Bioethics Discussion Blog: Patient Modesty: Volume 27

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Wednesday, November 11, 2009

Patient Modesty: Volume 27



Yes, throughout these threads on patient modesty, it does appear that often what is missing and what should be corrected is the lack of communication on this issue both on the part of the patient but also on the part of the various healthcare providers, clinics and hospitals. It may be that many of both parties display modesty in communication by not speaking out or asking out about modesty. Hopefully, this issue of modesty in communication can be eliminated on both sides and that the concerns of patients in physical modesty can be resolved.

Continue writing.. ..Maurice.

Graphic: A photograph taken by myself at a local clinic and modified with Picasa3.

NOTICE: AS OF TODAY NOVEMBER 28, 2009 "PATIENT MODESTY: VOLUME 27" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 28.

141 Comments:

At Thursday, November 12, 2009 1:02:00 AM, Anonymous Anonymous said...

The fact that a woman has a piece of paper from some community college doesn't entitle her to my body. I will always fight that sense of entitlement to the death if I have to. Perverts aren't welcome in my medical care no matter how much power they believe they have, and that means nurses, aides and techs.

 
At Thursday, November 12, 2009 6:47:00 AM, Anonymous Anonymous said...

Obesity is very much a boon for
fast food resturants yet not so
good for companies like speedo
or victoria secrets. In the U.S.
two-thirds of all women are overweight and one-third of those
are obese.
The prevalence of obesity among middle age women 35-64 has increased a minimum of 2 percentage
points per year over a 40 year time frame from 1960-2000. I certainly won't go into the cost
of lost labor and the impact it
has on healthcare costs,but certainly one could make some good
assumptions from a modesty perspective.
With female nursing at 93% its
fair to say young male patients are
the ones being looked at,yet how
are the obese looked at? I've heard
many a nurse say " God I hate starting an iv on fat people."
One charge nurse said, " she's
too heavy for the cat scan machine,
call the zoo." (The local zoo usually knows who has the largest
weight capacity on cat scan,mri
and nuc med machines.). "Who's good
at starting iv's on whales" said one nurse.
Many an icu nurse complains about their patients as well," her
legs are soo heavy I need two people to hold up each leg so I can
cath her." Sure,I can do an ultrasould of her gallbladder,but
because of the large layer of adipose tissue it won't be very diagnostic. One nurse said,he's
so fat I can't find his penis.
At what point does ones concerns about body image overcome
all natural concerns about general
modesty as we know it. Surely in
these instances no one is looking
and if so its a look of confusion.
The confusion of "why did they
give me this patient or she will
need a picc line as no one can start an iv. She's only been here
30 minutes and she wants a tray."
Imagine the stress it places
on the attending physician,the
difficulty in obtaining good
diagnostic tests due to the body
habitus. Certainly, with childhood
obesity increasing as it has over
the last 20 years has modesty as
we know it just a cover up for
other serious psychological issues
regarding body image. and body dysmorphic disorders.



PT

 
At Thursday, November 12, 2009 6:51:00 AM, Anonymous Anonymous said...

It seems ludicrous to me that a restroom attendant has a bona fide job qualification to be the same gender as the occupants of that restroom but a CNA who has no medical background has access to the most intimate aspects of patient care. What's more ludicrous is that nursing facilities are not required by law to have both gender caregivers on staff to meet the privacy demands of the few who need it.

Responding to the blogger above me. Perverts exist in all segments of the population and just because someone works in a particular field does not make them a pervert. What does is behavior that would dictate such. Let's hold the medical profession responsible for the lack of process in tracking these individuals and banishing them from the field. Low level employees that have never had authority, that come from poverty are sometimes angry with a "chip". What better way to get even than by humiliating those who have more and what better way to enjoy a power trip that they would not have outside.

PT Yes, some women do like to look at bare chested men as do men who like to look at a nice looking female leg. No man will go to jail because he is shirtless and no matter what you say the male chest is not considered an intimate body part!

Rev. Fred--Would you contact me at marjoriestar3723@yahoo.com? Would like the opportunity to speak with you off the blog and thanks for your kind remarks.
Marjorie Starr

 
At Thursday, November 12, 2009 10:37:00 AM, Blogger MER said...

On the last volume, we were talking about the choices doctors and nurses have. Can they decide who they want to treat? Can they fire patients and under what circumstances? Here's an interesting article about this, on a website that contains quite a few interesting
articles focused on patient advocacy.

http://patients.about.com/b/2009/11/06/does-your-doctor-have-the-right-to-fire-you.htm

 
At Friday, November 13, 2009 12:48:00 AM, Anonymous Anonymous said...

My OB fired me. He said "we don't have a good relationship". I suppose I didn't hero worship him like a lot of his other patients do. OBs are so in demand here they can pick and choose their patients.
NP

 
At Friday, November 13, 2009 6:51:00 AM, Anonymous Anonymous said...

Marjorie said

"PT yes,some women do like to look at bare chested men as do men like to look at a nice looking female leg.No man will go to jail because
he is shirtless and no matter what you say the male chest is not considered an intimate body part."

Marjorie you have missed the point
I intended to make. To me its
irrevelant what society says and
only matters to me if those attitudes of society infringe on
my rights and discriminate against
me.
As an example I am not a breast
man and the female breast does
absolutely nothing for me. I've
known women who put $15,000 on
their credit card to have breast
enhancement surgery and believe me
its all I can do to keep from
laughing in their face.
Several plastic surgeons I know want to see all women undergo a psych eval before breast enhancement surgery.
They've told me they are being
approached by 15 year old junior
high school girls wanting breast implants. Women in our society have
a psych hangup with their breast size. Thats how many of these societal norms come about.
These same societal norms by
some thought process have decided
that men don't deserve any privacy
in healthcare procedures.You have
to be a man to see just how pervasive the process is.
Regarding your comments that "a
restroom attendant has a bona fide
job qualification to be the same
gender as the occupants of the restroom" is incorrect. Obviously,
you've never been to some of the
mens restrooms at Dallas international airport. Where women
with towel carts position themselves next to the urinals ready to hand you a towel for a small fee of course.
The problem with these societal
norms are they don't emcompass both genders equally and fairly
and one only has to look at healthcare to see the disparity,
all the while the female aspect
of the industry ignores and pretends that the problem dosen't exist.


PT

 
At Friday, November 13, 2009 8:11:00 AM, Anonymous Anonymous said...

I have been reading on many blogs about patient modesty issues. But the worst case of gender inequality seems to be with respect to group physicals as applied to males and females. The group physicals in schools and colleges as a part of sports requirement seem to be badly discriminatory. While girls are said to get female doctors and female nurses, boys in many cases are examined by female doctors and female nurses. How can children be subjected to this? How bad an effect do these have on children? Have the opinions of parents been even polled so far as with the gender preferences with respect to healthcare in general?

Here in India, physical exams done in schools are rarely invasive. Just height, weight and look in the ears, eyes. Nobody really cared and they served no purpose either. But to hear that children have to be naked in public sometimes without even a screen and in front of the school nurse and/or principal!

Also, as for female doctors using females as chaperones is quite often to protect themselves from sexual harassment by male patients rather than just for the convenience of not hiring both sexes as assitants/nurses. How far is this true?
---------SKI

 
At Friday, November 13, 2009 8:44:00 AM, Anonymous Anonymous said...

PT
Looking at the full scope of your position, I agree with you completely. It's ridiculous that a woman would stand in a men's room handing out towels at the urinal.

What do you think would happen if men asked her to leave the room,(without the towels of course) That's the issue and the only one that will give you and other men, their due rights!

It's important to make these issues public and also unjust that it is a bona fide job qualification in a lady's restroom and there should be no discrimmination.

Try a lawsuit regarding this issue. It's not the money you're after, but the negative publicity to the establishment.

You make excellent points PT. By the way, what is your profession?
Marjorie Starr

Marjorie Starr

 
At Friday, November 13, 2009 9:08:00 AM, Anonymous Anonymous said...

Its interesting now that this issue
has come to light on this thread
in that every patient I know of
for being fired as a patient was
female. Usually,the office manager
does the firing for infractions such as being non-compliant,
sexually coming on to the physician or high drama. When you've been referred to pain management is usually a good sign you've been fired but in a nice way.
Resturants reserve the right
not to serve you as well as many
other establishments. Its certainly
not uncommon for patients to fire
their physician on the basis of the
behaviors of office staff. Walking
in on exams,etc.


PT

 
At Friday, November 13, 2009 10:03:00 AM, Blogger swf said...

Rev. Fred:
Thanx for the kind sentiments. I occasionally wonder what the conversations would be like if just those who agreed on the basics of choice were in one room. We certainly disagree on enough to keep a conversation lively!

NP:
Although I have never been fired by a DR., my last Ortho did suggest that I seek counciling for my "extreme" gender issues before I return. Apparently the other female patients didn't mind doning a paper gown for a shot in the shoulder.

 
At Friday, November 13, 2009 9:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Notes:
Marjorie, could you e-mail me (DoktorMo@aol.com) your e-mail address. Rev. Fred was unable to make contact with the address you provided to the thread.

Also, all of the comments to this thread has been posted, none rejected. If a comment has not appeared, I haven't received it to moderate. (I also checked my Spam box). Please write it again. ..Maurice.

 
At Saturday, November 14, 2009 2:08:00 AM, Anonymous Anonymous said...

MANY nurses are sexual predators and that is how I will treat any nurse or aide that tries to see or touch me. Why does society put up with those perverts?
SP

 
At Saturday, November 14, 2009 7:00:00 AM, Blogger Marie said...

This is an incredibly timely post for me. I am about to undergo my third shoulder surgery since fracturing it last year.

I have PTSD from being sexually abused. Instead of the surgery, and the accompanying loss of control, getting easier, it is getting far worse.

I know my breast will be exposed at least temporarily as they prepare me for the surgery and I am sick over it. Irrational, yes, but this is still very, very real to me and my anxiety is through the ceiling.

I truly love my surgeon and trust him. But trying to explain this to someone who really doesn't understand is humiliating. They look at you as if you are nuts.

Modesty is so important, even if you don't have issues like mine. I would suggest that practitioners use a combination of empathy and respect when dealing with patients who have to be disrobed in any way. You never know what someone has had to deal with.

Marie

 
At Saturday, November 14, 2009 2:16:00 PM, Anonymous Anonymous said...

Marie,
You are not alone. A patient advocate, I've been working on developing special protocols in healthcare for people who have been sexually assaulted or abused. I'm one of those people.

Using PTSD as a disability, siting medical an psycological reasons, recommending that victims get same gender care and that re-traumatization is likely in healthcare due to common triggers like exposure of the human body.

Feedback from victims who would like to change the system and want support are free to e mail me at:

marjoriestar3723@yahoo.com

If that doesn't work, try:

marjoriestar3723@aol.com

Best wishes on your upcoming surgery. Make sure your doctor understands your needs.
Marjorie Starr

 
At Saturday, November 14, 2009 5:54:00 PM, Blogger MER said...

To PT -- We've occasionally disagreed on some issues, but I found an article that agrees with much of what you've been saying about ethics violations. You'll find it in the November 2009 issue of AARP Bulletin on page 8. It's titled Medical Ethics? --

"Some medical students are making a mockery of the Hippocra-ic oath. A study in the Sept. 23 Journal of the American Medical Association says 60 percent of medical school deans reported they were aware of 'unprofessional content' being posted by students on online social networking sites such as Twitter. The infractions include profanity, sexual suggestive material and breaches of doctor-patient confidentiality." (written by Mike Tucker)

Some of us have commented about some of the unprofessional material posted on allnurses.

I think this may be a generational behavior. I would suggest we may see similar behaviors among younger nursing, cna, med techs, etc. students. And, as PT has suggested, this behavior, practiced and gotten away with while in school, carries on into the profession itself and can be found in hospitals in clinics. I don't know how many medical professionals are guilty of this -- probably a small number. But any number is too much, especially if they are not reported by their fellow professionals.

I'd appreciate Dr. Bernstein's take on this. How serious is this?

 
At Saturday, November 14, 2009 6:40:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, it is a important issue that you bring up and it certainly can be related to the matter of how patients are treated when the students enter practice or it could be a transient behavior of "letting go" from a intense didactic and emotionally taxing educational process. Though studies have been rare, there is at least one study (Papadakis MA, Teherani A, Banach MA; et al. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005;353(25):2673-2682) that shows that the unprofessional behavior of medical students can be correlated with their later professional problems brought to the attention of their state medical boards.

I read the JAMA article. I am not sure at this time what are the observations at the medical school where I teach and these behaviors on social networks has not been brought up either in our "introduction to clinical medicine" faculty meetings or with my own students. This is all I can say at this time. ..Maurice.

 
At Saturday, November 14, 2009 7:15:00 PM, Anonymous Anonymous said...

Mer, I don't think med students are worse now just not very smart (by posting their indiscretions on the internet). I recall reading on this blog of an old male doctor recalling in his younger years bringing in male friends to watch unsuspecting women give birth or having breast exams. Unfortunately, men do not mature until they reach about 30 years old and for that reason I would never allow a male med student near me. Sorry I sound sexist.
NP

 
At Saturday, November 14, 2009 10:11:00 PM, Blogger MER said...

NP -- I'm not agreeing or disagreeing with you -- but I find your reasoning faulty. Your first sentence refers to med students in general, neither male nor female. From there you move solely to male med students and then seem to assume that the med students we're talking about in today's situation are all male. That seems to be your conclusion. The studies Dr. Bernstein refers to and the cases quoted in the JAMA article -- I don't know if they're broken down by gender. Also, I've read what I consider to be unethical postings on blogs by female doctors and nurses, too. Look at our recent discussion about Dr. Orange's article. So -- I don't know how you come to your conclusion, unless it's just through personal experience. You can believe what you want, but your conclusions don't seem to logically flow from the article or studies quoted. And, yes, they do seem sexist to me.

 
At Saturday, November 14, 2009 11:20:00 PM, Anonymous Anonymous said...

MER

Yes you are correct on
your observations and the bulletin
you mentioned. I've spent a fair amount of time on the student doctor forums which is http://forums.studentdoctor.net
about 2 to 3 years ago and I saw
such behavior written there. I
never thought it was bad just some
insensitive gossip that yes could
embarass many with.
In fairness I have known many
physicians of all specialities over
the many years I worked in healtcare. Most were very straight
arrows and highly dedicated. But what really distubed me was the
behavior of nursing staff of which
I'd read about them on allnurse.
Behaviors I knew were true
as I remember such behaior being
carried out long before the interent came t0 be.


PT

 
At Sunday, November 15, 2009 2:44:00 AM, Anonymous Anonymous said...

All of what has been said is true. Also true is the systematic humiliation of medical students and nursing students while in training. Did you know that it is in the literature that med student who have been humiliated often pass the humiliation onto their patients in much the same way that child abuse is passed on?

Medical students (who turn into doctors) who disrespect their station and patients who behave in this way are subject to misconduct charges. It would seem to me that the burden of fixing this culture must start at the beginning of training. You cannot teach respect for patients by teachers who don't respect you.

The disrespectful humiliating treatment of medical students and nursing students will be passed down, these things do happen and they happen all the time; not just rarely.

I was fortunate enough to interview the Director of Risk Management of a major city hospital. Her interview was frightening, the subject of lawsuits were frightening and I'm afraid to say that the impropriety level may be way higher than we know.

While medical errors are high, these other infractions impede the mental health of patients who have been subjected to such treatment.

Given the research done showing that humiliating treatment is more harmful to victims of torture than physical torture, one would think that the medical system would make this issue paramount.

This is all the more reason that victims of sexual crimes be protected in healthcare. The medical industry must do something to make sure that when an infraction occurs, the penalties are stiff. Anything short of this will just promote the current culture.
Marjorie Starr

 
At Sunday, November 15, 2009 10:21:00 AM, Anonymous Anonymous said...

Marjorie said


"The disrespectful humiliating
treatment of medical students and
nursing students will be passed
down." Also true is the systematic
humiliation of medical students and nursing students while in training."
Nursing students sometimes and
rarely in the past practiced iv
sticks on each other. The rest of
their clinical training was in
the hospital on actual patients.
That's where the word ambush
came to be used in that a nurse might come in say to give a male patient a foley and she has 4 nursing students behind her. Today
and it has been the practice for some years now,nursing students must ask the patient for permission
to be present. The same occurrance
with medical students at hospitals.
If you don't want them simply request "non-teach" ,these words will be placed in big letters on your chart.
At many medicals schools would
be patients would be paid a fee to
have a medical student perform a
specific procedure,rectal exam,pap
smears etc. If I recall the payments were usually $100.00.
Remember, these were volunteers
being paid for their time and the
exam was supervised. Much different
from say volunteering for a clinical study whereby you are
paid several thousand dollars and
have a specific disease process
such as diabetes for a new drug.
Back in the 70's medical schools had very few women. In
many classes there were none. If
they did perform procedures on each
other and they did not, who is
being humiliated? The same applies
at nursing programs. Today's nurses
are at 94% female. But in the 70's
it was 98 to 99% female. Similar to
the gender breakdown in medical
school.Same scenario,who's being
humiliated,no one,at least in their
classes. For the last 15 years or
slightly more there are correct
anatomic manufactured training aids
at nursing schools. On these aids
iv's can be practiced,foley insertions,ng tubes(nasogastric)
etc. These are correct anatomic
manequins for chest compressions,
and just about anything one can imagine for nursing education.
One more thing,one does not
interview risk management,they
interview you!


PT

 
At Sunday, November 15, 2009 1:17:00 PM, Blogger MER said...

Marjorie -- I must say that your observations are right on. They match up with much of the research I have done. Humiliation works its way down. My take is that the kind of humiliation medical students used to go through, although not gone forever, doesn't exist as it did in the past. There are many more enlightened doctors like Dr. Bernstein and Dr. Sherman out there. But it still exists. These medical students then pass that humiliation down. Historically, nurses have been treated like servants and humiliated by doctors. Although this has improved, we can still read about this happening. Why do some people think then that this humiliation isn't then passed downward to the patients, the most vulnerable, powerless within the hospital culture. I'm not suggesting this happens all the time. I'm just agreeing with Marjorie that this culture of humiliation works its way down through the power hierarchy.
I would also like to pass on this poem and the website where I found it. It speaks to communication, and I think it should be read and practiced by patients and caregivers alike. "It is un-attributed but it is understood to have been written during the 30 year period that the author was held in a mental institution. It speaks volumes about the need for us to change the way in which we treat our fellow human beings. NOTE -- The line breaks are not accurate below, but you can check the original site to see how it should look.


Listen – a poem
by Michael Skirving

When I ask you to listen to me, and you start giving me advice,
You have not done what I asked.
When I ask you to listen to me and you begin to tell me ‘why’ I shouldn’t feel that way,
You are trampling on my feelings.
When I ask you to listen to me and you feel you have to do something to solve my problems,
You have failed me, strange as that may seem.
Listen! All I ask is that you listen; not talk, nor do – just hear me.
And I can do for myself – I’m not helpless.
Maybe discouraged and faltering, but not helpless.
When you do something for me, that I can and need to do for myself,
You contribute to my fear and weakness.
But when you accept as a simple fact that I do feel what I feel, No matter how irrational
then I quit trying to convince you and can get about the business of understanding what’s behind this irrational feeling.
When that’s clear, the answers are obvious and I don’t need advice.
Irrational feelings make sense when we understand what’s behind them.
Perhaps that’s why prayer works sometimes for some people;
Because God is mute and does not give advice to try to ‘fix’ things, He/She just listens, and lets you work it out for yourself.
So please listen, and just hear me, and if you want to talk,
wait a minute for your turn, and I’ll listen to you.

http://www.brefigroup.co.uk/corporatecoachblog/2009/11/13/listen-a-poem/index.html

 
At Monday, November 16, 2009 8:50:00 AM, Anonymous Anonymous said...

With respect to the above statement that humiliation works its way down, the question then arises as to who really would like to be at the lowest rung just above the patients? About increasing the number of male nurses, an earlier blog once said that male nurses eventually look to moving out of patient care and into administration. This now seems to be a natural move away from being at the lowest end of the system. Is there any data on how many male nurses choose to stay on in the care area after say 5 years or so?

Also, just wanted to ask if there are any mental prepping sessions at any school at all where children are groomed about healthcare and how to approach it especially the intimate parts. This is in relation to my discussions (or attempts rather) about my affliction with epididymo-orchitis with my parents. My parents asked the most delicate questions about "them" and when I used the word "testicles" once or twice I saw both of them visibly flinch. If this is how hard it is to talk to them now at my age, I wouldn't have even imagined talking to them 10-15 years back (might have gotten slapped for all I know).

The way it is with sex ed, is it possible to include some prepping sessions which might ease the tension up a little.
------SKI

 
At Monday, November 16, 2009 12:09:00 PM, Anonymous Anonymous said...

Male nurses do move out of patient care and into supervisory, dept head, or administrative positions in order to advance in pay. What the stats are who knows.

Doctors give alot less demeaning crap and humiliation to male nurses. Male nurse won't tolerate it. They evidently do this to female nurses - Why? Because they can!

 
At Monday, November 16, 2009 4:56:00 PM, Anonymous Anonymous said...

Women Doctors: Waste of money?

www.businessweek.com/careers/workingparents/blog/archives/2008/04/
women_doctors_w.html

An article in the respected British Medical Journal opines that
there are too many female doctors.
The author,Dr Brian McKinstry of the University of Edinburgh,worries
that medical staffing could be nearing a crisis now that Britain,as well as Canada and the US,is producing more female medical
school graduates than male.

My take as others is this: The
femininisation of medicine is a bad
thing for the profession in the long term.

If you are interested in a career
in Astrophysics and you have not
mastered multivariate calculus and
Newtons laws of gravitation by the
first year of high school,forget it. No level of affirmative action
will get you down that road!

This is how many women got in to
medical school,with a 3.2 gpa and
bumping more qualified male candidates,by affirmative action.

My other reason and this applies
to female nurses as well as cna's
etc. is male patient privacy is
not a concept.
"Little girls are special cuz my
mommy told me so" is where their
concept ends.

I've looked at just about every
nursing forum on the web as to
comments female nurses have in support of more male nurses. This
is what they say. Yes,there should
be more male nurses entering the
profession so they can help roll
and turn the more heavier patients.

D you think they are going to give the real reasons why,never!


PT

 
At Monday, November 16, 2009 5:30:00 PM, Anonymous Anonymous said...

"This is how many women got in to
medical school,with a 3.2 gpa and
bumping more qualified male candidates,by affirmative action." When PT? 30 years ago? Does it happen now? Can you not accept that women are as intelligent as men? And what is so bad about female doctors working fewer hours? They are probably not treating people like they are in a production line. Obviously they are not trying to earn a truckload of money like male doctors are, so perhaps this means they are more altruistic. I for one do not want a Dr that is working 70+ hours a week. They are probably too tired and prone to making errors.
NP

 
At Monday, November 16, 2009 8:13:00 PM, Anonymous Anonymous said...

NP


Please review the case summary
of Allen Bakke: Regents of the
University of California v. Bakke.
Additionally,the supreme court
in the summer of 2003 upheld certain kinds of affirmative action. Polls indicate that many americans percieve of a policy to
be synonymous with quotas,set-asides and preferential treatment that benefits minorities and women at the expense of white males.
Personally,I'll take the male
physician who works 70+ hours a
week,he is the one who most likely
earned his admittance rather than
a women who has something to prove to the world and those are the worst kind.


PT

 
At Tuesday, November 17, 2009 3:36:00 AM, Anonymous Anonymous said...

I agree with PT. The top students should be accepted to medical school with no regard to gender or race. If 80% of the top students happen to be white males then they should be the ones accepted. Requiring a particular percentage of females or minorities is ridiculous and unethical.

 
At Tuesday, November 17, 2009 4:08:00 AM, Anonymous Anonymous said...

Marjorie,

My question is what exactly do you consider sexual abuse? When I was a teenager I was ambushed before an elective surgery (above the neck) when they told me I had to be naked under my gown. I was very clear that if I was required to be naked under the gown I would cancel the surgery and my parents backed me up. The nursing staff relented and told me I could wear scrub pants under the gown and I finally agreed. I learned after the surgery that the scrubs had been removed after I was unconscious and then I was redressed afterwards. They lied to me, deceived me and stripped me naked against my will after I couldn't defend myself. Would you consider that abuse? Does it matter what gender I am?

A major problem is that I'm sure many people have been sexually abused in a medical situation and may not have ever known it. Should special consideration only be given to those patients that have a proven case of a sexual assault? Why can't everyone have a say in who sees them naked and preps them for surgery?

In your opinion can men be sexually assaulted? If so, who decides if a situation is a sexual assault or if it was professional? Obviously in my case they didn't get my informed consent nor the consent of my parents once I questioned their procedures. Is that an assault?

SLO

 
At Tuesday, November 17, 2009 4:15:00 AM, Anonymous Anonymous said...

I guess I've been lucky in my life because I haven't spent much time with doctors or hospitals. Is completely avoiding medical care the only way to keep nurses hands out of my pants?

I think SP is right, there are a lot of sexual predators in the medical world. It seems like women in our culture aren't considered predators. How can they continue to get away with things that men would be sent to prison for?

 
At Tuesday, November 17, 2009 5:19:00 AM, Anonymous Anonymous said...

The fact of the matter is that our world is approximately 50% male and 50% female.

It is abundantly clear on this blog and others that there are gender preferences in healthcare that for some make the difference of being able to get care and those that cannot.

Everyone here can agree that we all deserve to have our privacy rights met, be treated with dignity and respect and that reform is needed to accomplish these goals.

Privacy rights of the patient must trump an employee's right to work. If this issue is as big as we think that it is, what kind of frustration do you think the professionals have when patients are refusing care? I'm sure it happens more often than they would like. That's why in informed consent they never mention the gender of the practitioner. So...I ask the question, is that really informed consent? My contention is that it is not, and puts the burden on the patient of asking these important questions.

Quite frankly, patients have other things on their minds, in a fragile and vulnerable state and should be greeted by the medical community with a pro active, cooperative framework. Medical care is anything but.

Those of you who feel I'm being idealistic, I would agree with you. However, I pose this question. How difficult would it be to put in reforms that would protect patients and create a more equitable relationship between patients and the medical community?

Regarding trauma from standard of care practices; this is another issue that needs tending. I'm not saying don't disrobe patients. I'm saying that it can be done in a private way. Allowing students, EMT's police to gawk at naked patients is traumatic, unnecessary and creates a very harmful scenario. Again, this is just another example of lack of respect.

Perhaps if there was an unwritten rule for every professional to put themselves in the patient's position and it was an infraction to put a patient in humiliating circumstance, not to do so, perhaps that is a beginning. At the very least telling patients
what to expect would take the "unexpected" aspect that is necessary to psychologically traumatize a patient. Instead they keep you "in the dark"
because they know objections would arise. (Ex. You're having surgery. You allow students to watch. What they don't tell you is that the students are all gathered around and that's when they decide to remove your hospital gown for draping and prepping. It would be so eacy to have practices that take care of the patient and then, invite the students). People who have never had surgery, have no idea this would happen to them.

I've said on another blog (and I apologize to Dr. Bernstein) that I feel the medical community is unethical, disgraceful and harmful.

Until reforms are made to protect the most vulnerable, until reforms are made making the medical community accountable, until processes are put into place to protect the most vulnerable, and mostly, until the medical community admits (what they already know) that they are causing great psychological harm, I stand tall with my convictions.
Marjorie Starr

 
At Tuesday, November 17, 2009 10:02:00 AM, Anonymous Anonymous said...

I think the problems are well cited. Is anyone in the process of framing suggestions which they can put to the medical community? Actual guidelines that will be stated in the hospital rules for all staff. And how will it be made to ensure that violations are prevented to begin with because once a violation takes place, the damage is more or less done. Patients (male and female) without the money or the means may not even want to make trouble even in the form of writing a letter to the hospital administration out of fear of being blacklisted.

Can anyone lead me to a document that has been framed by patients with a view to reform and in the process of being submitted to the relevant people? I am not being sarcastic here; I am genuinely interested.
-------SKI

 
At Tuesday, November 17, 2009 2:47:00 PM, Anonymous Anonymous said...

Any patient of any age or gender is
subject to abuse wether it be sexual or physical and abusers can
be male or female. Abuse can happen at any medical facility
as no one is immune. The secret files of risk management are bursting of dead bodies as they are
just as good at keeping secrets
as the CIA,its called containment.
There is a hugh misconception that only women are abused at medical facilities. Young female cna's physically and sexually abusing residents at a nursing home recently in Albert Lea Minn. not once but twice in that town leads credence that this happens regularly.
Don't expect that just because
a female patient says that they are a victim of sexual assault at a medical facility to be handed a sexual abuse card. They don't hand
those out and if they did you'd
see a long line of men standing
there as well. Long before the
internet was invented I've seen
men abused at medical facilities.
Most of the time you won't read about it as these instances are contained.Only recently have laws
in states been passed that any form
of sexual assualt against patients
must be reported in 24 hours to local police authorities.Despite such laws on the books assaults that occur in medical facilities go
unreported to the police.
A perfect example of this occurred here in my state recently
whereby a hospital administrator,
a psychiatrist and a nurse
practitioner were charged for not
reporting a sexual assault for
reasons of containment. This was the 7th sexual assualt at this facility in one year! Go figure!


PT

 
At Tuesday, November 17, 2009 3:06:00 PM, Blogger MER said...

"I've said on another blog (and I apologize to Dr. Bernstein) that I feel the medical community is unethical, disgraceful and harmful.

I need to both distance myself from what Marjorie writes (above), and agree with some of what she says. Verbal and physical abuse indeed works its way down. Nursing and elementary school teaching (both historically dominated by women)are examples of how those at the bottom of the power hierarchy at times take their frustrations out on each other and sometimes even on their clients. On their clients, not necessarily actively but through passive aggression.
Here's an interesting thread on allnurses that talks about how nurses, so often the victims all kinds of abuses, take it out on each other. I read recently of a nursing convention where one of the main topics was bullying in the work place. We know that those who are sexually abused, often sexually abuse others. Verbal abuse and humiliation also follows that route. Here's the URL which is titled "LATERAL Violence. How Nurses treat Nurses!"

http://allnurses.com/general-nursing-discussion/lateral-violence-how-232873.html

 
At Tuesday, November 17, 2009 7:56:00 PM, Anonymous Anonymous said...

SKI,
The focus of my work is exactly what you're talking about. Much of my posts reflect my research. More research needs to be done to establish all the different areas of impropriety. (Imagine, this is only one issue, exposure of the human body). It is fortunate that I have political ties in a few areas and when my presentation is ready it will be presented in the correct light, with the correct information, in the right way with the right motives. My research has taken seven years. If you feel my posts are clear, concise, and orderly, it's because not only am I a survivor of medical sexual abuse, I'm a researcher as a result of that and used my own experience as a springboard to analyize the medical industry and effects on patients that suffer. We are isolated.

I'm now working on a book of a collection of stories of incidents that have traumatized patients due to "violations". The money will be will either be split between the writers (and their stories must be verified) and a non profit agency.

It is only with explicit detail that the public will fully understand what exactly is happening in healthcare.

SLO,
There are several different issues regarding what happened to you. First, they operated without informed consent (because you did not give permission to be undressed, further you stipulated conditions).

Today you would have a law suit and win. There was an Orthodox Jewish woman at a hospital and she stated for her C section due to her religion it was foribidden for a male to see her unclothed. The hospital assured her and guess what happened. There was a male nurse in the room who saw and touched her naked body. She sued, lost in a lower court, then won in a higher court. The court said that it was ok for the hospital not to treat her but that they couldn't say they would honor her requirements and then do the opposite.

Sexual abuse would have to indicate some impropriety of a sexual nature; difficult to prove in this case. However, I would consider your experience abusive in that you were traumatized because you didn't expect them to do this to you, you trusted these individuals to respect your wishes, violated because they did what they wanted and lastly, the worst abuse, they eroded your trust. You were abused.
Had you been awake, you could have refused again, or felt the humiliation of being violated (and that would have been considered sexual assault and battery) so because you were asleep and more likely than not, no sexual abuse occurred. Do not, however, think that this was not a very serious offense.
Marjorie Starr3723

 
At Tuesday, November 17, 2009 8:11:00 PM, Anonymous Anonymous said...

Very well stated MER and to see
a perfect example of this is visit
this site.
www.aboutmytalk.com/t19397/s&job.html

Or simply do a search on yahoo

why I hate nursing

Very interesting to read all
10 pages,yet its nothing new to me.
It will be easier to do the search. Personally,I've seen this
abusive behavior from nursing
towards physicians,pharmacy
respiratory and radiology and
whomever else gets in their way.
In fact there was a study done
that evaluated the behavior of
female nurses towards male and
female physicians. The study concluded that female nurses were
continually challenging male
physicians. One can only imagine
how this behavior is carried out towards male patients as well.


PT

 
At Tuesday, November 17, 2009 8:17:00 PM, Anonymous Anonymous said...

Here's a charming blog by an ER resident and his views of the gynecology department aka "the tuna room". http://stanford.wellsphere.com/life-as-a-doc-article/the-gynecology-room-redux/561184
NP

 
At Tuesday, November 17, 2009 9:21:00 PM, Anonymous Anonymous said...

Thanks for the response Marjorie and PT. I guess you can add me to the very long list of abused patients that wish they had done something back when it happened.

SLO

 
At Wednesday, November 18, 2009 8:38:00 AM, Anonymous Anonymous said...

SLO,

The good news is you're doing something about it now. What helps lots of victims overcome regret, is that the issue is much bigger than than any individual. Speaking on the subject now will help with research, presentations, and advocacy.

Never before have we the opportunities that now exist to contact and communicate with each other, thanks to Dr. Bernstein and others.

I enoourage if you want to see change (in our lifetime), and want to make a difference, I'm here to help facilitate that change.

Every one of us wants our privacy needs met. We have that right. Until we stand united and lobby for what we want, it won't happen.

The medical community has taken extraordinary action to keep things hidden. It's time for the destructive psychological harm they are causing to stop. It's time to hold them accountable for informed consent abuses and time for them to help fix the problems.
Marjorie Starr

Anyone interested in moving this issue may contact me at:
marjoriestar3723@yahoo.com

 
At Wednesday, November 18, 2009 8:45:00 AM, Anonymous Anonymous said...

Marjorie Starr,
Wish you good luck with your book and your goals. When you finally publish, do drop us a line so that we can go out an get a copy of your book.
--------SKI

 
At Wednesday, November 18, 2009 12:03:00 PM, Anonymous Anonymous said...

Majorie, I have no written proof but when you state that patient had a legal case against the hospital for having the surgical attire removed, I'm not so sure about that. When a patient signs a consent form it is really a carte blanche for the doctor and the staff. You submit "to all" by signing the form. You are also consenting to any and all "helpers" that will assist the doctor - be it male or female. Obviously the consent forms have been created through legal counsel and have their butt covered every way from Sunday.

Malpractice cases are most difficult to win and a case as this would be impossible. An attorney would not take it on a contingency basis. So it amounts to how much do you want to spend to make your point. Most people don't go to the trouble and don't have the funds to fight something they have a 1 in 1000 chance to win. It is money and time wasted. The majority of the time people go in to the OR and they are stripped or the gown is completely raised once the general or sedation is administered. That is routine. People aren't aware of what happens "step by step" in the OR once they are put under or sedated. They are disrobed, scrubbed, prepped, shaved, positioned and draped. Then when the procedure is over.. the drapes are removed, the skin is cleaned again (topical cleaning solutions and blood cleaned off the skin), wound dressed, and the patient is re-dressed with a new surgical gown. Patient is transferred to a guerney and rolled to the PACU.
JW

 
At Thursday, November 19, 2009 3:53:00 AM, Anonymous Anonymous said...

JW,

Here is a link below to the lawsuit mentioned.

http://www.nursinglaw.com/malefemale.pdf

I didn't say she won a case for having her attire removed. She won the case because the hospital agreed no male personnel in the operating room and then went back on their word, against her will, humiliating her and disregarding her religious requirements.

It begs to ask this question: When gender is brought up by the patient, does that not become part of the informed consent process, especially when she/he has issues from previous psychological trauma?

You are correct about carte blance when you sign the consent form. By doing so, you are giving up your rights.

Here is a protocol one can use to add protection for those who have trauma due to sexual abuse.

First, you put in writing (at your doctor's office) what you need, making it part of your medical record . Back it up with a letter from a therapist regarding competency and how exposure against your will is retraumatizing and then you make it part of your hospital chart. You also make your needs in writing to the hospital and the surgeon, removing your informed consent if the facility will not cooperate.

The above is not perfect but it's a start. They will have a much more difficult time in refusing (when they know they can accommodate) when there's proof of possible liability and harm by either ignoring or refusing your request.

Patients are more informed and for those with modesty issues, know exactly what happens in the OR.

What I'm saying is if you establish a pre existing condition whereby opposite care would be harmful to the patient, the patient is competent and then those needs are ignored, or worse, the patient is lied to, you have created liability for the hospital.

What is at stake now is the legal issue and this is the crux of my presentation: If it is documented that a patient's privacy rights have been purposely violated and that patient has a condition that would erode the mental health of that patient if their wishes were violated, and that patient revokes the informed consent (ahead of time),then they informed consent is revoked. Now the hospital must either accommodate or refuse treatment.

Now there's a publicity problem for the hospital. If there is a medical reason for same gender care and the patient has serious medical issues that they refuse and that patient goes public, watch the "heads roll".

You must be some kind of medical professional due to the mindset of your post. Are you? And..if so, you would have to agree that the primary function of any medical institution is "to do no harm".

People with psychological trauma due to sexual assault have needs that trump medical ones. This is not only their right, but the disgrace of the medical community when these needs are violated in the name of "safety for the patient". What good is a medically sound patient when their soul is forever damaged. What good is a healthy body when one is tormented by violations against their will? What good is a medical insitution without caring for all of their patents? What good is the patient bill of rights when it says that they will protect your dignity when they are not.
marjorie star 3723 220

 
At Thursday, November 19, 2009 4:02:00 AM, Anonymous Anonymous said...

I guess I'll just have to avoid some types of medical care the rest of my life because I'll never submit to those perverts again. I don't trust them. I know I can defend myself and make my own decisions as long as I'm conscious but I'll never allow them to knock me out and have complete power over me again.

SLO

 
At Thursday, November 19, 2009 7:15:00 AM, Blogger m said...

I've been reading this blog for some time, the topic becoming acutely interesting to me with mounting medical issues and procedures both behind me and ahead of me. First let me say that I am not a particularly modest man. Any body shame I have has more to do with my embarassment about my emerging lack of fitness than any specefic body part. My observations about my treatment over the last year by doctors, nurses and technicians are only my own. I don't purport to speak for anyone else. With that said, I am most comfortable when I am being treated respectfully. I can be treated respectfully fully dressed or completely naked, by a man or a woman, by a doctor nurse or technician. Respect includes askign me who can observe or participate, advising me of what's about to happen, recognizing my apprehension, maintaing professionalism and a sense of humor. I get uncomfortable when I'm ignored, treated like I'm just a body part or a procedure or when practioners assume they are in control of what happens. It's not about nudity, or gender, or teaching. It's just about respect.
Michael H

 
At Thursday, November 19, 2009 7:17:00 AM, Anonymous Anonymous said...

In regards to the lawsuit referenced above it's important to note that in the decision it makes it clear that they didn't have to accede to the demand for same gender care. Once they did they were then liable.

 
At Thursday, November 19, 2009 7:56:00 AM, Anonymous Anonymous said...

Marjorie


The problem I see with all
of your comments revolves around
sexual assault.I believe you see
this as a female problem only which
it is not. Male and female patients
can choose the gender of their provider,yet once we arrive at the
door step of the hospital the game
changes dramatically. Its 94% female nurses and 99% registration
staff. It dosen't end there as the
percentages are carried over to the
OR staff,ICU'S and floors.
Male patients are ambushed everyday in facilities across the nation despite the fact that some
may ask for specific gender teams.
Furthermore its the same picture at outpatient surgical suites,LTC facilites and nursing
homes.
//topofmyhead.blog-city.com/examples_of_unprofessional_nursing.html
This is an example of a female
cna sexually assaulting a male patient. His religion had nothing to do with it,should he be able to sue the facility? This site called
health care POV,thread titled
disturbing sexual behavior of female nurses involves a male patients wife complaining to the
facility in that they requested
all male staff,yet during the
surgery female staff were brought
in for the case. They were lied to!
Show me one single case on the
internet where male staff took a
cellphone pic of a female patient's
genitals. I'll direct you to the
sites this year alone of 15 cases
of female providers taking cellphone pics of male patient's
genitals!


PT

 
At Thursday, November 19, 2009 8:32:00 AM, Anonymous Anonymous said...

As an observation, I find that it has been a while since Dr. Bernstein has posted. I find this similar to how Dr. Lisa stopped posting after a while when going through the previous threads. Both Marjorie and SLO have reported cases of abuse and trust erosion by doctors. Most doctors would be willing to see the healthcase system change for the better. Dr. Bernstein has provided a great forum through this blog for patients to share their experiences. Both Dr. Bernstein and Dr. Lisa stressed the need for communication at the point of receiving healthcare and both have made efforts to open these channels of communication.

But when the communication do take other forms as it seems to now look like, what is the opinion of Dr. Bernstein?
--------SKI

 
At Thursday, November 19, 2009 11:46:00 AM, Anonymous Anonymous said...

First off, a person not wanting opposite gender care shouldn't have to fall under pyschological trauma from a previous sexual assault or religious reasons. Following your advice on how to deal with getting what you want, I can only surmise doing this would create a real scene and would have the entire operation of clerical staff in a huge uproar. This doesn't happen often and they wouldn't know what to do or how to handle it! Yes, I have medical background in my immediate family.

The only way I see to completely ensure what you want as a patient is to insist on what you want, have it in writing, and have an advocate you trust to stand in during the operation from start to finish! Way too many times people are told one thing and you ARE lied to. Happens all the time. Then it's spilled milk.
JW

 
At Thursday, November 19, 2009 2:22:00 PM, Anonymous Anonymous said...

Hi SKI. This is Dr. Lisa. I was the response above today and forgot to sign. I haven't been here in some time as things have been busy at work and at home. I missed quite a bit and didn't go back and read old posts. I will try and be here on a more regular basis.

I am still very much in favor of open communication. There was a great commercial recently with a women asking tons of questions at a restaurant and then being dead silent at the doctor's office. I found it to be spot on based on a lot of what has been stated here.

I hope it helped to open the eyes of some on how important it is to ask questions in regards to their health which is so vitally important. I also try to do my part and approach many of the things patients could find embarassing to open the lines of communication and let the patient see these things as natural and normal. I would hope others do the same.

Dr. Lisa

 
At Thursday, November 19, 2009 2:42:00 PM, Blogger Maurice Bernstein, M.D. said...

SKI, I have posted periodically but frankly I want my entire blog to have the topic set by me but generally I don't want to take sides on the issues and leave that up to my visitors. Yes, if there are valid ethical or legal points that I am aware and that may have been ignored or misstated, I should write and educate my visitors..which I do.

I have repeatedly explained my ignorance of many of the specific issues of patient physical modesty until I was educated by reading the responses here since this was never brought out by my patients. As I have written, I taught and continue to teach my medical students about general modesty and professional issues in performing a physical exam but until recently the teaching never included the concerns voiced on these threads.

As far as the tone or content of the postings here, they should be civil, not ad hominem to any specific person or writer and at this point (volume 27) should mostly avoid hearsay and not be written without resource documentation of specific allegations.

On this blog, I would rather be a moderator rather than a fighter. Outside the blog, in practice and with my first and second year medical students, I intend to be aware of what has been written here and take that now into consideration in what I do. ..Maurice.

 
At Thursday, November 19, 2009 3:18:00 PM, Anonymous Anonymous said...

Why should a patient who is of some
specific religion be entilted and
granted specific gender requests.
If one is to be granted such
requests then everyone must be accomodated. Religion has nothing to do with it or is this just a
tactic that women can use when the
need suits them.


PT

 
At Thursday, November 19, 2009 4:13:00 PM, Anonymous Anonymous said...

PT,
I don't recognize this entire issue as a female problem. My postings, of course, reflect my experience as everyone else's and, I happen to be female just as yours clearly represent the male perspective.

Let's make no mistake about it. I'm not sure whether it was on this blog, but I mentioned that our society is basically 50/50 and plenty of work to go around for bother genders. There are inappropriate behaviors for both and have been cited here. As a matter of fact, the nurses involved in my care when my abuse occurred were female and part of the problem.

The reason abuse is used in my posts is because it is a rampant problem, this modesty issue is many times at the center and there is much apathy. Anything I can do to build awareness, advocacy, and support is my duty.

No one should have their privacy rights invaded and yes, it's entirely about respect and nothing more. The audacity of behaviors that continue to occur is appalling.

Men must step up to the plate refusing opposite gender and requesting same gender care. Legislation must be put into place assuring that privacy rights by both genders are upheld and that facilities in order to be licensed must appease both genders in the clinical setting.
marjorie starr

 
At Thursday, November 19, 2009 8:19:00 PM, Anonymous Anonymous said...

PT
It just so happens that religious preferences regarding modesty are not a "female" thing. For one, Muslim men have their religious dictates as well as do some on this blog.

Everyone on this blog has issues with this subject. Some are female, some are male. Let's respect each other's rights and entitlements (based on each person's experience) and look at this as an issues we all share. That's exactly what it is, of course.

The medical community is only a segment of our population just like the general public. You will find some good and bad in both.
Marjorie Starr

 
At Thursday, November 19, 2009 9:32:00 PM, Anonymous Anonymous said...

Marjorie


Show me one instance where muslim men have these concerns
and that such concerns were respected and accomodated.


PT

 
At Thursday, November 19, 2009 10:42:00 PM, Anonymous Anonymous said...

Dr. Bernstein and Dr. Lisa,
Absolutely great that you can find time for this discussion with your professional and family commitments. My question was actually a little different.

Let us assume that proper communication didn't take place at the time of treatment by the doctor or other support staff and the patient wasn't fully aware of his/her rights but goes back home angry and violated. The case may be due to simply lack of communication or may be due to deliberate harmful intent. The question: is there a way to get this solved without litigation that may be expensive, unpredictable and cause other unexpected events?

Doctors would like to remove bad apples from their system but so far it seems to be done in a very closed door manner. Here in India, litigation against doctors was incredibly tough before. The only few cases of doctors being punished for wrongdoing was in extreme cases like removing the wrong kidney. The doctors agreed on accountability but were shocked to see a law come into force that made them directly punishable by courts. There was a hue and cry by the medical community that they didn't want to come under direct scrutiny either by criminal or consumer courts but would like their own panel. Recently, the law was amended to the effect that medical wrongdoing must first be established by a panel of doctors and only then can the doctor be tried. This has caused protests from the general public that this would make doctors even more difficult to bring to book as the first report must be given by doctors themselves.

In the end, everyone agrees that there are just a few doctors that are bad apples. There have been many public debates in India on what might be the best way to ensure that the healthcare system remains clean. Here is where the suggestions dry up. Doctors assure people to file complaints and that they will do their best to punish errant doctors. However, the general public has never been assured by this.

So finally, if a patient comes to a doctor with a case of wrongdoing, would a doctor in a honest manner provide the best possible recourse to the victim? What can be done to ensure that if genuine cases are brought to doctors, the victims will be helped to get relief?
------------SKI

 
At Friday, November 20, 2009 2:57:00 AM, Anonymous Anonymous said...

PT,

It is not my job to analyze my research based on your genderisation and abuse of men! What I said was that Muslim men have religious dictates regarding bodily modesty. Look it up!

Most will agree that this blog is not about an adversarial contest between bloggers. What it is, is an opportunity to share views, opinions, and opportunity for fixing a broken system. Let's do that.
Marjorie Starr

 
At Friday, November 20, 2009 3:48:00 AM, Anonymous Anonymous said...

marjorie star

Who decides whether someone is "traumatized" by an event, and why is being retraumatized any worse than being traumatized? If someone doesn't have a therapist backing him/her up does it mean that his/her traumatization isn't "official"? Can't a patient make their own determination?

If someone knows ahead of time that they will be traumatized if an opposite-gender "caregiver" sees or touches their genitals is it less important if it hasn't happened before and made "official" by a therapist? Why should you have to be traumatized at least once before medical workers have to respect your morals and dignity, especially when you tell them your feelings ahead of time?

I don't think it should take a prior traumatization to expect your "caregivers" to respect your morals. It should be nipped in the bud to prevent it from happening the first time.

Also Marjorie, in the lawsuit you mentioned, do you think the lawsuit would have been won if the patient was a man and the unwanted nurse was a woman?

Anon1

 
At Friday, November 20, 2009 4:04:00 AM, Anonymous Anonymous said...

Sorry, but I could never have any respect for a female Urologist. They're as unethical and immoral as male gynocologists. They are equal to prostitutes in my opinion.

 
At Friday, November 20, 2009 8:48:00 AM, Anonymous Anonymous said...

Dr. Bernstein,
I can't understand any purpose being served by the comment made by Anonymous 4:04am. As the moderator of the blog, I would have thought you could have skipped this post. I remember how on Dr. Sherman's blog, Dr. Alex simply stopped posting after the nature of the comments on some of the postings. It would be sad to lose Dr. Lisa for a similar reason.
-----------SKI

 
At Friday, November 20, 2009 10:47:00 AM, Blogger MER said...

This may seem off topic but it ties in with the comments by our poster from India. I'm providing a URL to an article about how elder abuse in nursing homes is punished or not punished in Minnesota -- You may recall that it was in Minnesota that two young girls, cna's, were charged this summer with abusing (some sexually)several nursing home residents. That case is currently on trial.
This article describes how difficult it is to get authorities to really do anything when nursing homes commit blatant wrongs. I post this because it shows that, if the kind of behavior described in the article isn't punished severely enough, what will they do with any kind of modesty violations? Probably nothing. Here's the URL:
http://www.startribune.com/investigators/70164857.html?elr=KArksi8cyaiUg7Kk8P3iUiD3aPc:_Yyc:aUHDYaGEP7eyckcUs

 
At Friday, November 20, 2009 11:19:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is MER's link but now clickable.

I don't have time right now, but I understand SKI's concern about the earlier anonymous posting. I will comment on the issue of thread moderation later today. ..Maurice.

..Maurice.

 
At Friday, November 20, 2009 11:51:00 AM, Blogger swf said...

SKI:
I disagree with you that DR. B. should not have posted the ANON. above and this is why:
Many people have had different experiences in their lives which influence the outcome of their feelings. Perhaps ANON. has had a "bad apple" or suffered some abuse in his/her life at the hands of a caregiver. This leads to people having anger and hosility toward not only genders in healthcare, but their motives as well.
Motives as to why a woman/man would choose a field with so much assumed (and many times unquestioned) entitlement to the naked bodies of the opposite gender have been spoken of alot on this blog. People often wind up feeling abused, molested, and confused about gender roles in future relationships. I hear it often with the people that I interview. The residual emotional pain is enormous.
I'm quite sure Dr. Lisa can handle these types of comments. And quite frankly, should she (and any other caregiver for that matter) not know all aspects of how they and their staff influence the lives of others?
Was it harsher than most people would post? Probably. But do we only want to know about the 'slightly' offended and the 'sort of' modest, and the 'kind of' hurt? Isn't our goal to find out how damaged and broken some people feel their lives have been left to them?
This subject turns very serious for many people.
But I also know of people who have been allowed to vent on this blog, move away from anger, and go on to control the strings of their own heathcare. A very real service that Dr. B. should be proud of.

 
At Friday, November 20, 2009 1:10:00 PM, Anonymous Anonymous said...

Marjorie


You should be able to back up
your research! Show me one instance
here in the U.S. whereby muslim men
have been accomodated,let alone an
orthodox jewish male.


MER


Apparently there have been
more sexual and physically assaults
by female cna's in Minn. since the last incident in Albert Lea.


PT

 
At Friday, November 20, 2009 1:12:00 PM, Anonymous Anonymous said...

SKI

If that is the posters opinion then that is their opinion
as I have the same opinion about female nurses and cna's. It's
freedom of speech!


PT

 
At Friday, November 20, 2009 1:44:00 PM, Anonymous Anonymous said...

sorry ski
but really what would you call a woman who takes a job to mess with naked men? think about how that really sounds before you judge what somone else says. you see?

 
At Friday, November 20, 2009 6:17:00 PM, Blogger Maurice Bernstein, M.D. said...

SKI, first ..don't leave these threads because of the responses to your previous comment. We need other views on the subject of patient modesty and the limits patients have in attaining their medical goals.

Secondly, I think in these 27 volumes most of us have read about the personal experiences which has disturbed our visitors. The symptoms and the disorders have been written and written again and again and now is the time to take a turn in the discussion to therapy.

I also think that generalizations of genders and generalizations of medical provider activities and behaviors is also unwarranted unless accompanied with documented resources which support the making of such generalizations. I also think that using the expression "all" in making either good or bad behavioral generalizations cannot be true.

What is needed now in these series of volumes is a concentration on discussions about how to find and execute mechanisms to attempt to mitigate and prevent the many unfortunate experiences that have been fully detailed here.

Please.. first "let's all get along", realize that there will be visitors who express their views in different ways but lets cut back the on more and more personal experiences (despite the therapeutic value of ventilation on a blog)since it does begin to impair discussion of ways to solve the problems in patient modesty. Make an attempt to write constructively and not destructively and document the source of any generalizations so that others can review and understand the validity of such generalizations.

You may disagree with my view of presentations for this blog and threads as moderator and if you do, speak up either on this thread or write me e-mail (DoktorMo@aol.com) but let's move ahead. ..Maurice.

 
At Friday, November 20, 2009 6:53:00 PM, Anonymous Anonymous said...

dr.
what we said to ski was not about him so why would he leave?????
it is how we feel about nurses and cna's and female drs. not him.

 
At Friday, November 20, 2009 7:44:00 PM, Anonymous Anonymous said...

I commend you Dr. B. for not censoring your posts and letting people speak their minds. If the good doctor decided which posts he should allow and which he shouldn't this blog wouldn't be any better than allnurses.com. There's no need to cover up some peoples beliefs. Dr. Bernstein has too much integrity to do that.

Somebody that wonders what really goes through the minds of "professionals" when they choose their field is no worse than "professionals" that believe they are completely ENTITLED to see and touch the bodies of other people with or without their consent, especially through manipulation of some kind.

SP

 
At Friday, November 20, 2009 7:51:00 PM, Anonymous Anonymous said...

If the Anon who posted the comment has good reason to do so why not follow his "prostitute" label by his own experience. Not only will that bring on suggestions from others about what can be done about it but will also inform others about this. From the post, I assume that the Anon who posted this is the same Anon who has posted similar comments about "filthy immoral females". Without any personal experiences (watered down if they are too painful to describe), Anon's post doesn't help.

We are almost all here for some reason related to modesty issues in healthcare. We are assuming here that Dr. Lisa can handle it. It only remains to be seen if people like her and Rev. Fred will stay on in this thread.
----------SKI

 
At Friday, November 20, 2009 9:10:00 PM, Blogger amr said...

I'm still here... :-)
--amr

 
At Friday, November 20, 2009 9:11:00 PM, Blogger Maurice Bernstein, M.D. said...

SP, you wrote: "Somebody that wonders what really goes through the minds of "professionals" when they choose their field is no worse than "professionals" that believe they are completely ENTITLED to see and touch the bodies of other people with or without their consent, especially through manipulation of some kind."

I am not sure what you mean. Maybe you can elaborate. Are you saying that the "somebody that wonders" is thinking in a presumptive manner about professional behavior and that professionals have been presumptive in selecting their profession, that is: presuming that the joining the profession is a means for sexual satisfaction or power? Is it presumption that is the common mindset or what? Just wondering. ..Maurice.

 
At Saturday, November 21, 2009 5:27:00 AM, Anonymous Anonymous said...

Post divided into two

MER & PT
Please read my post again. I didn't state any examples of lawsuits involving Muslim men. That, I'm a afraid was a challenge from PT and MER. What I said regarding religious dictates, is that Muslim men have theirs in response to PT's response to the lawsuit filed by a religious woman. Here are two URL's regarding male modesy hijab:

http://mens-style.suite101.com/article.cfm/definition_of_hijab_for_muslim_men

http://www.ezsoftech.com/Akram/hijab.asp

It was also noted during the Abu Graib abuse cases how especially degrading it was for Muslim men due to their religious culture to be forced to undress in front of the female guards.

 
At Saturday, November 21, 2009 5:33:00 AM, Anonymous Anonymous said...

Previous post re: response to MER and PT was from Marjorie as well.

Anon You are absolutely correct! Abuse is in the "eye of the abused". You would think that in a medical scenario explaining that you've been assaulted or previously humiliated that the staff would do everything possibe to protect your sensibilities. Think again. Someone, perhaps PT said it well. Something like "you don't get a ticket that says medical abuse victim". My protocol for making sure I get what I need that I shared here pushes the medical community into a corner where they cannot move without either doing harm to the patient, giving them what they need or refusing treatment. That's exactly what needs to happen. It was mentioned that this tactic will throw them into a state of not knowing what to do. That's exactly where it needs to go for this issue to be fixed. I should note that just refusing the male care is enough to send them into a tizzy.

Writing letters and requests throughout your procedure process (as someone suggested on here)will not get you what you need. I have done that time and time again even requesting special consults with surgeons. Time and time again I have personally seen the open lies, drugged patients (me) signing consent forms they would not and erosion of trust. The harm that this (erosion of trust)and re-traumatization causes is that it degrades the mental coping mechanisms of the PTSD patient causing triggers to become more obtuse, frequent and eventually that person cannot function. PTSD is a condition that has movement. It doesn't stay the same. It gets better; it gets worse. Calm waters, lack of triggers promotes health and healing. Re-traumatization promotes new (thereby more) triggers. Here's an example. Someone with PTSD due to one traumatic experience may have triggers so isolated that the problem can go on for years and years and unless the person is in a similar circumstance, they will not have triggers. So, if someone had an incident in a hospital involving staff and that person spent the next twenty years healthy, they wouldn't find out they had a problem until they re-entered the system. They might have had symptoms but if otherwise mentally healthy would not recognize those symptoms. Think of this brain injury starting as a pinpoint in the brain and that re-traumatiation causes that damaged piece of brain injury to grow into the size of a dime. Further trauma just keeps increasing the trauma center and eventually one can end up in a catatonic state. What I have done is create almost an iron clad defense paralyzing the system in either compliance or refusal of treatment. Legally if they force a competent patient against their will and if they can accommodate the patient need, they must will be cited for malpractice for doing harm to the patient. They will comply if they have the staff and if they don't-- move yourself or be prepared to die! What victims cannot afford at the any cost is to have their autonomy taken from them and treated against their will. This is just another sexual assault to them.
marjoriestar372350

 
At Saturday, November 21, 2009 9:05:00 AM, Blogger Maurice Bernstein, M.D. said...

Some anonymous visitor wrote today: "ski, there's a difference between stating your opinion and picking fights. Try to do more of the former. ". I rejected this comment from publication as a unnecessary and perhaps ad hominem remark but I decided to write it here on my own post as an example of the kind of writing that doesn't contribute anything since there is no notation of exactly what aspect of ski's opinion was non-pertinent and non-constructive to the topic and only of value to "pick a fight".

Anonymous and others, please don't write here with that slant about other's contributions. Discuss the other's views but don't try to diminish their value with a simple accusation and nothing further.

Sorry to appear as a "school teacher" but I did want to express my view as a moderator. ..Maurice.

 
At Saturday, November 21, 2009 9:27:00 AM, Anonymous Anonymous said...

As a follow-up to my previous post, I would only ask that people who have had bad experiences should share to some extent what they have been through. This blog could serve as a great medium for people to support each other. Besides, the anonymity the internet provides allows us to share our feelings without disclosing our complete identity. I too sign my posts as only SKI. I do not put my email address as I have no other reason to be on this blog than to share what I feel or hear what others have to say.
---------SKI

 
At Saturday, November 21, 2009 9:43:00 AM, Blogger Maurice Bernstein, M.D. said...

In this regard, I would disagree with SKI. In the over 4 years of these threads, virtually all have contained numerous descriptions of personal experiences of my visitors. I am glad they had the opportunity to ventilate here and as I have previously stated I think that the ventilation is in some way personally therapeutic.

But I think further descriptions of the varying nuances of personally experienced acts against one's physical modesty is not productive for these threads. We all know that a problem exists for a small or a large proportion of all patients (there is no way of judging small or large from just what is written here) and the goal now is to do something about it. I think that should be the point of further volumes. ..Maurice.

 
At Saturday, November 21, 2009 10:40:00 AM, Anonymous Anonymous said...

Dr. B,
I don't think one can derive a formula to solve this problem. To solve this problem, those patients who have wronged need to find ways to raise the issues with their healthcare provides and local authorities and get back with their experiences. Through this individual but mutually supported and advised effort, the entire issue of male patient modesty can grow into a movement. Modesty violations have taken place far longer than the 4 years of this blog and will continue to do so for a while. To assume that all violations have been reported and nothing new can be cited would be wrong.

Yes, we need follow-up of actions. Marjorie is writing her book. Swf is interviewing patients and compiling reports. We could hear about the efforts of others as well.

But if the Anon post above could come in with what his experience was and then even later with how he took the matter up, how would it hurt? That was also a question which I asked in one of my previous posts - has anything being put on paper from patients and to this Marjorie responded.
---------SKI

 
At Saturday, November 21, 2009 11:34:00 AM, Blogger MER said...

"It was also noted during the Abu Graib abuse cases how especially degrading it was for Muslim men due to their religious culture to be forced to undress in front of the female guards.

What we need to remind ourselves of is that this behavior is a "policy" (mostly unwritten) in warfare in general and has been in our current wars in particular. These men were humiliated as a strategy to get them to talk, confess. The same has been done to females in this and other wars -- human rights' violation stories are full of this kind of degradation, often followed by death. That's why this whole issue of "body" and "modesty" cannot be treated casually by the medical community. Exposing one's body to strangers is a neutral event. An exhibitionist or pervert can use it to shock people. It an be used to dehumanize and torture people. I can also be used as a necessity in medical situations to make people well and save lives. How it's done, how much respect and dignity is afforded the person is what matters, what moves the event from a neutral experience to an either or positive one. And of course, at heart is how the person feels about the exposure, whether he/she wants it to occur in front of same or opposite gender caregivers, in the case of medical treatment.

 
At Sunday, November 22, 2009 3:24:00 AM, Anonymous Anonymous said...

MER
Said beautifully!!!!!!
Marjorie Starr

 
At Sunday, November 22, 2009 6:12:00 AM, Anonymous Anonymous said...

As far as I'm concerned if I can't be treated with respect and dignity, which to me means keeping females away during any intimate care or exposure, I will refuse to be treated. If that's the case I hope, for their sake, that none of them have a conscience. I hope for my sake that someone in the hospital has a conscience.

If they try to take my morals away from me they might as well be taking my soul. Like marjorie has said, what's the point of fixing my body when they're destroying me psychologically. (or something like that)

LG

 
At Sunday, November 22, 2009 7:12:00 AM, Anonymous Anonymous said...

Mer

Since you are reminding us of
abu garib remember that these
techniques were perfected by the
US military and used against
perfectly innocent inductees for
over thirty years.
Seems they are a useful tool
in US prisons as well despite the
fact that female guards are
charged more with raping inmates
than anyone else according to the
dept of justice.


PT

 
At Sunday, November 22, 2009 7:12:00 PM, Anonymous Anonymous said...

Hi SKI. It would depend on the doctor and situation. Many would be willing to sit with upset patients and others might not. Some might fear litgation and not want to speak without an attorney present depending on the subject matter. There really is no one answer here.

I believe some of what you are referring to is the issue of informed consent. These days most hospitals give the forms to the patient about a week before the surgery when it isn't an emergency. You can even call and request the forms should this not be your hospital's policy. Most doctors go over the procedure, etc. in their office before the surgery is even scheduled.

I would always be willing to discuss issues with a patient whether they related directly to my service or not. If I felt further action needed to be taken I would get involved depending on the circumstances and/or point them in the right direction.

Doctors absolutely want to remove bad apples from the profession. There is no doubt about that.

In America a patient can meet with an attorney in regards to filing suit. Most medical malpractice cases never see the inside of a courtroom here.

In America you can also file an official letter of complaint. They review the complaint, gather all pertinent informatation, and will respond with their decision. It can range from no action all the way to loss of license.

Hope this helps.

Dr. Lisa

 
At Monday, November 23, 2009 6:12:00 AM, Anonymous Anonymous said...

I wish it were as easy to choose a nurse as it is to choose your doctor. That would sure solve a lot of problems. Especially for those like me that have no respect for nurses or aides.

 
At Monday, November 23, 2009 10:25:00 AM, Anonymous Anonymous said...

This occurred in Waco Texas last
week.

Authorities say a Texas woman lied about having breast cancer
and spent $10,000 raised at a benefit to have her breasts enlarged. McLennan County sheriff's investigator James Pack says Trista Joy Lathern 24,shaved her head to look like a cancer patient undergoing chemotherapy.
Pack says Lathern,wanted breast implants to try to save her seven month marriage. She is charged with theft by deception.


Certainly,considering the concerns right now with the healthcare debate and a lagging
economy,this makes good reading.
This is one of the reasons why I don't contribute to such causes
as instances like this occur often.
Likewise,many patients often
complain of sexual assault and
unfortunately for the patient and the system nursing rarely reports
these assaults to law enforcement
within 24 hours as required.
Currently,the number of sexual assaults in medical facilities is
truly not known in that for the
most part patients are unaware of
said occurrances. Patients who are
comatose,barb induced comas on a
ventilator are the most susceptible
to sexual assaults. Many patients
simply make up these accusations
for attention and/or hopes of a
lawsuit.
As it relates to patient privacy the problem needs to be taken to the core. Some feel it
might be advantageous to write
books on the subject,however,unless
you are a prolific vampire novelist
no one will take notice.


PT

 
At Monday, November 23, 2009 12:29:00 PM, Anonymous Anonymous said...

Try telling a nurse you want a second opinion! They will go get the doctor,usually a male and you tell him your problem with a female. Sometimes it works.

 
At Tuesday, November 24, 2009 4:07:00 AM, Anonymous Anonymous said...

PT
You're right...nobody would take notice with a book complaining about privacy concerns. But, they will have to pay attention to an expose on how the medical industry works and the harm it is causing to sometimes unsuspecting patients.

You know all those that are "hidden" by the medical industry? Watch them come out in droves of support of something they all want. And, then there is most of you with privacy concerns.

Because there are "standard of care" practices that are damaging to patients, those needs will be met too.

It's already started in labor and delivery. Once laws are passed protecting the most vulnerable things will spill into the public sector.

This has to happen because the premise of the case presented supports our already existing laws, rights of the disabled and will force the medical community to conform to prevent harm.

It amazes me that they don't want to. They are resisting someting that wlll ultimately benefit them. Conforming to gender issues gives the impression of respect to the patient. Patients will become more cooperative, allow more students and the staff will be happier with happier patients.And, for most of you...I think it's a fair bet that some of those privacy concerns won't matter as much. The only ones left are the abused. It will always matter to them. Mer was so right that it's not about nudity; it's about being respected as a human being and having your needs recogized and met.
Marjorie Starr3723

 
At Tuesday, November 24, 2009 9:02:00 AM, Anonymous Anonymous said...

Dr. Lisa,
Thanks for your post. Your post did answer one question of mine that a patient in distress could approach another doctor and seek advice/help. The complaint of patients is quite often that doctors clam up whenever they have to comment on another doctor as one day they to might face the music from their colleagues. Recently there was a case in India where a male doctor was accused of molesting a woman under examination. It then turned out that he had a long history of misbehavior and also complaining against senior doctors and colleagues. The result was when he was arrested, his colleagues just threw him out among the sharks to let him have it. What I found striking was that an offender here had a pattern of behavioral problems. There was a history somewhere.
--------SKI

 
At Tuesday, November 24, 2009 3:02:00 PM, Blogger rev. fred said...

SKI wondered as to my reaction to ANONYMOUS' appraisal that all female healthcare workers who perform intimate exams and care on men were to be rendered prostitutes. Admittedly, this is an extreme evaluation; but I can concur that the female staff in the operatingroom when I had a left inguinal hernia surgery behaved in a whorish manner, and treated me, as if I were vulgarian Howard Stern. This is a strong statment to come from a pious pastor; but I will stand by it. Are all female nurses like them? I hope not! The behavior of the surgical team is indicative of what we see unfolding all around us. The lack of a moral compass! Hospital staff often take their cues from soap operas and sit-coms! Do not forget, that I am made privy to the dark side of humanity. Visiting a parishioner on life-support, I pulled back the curtain, and discovered a doctor and nurse in each other's arms, and smooching! I have officiated at funerals of nurses who died from an apparent drug overdose. In my office, I have counselled nurses in rehab programs, due to stealing patient's prescriptions in the nursing home. A nurse had her license suspended for physically abusing a mentally challenged son of her live-in companion. A high profile nurse in the community was a closeted recreational nudist, and enforced a policy of nudity among her children. When the two daughters and son come home fromm school, off came the clothes. Entering puberty, the son no longer welcomed atmosphere, and covered himself. His mother wrestled him on the floor, and yanked off his briefs. In an effort to remove himself from this situation, he lied that he was a behavior problem, and moved in with his aunt and uncle. Locally, frontpage headlines in my town have repeated three local doctors were arrested by the feds for operating an illicit drug business; and a fourth doctor was shot dead at a highway tollbooth, by his wife's hit-man! Doctors and nurses do not have a monopoly on scandal or virtue; nor do they fall from the sky! Emerging from the population, they are a cross-section of the society. As the culture becomes increasingly decadent, we will witness greater degeneracy in the office and workplace. How could it be otherwise?--REV.FRED

 
At Tuesday, November 24, 2009 5:18:00 PM, Anonymous Anonymous said...

Amen REV.FRED.
As patients we are just expected to trust, respect and obey any and every nurse that pops up along our path to healthcare. We are expected to allow them to enter into our most private of places and do intimate things to our bodies that quite often patients won't even do with their own spouses, and keep our mouths shut and obey.

As you said Rev, we don't even know these people. We don't know what they have on their minds and we often don't know what they do with our body when we are unconscious or doped up. Though I've heard that male nurses, aides, etc aren't allowed to be alone in a room with a female patient, female nurses, aides, etc are usually allowed to be in with naked and unconscious male patients. Apparently we're expected to believe that female nurses are too virtuous and spiritually clean to ever take advantage of a situation.

Doctors have worked hard to get where they are and usually have too much to lose, so I don't worry too much about them doing something stupid or risky that could ruin their lives. Nurses on the other hand have much less to lose, especially nurses aides. A few weeks of school and they're trusted to do the most intimate and private things to patients of both genders. I'm amazed at what CNAs are allowed to see and do, often things much more intimate than your doctor will ever do to you. I just can't believe they're trusted to do those things!

It seems that the less education a medical worker has, the more intimate things they see and do. Full body shaves, baths and showers, undressing/dressing patients, inserting catheters, all done by someone with practically no education. It just overwhelmes me to hear about teenage girls shaving men for abdominal surgeries and other similar things! If they get caught doing something bad to patients what have they got to lose? Practically nothing! That is if the other nurses actually turn them in for it or anyone even knows what they did while alone with a patient. PT has given us many examples of that, and they were only the few that got caught.

Well, I can't help to defend the many, many patients that allow that to happen to them or their loved ones. All I can do is defend myself from ridiculous situations like that. I don't let CNAs do anything intimate do me, and I only let male nurses do the intimate things I can't avoid. I suggest that everyone pays closer attention to who do things like prepping you for surgery or who inserts your catheter, etc. You most likely don't know them and apparently they'll send just about anyone to do the most itimate things. Age, gender, education, experience and background aren't important and don't matter to whoever it is that sends the CNAs to do the most intimate things. We need to get more involved with our care and make sure those that do our intimate care actually have something to lose and can be trusted.

To the nurses and CNAs out there - don't you have a conscience? Do you really believe you are entitled to take those kinds of liberties with other people's bodies? How are we supposed to know we can trust you?

GL

 
At Tuesday, November 24, 2009 9:44:00 PM, Blogger MER said...

Part 1

I’ve been waiting for the right time to publish this next piece. The last few posts seem connected to what I have to say, especially the recent post by GL. I’m beginning to think that the idea of female nurses attending to the intimate care of male patients – although presented on the surface in hospital culture today as completely appropriate and acceptable and normal for both patient and nurse – is much more controversial. You won’t find much in print, especially in this country, perhaps because the idea that it might be inappropriate or unwelcome for some men is not politically correct, nor does it fit into the scheduling, hiring and economic culture of large hospitals.
It’s extremely difficult to research attitudes. You can, of course, interview people and take polls. But you’ll often get what people think they think, rather, necessarily, what their true attitudes. You really need to study the surrounding culture, popular ads and media, letters, journals, etc. We can learn much about these modesty issues, I think, from review medical publications rarely read by the general public. The old journals, especially, can give us insight into some of these controversial issues.
Take, for example, two 1907 issues of The American Journal of Nursing (AJN) (March and May). The topics? Catheterization of male patients by female nurses. It was an open, discussed controversial subject back then.
Annie L. Williamson, R.N., Superintendent of Oswego Hospital in New York, wrote in the March issue that what's often overlooked when discussing this subject is “...the moral effect on the patient, and his mental attitude towards such treatment and the nurses who are obliged to give it.” In other words, the danger is what the male will think of the nurse who does this job. Williamson goes on to comment on the unsavory moral status of the patients “who fill the male wards in our hospitals,” which is “too well known to need comment.” (p. 495)
What's she talking about? What's too well known that we don't even need to discuss it? Even back in 1907, most wealthy people didn't go to hospitals unless they had to. The hospitals or doctors came to them. If they did go to hospitals, they went to private hospitals or to special wards and were accommodated as a special private patient. Even cultured, educated men who were not wealthy may have gotten special treatment.
So who are these men with unsavory morals? They are the poor, the working class, the uneducated, the uncultured. According to Williamson, it was particularly dangerous for a female nurse to do this kind of intimate work on this kind of man “without lowering herself in his eyes, and establishing, from his standpoint, a relation much to be deplored...” The average {male} patient, she writes, “cannot be expected to look at the subject in a purely impersonal and professional light.” (p. 495)

 
At Tuesday, November 24, 2009 9:48:00 PM, Blogger MER said...

So – what's going on here? Are we stereotyping men? Keep in mind – the concern here is not about the man's embarrassment or possible humiliation. Indeed, it's suggested that, rather than being embarrassed, the man is more likely to presume that much more is going on than a mere medical procedure, and that the nurse doing it is not worthy of his respect. Is there any basis for a man feeling that way?
Remember, the history of modern nursing is a history of early nurses who did not come from the upper classes. Indeed, as the Industrial Revolution progressed and as young women from the farms moved to the cities, and as the medical profession grew – nursing became a viable option for these young women as an alternative to less dignified occupations such as factor work. In fact the early reformers saw nursing as an alternative for some of these girls falling into prostitution. Early nurses, before nursing schools (the 1870’s in this country) and professionalization (about the WW1 era), had to be closely monitored and supervised by matrons who where usually from the upper classes or upper middle classes and considered to be more morally stable.
Williamson says that any nurse doing this kind of intimate procedure on men must “exercise...great dignity and discretion, to prevent the patient presuming.” Notice again that the concern here isn't really for the male patient, especially those with questionable if not degenerate moral character – the lower, uncultured classes.
Williamson does talk about the other kind of patient, the man of “upright character.” What would be the effect of a female catheterizing him? It would, she says, violate “all his ideas of propriety, not to say decency,” and it would be a “severe shock to his moral sense.” This would be especially so in the “case of young men and boys.” But again, the focus isn't so much on the patient as it is on the nurse and the profession. “Their reverence for women, and especially for nurses, is apt to be sadly shaken,” Williamson writes.
I need to emphasize again that the major focus here is on the effect this intimate activity will have on the image of women in general and nurses in particular.
How about doing the procedure under sheets so the nurse can't see anything? “What of the touch?” Williamson writes. The contact of the nurse’s hands on the man's genitals is “as likely to have an evil effect on the patient.” Of course, “evil effect” in this context was an Edwardian euphemism for an erection.
Williamson goes on to argue against the idea that nurses should be taught only to do this procedure on unconscious patients. She tells a story of a nurse who did that, but the patient wasn't really unconscious, remembered it, and “afterwards related, to a choice circle of friends, no doubt with embellishments, what had taken place during the time that he was profoundly unconscious.” It still isn't about the man's feelings as much as it's about the man retelling the story in such a way as to lower the moral character of the nurse.
Williamson isn't suggesting that nurses not be taught this procedure. They should, and they should be willing to do it in an emergency. That would be their duty. She claimed that any nurse who could do the procedure on a woman could easily learn to do it on a man.
In the same March 1907 issue of AJN, a writer, R.C., a female medical student, weighs in on the issue. She complains about the difference between the textbooks used by doctors and nurses, the nursing student text being inferior because “The human body was everywhere expurgated as were the lectures.” She called attitudes like Williamson's “superficiality and prudery,” and added, “Is it justice to the nurse to say that her morals are tainted by this necessary work?” She then adds: “Would anyone dare make this assertion of our celebrated gynaecologists, who examine thousands of patients? – women.”

 
At Tuesday, November 24, 2009 9:48:00 PM, Blogger MER said...

Part 3

R.C. makes the issue clear. This issue is really about the strength of moral character of the female nurses. Are their characters and morals strong enough to do this kind of intimate work on men? R.C. says yes.
In the May 1907 issue of AJN, May Alzada Mott writes: “...I do not think in a hospital where there are interns and male nurses that a female nurse should catheterize a male patient, especially the class of young men and boys one is apt to meet in the wards and who cannot understand why a nurse is a nurse and what it means.” If this attitude appears to be condescending, perhaps it is. Men of these classes are not considered intelligent or sophisticated enough to understand what's going on between nurse and patient. There must be sexual motives, this argument goes, associated with any women who would perform such a procedure on any man – at least that’s what this “class” of men would just normally assume. Was or is there any truth to that, or is it just a rationalization?
R.C goes on: “It is true there are some nurses from whom the act of catheterizing a male would detract nothing – she would still be the same dignified, discreet, womanly nurse, but there are some others who have not enough stability of character, and would be better out of a male ward.” R.C. recognizes that, even if we consider this activity appropriate, it isn’t appropriate for all nurses. She also states, as does Williamson, that nurses should learn to do the procedure and be prepared in emergencies.
But note again that the big danger here is the dignity of the nurse, not the comfort of the patient. It's implied that most male patients, especially of the uncultured, uneducated lower classes, will misinterpret the interaction and presume too much. There is more concern for the better class of men and older boys. Their moral sense would be shocked with the result that they would lose their reverence for women – again, the concern for the female sensibility and image more than for male modesty.
So – what does all this mean for us today? I’m not sure. But I do believe that attitude we read here from 1907 is still alive. To what extent? I don’t know. But from the research I’ve done, I think a significant number of female nurses would just rather not do this kind of intimate procedure on a male. Why? Could be for many reasons. Perhaps they feel uncomfortable. Now, I’m not saying they won’t do it. It’s their job, so they’ll do it if required. I believe there is a struggle in the profession that doesn’t get expressed in public – the conflict between the gender neutral culture of the hospital vs. the importance of gender boundaries in the general culture.

 
At Tuesday, November 24, 2009 9:50:00 PM, Blogger MER said...

Part 4

This issue is not dead. Consider the following articles:
“Male catheterization and the extended role of the female nurse” in Community
Nurse, 2000, Feb; 5(2): 81-6.
“Male catheterization and the female nurse: still a controversy” in Community Nurse, 2000, June; (5):23-24. The abstract states: “Custom and tradition decreed that male catheterization was carried out by male nurses and doctors. Myth, misunderstanding and misbelieve can perpetuate the notion that it is inappropriate for a female nurse to catheterize a male patient.” Articles like this are attempting, it seems, to justify this change from the old “custom” and “tradition.” But the fact that articles like this need to be written suggest that there is resistance to this change.
“Male catheterization and the extended role of the female nurse” in Community Nurse, 2000, Feb; 5(2): 81-86.
“Male catheterization by female nurses: a small-scale survey” in British Journal of Nursing, Vol. 7, Issue 13, 23 Jul 1998, pp. 757-764. The results of this survey indicated that “while most nurses agree that it is acceptable for females to catheterize male patients, most female nurses do not undertake the procedure” because they thought there were polices against “patients being catheterized by nurses of the opposite sex.” Although rarely discussed in print, it may also be that a significant number of female nurses don’t feel comfortable doing this.

 
At Tuesday, November 24, 2009 10:18:00 PM, Anonymous Anonymous said...

Personally I think the men who complain about having intimate procedures done on them by women are distinctly in the minority. There certainly are several such people (a.k.a., less charitably, loudmouths & whiners) on this board, but in real life I have encountered zip.shit of them...that is none, zero, nil, nah-nah, 0....Most other guys I have encountered if they mention the gender of the nurse or whatever at all and that gender is female, it is with a wink and a smile. I play golf with about a dozen different guys regularly and another two dozen from time to time and I have never heard one complain about being worked on by females. If anything, they seem to like the attention. As do I.

Now I realize this will send some on this board into hissy fits, claiming that fetishes and all sort of perversions are wildly afoot in my mind and in the minds of any who countenance my view. So be it. That's their problem, not mine. As far as I am concerned I am in the camp that likes the attention, because it makes me feel good. Guys who can't stand their attention can turn red with embarrassment for all I care. Let them ask for male nurses till they are blue in the face. That would be white of them, eh? (See? They can be patriotic at the same time.) The more often they succeed the less chance the male clinicians will be assigned to me.

Al

 
At Tuesday, November 24, 2009 10:34:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, thanks for all the research you did and making a fine summation. I have to tell you and others here that as a physician a major concern of physicians regarding modesty issues of patients is that what actions we do will be misinterpreted by the patient as sexual and that attention should be given to avoid any behaviors which might be so misinterpreted. And this is not easy when performing sensitive exams or procedures on patients and our attention should be on doing a thorough exam or procedure which will be of value and not missing something because of our concerns.

By golly, I am glad to see there are men folks like Al who can come here and tell us that they are comfortable with female nurses performing those duties which others here have rejected. I am not trying to diminish the concern of the others but just to read here that there is another view. ..Maurice.

 
At Tuesday, November 24, 2009 11:13:00 PM, Anonymous Anonymous said...

What makes a CNA want to become a CNA? It can't be for the pay. It probably isn't because they enjoy cleaning up poop. It certainly doesn't put them into a higher class in society. My guess is, the nudity.

At least there are some guys like Al and a few other perverted CFNM lovers that seem to enjoy it. Well, like Al said, send guys like him the female CNAs because I know the CNAs will love it as much as the guys do. That way it'll be easier to send me the professionals if I'm hospitalized.

 
At Wednesday, November 25, 2009 12:05:00 AM, Blogger MER said...

Maurice: But notice what we get with Al. Not just an opinion. But the need to ridicule, make fun of those who don't agree with him. It's not that he's just comfortable. He's proud. Of course he ridicules those who don't agree with him with a subtle disingenunity. It's not often that those who prefer same gender care make fun of those who don't. But I often see Al's kind of attitude. It's not a live and let live attitude. It's almost as if he has a need for the kind of bravado he shows to buck himself up. Prove himself a real man. It's also as if his attitude represents some kind of masculinity deficit -- that is, real men enjoy the attention of real women. Can't you read between his lines? He's bragging, boasting. Look at me, he's saying. I'm a real man. And I can prove it. Frankly, I find his attitude pathetic.
And frankly, Maurice, I'm surprised you don't see through it. Or maybe you do and you're just being kind.

 
At Wednesday, November 25, 2009 12:30:00 AM, Anonymous Anonymous said...

I just did an interesting google search. The phrase "hate nurses" brought up over 15,000 hits. Without the quotes it found 2,840,000 hits. Food for thought.

 
At Wednesday, November 25, 2009 1:29:00 AM, Anonymous Anonymous said...

Al,
Its the case with many of us guys. We just don't want to admit being embarrassed. I remember about how I spent a week in the hospital a couple of years back and was greeted by my friends with "hope the nurses took real good care of you". I too grinned and said "Feels good" but I was embarrassed. A friend of mine who hurt his knee once had a female doctor ask him to strip completely naked. He joked about it to us but told me once over whiskey about how disgusted he felt.

What many people have posted before here has been about why they should be not allowed any modesty in front of a nurse who is fully clothed. Even the nurses themselves would not want the kind of treatment if roles had been reversed.
--------SKI

 
At Wednesday, November 25, 2009 4:35:00 AM, Anonymous Anonymous said...

Dr. B,

Police officers often have a very dark opinion of humanity due to their experience dealing with those on the fringes of society.

Here too, you are looking at a segment of the population who have issues with patient modesty. Those who don't wouldn't come to a blog like this most often, because this is not an issue for them.

It poses the question, why is this an issue for some? I was one of those people who accepted care, may have felt a bit uncomfortable meeting a new male doc for an intimate exam (especially when I would not see them again). However, I never thought much about it and was treated respectfully in the exam room. It was so insignificant that I never thought about it at all.

So..that brings us to why people change their mind or have these issues and whether they always had them or that behaviors inside and outside healthcare influence privacy concerns.

They range from previous sexual assault outside of the medicine, to impropriey, poor treatment or abuse inside the medical arena. They also come from cultural and moral issues that Rev Fred has said so succinctly.
Marjorie Starr

 
At Wednesday, November 25, 2009 7:57:00 AM, Anonymous Anonymous said...

I've been reading here for awhile at work and have'nt posted since there are not many women here and from there posts about them it is definately a man's blog!
But AL made me think.
Now my husbands body belongs to him and he is going to do what he wants to with it. But if he came home winking and enjoying the touch and atention of a strange woman at the hospital he can do it without me because we would be getting a divorce.
I don't care if she calls herself nurse or not, she can have the dirtbag.

 
At Wednesday, November 25, 2009 8:13:00 AM, Blogger MER said...

"I am glad to see there are men folks like Al who can come here and tell us that they are comfortable with female nurses performing those duties which others here have rejected."

Actually, Maurice, Al has told us nothing about how he fees about these private procedures. He's speaking in general terms about enjoying female attention, which I think many men on this blog can identify with. Few on here reject female nurses outright -- only for the most private procedures.

Maybe Al could comment on how he appreciates the attention of female nurses for specific procedures, like cathaterization or some of those more private, invasive, urological procedures.

And note what Marjorie's saying. Most men who don't want female nurses for intimate care, weren't born with that attitude. Most accepted female care until something happened. Not necessarily abuse, but more likely a feeling that they wren't being respected, that their dignity was ignored. Read the past posts. Many men on this blog walked into the hospital trusting and were burned. So I don't think we're talking about innate feelings. These men were open to female intimate care at one point. But they changed their minds. And it probably wasn't just the female nurses but the whole hospital culture that disturbed them.

 
At Wednesday, November 25, 2009 8:43:00 AM, Anonymous Anonymous said...

I don't believe Al is real. Sounds like a story from the back of a porn magazine. Nice try, but it was amusing.

Gal

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

MER, with regard to Al, I just want to see other views presented on these threads. I am at the moment not concerned about the full intentions of his posting and I certainly can't empirically at this time determine that. Sometimes I am not sure about the full intentions of his opposition when I read all the generalizations about nurses and nursing assistants written to this blog. My mantra is "why can't we all get along?" Yes, I admit, there is a problem within the medical system to the understanding and a problem in reacting to a valid issue of modesty which is of deep concern to a proportion of the patient population but we must all get along to facilitate solving this problem and degrading innuendos on either side of the issue is unacceptable. Anyway, that is my view. ..Maurice.

 
At Wednesday, November 25, 2009 9:26:00 AM, Blogger Maurice Bernstein, M.D. said...

On Google today, there are 20,000 hits for "I respect nurses" (in quotes) but if you read some of the links, the expression is used out of sarcasm. What this means is that one really can't evaluate the significance of the raw statistic but needs to determine the context of the use of the expression in each link. I have no time for that.. maybe some day Google will also provide statistics regarding context. ..Maurice.

 
At Wednesday, November 25, 2009 9:27:00 AM, Anonymous Anonymous said...

(Dr. I didn't sign my post. I'm the one whp mentioned divorcing my husband if he was like Al. I am Besty G. Sorry)

 
At Wednesday, November 25, 2009 9:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks Besty G. for the identification. I should remind again the others who are simply Anonymous to at least write a consistent pseudonym or initials after your posting. ..Maurice.

 
At Wednesday, November 25, 2009 12:13:00 PM, Blogger MER said...

I probably shouldn't have to say this, but because there is a significant amount of anti-nurse posting on this thread -- I need to again make it clear that I have a great respect for nurses. What I'm trying to do with these long posts is trace social attitudes. I'm not commenting on the character of nurses. As I've said before, this issue isn't so much about nudity as it is about respect for human dignity. When that's present, and when communication is open a genuine, this modesty issue fades into the background for many.

 
At Wednesday, November 25, 2009 12:32:00 PM, Blogger swf said...

Mer:
"It's almost as if he has a need for the kind of bravado he shows to buck himself up. Prove himself a real man. It's also as if his attitude represents some kind of masculinity deficit -- that is, real men enjoy the attention of real women. Can't you read between his lines? He's bragging, boasting. Look at me, he's saying. I'm a real man. And I can prove it. Frankly, I find his attitude pathetic."

I agree, and look at this a bit further..
Bragging about getting the attention of someone who is paid to be there proves nothing. In essence, you didn't garner the attention, you paid for it. Where is the bravado in that? It sort of disproves masculine abilities, as if one can not get female attention unless begging for it in a hospital, where any man could get the same attention.
Forgive the example, but it is like the guy who pays for a prostitute and tells his buddies what a great date he scored last night.

 
At Wednesday, November 25, 2009 3:31:00 PM, Anonymous Anonymous said...

"That would be white of them, eh?"

Good grief. Who cares if he is desperate or pathetic. But Doc you missed the fact that he is racist....unless you planted it to see if we noticed prejudice.

Gal

 
At Wednesday, November 25, 2009 4:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Gal, no I don't play games with my visitors. I obviously missed the connotation at the time I allowed Al's piece to be published. What would be appropriate would be for Al to read what has been written about what has been interpreted by others regarding his motivations and then write to us a less ambiguous, sexist or racist (if it was ambiguous, sexist or racist)of expression of his views. Personally, and with my apology, I missed all what others are concerned about but let's see what Al has further to say. ..Maurice.

 
At Wednesday, November 25, 2009 8:53:00 PM, Anonymous Anonymous said...

Found this at another site. It certainly rings true when compared to hospitals.

I wanted to tell everybody about a guy named Miguel. He is a custodian at a local gym. During a normal workday he is assigned to clean up and mop both the men's and women's locker/shower rooms. Three times a day he enters the women's locker/shower room without knocking and mops their floors while women are changing and showering naked in the shower area. He explains to the women that they shouldn't be embarrassed because he is a professional who's just doing his job.

After mopping for about ten minutes he leaves and comes back with three other men. He explains to any naked woman that tries to object that it's OK because two of the men work here too and the teenager is just there to observe because he's receiving on-the-job training and will soon be a professional as well. "Oh, and by the way," he says, "you have nothing to worry about because we're all gender neutral. None of you have anything we haven't seen before". Most of the women reluctantly agree and go on with their business, ignoring the four men.

As most of you have already figured out, this is a fictional account. But is it really any different than what goes on in hospitals and clinics every day? If a "professional" nurse or student nurse don't let naked men get in the way of doing their job, why should professional custodians (or other professionals) be treated any differently for trying to do their professional job?

 
At Wednesday, November 25, 2009 10:14:00 PM, Blogger Maurice Bernstein, M.D. said...

"why should professional custodians (or other professionals) be treated any differently for trying to do their professional job?"

Because...

Custodians are not given license, permission by society, to routinely intrude upon a person when they are undressed as part of their "professional" work. ..Maurice.

 
At Thursday, November 26, 2009 1:19:00 AM, Anonymous Anonymous said...

I love that story. I wonder if any medical workers will read that and really think about it. My guess is if they do and they have a conscience it will hurt their pride and they'll come up with all kinds of weak excuses about why they're different.

If they think society gives them extra privileges that nobody else has it just proves their arrogance and the fact that they put themselves above "normal" people.

Doctors are extremely important and necessary, and obviously we would all have worse lives, or no lives without them (can't say I think the same thing about nurses). But they should think less about their version of "society" and more about every person as an individual. Just because "society" in their minds says it's OK to put EVERY patient in every kind of intimate situation doesn't really mean each individual person agrees with it. Instead of TELLING every patient it's alright because society says it is, maybe they should think about asking if that particular patient agrees. Then again, asking each patient what they think would definitely slow down the assembly line and cost them money. We all know what's most important.

I don't doubt Dr. Bernstein is one of those doctors that does care, or we wouldn't have this blog. I don't imagine he gets paid for all the hours he spends here. But grouping every individual person as "society" is no different than calling all doctors and nurses perverts and saying they're ALL only in it for the money.

Many people in our "society" wouldn't care if male custodians cleaned women's locker rooms like in the story. They may think they're only "doing their jobs" for the greater good. They're not hurting anyone and SOMEONE has to do it. They might think that custodians see that kind of thing every day so they don't even notice if the women are naked or not. "They're professionals so why even question it." Who's to say all custodians are perverts and all CNA's are completely gender neutral? Because they took different classes in the same Community College?

I'm not suggesting custodians should do what they did in the story and I'm not comparing them to doctors. But there are many details and observations that shouldn't be overlooked concerning common sense and common courtesy. The locker room MUST be cleaned, but why not women instead of men? Why would they have to clean it at that exact time? Why does it take more than one custodian? Why would the custodian need an assistant to spray the mirror before he wipes it, or to be there to take notes? Does the custodian really need to have someone hand him the mop before he can use it? Why wouldn't the custodian ask the women if it's OK to enter instead of forcing his way in whether they want him in or not? I think all these questions can be compared to the medical world. Women at that gym know the locker room will have to be cleaned, it's necessary. But why under those circumstances with such a total lack of respect and dignity when it could have been done differently.

It's obviously necessary for a doctor to be involved with intimate situations, and support staff will often be necessary as well. But why have them as an audience when they're not really necessary and why not let the patient decide who he or she would be comfortable with when assistance is necessary after explaining why it's necessary? Why surprise or bully them into something they're not comfortable with?

 
At Thursday, November 26, 2009 1:23:00 AM, Anonymous Anonymous said...

Comparing the custodian story to the medical world, the management at the gym might say:

"Well that is how we do it here so if you don't like it you can find another gym (that treats their clients with respect). "Society" and the law says they need a clean locker room and that is how we do it. Why would you argue about the way we do it if you, as a member of society expect and trust us to keep the locker room clean? I can't believe you're questioning our judgement. We are a respected, licensed and trusted community gym so if you disagree with our methods then there is something wrong with you, not us. Society says so. We trust our custodians to do their job properly and without judgement. All of them got their degrees in custodial science at the community college and are true professionals. Let them do their job. Frankly I am shocked that you would complain about our methods because nobody has ever questioned them before. You're the first. What's wrong with you? Our custodians are professionals and it's insulting that you would question their professionalism."

I hope the people in the medical world that read this can understand my comparisons and think about it.

Anon1

 
At Thursday, November 26, 2009 1:39:00 AM, Anonymous Anonymous said...

It is also pertinent to note that medical professionals are treating people who sometimes need to be in a state of undress in order for them to perform their jobs. Custodians could perform their task when a facility is closed.

Society as a whole may seem like they've given permission, however, there seems to be a large segment that has not.

Majority rules, privacy rights must be fought for in the medical setting.

Custodians in the medical setting with naked patients come in rooms all the time with a sense of entitlement as well.
marjorie starr

 
At Thursday, November 26, 2009 2:22:00 AM, Anonymous Anonymous said...

Fine Al, you can have them. Send the perverts to the perverts and leave the professionals for me. I'm happy with the male nurses and assistants. Nothing they do feels sexual in any way so for me an intimate procedure is nothing more than a slightly uncomfortable trip to the men's locker room. If you and others prefer the sexual stimulation then that's between you, your wife and God.

I agree that if I was being gawked at and fondled by a woman I couldn't help but think of it as sexual. That's why I avoid it, for my own morals and for the sake of my marriage. For me, if being "touched" is absolutely necessary for my health, it's nothing more than a very uncomfortable but necessary medical procedure if a man did it. Something I would try my best to avoid but will reluctantly agree to if my life was on the line.

I'm not very comfortable changing in a men's locker room but I do it when I have to, but I would NEVER consider changing in a women's locker room. Naturally, seeing women naked would be better than seeing other men naked, but it's wrong and my conscience and morality would never let me do it. That's something nurses and aides should think about.

Another thing, what do the husbands of nurses and aides think about their wives fondling men's private parts all day? Not necessarily the comparing of his privates to other men but more for the immorality of it. I could never be married to a woman that does that. It gives me the shivers to even think about it.

Anon1

 
At Thursday, November 26, 2009 10:37:00 AM, Anonymous Anonymous said...

Good point, Anon 1, how do husbands deal with that? Your wife who say works in the OR as a circulating nurse comes home and has as a matter of routine and her job been handling male genitals all day. Shaving, scrubbing, handling a male patients genitals day in and day out. Do these nurses not tell their husbands that they do this? Maybe they keep them in the dark just as they keep this information from many a patient because it is done after they sedate the patient.

 
At Thursday, November 26, 2009 10:58:00 AM, Anonymous Anonymous said...

Comparing the custodian story to the medical world, the management at the gym might say:

"Well that is how we do it here so if you don't like it you can find another gym (that treats their clients with respect). "Society" and the law says they need a clean locker room and that is how we do it. Why would you argue about the way we do it if you, as a member of society expect and trust us to keep the locker room clean? I can't believe you're questioning our judgement. We are a respected, licensed and trusted community gym so if you disagree with our methods then there is something wrong with you, not us. Society says so. We trust our custodians to do their job properly and without judgement. All of them got their degrees in custodial science at the community college and are true professionals. Let them do their job. Frankly I am shocked that you would complain about our methods because nobody has ever questioned them before. You're the first. What's wrong with you? Our custodians are professionals and it's insulting that you would question their professionalism."

I hope the people in the medical world that read this can understand my comparisons and think about it.

Anon1

 
At Thursday, November 26, 2009 12:49:00 PM, Blogger MER said...

Part 1

"Custodians are not given license, permission by society, to routinely intrude upon a person when they are undressed as part of their "professional" work. ..Maurice."

Although I agree with your basic premise, I think you've oversimplified this.
1. It was another world when that "license" and "permission" was granted doctors by society. Permissions like that need to be rediscussed and renewed. Note that I say "doctors." In the last 30-40 years, many other medical jobs have been created -- all kinds of nurse assistants and technicians that require what might be considered non professional training people complete access to he most intimate exams and procedures. And frankly, these positions are now doing many of the intimate procedures (or assisting with them) that doctors and nurses did and assisted with in the past. Are these nurse assistants and techs professionals? Do they have the same "professional" status that you do, Doctor? I say, no. Have they been granted the same license and permissions that doctors and nurses have been granted by society? HAve these questions even been discussed and debated with patients at the table? Obviously, not.
2. The entire definition of "professional" has changed in the last several decades. Everyone is a "professional." Plumbers, electricians, carpenters consider themselves "Professionals" by one aspect of the definition. And, frankly, some of these so-called "professions" go through mnore rigorous training that do some nurse assistants (cna's). Granted, there is still the concept of a "profession" and those characteristics that attach themselves to such a calling. But more and more these other "professions" are adopting some of those same characteristics.
3. I'll give you an example. A significant number of female OB-GYN will accept a male doctor but not a male nurse. Why? Does it have something to do with the concept of "profession" in the patient's minds? Is it that they have been socialized to accept male doctors but not male nurses? Many male nurses, though accepting this attitude, don't understand why a male is accepted in on sense but not in another. I suggest it's connected to the idea of a "professional."

 
At Thursday, November 26, 2009 12:49:00 PM, Blogger MER said...

Part 2

4. Professions face their shortcomings, discuss,debate and try to improve. We see that kind of professional attitude on this and Dr. Sherman's blog. To some extent we see this on allnurses.com, though they find some topics more uncomfortable than others because nursing is so female dominated. Someone, show me a medical tech or cna site where these issues are discussed as they are here. You won't find one. Why? These occupations are not professions. They are jobs.
5. The custom in many hospitals now is for almost everyone to wear scrubs. What do scrubs represent? Among other things, they stand for access. If you're wearing scrubs (and in some hospitals custodians and housekeepers wear scrubs), a patient can't tell you from a doctor or nurse. Who's who? It's not uncommon at all for these same people wearing scrubs not to wear name tags. I've heard doctors and nurses tell me sometimes they don't know who's who in these large hospitals. And, if you're wearing scrubs, you can go almost anywhere.
6. This "license" and "permission" you refer to, Maurice, was originally extended to doctors and nurses. Now it seems to be extended to the hospital itself, anyone in the hospital, anytime, anywhere -- depending, of course, on how savvy and considerate any individual hospital is regarding patient dignity. It will vary. But the true "medical profession," which I consider to include doctors and nurse, cannot just assume that this license extends to everyone associated with what they do for patients, especially these intimate, embarrassing procedures.
That's why I've pushed for written polices regarding patient requests for specific gender care. The medical profession had better start discussing this question seriously or polices will be forced upon them through legislation.
So, although the custodian analogy has many problems -- it's trying to tell the medical profession some important attitudes held by many patients about what they consider professional and nonprofessional access to their bodies. The profession had better start listening.

 
At Thursday, November 26, 2009 12:53:00 PM, Blogger Maurice Bernstein, M.D. said...

A physician's or nurse's license to perform their professional duties is set under the laws of the state and supervised by state boards of practice (representing the society of the state). Physicians and nurses represent true professions since they have established professional codes of conduct. The laws and codes permit the examination and treatment of patients within the standards of practice and established ethics. A custodian has none of this. A custodian is not licensed though his or her employer may have a business license or other other licenses. A custodian does not need a formal education, certification or diploma and does not require a license to practice. Society needs custodians as much as society needs physicians and nurses, in their own way they are both important contributors to a safe and healthy society but the job of a custodian does not primarily involve attending to undressed clients and society, boards and laws never gave them that privilege as part of their occupation. Doctors and nurses have that privilege. ..Maurice.

 
At Thursday, November 26, 2009 2:44:00 PM, Anonymous Anonymous said...

"Frankly I am shocked that you would complain about our methods because nobody has ever questioned them before." Anon 1, that is a very interesting observation. On another site I visit, I hear a lot of women who've had hysterectomies complain to their doctor that it has affected them in an adverse way sexually. And so often their dr feigns complete surprise and tells them that they are the first to tell them. Obviously its a universal ploy used by doctors for any complaint. Well we now have the internet and we are empowered to know we are not alone
NP

 
At Friday, November 27, 2009 8:09:00 AM, Anonymous Anonymous said...

Excellent points MER. That's exactly what's happening. The last time I had an exam was for a clinical study and a guy wearing scrubs gave me a simple exam and took blood. He wasn't wearing a name tag so I asked him what his official title was and he told me he was a "clinical study coordinator".

I still have no idea what his actual job was but I think he was a nurse. Though he could have been the janitor for all I knew. I didn't worry much though. He was a guy and seemed to know what he was doing. If it was a woman and I had to take more than my shirt off I would have made a big deal about it.

DG

 
At Friday, November 27, 2009 9:49:00 AM, Blogger Maurice Bernstein, M.D. said...

DG, may I make a suggestion. Don't let anyone touch you in a hospital or clinical environment without the person wearing a name tag which identifies the individual with his or her degree ans full title. A "clinical study coordinator" could be anything from a physician to my son-in-law's occupation as a representative from the pharmaceutical company who is monitoring the company's research project in various hospitals. I have to ask him when I see him today if he ever draws blood. ..Maurice.

 
At Friday, November 27, 2009 4:38:00 PM, Anonymous Anonymous said...

Like I said I've been reading these things for awhile and I was really hoping people like Mer, Alan, Swf, Marjorie, PT, Jimmy and the dr. B. and espesially the Rev. could help me, but I just get madder and more frustrated .
Who are these state certifiers and invisable people who just decide for ME and MY Body that these other people can invade it?? Nobody asked ME...do I want to be naked infront of these millions of strangers? No. No. Who are they to take the choice from me and say it is ok with them? Who cares, its not OK with me.
Isnt it my body? It is so upsetting that I protect it from strangers and some nameless facelees people take my choice of my naked body from me??
I am too upset for words. It is like rape and the legal is on their side not mine. How can this be true? How can this be OK?
If I have to protect my naked body from invaders who just chooose to do it no questiones asked only because they want and can get away with it, then I just wont go get care.
This is too unreal for words. MY NAKED BODY? YOUR RIGHT TO IT? Why is this even legal or an arguement??
I would rather die than give in to these people who just want a job to molest me. I hate them all for taking my body away from me. This isnt civil, ethical, moral, or even normal way of life.

 
At Friday, November 27, 2009 10:42:00 PM, Blogger Maurice Bernstein, M.D. said...

In response to Anonymous of 4:38pm today, what can anyone say to your desperate concern and view of the medical profession except avoid interfacing with the medical profession and all of its participants. This would not be a rational decision in view of people's dependence on physicians and nurses at certain times in one's life.

Anonymous writes "Who are these state certifiers and invisable people who just decide for ME and MY Body that these other people can invade it??" They are similar to all those who make laws involved in many activities in our lives for which many of us has never given our approval.

I can tell you that physicians are very much aware of the special privileges which have been given to them that others may not have and the need to use them with caution and professionally.

Yes, I will admit that the modesty concerns of some patients have been underestimated by physicians and the medical system and have not been met in all cases. But I deny that physicians in general are malicious, sociopaths, sexual perverts and rapists. And as I noted in the first paragraph, those who earnestly and irrevocably believe that my denial is biased and these descriptions of physicians are true, then there is no hope to change the behavior of physicians and one should avoid them. ..Maurice.

 
At Friday, November 27, 2009 11:28:00 PM, Anonymous Anonymous said...

Good idea Dr., I'll be more careful from now on and make sure I know exactly who someone is before I let them touch me. I got dropped from the study after the first visit because I started to late. I really wanted that free Upper Endoscopy though.

I sympethise with the anonymous person that wrote about not being a part of who decides who sees him naked. I feel the same way. Apparently on my last visit I was more concerned about the gender of the person than his title. I didn't know at first how naked I had to get but I wasn't too concerned about it since they sent a guy in to see me. It would have been a different story if they had sent a woman.

DG

 
At Saturday, November 28, 2009 2:36:00 AM, Anonymous Anonymous said...

To Dr. Bernstein and Anonymous 11/27 4:38 p.m.

My views are radical. They have to be.

First, to anonymous, please look back in this blog 27 to see how you can push the envelope to either get what you need or refuse treatment. I, too, share your sentiments and would refuse to go to a hospital even if it meant my life. That doesn't mean that I don't atleast acknowledge the opportunity to change my mind under the right circumstance (as unlikely as that is).

To Dr. Bernstein,

Anyone who has a desperate need to avoid healthcare for modesty reasons and assaults on their dignity must have a reason for it. The stories and abuses are rampant.

Please answer these questions.

Why should patients be forced to be abused, degraded and re-traumatized?

Why should the medical community continuously be allowed to behave this way without self discipline?

Why should someone who has a history of sexual abuse (especially when the original offense happened in a hospital) be forced into an environment that is mentally and physically harmful to them?

Why isn't the medical community and the mental health association doing something by developing protocols to help the vulnerable?

My reasons as mentioned before (Medical Sexual Abuse) is about as good as any other. It's what's important to the patient.

The rights of patients are trampled on every way possible when you enter the hospital.

American hospitals are to serve the instiution and not the patient. Mer said is very succinctly when Mer mentioned the prison system, mental health system and the medical system. It is disgraceful that these abuses continue in this day in age.

Why is it that the research has been done, the writing is on the wall and the medical community doesn't want to recognize human rights abuses occurring in our hospitals every day. While visiting a family member over the weekend, the very first rule under patient rights said something like this, "You have the right to be treated with dignity and respect inline with your beliefs?"

When you consider the avoidance that people have as a symptom of Post Traumatic Stress Disorder, it is a travesty that the medical community doesn't support previous victims of sexual abuse, assualt and torture in the healthcare setting. The employee rights trump the privacy rights of patients.

The last questions, "Why should I have to avoid healthcare? Isn't it time that the medical community did something other than force emotional damage on the already traumatized? What kind of disgraceful medical care is that?

You have been very kind to do this blog. How can you watch the people damaged and not want to facilitate a movement recognizing these issues?
marjorie starr3723

 
At Saturday, November 28, 2009 8:48:00 AM, Blogger Maurice Bernstein, M.D. said...

I talked to my son-in-law who says he is not a "clinical study coordinator" since he is not part of the research team but simply monitors the progress of the study for the pharmaceutical company. He never has drawn blood. He stated that the coordinator is a licensed physician, nurse or other licensed healthcare provider who could, if needed, draw a blood specimen. He does agree that such a person should make themselves easily identifiable for the patient. ..Maurice.

 
At Saturday, November 28, 2009 9:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Marjorie, If "medical sexual abuse" represents means sex acts by intent or by action on a patient, I totally disagree with those who state that there is "medical sexual abuse" or words to that effect that would paint all the physicians, nurses and healthcare providers with that same brush. Nor do I agree that entering any hospital is equivalent to entering a "little house of sexual horrors". The vast majority of physicians, nurses and hospital like myself, my wife and my hospital attempt to work and do work for the patient's benefit often with personal and institutional sacrifices. To set us all as some pathologic social creature is a totally irrational view of the medical profession and its responsibilities and work. To those who look at medicine in that slant should look elsewhere, if they can, for help when needed and not subject themselves for this assumed universal socio-pathologic "profession".

Now, as I have repeatedly stated in these volumes and totally agree with those who have commented about the lack of understanding by the medical profession of the importance, the value and need for clinical gender selection by some population of patients. As I have repeatedly written, this concept was not emphasized to me or understood by me for the many years of my practice until I started reading the visitor responses here. And I think that the vast majority of healthcare providers and many institutions are to varying extent likewise ignorant or unwilling or unable to mitigate these concerns. I have agreed with those here who want a change in healthcare provider mentality but also in response so that all patients who have gender concerns can get their safe and satisfying medical care without prejudice or unnecessary delay. I also agree that such patients should form activist groups to help broadcast the need and facilitate such changes in the medical community. I will continue these threads to promulgate such ends.

But, again, I want to state that I reject a psycho-sexual-sociopathic label to all in medicine. ..Maurice.

 
At Saturday, November 28, 2009 11:08:00 AM, Blogger MER said...

I want to state that I agree in essence with what Dr. Bernstein has written in response to Marjorie. Marjorie noted that I wrote about prisons, mental institutions and hospitals together. My intent isn't to suggest that hospitals are equal to those other institutions. What I'm suggesting is the power dynamics and strategies regarding nakedness are similar in all three institutions, not necessarily in intent but in results. I think at times that some medical professionals are unaware of how their patients are reacting to nakedness, or, the caregivers rationalize and attribute positive or neutral feelings to the patients, feelings that don't exist. My point in all this is the caregivers need to consciously understand how nakedness has been (and is)used negatively to demean and humiliate people -- and they need to understand that patient feelings in this area can be extremely damaged regardless of the caregiver intent. Again, communication, honesty and a genuine approach makes all the difference.

 
At Saturday, November 28, 2009 11:38:00 AM, Blogger MER said...

I think one point that is rarely discussed, a point I've heard from a few men I've interviewed, and from some nurses -- is this:
Although most reasonable people know that the vast majority of female nurses and cna's do not intend to sexual arouse the men they treat intimately -- that doesn't mean that some men don't feel sexual arousal sometimes, depending upon the context. And the fact that they do feel aroused, doesn't mean they're doing it on purpose or enjoying it. They may be tying to stop it and it may bother them deeply. But it happens. So, regardless of caregiver intent, some men feel sexually aroused during some of these intimate procedures. It's part of the male psyche. Some caregivers misinterpret any arousal the man demonstrates. The see it as sexual harassment or as lack of male modesty. And, frankly, some men, to cover their embarrassment, shrug it off or even brag or otherwise make statements or comments that suggest to the nurse she is being sexually harassed. The man may even give the impression that he's not modest, a brazen response that may give some nurses the impression that most men really don't mind female intimate care.
I've heard men tell me that as long as they don't find the female nurse attractive, things will usually go fine. One man said, "As long as she doesn't turn me on..." It may be not only a matter of gender, but also a matter of age and how attractive the nurses is to the male patient.

A few nurses have told me, and I've read it on some blogs, that it isn't uncommon to send in an older nurse to deal with some men needing intimate care, knowing that it will make a difference in the man's eyes. Men have said that the care seems more acceptable with an older, less attractive nurse (attractiveness being relative, in the patient's eyes)
These attitudes are generally part of the underground structure of what's going on between patient and caregiver, especially in opposite gender intimate care situations with male patients. You don't find many people bringing this subject out in the open.
I can't speak for how women may react to what they considered handsome, good looking male doctors or nurses in these situations. But, to some degree, I believe this dynamic happens to both genders.
Of course, it happens to caregivers, too -- their feelings of physical attraction to a patient. But most prefer not to even discuss this, and I can understand why. Most doctors and nurses learn to handle and deal with these feelings. But as I've suggested on past posts (and I've cited articles about this) -- the way doctors and nurses handle this can be either positive or negative, damaging or empowering to themselves and the patient. Some strategies they use protect them yet may damage the patient trust.
This is one reason why this gender neutral attitude disturbs me. The issue isn't whether caregivers should know how to treat both genders. They should. The issue isn't whether patients perhaps shouldn't just accept any gender care. That would be nice, especially for the institution and maybe even for the patient, as would all Utopian ideals. But that's not how it is. What disturbs me is that there's enough professional literature out there to strongly indicate the importance of gender for both caregivers and patients. And although to some degree it is acknowledged within the profession and dealt with, it most often isn't approached open and honestly with the patient. It's kept secret.

 
At Saturday, November 28, 2009 12:18:00 PM, Blogger MER said...

An item in today's L.A. Times. The Journal of Epidemiology and Community Health reports a study that claims that "Walking away or letting things pass may be an unhealthy way to deal with unfair treatment on the job. This study of 2755 men comes out of Sweden. Men who reported these "covert" strategies so many were more than twice as likely to have a heart attack or die from heart disease over the next 10 years.
We've talked about how men don't complain, but are ambushed or just let intimate care situations happen to them in hospital or clinic settings. Now, imagine a man who has a heart condition under the stress of not wanting opposite gender intimate care but being unwilling to ask for same gender care. In a situation like this, the system itself that isn't proactive could be putting the man in more danger than it realizes.
I realize this sounds like a stretch to some. But let's be honest -- medicine knows how important factors like stress and psychological well-being play in patient care and ultimate success. Although we can't always quantify it, it's no mystery.

 
At Saturday, November 28, 2009 12:54:00 PM, Anonymous Anonymous said...

It seems to be forgotten repeatedly that when I write, it is in the context of any person who has been abused whether in the healthcare system or elsewhere.

These patients need different protocols. These protocols have been established when dealing with rape victims when they enter the hospital immediately after their ordeal. What I am saying is that victims of sex crimes no matter where or when they happened need protection.

Institutional sexual abuse does occur. It occurs in our mental institutions, hospitals, nursing homes and of course, in the penal system as well. It may occur more often in certain populations but for those victimized it is alive and well. It colors all other medical treatment or lack of. You might want to look at advocateweb.org and some of the postings right here.

Nobody can invalidate my experience of sexual abuse in a hospital by a deviant physician and cruel and abusive staff at the most vulnerable time of my life. I'm not saying it happens every day or to everyone.

Mental health is every bit as important as physical health; sometimes more. It's not one or the other. Both need to be incorporated into treating patients. Bodily exposure to those previously traumatized and humiliated is tenfold for a previous victim. Evidence shows that extreme humiliation causes people to avoid at all cost and even at extremes, commit suicide rather than be subjected to such treatment.

Ignoring this segment of the population is morally, medically and ethically unsound.

There is nothing wrong with the wonderful healthcare workers that want to do the right thing for the patient no matter what their gender. And, for most people this isn't a huge ordeal. Benefits and risks are weighed by the patient.

However, when it comes to intimate care for some segments of the population, it's more than a choice. It's a matter of life and death.
marjorie starr 3723

 
At Saturday, November 28, 2009 1:23:00 PM, Anonymous Anonymous said...

Sexual assault does not only constitute rape. It constitutes forced intimate care, stripping of patients against their will. Deviant staff may comment on a patient's body, underwear or leering and making sexual comments to a patient. Staff may expose bodies when no bodily exposure is necessary. Some treatments would be considered assault and battery in another setting.

What MER is saying is exactly what I'm saying. Victims with ptsd and have issues like these risk stroke, heart attack especially if they already have these conditions. This makes opposite gender, disrespectful and forced care abusive, degrading and damaging to the patient.
marjorie starr

 
At Saturday, November 28, 2009 2:50:00 PM, Blogger MER said...

I know this will make no difference to a few people, but suggest you read a detailed description of what a surgical nurse does. Read it carefully. Although the word "modesty" isn't mentioned, it is embedded within the concepts patient comfort, which is mentioned several times. Now, I'm not saying that bad things "never, never, never" happen in the OR, but I believe it's much less common that most people think. Those who are suspicious of what goes on there and never want a female nurse -- you're feelings should be respected if possible. But the reality of what's going on, I think, is reflected more in this URL that is in many post we read on the web.
http://allnurses.com/nursing-articles/what-do-operating-426443.html

 
At Saturday, November 28, 2009 7:18:00 PM, Anonymous Anonymous said...

Part 1

I’ll never forget the first time I entered that forbidden place called the OB ward. It was like a club that I wasn’t invited to, and unless I whispered the secret code word correctly, I would never gain entrance. The “Girls Only” sign wasn’t on the door, but still, I could see it. All of my female nurse colleagues went cruising into this sacred place, and then, there was only me—the lone male nurse—waiting outside. I stood in the hospital corridor and was hesitant. Me, the guy who has no fear, was nervous. Fear of the unknown tends to do that to you. The old “Never let them see you sweat” adage was thrown out the window and I was dripping angst from my brow. As I stood outside the OB ward, it hit me like a lightning bolt—wait a minute, other nurses were in there helping women give birth and I wasn’t! As I steamed over this, I took a shot of courage (a cold Starbucks Café Latte) and pondered my circumstances. In I went into the world of major estrogen and out I came a different person. At first glance, it wasn’t bad. There were women laboring in beds. The one thing that keeps you focused in a OB ward is simple—these gals are not wearing clothes, and the only way you can identify who they are is by wrist bands. It was an exercise in concentration trying to figure out who was who, and while I was concentrating, unfortunately, I managed to sashay near the OR. I was unknowingly standing next to the OR exit and of course, two women cruised by me on gurneys with nothing on. After the initial averting of my eyes, and it then occurred to me; after you see one naked butt, they all start to look the same. It’s no big deal, and if you don't believe me, watch Showgirls a couple of times—it gets old real fast and you don't even notice it anymore. I had been officially baptized, and it was no big deal. After a while, you just get used to nakedness and it’s all business. The patients don’t say anything, I don’t care, hey...nobody cares! In fact, after 1 hour in a OB ward, you don’t notice anyone naked. It’s a mind-numbing thing to experience—getting complete wrapped up in a job and not noticing the other stuff around you. You’ve got limited time to talk to the patients before they leave, so make hay or fail is my mantra. Should men be allowed in OB wards? Absolutely.

-Horne-

 
At Saturday, November 28, 2009 7:18:00 PM, Anonymous Anonymous said...

Part 2

The misconceptions about the atmosphere are overrated. It’s a professional setting, and if the nurse is professional, the whole experience is smooth as silk. There are plenty of men who have gal friends and have no ulterior motive in the friendship—contrary to popular belief, women and men can co-habitate in extreme conditions. Even when one is naked. The only way a male nurse can do his job in a OB ward is if the patients don’t look at him as a guy. They will look at him as one of the gals if he doesn’t act like a guy. If he knows his job, and asks relevant questions, he will be welcome in the OB ward. It's like having a male gynecologist—if he's fairly comfortable doing his thing, it makes the female patient fairly comfortable. If he's uneasy, it's time to get out of the stirrups. It's a symbiotic relationship—the relationship only works if both parties are comfortable with the other. The key is to gain the players’ respect and trust. If you can do that, they will accept you with open arms, and, actually, be on their best manners when you talk to them. Prove to them you know your stuff, and you will have proven to them why you belong there. Acceptance will be given if you represent your profession in the highest degree. OB wards are overrated. Guys in OB Wards are overrated. Heck, with 10 percent of the population homosexual, there's a good chance that some of the female nurses are homosexual as well. Should they be banned from OB Wards? Giving birth and having a healthy baby? Now that is underrated, and the goal of every nurse—it’s what keeps us focused. The rest is all overrated. Especially butts.

-Horne-

 
At Saturday, November 28, 2009 7:20:00 PM, Anonymous Anonymous said...

Part 3

OK, now that you have read this take a look at this link upon which the above posts are based.

http://bleacherreport.com/articles/111519-female-reporters-in-the-locker-room-does-it-work

-Horne-

 
At Saturday, November 28, 2009 10:54:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY NOVEMBER 28, 2009 "PATIENT MODESTY: VOLUME 27" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 28. ..Maurice.

 

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