 3 urologists in
the practice will employ a pa.
There are currently between 7 and
8 thousand urologists in the united
states. Most urologists practice solo and employ an office manager
and an ma(medical assistant) and
every one of these medical
assistants are female,period!
PT
If an examination of someone’s genitals by a physician is sexual, then it is homosexual if the genders are the same.
If an examination of someone’s genitals by a physician is NOT sexual, then it is it doesn’t matter what the genders are.
Carlos
SWF I really liked the earlier post reagarding if providers were truely honest in their quest to understand how a paitent feels they would has questions that would truely get to the heart of the issue and then give an honest answer instead of the standard approach ie. which is more important a competent provider or your modesty, and therefore inferring patients don't care about their modesty as long as providers are capable.
Dean, I was with you to a point, there is absolutely nothing wrong choosing a female provider, there is absolutely nothing immoral or wrong with female providers caring for male patients or visa versa as long as both sides are comfortable with it. Its just as wrong to say opposite gender care is wrong as it is to say people who want same gender care are wrong. Where I disagree with you is seem to make the decision of what is rational, and what isn't. That really isn't your right or within your ability to define for someone else,
Marjorie, my point is the medical Dr.'s primary purpose is our physical health. If a provider decided that they would avoid uncomfortable situations for all patients at all costs, there would be no PAP's, DRE's, Breast exams cause I don't care what the gender of the Dr. is a DRE is just plain uncomfortable, physically and emotionally, but it is important to have so I have it done and would leave my Dr if they didn't stress the importance. My PCP had to bug me for months to get a colonoscopy after I turned 50, he did everything he could for my comfort, knocked me out before etc. I was still uncomfortable, he knew it, but hit a balance to get the job done. I believe that was one of Dean's points, a PCP that lets you die for comfort without trying...not good,
The difference between emergency-life and death does not give providers carte blanche which I think some of them fail to realize. I do believe the God syndrome does manifest itself in these situations thinking they have the right to make decisions for us when we are perfectly mentally capable..but there is a difference. I am very uncomfortable with nudity and opposite gender, but would be more accepting of it if I were shot, in extreme, and dying than if I were there for simple screening. If you took Peyton Manning up in a plane and told him you were doing to toss him out, I doubt he would be worried about football at that time...doesn't mean he no longer liked football...but at that time it wasn't THE priority.
SWF hit is on the head, this is not only a personal choice, even for those on the same side of the issue...there is a lot of grey areas, a lot of difference in intensity....alan
Lisa
I forgot to ask, I know some proceedures absolutely need more than one person, but often Dr's use assistants for speed, convenience, etc. In the case of the cystro. could a Dr do the prep and the cystro by themselves if a patient were to ask. It seems to me a certain amount of prep by assistants is simply to speed up the process but could be done by the provider if the patient were really uncomfortable with having an assistant. Also, are you required by law to have RN's do these functions such as preps? One of my family members works at a local hospital, she basically went to a few weeks of night classes now works in recovery and in different roles in the hospital as needed. She is not an RN or even a CNA as I understand. Seems with the high unemployment someone would be available with some training the old orderly concept. Something one of the hospitals I talked to does is job share, they and another smaller hospital share a male Tech and schedule certain procedures ie transrectal ultra sounds on those days...I thought that was truely outstanding for a small hospital,
Perhaps you said and I missed it, what exactly drew you to urology? I want to go on the record saying I think its great that you did, there are female urology patients who prefer a female Dr., there are males who prefer female providers and those who just don't care. Choice requires diversity, its the same with male gyn's, while they seem to be a dying breed, there will always be those females who may prefer a male or who don't care.
Sorry to play 101 questions. Have you and any or the other Dr.'s or assistance ever talked about a certain patient's or patients in general anxiety about this. I mean this in a professional way, from the level of concern you express I doubt you gossip or make light of it. You are obviously aware of it since you make an effort such as positionaing assistants away from the patients genitals, facing the table away from the door etc....I would assume the assitants that work for you are aware as well....or do you think they do not realize some patients are uncomfortable with this...the reason I ask, I was standing in line the other day, a nurse I know was conversing with a woman about her teenage son's surgery, the ususal small talk...the nurse made the statement, I felt so sorry for him, he was so embaressed when I prepped him....he was so sweet. etc. I didn't see anything wrong with the conversation they weren't laughing about it as if they thought his discomfort was funny.....has/does this happen in your practice or is it the elephant in the room that no one talks about......alan
"If an examination of someone’s genitals by a physician is sexual, then it is homosexual if the genders are the same. If an examination of someone’s genitals by a physician is NOT sexual, then it is it doesn’t matter what the genders are."
This is the kind of simplistic, reductionist reasoning that we can't allow to pass without comment. Forget the modesty issue -- let's just talk about logic and argument.
We're talking about at least two points of view -- the patient's and the doctor/nurse. So, to whom does "if it isn't sexual" apply to? Assume that it isn't sexual to the medical professional. Assume it isn't sexual to the patient. Does that cover all feelings and emotions? Consider. How are we ever going to really know whether it's sexual or not to either party? It's not something that will be readily discussed or admitted. Does it have to be sexual in nature to be of significance? Emotions and feelings, stress and discomfort are more complex that the above statement suggests. It's not that simple.
And alan -- you write: "a nurse I know was conversing with a woman about her teenage son's surgery, the ususal small talk...the nurse made the statement, I felt so sorry for him, he was so embaressed when I prepped him....he was so sweet. etc.
This is a good example of the double standard. I want you to imagine a male nurse talking with the father of a teenage girl, saying the same thing. What's the likely of that happening. Even if by some rare chance, a male nurse did prep a teenage girl, he certainly wouldn't feel comfortable say that to the father. Frankly, though probably not intended, the remark sounds condescending to me "Poor thing, too bad that's just the way it is in the world. No other alternatives." God forbid the nurse thinks of out the box and gets a male nurse to prep the boy. Can't to that, Scheduling and entitlement and all that.
SWF,
Thanks for your kind wishes. The biopsy is done and now waiting for some news. Thanks.
Alan,
Interesting that you would separate physical wellness from mental wellness. Did you know that there are physical links between the two?
The newest I've heard is a direct link between depression and osteoporosis.
Dealing with trauma survivors is a different situation that one would not understand unless they have been traumatized themseslves. You cannot separate the two spheres of being. Someone who has a history of stroke for example would have a significantly higher blood pressure if forced into opposite gender care for intimate needs at a time like that. It could mean the difference between life and death.
Should I need surgery has a result of the biopsy it will be same gender care or it won't be done.
Based on my history of medical sexual abuse it it absolutely outrageous that I should have a problem having my needs accommodated. Literally forcing someone into another traumatic situation is both medically and psychologically unsound. They would take a bad drug off the market in a second. Therefore, just as a bad drug would be removed from circulation, protocols need to be set to protect previous victims of abuse/torture when they must enter healthcare.
Senator Patty Murray (Washington State) recognizes this and a bill is pending for special treatment for victims of sexual assault in combat when they come home and need special provisions.
In time I believe my work and that of others will be recognized and set standards for healing the whole patient. We are not the sum of our body parts.
Marjorie Starr
I've seen female nurses wear scubs
with betty boop figures and sexy
nurse phrases on the scrubs which
in a medical environment is innappropriate. What if there were
such a creature as a male mammographer with the words sexy
male or sexy mammographer on his
scrubs?
Urologists rank low in pay among the specialties. Average pay
is about 250k,whereas average pay
for an orthopedist is 350K. One
must consider malpractice insurance,electricity,computers and
other overhead such as an office.
Medical supplies,advertisement,
medical equipment,office furniture
and salaries for employees.Total
overhead can easily exceed 100K a
month. Nurses want health insurance,a 401K plan,vacation and
other perks that they can get from
working at a hospital or ltc facility. This is part of the reason they don't work at physicians offices. The other reason is economics 101 for the
physician and the fact that their
skills are not utilized at physicians offices. Why would you
need a nurse to administer meds
when the physician can simply write
a script for a patient that they
can fill at a pharmacy.
PT
I will be praying for you, Marjorie. I hope all the news to come is good news.
Lisa
Hi Alan. I could do a prep if need be but would have someone assisting in the cystoscopy. We have one male tech and the rest of our staff is nurses. MAs wouldn't be able to do all the things our nurses do in office. They can be utilized in a lot of different ways where the doctor is directly involved. They can assist in a procedure i.e. a cystoscopy or other procedures where an extra pair of hands is needed. They can often be used to take notes for the doctor or be utilized to chaperone. These two are done together by one person. Having someone take notes does help out and save time. The nurses also then know the additional testing and follow up needed and can help the patient arrange that.
We do our exams behind a curtain and even that could be a liability so many doctors don't do this. New patients are met with privately so you can go over their health history. This should always be done privately.
Many offices do hire MAs. It can save a lot of money for the practice. They work directly under the doctor's license and as such they work in a doctor's office. Some MAs do have formal education for this field, but they can also be hired and trained directly by a physician. I would think your family member is a CNA as they are working in a hospital. The course is offered here at a local community college. I believe it is one semester.
I always knew I wanted to operate. I chose urology because it allowed me to do so and I really enjoyed the specialty. It wasn't what I initially thought I would do but I love it. It's very rewarding because you can help people lead a more complete life.
You really don't learn about modesty based on sex of the patient but the patient in general. We would never hire anyone we didn't feel was compassionate or emotionally mature enough to deal with urology. They would never dream of barging in or opening a door when a patient was undressed. We also always knock and wait for the patient to grant us permission to come in. It's common courtesy. It's disappointing to read these things aren't always done.
I think everyone not just patients realize having your privates examined isn't the most comfortable thing in the world. I don't think the nurse you spoke of meant any harm, but I don't think it was necessary for the nurse to share that info with his mother especially in a public setting where others could hear it.
Lisa
Lisa:
"You really don't learn about modesty based on sex of the patient but the patient in general."
I have to ask why this is a concept that needs to be 'learned'. All humans have modesty issues, and all humans know that without being taught.
Do you also wait to be taught love, grief, sorrow, jealousy in med school before you can acknowledge and admit that they exist? I am fairly certain that you do not. It is just that modesty is the convienient emotion to dismiss when it goes against our own needs and happiness.
Your female 'caregivers' may feel very fullfilled doing something, but if it results in harming someone then their happiness is very self serving, damaging, and dangerous. Men should not be expected to expose their bodies just so your female 'caregivers' have a fullfilling afternoon.
"We would never hire anyone we didn't feel was compassionate or emotionally mature enough to deal with urology." Again 'we' is not the issue. If the patient is really who you care about then 'they' are the concern in the issues of who touches their body.
Many times the question is not are the women mature enough to handle these male patients. It is instead, does the male patient really want a woman doing this.
Of course the process is embarrassing, but does it need to be humiliating and damaging too?
If the patient is really being considered, any interests should be in their behalf, and it isn't.
'Caregivers' do understand this, the question is why don't they care enough to fix their own damage?
I 100% believe patient modesty should be taught in medical school, swf. It should be taught to anyone working with patients. As students we have never dealt with patients before and need to be taught proper draping technique and how to appropriately uncover a patient. They do go over closing curtains and related things also as they should.
"We" is very important in our office because as the doctors and owners of our practice we set the tone of how the office is to be run. Emotional maturity, discretion, and kindness are key qualities we look for in addition to excellent quality of care. We feel these are necessary attributes for our patients to be cared for properly.
I didn't say my staff was fulfilled. I said I felt rewarded by my work and I do. I do however hope my staff does go home feeling rewarded and fulfilled about their jobs as well. They are hard workers and large part of our success. I hope everyone feels that way and loves their work regardless of their field.
Our patients aren't forced into anything. They can leave at any time if they aren't happy with how the practice is run and who is doing what. There are no secrets and we keep them abreast of what will be happening and who will do it.
If they were grossly uncomfortable I don't think they would return for vasectomies, cystoscopy, etc. nor would I want them to. I would urge them to find an office to suit their needs and make them more comfortable.
The reality is there aren't many male nurses out there. I believe latest stats have them at 8%. I can't speak for all doctor's offices, but we would hire male nurses.
If you want men to have more choice talk to the boys and men in your life about the field. The only way men start to have more choices is if more men go into the field. I listed above some ideas which could get everyone involved. Hopefully some will follow through versus just speaking out here.
Lisa
Lisa, in my teaching of first and second year med students in their "Introduction to Clinical Medicine" course, we teach all that about the need and practice for patient modesty. And when the student forgets to close the drapes around the hospital bed, I am there to do it and the student then understands.
But so much of this is, by some, forgotten in later years under the pressures of time and technical responsibilities. There also, I think, creeps into the developing physician's mind that the main goal, the main responsibility of the doctor is to attend to a diagnosis and treatment and that the patient has primarily the same goals set for the physician.
As I have repeatedly told my visitors on these threads, I have learned that to some patients, probably more than others, issues of modesty may take priority over diagnosis and treatment. The latter learning is based on the statements of some patient-visitors here who will put off or refuse a needed exam or procedure because their modesty needs are being ignored or not met. ..Maurice.
Lisa, thank you for your kind wishes.
It has been my experience that utmost respect for dignity and modesty concerns are abundant in the office setting. Proper draping, only necessary personnel and courtesy has always been provided to me whether the doctor is male or female.
What made some of my hospital experiences so unpleasant, is that the issues "covered" in the office are out the window in the hospital. For those experiencing their first hospital stay, this can be extremely upsetting. Letting patients know what to expect may not remove embarrassment but will alleviate trauma when unexpected things happen to them in a room full of people.
Today's "in and out" surgeries have lowered the bar on modesty issues. Patients are shaved for surgery in the presence of an entire room of personnel in the operating room, sometimes while awake.
I must say that when I went into premature labor and was rushed to the hospital, the nurse in the ER said (and I never forgot it), "lets turn this gurney with patient legs facing the wall. We don't want a sideshow in here".
It was this type of caring nurse and prior courtesies that left me unprepaired for cruel and degrading treatment and sexual deviance on the part of a physician while giving birth full term to that same baby.
This is why I'm advocating for a research study that looks into the psycho social aspects of medical care that are psycholgically damaging to patients. Only then, will the modesty issues be in context with everything else, the vulernable can be protected and make life more comfortable for nurses, doctors and patients alike.
Dr. Bernstein is right. Those modesty issues are more important to me. This is what happens when your autonomy, dignity are taken away and replaced with devastating humiliation and cruel and degrading treatment. Feeling naked under the gown is like having someone who has not been traumatized covered with maggots dumped on their head. It's intolerable.
While most in healthcare are caring individuals, there are those who are not, gravitating to healthcare because of patient vulernability. There needs to be accountability and responsibility for those who abuse their power. Patient sensitivity issues must be addressed and as I've said on other posts, it's time to treat the whole patient.
Someone who is re-traumatized over and over again will sink into the depths of despair. It's sorry to say that the industry really does not care enough to fix the "white elephant" that is always in the room with patients and never in the room with the caregivers.
Marjorie Starr
Lisa said
"We have one male tech and the
rest of our staff is nurses."
Which should be "staff are nurses". Plural!
Not sure why you call the male
a tech as you haven't explained to
us exactly what his credentials
might be.
I know the exact statistics by
state,gender and credentialing
for all licensed and practial
nurses. That includes emts,pcts
and cnas as well as mammographers,
radiographers,pharmacists and physical therapists etc.
Furthermore, I know whether they are employed by a hospital, physicians office or nursing home.
Everyone who carries a license
has a file at their respective licensing board and that information is public record.Based
on these records statistics are
published each month! Statistics
of which many including myself have
been looking at for years.
PT
I agree with you on everything, Dr. Bernstein.
Our teaching on patient modesty was very strict and done on an ongoing basis as well. It wasn't a mistake you would make twice.
We remind our staff at weekly meetings however I don't think there is ongoing training on this issue in all offices or hospitals. There should be for all levels. I'm going to see what I can do to make that happen at my hospitals. I will report back on feedback I receive.
I've enjoyed reading all the views on your site and the wide gamut of feelings on the subject.
Thank You,
Lisa
I found a nursing school that has many of its training videos available online. Although they look somewhat dated the ones that involve "intimate care" stress over and over again the need to protect the privacy and modesty of the patients....Pat
http://deptets.fvtc.edu/nursing/index.htm
"Which should be "staff are nurses". Plural!"
I'm sure you know many things, PT -- but "staff" is a collective noun thus singular. "...our staff is nurses" is correct.
Lisa, Please do not be offended by the views of some of the posters on here. Feelings run strong. I think it is essential we get as many MDs posting in here as possible, not drive them away.
I personally would not entertain any intimate care which involved any females at all. My choice, my risks.
I personally happen to believe that females in many cases make better doctors and almost certainly nurses, than men. I just have my personal feelings which come first.
I am glad to report that I have now found a GP who will treat me on my terms in term so of confidentiality. The downside is I now have to make a 50 mile round trip just to see my GP.
No so Mer
Staff: Collective noun-a body of
assistants. Pleural if we take it to mean a number of assistants.
When a possessive adjective is
necessary,a pleural version is
used as in our staff are nurses.
The possessive adjective being
our takes on more then one.
BTW,In bristsh language all
collective nouns are pleural.
Reference was made to staff of
nurses meaning more then one.
Now, lets move on to the male tech as we would like to know his
credentials so that I may make a point.
PT
I'm sorry to say that my post from last evening was not posted. I cannot imagine why. It thanked Lisa for her concern and supported things Dr. Bernstein said.
jw, We shouldn't have to put ourselves at risk because of modesty concerns. Privacy is upheld by the Constitution and even Title 7 protects our right to privacy.
My personal feelings agree with yours completely. Most of my standing is based on my history of medical sexual abuse and the fear of feeling degraded by the presence of opposite gender during intimate exams. There is a small part of my feelings based on my experiences that by taking a radical stand, with my history that if a hospital didn't comply if they were able, would be cause for unpopular feedback from the public.
It boggles my mind that just because you're in a medical setting, that non medical personnel like CNA's have the right to invade privacy and humiliate patients, seniors in our nursing homes. It further boggles my mind that the abuse stastistics do not support same gender care for non medical issues, so to limit the ability for those in power to abuse. Abuse can be as simple as an old man refusing a bath from a young woman and forced to comply. Implied force from being soiled and having no choice is abusive, humiliation and degrading treatment to the poor soul thoroughly humiliated by having a young person of the opposite sex change their diaper. How can the world be so cruel?
Marjorie Starr
I think Lisa touched on a point that is actually a subset of the argument at large wherein she stated ownership of the office environment as it was "our practice". I think many of us feel more comfortable with our Dr.'s becasue (a) most of the time we choose them and (b)we understand the extent of the training they have and the long journey to being a Dr as well as the fact that lets face it, it takes an exceptional person to complete the requirements....not so with support staff. They can be an RN with as little as 3 years in accelerated programs or they can be a cna with a few night classes and in any case we have no choice it their being involved in our care. We hold Dr's responsible for their staff and the over all experience. This much I think is understandable. Where I think we go seperate ways I think is exactly what role providers and the medical community should play in these issues. While I agree 100% we as patients need to get involved in bringing more males into nursing...the medical community does not deserve a free pass on this. There was a time when there were hardly any female MD's, the medical community got involved proactively recruiting females into the profession, scholarships were provided at the college I attended that were specifically for female med students only, college professors and guidence departments actively coached females into going into the profession, there was a real effort to eliminate the "he" in Dr in promotions and education...those efforts are glaringly absent in the issue of gender dispairity in nursing. Providers requesting-questioning-demanding this issue be addressed would have far more effect than patients. Providers are in the inner circle of medicine, we are not. If a urology practice had male techs and advertised men's health centers and ran mention that men had options....what would be the effect, there are numerous womens health centers that advertise "because your special, women caring for womens needs". That perhaps is a problem, perhaps we as patients expect our providers to advocate for us at a level that is not part of their responsibilities. Perhaps we expect to much. On the other hand, perhaps providers are to willing to just pass it off as the way it is, its not their responsibility to advocate for patients in this area. There in lies some of the "anomosity" toward providers which may or may not be warrented. Its one thing to say you have to use female assistants because that is all that you can find. But what are you doing to rectify this, have you ever told nursing shools you are actively seeking and want to recruit males specifically to have diversity in your staff, have you ever contacted schools to express this......on the other hand, is that really your responsiblity....I don't know, I am just wondering our loud. For me, I am actively doing small things, contacting hospitals in my area to inquire and request, I have just started a small scholarship in conjunction with a local hospital to provide a small scholarship for males interested in nursing.....anyone got thoughts on who should be doing what here??? alan
I could be wrong, but it doesn't seem that Lisa has been offended by our questions. If she has, I would leave that to her to address. Dodging the landmines of our questions could get frustrating at times I would imagine. But what we have learned is the honesty with which she runs her practice , no ambushing techniques, and (I believe) the willingness to try to see the issue as we see it.
Yes, the subject of who has rights to our body is a very passionate one, and can get quite heated. We all know from posts here and (for some) tragic situations in life that there are alot of additional emotions that go with exposure, and when it appears forced or co-orced dramatic results insue. The patient needs to be the one to fend off any advances that they feel are inappropriate and at a vulnerable time. That is very difficult in hospital situations, but not impossible. It is however much easier in a facility situation. Leaving or not accepting treatment during a planned visit is pretty easy.
My continuing question about training in the med field is one of gender modesty, gender choice, and not just modesty in general. Pulling curtains and placing drapes are quite basic, and doesn't really address the gender issue. Learning that there will be people who prefer not to have certain gender intimate care is the specific modesty question that doesn't seem to get much time or care in training. Not a single 'caregiver' I have spoken with can say that any amount of time was spent on the subject, and if it was they would have considered it a conflict of their interest. My point is that if they honestly addressed it then they honestly would have to be willing to fix it.
I would also point out that most of these people I have spoken with have intimate care issues themselves, and I find it disturbing that they are expecting so much more from patients than they themselves are willing to give.
PT -- Last I knew, we weren't dealing with British English in the U.S. "Collective nouns are seen as a unit, one. That's why they are most often singular. I know it sounds incorrect, but that's the general rule. BTW, don't know what you mean by possessive adjective. "Staff is/are nurses" -- Staff is the subject, "Is" is a linking verb. "Nurses" is a predicate nominative. I will concede that language changes and it seems to be moving more in the direction you indicate. Sorry to get off topic.
Mer and PT:
Not to have tooooo much fun with this; my wife is an editor. Collective nouns are sometimes thorny and PT is right about the use of plural in the UK. However, Mer is right being that we are in the US. Please refer to the following website under the paragraph: Using Nouns in the Collective Class Correctly.
In the original sentence: "We have one male tech and the rest of our staff is nurses.", Lisa is describing the personal attributes of the staff (staff being a collective noun) thus the emphasis is on "staff" not "nurses". If the emphasis were reversed then it could be argued for using "are".
Another way to parse this is to reword the sentence such as: "Our staff [is] made up of one male tech and the rest nurses. Clearly here, the rest of the sentence after "is" is nouns describing the attributes of the collective "staff" - thus singular.
But… if you are in the UK, all collective nouns are plural regardless of the above. So, since I think Lisa is from the US, "is" wins. :-)
My wife suggests using the word "comprises" which gets around the whole issue…..
Now… back to Physical Modesty…
amr
Not JW said
"I personally happen to believe that females in many cases make
better doctors and almost certainly
nurses,than men."
Do women make better astro
physicists,mathematicians and
chemical engineers at the phD
level? Why would medicine be any
different than the above mentioned disiplines? Would your opinion
be different if it was daddy that
gave the cough medicine?
Medical school traditionally
consists of two pre-clinical years
of classroom learning,followed by
two years of clinical clerkship
training. There have been many
extensive studies that clearly demonstrate men make better OB/gyns
and pediatricians than women.
In no way am I suggesting that
women ought to seek a male ob
physician,its a choice. Recall that
many women were allowed into medical school thanks to affirmative sction. I certainly don't think its fair to suggest they make better nurses either
and its comments as such that deter
many men from entering such professions.
PT
A few things..
Marjorie, I apologize. It appears that amongst all the postings, I failed to OK your posting from yesterday until now. I am not deleting postings from anyone on this current thread and hope I never have to do so.
I am not worried about an occasional "off topic" commentary with followup. What it shows is that readers are reading and paying attention to what is written by others. And the "off topic" discussion provides a breathing space for the more difficult main topic.
We are approaching 150 comments on this Volume, I will have to start Volume 26 later today. ..Maurice.
FURTHER NOTICE: AS OF TODAY OCTOBER 24, 2009 "PATIENT MODESTY: VOLUME 25" WILL BE CLOSED FOR COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 26.
Post a Comment
<< Home