Bioethics Discussion Blog: Patient Modesty: Volume 26

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Saturday, October 24, 2009

Patient Modesty: Volume 26




The issue of patient modesty and healthcare provider gender selection and provision is as most of my followers of this topic know a multifaceted complex issue. We can't learn enough about the topic simply by reading the comments of those patients who have found the issue affecting them personally and medically burdensome. We needed to have input from other views but, unfortunately, such visitors with other views are rare here. Nevertheless, we have to able to have a naturist, CSM, in past Volumes and who has returned briefly in Volume 25. We have had a male nude art model, Edo, who is back and with us. And now, we have a female physician urologist, Lisa who is providing us with the insight of the issue in a specialty in which the issue is particularly pertinent.

With this introduction, let's go on with the discussion.. ..Maurice.

Graphic: Physician Performing a Cystoscopy. The original image from the United States National Institutes of Health, modified by me with Picasa3.

AS OF TODAY NOVEMBER 11, 2009 "PATIENT MODESTY: VOLUME 26" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 27.

125 Comments:

At Saturday, October 24, 2009 8:29:00 PM, Anonymous Anonymous said...

We keep touching on the subject that women have changed the way doctors are recruited. There were once only male doctors and that trend has changed because of the actions and outspoken communication by women. So, how did that come to be? Why are we men not able to effectively communicate with providers so that we can be made more comfortable? I keep asking myself what is so different for the women than the men. Well, I think a factor that helped women in this process of change was that there were so many providers already on their side. At last reference, only 8% of nurses are male. I’m sure that number was much lower back when this started. People tend to communicate more effectively and openly when they are surrounded by those who share their same concerns and feelings. I feel that women were couched not to just accept it like we all have been told. These women with concerns had someone to turn to with their feelings, someone to confide in but all we have is women. If their were more males, maybe more males would open up with their concerns? Much like the visitors have done who have come to this site. It’s easier to communicate when you have someone on your side, not when 92% of the providers are telling you that you’re wrong. Jimmy

 
At Saturday, October 24, 2009 11:16:00 PM, Anonymous Anonymous said...

Jimmy makes a very good point. Not only do men have 92% of the nurses telling them they're wrong but 99% of the other support staff, from billing clerks to cnas, telling them they're wrong. A man feels like he's walking into a beauty parlor and demanding a barber.
--rsl

 
At Sunday, October 25, 2009 1:10:00 PM, Anonymous Anonymous said...

You certainly don't hear female patients complaining about this
problem when their mammograms come
due. If you are a male and if you
don't complain and comply its most
likely assumed that you are enjoying it,therefore,you are placed in the exhibitionist category.
A category that could lead to
a cellphone pic of your genitals
and ending up on someones facebook
page,seems to be the rage here in
arizona. If you do comment that
you prefer same gender provider
be prepared for a barrage of comments and odd,surprised looks.
All part of the double standard,discrimination package
handed to male patients for years.


PT

 
At Sunday, October 25, 2009 1:21:00 PM, Blogger swf said...

One of the challenges of opening yourself up to opinions is the possiblity of conviction. Am I a part of a problem that needs my help towards solution? Is my awareness my conviction? If I now know that my actions create harm am I obligated to seek healing and wellness?
Will I take action upon conviction?

Most people wont. They wait for someone to fix the injustices all the while saying you're not doing enough. Others say yes, I see the need but I wont be a part of your solution.

It takes more than the victims of actions to cause a reaction. It takes the help of those who
( perhaps unknowinly) cause the harm as well. It takes humility to see the need in themselves: perhaps the kind of humility they ask so often from others and are unwilling to give themselves.

Dr. Bernstein took the challenge and opened this forum for discussion, and has admittedly learned a few things that he had never been aware of before. That's a humble act.

The challange now is to ask the rest of the medical profession to be a bit humble too.
Be a stepping stone to the milestone.

We shouldn't have to do this alone. If you see it help change it. It is just a basic act of humanity for everyone.

 
At Sunday, October 25, 2009 2:04:00 PM, Blogger MER said...

"Jimmy makes a very good point. Not only do men have 92% of the nurses telling them they're wrong but 99% of the other support staff, from billing clerks to cnas, telling them they're wrong. A man feels like he's walking into a beauty parlor and demanding a barber.
--rsl"


Here we are on the...what...26th volume of this debate? And some are still crying and whining. On an earlier volume, I referenced a Dagwood and Blondie cartoon. Dagwood is sitting alone in his briefs on an exam table. A nurse or doctor comes in and he says he's cold. Why are you in your briefs, the ask? The nurse told me to get undressed. Do you do everything women tell you to do?

Sorry -- but the more I read repetition after repetition after repetition of the same complaints -- the less and less and less sympathy I have for men who just won't speak up for themselves. , Unless your in prison, no one can force you to do what you don't want to do. You can only be imposed upon if you allow it.

Now, don't talk to me about the power dynamic, psychological elements, the power of medical culture and systems -- I've been writing about that in post after post. I know that exists.

But we've got to move on, folks. What are you doing to solve this problem? Several on here, including myself, have commented on specific actions we're taking.

"The challange now is to ask the rest of the medical profession to be a bit humble too.

A significant number of them are humble, are aware of this modesty problem, and are doing their best to deal with it. Good luck with the rest. They'll have to be dragged kicking and screaming into the 21st century. And if that's what we have to do, then let's do it.

This whining and cry-babying is not useful at all.

 
At Sunday, October 25, 2009 2:36:00 PM, Blogger swf said...

I agree Mer. Let me ask you.....
How many people responded to your ideas that you posted? The usual group? How many people resonded to the medical privacy site for help? The usual group? How many people have posted what they are doing for change? The usual group?

I finally removed my email contact. I put it there for people who were interested in helping and all I got was negative nasty comments.

Like it or not, we need the support of the medical community. Not just to agree and sit back, but to be affective in change.
Perhaps we should ask again: who here wants to help make make changes???

 
At Sunday, October 25, 2009 3:25:00 PM, Anonymous Anonymous said...

I don't think taking a realistic look at a problem, in order to define and solve it, is "whining or cry-babying." Clearly seeing the obstacles is essential to overcoming them.

"We keep touching on the subject that women have changed the way doctors are recruited. There were once only male doctors and that trend has changed because of the actions and outspoken communication by women."

Jimmy's point is that women's success in getting female doctors will not directly map on men getting male nurses and support staff because women, in an otherwise female environment, were empowered to complain. It would be naive to expect this from men given the present situation; therefore, other approaches must be tried.
--rsl

 
At Sunday, October 25, 2009 3:45:00 PM, Blogger Maurice Bernstein, M.D. said...

A suggestion: why don't all my visitors who hold the view generally expressed here...all go to the social networking sites including YouTube videos and make the issues known to the general public (and I am sure a bunch of doctors and administrators access those sites too). Start now. You can refer to my blog (and most likely Dr.Sherman's blog)as an additional resource (but I am not recommending this out of blog self-interest, trust me!) But every visitor with the same view, male or female should get to it..and keep posting on those sites. I understood that President Obama certainly was helped into the job he now bears because of such internet sites. Do it! ..Maurice.

 
At Sunday, October 25, 2009 4:30:00 PM, Anonymous Anonymous said...

"Sorry -- but the more I read repetition after repetition after repetition of the same complaints -- the less and less and less sympathy I have for men who just won't speak up for themselves."
Thats not fair mer. Some people aent as strong as you.
"Most people wont. They wait for someone to fix the injustices all the while saying you're not doing enough. Others say yes, I see the need but I wont be a part of your solution."
swf Not evryone can be an advocate.

 
At Sunday, October 25, 2009 4:43:00 PM, Blogger MER said...

"It would be naive to expect this from men given the present situation; therefore, other approaches must be tried."

I'm not convinced of that, rsl. I have higher expectations of men. Men need to realize that taking a stand for who you are and what you believe in is masculine, not wimpy. I believe that most women respect strong men who know what they believe in (assuming what they believe in is not criminal or unethical) Men will have to risk being called sexist by some (a minority, I believe) of feminists. Can men take the hits and reasonable argue their case? It's all about gender equity and sexual discrimination, folks. Gender equity doesn't translate as women's rights.
On the last volume, I posted a set of guidelines from a Toronto hospital for how they dealt with patients asking for specific gender (and other) care. The guidelines seem pretty reasonable to me. Did anybody read it? I saw no responses to it.
I'm sending it to several American hospitals, asking them to send me a copy of their policy on this issue. I'll bet most don't have any written policy. When you have no written policy, you can pretty much do what you please, which is what most do.

Read that guideline. It's not perfect, but it's a start. It clearly separates those who want specific care because they are racist or sexist -- from those who are just embarrassed or humiliated. It outlines a protocol for caregivers to go through. It doesn't promise anything -- and it's certainly written from the caregiver point of view -- but it opens up the discussion and includes the patient.
This is one thing we can do. Pressure hospitals to deal with this issue -- in writing. Written policies. Force them to discuss this issue in terms of how they will specifically deal with it.
Good advice from Dr. Bernstein about using youtube and other social networking outlets. Anyone want to start a facebook page on this topic? If you do these things, expect to take the hits. You're gonna get them. Plan for it.
Go for it.

 
At Sunday, October 25, 2009 5:04:00 PM, Blogger Maurice Bernstein, M.D. said...

MER,if someone doesn't want to "take hits" when expressing possibly a controversial issue, one might as well "curl up" and resign themselves to the status quo. ..Maurice.

 
At Sunday, October 25, 2009 5:36:00 PM, Blogger MER said...

I agree, Doctor. But don't you think that's part of the problem? The intimidation factor. As with a formal debate, the idea is to expect challenges, be ready for them. Anticipate the arguments on the other side. Prepare counter arguments. Knowledgeable patients need to go into these situations with, not swards drawn, but with their hands on the hilt -- ready for possible confrontation. As I've said before, don't go looking for a fight. Have high expectations of the health care system, and let them know you have those high expectations. But be ready.
Those who are not prepared for rational confrontation give in, get angry, or get lost. I might even suggest that it might be worth the effort to carry with you handouts like a copy of those guidelines from that Toronto Hospital. If you run into trouble getting same gender care, consider handing a supervisor those guidelines. Say you'd like to see their guidelines.
By the way, Doctor, does your hospital have written guidelines similar to the ones I posted? If not, why not? Would you consider trying to get some established?

 
At Sunday, October 25, 2009 6:55:00 PM, Blogger swf said...

"swf Not evryone can be an advocate"
Please don't misuderstand and make this term bigger than what it is. I personally do not expect people to "march for modesty" and am not picketing facilities who are not offering same gender intimate care. I just speak up because I believe men and women deserve the same choices.
And in all honesty at some point you will be face to face with a 'caregiver' and the responcibility of your body will be yours.
Now, letters, calls, surveys, websites, handouts, will all be very useful in setting the atmosphere of respectful care conversations. It may even help people realize the it is not the disscussion that is embarrassing, it is not having it that leads to problems. We can advocate from here to heaven, but we can't be with you when the important conversations need to happen.
In the end, everyone will have to get used to speaking up and being their own advocate for their own body.

 
At Sunday, October 25, 2009 9:24:00 PM, Anonymous Anonymous said...

I've tried to illustrate a number of points while posting to
these threads. Female providers
from clerks,nurses and physicians
have no interest whatsoever in
making accomodations for male
patients. Its simply not in their
interests to do so as we've seen
comments from female providers such
as orange and keagirl.
They may post comments but their
real intentions are manipulating
and disingenuous. I would very much
like everyone hear to visit this
site regarding a female urologist
and her comments at the bottom of the page regarding male patients.

www.nytimes.com/2008/09/09/health/
09urol.htm

Sould anyone think her comments
lame I have literally thousands of
others that are not. The mentality
seems to punish men for some reason
or another.


PT

 
At Monday, October 26, 2009 12:00:00 AM, Blogger MER said...

I read the article, PT. Interestingly, you hear the same from male nurses in a female dominated environment -- that the women talk about topics that surprise, embarrass and even offend the male nurses. I think you see that in any field dominated by one gender. At the end of the article, of course, we see what you're talking about -- the female urologists says to the male patients that she's the doctor that's there so basically take it or leave it. There's the attitude that men better just get used to this. We do see the attitude of gender neutral embedded in the point of view. So -- we need to educate these doctors. I marvel at their medical knowledge. That doesn't make them experts in human psychology or gender studies. There's a lot they need to learn from their patients.
Note, too, that this article is written by a male. Too many men feel the need for approval by women. That seems necessary for them to acknowledge their own masculinity. They will write what they think women want to hear. And, frankly -- with women moving into more dominant roles in all aspects of our culture, especially the professions -- some men see the writing on the wall and may be consciously or unconsciously positioning themselves to be on the (politically) correct side. The social trends show women moving into and dominating most areas of our culture related to communication.

 
At Monday, October 26, 2009 12:21:00 PM, Anonymous Anonymous said...

I think it definately will be harder for men for several reasons, not the least is men are not seen as a minority, do not fall into the protected catagories by and large and therefore its not very common to identify discrimination with males. It is not policitcally correct to view men in this light. Second we have been condictioned to suck it up and shut up. And as mentioned when your entering an area with a 92% vs 8% dispairity you are facing some pretty tough odds.....that said, if blacks in the 50's and 60's had accepted they were a minority and the road was to tough where would they be today, women went to the streets for the right to vote, while technically not a minority in numbers they faced the same power dynamics blacks did. No one said it was going to be easy. While I might not go quite as far as MER, its not as easy to stand up when you are face to face with the situation knowing the gender dispairity may make it impossible to be accomodated and requesting/demanding will only shine the light on it....the social environment we face to day is much less daunting than blacks and women faced. We will not have our houses or churches burned for advocating, we will not be beaten or worse for demanding equal treatment...and as pointed out above, there are many ways to advocate. The Martin Luther Kings of the world are a rare breed. But anyone can send a letter to your hospital, to your local school guidence counselor, send an e-mail. These are pretty non-threatening, not a lot of intimidation there. Small steps, but they are steps and it makes it easier for you to take the next step.....sort of like voting, it validates your right to bitch. Whats the saying, if your not part of the solution your part of the problem. You don't have to chain your self to an ambulance but if you haven't done something as simple as send an e-mail or letter...it does become just complaining....alan

 
At Monday, October 26, 2009 1:57:00 PM, Blogger swf said...

I agree that we have to move on to positives, progress, and what is being done about this, but there are a few posts that I have been battling to try to understand.
Not the words or premise, but the confliting emotion behind them. As a woman if I get this wrong, I am counting on the men to correct me.

There are many posts that critisize female 'caregivers' and also defend them, sometimes within the same post. While confusing, I have to interpret that as a sort of chivalry: that men do still want to protect and defend women despite what they may be personally feeling.
However as women, we can feel free to say these things because we have no inner need to protect their gender. And, women can not really throw feminism in each others faces, so we feel free to toss the cards on the table. Perhaps that is why some men here keep cautioning not to judge so harshly (chivalry) and women feel freer than them to do so. (no gender harm or feministic repercussions)
That's not an excuse to not speak up, I'm just saying it must cause some conflict for some men, and I see it in posts that reflect both messages in the same place.

This is not meant to be a new revelation....I am just trying to understand certain things better instead of assuming and just moving on.

 
At Monday, October 26, 2009 2:04:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I looked at the original post for your picture, I find it interesting that the patient and the provider were both female....so what is the underlying or subconcious inference that we have a female urologist which is a rarity doing the exam on a female patient. Is the author indicating they recognize the sensitive nature of the procedure by using same gender provider/patient???? are they sayin this (same) gender.....alan

 
At Monday, October 26, 2009 2:26:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, interesting point. I'm glad you checked the link. Actually, it appeared to me the patient was female and I tried to blur the genital area and cover with text to make the patient gender uncertain for the graphic but probably to no avail. I actually thought the doctor appeared gender uncertain.

Yes, if both were females, I also would wonder if there was some subtle message the artist and/or the NIH were trying to express with regard to patient modesty. ..Maurice.

 
At Tuesday, October 27, 2009 5:22:00 AM, Anonymous Anonymous said...

SWF I don't know about anyone else but for my part I am trying not to read intent into the actions of female providers. While I have a strong preference and feel strongly the medical community has downplayed or disregarded this aspect of care for their own benefit I have trouble catorgorizing individual providers as being malicous or evil. I beleive to a large degree many take the path of least resistance which is the status quo. The instituion gains efficiency through pushing the gender nuetral agenda, this equates to profits. Individual providers buy into it for numerous reasons because it is what their employers want, because its what they are taught, and becasue it is easier for them. Now, that doesn't mean I give them a carte blanche pardon, I do not think it makes them evil. I think its important to acknowledge the reason many of them do it, but it doesn't excuse them. I think its easy to interpet this as playing both sides of the fence. Where the understanding ends is the fact that I definately believe individual providers recognize the fact that it is uncomfortable for patients and 1st off attempt to ignore it 2nd fail to acknowledge it even exists 3rd fiegn ignorance, and 4th fail to do anything about it thus through their leming like behavior perpetrate the problem. That said, I do not take it so far as to think they committ these transgressions from malice but more from lack of will to correct it. Doesn't mean I excuse them...just understand.

Lisa
I have to call you on a couple things. I have been so pleased to have you in the conversation I didn't want to come off as challenging or aggressive so I let a couple qustions slide. I have to tell you I really enjoy the intellegent insight and counter points you bring. I also have to admit I was a little impressed and amused with how delicately you answered the questions...kind of. I was going to let them slide but swf's comments may have made me rethink. Two questions I asked that I would like a little more clarity on if you would. (1) when I asked what the gender of your GYN was, you answered it was easy for you to choose you used the same one your mother did, the practice had a female and two males...so, whom do you use, the female or one of the males...not condemning just curious (2) I asked if you sensed your male patients were more uncomfortbale when there was a second female in for proceedures requiring exposure such as cystro's...obviously this is just a perception on your part, maybe you answered but I didn't comprehend....thanks everyone...alan

 
At Tuesday, October 27, 2009 1:04:00 PM, Anonymous Anonymous said...

I guess I should clarify and apoligize for my earlier post. It was just a thought I had in trying to determine what the difference is between men and women who have spoken out on this subject. It has been noted numerous times that men simply don’t speak and clam up but women have spoken against this and have had success in forcing change. That is true and I agree that everyone should stand up for what he/she wants but you still have to have some type of support system for you to feel comfortable to do that. I was just simply posting a factor that I think contributed to women getting to the point that they are today and finding that strength that they needed in the beginning just to get started. That’s it… Didn’t mean to stir up something and wasn’t whining or crying, just a factor that I thought we haven’t considered or touched on in these 26 volumes. Jimmy

 
At Tuesday, October 27, 2009 3:54:00 PM, Anonymous Anonymous said...

I understood you perfectly, Jimmy. Without support, in an environment that was 99% male--including staff--I seriously doubt that women would've just up and complained either.
--rsl

 
At Tuesday, October 27, 2009 4:54:00 PM, Anonymous Anonymous said...

There are a couple of points I'll
have to add to your comments Alan
in regards to providers. You've
suggested that behaviors are not committed through transgressions of malice.
How then do you account for acts
of unprofessional behavior among
many female providers? Some people
are just bad apples from the get
go before they considered health
care as a career. To many its just
a job,a paycheck and whatever perks
come along. Human history has
demonstrated time and time again
what happens when some have power
over others,abuse.
You don't need to take my word
for it,simply look on the internet
and one can find examples at every
single facility. What you have is
a gender in healthcare that has
barriers of protection for their
own while disregarding others.
That's discrimination and no
more different than telling a black
person to take a seat in the back
of the bus. It is not a rosey
picture as some might think. No one
in the general population and many
hospital employees for that matter
will know or hear about all the
bad things that happen to patients
that are acts of malice.
Remember malice is often a
byproduct of authority,abuse through power.


PT

 
At Tuesday, October 27, 2009 9:51:00 PM, Anonymous Anonymous said...

I would like to respond to MER about his comments about the Toronto hospital UHN. I was unable to link to the document from your post. I had to go onto their website and dig to find the document. It was not easy to find and I’m sure I would not have ever seen it had I not been specifically looking for it. Having been a patient who has requested a female physician (I am female) I was told quite clearly that TTH is a teaching hospital and that if I do not take who I am assigned they will simply not see me. This is quite acceptable according to the College of Physicians and Surgeons of Ontario. You see, the students take priority over patients. I have had the same problem at St. Mike’s. Someone on this blog once mentioned St. Mike’s radiology policy on same-gender care. I had to look to find that one too. At St. Mike’s there was no mention of that policy when I registered, nor did I hear the receptionist mention it to any other patients. Please, don’t hold these institutions in such high esteem. I believe these policies are buried in the depths of their sites for a reason. I have worked in teaching hospitals for almost two decades. I know now what to expect. And yes, I have had to refuse care and walked out. Patients are not the priority, we are teaching aids. You would think in a city as culturally diverse as Toronto things would be different.

Dr. Bernstein, I would like to thank you for this blog. I have learned a great deal. I have been told by friends and by medical professionals that I am foolish, stupid, irresponsible etc for my beliefs and feelings. It is nice to know that I am not alone.

J.

 
At Tuesday, October 27, 2009 10:15:00 PM, Blogger MER said...

Doctor:
Did you get a chance to read the Caregiver Preference Guidelines I referenced from that Toronto hospital? If you read them, what do you think?
Does your hospital or any you know of have similar guidelines?
Do you think such guidelines are necessary or unnecessary; useful or useless?
I would like to hear your thoughts on this.

 
At Wednesday, October 28, 2009 4:00:00 AM, Blogger MER said...

J -- I'm providing that link again:
http://www.uhn.ca/About_UHN/corporate_info/reports_statements/docs/Caregiver%20Preference%20Guidelines.pdf

It works fine on Dr. Sherman's blog where I also provided.

What you describe, J. is the abyss that exists between the operating mission and principles hospitals claim and what they often practice. I suggest those on this blog look at this set of guidelines, print it out, carry it with them to the hospital, ask to see the guidelines of that particular hospital. Challenge these medical professionals.

J -- This document is dated Sept. 4, 2007, so it's relatively recent. We as patients cannot let hospitals get away with the kind of dishonesty you describe. We need to challenge them -- and if they don't respond to us, go public. I would bet, these days of health care reform we could find a television, radio or newspaper reporter interested in writing a story. I could see one of those on this blog, armed with all the mission statements and policies regarding privacy, going into the hospital undercover to see if these operating principles are really adhered to.

J -- it's not a question holding these hospitals in high esteem. It's a matter for us as patients to demand that they live up to the professional codes and standards they claim to profess. They need to be reminded.

It was easy in Socrates Athens to say to say you believed in justice
virtue, courage and equality. But Socrates challenged you to actually define these concepts and give examples. When people tried to do this, they often dug themselves into a whole and they learned that these concepts were not so easy to define.
We need to force medical professionals to explain and define what they mean by privacy, modesty, dignity and respect. We need to remind them that patients have a voice in defining these terms.

 
At Wednesday, October 28, 2009 6:37:00 AM, Anonymous Anonymous said...

Dr. B: Could you post the direct link to the UNH site MER is referencing? I also was unable to locate it.

JW

 
At Wednesday, October 28, 2009 11:27:00 AM, Anonymous Anonymous said...

It seems as though much of the conversation on this blog is like a competition. Which gender providers are less/more sensitive? It's not the gender of the provider. It's the gender of the provider in context with the gender of the patient and opposite gender care. It is my opinion that if less focus were put on this "no win" argument (that simply said means that either one sex or the other responds more to this blog) and more focus were put onto the issues that effect both genders, we would accomplish more because these issues are essentially the same.

Here are the issues as I see them. First, in order to get the medical industry to address gender issues, there has to be harm that not addressing them causes. Second, those aspects of harm need to be identified so that protocols can be established to protect patients and alleviate that harm.

Reasons that patients feel violated are many. Among them is a lack of respect, insensitivity, and yes, abuse. Abuse means any behavior that is done with malice in mind. It is terrible to say, and even worse to admit, that this kind of thing goes on from the lowest of positions in healthcare to the highest. When we look at healthcare providers we must acknowledge that they are simply a segment of the population and as such, will contain all segments--both good and bad. Some of these segments are people who are deviant who gravitate to healthcare because of opportunity and patient vulnerability.

Those who don't agree can object all they want, however, we see it documented in elder care abuse, abuse of the disabled, abuse of the mentally ill. What constitutes abuse? Anything that will do harm to the patient. How do you define that when different things harm different people? Very easily. Privacy violations, humiliating patients, loss of autonomy and more.

I've said this before. A research study must be done to recognize the psycho social aspects of medical care that cause psychological damage. Analyzing patient experiences in bulk will show a patterning of sorts and a basis to work. Second, once those aspects are identified, protocals or changes to the way things are done (probably putting the focus on treating both the mental and physical aspects of illness).

Third, at the very least, those at high risk for re-traumatization are those who have suffered previous offenses and have a background or ptsd (that is recognized as a disability).

Wihtout showing that current behaviors and attitudes are showing harm, there is little hope for change.

At the core of these discussions is the emotion called "humiliation". The effects are devastating so much so that sexual humiliation (and cruel and degrading treatment) is now documented as doing more harm than physical torture does to victims of war. While I'm not suggesting that what happens in hospitals is always cruel and degrading, the experience is "in the eye of the beholder".
Marjorie Starr a/k/a bjmd
Marjorie Starr

 
At Wednesday, October 28, 2009 12:50:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, thanks for the reminder. I have been so busy with ethics consultation issues at my hospital and my teaching responsibilities that I whizzed by your previous request. Actually, for the information of my visitors, I cannot devote full time to this blog so there may be a number of hours elapsing before what is written is finally published. But i intend to moderate the comments as soon as possible and usually in the same day. Don't give up if you don't see it published within a couple of hours, I'll get to it. Again, MER, thanks. ..Maurice.

 
At Wednesday, October 28, 2009 1:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is the active link to the University Health Network of Toronto, Canada and the PDF file which describes their policy. ..Maurice.

http://www.uhn.ca/About_UHN/corporate_info/reports_statements/docs/Caregiver%20Preference%20Guidelines.pdf

 
At Wednesday, October 28, 2009 4:40:00 PM, Anonymous Anonymous said...

I've certainly never implied that
it was a competition among which
genders are more or less insensitive. The perspective is
from my viewpoint being a male in
that 93% of nurses are female. That
99.9% of medical receptionists are
female and that 99.1% of emergency
room registration clerks are female and these statistics are stacked against male patients.
That annually 80 people die each
year from lightning in the united
states. Your chances of being hit by lightning are .000032%,now these are statistics stacked
against everyone!


PT

 
At Thursday, October 29, 2009 5:56:00 AM, Anonymous Anonymous said...

Yes, PT, we are all speaking of our experiences. While I agree with you, for women the stastistics are also stacked when you look at the abuse factor. One in 6 women are sexually assaulted over their lifetime; one in 33 men. 90% of sexual deviancy cases are men abusing women. So...in this way I look at things the same way you do.

You are not the only one (and rightfully so) that is upset with the imbalance of female/male nurses. It is people like you who will change the system by rejecting female care for intimate procedues. This is exactly the reason that women seem to be getting more what they need.

I would agree with you except in a hospital setting where, in the OR, ER you have little choice (for either men or women) and we must fight for what we believe.

Whether someone was traumatized or not, harm can be defined as avoiding procedures due to embarrassment or humiliation. It is a huge problem with solutions, however, the medical community refuses to accept that gender of the provider (when important to the patient), makes all the difference.
Marjorie Starr

 
At Thursday, October 29, 2009 5:24:00 PM, Anonymous Anonymous said...

Mammography is just one of the many
services offered at UHN hospitals,
yet all the mammo techs there are
female. Yes,I checked.
As I see it mammography is the
hallmark of which all double standards in healthcare are based.
Now,if you look at their care
giver preference guide, sex of the
care giver is included in the mix
and as such I see it as a farce.
What if a female patient wanted
a male mammographer,then what.Could
you imagine the comments that might be made? No way in hell could
that facility accomodate her,let
alone any other facility in Canada
or the United States.
Would they think it odd,yet any different if a male requested a female nurse. Take a look at the
flow chart. In the time it takes to
read through the flow chart they
could have called a male nurse.
Its no better in Canada or
australia as 94% of nurses are
female.


PT

 
At Thursday, October 29, 2009 6:40:00 PM, Blogger rev. fred said...

As a seasoned, veteran pastor, I have had the experience of visiting hospitals and nursing homes, with high frequency, for 37 years. Hospital/nursing home ministry is not very fulfilling of my many responsibilities, due primarily to the repeated violations of dignity, privacy, and modesty of my flock. Called to the ER by the patient request, I spoke to a female nurse at the desk, introducing myself as the pastor, and that my presence had been solicited. Also, you should be told that I was wearing a clergy collar. The nurse told me that she had just left the patient, and that it was alright for me to go in. Prior to any entry, I announce my identity to the occupant. Walking in, I discovered my parishioner stripped naked from the crown of her head, to the soles of her feeet. No, she did not kick-off her cover; she didn't have any! Immediately, I went for a stack of sheets found on a chair, and covered the lady. The patient was groggy, but recognized me. Please understand, that absolutely under no circumstance would I intentionally intrude into the room of any woman or man, in such an embarrassing situation. I violated my church member; and the nurse violated both of us. I regret that I did not report her to the supervisor. One of the bloggers has repeated cautioned that you do not go to a hospital looking for trouble. I go with my notepad and pen, prepared to write-up, commendable as well, as unacceptable behavior. A short while ago, I concluded a visit at an out-of-town hospital. Aboard the elevator with a group of female nurses, one of them discussed an adolescent male visitor who had fathered two out-of-wedlock babies. Next she proceeded to broadcast that her 13 year old son was having sex with a 16 year old girl. If she would publicly comment about a visitor and her son, am I to assume that I would be exempted from her tongue? With bread and unfermented wine on a stand, observing holy communion with a patient, I've witnessed a nurse interrupt, questioning if she had a bowel movement! Kneeling by the bed for prayer or linking hands with a family for intercession, nurses have been known to enter and simultaneously perform unnecessary tasks. Be assured, I am committed to this movement. Never discount the enrollment of people of faith with this issue. Religious reasons are not the only argument for same gender intimate care, privacy and and dignity; but one with a long tradition, which can be used to substantiate the cause. With the growing number of Moslems and the influx of immigrants from the Third World, already we are witnessing a challenge to the assumptions of the medical world in this country. It would be prudent to latch onto the coattails of the Moslems with this subject. Creating a coalition of kindred spirits, the subcultures of Mormons, Orthodox Jews, Mennonites/Amish, Holiness sects, and clergy like me, can join the parade, and turn-around policy.
-REV. FRED

 
At Thursday, October 29, 2009 7:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Rev. Fred, I am so pleased that you have been able to post your comments directly to these threads.

I certainly cannot defend your experience with the nursing profession and you might even find physicians who would cause your mind to wonder "what are they thinking about by their behavior..or are they even thinking?" Unfortunately, under work pressures and because of a lack of awareness of their own unthinking behavior, such events that you described will happen in many hospitals and clinics.

When stuff like what you describe happens, you have to act on it.. tell the nurse in the elevator to "shut up" and/or point to the sign in the elevator that is present in virtually all hospitals regarding non-allowed communication during transit. Or that nurse that led you to the naked patient---that inattentive nurse could be the very one who will overdose the patient on an IV and not realize what she had done. ( Excuse this Disclaimer: Fellow thread readers, I use "she" only because of statistic probabilities repeatedly noted here about the gender ratio of nurses--I will admit that there could be non-thinking male nurses too!)Report that individual to the Administration with the details of your observation. ..Maurice.

 
At Friday, October 30, 2009 6:30:00 AM, Anonymous Anonymous said...

Who said the "accident" regarding the nurse and the naked patient was accidental.

It is imperative because such an accident can be accidental, that documentation of each incident be in every employee's personnel chart. There are too many hard working wonderful employees, and too much damage to patient's from such an incident that without charting these incidents, employees you have ill intent can continue their behavior. For everyone else involved in an "accident" more training and consequences for repeat offenses should also be noted. Whether an accident or on purpose, the patient is the one suffering and there is no excuse for this kind of incident to occur at all.
Marjorie Starr

 
At Friday, October 30, 2009 4:37:00 PM, Anonymous Anonymous said...

Rev. Fred

I believe your comments
as I too have seen this countless
times. I've been a victim of this kind of disrespectful behavior as well.Few of these incidents are
accidents and I see it as a disconnect in advocating for the patient. This behavior is simply
one of many steps where there is
failure in patient advocacy. It
certainly can take many shapes and forms.
Certainly,its unfortunate that you did not make a complaint
about this. Interestingly by now
one would think that everyone in
healthcare knows not to gossip in
the elevator. It is a trademark
used as examples by human resourse
do's and dont's regarding hippa
violations.
People need to realize that family and visitors to hospitals and facilities have a
lot of power in bringing forth complaints, the kind that can
effect change for the better.
It is definitely ironic
when you read about providers
complaining about the treatment they or their family have recieved
while in the hospital.


PT

 
At Saturday, October 31, 2009 11:56:00 AM, Anonymous Anonymous said...

PT I concur with your observations and remarks regarding a female patient requesting a male healthcare provider. It is norm (or more acceptable) for a male patient to request a female however, turn it around and it does seem very odd indeed doesn't it if a female patient were to request opposite gender care for any reason but for the reason some men use -- homophobic. What about a female patient being homophobic if a female touches her in private parts? Same situation but somehow we don't hear about that, do we?

JW

 
At Saturday, October 31, 2009 4:27:00 PM, Anonymous Anonymous said...

JW, You're right. It seems that women and men are equal but different. I've thought about this gender issue from the male perspective. It's a split. Some men prefer female care. Some men are really uncomfortable with men taking care of their intimate needs and the rest are uncomfortable with women taking care of their intimate needs. Too bad there isn't a third sex! I do think it's biologically linked to strong feelings of distaste to heterosexual men regarding the slightest implication of homosexuality even when there is no implication. The implication is the unclothed body and that's enough to send men running.

Women on the other hand do not feel this same homosexual threat from other women and given the vulnerable supine position women need to take during intimate exams, it's too close to a sexual encounter. Furthermore, women are culturally taught that their sexuality depends on how they look.
What could be worse than a medical encounter when you look terrible and have to be naked in front of men?
Marjorie Starr

 
At Sunday, November 01, 2009 10:32:00 AM, Anonymous Anonymous said...

Mens fears of homosexuality with
reference to male providers is a
misconception as I believe it is
a myth brought on by female providers to maintain the status
quo.
Most men see male physicians so
tell me,whats the difference? The
percentage of male nurses are at
about 7% which by the way would be
much higher if not for the nursing
programs across the nation which
for years have worked hard to
dissuade men from nursing. Much
worse to ellicit their failure
rather than foster an environment
for their success.
In all the years I worked in
healthcare I've only thought 2 male
nurses were gay. I've certainly
learned of many female nurses that
were gay but then you'd never know
it.
In 2003 about 287,000 women
sought breast enhancement surgery
of which 92% of those surgeons
were male,apparently they thought
it was worth it to look terrible
while naked in front of men.
Certainly, they could have chosen a female plastic surgeon
as in 2003 there were plenty to
go around. The fact is men just
are not given the same choices as women in healthcare.



PT

 
At Sunday, November 01, 2009 4:00:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, you wrote:
"The
percentage of male nurses are at
about 7% which by the way would be
much higher if not for the nursing
programs across the nation which
for years have worked hard to
dissuade men from nursing."

What documentation do you have for that statement regarding the nursing programs and dissuading men from nursing? If that is happening, is it a policy of the nursing schools admission committee? It is hard to believe when physician education ends up with virtually 50-50 percent male vs female students. On what rational and humanistic, legal and ethical basis could nursing schools have support for such a restriction of male gender nursing students? How is tha pay for male vs female nurses in terms of experience in practice or specialty? ..Maurice.

 
At Sunday, November 01, 2009 5:19:00 PM, Anonymous Anonymous said...

Women do not nay better chance getting same gender care in an operating room as most OR's are mixed gender and asking for same gender is like asking them to stand on their head.

My comments based on sexuality confirmed social behaviors is just that. Your sarcastic remarks justifying why women go to male surgeons is simply in defiance of someone else's knowledge base or opinion and not appreciated.
Marjorie Starr

 
At Sunday, November 01, 2009 5:35:00 PM, Anonymous Anonymous said...

Dr. B,
When PT said "dissuade," I got the impression he was not referring to open discrimination in admission, any more than female doctors were overtly treated in the past. My take is that he's talking about lack of outreach and support for male students and a subtle culture of discouragement once they do attend. To wit, I've also noticed that the ads for CNAs, MAs, etc., both TV and print, virtually never depict males, a few of them actually hinting at a preference for single mothers. Contrast this to the recruitment efforts in unemployment offices to train women--and ONLY women--for construction jobs. (I've wondered about that. Indigent able-bodied men are offered low-paying menial jobs, while women are begged to train for high-paying construction jobs that the guys would kill for.)

So while there are no armed radfems guarding the door to the admissions office, there is nothing resembling a welcome mat either. Nor a hint of affirmative action. And, in total agreement with PT (usually), I think their outreach is purposely muted and probably non-existent.
--rsl

 
At Sunday, November 01, 2009 7:13:00 PM, Blogger amr said...

Lo and behold - on facebook today, there was an ad specifically recruiting males to become nurses. I'm sorry I didn't take a screen shot and link to the school.... But at least one school is actively going after men.

amr

 
At Monday, November 02, 2009 1:01:00 PM, Anonymous Anonymous said...

There is a study published by the BMJ in 2004 that analyzes the gender makeup in healthcare occupations and how it changed from 1971 to 2001 (a 30 year period) in New Zealand. The entire top 10 healthcare occupations that were female dominated remained female dominated but only 1 of the top 10 male dominated remained male dominated. The term dominated was used if 90% of those employed were of the same gender. Be sure to click on Table 1.

From reading this blog many already know & have stated this but I have never seen the results documented and presented. The good news is that things are balancing out in the male dominated healthcare occupations (except for surgeons) much to the delight of our female visitors no doubt, but the bad news is that things are not balancing out in the female dominated healthcare occupations much to the ire of our male visitors. I do think patients having choice, including gender choice, is a always a good thing, the patients get the services they need with whom they are comfortable with, the providers can also see whom they are comfortable with, if that is an issue for them. It’s a win-win. So why aren’t men going into these female dominated healthcare occupations? ...Dan..


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC314508/

 
At Monday, November 02, 2009 2:57:00 PM, Anonymous Anonymous said...

Marjorie said

"Your sarcastic remarks justifying
why women go to male surgeons is
simly in defiance of someone else's knowledge base or opinion
and not appreciated."

My comments are based on statistical data which by the way
are readily available from the

American association of plastic
surgeons and the america society
of plastic surgeons. Data which is readily avaliable to the public,
provided that you are willing to
dig for it.

Maurice

Its well documented that for years male nursing students were
discriminated and frowned upon.It
is not my goal to diluge your site
with websites that certainly do
add light to this,however,one only
needs to look at mammography to
see the extent that males of various displines and modalities
were and have been discriminated
against.
The requirements to perform
mammography are a two or four
year certificate from an accredited
college in radiologic technology.
Successfully passing a comprehensive test strictly administered by the ARRT,only then
can one be allowed to "cross train"
into mammography, a process that
takes about 3 months. There are
over 265,000 registered medical
radiographers in the united states.
I said registered and I got that
number from the ARRT.org in minnesota. Additionally, one must
be licensed in their state as well. Some states,a few don't have state requirements,those that do
keep statistics on hand as to age and gender of technologists and
modality.
There are over 22,000 medical
radiographers in the state of California alone. About 8500 of
these radiographers are male,not
one works in mammography. As
previously mentioned,one must be
cross trained in mammo. It is not
a skill that is taught at any
college or university.
Does this suggest that men
simply don't ask to be cross trained,or are such educational
requests denied. You certainly
cannot at least to a large degree
discriminate against male candidates at nursing programs,
but you can discourage them at
every step of the way.


www.lasvegassun.com/news/2008/may/27/man-woman-nurse-engineer/


PT

 
At Monday, November 02, 2009 3:40:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I don't intend to challenge your statistics myself but I would appreciate, for the benefit of all who would like to look at the resource where you obtained your figures, if you would provide us links, if possible, to those resources. It shouldn't really take much effort on your part but it would be a valuable contribution to those who find the statistics of sufficient interest to follow up. By the way, this comment is not just to PT but to all (though I do say that MER and some others have generally been good examples to follow in this regard).

My philosophy about this blog is that it should be more than a "hearsay" but a blog where the discussions can be referenced as appropriate to the comment. ..Maurice.

 
At Monday, November 02, 2009 4:34:00 PM, Anonymous Anonymous said...

If you look at healthcare as a supply and demand issue, like any other commodity, it is simple to see why certain jobs are linked to one gender or the other. Someone mentioned mammography and it boils down to the same argument. It is not about the provider, it's about the patient.

I know for a fact that Sloan Kettering uses male mammographers because someone I know was a patient there. A mastectomy patient who was very upset at the thought of having a male mammographer. She had no doubt as to his competency, however, she was not likely to expose herself and simply refused.

Why are some more concerned about the welfare of the clinician, rather than the welfare of the patient?

Title VII has the privacy exclusion for a reason. Those of you who don't want to recognize it are the brunt of the problem. Time to start thinking of the patient, their needs, their feelings.

Looking at the basic 50/50 split with gender, there are plenty of jobs for everyone in every field they want to go into. Not everyone has a problem with opposite gender care under intimate circumstances. However, there are many who are afraid to speak up, feel humiliated and avoid healthcare in the future. Why should sick patients be put into this position when a simple question and alteration of the current system would solve all the problems?
Marjorie Starr

 
At Tuesday, November 03, 2009 7:30:00 AM, Blogger Maurice Bernstein, M.D. said...

Regarding the issue of excessive or unnecessary pap smears taken in the context of patient modesty which was previously commented about on these threads, here on the next Comment or two is the Summary of latest recommendation from the U.S. Government and the full description can be found on the U.S. Dept of Health and Human Services website. ..Maurice.

 
At Tuesday, November 03, 2009 7:32:00 AM, Blogger Maurice Bernstein, M.D. said...


Screening for Cervical Cancer
Recommendations and Rationale

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for cervical cancer and the supporting scientific evidence, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition1.
Summary of Recommendation



The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix.

Rating: A recommendation.

Rationale: The USPSTF found good evidence from multiple observational studies that screening with cervical cytology (Pap smears) reduces incidence of and mortality from cervical cancer. Direct evidence to determine the optimal starting and stopping age and interval for screening is limited. Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years (go to Clinical Considerations). The USPSTF concludes that the benefits of screening substantially outweigh potential harms.


The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer (go to Clinical Considerations).

Rating: D recommendation.

Rationale: The USPSTF found limited evidence to determine the benefits of continued screening in women older than 65. The yield of screening is low in previously screened women older than 65 due to the declining incidence of high-grade cervical lesions after middle age. There is fair evidence that screening women older than 65 is associated with an increased risk for potential harms, including false-positive results and invasive procedures. The USPSTF concludes that the potential harms of screening are likely to exceed benefits among older women who have had normal results previously and who are not otherwise at high risk for cervical cancer.


The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease.

Rating: D recommendation.

Rationale: The USPSTF found fair evidence that the yield of cytologic screening is very low in women after hysterectomy and poor evidence that screening to detect vaginal cancer improves health outcomes. The USPSTF concludes that potential harms of continued screening after hysterectomy are likely to exceed benefits.

The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer.

Rating: I recommendation.

Rationale: The USPSTF found poor evidence to determine whether new technologies, such as liquid-based cytology, computerized rescreening, and algorithm based screening, are more effective than conventional Pap smear screening in reducing incidence of or mortality from invasive cervical cancer. Evidence to determine both sensitivity and specificity of new screening technologies is limited. As a result, the USPSTF concludes that it cannot determine whether the potential benefits of new screening devices relative to conventional Pap tests are sufficient to justify a possible increase in potential harms or costs.


The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer.

Rating: I recommendation.

Rationale: The USPSTF found poor evidence to determine the benefits and potential harms of HPV screening as an adjunct or alternative to regular Pap smear screening. Trials are underway that should soon clarify the role of HPV testing in cervical cancer screening

 
At Tuesday, November 03, 2009 9:25:00 AM, Blogger swf said...

Advocates: I have the primary logo ideas posted on "MIAB" and working on the scan thing on my computer to post the actual product. Will post this on DR. Sherman if I can't catch you here....

 
At Tuesday, November 03, 2009 3:10:00 PM, Anonymous Anonymous said...

Marjorie

Mammography is not performed at the sloan-kettering cancer hospitals in New York,but rather they are referred to the
Evelyn H.Lauder breast center.
Furthermore,in the state of New
York there are 2901 mammographers
and to confirm this please visit
www.arrt.org,click on annual report
and click to pg 41. It is a PDF file.
In the state of New York the 2901
mammographers are all female. This
information can be obtained by
calling here:

518-402-7580
Bureau of environmental radiation
protection. New York ,Dept. of health.547 river street-room 530,
Troy New York 12180-2216


I was in New York in 2004 with
the AUA convention and thus being well aware of the services of
Memorial sloan-kettering facilities. Another of their facilities is the Sidney Kimmel
center for Prostate and genito-
urinary cancer. A center that
has more then its share of female
nurses!


PT

 
At Tuesday, November 03, 2009 6:54:00 PM, Blogger rev. fred said...

Dean, your psychological analysis of MoralMan, informing him that he needed to go see a shrink, may be a faulty diagnosis, and it is most certainly unkind and unnecessary. I could come-up with at least six theories to suggest why you intentionally sought a female physician; and you may want to run an evaluation on me. Mean-spirited speculation based on a few sentences in untenable, fails to contribute to meaningful discussion, and is ungodly. My Bible which causes you so much vexation, challenges me with "love is patient,love is kind,...love is not rude,..."(First Corinthians 13).In MoralMan's response, I hear the cries of anguish and exasperation of a guy who is attempting to define and defend sexual integrity for himself. Maybe the next time you pray, the Spirit will nudge you, to extend an apology. - REV.FRED

 
At Tuesday, November 03, 2009 7:10:00 PM, Anonymous Anonymous said...

All I can tell you is that a relative was a patient there several years ago and told me of her experience. Be that as it may, she was a patient and her care was coordinated through Sloan Kettering. I plan to check this out myself and will report my findings.
Marjorie Starr

 
At Tuesday, November 03, 2009 8:05:00 PM, Anonymous Anonymous said...

Maurice, I have been reading this blog for some months now and I am constantly reading so called facts posted by PT, such as "extensive studies that clearly demonstrate men make better OB/gyns
and pediatricians than women." Could you please ask PT to provide references to these kinds of statements? Because I have read the contrary to statements such as the above, so I would like to know where PT gets his "facts" from. I would particularly like to know how male gynecologists are better than female gynecologists when in the past, in medical school, the male teachers would tell their future (mostly) male students that "period pain" is psychological and doesn't exist, except in the minds of neurotic women.
NP

 
At Tuesday, November 03, 2009 9:25:00 PM, Blogger Maurice Bernstein, M.D. said...

NP, I already have noted the importance of references which our visitors can access to document what was written here (my comment yesterday at 3:40 pm). I wrote that comment to PT but also everyone writing here. ..Maurice.

 
At Wednesday, November 04, 2009 1:58:00 PM, Anonymous Anonymous said...

NP

I'll be happy to post those
references regarding the study I
mentioned. I will tell you the study in particular looked at a number of facets such as assertiveness during the pre and
post clinical years. Certainly,
there is nothing secretive as these
studies or references are readily
available on the web.
I've spent a considerable amount of time researching various
articles that are revelant to this
thread.It seems despite the fact that I do list references
from which the data was obtained,
some seem to refute it or are
not willing to accept the truth.
One might be willing to argue
with the results of a specific study but you cannot argue with
say the number and gender of
mammographers in a specific state.
Those are people with registered licenses,documented and that is data that cannot be refuted!


PT

 
At Wednesday, November 04, 2009 9:19:00 PM, Anonymous Anonymous said...

This is an article that appeared
in newspapers yesterday across the
u.s.

Providence R.I.

Rhode Island health officials
have fined a hospital $150,000
and ordered it to install video
cameras in its operating rooms
after it had its fifth wrong-site
surgery since 2007. In a letter sent Monday to Rhode island hospital,state health director david gifford said he is ordering the hospital to assign an employee
to observe all surgeries at the hospital for one year.
The most recent incident involved a surgeon who operated on the wrong finger. Three others
involved brain surgeons.


I must interject to state that
this really isn't about mistakes
made by the surgeon. The mistake
begins with the nurse in pacu, an
adjacent area that involves pre
and post operative patients. The
mistake continues with the circulating nurse and finally
with the anesthesiologist.

To install cameras in the operating room is just a stupid fest. What is this supposed to solve and are patients to be informed that they are on camera?

Who would be the hospital employee assigned to do this job
is my first question. Can they be
expected to read the wrist id band
from their perspective. How can they really expect this to work
and why watch the whole surgery.
Whats next,cameras on the assigned employee?


PT

 
At Thursday, November 05, 2009 4:35:00 AM, Anonymous Anonymous said...

I too heard on the news about the hospital in Rhode Island placing a person in the OR to observe and the installation of cameras! What a complete waste of payroll and resources. As far as the camera what a total waste. What is that going to cost between the two? And so now what does it accomplish? The error placed on tape? That is in no way going to avoid errors. And talk about an invasion of privacy!
ecommendations from the AORN have been in place for years for the "time out" protocol to avoid mistakes. Evidently this hospital has not implemented the 'time out.' Yes, the error begins with the Pre-op holding area nurse and follows with the circulating nurse in the OR as they are responsible for the 'time out' protocol.

Too much of what I have always said - "Run 'em in, run 'em out!" Bottom line... money, money, money. Wikki, Wikki, as they say in Hawaii. The errors would stop if people stopped using this hospital for surgery. See how fast they'd clean up their act if the money dried up and patients went to other facilities for their surgical needs.

JW

 
At Thursday, November 05, 2009 6:14:00 AM, Anonymous Anonymous said...

PT,

Why are you so offended about the lack of male mammographers? Would you rather see them employed sitting on the sideslines because the female patients refuse them?
It's probably been identified as a bona fide job qualification due to the emotional sensitivity of the test, to employ only women. It's perfectly legal and perfectly understandable!

Secondly, does anyone know why mammographers don't wear gloves? It's offensive that anyone touch bare skin when not medically necessary regardless of the gender of the technician.
Marjorie Starr

 
At Thursday, November 05, 2009 3:27:00 PM, Anonymous Anonymous said...

Majorie, I don't always line up with PT, and I am not trying to speak for him, but you have several time seem offended by the contention that same gender providers is especially tough for males. That males may face special challenges. The sheer dispairity in gender make up of nurses with only from 6-10% being male. If you look at the case history where bona fide has been upheld, overwhelmingly they have been for protection of females and not males. Mammography is no different that urology. The vast majority of breast cancer patients are female...but not all, the majority of urology patients are male...but not all....the point is, we have made accomodation for female modesty in L&D, and we intentionally staff and have womens health clinics, all of these efforts are appropriate, what PT is saying is those same accomodations are not made toward males. It does not in anyway diminish what females face, but to deny males face special hurtles due to the fact that (1) there are so few male nurses and (2) male modesty just does not get the same level of concern as females is ridiculous. Doesn't mean it is less traumatic when it happens to females, but the chances of multiple opposite gender exposure is greater for males simply due to numbers and is exagerated by lack of concern for males....alan

 
At Thursday, November 05, 2009 3:54:00 PM, Anonymous Anonymous said...

Marjorie

First,let me correct you on the
medical jargon. Mammographers are
not technicians,they are technologists. Please visit this
site www.ARRT.Org as it will most
likely explain the difference. The
difference is similar between say
an LPN and an RN. To appreciate
the difference please visit this
site.
www.rasmussen.edu/program/difference-rn-lpn.asp
Secondly, I never said I was
offended about the lack of male
mammographers. Truthfully,I couldn't care less about the issue
as I only use it as an analogy,a
statistic and a tool.
Mammography is the hallmark of
which all double standards in health care are based. If you cannot extend the same thought
process towards male patients then
no its not perfectly legal and not
perfectly understandable. You see
it that way as you were taught to
see it that way.
Discrimination is not perfectly
legal and not perfectly understandable. It represents the
worst humankind has to offer. I
have never contributed to the susan
g. Kommen foundation for breast
cancer and I never will. They never
mention that 1% of men will get breast cancer and they never acknowledge it as well.
Describe to me one group of
healthcare worker that is exclusively male for male patients,
you cannot as such a group does not exist. Why is it perfectly legal and perfectly unstandable
for women yet not for men.
For those facilities that staff
for their female patients not only
do they discriminate againt the male patient,they discriminate against a potential male employee.


PT

 
At Friday, November 06, 2009 5:56:00 AM, Anonymous Anonymous said...

It appears we have lost Lisa, not surpising I would imagine she has a very busy life, It was great while she was here. I had asked a couple of questions of her and didn't quite get a clear answer. I had asked the gender of her gyn, she said she chose the one he mother used, she went to a practice that had a female and two males, didn't say which. I asked her if she could tell if her patients were more embaressed by the presence of additional female nurses,,,did not get an answer. I think this tends to be a common thread. Avoid answering directly questions that are telling. I don't mean this to be mean spirited but rather an indication of the issue. When Dr's like Lisa tell of the accomodations they make like having the nurses stand away from the genitals of the patient, closing curtains etc they area acknowledging they recognize there is an issue, however to truely address the issue to the satisfaction of the patient would require much more, it would require starting with changing the way men look at nursing to get more men into nursing, scheduling, asking, training and educating, perhaps double staffing in some areas, etc all which would take large investments of money and time. If they admit they recognize this and choose not to take these steps because they are to hard or costly, they are basically saying they will not do everything in their power for the benefit of the patient...and thus are perhaps violating that prime commandment "do not harm", it puts them in and ethical quandry.........if they acknowledge they are causing the patient emotional harm, when it is in their power to at a minimum start the process that would ease it...how do the continue practicing the way they do...which is cost effecting for them,,,so they have to ignore the questions, for to admit they know...admits they are harming the patient without doing everything they can to address it.....doesn't make them evil, just human,,,,alan

 
At Friday, November 06, 2009 6:54:00 AM, Anonymous Anonymous said...

PT,

First, let me clarify why what I said is perfectly legal. You might want to read the detail on Title VII, the ruling that workers cannot be discrimminated against with regard to race, religion or gender.

Title VII has one exception. The exception that when privacy is a violation of the consumer, and a bona fide job qualification can be established, that it is perfectly legal to only hire one gender or the other.

While women and men are equal, they are different. It has been established that forcing compliance to be unclothed in front of members of the opposite sex is a sexual violation, a privacy violation that is different from a consumer preference.

There doesn't have to be penetration for a woman to feel raped or for the psychological consequences of sexual assault to last a lifetime. You do not want to recognize that, you only care about the employee and not the feelings of the patient. Therefore, whatever you do in healthcare, cannot be considered patient oriented, nor are you concerned about harming someone as a result of action.

I never said that this should be a one sex issue and not the other. Women, with a history of being considered unequal, have had to fight for their modesty right. It is not the fault of the female component of our society that men have not fought to protect their rights. I think that they should and deserve equal protection. So, you see, in some respect we are on the same page. Protecting patients in healthcare is every caregiver's first obligation. Promoting equal rights for the employee instead, does the opposite.

What I'm asking you and everyone to do, is understand that different people have different needs. It has been established that the females of our human race have different sensibilities. While this may be a generalization and some men share some of these sensibilities, it doesn't make sense to take away the rights of one group because the other group does not have the same rights.

What does make sense, that we, on this blog and others, work together to see that all of our rights are protected. PT, become a uniter, not a divider and for goodness sake, stop knitpicking everything everyone says because they are not medically based.
Marjorie Starr

 
At Friday, November 06, 2009 7:41:00 AM, Blogger swf said...

It often surprises me how many spouses or S/O's do not discuss this subject with each other. The majority of women I speak with have a preference in same gender care, yet some have no idea if their husband feels the same. I would urge all women to open the dialoge at home.
If you are part of the percentage of women who make appointments for the family, then you do your spouse a disservice by not knowing this. If you represent the family care, then know the familiy needs!Get the information on facilities that are on your insurance coverage and make those calls yourselves. Most often his doctor passes the job of making an appointment to a female staff member who may not have your husband's modesty issues in mind. And given the type of facility, may very often consider it a conflict of interest to care.
If your husband has discussed the issue with his doctor, I would still recommend putting a letter of some form (like the ones suggested here) in his file as a reminder to the staff members.

Ideally, we all advocate for ourselves, but in the event you are in that family position, then take that responcibility too.

 
At Friday, November 06, 2009 7:44:00 AM, Blogger Maurice Bernstein, M.D. said...

Marjorie raises an interesting point. If both genders are, in the United States, constitutionally equal(aren't they?) shouldn't the benefits, given and not given, under the Consitution be at least equal? If one gender has something the other gender does not have and cannot be similarly provided, wouldn't it be just to deny that something to both genders equally? (that is--take an advantage away) On the otherhand, is there anything in our Constitution which states that both genders have been given equality under any and all conditions? ..Maurice.

 
At Friday, November 06, 2009 8:05:00 AM, Anonymous Anonymous said...

Alan,

I agree with you completely and understand. It seems we need to work together to get what we all want.

While I understand the statistics, when I need a procedure, they don't want to accommodate my same gender needs, don't recognize the importance of it for victims of medical sexual abuse and it boils down to this. Our health system is not based on the needs, wellbeing or on behalf of the patient. It is based on the needs of medical staff.

Only after males refuse female nurses and upset the system and bring harm to the forefront will the system change.

I disagree with Dr. Bernstein in the case that in order to change a system, harmful experience needs to documented and cannot be until it is analyzed with patient experience, psycholgists who recognize the power imbalance, right to patient automony and the damage that occurs when rights are not uppheld.

I've said before that based on my experience, it is outrageous that my needs are not considered important. The medical community feels no obligation to support those abused by the health system. All we can do is enforce our rights uphheld by the consitution (that the medical community has abudantly think they are not part of), refuse treatment, make everything public and go from there.

Yes, there are an abudant amount of female nurses but once you need a procedure or operation, female needs for same gender care are not met either.

Look for my book coming out regarding the medical system and how they refuse to recognize this modesty issue as a basic human right, the damage they are causing and that many of the practices that are considered "standard of practice" are damaging to patients.

While medicine is in the 21st century, the way it is implemented might as well be the middle ages.

One of the reasons that the medical system doesn't want to change is that once it does, their power diminishes. Shame on them!!!
Marjorie Starr

 
At Friday, November 06, 2009 8:58:00 AM, Blogger MER said...

I've been busy but I've been reading the great posts recently. Alan makes a good point that I've found frequently to be true. Medical professionals come on these blogs but frequently don't answer some of the more uncomfortable questions. Their intents and motives are good. They probably don't really have any practical answers.
Swf's point is excellent. Spouses need to talk this over. Men are less likely to bring up this subject, even with their wives. So the wives should bring it up, especially, as swf says, the wives are the ones doing the medical apointments.
Finally, one point to Marjory. Let's not forget. A significant number of people who have been sexually assaulted or abused never report it or even talk about it. Consider this: It's more acceptable today for women to speak out about these abuses. It's not so acceptable for men to speak about it. Earlier I posted a study that indicated about 1 in 6 men are sexually abused are assulted.
The point is, how is a medical professinal to know this about their patients. It's not always going to be in the charts. And, frankly, some men have never even told their wives about their abuse.
That's why the reason why patients prefer same gender care, in some sense, is irrelevant. The patient may not want to talk about it for extremely personal reasons. The shouldn't be forced to tell their story to anyone, especially as they enter the hospital culture where they are confronted with many strangers who expect to do intimate care. When the patient says he or she wants same gender care, that should be respected upfront.

 
At Friday, November 06, 2009 9:46:00 AM, Blogger Maurice Bernstein, M.D. said...

You may find the following irrational and inappropriate for the context of the issues discussed on these Patient Modesty threads or simply too philosophical. Nevertheless, I have to introduce this question since so much has been written particularly in the earlier threads about the need to attend to patient modesty of individuals in the operating room or elsewhere who are unconscious during a procedure and where it is suspected by those individuals that their modesty concerns are being violated by exposing certain parts of their bodies without their awareness or permission. Is that a correct summary? Now for the question: When a person is recently deceased and is being prepared by the morticians or examined by the coroner, does modesty issues further pertain? If not, why not? And then if not, wouldn't the argument, as an analogous situation, be the same as an unconscious patient, unaware of the degree of exposure or who had access to that exposure? Is the difference the fact that an individual who is not dead still can worry about the possibilities after the procedure where obviously the deceased individual will not. Or is there something to physical modesty that transcends whether the individual is alive or dead? Just wondering.. ..Maurice.

 
At Friday, November 06, 2009 1:02:00 PM, Anonymous Anonymous said...

swf - you raise a great point. I think people don't address this ahead of time because for the most part unless a man has experienced healthcare he and his wife don't really understand until it is too late what happens. People are ambushed and blindsided. It is then afterwards you are upset and angry. As we have discussed the healthcare workers do not inform patients and/or family prior. They don't want to because they know a certain percentage of people will object and then they are inconvenienced with making 'changes'. After people have had several experiences only then are they aware of what happens.

JW

 
At Friday, November 06, 2009 3:37:00 PM, Anonymous Anonymous said...

Marjorie

I'd say that referring to me as
"knitpicking" is a rather strong
word to use wouldn't you say. I'm
not sure what you mean by "it has
been established that females of our human race have different sensibilities." Yet men don't,as
if to imply we are not likely to
be offended or receptive to
impression. Further,you mention
that "it is not the fault of the
female component of our society
that men have not fought to protect
their rights." I guess not, we've
been too busy losing our lives in countless wars so many can enjoy
freedoms and rights most take for granted.
Yet that certainly dosen't give female providers the right to
assume I don't have sensibilities
or the assumption we don't care.
I wouldn't be doing my job as an
activist if I didn't make it a
point to get under people's skin
now would I?


Maurice

Regarding practices and behaviors of funeral homes I could
certainly go into great detail on
this subject as I've numerous sites
that might be of interest to this
thread. There has been much concern and a push as well for
better ethics and practice among
funeral home directors and staff.


PT

 
At Friday, November 06, 2009 5:38:00 PM, Anonymous Anonymous said...

swf hit an interesting point, I seem to recall Lisa saying sometimes her male patients are surprised at her gender becasue their wife made the appointment. I make my own appointments but would be really ticked at my wife if she did that without asking me...

Dr Bernstein, I think you item is even more individualized than most. My personal feelings, if I had my preference, all male, but realizing the difficulty I have little anxiety as long as the exposure is when I am completely out and it would be all the better if I never met the people before or after that were present during the procedure. Unfortunately they bring the circulating nurse in for safety reasons prior to make sure they are doing the right procedure, etc. but I have never seen them afterwards so it is better. To me when I am out I don't have to experience the exposure so its less traumatic, I won't use our local hospital unless I have to for emergencies becasue I know the people (small town) and will see them again. After death, not experiencing it or knowing about it so whatever...doesn't bother we what happens then. Being awake and experiencing imprints it in my mind...and I revisit it after the fact....so thats why I have problem with it....but thats just me, and before anyone jumps on this...its just me, I am not saying its right for you.....alan

 
At Friday, November 06, 2009 7:12:00 PM, Anonymous Anonymous said...

Maurice to answer your question about morticians, I have often thought that when I bury my mother I will to go an all female funeral parlor we have here. I just don't want to take any chances. (As you've probably realized by now most of your contributers are extremely paranoid).
BTW I was reading a comment by a doctor who said that Drs do make mistakes because "we're only human". I just don't know how to reconcile this with the fact that when they see a naked body they say they are "gender neutral."
NP

 
At Friday, November 06, 2009 10:09:00 PM, Blogger MER said...

Doctor: Your mortician analogy. Perhaps a comparable analogy might be someone who donates his body to medicine. He/she knows that exposure will be necessary. But the expectation is that the body will be treated with respect. It's a matter of trust because once dead, your dead. It's a living concern. I would expect the same might be true with your mortician analogy. In both cases, it might bother those people, while living, to think that unnecessary observers were present during these procedures, or that the body was exposed unnecessarily or ridiculed, etc. But the dead can never learn if these unprofessional things happened. As you said, the living can find out if something they disapprove of happened while they were unconscious. That may be the key difference.

 
At Saturday, November 07, 2009 5:06:00 AM, Anonymous Anonymous said...

Mer, I agree with you. There is important element to this. The health psychologist that works with me in publication recently spoke of recent findings on patients who were unconscience.

It seems that the body itself has memory and the body will react to psychological trauma even if the patient doesn't remember.

Bodily reactions to trauma express themselves with increased stress hormones like cortisol and causes problems such as asthma, gastro diseases, and heart disease (that many ptsd survivors later get even if they didin't know for years they had been traumatized).

Further, the unconscience patient may also have cerebral memory that still must be tested.

I will let you all know on Tuesday after I meet with her again for credible information on the subject.

I would imagine that the dead would no longer care about their "used" body then you would with an old coat you took to charity.
Marjorie Starr

 
At Saturday, November 07, 2009 11:38:00 AM, Blogger swf said...

"It has been established that the females of our human race have different sensibilities."

I have to agree with PT here. One might casually read that and pass it by, but what it means in comparisons on this subject is vague. A study/survey
(for example) of the people here might render a result stating that (on this topic) the genders may be highly similar in reactions to exposure and the impressions of forced compliance.

I would hate to think that statement gives women an advantage that men should not have, or a bad reason as to why they do not have those rights yet.

These studies would have to be extemely specific for fair outcomes,

 
At Saturday, November 07, 2009 3:36:00 PM, Blogger MER said...

Earlier, I posted a link to a Toronto hospital stating clear polices about how to deal with specific care requests. It seemed to be based mostly on racist sexist requests, but it did include a statement acknowledging that some some patients may just feel uncomfortable with opposite gender care and that needs to be respected.
Here's an even better policy statement from a hospital in the UK. What's interesting is that if a patient requests specific gender care and it's not available, that needs to be recorded. Thus some stats are created that can indicate staffing needs. I doubt very much whether these kinds of stats are kept anywhere in the US. If they are, they're certainly not reported.
Dr. Bernstein: Earlier I asked your response to the previous policy from Toronto. Now I asked your response to this policy, too. And, I'd like to know whether your hospital has such a written policy and/or whether you know of any American hospitals that have such written policies.
We're always talking about what we should do on this blog. Well, here's something we can do. Read these polices I've posted and send them to local hospitals asking if they have such written polices. Make sure you make it clear you're looking for "written" policies. It's so easy for them to just say, oh, yes, we do this or that. Is it in writing? If the hospitals don't have such policies, why not? Ask them to justify their decision.
Now, I know someone stated that these hospitals in Canada and the UK don't always live up to the policies. But at least they're in writing. If a patient files a written complaint, and the complaint is reviewed, these polices are bound to pop up as part of that review. In fact, the complaint can even ask if such polices exist which will force them to the surface. The same isn't true, I believe, in American hospitals. The written polices don't exist, so during the review of a complaint the hospital isn't required to fall back upon specific standards.
I again post the question: Why is it that I'm finding all these policies in the UK and Canada? I've never found anything like this from an American hospital.
Here's the URL to this UK policy document:

http://extranet.somerset-health.org.uk/area15/policies/CaringForPatientsOfTheOppositeGenderJul06.pdf

 
At Saturday, November 07, 2009 5:37:00 PM, Anonymous Anonymous said...

Mer,
Your points about people not reporting or speaking of sexual assault/abuse are very well stated. I suppose the issues boils down to this. Whatever issue is more important will prevail. All one should have to say is that they had a bad experience and this is what I need. That's all they should have to say, however, that would be in an ideal world.

So, if it were more important to me to get that same gender team, I would have to speak of my past. You are absolutely right, nobody should have to.
Marjorie Starr

 
At Saturday, November 07, 2009 5:45:00 PM, Anonymous Anonymous said...

Maurice as a doctor maybe you can enlighten me. PT complains that there are no male mammographers for the 1% of males that get breast cancer? I think that is what he is complaining about. But surely it is impossible to give a man a mammogram anyway (it's hard enough if you are small breasted) and they would be given an ultrasound? And they would surely then be accommodated. Perhaps that is why there are no male mammographers?
NP

 
At Saturday, November 07, 2009 5:58:00 PM, Anonymous Anonymous said...

MER unfortunately people who have donated their bodies to science have had them abused. See link.http://www.smh.com.au/news/national/cadaver-abuse-unsw-apologises/2007/02/06/1170524072141.html
This is a prestigious university too.
NP

 
At Saturday, November 07, 2009 9:03:00 PM, Anonymous Anonymous said...

NP

Your argument dosen't hold much
credence as there are many small
breasted women who get mammograms
and who still wear bras.
About 1400 new cases of breast
cancer occur among men each year
while some men suffer from gynecomastia,men with large breasts. The condition predisposes
men to breast cancer. You see,the
problem with men who have a breast
abnormality typically wait longer
than a woman would to see a doctor,
increasing the possibility that the cancer will be in the advanced stage. Men's breasts are generally leaner and less tissue than a woman
and as a result the cancer spreads
into the muscle,which is more difficult to treat and resulting in
modified radical masectomy.
The problem with ultrasound is
that it does not give the fine tissue resolution that radiographic
mammography can provide. Mri and
ct are first choice modalities even
in breast biopsies.Xeromammography
solves a lot of the technical problems in tissue resolution in
that two-dimensional modulation
functions resulting in larger pixel
size.
In conclusion,here is a site
called breaking down medical
stereotypes and the website is
www.theuniversityhospital.com/healthlink/archives/articles/stereotypes.html
Sadly,you won't find any information regarding breast cancer
among men with any of the breast
cancer foundations. Perhaps Dr B
would be willing to provide a link
to this site. I believe I've
previously explained why there are
no male mammographers.


PT

 
At Saturday, November 07, 2009 9:39:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, the references you gave regarding hospital making statements recognizing healthcare provider gender requests are remarkable in that recognition and attempt at mitigation. I have not had the chance yet to show them to the chief operating officer of the hospital with which I am affiliated though I do plan to do so.

PT, here is the clickable link for the site to which you referred.
Male breast cancer is rare. In my over 40 years of practice in internal medicine, I had only one case which was confirmed as breast cancer in a man. Hopefully I didn't miss any. My medical students are repeatedly reminded to perform breast exams in all men patients. But men: how often has a physician performed a breast exam on you during a general physical exam? ..Maurice.

 
At Sunday, November 08, 2009 6:40:00 AM, Anonymous Anonymous said...

Mer,
You will also find informaton from Australia and New Zealand as well. The UK has mixed wards. Not only are patients deprived of their privacy with clinicians, they are also on public display to the opposite gender person in the next bed. This is a very "hot topic" in the UK.
Marjorie Starr

 
At Sunday, November 08, 2009 4:11:00 PM, Blogger Rev.FRED said...

seven years ago, i had a mass on my right breast, requiring both a mammogram and an ultrasound. If necessary, I can remove my shirt for female providers. Two female techs administered my mammogram, and were giddy during the entire procedure. The female tech performing my ultrasound exhibited a reserved, masterful demure. The mass was due to negative side-effects caused by a prescription. The most troubling issue of the ordeal was the perspective of the few female friends I made privy my condition. They said that the male breast is unimportant, and that I should go to the local horse doctor and have it whacked off. Locating an out-of-town cosmetic surgeon, the mass was taken out through a tiny incision at the base of the nipple, without damaging the aesthetics of my torso. The modest cost above the allowance of my health insurance was absorbed by me. I'm glad that this Type A Personality became his own advocate. -REV.FRED

 
At Sunday, November 08, 2009 5:49:00 PM, Anonymous Anonymous said...

REV. FRED

I'm glad everything worked out
for you regarding the mass in your
breast. I'm continually amazed by
the absolute ignorance displayed
and spoken by the female public
as well as female providers regarding health issues men face.
We certainly do have our work
laid out for us and as always we
should complain vehemently as to
any unprofessional behavior be
it verbal or physical when recieving healthcare.


PT

 
At Sunday, November 08, 2009 6:11:00 PM, Blogger Rev.FRED said...

MER, SWF & ANONYMOUS, thank you, for persuading me to concede, that continued conversation about the morality of modesty is futile. You point out, that discussion must shift as to how the medical provider will address the patient's rights to dignity and privacy. The healthcare worker is forced to move from generalization to personalization, with this issue. Patients need to think through, and articulate their insistence on same gender intimate care. What will they do with the likes of me? When I was ordained, among my vows, was a sacred promise to uphold "celibacy in singleness and fidelity in marriage." No "HOW TO" manual was passed out by the bishop, defining and interpreting the ways this expectation is to be lived out. As a never married religious professional, who takes with seriousness a call to a devout and holy life, I have enacted numerous disciplines to help me live a chaste life. I will discuss a few of them. The computer I send this message is owned by the church. At its initial use six years ago, in the presence of the benefactor, I anointed the screen with holy oil, and uttered a brief prayer, promising the Lord, that the computer would never be used for pornography or illegal and illicit activities. By God's grace, I have never violated this pledge. Eighteen years ago, I got rid of my TV. Disgusted by the tsunami of filth which calls itself entertainment, I have a zero-intolerance for sewage being pumped into the parsonage. Refraining from all physical embracing of my congregants, I never want to be misconstrued as engaging in inappropriate touching. Hugs are always initiated by others--never by me. For 36 years, my flock has never seen any flesh on my body, except my face and hands. I do not own a short-sleeve shirt or Bermuda shorts; nor do I go bare-chested when working outside on a hot summer day. As a Protestant monk, living in a monastery without walls, I know that I am an oddity. Finding myself in a veneral culture, I too, am bombarded with sexual imagery and temptation, and have fostered a lifestyle which keeps me on the path of righteousness. With knowledge of some of my background, let's take me into a doctor's office or a hospital. When I cross the threshold into medical world, my promises to the Lord are not suspended. I would like to believe that there are a few bloggers who would challenge the suitability of a male nurse bathing a nun or might question the advisability of a nun to consent for a male to administer a pap smear on her. As a consecrated male virgin,if I am in need of intimate exams, procedures, scans and care, should I be expected to drop my pants, and do the full monty, for female providers? It is foreign to my life experience; and viewed by me, as an infraction of my religious vocation, and personal dignity. Total exposure of myself to a male provider is awkward for me; the complete revelation of myself to a female provider is an emotional melt-down. Are doctors, techs, and nurses seeking to put up walls or build bridges with their patients. REV.FRED doesn't want to take off his chastity belt, how are you going to accommodate him, for the sake of his health? -REV.FRED

 
At Sunday, November 08, 2009 7:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Rev. Fred, I am so pleased that you wrote this commentary. It is precisely what I have desired to more fully expand our understanding of patient physical modesty in multiple aspects of human interest and behavior. Your contribution adds to the views of our naturist, CSM and our male nude model, Edo. Of course, I appreciate the views of all who are writing here but the views of "outliers" to the common expressions usually written here is of particular value too. Thank you..and thanks to all who have and are participating since that is what is keeping these threads interesting and informative and most popular on this blog. ..Maurice.

 
At Sunday, November 08, 2009 11:49:00 PM, Anonymous Anonymous said...

Sorry to barge in if this post is closed with the previous post of thanks from Dr. Bernstein. I am not really a medical activist but have the issue of societal roles in general.

When I see that male nurses are so few, I ask myself (I am male) - Would I have become a nurse had I known there was a shortage? No I wouldn't. Don't wish to be insulting to those who are and leading respectable lives, but I am squeamish and can't seen myself as a care provider. Every day we see ourselves dependant on people whose services are extremely essential but even knowing so would never consider walking in their shoes - be it male nurses, policemen, soldier and so on. Sometimes, I find that society as a large never tries to understand the people who perform these services, their apprehensions or their ambitions. There are so many in lower income group of society who due to lack of the financial support or other factors do not get access to the kind of education many of us get (I count myself here since I doing a PhD in engineering). Until a few years ago, I hardly even noticed them when they perform menial jobs in our midst.

I am from India, and here nursing is a profession reserved almost entirely for girls from the lower to middle income group. They find that with the environment being predominantly female, they are welcome there. These girls are not career minded ambitious girls but quite often those who wish to help their families with additional income. The nurses I have come across have been wonderful to me even whatever state of exposure I have been in. I might have preferred a male nurse if such an option was given to me but I have no reason to complain. I however feel that the larger issue is in this stereotyping of vocations particularly among the lower income group. One never finds a female carpenter or plumber the same way male nurses are a rarity. More opportunities need to be provided to these people in terms of career options and the necessary financial support to carry them through. The girls who do venture far such as into the army face horrific ordeals as gathered from some of the female soldiers who were in the frontline.

Another issue is to break barriers among boys on what is the right guy career they should choose. With all this macho crap thrown around on our entertainment as the reverend pointed out, boys do not consider studying hard a guy thing. I remember all the taunts I have listened to as I grew up about being girlish with my inclination for studies and not sports. Incidentally most of the taunts were from older relatives and teachers rather than friends which is what makes me mad. The system itself disparages us from following we believe is vital.

Until we reach a stage (in who knows how many decades/centuries) where children can be encouraged to understand what they cherish the most and follow them, we will have skewed sex ratios in many of our essential services. I hope soon I will be able to help in some small way. ----------- SKI

 
At Monday, November 09, 2009 8:06:00 AM, Blogger Maurice Bernstein, M.D. said...

SKI, first of all, my thanks posting to the visitors was not related to any impending termination of these patient modesty threads but only thanks to all those who have contributed to make these such interesting threads.

Secondly, you are not "barging in" but are very welcome here.

I think that the point you made regarding the ratio of women to men in the nursing profession does have a lot to do with cultural norms and until those norms are altered, it will be very difficult to get men into nursing and one cannot always blame the healthcare system for the imbalance. But altering the psychologic attitude or cultural bias of what men can or should do and what women can or should do is not going to be a rapid process. Women have more easily and readily migrated into male occupations without "gay" connotations, yet I think those connotations in the case of men would be harder to shake-off and remove.

It could be that those who want equal gender accessibility for men may not find that happening soon. ..Maurice.

 
At Monday, November 09, 2009 1:02:00 PM, Blogger swf said...

I too appreciate Rev. Fred's posts. (I realize this is partly selfish as I feel a bit more validated in my own moral/modesty stance!) But seriously and in all honesty, it is nice to find that in some form others have a similar outlook as yours.
I also see that for the purposes here, and in advocating in general, moral issues are probably too explosive of a topic.
And as Mer, alan, and others have pointed out, confuses the issues of the broader rights of choice to modesty and privacy.
I do not think that should preclude individuals from being honest with their own providers and hide the fact, if that is the basis of their issue.
I have been very clear with my providers. Not once have I ever asked a single doctor or provider to do something against their moral code or deny their convictions, and I don't expect them to ask it of me.

We all have the right to be equally human.

But let's skip morals and talk modesty......
Sometimes it seems as if we are so polite with providers that we forget what we are really talking about. The subject is simply about exposing and allowing our nude body to be looked at and touched.
How complicated should that really be? Naked/exposed/strangers/choice/...
just not really that difficult of a concept.
For those who find this confusing, tell me why.
We fight entitlement all of our lives, and fend off those who do not want our bodies to be our own. Is it really so hard to understand that we all expect the choice of who exposes and touches us? And for our very own private reasons?
Whether we are in a parking lot, an elevator, a car, a hospital, or a bar?

Our bodies should still belong to whomever we choose, not whoever chooses.

 
At Monday, November 09, 2009 3:49:00 PM, Anonymous Anonymous said...

SWF, beautifully said! We do have the right to be equally human. The problem is that we are not considered equally in healthcare, nor is healthcare a patient oriented profession! We are objectified, dehumanized and expected to take it!
Whose fault is it? Partially ours, for accepting it as a society.

It's not hard to understand at all. The medical people understand it (to the tune of $$$$ in lawsuits over these issues). They don't want to understand it, accommodate it, or even acknowledge that their behavior can cause great harm.

Just read a study today that findings showed preservation of dignity in a healthcare setting was completely and totally up to the providers as to patient experience.

When the medical community considers these dignity issues as important as healthcare issues, then and only then will things change.
Marjorie Starr

 
At Monday, November 09, 2009 4:35:00 PM, Anonymous Anonymous said...

Marjorie


The number of medical malpractice lawsuits have actually
declined since the 1990's.Without
loss there is no malpractice,even
in the face of negligence. Studies
have shown that only a small number
of patients between 2-5% that have
experienced wrongful injuries file
malpractice lawsuits.
You can't sue for modesty violations,furthermore in 2000 the
prestigous institutes of health
announced that 98,000 patients die
each year from medical mistakes.
I've always expected that number
to be more around 250,000 annually
and as expected people think automatically these mistakes are
related to physicans,not even close.
The vast number of these deaths
are related to a lack of hand washing,nurses not washing their hands. Contraindications from
pharmaceuticals,patients not
following their physicians advice.
www.wrongdiagnosis.com/mistakes/
nosocomial.htm


PT

 
At Monday, November 09, 2009 5:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is a dilemma involving the taxonomic habit speaking of "male nurse"--that is, classifying a nurse who is of the male gender as "male" ("the male nurse")and when using the word "nurse" alone as being set in the category of female. Well, that would be OK for those men who would want to know in advance that the nurse coming into the room was a man. However, if one is interested in changing the whole cultural custom and now look at the profession of nursing as genderless (just as an airline pilot, train engineer, architect, CEO, etc. etc are not given a gender prefix if that person happens to be a woman)then what happens to the advance notice to that male patient? "The nurse will be with you shortly." We do want to encourage all genders to enter the nursing profession by not implying that a "nurse" can only be a female, don't we? Just wondering. ..Maurice.

 
At Monday, November 09, 2009 7:03:00 PM, Anonymous Anonymous said...

PT
You may not be able to sue for modesty violations but you can sue for abusive, degrading treatment when it is responsible for Post Traumatic Stress Disorder and when you can prove the "error" is with malice, deviant behavior or sexual assault. Lawsuits that come under the term misconduct or sexual misconduct fit into this category.

Sexual abuse is prevalent in mental hospitals, elder care facilities and yes in our hospitals too. Just forcing a patient against their will is more than a modesty violation, it's sexual battery.

It boggles my mind that those who work in healthcare feel so threatened that they don't want to acknowledge two things. First, that people are psychologically traumatized from degrading treatment and second, the reasons behind the degrading treatment.
Marjorie Starr

 
At Monday, November 09, 2009 7:07:00 PM, Blogger MER said...

When announcing that "your nurse" will be in to see you shortly, the speaker could say -- Your nurse is "Jim" or "Sally." "He/she will be in to see you shortly." That at least let's the patient know the gender of th nurse. This isn't that difficult. But it must begin with the acknowledgement that gender may matter to some patients. If that notion isn't accepted, then this becomes a difficult communication problem. I'm assuming also that the patient knows what it is exactly that the nurse will be doing. That he/she isn't being ambushed. It's funny that we've got to dance around this gender issue. Why can't we just ask patients about their gender comfort level? Is that so radical? I guess it is.
Marjorie: I've found several British publications that discuss how to define patient "dignity" and "respect."I haven't found any from the U.S. Not being a medical insider, I really don't know what's going on. But my instinct tells me that there's not much discussion about these kinds of words once the institution puts them in their mission and or policy statements. No one seems to be asking how these lofty mission statements can be specifically implemented on a daily basis, and what the practical implications of these statements are.
The position seems to be that the medical profession is in control of a patient's definition of dignity. We define your dignity, the system seems to say. Patients need to realize this and reject it. At the very least, the patient must say, we'll sit down and discuss my dignity. I'm a stakeholder in all this and my input is just as important as yours. The patient must demand this. Compromises may be necessary in some ways. But where patients can't be accommodated, it must be justified using reasonable arguments.
That's why I've been focusing recently on those patient choice police statements I've posted here. American hospitals need them. I don't think they have them. Maybe we can convince some hospitals to compose them. BUT -- the committee that puts them together must have a few patients on them. Once in writing, these abstract words enter into practical considerations. How do we deal with this issue, the policy statements ask.

Patient perspective must be embedded within these statements. And I mean patients. I reject the notion that doctors and nurses, because the are or have been patients, can represent the patient point of view -- the notion that we don't really need any regular "patients" on these committees. There needs to be at least two regular patients on these committees -- a male and a female.
Now, I can hear some of you already. "This is too idealistic, not realistic." Okay. But I've also said that those hospitals that don't buy into this need to be dragged, kicking and screaming into the real world. Show the policy statements I've posted to your local hospitals and ask if they have similar ones if,if not, why not.

 
At Monday, November 09, 2009 7:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Marjorie, so that we are all understanding the same definitions, the question is what do you define as "degrading treatment" for example in a hospital environment? What should the treatment lead to or occur which could meet the criteria of "degrading". Could you list reasonably common examples which you find are degrading? I am not here trying to deny your use of the term but I would like to understand how it is defined and to what it is applied. ..Maurice.

 
At Monday, November 09, 2009 7:49:00 PM, Anonymous Anonymous said...

The previous posts have indicated that court rulings have upheld the rights of hospitals to hire only female staff for their women's wards such as L&D. However, I was thinking - how many of the procedures that are performed specifically on women may have to be performed under emergency situations by male staff? An example was given of mammography where it was stated that no male mammographers are presently employed because women would prefer female staff anyway and men form a minority of breast cancer cases. Mammography seems one case of a non-emergency procedure where a patient can choose the staff member. However, is that the case for many procedures?

For example, L&D could also be an emergency in the case of complications, injury etc. If the patient then is not in a position to visit the women's ward of her hospital, it would then result in an OR case where the staff are mixed. But to have mixed staff in OR these staff would have to be trained at least in all the procedures. If women's wards do not allow male staff (doctors or nurses), could that lead to a health situation where sufficiently trained staff may not be available when needed? The previous posts have said that teaching hospitals don't give patients a choice on who their care provider should be. But would the teaching hospitals be entirely sufficient as far as training capacity is concerned. If many patients prefer to visit only private hospitals or practises which would choose their staff, could it not result in a situation where the women who exercised their choice at one point may not have any when they need it the most?

To completely segregate male and female patient health care doesn't seem even thinkable in a civil society. Hospitals where only female patients are treated by female staff or male patients by male staff is not at all practicable let alone ethical. So by exercising choice on gender care would it possible that certain doctors may not be able to treat certain type of patients when the need arises? -------------SKI

 
At Monday, November 09, 2009 8:32:00 PM, Anonymous Anonymous said...

I don't care how some of you justify it I will never let a filthy, immoral woman even be in the same exam room as me.

 
At Monday, November 09, 2009 8:56:00 PM, Blogger MER said...

SKI -- You use an extreme example. I don't think most people would consider a segregated situation where only males treat males and only females treat females -- although there are situations and places today where only females treat females. But it would be rare to find the same for males.
How does one resolve the conflict between the need for doctors and nurses of both genders to learn how to treat each gender -- and the rights and dignity of the patient? Is a question of that beggars can't be choosers? Those who can't afford private hospitals must just take what they get regardless of dignity or respect issues?
As you suggest, there is more danger that male nurses don't learn how to treat certain female conditions -- rather than the other way around. In some places, male nurses are discouraged from OB-GYN and other female procedures. Though you would find male doctors at an all female clinic, you most likely you wouldn't find male nurses there, and probably not a male tech. So -- if what you're saying is that medical professionals of both genders need to learn to treat each gender -- I would agree. But I believe it's the male medical professionals who are not learning to treat both genders in some areas, especially in the nursing and cna field.
As far as medical students being forced upon patients, even in a teaching hospital -- I don't think that's considered ethical. The patient can be convinced, coerced, intimidated. If they can afford nothing else they have no choice. I suppose they could be told to go elsewhere even if there's no place else for them to go. But then, that isn't really a choice, is it? I would hope that even in a teaching hospital they accommodate if they possibly can rather than just deny. I could be wrong. I'm sure it happens.

 
At Monday, November 09, 2009 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous, I don't think anyone would disagree with your decision.
First of all, if a healthcare provider (either a man or a woman) was found to be "filthy" and a possible source for organisms of all kind, certainly a patient, particularly one with an illness which was associated with some immunocompromised state would be at greater risk. And with regard to "immoral"--this is equivalent to unethical and as a professional especially as a healthcare professional, man or woman, unprofessional. So.. I, myself, wouldn't accept a filthy, immoral healthcare provider, man or woman, in the same exam room where I was either the doctor or a patient. No disagreement here! ..Maurice.

 
At Monday, November 09, 2009 9:14:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, I know that my first and second year students, in my medical school, are not "forced" upon any patient.. absolutely and, though I don't teach third and fourth year students in their clerkships, I suspect if a patient refuses their participation in their case, the student will find an accepting patient elsewhere. With regard to interns and residents and attending who are all treating physicians, selection may be impossible in a primary teaching hospital, such as a county hospital, due to necessary assignments, handoffs and rotations. ..Maurice.

 
At Monday, November 09, 2009 10:46:00 PM, Anonymous Anonymous said...

I asked this question due to a recent ailment. I had epididymo-orchitis recently and visited my college hospital. At the time I visited, the pain was bad and there was considerable swelling. I later learn that when a patient reports severe testicular pain, torsion needs to be considered first. Anyway, when I went to the hospital, there were only three female doctors available. This might have been for some particular reason as the hospital has both male and female and usually both sexes are available at all times.

There was a female doctor to whom I had several times before and I had been very happy with. She was usually thorough and very compassionate/soft spoken. I went to her. Did I feel awkward to tell her about my pain? Yes. She asked the usual questions - was there any injury, any recent sexual activity any blood in urine? Did I feel awkward? Again yes, but I was worried about my health more than talking to someone about it. I thought she would perform an examination. She didn't. She referred me to a surgeon who would be coming in three hours. I never expected this. She isn't the kind who will write out a prescription or a referral without an exam. I didn't want to ask if she would examine me as I thought I would look like a pervert. But if a patient goes to a doctor with some part swelling or hurting he/she would expect an exam. My guess is she wasn't rash, she probably had not much experience with testicular exams. Maybe it was for the modesty of the male patients when she was a med school or whether it was felt there was no need for a female doctor to be able to be adept at examinations that male doctors would do anyway.

The result, I waited for three hours in pain until the surgeon showed up. He did an exam and referred me a to urologist with a doppler study. In India, a patient can't directly go to a specialist like a urologist but has to be referred. It took another three hours to get a doppler study done and torsion was ruled out. It took 7-8 hours in all to ensure that I had no need to be hospitalized and medication would be enough. If the first female doctor had performed the exam, seen the pain and swelling and referred me to the urologist, I would have known in maybe 2-3 hours. If she had asked if it was OK to examine me, I would definitely have said yes. I am not a doctor, but I feel I was lucky here that it wasn't torsion.

I have recovered now, but this has made me look on the internet for discussions on this topic until I found this wonderful blog (and better still have been welcomed by the Dr. himself). I feel modesty is important. Doctors and nurses can be given a short ethics course on how to treat patients to put them at ease. I feel unnecessary invasive exams can be ruled out. I am 29 and have never been subjected to a regular full exam where I have had to be exposed. I have only been exposed when I reported problems. But I feel all doctors (male and female) should have adequate training on patients (male and female). That I feel is the only way to ensure we have a strong health system that works even in crisis. Any rules that prevent a doctor to treat any patient should be done away with.

I remember what my Maths school teacher once told me. If you use up your options when studying for the exam, you won't have any when you are sweating it out in the exam. --------------------------SKI

 
At Tuesday, November 10, 2009 7:43:00 AM, Anonymous Anonymous said...

Dr. Bernstein,
Thank you for asking a very important question that is complicated when dealing with healthcare issues. The determination of whether treatment is considered cruel or degrading must be made from the patient perspective.

The analagy used would be if someone were shot by friendly fire, does the bullet not hurt? Can the victim die? There was no ill intent, yet someone was wounded.

While the reasons for mistreatment are many, the result of that treatment is borne on the backs of the patients victimized. Many times, however, patients are punished when thought to be uncooperative and humiliated. Elder care abuse is a perfect example of this. Patients put on display while bathing, toileting, etc.

We have all heard of the Abu Graib sexual abuse of prisoners. Healthcare has fine lines and is not as easily identified, therefore, not as easily rectified.
However, it can safely be said that nobody likes to be publicly stripped, harrassed, ridiculed, gawked at, or sexually assaulted.

Sometimes things happen in a healthcare setting that just shouldn't. My mother, an R.N., stroke victim was mistreated at the end of her life. Unable to speak or move either side of her body, I walked into her room to find her hospital gown bunched around her neck, blankets down at her feet, completey naked. The curtain was pulled back blocking the roommates view. However, anyone and everyone who came into the room (including the roommate's visitors had full view of my mom and she of them. The roommate's husband, sitting on a chair, gawking at Mom walked out of the room when I walked in.

While she couldn't talk, she was mentally alert and devastated. She still had facial expression. What would cause such a situation?

The best news was that someone was bathing her and got called away and forgot to cover her or pull the curtain. Nor did she have any protection from soiling herself.

The worst news is more sinister. However, here is the innocent patient. Complicating further, was the complete vulnerability of this woman and as one of them (a medical professional) trusted the facility to take care of her. We can assume that she did not want to be left in such an undignified way publicly. Because of her inability to move, and the assumption that she would not want to be left in this condition, her experience was that of being restrained, publicly stripped and put on display.

Often in healthcare, patients are not informed of prepping procedures, consent to students, etc without being fully informed and humiliated due to unexpected bodily exposure in front of large groups of people.

Cruel and degrading treatment has devastating effects on patients and can and does cause Post Traumatic Stress Disorder. Add a deviant staff member and it's assault and battery. There doesn't have to be penetration for a sexual assault or misconduct complaint to be filed.

I've mentioned before that I'm working with a someone who has entered into a brand new field in healthcare called "Health Psychology". Her patients are the victims of such disasters. We are working diligently to present the data to legislatures to help correct what the Patient Bill of Rights tried to do.
Marjorie Starr

More has to be done to protect patients and while modesty covers a large array of situations, when devastating to the patient, causing harm to the patient, permanently eroding trust when they enter a hospital full of the same strangers who enabled their personal disaster to happen previously, you are left with a segment of the population who will no longer subject themselves to such a lack of dignity and respect.
And the best part, they are paying to be mistreated.
Marjorie Starr bjmd7213

 
At Tuesday, November 10, 2009 7:48:00 AM, Blogger Maurice Bernstein, M.D. said...

SKI, in a way I am disappointed with your doctors from the initial doctor to the surgeon and to the urologist. Why? There is no medical indication NOT to relieve a patient's pain (especially in your example, testicular pain) while a workup is being undertaken. The only indication for being cautious with the use of analgesics would be if it was essential to use the pain as a signpost for clarifying a differential diagnosis or that a diagnosis was already established but, in face of some needed delay in starting definitive treatment, the pain was a marker for watching whether the condition was deteriorating. Testicular pain would not be such a symptom. The doctors" behavior, based only on what you wrote, doesn't meet the ethical and professional principle of beneficence. Maybe the urologist did "good" for the patient after a diagnosis was established but everyone should try to do "good" to the patient even before. Anyway, that is my personal opinion. ..Maurice.

 
At Tuesday, November 10, 2009 8:15:00 AM, Blogger swf said...

SKI

"Any rules that prevent a doctor to treat any patient should be done away with."

That is rather broad. Have you thought of all of the possible circumstances before you would make this statement?

If you have no problem with exposure to women that is certainly your right. It is your body: your choice, and we should always be about supporting choice with the bodies of everyone.
But a blanket statement that those who do care should not have options built into the heathcare system just takes the rights to their own body away. Not a very healthy way to run a society.
One which we are trying to change without taking away your rights while doing it.

 
At Tuesday, November 10, 2009 9:04:00 AM, Anonymous Anonymous said...

swf

Yeah I guess that statement was way too broad. I retract it.

If you read my post, I was embarrassed to talk about my pain to the female doctor. Do I have problems with exposure in front of women - oh yes, a great deal! But when I faced the question about physical well-being versus modesty, I would definitely prefer well-being. I suppose I won't forget for a long time those 7-8 hours of waiting (not to mention the physical and mental pain) that it took for me to know that I was in no grave danger. This got me into thinking about the dangers that can be caused by delays in treatment and testing. As a patient if I had got the immediate attention followed by the referral, I would have far less stressed out. On that day I was examined only by males (the surgeon and the urologist). I would prefer to be treated by male personnel as far as possible, but I realized that when I am in a situation like I was then, I would have given up my modesty.

I got to thinking about how often do medical delays result in a situation getting far too serious. As said before, the issues of modesty have begun to be raised only in the past few decades. So we are talking about a maybe a generation of doctors who are aware of the sensitivity needed to deal with a patient. But as this issue grows larger and options are given to patients on how they can choose their health care providers, could this not lead to cases where medical staff just don't have the necessary amount of training? If the entire system begins to change at all levels, would it be possible that certain type of doctors just don't have certain skills? What would be the potential risk in that case of delayed treatment?

I opened my eyes to this issue only a month back when I first had my problems. I read all the posts and couldn't stop reading when I found the amount of data and the perspectives people have gathered through discussions. ---------SKI

 
At Tuesday, November 10, 2009 10:07:00 AM, Blogger MER said...

Doctor: I may not have been clear in my comment about students being forced on patients. I was being sarcastic. Over many blogs you have discussed how you train our students. I would considered it rare that doctors or nurses force themselves on patients. Who would want do that anyway? I'm not saying it never happens, but point I was trying to make (though poorly), was that even in teaching hospitals caregivers try when they can accommodate. And SKI brings up an interesting point.
We've been talking about patient choice and modesty. Sometimes the modesty of the caregiver may get in the way of the best treatment. Even a modest patient may put the modesty aside due to his/her concern for health and life -- yet the doctor or nurse may be too modesty to do what needs to be done. That may happen more often than we think.
Re Marjorie's last comments. Perhaps we can use this analogy as to what might be considered cruel or degrading. The definition of sexual harassment is controlled by those being harassed. You have an obligation to inform the harasser and tell him/her to stop. But you decide whether you've been sexual harassed. The same could be considered the case (with limitations) for what's acceptable regarding modesty. That's why more discussion needs to happen between caregiver and patient about the patient's values and feelings in this area. I'm confident if we're all honest and open, we can more often than not come to compromises and agreements that meet the needs of both patient and system. But that depends upon open, honest dialogue. And, as I've said before, the system needs to take the lead in this area. This doesn't release the patient from responsibility. But we've talked considerably on this blog about the psychological power dynamic in this relationship. But Marjorie's analogy of friendly fire is accurate. Friendly fire or not, regardless of the intention, one can still be killed. And when you're dead your dead.

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

Just to add. When it comes to training of interns and letting resident doctors getting experienced, are the facilities available to train them adequate? I once had a friend who was in med school when I was an undergrad in engineering. He told me about how they had to fight for patients. I didn't think about it then. But is it because there just isn't a good enough ratio of experienced docs versus students to create a smooth learning atmosphere? In a earlier post I read about how patients are humiliated by examinations by a large number of students. If we begin to offer choices at certain places are we not creating a scarcity of opportunities for learning elsewhere? If opportunities to learn were vast and suppose all hospitals were required to train medical staff, would it not reduce the burden on teaching hospitals and the appalling incidents of modesty violations occurring at county hospitals?

I am all for choice. But this is the medical profession which can decide someone's life. The decisions we make will affect us and out loved ones. By going pro choice and excluding males from female wards, would we accept a risk to our loved ones? I am new to this. But I could do with some info.

Dr. Bernstein,
As far as training of medical staff are considered, what are the major drawbacks that you would consider? Do you see a worsening of training opportunities in terms of regulations and if so which regulations primarily hurt the training process?

----SKI

 
At Tuesday, November 10, 2009 10:47:00 AM, Blogger Maurice Bernstein, M.D. said...

SKI, in the training of medical students, generally I think there is no big problems in terms of access to patients to learn from. What is a problem and which I have repeatedly written about on this blog is the "hidden curriculum" where the more senior supervisors of the 3rd and 4th year students and interns provide their own "curriculum" which is often based on their own personal experiences but is often degrading to the humanistic teachings we give the students in the first two years. This curriculum could still be made "uplifting" and more ethical despite the new responsibilities and time limitations of the students if those supervisors would only have been taught how to be better teachers rather than simply "smart" clinicians. ..Maurice.
p.s.- SKI, It's now late, India time.. you should go to bed.

 
At Tuesday, November 10, 2009 5:28:00 PM, Anonymous Anonymous said...

SKI said

"To completely segregate male and female patient health care dosen't even seem thinkable in a civil society."

Who said our society was civil
and it is segregated on the female
patient side.Its called mammography,L&D,outpatient surgery
as well as most hospital surgery
and pacu units.

"The previous posts have indicated that court rulings have
upheld the rights of hospitals to hire only female staff for their womens wards such as L&D."

No courts have ever ruled
on this as nurse managers in L&D simply don't hire male nurses.


"An example was given of
mammography where it was stated that no male mammographers are presently employed because women would prefer female staff anyway and men form a minority of breast cancer cases."


Men with breast cancer are
the last thing on people's minds
and as a result never enters into any equation. Furthermore, there are no male mammographers simply because they are for the most part blocked from being cross trained into mammo.Big difference from having a pool of male nurses versus a pool of male mammographers. There are no
pool of male mammographers to hire
from.



PT

 
At Tuesday, November 10, 2009 11:25:00 PM, Anonymous Anonymous said...

I just have the habit of looking at the argument from various angles. Patients must be allowed to choose the gender of the doctor they would like to be treated by. So we would like to extend this choice to doctors also? Can we give a male doctor the right to refuse to treat a female patient or a female doctor the right to refuse to treat a male patient? There have been previous posts where men have stated they preferred to be treated by women because they are homophobic. What if the woman doctor refuses to see a male patient if she has an aversion to the male body or detests men who have homophobia? If a male doctor refuses to treat a woman for fear of lawsuits or that he will treat women only between a certain age, what then?

We could say they should just be professionals, but if they are professionals, should patients allowed to choose? For that matter do doctors discuss these issues as to whether they have the right to treat certain patients despite their oath? Is the oath legally binding or can the doctor exercise his rights of choice?
---- SKI

 
At Wednesday, November 11, 2009 4:42:00 AM, Anonymous Anonymous said...

It seems taxing on the health system to have same gender care for general healthcare services "accross the board".

The only time it makes sense to employ same gender care is when enough people complain and refuse due to a violation of their privacy.

The only time a lawsuit would ensue would be if a job applicant were refused employment. If a lawsuit were brought to the facility who declined employment, the burden of proof would be on the facility to prove a bone fide job qualification is justified based on the right of patient privacy. The courts have alredy ruled that privacy needs are different from a consumer request.

When enough suits have been won due to the Title VII privacy exception, the lawsuits cease when employees go to an atty and find that in case after case, this issue has won if the facility can prove it's a qualification for employment.

That's why some facilities have felt justified and warranted to only hire one gender or another.

Men need to enforce their privacy rights. When enough complain the providers will start to genderize those professions where the same privacy rulings would occur. Male consumers who accept treatment from females are working against the males who want same gender care. Until their is a need and refusal becomes the norm, rather than the exception, men will not have their privacy rights met.

Why, then, is it important to have male mammographers? The male breast is not considered an intimate body part. It is socially acceptable in pubic under the proper circumstances for men to appear in public topless; not so for women. So please tell me why this is more an issue than having a male or female podiatrist?
Marjorie Starr

 
At Wednesday, November 11, 2009 8:42:00 AM, Blogger swf said...

Marjorie:
All excellent points, and you are correct. These things are not taken seriously and once the damage is done, it's done.
The problem would be developing a system of accountability that admits damage all on levels, instead of always declaring that gender/exposure/ or privacy breaches shouldn't be actionable because the medical field is an exception to all laws of bodily ethics.
In reference to statistics: I know most of us here (including me)are hesitant as to the factual basis of statistical publishings,and one must consider the motive of numbers on either side of this issue. But combining the smallest numbers that have been sited, 50 to 53% of men will admit to some concerns about opposite gender care, and 51 to 60% of women. There are two points here.
1) That still leaves millions of people willing to accept care from either gender, and probably millions who would accept students of either gender.
2) This is not exactly a run away percentage. The difference in male/female statistics is not all that large when given a median average.If the medical community considered this enough to give choices to women, it should be enough to give choices to men.
Perhaps the difference really is in support, as many here have stated.
Yes, women have fought for many rights and considerations, but not alone. Many men were there supporting them in their efforts.
And, people of many ethnic origins were marching for civils rights.
No one EVER gets there alone...
So it really is time (in my humble opinion) for female caregivers to stop holding these entitlements so close to the vest, and consider both genders, as was done for them.
I guess my point is, let's try to find equality here, and stop "marching" to a place when you are already there.

 
At Wednesday, November 11, 2009 10:21:00 AM, Blogger MER said...

SKI -- It's fine looking at issues from both sides, but your argument here is somewhat faulty. It's not an even comparison -- patient rights of gender choice vs. doctor or nurse rights. One could argue, and it is being done, that doctors who oppose procedures like abortions should be able to opt out. This involves their values system. But the code of ethics and oaths doctor take, it seems to me, preclude their right to patient gender choice because they may be uncomfortable. If they're uncomfortable, they can go into a field where they don't have to do what makes them uncomfortable. Patients most often don't have choice. Patients can't pick their disease based upon how intimate the caregiving might be.
swf -- It's a much bigger issue than individual female caregivers holding on to entitlements. A cultural shift must occur, and it's the system we're fighting, not necessarily the individual caregivers. On a much earlier volume I wrote about how those in power rarely see how they're marginalizing those who don't have the power. A field dominated by one gender (or race) often creates a blindness among those in control. They don't see anymore. They take the status quo for granted as just the way things are, should be, and will ever be. We've seen that historically. Very often power must be wrestled from those in control. Not that men won't have many female allies in this struggle. I think they do now and will. But don't assume people in power will just give it up for altruistic reasons. That's not how human beings generally behave.
Go to Dr. Sherman's blog and read a recent post by Art Stump describing how his hospital just ignored his complaint about a particularly serious modesty violation. He had to contact a lawyer. Patients will often be ignored regarding this modesty issue. They theory is that if you keep ignoring it you'll wear people down and the issue will just go away. Unfortunately, that's too often true.

 
At Wednesday, November 11, 2009 11:05:00 AM, Blogger swf said...

I do agree with you Mer: it really is a much larger issue that I didn't mean to turn so simplistic. However, I do see this as one of the important issues. So many women that I interview and know personally that are in the healthfield simply have no problem with the disparity, and even consider it 'one for their side'. Now to say that they do not see it is not correct because they admit it. To say they do not care is more accurate. If they did care, the 91% of them could really make a difference in advocating.
Perhaps I am wrong in considering this selfish, and not just human nature. I would certainly be willing to re-examine my heart on that one.

 
At Wednesday, November 11, 2009 12:37:00 PM, Anonymous Anonymous said...

You are correct MER in your assessment of the hospital ignoring modesty complaints. They do feel they are "right" and they have legal rights on their side to do as they see fit and what works for them. They have been doing things their way since time began and give little concern or crendence to the 'few' people that raise this issue. A patient can bitch all they want and nothing will change because the damage has been done and it is spilled milk and THEY KNOW IT! They figure in time you'll get 'over it' and you'll fade into the night.

 
At Wednesday, November 11, 2009 12:51:00 PM, Anonymous Anonymous said...

SKI


Physicians have a right to refuse
care to patients at their offices,
its called firing the patient and
works both ways.


Marjorie

If the male breast is not considered an intimate body part
why then are women so interested
at looking at mens chest's? That
is only what society teaches us
and if a male patient wants a male
mammographer then he should be
accomodated. Irregardless of what
society thinks,its about the patient and if male patients can't be accomodated then no one should.



PT

 
At Wednesday, November 11, 2009 1:54:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, physicians can legally and ethically reject for any reason accepting a patient to establish a doctor-patient relationship under most circumstances. However, once a doctor-patient relationship has developed (taking a history and/or performing a physical or writing a prescription), any rejection of such a patient would represent abandonment unless the physician helps the patient find another physician to continue the care. ..Maurice.

 
At Wednesday, November 11, 2009 2:00:00 PM, Blogger MER said...

"Perhaps I am wrong in considering this selfish, and not just human nature. I would certainly be willing to re-examine my heart on that one."

swf -- People in power normally don't want to give it up. That's human nature. one views this depends upon how you view human nature. We're mixed. Humans are capable of doing the most altruistic, selfless actions. We're also capable of doing the most horrific actions. But it's a battle for most humans to be selfless. We are selfish at heart. That doesn't mean we can't change. When people ask why good people do bad things, I ask why good people do good things. That, to me, is the question.
What I'm saying in essence is that what you're describing is human nature. When men held power in various professions, did they want to give it up? Did they realize they had a good thing and wanted to keep it. Certainly. Same is true for many women in health care. Some will come over and help men with this issue. Others need to be dragged kicking and screaming into reality. That may involve simply facing male patients who make their values and requests clear and refuse anything else. Men who won't be worn down and intimidated or put off or ignored. But I'm not optimistic. Most patients in general, men in particular, will not stand up for themselves. Most caregivers know that and many proceed with whatever they're going do because it's easier for them and the system.

 
At Wednesday, November 11, 2009 3:21:00 PM, Blogger Rev.FRED said...

Awhile ago, Larry raised some questions related to my Advance Directive about intimate care provision by same gender providers. I am perceived to be some kind of numbskull. If I taken conscious, painstaking efforts to uphold a celibate lifestyle, why would I in a coma, welcome women attending to my privates. Is this death with dignity?
Did it every cross one's mind, that I am a voice crying in the wilderness? I am willing to do, what other men will not, or cannot do. Rosa Parks defied convention, and refused to forfeit her seat on a bus to accommodate a white passenger, resulting in her arrest. A police record does not look good on a resume. Why would Rosa subject herself to a confrontation with law enforcement? Why couldn't she just keep her mouth shut like everybody else, and get up?
Archer William Tell would not tip his hat and bow to the ego-maniac King. As a punitive measure, his majesty forced theh dissenter to use his own son as a target practice with an apple on his head. The high price for non-conformity for refusing proper protocol was to put a kid at risk. The history of the world is replete with men and women who have taken unpopular stands, forced to defy what was in their best interests, even survival, in order to dramatize just, honorable, and righteous causes. I am so committed to patient modesty, dignity, and privacy, that I am willing to take a legal, extreme measure, to get my point across. It is certain that my Declaration will generate some discussion. I like my position better than none. -REV.FRED

 
At Wednesday, November 11, 2009 3:29:00 PM, Blogger Rev.FRED said...

Dr. Bernstein, please take no personal offense, at the following church humor:
A surgeon, dressed in his scrubs, from head to toe, was prepared to begin an operation. Dropping over dead, he appeared before St.Peter at the Pearly Gate. St.Pete informed the new arrival, that all inhabitants of heaven had to don a white robe. The nationally acclaimed surgeon wanted to retain his garb, but reluctantly agreed to conform. Wherever he went, the surgeon saw a man wearing the green scrubs, mask, and plastic gloves. Outraged by this unfairness, the surgeon went to St.Peter for an explanation. St. Pete replied, "OH! That's God! He noticed that on earth, doctors like to play God. Well, up in heaven, God enjoys playing doctor!"
(Don't get mad at me!)-REV.FRED

 
At Wednesday, November 11, 2009 6:21:00 PM, Blogger Rev.FRED said...

Making conversation, friends sometimes after me, with whom would I most want to spend an evening for good conversation. At the top of my list, would be SWF, MER, MARJORIE, JIMMY, JW, ALAN, and
DR. BERNSTEIN listening in. "Iron sharpeth iron," saith the Good Book. And of course, this blog is the next best thing to a live gathering. Thank you, Dr. Bernstein, for setting this wheel in motion. - REV.FRED

 
At Wednesday, November 11, 2009 7:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Rev. Fred thank you for your compliment. These threads on patient modesty do have a life of their own.. and as a moderator of our blog, there is not much in the way of my personal crafting is necessary for the discussion to proceed.

But I should also state that as creator of this blog and one who has written the beginnings of discussion of, at this time, over 700 other aspect and problem threads in medical ethics beyond that of patient modesty issues, I tend to look to the broader issues of ethics in research, clinical care and medical education. These areas of bioethics all have areas of a system which may need ethical fixing.

As I have written, the patient's focused concerns regarding physical modesty was something new to me despite being in medical practice for years. But I have learned and I now understand, however, though I think about the subject with each visitor posting I allow to be published, it is certainly not with the fervor of you guys and gals. So please excuse me if I don't write here with any activistic tone or actions (even though I have repeatedly advised such actions for you in the past for you to attempt to mitigate your problems.)

I write all this because I want my visitors to these patient modesty threads to consider, as I do, that patient modesty is only one aspect of the broad medical system. Therefore, I would hope that you all look at some of the other medical system issues that are present on this blog (as I know some of you have already been doing) and write your views on those threads. You all have shown analytic capacity here on patient modesty. I know I can expect similar value to your comments made on the other threads. ..Maurice.♠

 
At Wednesday, November 11, 2009 7:43:00 PM, Anonymous Anonymous said...

Whether it is healthcare or any other service, a professional does have the right to choose. Ethics may be varied and one set of ethics can't be found acceptable while others are found unacceptable. If a doctor can choose, he/she can choose on any grounds. And has been stated by others, this choice is available. I read an account by an army nurse about how she hated to present at the army group physicals for men. She said of how her husband begged her to get a transfer out of it and the strain it put on their relationship. There are accounts who female doctors who classify male patients who seek female doctors and one classification is "perverts". I don't think one can rule out completely the choice of doctors.

As for Marjorie's comment that it is acceptable for males to expose themselves, I read in Rev. Fred's previous posts about how he had never exposed any part except for his face and hands. Why should he be subjected to healthcare by a female provider even if it is for a shoulder injury? Here I do see that women themselves don't understand choices of men.

I have read countless questions asked by women on the internet that their husbands had an erection when being examined by a female doctor. Has it never occurred to them in that case to ask for a male doctor for their husbands? Instead of choosing a female doctor as their family physicians and then suspecting their husbands of wrong intentions, why not select separate doctors for them and the males in the family? As for women supporting the cause of men as far as gender of healthcare provider, could this not be an natural area to start?
-----------SKI

 
At Wednesday, November 11, 2009 8:44:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE:AS OF TODAY NOVEMBER 11, 2009 "PATIENT MODESTY: VOLUME 26" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 27 ..Maurice.

 

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