Patient Modesty: Volume 29
The issue of patient physical modesty continues and currently there is discussion of the role of spouses or intimate mates in the active support or reaction to their opposites' personal experiences with regard to possible nudity or genital exams or procedures carried out by healthcare providers, perhaps of either gender. In other words, to what extent should spouses or the others react? Should sex in marriage or other intimate relationship be disrupted or ended if their opposite was examined or had a procedure performed? How is consideration of this concern related to the overall issue of providing an opportunity for patients to make gender selection in healthcare providers to ease patient's modesty issues? As we begin Volume 29, continue writing on this and the general topic of patient modesty. ..Maurice.
Graphic: Postcard:“Don't Be Afraid” - Man and woman in bathing suits with bathing machine, c. 1910 from Wikipedia and modified by me with Picasa3.
ADDENDUM 1-3-2010: CONTRIBUTORS TO THESE PATIENT MODESTY THREADS HAVE AN OPPORTUNITY TO EXPRESS THEIR MODESTY CONCERNS TO A BROADER AND MORE SIGNIFICANT AUDIENCE THAN SIMPLY AND ONLY WRITING COMMENTS HERE. THE ONLINE PUBLICATION HOSPITAL.COM HAS OFFERED TO CONTINUE THIS DISCUSSION ON THEIR PUBLICATION. WITH A GREATER AND MULTI-DISCIPLINE MEDICAL SYSTEM AUDIENCE THEIR PARTICIPATION WILL BE A VALUABLE CONTRIBUTION TO THE BROADCASTING OF THE CONCERNS BEING EXPRESSED HERE. ..Maurice.
NOTICE: AS OF TODAY JANUARY 9, 2010 "PATIENT MODESTY: VOLUME 29 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 30
posted by Maurice Bernstein, M.D. @ 9:25:00 AM
127 comments
127 Comments:
I saw an NP a few years back because i was having to take a piss very frequently, the duration went from 1 hour to like 30 mins to 20 etc and i decided id better see a doc at urgent care, had to stop to use restroom on way there even. got there and wasnt able to wait in line cause i had to go again, i asked the nurse if they could come get me in the rest room because i cant stop having to take a leak, trust me i was far from thinking of flashing at this time, really worried wtf was wrong. while in restroom the pee started to turn orangish and like every min or so i had to go. finally they took me to a room, nurse gave me a container to pee in and i was pretty much non stop into it. a second nurse came in and saw my willy out and sticking into the container and asked me to please not do that here. i explained i cant stop going to restroom, somethign is wrong and thats why i am here. finally the NP came in and i asked her what could be the problem, she grabs my willy as if it were a chore she didnt want to really do. sticks one of those probes in it to do a scraping (hurt like total hell) and said its probably an STD from someone i had sex with recently (with a sneer on her face) she then gave me a shot of something in my butt cheek which nearly instantly made the urges to piss go away. prescribed some pills, antibotics and sent me on my way. The culture came out as ecoli when i went for a followup at my regular doctor. strange, ever since then i havent been able to maintain an erection unless im fluffing it or having intercourse. ill get hard but it will start to go down without "attention" wonder if she damaged me somehow with that probe?
Kaz
Here are some postings written to Volume 28 but after I closed the Volume today. I would agree with Marjorie for those who remain as an unidentified Anonymous should for the sake of a "healthy debate" to identify yourself with some consistent pseudonym or initials. ..Maurice.
That's right anonymous, it wouldn't bother me a bit. All that is important to me is that is does not bother him; that he gets the care he needs when ill.
However, I'm sure if there were deviance involved, it would bother both of us.
We are all products of our experiences. When I realized I had issues,I felt it important to understand why I had issues. It might be interesting if some of you would do the same. I'm not making a judgment, just inviting you to explore your own psyche. It might help when these issues come up to be able to explain why you feel the way you do. It would give support to your feelings and needs both to the medical community and to spouses.
Anonymous...identify yourself and thanks for this healthy debate.
marjorie star
swf wrote the following:
Marjorie:
I certainly understand allowing your spouse their belief systems, and how the happy marriage would result. I too have been married for awhile. There is a degree that even that extends to however. For example: if I decided prostitution was 'a great little way to make some cash'....I would not get the loving support of my husband!
Extreme example: but quite frankly we have a tendency not to support our spouses in decisions that we feel break our vows. Or at least that is how mine works with regard to respecting the other. But we all have different standards regarding our spouses actions, and the 'amusing' example above was meant to show that infidelity can be viewed in lots of ways.
This issue of spouses and modesty -- I would hope that spouses would agree upon this before they get married. It's so significant. If they didn't agree upon this or even discuss it, after their marriage, I would considered it a breach by the party offended to assume that their partner should surrender his or her autonomy in this matter. A marriage contract doesn't entail surrendering every aspect of one's individuality, for either gender. But a couple's value system had better be similar or serious conflicts like this could emerge.
But -- the foundational premise of this argument seems to be the belief by some than any opposite gender medical care is immoral. If that assumption is correct, we need to just agree to disagree -- because I don't accept that premise.
After I posted my last reflecting on the fact that it would not bother me a bit if care were needed, I thought of something.
Looking deeper into what women are saying about their men with regard to what they consider modesty violations, it seems that it's the behavior of the spouses that's in question. Here's why. The medical model is what it is. It hasn't changed and for the most part, the clinicians who work in the medical model are simply doing their jobs the way they were taught; nothing more or less. The model can create situations that amplify humiliation.
What seems to be looming though is the behavior of the male patients in context with the fixed model and it's their behavior that the spouse's object to as much as the medical model.
With all due respects we are talking about medical experiences; not involvement with prostitutes.
I will stand with my other post that it bodes well for those concerned about the exposure of their spouses genitals in the name of healthcare look into the reasons why.
Comments will no longer be posted by me regarding unidentified individuals.
marjorie starr
Mer,
Neither do I.
Marjorie Starr
Marjorie,
I assume that at one time you didn't mind men giving you intimate care, but after you were assaulted you changed your mind. Don't you feel any sense of "looking out" for your husband so something similar won't have to happen to change his mind?
unidentified individual #1
Unidentified individual #1,
Actually what happened to me involved cruel and degrading care from both genders, and a deviant male physician. It happened at a time when no spouse would be permitted in the room--pre-op.
Medical sexual abuse is a real issue. It's something that I've devoted the last 7 years of my life. It happens but it doesn't happen all of the time.
My spouse is not a child. You cannot protect everyone all of the time. It's important that individuals have their autonomy.
I will say, that when my husband had recent surgery I protected him in that I would not allow entry of nurses when he was in a state of complete undress. It, was what he wanted me to do. She was coming in the cubicle to give him a paper and I made her wait.
There is a difference between looking out for bad medical procedure and taking away your spouse's autonomy insisting on things that are not important to him.
What if a female nurse came in to put in a foley? If my husband had no objection neither would I. I would also leave the room to give him his privacy.
I can see, that there is a thin line between the two. What I take issue with is insisting on things at the detriment of care when the issue isn't important to the patient.
I could care less who sees my husband undressed as long as he doesn't care. The issue isn't nudity; it's respect. Walking in on someone without asking permission is disrespectful.
It is I who have issues. What right do I have to traumatize people into making my issues theirs? What right do any of us have in refusing care for a loved one when that person has no objection? It's really a very negativee and destructive path for you, your loved one and the medical team trying to do their job. I think Dr. B would support me on this one!
It is my level headedness, fair judgment and focus on issues that are detrimental that make me viable, credible, understandable and I've probably surprised some on here with my pragmatic look at medicine.
We cannot be angry with individuals trying to do their job. What we can do is take every opportunity to educate the medical community on the issues we discuss on this blog.
marjorie starr3723
As I see it, most of the issues spoken of here can be divided into two primary beliefs/opinions.
A. Those who believe that there is nothing inately wrong with opposite gender intimate care, and anyone who chooses to do this for a living should not be judged as anything more than wanting to provide care. Intimate actions/functions performed by these people are not the same as intimate actions/functions performed by others.
Z.Those who feel that intimate actions/functions performed by these people are exactly the same as intimate actions/functions performed by others, and the assumed entitlement to their body is an act of disrespect and therefore inappropriate.
Somewhere in between these camps we get most of the range of issues (including no intimate care at all regardless of gender) although some people do feel one of the above ways with no grey areas. Most of them are called 'extreme', because they feel absolutely opposite from us and we can not ever see ourselves feeling as they do. However:'extreme' is really used here in relation to our opinion, and not based on the proof of any percentage of population. Most true A's and Z's here are ridiculed as not being normal in our eyes, (certainly not as worldly and wise as we )when in fact both of these feelings are perfectly normal and are indeed quite common.
I see many 'extreme' opinions in the last few volumes, almost to the points of either passively nonexistant to utterly self absorbed. Are they normal? Yes, I know a lot of people who are either painfully noncomittal or wildly self serving.
There are many opinions here that although I understand the concepts I will never have the same feeling. None of us are absolutly right or absolutly wrong.
Mer is right, in the end the only real choice is to agree to disagree. But I think we can all agree that choice is still the only answer for all of us 'extreme'ly normal people.
Majorie- interesting last post, I find myself agreeing with everything you said and your reasoning but I didn’t understand one thing. You said you would leave the room to give your husband privacy. By staying you let the staff know you their actions are being observed, so they will be on their best behavior. He’s been your husband for 35 years, he has already let you know him in the most intimate of ways, why would he object to you seeing a medical treatment or procedure on him. Of course, if you couldn’t stand the sight of needles, blood, etc or if you specifically asked and he wanted you to leave, by all means honor his request but I don’t know of any husband who would ask his own wife to leave the room. -Dani-
"well for those concerned about the exposure of their spouses genitals in the name of healthcare look into the reasons why.'
I know the reason why. It wasn't appropriate for a strange woman to touch my husbands genitals. This shouldn't really be that hard to comprehend.
Will someone please explain why these women are so sainted that you forgive them anything? For god sake, they are just regular women. They eat they drink they pee they blow there nose they buy toilet paper. Lovely pictures all, just like everyone else.
Please take the starlight from your eyes and these women off the pedistal and grow up.
"I could care less who sees my husband undressed as long as he doesn't care."
You might well ask yourself to look into the reasons why you don't care. I well imagine that will also answer why I do.
swf, excellent summary! And of course I am of population A both professionally but also privately if I am a patient. I think that any healthcare provider (and my experience is that this represents virtually all healthcare providers) is allowed and can render intimate care which is appropriate for their training and skills and which is appropriate for the clinical situation of the patient. A plumber is not permitted to render intimate bodily care to fix a plugged up sink but a female urologist or female nurse is permitted to insert a Foley catheter into the penis of a man who has severe prostate obstruction. And if this is done professionally that is all that matters. Now whether the patient is dissatisfied with the gender of the healthcare provider, that is another matter but it doesn't mean that it is wrong, unethical, illegal or unprofessional or if I may say "sexually provocative" for that Foley to be inserted. Those patients who for whatever reason or motivation want to decline the exam or procedure because of the gender of the healthcare provider should be free to do so but that should be the option available to the patient and has nothing to do with the professional permission given to the healthcare provider.
I think much of the discussion here about sexuality, perversion and such truly muddies the waters regarding ways of making medical care as beneficent as possible for the patient.
The discussion should be on the need for patients who are displeased to speak up. It should be about physicians, administrators and other healthcare providers to listen and for the medical system to be changed to allow for gender selection by the patient as much as practical. And the discussion should be about ways, in addition, for patients with the same philosophy and needs get together and form activistic groups, by their presence and actions, to facilitate the process for change.
But to me, personally, all this sexual this and that back and forth is should I say "teen-aged childish", unrealistic and does not contribute anything to change. ..Maurice.
I would like to end the myths that cross-gender intimate care of a spouse "shouldn´t matter". I really don´t care the "we´re all professionals" crap, female nurses are women just like everyone else, anmd pretty unprofesional at that. The point is why we tolerate in the name of medical care. I agree with Marjorie that privacy rights are individual, but HERE¨S THE POINT: if you put the temporary needs of a stupid and entitlement-minded teenage nurse over the real emotional well-being of your spouse, who swore after all to love you -you just don´t care. Period. If you´re so callous that you don´t care -I do- don´t complain. And nurses are disrespectful- it´s not stereotýping a whole group, it´s the way it is....Then there´s the issue of DECEPTION, if after you reached an agreeement, he lies to you and she covers him up in the name of "patient privacy", it is just a conspiracy. If he breaks the promise adn even lies to me about what happened, only to try to have sex with me as usual, I feel "entitled" to refuse any sexual service to such an insensitive person!!!! If that nurse really cares about him as much as she says perhaps he can improve his well-being enourmously by also relieving him sexually!
Great post Maria!
Dr B you said "Those patients who for whatever reason or motivation want to decline the exam or procedure because of the gender of the healthcare provider should be free to do so but that should be the option available to the patient and has nothing to do with the professional permission given to the healthcare provider."
The majority of patients aren't in a position to decline an exam or procedure and quite often never gave the "professional permission" in the first place. Things are just done to them when they are unconscious or so doped up they don't realize what's happening to them. That's when personal morals should be assumed and family should step up to bat for them.
Even those that sign informed consent contracts have no idea what will happen to them when they are unconscious and who will see them exposed. Many inexperienced patients (like me until last year) never suspect that opposite gender workers will be stripping them naked and handling their genitals. I didn't think there would ever be an unnecessary audience watching. I never imagined something so unethical and immoral would ever happen. I always assumed patient's bodies would be treated with respect. Allowing the opposite gender to see and (God forbid) touch patient's genitals, especially nurses aides is so unethical I never suspected it would ever happen. I always thought doctors were more involved and did more than show up for a couple of minutes. I guess I was naive and just trusted the medical profession to have morals and respect human modesty.
GR
"If that nurse really cares about him as much as she says perhaps he can improve his well-being enourmously by also relieving him sexually!"
Great point. How can that be much different? It's basically inserting a foley without the foley. If they make those particular physical movements to his penis when he's in pain or unconscious why not make the same movements when he's not in pain or when he's conscious. Pre-op shaving and scrubbing, catheter care, certain penile procedures, etc are all done by female nurses, MAs and CNAs. Doing exactly the same thing when men aren't in pain, unconscious or very worried about what's going to happen to them would be considered sex.
As someone stated earlier, why are nurses considered so much higher and angelic-like than normal human beings? If while they do what they do they are wearing just their underwear instead of scrubs they would be considered prostitutes. Why is it so different? To me, having a teenage girl wrap her hand around my penis and move it around is something a prostitute would do. The only difference is the medical "professional" would be holding a catheter or an electric shaver in her other hand and wearing scrubs.
If my wife didn't get furious about that I would be very disappointed in her. What really upsets me is that in most cases it CAN be done differently. A male can be sent to do it and there never needs to be more than one person in the room. More privacy CAN be given. If a male shaves, scrubs, bathes or inserts a foley it is very unlikely either the nurse or patient will think of it as being sexual.
Another thing is I see many people here are being critisized for saying ALL nurses are perverts. In defense of medical professionals others say that NO nurses or assistants are perverts. I think a great many ARE perverts, especially those with less time invested in their education such as CNAs, MAs and techs. How are we to know who is who? Many here ask "what's the difference if they enjoy it or not? It's their job. It doesn't hurt the patient if the nurse enjoys it. The patient won't even realize she enjoys it." That astounds me. Even if the "professional" has 4 years of education, 2 years, 3 months, she is using a patient for her own sexual pleasure. Anyone who says or thinks NO nurse or assistant does that is even dumber or more naive than those that say ALL nurses are perverts.
GR
Nobody has ever asked me to leave the room when my husband is having procedures.
However, having another pair of eyes watching objectifies the patient and in itself is a cause for humiliation.
Would you like your husband to watch you gyn exam?
If so, we all have our preferences and my husband and I have ours and is not open anyone's values except ours.
I must say though, that the route that this blog is taking is absolutely ridiculous. Women who do not trust their husbands have issues and dilute the purpose of the blog.
I, who was abused in a medical setting have never said that all anyone is perverted. It is just like the general population.
Dr. B, A plea to get this blog back where it belongs, please.
marjorie starr
marjorie starr
Dr. Bernstein,
I've been TDY on a couple projects and haven't participated here in a while, and I must say that I'm a little dismayed to see the direction some of the discussion has taken.
Your recent post stating "Now whether the patient is dissatisfied with the gender of the healthcare provider, that is another matter but it doesn't mean that it is wrong, unethical, illegal or unprofessional or if I may say "sexually provocative" for that Foley to be inserted. Those patients who for whatever reason or motivation want to decline the exam or procedure because of the gender of the healthcare provider should be free to do so but that should be the option available to the patient and has nothing to do with the professional permission given to the healthcare provider." is right on the money.
I also agree that "all this sexual this and that back and forth is should I say "teen-aged childish", unrealistic and does not contribute anything to change", but would add extremist, misogynistic and in some cases bordering on irrational.
In my opinion, if progress is to be made on the issue of respect for the patients' rights of privacy and modesty, it needs to be done through logical rational discourse based on those rights and the patients' willingness to assert what is important to them. The issue is not that these rights exist, but getting the health care system to respect them. Again, in my opinion, all the peripheral crap and moralistic/sexual this and that is not really pertinent, detracts from the focus and is potentially counterproductive.
Marjorie, you wrote: "Dr. B, A plea to get this blog back where it belongs, please" Actually, I don't know where it belongs since the title of these threads have been "patient modesty", the interpretation of that title is obviously up to the reader and poster. Obviously if most of the writers felt that modesty must be trumped by medical expediency and medical benefit for the patient then the views expressed here would be entirely different.
What I do dislike in what is written here is to negatively paint any group with an unestablished broad brush without documentation of resources supporting that view and available for others to research that documentation. Healthcare providers should be looked upon at the outset as ethical and professional and law-abiding individuals (just as all of my visitors should be looked upon) unless there is contrary valid documentation.
The best thing I can offer to these threads is for the writers to be civil, be rational in what is written, identify yourself with some consistent pseudonym if you want to remain otherwise anonymous and to follow the lead of MER and document,document and document the origin of the views that you are trying to express.
If these steps are followed, then constructive discussion will ensue and the misconceptions of many of us will be corrected as the volumes dealing with patient modesty continues. ..Maurice.
Personally I feel "GR" makes valid points. Patients new or fairly new to the system have no clue that females will be doing such intimate procedures with any advance warning or consent. One learns the hard way that this goes on.
MER states couples should discuss this early on so they agree on such things. Are you kidding me? People have no idea this crap goes on until they have an experience that is upsetting. As stated many times on this blog we all have differing viewpoints on this subject. The main thing that is missing in the healthcare field is "communication". The patient is NOT informed and are blindsided and bambuzzled. That is when the patient feels violated and angry. Respect involves complete transparency and consent.
JW
Personally I feel "GR" makes valid points. Patients new or fairly new to the system have no clue that females will be doing such intimate procedures with any advance warning or consent. One learns the hard way that this goes on.
MER states couples should discuss this early on so they agree on such things. Are you kidding me? People have no idea this crap goes on until they have an experience that is upsetting. As stated many times on this blog we all have differing viewpoints on this subject. The main thing that is missing in the healthcare field is "communication". The patient is NOT informed and are blindsided and bambuzzled. That is when the patient feels violated and angry. Respect involves complete transparency and consent.
JW
Not long ago, I visited a male parishioner in rapid decline, at a nearby nursing home. As I was about to walk through the opened door of his private room, I found a female physician (she was wearing a white coat), and a female nurse, lifting the man's gown to examine his privates. Immediately, I made a u-turn and waited for their exit before my re-entry. I suspect that my late church member had some kind of affliction between his legs, prompting the inspection; but did this man die with dignity, when he was put on parade? I wonder how many other times this happened to him! The room had no curtains or screens, and the hallway is the main thoroughfare of the facility--why was the door not closed? Several of my congregants are employed as nurses at this home. I described the appearances of the doctor and the nurse, to learn their identities; but said nothing of the episode. If the occasion arises and someone presses me about my "score-card" of the local nursing homes, guess what grade this spiritual teacher will assign, because of the unprofessional behavior of its attending physician! Returning to the home to see other members, I have bypassed this doctor several times, and harbor illwill in my heart toward her! Sometimes, I am asked, what would I do, if I had a million dollars. My answer is forever changing. At present, due to this discussion board, I would invest it to organize teams of "UNDERCOVER" patients planted in hospitals, nursing homes, and doctor's offices, to receive intimate exams, procedures, scans, and care, to test the providers accommodation and treatment. Gathering information, the experiences would be publicly disclosed on a national website for scrutiny. Watch how quickly we begin to see things change. Mark Twain said "When it comes to money, we all belong to the same religion!" When pressure is put on the medical world to shape-up, they will come to "believe" in modesty. I wear a cross around my neck; I'm afraid that too many hospital administrators wear a dollar sign. - REV. FRED
Maurice said
"Healthcare providers should be looked upon at the outset as ethical and professional and
law-abiding individuals(just as all
of my visitors should be looked
upon)unless there is contrary
valid documentation."
But Maurice,most of us have and
look where it got us,on your site!
Have you ever pondered the number
of disgrunteled patients who perhaps don't know about this site,
yet with bad experiences would like
to make their views known. If that
were the case I doubt you or anyone
could keep up, you couldn't make
volumes fast enough.
My contention with healthcare
and that includes any other service
industry,trust no one.I've seen the
many bad apples that healthcare has
to offer. Fact is the bad behavior
you often see and read about was and continues to be encouraged in
many facilities.
Mer
Previously,you made reference
to frostiness in describing a
demeanor among nursing staff.Many
may use it as a defense for burnout
which is really an excuse for
laziness. There was an ongoing
thread on allnurses which essentially describes how many
hospitals are leaning more towards
better patient care and patient
satisfaction. Some of the nursing responses were,"it sucks,ridiculous
and absurd."
It begs the question,why did
these people choose nursing in the
first place?
PT
I don't agree that this blog is going astray. Like Dr B said, "the title of these threads have been "patient modesty", the interpretation of that title is obviously up to the reader and poster." I don't recall any threads here that that are specifically used to discuss patients that have previously been sexually assaulted yet we have had that topic shoved down our throats for awhile.
I agree with the previous 3 comments from JW, Rev Fred and PT. Rev Fred I like your suggestion about undercover patients. Even if you can't do anything legally with the testimony of the undercover patients you could at least try to get them on some type of undercover show like Dateline or 60 Minutes. If hospitals and retirement homes know there is the possibility of undercover patients they might get their act together and stop abusing and parading their patients.
Thanks again for spending so much time with this blog Dr B. I find it very admirable that you allow people to voice their opinion here. Even when they might be openly critisizing your personal opinion or your profession you still post it when many moderators would censor it and only post what they agree with (like a certain other nurses site). Thanks.
Anon #1
I have a question about Versed or similar anesthtesias (it regards patient modesty). From what I understand Versed is given during a procedure like a Colonoscopy and it probably won't knock the patient out but only relaxes them. In that relaxed state would the patient allow things to happen that he/she wouldn't ordinarily allow? For example if I normally wouldn't allow a female nurse to see me undressed would Versed make me not care? From what I understand the patient would forget everything that happened during that specific time and the medical team knows that and often takes advantage and does things they know the patient won't remember. But would it loosen their morals during that time as well?
Rigby
Hexanchus said it well....
I agree that Advocating needs to be broadbased and directed toward "Respectful Care". Splintering the advocacy movement into different areas of morals, fidelity, jealousy, abuse, and spousal trust can hurt the unified purpose. When approaching the idea of respectful care, we are talking about dignified care in the eyes of the patient and their rights to choices and their body, and is a goal for ALL patient's needs.
We also need to be respectful to the medical community. Issues with such emotions can easily break bonds of communication if disrespect is shown, or people are on the attack. If we gear our advocacy toward options for the patient, all of the opinions in the sprectrum should be covered, whether it's modesty, morals, infidelity, abuse, or simply preference.
However:
"I must say though, that the route that this blog is taking is absolutely ridiculous. Women who do not trust their husbands have issues and dilute the purpose of the blog.""Dr. B, A plea to get this blog back where it belongs, please."
I thought discussion was the purpose of this blog, and who is to choose which points are valid and which are ridiculous? Disagree if you choose, but don't demean their right to even post their thoughts.
How can all opinions be invited and then asked not post if their purpose or statements do not agree with ours? Discussion dilutes nothing if you are firm in your own beliefs.
All comments are valid if civil, and a rare opportunity for understanding.
Reread Maria's post, for example. She actually did ask us a few ethical questions.
Rigby, a simple answer to your questiion is 'yes.'
Versed and Propofol, both drugs used for surgical pre-op or sedation during endoscopy, colonoscopy, etc. makes a patient very sedated. You breathe on your own although oxygen via nasal canula is usually given and vitals are monitored. Depending on the patients weight and the dosage of the drug given will be the determining factor on how much asleep the patient becomes. Basically, both drugs put you to sleep and you wake up NOT remembering a thing. If given a very light dose, you might not be completely asleep but very, very drosey and can watch the monitor and see and hear what is going on ... but simply put... you don't care what they do - because of the sedation. Most times they give enough so the patient is completely "out." Then they have their way.
JW
During the next month, I have first-time appointments with three doctors, prayerfully selected, and known to be Jewish men of faith. At my initial meeting, I will declare my modesty needs for possible intimate procedures and care with same gender providers. If the doctors agree to become my advocate, is it in order for me to request that diagnostic order forms include male providers? (I know that I know that I know, the with a mere verbal promise, communication breaks down in the medical system.) Secondly, before I sign any papers or undress, am I in order, to question the nurse/tech/helper, if this written same gender provider has in fact been authorized by the doctor, and will it be honored? Since hospitals are notorious with pushing a stack of papers requiring signatures, permitting no time to sift through them, is it within my rights, to request a prior mailing of informed consent forms, for me to carefully read them? If I have a doctor's agreement to safeguard my standards of modesty, is it allowable, for me to write conditions with my signature.?For example, attached with my name, I might write, APPROVAL CONTIGENT UPON PRIOR AGREEMENT FOR SAME GENDER PROVIDER OF PREPPING AND POST OPERATIVE CARE IN THE ICU.And last, if I am enabled to jump through all these hoops, and meet resistance or violations, what is my legal recourse? Inquiring minds, want to know.(Do not accuse me of looking for trouble, I'm just trying to get my ducks in a row! During my college days, some of the students referred to me, as "Mister Fred Rogers" of the Neighborhood!--REV.FRED
During the next month, I have first-time appointments with three doctors, prayerfully selected, and known to be Jewish men of faith. At my initial meeting, I will declare my modesty needs for possible intimate procedures and care with same gender providers. If the doctors agree to become my advocate, is it in order for me to request that diagnostic order forms include male providers? (I know that I know that I know, the with a mere verbal promise, communication breaks down in the medical system.) Secondly, before I sign any papers or undress, am I in order, to question the nurse/tech/helper, if this written same gender provider has in fact been authorized by the doctor, and will it be honored? Since hospitals are notorious with pushing a stack of papers requiring signatures, permitting no time to sift through them, is it within my rights, to request a prior mailing of informed consent forms, for me to carefully read them? If I have a doctor's agreement to safeguard my standards of modesty, is it allowable, for me to write conditions with my signature.?For example, attached with my name, I might write, APPROVAL CONTIGENT UPON PRIOR AGREEMENT FOR SAME GENDER PROVIDER OF PREPPING AND POST OPERATIVE CARE IN THE ICU.And last, if I am enabled to jump through all these hoops, and meet resistance or violations, what is my legal recourse? Inquiring minds, want to know.(Do not accuse me of looking for trouble, I'm just trying to get my ducks in a row! During my college days, some of the students referred to me, as "Mister Fred Rogers" of the Neighborhood!--REV.FRED
how far do we go in "accepting" what ever our spouses do? look but don't flirt? flirt but don't touch? touch but don't kiss? kiss but don't get naked? get naked but don't have sex?
really, there has gotta be some boundaries you guys, or else it's not a marrieage. it's just roomates with benefits.
As far as I'm concerned, until the day that doctors, nurses, aides, techs, receptionists or any other so-called health "professional" give us the respect of asking us about our gender preference before ordering us to expose our most private of parts I will never trust or have any respect for them or consider them professionals. I'm not saying that 100% of them must act that way before I trust anyone in the medical world, I mean individually I won't have respect for that person if he or she doesn't ask me ahead of time if it's OK for him or her to see my exposed private parts. Giving my consent for a doctor to see me naked doesn't include nurses or aides or anyone else. I normally let my doctor or surgean know that male assistants or nurses are OK as long as they're necessary.
I've never had a problem with unwelcome visitors (as far as I know) because I always take the initiative to explain my gender preference before anything happens but I shouldn't have to speak up on my own. A good, responsible healthcare worker should ask before taking any liberties with my body. I don't consider myself any more special than anybody else nor do I believe I'm incredibly attractive, but that doesn't matter. Even the ugliest people on earth deserve respect and dignity. I do hold doctors responsible for their support staff.
I suspect there will never be a day during my lifetime that the medical world will act that responsibly and give us that respect but I hope there are some individuals out there that will. For now, honoring my requests when I speak up is better than nothing.
Emergency situations are more difficult to organize but my hope is that someday the ER will be segregated by gender, but I know that will be impossible to ever achieve.
The other Anon
swf,
I think we're pretty much on the same page. The bottom line is that the patient has the absolute right to decline an exam or procedure for any reason, including the gender of the provider(s). It really doesn't matter what the patient's reason or motivation is. The goal should be to get the health care system to at least acknowledge this, and hopefully even embrace it (yeah, I know...don't hold my breath...).
Your point that everyone has the right to their own reasons and opinions on this is well taken, and I certainly hope that nothing I have posted has been misconstrued to imply otherwise. That said, these personal reasons, whatever they may be, are not, in my opinion, germane to the goal stated above.
What I do take issue with is when comments cross over into a blanket character assassination of a class of people based on their profession or gender, even to the point of calling them perverts or likening them to prostitutes, without any factual data to back up those assertions. I'm an engineer and a scientist - if someone expects me to put any credence in their assertions, they'd better be prepared to back them up with hard data. Again, in my opinion, these defamatory comments contribute nothing positive to the discussion, detract from the focus, and are potentially counterproductive. Rightly or wrongly, they also color my perception of the validity of rest of the poster's comments. Not that anyone much cares what I think, but from experience I suspect that there are a whole lot of people that think along the same lines.
Dr. Bernstein has been very fair in allowing everyone to post their comments here, for the most part without censorship, and I hope that continues. I have noticed his concern regarding the type of comments referenced in the paragraph above and his polite request to keep it civil....guess I'm just a little more blunt.....
It is time for me to go. Will advise when the advocacy blog is up and running.
It is disappointing that one cannot see that any modesty violation after discussion and agreement with medical professionals not only erodes trust, but is inherently against one's will even in a passive state. This IS abuse and at the crux of the patient modesty problem.
Perhaps the one who said "ramming abuse down our throats for awhile" is in denial of the what's really happening in healthcare with regard to patient modesty. Once you make your needs known and they are not followed at the foundation of who we are and our autonomy and integrity, you've been abused. Any action that can be construed as sexual humiliation, that happens against a patient's will is a sexual assault.
Patient modesty is about just that; not that of Tom, Dick, Harry or a spouse that is really worried about her spouse's behavior. It poses the thought, "Why would any spouse put up with behaviors that assault their dignity as much as a modesty violation? " Can these marriages be happy when the husband doesn't respect the wife and her emotional well being by behaving in a way that embarrasses her? These issues are really not about patient modesty. It's about one spouse's inappropriate behavior that embarrasses the other spouse. Thereby, requesting same gender care eliminates the embarrassment, thus perceived as a modesty violation.
Resent my comments if you want; the truth speaks for itself and I hope every spouse living with the daily humiliation of living with a someone who is disrespectful gets the courage to stand up and say that this behavior is unacceptable.
It is only when expectations are set and boundaries are made that any relationship can be truly healthy and happy both inside and outside of marriage, children, etc. All the best to those people with these concerns. When boundaries are violated and you say nothing, you are giving permission for bad behavior. When boundaries are violated and you say something and your wishes are ignored by continuing the relationship you are enabling the behavior and just as responsible. I don't say these things to blame, just to open eyes and pose thought for positive action to improve relationships.
These issues are extremely important for a marriage to survive and the issue deserves looking into. This is not a modesty concern, it is a lack of respect concern, and a spousal dignity concern under the guise of modesty. Sometimes it's important to look beyond symptoms and get to the crux of what's really going on.
Rev. Fred, There are laws to protect and lawsuits that have been won when patient modesty was promised and then eroded by the presence of some opposite gender employee. The ruling pretty much said that the hospital has the right to refuse your request however, if they agree and then do not follow through, you have legal action. We all know that this is meaningless once we have felt violated, but it's a start.
Dr. B, Thanks for the opportunity to post on your blog and I hope that you can encourage your piers with what you've learned on this blog to create an atmosphere that is psychologically healthier during hospitalization. One day all of you doctors might just be a patient! There is much work to be done.
Happy Holidays and a very Happy Healthy New Year to everyone!
Anyone who wants to stay in touch may contact me at:
marjoriestar3723@yahoo.com
marjoriestar3723@aol.com
marjorie starr
Hexanchus:
For what it's worth you have not offended me. I see your point about productive comments...perhaps you are correct overall.
My advocacy remains professional, and based on the mission statement set a few months ago. The personal side of me appreciates all comments representing all extremes even if they do not represent my view. The emotions behind the actions, if you will.
As long as they remain here and not part of actual mainstream advocacy mission I believe our movement will still be a solid one.
Quite honestly, until you mentioned it, it never occured to me that people might not see the difference in how one advocates verses how one is willing to discuss extremes. Thanx for the heads-up.
Marjorie: Good luck with 'Goliath'.
MER said --
I want to second what Hexanchus said recently. I support every patient's right to the gender care that they feel most comfortable with. But I wont just sit back and tolerate bigotry and claims that cannot be backed up.
I do want to comment on something that Hexanchus said:
"The bottom line is that the patient has the absolute right to decline an exam or procedure for any reason, including the gender of the provider(s). It really doesn't matter what the patient's reason or motivation is."
I agree with this, but the problem is that, too often caregivers interpret the declining of an exam or procedure because of the gender of the provider -- as turning down treatment. How often does "declined treatment" get recorded in the charts when -- in fact -- the patient wants treatment but from a same gender provider? That's a problem, I think, that needs to be addressed.
I wish Marjorie the best of luck with her book. I ask her to let me know if I can be of any help by passing on some of my research. I'll be glad to contact her.
-- MER
Let's talk turkey! Love does not make the world go round--money does! The supermarket where I shop, one of a regional chain, has as its official posted policy:"The customer is always right!" Policy Number 2 is "Refer to Policy Number 1." We all know that the customer can be misinformed, inexact, bullheaded, fickle, stupid, forgetful, and maybe even dishonest, but the corporate decision is to give the customer whatever he wants. Why does the store bend over backwards? It recognizes the keen competition and wants to assure the return of the customer, with a wallet or purse, to make more money. This blog is an indicator that a significant minority of the population is seriously concerned about modesty issues in MedicalWorld. Why are the customers being ignored?Profit could be made by attaching a surcharge for same gender providers with intimate care.Because both male and female techs,nurses and helpers would have to be on stand-by to handle these irregular requests, the institution could justify the fee.Why is this potential market not being tapped? When I visit the local hospital, every time a baby is born, the entire facility hears over the PA System the recording of a musicbox playing "Rock-a-bye Baby". Newborns are dressed in pink or blue caps and wrapped in color appropriate blankets. The parents are hosted to a candlelight dinner with a fresh red rose on the tray. A nearby hospital supplies gourmet menus to its patients with entrees such as Chicken Kiev and Cordon Bleu. All of these "extras" are inducements to produce a satisfied customer, and to increase the likelihood of a return visit. I don't need Pheasant Under Glass in the hospital, I want an accommodation of my modesty. Why does MedicalWorld seek to impress me with this glitz, but ignores my heartfelt cry? Nowhere on this blog have I alleged sexual motivations are behind the intimate care provided by opposite gender healthcare workers. Statements have been made by some of you, revealing displeasure that doctors, nurses, and techs are charged with deriving sexual pleasure in the performance of their duties. MedicalWorld itself must take responsibility for generating these negative images, because it is doing nothing to disquiet them. MedicalWorld is unable to come up with a substantive reason for foisting gender neutrality on the population. When the possibilities for profiteering on this issue are bypassed, and the institution refuses to compromise, some of us suspect if there just might be a hidden agenda by leadership, which could be dark!
-REV.FRED
REV FRED
The notion of undercover patients in hospitals is a novel
approach but I believe is unethical and heres why.Would you
tie up limited ER resources for
a fake patient to test the waters.
If you did such a thing it
would be more reasonable to send
two patients,male and female of
the same age for the exact same
symptoms. Even then its not a
fair and exact measurement although
it would be interesting to see
how each is accomodated.
We really don't need to do this as the proof is there
as to the double standards that
exist at most facilities,its just
that few are willing to admit it.
PT
MER said:
Very thoughtful comments, Rev. Fred. I've said in past posts that up front, honest communication by the health care system about modesty issues, serious attempts to accommodate patient modesty and same gender care ,andday-to-day conscious attempts to respect patient dignity embedded in hospital policy -- that's not just good medicine, it's good business. But the system doesn't accept that. With the increase of competition, though, they'll begin to see it. Notice all the advertisements for medical care, especially in big city newspapers.
I'm reminded of a 1906 quote by George Bernard Shaw: "Let no one suppose that the word 'doctor' and 'patient' can disguise from the parties the fact that they are employer and employee."
Now -- we all know it's not as simple as that. Shaw was a cynic in many ways. But his words have a significant amount of truth to them, especially in today's culture. In the last 30 years or so, we all know how the money interests have taken over American medicine. The American medical culture is not about curing patients. It's about making a profit. I just read an article about how those few doctors selecting general practice in medical school get little respect form their fellow students. General practice is considered a default area by some, a place where doctors go who don't have the intelligence to go anywhere else. You're right, Rev. Fred, it's about money. That needs to change, and I don't see the change coming from within the system itself. -- MER
OK fellow patient modesty threaders, I just received the following from significantly a fully anonymous writer and I rejected it (one of my extremely rare rejections as you can guess)but I reproduce it here only as an example of what NOT to write:
XXX...loosing the edge? Becoming one of the cold unemotional players here? No more heartfelt chats? Stats stats stats???
Boring boring boring
Another one bites the dust.
Well, XXX are the initials of someone we are all familiar with here on these threads. What I want to emphasize again is that this is a discussion blog but everyone has the right to express their views on the topic itself and not to be critical of others if they do or do not change their minds, opinions or how they express themselves as the volumes progress.
The observation that a visitor is changing emphasis can be noted but in a more civil way, perhaps requesting explanation as part of the discussion dynamics.
And after all, we all are learning.. including me. ..Maurice.
Too bad. One or two of the last comments Marjorie made were out of line but she did provide some good discussions before that. Those discussions will be missed.
Are there any male nurses that read this blog? I am very interested to know how easily a male nurse can get hired. The #1 biggest excuse I've heard for the lack of male nurses is that none apply. They make it sound like any and every qualified male nurse can get hired at any facility in the country. Apparently according to the excuses I've heard once a man finishes nursing school he could pick any city in the U.S., if not the world.
I have often pondered the idea of going to nursing school myself to not only put that excuse to the test but also be able to help protect men's dignity as often as I can. My problem is I'm too homophobic and too principled. I can't stand the sight of naked men and seeing and touching naked women is just as much against my principles and as immoral as woman seeing naked men. In the healthcare industry that is.
I would love to hear from a male nurse just how easy it was for him to get hired and how patients, doctors and other nurses treat him.
SLO
SLO
I'm not a nurse but its fairly
easy to answer your question as you
never see male ma's at urologists
offices or general practitioners
for that matter. Dosen't matter
wether its ma,lpn or rn after your
name,its usually not a male that
they want.
Furthermore,they've done a good job keeping out male radiographers from entering mammography completely.
PT
I received the following message from some anonymous writer.
Thanks PT.
I would assume, in the continuity of the messages, it was from SLO, however there is no identification.
Everyone, please be sure to identify yourself on all messages with some consistent pseudonym or initials. In addition, try to avoid one word messages except when in immediate continuity it become obvious to whom and to what the word is referring. Nevertheless, it still is more productive to amplify what specifically the word represents with a few more words.
I may be looked upon now as a first grade school teacher talking to his students by the above advice but the fact is that as moderator I want this blog to be a clear, rational and efficient method for transmitting views from one visitor to another and also to me. I hope I am not insulting the maturity of anyone. ..Maurice.
Finally, finally -- some acknowledgement of this modesty issue in a major publication by a renowned doctor and writer. And – although the word “modesty” isn’t used, the meaning is clear (to me, at least). In the December 17, 2009 issue of The New York Review, there’s an interview with Dr. Jerome Groopman. He wrote the recent book, How Doctor’s Think, which I highly recommend. He’s asked about the importance of the “symbolism and meaning attached to a patient’s illness.” Here’s what he says:
“I think it’s important that a physician try to understand the experience of illness as best as he or she can. It’s clear in certain necessary but difficult and disfiguring surgeries like mastectomy. There are patients who experience gastrointestinal disease, colitis, inflammatory bowel disease. And these are sensitive and often highly symbolic parts of our bodies. It’s incumbent upon a doctor who cares for patients dealing with maladies that affect these organs that have resonance with us on a symbolic level to probe and try to understand the experience of the patient.
“And it varies. Some patients may see malfunction in such parts of the body in a highly charged way, and others may not. And in making decisions in trying to help the person make choices that potentially could be live-saving, you want to be sure that you have as much insight as you can into how the person thinks about his or her body and how those thoughts and feelings factor into their preferences.
“It’s a lot more than what you would find in some algorithm or guideline that says, well, if you have this tumor, this is what you do. If you have this inflammation in the bowel, this is what you do. That’s not enough.”
What insightful and wonderful thoughts. What part of the body could much more symbolic that the genitals? Groopman is saying that doctors need to understand how patients feel about where the disease is, what part of their body is being treated, and what that represents symbolically to the patient. He says just what we’ve been saying. How patients react varies. Some see these body parts as “highly charged.” Others don’t. He then talks about choices patients need to make, life-saving choices, and how the patients’ preferences factor into the doctor’s treatment plan. Sound familiar?
What I find especially interesting – Groopman doesn’t use the words privacy, dignity, modesty. Why not? They’re embedded within his comments. Is there a tendency in medicine to shy away from these particular words. I wonder if most doctors interpret Groopman’s words as I do, or whether they see what he’s saying as something entirely different.
Dr. Bernstein – I would ask you run these comments by your students to see how they interpret them.
-- MER
MER, excellent contribution to the discussion... and here is the link to the article which covers a lot more about the practice of medicine and surgery. MER, I agree that Dr. Groopman's views on patient symbolism and the need for physicians to be aware of that perception, while not mentioning the genitals as an anatomic area for pathology and clinical management, the same would apply as with the bowels or breasts.
I would say that the notion of "symbolism" is unknown in the minds of physicians who usually don't think of anatomy and its pathology in symbolic terms. Doctors are not taught to look at a rash on a patient as what is its philosophic meaning to the patient or in what other ways will the patient look at the rash other than an irritating and/or disfiguring symptom. Only the thoughtful doctors will consider that the patient might find the rash in terms of a "punishment" for past deeds or an opportunity to avoid an anxiety producing relationship or interaction with others. The same symbolism but of the genital area may be responsible for the basis of the various concerns regarding healthcare providers attending to that anatomic area. Who knows, maybe some patients find that any and all manipulations in the genital area no matter how professionally it is carried out represents some loss of the patient's ability to manage and control his or her sexual experience (in essence a "rape") and now "contaminated" by the experience has to face a spouse or other with the guilt of being not strong enough to prevent what happened.
Whatever the psychologic effects and symbolism, the problem of physical modesty is real and needs to be attended to for each patient for whom this is a problem. ..Maurice.
Over the years my various doctors have been spending less and less time with me, and I'm not the only one. Doctors are now pushing more and more of their duties onto unqualified nurses resulting with very unqualified nurse's assistants stepping up to do the nurse's jobs. Is it any wonder why the U.S. healthcare system continues to get worse?
I know that the patients have a lot to do with this though. With more petty and false lawsuits come higher insurance costs, and with that comes the doctors offices and hospitals cramming more patients down the assembly line. With twice as many patients the doctors only have half the time to spend with each of them. But can't they see how ridiculous it is to allow nurses to do more than they're qualified to do? We not only have to entrust our life and health to nurses who don't know what they're doing, but also all the extra work makes those nurses so grouchy and bitchy that they are very difficult to put up with.
Isn't the ridiculous increase in medical costs to the consumers and insurance companies enough to treat patients with respect and give them the medical treatment they deserve, from qualified doctors?
Brandon
Look, all I was saying is that if someone wants to speak for me I feel better knowing they see all of the emotions and are willing to talk to anyone here about them.
It is not an advocate site, but if that's all you want then say it, In the meantime, if stats are all you want then you loose the meaning of the people saying it.
I respect people who speak up, not people who conform to wishes.
Rename the blog, or let people feel how they feel.
Better?
significantly a fully anonymous writer
Over these 29 volumes on patient modesty I have given plenty, plenty opportunity for my visitors to ventilate and while ventilation may be therapeutic to the individual, ventilation does NOT lead to discussion and discussion as in the title of this blog is what this blog is all about. Discussion can be of value to understand old and new concepts but it also can be the pathway leading to change and improvement of life.
My point is that certainly one side of the issues of patient modesty and gender selection of healthcare providers have been amply expressed through the many personal stories written here as well as the references of stories of others who have not participated here but have written elsewhere. What is needed now and for the remainder of this volume and in the New Year is a discussion of approaches to mitigate the issues.
Of course, I too respect people who speak up..but speaking up about ones trials and tribulations simply to a blog is inadequate. Speaking up to the medical system is another matter and will probably be the best way to get the system changes.
Let's maintain this as a discussion blog and simply moaning and groaning at this point (after literally thousands of such moans and groans) should be brought to an end. Yes, set the issue with referable references, engage in productive discussion and then work toward a solution. What other approach could be more rational? ..Maurice.
It's difficult or even impossible "Speaking up to the medical system" when the medical system refuses to listen. Every individual medical system I've encountered (hospital, clinic, etc) has their way of doing things and won't even consider making any changes. Our opinions and suggestions mean nothing to them. Our personal morals mean nothing to them. Our modesty and dignity mean nothing to them.
Dr B, I do admire you and what you're doing here and there may be a handful of other doctors out there (like Joel Sherman) that care and respect their patients like you do. I just haven't been able to find one in my area. Thanks for doing what your doing, and yes, you have allowed a lot of venting here and I think by letting them vent you have helped them.
LG
Maurice
There is "moaning and groaning" on both sides is there
not? The link provided to Dr.
Groopman and his comments are just
rhetoric and more moaning and groaning. I don't see that his
comments are going to change anyone's perceptions in the field and thats really where it counts.
I think very few come here
to ventilate but the majority including myself are here to paint
a real picture that many don't see,
but I'll tell you many here simply
resent the truth and don't like the
truth being told.
PT
PT, I am not against painting a picture..and indeed that is what I am trying to do with my graphics associated with each volume on this topic. But hasn't the picture already been painted with all of its colors, shades and nuances and hasn't it been repainted it many times throughout all these volumes? Surely even the cracks and crevices of the picture frame itself have been thoroughly identified. But those cracks haven't been repaired and the picture is just that something to look at and moan but has not been as yet sold to the system for restoration. That's what is necessary now: selling the picture! ..Maurice.
These "see thru your clothing" scanners used in airport security have been in the news the last week. Read the article below and watch the video, notice how there is no mention of the gender of the officer viewing the screen or if there will be male only and female only scanners. I guess they think we will all just accept this. Kelly.
http://news.yahoo.com/s/ap/20091231/ap_on_hi_te/us_tec_airport_screening_q_a
http://www.youtube.com/watch?v=GirKmyKkewc&feature=youtube_gdata
I that PT is suffering from PTSD from his early army experience. In fact I think you will find that many of your posters are suffering from this disorder, otherwise they wouldn't have googled "I hate doctors" in the first place. A classic symptom of PTSD is cynicism and distrust of authority figures which doctors are. Perhaps the medical profession should be trained to recognized this disorder.
NP
Re Kelly's comment about the airport see thru scanners. Very good point, Kelly. I note a pattern here in our cultural attitudes toward body modesty and privacy. The fact that the gender of the officer behind the machine viewing the passenger is not mentioned -- the same kind of gender neutral attitude in medicine -- indicates how important that fact is. The details or facts we leave out are as essential as the ones we put in. It's obvious in our culture that it makes a difference to men and women what gender views them naked and under what contexts. Leaving out gender here is an example of the elephant in the room syndrome. Gender is that elephant. It's all around us, filling up the room, but people don't want to talk about it as a relevant factor.
But there's another pattern I've noticed from these airport scanner stories. In defending these machines,authorities note that passenger faces are blurred, and the officer viewer never sees the real passenger. He/she's in a room and the passenger and the viewer never come into contact. This kind of anonymous relationship is often the case in medicine. The idea is that, however embarrassing the exam or procedure, the patient will probably never see the assisting caregivers again. And, frankly, this does work for some patients. They realize the possible embarrassment, and just want to be knocked out and never know who did what and never meet them. But it doesn't work for everyone.
Now, I'm not saying these attitudes are right or wrong. I'm just suggesting they are indications of how we face this issue in our culture.
If patients are going to make changes in medical culture, they must understand how doctors and nurses are socialized to see and acknowledge certain things, and not see or acknowledge (talk about) other things. All of us, patients and doctors alike, have the same physical viewing apparatus. We don't see differently from a physiological point of view. We see differently from a social, cultural point of view. Doctors and nurses (generally) are socialized to not consider modesty and nakedness as relevant to what they do. Many have actually learned to "not see" it. Of course they see it, but it's not acknowledged as relevant to what they're doing. And, like all elephant in the room topics, it isn't discussed -- especially with patients.
Every profession learns to see what's necessary to do their job. This also implies that they learn what not to consider important, or of worth seeing. Recall driving down a busy street. Do you see everything? Obviously not. It depends upon what you're looking for. If you're running out of gas, you'll be sure to see all the gas stations, and miss the restaurants. If you're hungry, you'll see the restaurants and miss the gas stations. If you're a real estate agent, you may note all the for sale signs.
To make changes in the system, patients must first tactfully force medical professionals to see differently -- to see and actually acknowledge the relevance of nakedness and modesty. That's why speaking up is so important. That's the first step. Until doctors and nurse start "seeing" differently, and eventually acknowledging what they see as relevant, patients won't get very far with this issue. And it must be the patients who do this.
With respect to Dr. Bernstein -- I don't think it's what they're taught in medical school that socializes them to this -- it's what they learn on the job in the hidden curriculum.
MER
Maurice
No, many parts of the whole picture have yet to be seen. Many
describe this picture were speaking
of through myopic spectacles.
NP
I've never googled "I hate doctors",but I have yahooed "I
hate nurses" of which there are
40,000,000 results and 40,000,000
good reasons obviously.
PT
Just a few questions: Does it make any difference if the passenger doesn't have to take off clothing to be screened so there is no exposure of skin for anyone to observe? Isn't full anonymity just as comforting a state in whole body screening as it is to writing personal history and feelings to a blog? Isn't such whole body screening much, much less invasive compared with being patted down? When one balances the possible death of even one passenger let alone 300 or even more humans below on the ground, doesn't screening for the terrorist trump any modesty issues? Any answers? ..Maurice.
MER,
I have come across a couple of male gynecologists on the web in all sincerity ask why do some women not want to go to them because they are male. It truly amazes me. I cannot fathom how they can be any good at their job when they don't understand this. Surely if they are studying this branch of medicine, the issue of modesty comes up?
NP
Same thing goes for female doctors, nurses and techs NP. If a man questions a female tech that's planning on giving him a testicular sonogram they act astonished and insulted. It's usually just an act but some may not understand until it's their turn to have a similar type of thing done by a man. Then they understand and feel the same way. Unfortunately as soon as they put the scrubs back on they forget again.
SLO
Dr. Bernstein, I agree with your post about the airport scanners. However, I am sure that the majority of the posters to this blog will feel otherwise. I doubt they will admit you make a good point about the anonymity and the undeniable feeling that it is for the greater good. Also, every article I have ever read on the subject has always mentioned that the screeners would be of the same sex ( as I think it should be-for a myriad of reasons). I therefore preempt any arguments that this particular cited article doesn't mention it. There would be no screening by the opposite sex, no matter how much you want to stake that claim. Also, off the subject-since I have been following this blog for a while now. I hope that Rev. Fred that has been posting on here is not one and the same with the infamous Pastor Fred out of Colorado that preaches hate and makes abhorrent "protests" that are too vile to even mention what happens there. If so, I think people may view his comments differently. I know I would.
Signed-Dean
I have been watching the news regarding the debate of this technology. Included was an interview from a politician regarding his fight to legislate this as a secondary security tool and not the mainstay of efforts in airports. His quote was; " I don't find it neccessary to see my eight year old naked before letting her on a plane". Most agreed.
But the arguments are familiar....
A. Modesty and privacy should be set aside when procedures involve national security.
B. The men and women will be trained professionals and should be allowed to do the job they are trained for regardless of gender.
C. They are looking for weapons and not paying attention to the anatomy of a body.
In short, they are playing the "professional" card, and if passed will be playing the "permission of society" card.
Lawyers have no doubt already sited foundation using the medical profession.
People are already used to making exceptions for one area of the job market, I do not see much of a problem convincing those same people to make exceptions for other market areas. Those who have a problem will avoid flying, as those who avoid certain medical procedures.
Regarding the question"Isn't full anonymity just as comforting a state in whole body screening as it is to writing personal history and feelings to a blog?"
Exposing one's thoughts is much different than exposing one's body,anonymous or not. I wouldn't find much comfort in a nude picture of myself being posted on my profile even if my face were anonymously blocked out.
NP:
"In fact I think you will find that many of your posters are suffering from this disorder, otherwise they wouldn't have googled "I hate doctors" in the first place."
Respectfully, for many people it is not a matter of trust. It is a matter of entitlement. I may trust a male doctor or nurse, but still maintain my belief that it is not for them to assume entitlement to see me naked.
For at least 7 years, researchers at the Pacific Northwest National Laboratory have had a machine that extracts the images of concealed objects and projects them on the image of a mannequin for screeners. But don't expect the gov't to adopt this technology; they have a vested interest in de-sensitizing people to intrusions on their privacy, and I'm sure people will grudgingly comply.
--rsl
Part 1 of 2
My recent research into silence and denial, has led me to some theories about what’s going on sociologically within hospital settings. I believe it’s important that patients understand this. Inexperienced patients, especially, who enter this alien medical culture need to appreciate where their caregivers are coming from and the kinds of strategies these caregivers use to get patients to cooperate with hospital policy and values.
First – this is about how we see socially and culturally. Medical professionals have been socialized to focus on certain things and not focus on other things. Though they may physically see nakedness and modesty problems, they have been trained to regard them as irrelevant to their job at hand. They have been socialized and trained to regard their gender as irrelevant to their relationship with the patient.
We can add to this various other factors: the prevalence of female nurses; the politics of medicine; the business and money factor; male/female staffing imbalances, double standards (against women, too) etc. And, we can’t ignore the whole issue of power. What we are allowed to see and acknowledge and regard as relevant is often controlled in situations where one group has power over another group. This also means that what we’re allowed not to see, acknowledge, talk about, or regard as relevant is also controlled by the group in power.
So – what does this mean for the patient entering a hospital culture and his or her modesty concerns specific to gender? Patients enter into this world bringing with them various perspectives and backgrounds:
1. The gender of my caregiver doesn’t matter to me. I’m comfortable with any kind of same or opposite gender care.
2. I have no idea what’s going to happen to me. I don’t know what to expect. I guess I’ll find out one way or the other.
3. I have definite feelings about this and I want same gender care for any kinds of intimate procedures.
4. I demand opposite gender care for my own reasons.
Add to these three basic positions whether the patient has had any experience with hospitalization and whether those experiences were positive or negative. This will definitely influence where the patient will reside on this continuum.
Now – what happens when caregivers face one of these three positions? Regardless of your position, you may get an introduction something like this: “Hi, my name is Sharon or Jane or Bill. This is my colleague, Carol or Ann or Dave. We’ll be working with you today.” They may or may not be wearing name tags. They may or may not describe their positions as nurses, cna’s or medical assistants. They may or may not describe exactly what “working with you” means. If you’ve done your research or have hospital experience, you’ll know what “working with you” means. If haven’t had any experience and don’t ask, you may be surprised.
By the way, that strategy – “We’ll be working with you today,“ is a popular one. It doesn’t’ give you a choice. It doesn’t’ ask a question. It just states what’s going to happen. It leaves it up to you to protest, which caregivers know most patients won’t do. It’s a conscious strategy to get you to go along with the program. So – how does this apply to the different positions above?
Continued...
MER
Part 2 of 2
POSITION 1 – Your values and expectations will match the gender neutral values of the hospital and your stay has the potential go just go smoothly, depending upon whether you consider your treatment to be respectful and dignified.
POSITION 2 – You’ll be moved along quickly through the system and, unless you express concerns, you’ll get what you get.
If you find opposite gender care acceptable, you move to Position 1
If you find that it does bother you and you don‘t express any concern, you’ll get what you get.
If you find that it bothers you and you express concern or ask for same gender care, you most likely run into caregiver strategies that try to resocialize you “not to see” gender as relevant. You may get responses like these:
“We’re all professionals here.” Translation: Gender doesn’t matter.
“I’ve done this many times.” Translation: Gender doesn’t matter.
“There’s nothing you’ve got that I haven’t seen.” Translation: Gender doesn’t matter.
You may get what you want. If so, fine. If not, at this point, you need to decide whether to just accept what’s available move to position 3 below.
POSITIION 3 – This could be the most dangerous position. Or, if staffing is available and you’re in a hospital that consciously tries to accommodate, things may work out just fine. But the fact is that these unwritten social rules in our culture – the things we don’t talk about but that rest beneath the surface of our everyday activities – these elephants in the room – have tremendous power because of their secrecy. Bring them into the open and they lose their power, but their openness may cause embarrassment, resentment and/or hostility. Those who ignore these hidden rules can be considered social deviants and suffer social sanctions or be stigmatized.
If you select this position, you may create a conflict between two differing social norms – that of the hospital, and yours and that of society in general. I’ll call this the “Socialization Wars.” The hospital culture is trying to resocialize you into what they consider their world. How do you react? What patients need to do is engage – begin to resocialize the hospital culture into your world. Remind them that “their” world isn’t really “their” world. It’s “your” world, too.
You must confront them politely, intelligently, tactfully, firmly, confidently and with respect. But you must not back down. This means you must be prepared. You must do your homework. Know the arguments. Prepare lines of reasoning. Don’t let them control the agenda – which will most likely happen when they try to switch from your needs and values to their and the institutional needs and values.
This battle will not be easy. Physically, you’re on their turf and under their control But the principle of patient autonomy, dignity and respect are also parts of the hospital culture, though in some cases those words have become “lip service.” Use those words.
But if you go into this battle, go in with your eyes wide open and be prepared. In avoiding your embarrassment, you may cause your caregivers embarrassment, and that could affect any future relationship you have with them during your hospital stay. But unless patients start resocializing the medical profession, we’ll make little progress. In our current medical culture, we can’t depend upon this being taught in medical school, unfortunately – despite the great efforts by medical instructors like Dr. Bernstein.
A FEW SOURCES
Enright, D. J. “The Uses of Euphemism” (1985)
Gawande,Atul. “A Surgeon’s Notes on an Imperfect Science.” (2002)
Goffman, Erving. “The Presentation of Self in Every Life” (1959)
Goleman, Daniel. “The Psychology of Self-Deception.” (1986)
Katz, Jay. “The Silent World of Doctor and Patient” (1984)
Zerubavel, Eviatar. “The Elephant in the Room” (2006)
-- MER
A couple of things. I think that "resocialization" is something we have to be flexible enough to do repeatedly throughout all our lives.
It is not a unique activity. We have to do this when we are young and move from home to school to college and into a job or profession, into marriage, etc. Unless we become a hermit, resocialization, adjusting to the rules and environment set by others which is as yet strange or even unknown to us but is what we must initially accept to move on. Obviously it much easier for individuals to resocialize than for established institutions but these entities must also change with new rules, new laws and changes in technology or economics.
With regard to the education of medical students, yes, they are taught about modesty concerns of patients but in more general terms and regarding more about how to tailor the physical exam process to meet the patient's concerns such as avoiding "unnecessary or unneeded exposure". Specific details are taught regarding how to perform female breast and male and female genitalia/rectal exams. The effect on patient's modesty in terms of the gender of the examiner is definitely not stressed since being a competent and caring physician of either gender is said to be the goal regardless of the gender of the physician or the patient. I think that students leave medical school with the mantra "If I am competent, caring and avoid sexually suggestive behavior and follow ethical standards then regardless of my gender I am a physician that any person of any gender should want as their doctor."
After all their work, after all their expense, after all their emotional stress, medical students are not going to easily accept being dismissed by a patient simply because of the patient's gender bias. I have held the same attitude all these years and while I never have been challenged by a patient because of my gender, I now see by the writing in these volumes on patient modesty about something that I was unaware. I have also begun to alert my students to also become aware. ..Maurice.
I essentially agree with your wise thoughts, Doctor. But when you write: "...medical students are not going to easily accept being dismissed by a patient simply because of the patient's gender bias" -- three words there give me pause.
"simply" and "gender bias"
I don't think this is a matter of "simply" -- I think it's much more complex. This isn't a "simple dismissal." It's a patient comfort issue that doctors need to accept as just part of helping patients to heal.
There is GENDER BIAS and gender bias. the first applies to those who have complete prejudiced against either gender. These people completely stereotype the genders.
But gender bias in small letters may be contextual, in our this blog's case based upon privacy, modesty and bodily boundaries. To me, that's acceptable. Are most women who go to female OB-GYNs against male doctors as a class? Do they hate men generally? Are most women who would prefer a female nurse during birthing procedures biased against men completely? I would say "no."
I would also suggest that most men who would rather have a male nurse do certain intimate procedures are not prejudiced against female nurses as a class. They would welcome female nurses for non intimate care.
You're students need to understand this, too, and not take a patient's refusal personally. But that's why this modesty issue might be discussed between doctors and patients so the doctor knows where the patient is coming from.
Much about this issue is made more problematic by lack of open, honest communication.
MER
MER, I wrote the word "simply" as the way a student would express the issue since at this point they are not going to look at it as "complex" as I now do. Also I believe "gender bias" to a medical student would not be a usual or reasonable behavior for a patient. They would look to issues of the medical student's unprofessional appearance or behavior as reasons for dismissal or otherwise related to patient fatigue, physical discomfort or patient's need to carry out other personal activities. By the way, in terms of statistics, after observing medical students every year in groups of 6 since about 1986, none of my students have ever complained to me that they were rejected by a patient because of the student's gender. Whether the patient felt it was a gender issue and only told the student "I'm tired"..well, that certainly was possible but we will never know. MER, I just wanted to clarify that medical students are not as sophisticated on the full issue of patient modesty as you and now I. ..Maurice.
Exactly MER.
I won't go to a male ob/gyn because I feel that as woman I am judged by my looks. So I think the first impression (even if fleeting) that the male OB-gyn is going to make is whether he thinks I'm attractive or not. Both are lose-lose situations for me.
If he thinks that I am attractive then I will feel vulnerable during an intimate exam. Even if he has honorable intentions. If he finds me unattractive, then I will feel like a worthless woman in his eyes (as society only values young fertile attractive women). So if he is performing an intimate exam I will feel that he is probably repulsed by me (which is even worse than the former).
They may not be conscious thoughts but it is biology.
NP
MER,
I agree with most of your synopsis, but question one statement. You wrote "Physically, you’re on their turf and under their control". This is a misconception that I think they would like patients to believe, but it's not true. In fact, the only power or control they have is what the patient chooses to give to them. They can't do anything without the patient's consent.
Unfortunately, I believe most patients don't understand that the patient is really the one with the power, and that is why so many find it difficult to stand up for themselves. As the saying goes, "knowledge is power", and your suggestion that patients need to equip themselves with the knowledge they need to stand up for themselves is right on the money.
So in addition to changing the institution mind set, we also need to be able to break out of the conditioning, socialization or brainwashing that has led us to accept the false premise that we are under their power and control. Unless we address the latter, the former will be much more difficult.
As has occurred already throughout most of the world and where here in California the new year and the start of the new decade 2010 comes upon us in the next 4 hours, I want to wish to the many visitors and writers to these patient modesty volumes that their hopes are heard soon and become reality if not in this upcoming year, at least sometime in the upcoming decade.
This topic is the #1 topic of interest on the over 700 current topics on this blog. Thanks to all for participating. ..Maurice.
"In fact, the only power or control they have is what the patient chooses to give to them."
That is true in many cases but not always. Quite often patients don't know what will or has happened to them when they are unconscious. TRUE informed consent is often not considered. If doctors, surgeans and nurses don't inform patients of questionable gender related details I believe patients are not truly informed. I don't mean the entire surgical procedure step by step, but relevant things like a young female CNA will shave you from nipples to knees, or the fact that a foley will be inserted and checked often by a nurse with a possible audience of other nurses and CNAs.
Patients often don't have the opportunity to object and have no control of the situation. Many details are conveniently left out of the pre-surgical explanation because they know the patient might object or cancel the surgery if they learn some of the specific details of the lack of respect for their modesty.
When a patient is conscious, alert and relatively pain free he/she does have some control of the situation if they are brave enough to assume that control. During a routine doctor visit a patient might have the conscious ability to make some choices but in a hospital situation patients often don't have the conscious ability to decide what happens to them.
No matter how mentally prepared we are and how expierienced we are we're often completely at the mercy of the caregivers and their idea of respect and modesty is all that matters. Even in elective procedures we have no power because details are kept secret.
Pete
Dean, are you saying airports have male and female x-rays seperate? A male line and a female line?
D
Pertinent to the issues discussed on these patient modesty volumes, here is a current news release about "patting down" potential passengers as an airport security measure. ..Maurice.
Pete,
I understand where you're coming from, but you didn't read the rest of my post.
Knowledge is power. If, as a patient, you are concerned about these issues, then it is commensurate upon you to take the steps to become an informed consumer. If you have questions or concerns about the procedures involved - tell them point blank you want the details and that you are withholding all consent until you are satisfied you have been given all the information you need to make the decisions regarding your health care. Tell them point blank that their job in the process is to provide you with information and their diagnosis and recommendation for treatment, if any, but that you will make the final decisions regarding any care or treatment. Every patient has the right to control what care they receive and from whom - all they have to do is assert them.
As MER pointed out, if you expect to be listened to and not written off, you need to be calm and respectful in your attitude while expressing your position - even if they don't extend you the same courtesy. It's can be a useful tactic - if you take the high road and they don't, you can always turn it around and use it against them. There's no need to be loud and assertive unless conditions deteriorate to where that level of escalation is required, and never a justification for being abusive.
It may appear from this that the relationship between the patient and providers is somewhat adversarial - unfortunately, when it comes to getting respectful health care in accordance with your preferences, it very often is. The main reason for that is the institutional mind set of the health care system, and that's what we need to change.
What a way to end the year! Yesterday, Dean suspected that the REV.FRED of this blog could be none other than the infamous PASTOR FRED OF COLORADO,who makes the headlines, demonstrating at funerals of gays and military servicemen killed in Iraq. Please bloggers, let me know if I have ever expressed hate rhetoric, uncivility or unpastoral behavior at this site. I have officiated at funerals for men whose cause of death was AIDS, and I have participated in military graveside ceremonies. The local American Legion has presented me with citations for my advocacy of veterans' causes, and my congregation for over two decades has hosted a countywide observance of Veteran's Day. And you want to link me with Pastor Fred of Colorado(I think you mean Kansas).Awhile back, I mildly rebuked Dean for stating that MORALMAN had issues and needed to see a shrink. Now he alleges that I am an equivalent to the Christian taliban. Dean, are you not aware of the Commandment"thou shalt not bear false witness against thy neighbor"?One of three things may be going on: I possess poor communication skills and portray myself as a radical fanatic with privacy and modesty; you possess insufficient cognitive abilities to interpret what I express, or three, you are motivated by malice. During my 60 years of existence, I don't when I have ever been more wounded, than by your insinuation. Since I an extremist,contribute nothing of substance to this discussion, and find myself unenlightened, it is in the best interest of all, that i permanently withdraw my participation.-REV.FRED OF PENNSYLVANIA
Rev Fred, I don't think it would be appropriate to leave since it seems to have been only one visitor who was questioning who you were and you have sufficiently explained and your history here on this blog is that you have written presentations which are only constructive to the discussion. ..Maurice.
Rev Fred,
I agree with Dr. Bernstein. You have made constructive contributions to the discussion, and while I may not always agree with everything you say, isn't that the the point of rational discourse?
Rev. Fred:
I hope you can rise above certain posters inabilities to be civil and remain with us. Although I can not understand the inability of some here to edit themselves in their hostility, I believe it would be a shame to let a poster of of such caliber give you cause to leave.
Speaking only for myself....you would be missed.
Whole-body imaging reveals naked
truth of airline security.
This was the article by Froma
Harrop of providence journal.
Body imaging can be seen as an invasion of privacy,but it could detect plastic explosives hidden on
airborne terriorists.
The TSA has tried to explain the
privacy safeguards with whole-body
imaging.The person looking at the pictures sits in a windowless room,and a filter blurs the subjects face.
(Thus,the officer has no idea whether the body belongs to Pamela
Anderson or one of many millions of
similarly built women on this planet.) The images cannot be stored or retained.
Note how they used a woman as
an example. Men don't count in the
realm of privacy issues.
Don't believe them when they say
the images cannot be stored or
retained and if that being the case
how can they identify your body if your face is blurred.
They have a way to identify you
of course.But my point in bringing
up this subject is any technology
like this will exploit the privacy
of people. Sooner or later some
well known celebrity will have his
Whole-body imaging on the enquirer
magazine for all to see.
Look,if HIPPA laws can't protect
your privacy what makes the TSA think they can!
PT
PT,
Note my post @12/31 @10.41 am.
--rsl
What about children? Are they going to be subject to body imaging as well? Over my dead body will that happen to my children
NP
Thank you, for your vote of confidence, encouraging my re-entry. Dealing with the public, anyone will meet up with negativity. Dean's comparison of me with Pastor Fred Phelps truly disabled me. My concern was that I have unconsciously presented myself to be a wild extremist. Every pastor makes a decision as to what concerns he/she will grant attention, and for me, the focus has become patient privacy and dignity, with a renewed emphasis on bodily modesty, especially as related to men. Dr.Groopman's article stated that a patient's body part(s)can take on paramount symbolic significance. For me, and other men(and women), our symbol of personal consecration to God, marriage, or integrity, are the reproductive organs. Some time in the future I would like to briefly discuss the Biblical foundation for this perspective. Recently, meeting with a cardiologist, an observant Jewish male, I declared my concern for modesty. The doctor said that little intimate procedure went on in his practice. I reminded him of heart catheterization by way of the groin. If I needed a catherization, he assured me that patient rights would be upheld. Having a cancellation, he wanted me to remain for a nuclear stress test on the treadmill. Questioning me if I were comfortable being bare-chested with a female nurse, I agreed that I was okay with it. Cupping my hands between my legs, I told the doctor that my only forbidden zone with female providers were my privates. Prior to scheduling a ct scan of my heart, abdomen and pelvis, I learned via websites, that I would have to completely disrobe with a sheet over me. Speaking with a female radiologist over the phone, I asked if a male tech would be available on the day I wanted my scan, to coincide with a second appointment with a specialist in the same building later in the day. Without any resistance, the female tech informed me of a male radiologist, across the street at the cancer center, who would be available on my desired date. If necessary, I could be comfortable in my boxer shorts with a female tech, but since this is my new hospital of choice, I want to establish a precedent for what might come down later. Laying on the tray, the male tech held high a sheet to create a screen, instructed me to pull down my pants below my knees. He stated that I could keep on my underpants. Next he tossed the sheet over me. Later, he requested that I completely unbutton and open my shirt (I wear no tee-shirts). After attaching the suction cups and wires for an e.c.g., he fully covered my upper body with a second sheet. I don't need a male provider to make these efforts for my modesty needs. A sizable Orthodox Jewish community exists near the hospital, and it is possible that religious Jewish men would seek attention for modesty in the presence of another male. Maybe the tech assumed this is what I wanted, or it could be that he safeguards the modesty of all his patients. Surely, this guy walked the second mile. It is my plan to write letters of commendation to the hospital president and department heads, expressing my appreciation for the sensitivity of both the female tech handling my call, and the male tech who performed my scan. I believe that a strategy to combat violation is to let the institution know of our gratitude, when it bends over backwards to respond to our needs. All administrators are hit with an avalache oF complaint, let's flood them with a tsunami of appreciation.-REV.FRED
-REV.FRED
NP,
in answer to your question, it includes everyone, including children.
You will be able to refuse the whole body scan, but will be subject to a physical pat down - that also includes children.
But wait, there's more! TSA has recently modified their guidelines to allow physical pat downs to include the breast and groin areas under certain circumstances - yes that also includes minors. They haven't been made public - probably to avoid a huge outcry.
Anyone else think this whole airline security thing has gone way too far? The recent incident occurred because of human error - they had more than enough information to keep this person from boarding the aircraft, but because of indifference or incompetence, that information never got to the people who needed it.
I'm fairly familiar with the new technology as I have done some consulting work in closely related areas. I can't say any more for contractual reasons, but some experts have said that the likelihood the new full body scanner would have detected the device is low.
Instead of spending hundreds of millions of dollars on new high-tech toys that invade the privacy of law abiding citizens, they need to spend the money where it really needed - identifying those with the real potential to cause harm and getting the information to where it can be used in a timely manner. Yes, I believe profiling should be a part of this.
I don't want anyone to take my
comments the wrong way regarding
Whole-body imaging and the safety
of airliners and passenger safety.
There needs to be more safeguard
and assurrance from the air travel
industry that passengers are safe
from terrorism.
Yet,the medical industry continually demonstrates that no
ones privacy is safe and despite the training and so-called asserted professionalism,the privacy of patients have and
continue to be disrespectfully
violated. Do you think the airline
industry will be any different
in ensuring privacy from this new
technology.
Hippa fines need to be dramatically increased and enforced
and violators should be given
mandatory jail time! How can the
TSA assure the public that passenger privacy will be maintained,they can't.No more than
the medical community can.
PT
Hexanchus, thanks for the advice. Rev Fred, I hope you'll continue to post. Your last comment helps give me hope that there are at least a few places out there that will treat me with respect.
Pete
Found on Dr Shermans site, MER said "cna's have little training compared with doctor and nurses, and they cannot claim the same professional status as doctors and nurses. Yet the health care culture seems to want to consider them professionals just like everybody else. I don't agree with that position. And, the health care community is increasingly giving cna's and nurse assistants more and more of the responsibilities that were typically carried out by the more experienced and trained nurses"
I'm a little surprised to see you write that MER but I agree with you completely. CNAs shouldn't be treated like professionals and shouldn't be allowed to do and see much of what they do and see. They are given important and very intimate assignments like prepping patients for surgery and that is just wrong. They are not educated enough and barely trained to help out with some fundemental duties but putting them in a position that involves opposite gender nudity isn't where they should be. Like MER said somewhere, professionals put into intimate care situations should have some psychology training and have the experience to know how to read the patients reactions to intimate procedures. CNAs don't have suitible training for that.
S
A couple of things:
First, here is the link to Hospital.com which is a website devoted to hospital news and issues in the multiple areas of hospital practice. The editor, with whom I have communicated previously and is aware of the patient modesty threads on my blog, today wrote me the following:
I would publish any concerns by your users and allow comments to be made under each post. I would also add a paragraph to start the conversation.
Sincerely,
Jill O'Brian, Editor, Hospital.com
1 International Blvd.
Mahwah,New Jersey
United States
Phone: (201) 247-8553
Editor@Hospital.com
Hospital.com
I strongly suggest that the visitors here make use of this opportunity to accomplish what I have repeatedly been stating here: "spread the word". Writing to such a publication should be more effective in educating the public and the medical system about your concerns than simply writing to this blog. Right?
Now with regard to CNA training. The following is a summary of the program at Maine Medical Center, Portland, Maine as an example. I would say that before making degrading statements about CNA training, first investigate the details of the certification programs themselves. ..Maurice.
CNA Course
Maine Medical Center values the CNAs employed throughout the hospital. CNAs are caregivers who provide patients assistance with activities of daily living and basic needs. They also help patients feel safe and comfortable throughout their hospitalization. These direct caregivers spend most of their time assisting patients and listening to their concerns.
Maine Medical Center offers a Certified Nursing Assistant course, which includes classroom work, skills labs, and clinical experience. The course is an 11- week, daytime course of 200 hours. MMC covers the cost of the course and the books. Near the end of the course, the students take the State Certification Examination.
The course is sponsored by MMC's Center for Clinical and Professional Development and Portland Adult Education.
The course covers:
• Age-specific care through the lifespan
• Safe patient care delivery
• Infection control principles and practices
• Body mechanics and mobility skills
• Communication skills
• Assisting with activities of daily living
• Nutrition and assisting patients with meeting nutritional needs
• Common health problems and nurse assistant care
• CPR and Basic Life Support (BLS)
In skills labs, students practice taking vital signs, assisting with patient mobility, and patient hygiene skills. The clinical experience allows students to interact with patients on nursing units at MMC.
Oh..by the way.. just a handy reminder: when communicating with the editor of hospital.com or writing commentary for that website: BE CIVIL, AVOID INFLAMMATORY OR UNSUBSTANTIATED STATEMENTS AND BE RECEPTIVE TO THE OPINIONS OF OTHERS
just as most of you have written and are writing to this blog. To write otherwise will only diminish the value of this opportunity to present your side of the issue. ..Maurice.
"I would say that before making degrading statements about CNA training, first investigate the details of the certification programs themselves. ..Maurice."
First of all, Maurice, to challenge a profession's training isn't necessarily degrade them. It's suggesting they may need more training and experience. Are you saying I made "degrading" statements about CNA's? I find that statement to be without merit. I made a general statement not necessarily about the quality of any particular program, but the time allotted to get it all done -- especially with those candidates coming right out of high school or with little life experience. Also, I'm recognizing that we need to look at individuals -- but that doesn't mean we can't look at general trends. But I have considerable experience in the field of education and communication, I am well aware of (as I'm sure you are as well) the difference between a curriculum as it appears on paper and what really happens in the classroom and how it is really evaluated.
Second, you've got to be kidding. All those topics you've listed in 11 weeks? You can't be serious. CNA training at heart is task oriented. It has to be. They're required to do a lot and 11 weeks isn't a long time. You can't convince me that they get sufficient training in human psychology, sexuality, sociology and communication. Gee -- all those communication skill in 11 weeks? People spend years studying the complexities of communication, and years practicing.
Some CNA candidates may have natural talents in dealing with people. But natural talents need to be developed, and how they're supervised makes a great difference. Nurses are always complaining about how they don't have time to do all the work that's required of them. I believe and sympathize with them. How many CNA's are sufficiently supervised? I don't know, but I suspect, not enough.
Maurice -- a doctor with your training and education -- I can't believe you want to stand by the argument that an 11-week training program for most young CNA's candidates is sufficient to allow them immediate intimate contact with patients at their most vulnerable.And they're at the bottom of the hierarchy -- so they're taking orders, not in any position to question the ethics or appropriateness of this intimate care. They're in no position to say this or that isn't right and we should ask the patient's preference. I also believe that much of this trend to give CNA's more and more bedside responsibilities is essentially economically driven. It's primarily about how the bottom line can be expanded.
Having said all that -- I'm perfectly willing to acknowledge there there many, many older, more experienced CNA's with a life time of experience that know human nature well and do a fine job. But this trend to replace bedside intimate with what turns out to be often the least trained, youngest, and lowest on the hierarchy hospital workers -- that's a economic trend I'm not willing to let go of without criticism.
The fact is, as I see it, CNA training is inconsistent and varies considerably from institution to institution. Are there any national standards? These statements don't mean I'm degrading individual CNA's or the position itself. But I do believe they need much more training and experience if they are to be considered "professionals" with the ability to "replace" tasks that nurses and doctors have spent years studying and practicing.
Anonymous, first of all the Maine Medical Center CNA program was one I randomly chose simply to show in summary that at least in the medical center's words something of the diversity of their program. Obviously, the details of the program and the outcomes of their graduates are not present. (By the way, as I have already noted elsewhere, even the outcomes of every one of our medical students when they are in practice is a big unknown!)
Maybe "degrade" was the wrong word to use but I think it is inappropriate to be critical of a formal certification training program and their trainees without documented detailing the specific program itself and where the deficiencies specifically lie. You write "should have some psychology training and have the experience to know how to read the patients reactions to intimate procedures. CNAs don't have suitible training for that" but how do you know exactly what psychology training they actually had presented? Also, remember, experience comes with time and exposure to patient's reactions either by a CNA or even a medical student and later a physician. As I have repeatedly stated here, even I have never been fully able to read those patient's reactions to intimate exams as been expounded on these threads. And to make matters worse, they never told me about their concerns! ..Maurice.
Thank you for your comments, Maurice. I forgot to sign MER at the end of that last anonymous comment. If I seemed a bit miffed, I was, but not at you. I'm just discouraged at the money-driven decisions within our culture in general which include the medical culture specifically. Face it. CNA's are cheaper to hire than nurses, as are medical assistants. I'm not saying money is the only factor here, but I don't think we can deny it's a significant one. 11 weeks of training comes no where near that of a nurse, yet we seem to be moving toward hospitals where CNA's eventually will outnumber nurses.
I'm beginning to think that standards in general need to be raised -- the BSN (Bachelor of Science in Nursing) should be standard. CNA's should eventually be required to get a 2-year degree. Not necessarily right away, but they should be required to work toward it. Same for medical assistants. I want CNA's to be considered professionals if they're doing the work they're doing. But that title must be earned.
It just seems to me, from my research, that, generally, there's not enough quality supervision and/or mentoring going on with nurse assistants and CNA's , even with young nurses. It varies from hospital to hospital. I find this complaint from nurses all over the web and these complaints seem to be confirmed with interviews I've done.
Lately, I've been doing some research comparing the occupations of nursing and teaching. Hospitals and schools, culturally, have much in common -- and these female dominated professions, nurses and elementary school teachers, also have much in common. We also see the use of aids in education, some with even less training than CNA's, and in some cases, working under little teacher supervision. Another money-driven decision-making process. Both professions are dealing with intimate aspects of human nature -- not just bodies, but minds, souls, personalities, individuals.There's much at stake when working so closely with human beings, mind and body and spirit.
MER
What do you think about this strange article?
http://psychologyofteenboys.blogspot.com/2007/03/mothers-role.html
If I wanted to have a patient advocate with me or near me throughout a surgery would that be possible? Not in the O.R. itself but outside of the curtain during pre-op to make sure a male is performing the pre-op and outside the recovery room to make sure it's a male that deals with my catheter?
S
Rev. Fred,
I truly apologize for the inference I made regarding you and Pastor Fred. I should have kept that thought to myself and I am sorry that I didn't. Please continue to post and add to this discussion. I can see from your posts that you are a sincere person and I am sure we would agree on other things ( for what it's worth). Even moralman needs a place for his voice to be heard-though people may rightly question his reasoning and totally object to his more extreme statements-we'll leave it at that. The bottom line I think, is that physicians should ask these questions of their patients beforehand and go forward accordingly.
Also, in reference to the question of me in regards to seperate male and female screenings- yes-that is the way I understand it. However, I could be wrong as I have not recently confirmed that and I guess it is possible that it would be the decision for the particular airport.
Dean
A few points:
1. The last comment by S -- When caregivers read a comment like that, I wonder how they take it. Do they think something's wrong with S, or do they wonder what in the hospital culture may be causing such attitudes? Could it be the "secret" culture of medicine I've described before. Is it lack of communication -- caregivers assuming patients don't want or need detailed information about what will happen to them and who will do what? Did S have a bad experience, or is the attitude based upon what S has read on blogs like this and in the media? In other words, where does this mistrust come from? Maybe S could enlighten us as to the source of his mistrust.
2. I need to make clear my use of the word "professional" when I say I don't consider CNA's to be professionals in the same way I consider doctors and nurses to be professionals, I'm using the word "professional" in a certain sense.
(a) When we say: Mr. X is not behaving professionally, we use the word to indicate, perhaps, "ethically." Mr. X could be anything from a lawyer to a plumber. That's not my use of the word. I'm not claiming that CNA's as a group don't behave professionally.
(b) When we say: Pam is a real professional -- we're probably referring to a combination Pam as competent, fair and ethical.
(c) When we say: It's Joe's profession -- frankly, we mean it's Joe's "job." The word often is used to mean occupation.
(d) If Mary does the work she does "professionally," we may not only that she does it well, bt that she does it for payment, rather than as a hobby or as an amateur. By the way, an amateur isn't necessarily a non professional (in all these uses of the word), it's someone who does something for the love of it. That's the root of the word.
(e) Historically, in our culture, the professions were medicine, law, perhaps scholar (university teacher) -- maybe one or two others. A profession was defined by certain characteristics, such as a shared vocabulary, extensive education and training, certification or license, professional organizations (AMA, etc.).
The uses of this word have changed dramatically in the last few generations. When I say CNA's are not professionals, I mean they do not fit my definition of belonging to a traditional "profession." What may be happening is that the real professionals, doctors and nurses, are using CNA's as their assistants and attaching to them the their professional status. Some patients accept this. Others don't. For some, it depends upon what kind of task the CNA is doing - that is, they may feel comfortable with a doctor or nurse doing the task, but not a CNA.
Anyway, I just wanted to clarify my position.
MER
Anonymous wrote today at 2:57am "What do you think about this strange article?"
Well, first of all it represents the only, solitary thread in a blog written March 2007 by an admitted 38 year old female consulting psychologist, Dr. Suchitra from India. There are two visitor comments.
The mother's role in the sex education of the male teenager is emphasized including the directly encouraging of masturbation and also the mother performing the genital exam of her teen age son. With regard to the latter, the doctor writes:
A good physical examination is essential for the genitals and this is best done by mothers for several main reasons.
such examination will not be liked easily, but when a mother does this the adolescent feels secure
it creates a better bond between amother and son
the son will feel more relaxed with his mother after such discussions andwill hide no facts
the sex life of the teen will improve considerably and a fertile future will be assured for him.
please donot neglect this issue and spoil you child's future.
Now, the reason I have allowed this topic to be introduced is to try to further a discussion we had on a valume many volumes ago and that is on the issue of the psychodynamics within the patient regarding modesty and need for gender selection. Outside of Dr. Suchitra's experience and outside of India, is this role of the mother and teen aged son common. And if so, could the teens reaction to this sexual "intrusion (?)" by the mother be a psychologic mechanism creating the modesty concerns described in all these volumes? Do any of my visitors recall such a relationship? Anybody want to discuss this? ..Maurice.
Doctor -- Can you vouch for the credibility of this recent site you posted. The profile of this "doctor" is that of a 38-year-old female but no details are given. This "doctor," if it is indeed written by a doctor, makes several assertions that seem extremely strange -- at any rate, they're not backed by any quoted studies. For example, the doctor states that male teens will just not allow genital exams by male doctors, so they must be done by the mother. Now, the doctor says he/she's from India, so there could be cultural considerations.
But intuition suggests to me that this is some kind of fetish site. The "doctor" is essentially unidentified, and it just does read to me genuine to me. Something seems very wrong about this site.
MER
S
Deep down most cna's hate and
disrespect nurses and in return nurses have an equal disrespect for cna's.For me to explain why would take up an entire volume.
Would cna's view an intimate
procedure any differently than
a nurse,x-ray technologist or
an observing respiratory therapist? No. There is an equal
propensity for either to think and
act unprofessionally.
I have seen more instances on
the web and in real life of nurses
acting unprofessional more so than
from what I've seen of cna's and
I believe its largely due to the
fact that there are more nurses than cna's. In my state there are
always more nurses than cna's that
are cited for unprofessional behavior,including found past
felonies not being reported to
state nursing boards.
PT
"S" from 1/4/10 6:04 am --
You can probably request an advocate but.. it is in the OR that you really need an advocate.
It is there you will be exposed naked, prepped with a skin solution which includes your genitals and a catheter is inserted. Most of the time a female circulating nurse does this and only after you are sedated so you are NOT aware. In the pre-op area you are aware and can certainly refuse a cross gender care person performing these things. In the recovery area you'll be somewhat unaware as you are waking up from anesthesia (if anesthesia was given - not local).
My personal belief is that you need an advocate during the entire ordeal to protect your wishes and rights.
JW
MER wrote: "Doctor -- Can you vouch for the credibility of this recent site you posted." Absolutely not. To me, it also doesn't appear to be a "fetish site" but I am not sure how common in India is the behavior of the mothers that the writer of this blog assumes. Maybe it was simply the blogger's wishful thinking. I hope that our writer from India SLI is still around to contribute this information.
Regardless of whether the behavior of mothers are common in India or an extreme outlier, the concept of a mother more forcefully and directly entering into the sexual education of her sons made me wonder whether this could possibly be a psychologic factor for such a male having experienced such a mother to reject females performing medical procedures or other nursing attention to their genitals or rectum. This seems to me a perfectly rational presumption which could be open to discussion. Perhaps we might find some patients could give such a history.
One could argue, why be concerned about the psychodynamics from earlier experiences, the goal is to mitigate the results? Well, that is true from a practical point of view since I am not suggesting that those men with privacy issues should undergo psychoanalysis for a "cure". As a doctor, I am always interested in etiology (why a symptom happens) and I believe the asking "why" would be worthwhile in this case. If a relationship could be found than perhaps that would be a strong argument against that "doctor"'s advice. ..Maurice.
Maurice:
Re: a mother's influence on a child's (boy's) sexual upbringing. After reading your comments, I recalled an interesting source and it took me a while to find it. The book is "Disorderly Conduct: Visions of Gender in Victorian America" by Carroll Smith-Rosenberg (1985). It's a collection of essays, one of which is "Beauty, the Beast, and the Militant Woman: A Case Study in Sex Roles and Social Stress in Jacksonian America." It discusses, among other things, the "subterranean mores" of American males that must be confronted and corrected. These underground mores included a "lascivious and predatory nature."
The presumption was that women "felt little sexual desire." It was lascivious men who manipulated female sensuality. Females were trusting and affectionate, always acting out of romance, not carnal desire. Women were innocent, defenseless, gentle and passive. Men were lechers, creatures controlled by sexual desires that couldn't be controlled.
How did Victorian women reformers hope to change their men? "The tactic of preference...was to educate children, especially young male children, to a literal adherence to the Seventh Commandment. This was the mother's task...The true foundations of such a successful effort lay in an early and highly pietistic religious education, and in the inculcation of a related imperative -- the son's absolute and unquestioned obedience to his mother's will."
I don't know what research is out there, but I'm convinced the ideal mother-son relationship was to include some specific, sexual instruction as well. "Obedience, entire and unquestioned, must be secured, or all is lost...The mother must devote wholeheartedly to this task, for self-will in a child was an ever-recurring evil." Translate child as boy child.
Mothers were to "watch over them continually...Let us...teach them when they go out and when they come in -- when they lie down, and when they rise up...A son must learn to confide in his mother instinctively; no thought should be hidden from her."
No thought hidden from her. That's pretty encompassing, and could include what we think were sexually taboo subjects for the Victorians.
The father, perhaps, was traditionally responsibility for the old Birds and Bees discussion -- but that most often probably was so vague as to make it worthless. But female society couldn't trust the male sensibility to socialize the boy child due to men's faulty nature.
Some fathers would be more likely to send the son to brothel for their first experience. It was up to the mother to give the son his moral education in sex, and that most likely included some of the real elements of the birds and the bees.
"Sons were naturally close to their mothers and devoted maternal supervision would cement these natural ties. A mother devoted to the moral-reform cause could be trusted to teach her son to reject the traditional ethos of masculinity and accept the higher -- more feminine -- code of Christianity. A son thus educated would be inevitably a recruit in the women's crusade against sexual license."
You'll find those quotes, and their sources, on pages 117-119.
MER
Thanks to those that responded to my question about a patient advocate. I did have a bad experience where I was lied to and had things done to me while I was unconscious that were promised wouldn't be done. JW, I didn't realize I would be scrubbed and have the catheter inserted in the OR. I thought they would be done in the pre-op area. Is it possible to have an advocate in the OR?
I think I'll pass on the elective surgery. I just don't think I can trust the nurses and CNAs and I can't trust the surgean to keep his staff in line. Thanks again for the responses.
S
From the Dr. Suchitra article:
"IT is very likely that the person examined and the person examining will get sexually aroused. the penis is likely to become erect as in the picture. This is natural and it is anther oppourtunity for a mother to teach her son to mastubate and to lead a hygenic sexual habit."
Is she saying what I think she's saying? First of all would a mother really feel aroused by examining her son's penis?
But it's when she said "it is anther oppourtunity for a mother to teach her son to mastubate..." and below is a real picture of an erect penis. The author looks like a fraud to me. It's either some kind of joke or a fetish site.
Here's an article about salesmen (yes salesmen!) in the OR. I doubt people realize the general consent forms, the way they are worded, allow the doctors to do this. Kelly.
http://www.heraldtribune.com/article/20100101/ARTICLE/1011020/
There are only 2 ways I will ever be seen naked by a female health professional, by being taken to the ER unconscious or by being lied to and completely betrayed by a doctor.
I am surprised that so far no one has taken me up on my suggestion to discuss one possible psychodynamic mechanism for the issue of male patient genital modesty toward female healthcare providers. Whether or not the "doctor" or her undeveloped blog is sincere, joke or fetish I think is immaterial to a possible (and it is possible and plausable) mechanism which would involve the aggressive intervention of a mother into the sexual education and actions of her son.
It is not unreasonable to propose that sons subjected to such a mother in earlier years would look at female healthcare providers as reflections of their mothers..and then reject their presence and actions related to the genitalia.
Think about it. Obviously, if virtually all the men who object to women healthcare providers had loving but not sexually demanding or sexually intrusive mothers then that psychodynamic theory could be readily discarded.
Again, I will explain that as a physician I am constantly interested in the etiology (cause) of a symptom or disorder and not only diagnosis and treatment. And as I have said I make no suggestion or have any interest having such sons undergo psychoanalysis treatment to resolve their concerns.
If I am simply contemplating an implausible relationship then let me know. But as I see it, if there are such aggressive mothers in the world there is always the possibility that this might explain the reactions of some sons subject to intimate medical examination and procedures by women. ..Maurice.
And to MER, we are no longer living in the Victorian era and women (and perhaps mothers) are dressed and undressed differently and sexuality and sexual practices of both genders and the medical consequences are clearly more widely communicated and discussed. So it wouldn't be impossible to consider that some mothers have followed or might follow the suggestions of that "doctor" with regard to their son's sexual education and experience. ..Maurice.
Doctor: I would point out that bodily modesty in our culture transcends attitudes toward health care workers. It's pervasive, and the current discussion about full body scans at airports supports the notion of how widespread the general concern is. The issue becomes more obvious in medical situations.
I've said before and I'll say again, I don't think we're as far out of the Victorian age sexually as we like to think we are. The fact the sex is all over the media might make us feel liberated. But I believe that what goes on in our minds and in our private lives may have more connection to Victorian mores than we readily admit.
You write about the issue of male patient genital modesty toward female healthcare providers. How about female patient genital modesty toward male health care workers? What is the etiology of that symptom or disorder? Or, is that most often just considered a natural part of female nature rather than a symptom or disorder?
I think you raise valid questions. I'm just not sure they're the right ones. Of course, I'm not sure mine are the right ones either.
MER
My mother didn't invade my privacy and respected my modesty and dignity. That's exactly what I expect from female healthcare providers.
If my mother had treated me the way that perverted "doctor" suggested I'm afraid of what my attitude towards women and sex would be. I could have made it a practice to run down the street naked and expect every woman I see to masturbate me the way my mother did. I wouldn't have had any respect for my mother, especially when I learned that my friends and classmate's mothers didn't teach them how to masturbate and treated their son's bodies with respect.
I can't see how having a mother that gave me handjobs would make me feel any differently about female healthcare providers. I think it would have kept me from having any respect for the female gender. The thought of a mother and her son each feeling aroused while she is fondling her son's genitals makes me wonder how this subject can even be up for debate in the civilized world. Would a man with that upbringing compare the sexual arousal he feels with his wife with that of his mother? It gives me the shivers just thinking about having a mother like that. Very creepy.
How are the fathers supposed to feel about this? Would a mother compare his penis to his father's penis? Imagine if the son is bigger than the father. Would his mother lose respect for his father?
CC
CC
If we reverse the roles we can
then see how innapropriate it would be in either case such as father and daughter or mother and son.
Kelly
Sales reps have always
been allowed in the or on many
cases where new instrumentation
such as orthopaedic equipment or urologic scopes are involved.
Personally,I think its
an invasion of privacy,but at least
in some facilities the rep is not
allowed to know the patients name
although not always enforced.
Additionally,I've never
seen a case in the or where the rep
really needed to be there. The surgeon should read over the literature or take a quick class
on the new instruments,its really
not that difficult.
PT
Very briefly....
I once sat in on a meeting with adult female children along with the fathers who molested them. A very popular excuse at that time was that the fathers were lovingly trying to introduce their daughters to sex in a controlled atmosphere, and make losing virginity less traumatic.
This 'act of love' was a very popular movement (excuse)a few years ago, of which I am sure many of you had read about.
I hold as much respect for the doctor's blog about mothers/sons as I do for the excuses of the fathers toward their daughters.
The question of the sales tech in the OR. As I see it, if the sales tech is essential, the doctor needs to discuss this with the patient, explain why it's necessary, and obtain the patient's consent. It would be even better if the doctor arranged for the sales tech to meet the patient beforehand to establish some trust. My contention is that this is more about good communication, patient autonomy, trust and respect than it is about modesty. You can't ignore good communication, or purposely keep these things secret, and then expect to have a trusting relationship with patients. Some patients, when they find out they've "signed off" giving permission for things like this without true informed consent, these patients may resent the whole hospital culture and then you've lost your trust perhaps forever.
MER
swf, do you know what literature is available about the rationalization of activities in "education" both by mothers-sons and fathers-daughters of which some acts could clearly be considered criminal. Again, if this kind of behavior involving either genders is not rare, again, maybe this would explain the physical exam modesty issues including gender selection of both men and women. I still remain curious about the etiology of these patient's concerns..Maurice.
With all due respect a mother showing her son how to masturbate is wrong for many reasons but let me turn the scenario upside down for a moment.
How many cultures would allow a father to masturbate there teenage daughters???? I do believe there would be a much higher number of fathers in jail.
Back to the mother article which I think is complete fantasy by the author. I think it is wonderful if a mother and son have a open relationship, the mother could refer the boy to books/pamphlets and some movies on the changes that occur during and after puberty.
I do think that a person adult modesty level can sometimes be influenced on the level of modesty one grows up around.
Did you-
Have brother and sisters?
Have both a mother and father growing up?
Did the family share one bathroom?
Did the family have a loose or strict clothing rules around the house?
I also think if a teenage boy saw a male doctor most of his life it will be very awkward for the boy to see his first female doctor. Same goes for teenage girls, so for the author to say a teenage boy does not want a male doctor to show him how to do a Self Testicular Exam is so off base.
Daniel............
Why are we wasting time discussing something that is obviously a hoax. It reminds me of a male gyno's blog who claimed that a woman had an orgasm as soon as he inserted the speculum. Pur-lease! In his dreams!
NP
NP, I understand your view BUT whether what the "doctor" wrote on her blog is a hoax, a joke or a fetish or whatever, sexual abuse in one form of another is not an unknown and post traumatic stress is attached by some victims as the consequences of such abuse. I am again, as I have in volumes past, tried to turn the conversation to whether such abuse by a parent to a child of the opposite gender might be a mechanism producing the physical modesty and gender selection issues. Now one could state that sexual abuse occurs only in father-daughter relationships and has not occurred in mother-son relationships despite the suggestible advice given by the "doctor". And if there was any rejection of a healthcare provider on this basis it would be only the women patients rejecting men. But, I wonder if this is fully the true situation. Can one expect mothers to relate to their sons in sexual abusive ways (perhaps rationalizing "education" but perhaps including self-gratification) and perhaps this behavior sets the stage for later rejection of female healthcare providers by those sons. What we need to know first whether there has there been any studies on this matter. What is wrong to look for a cause even though we don't yet have the final solution to the issue? ..Maurice.
OK folks.. I have started the literature review with this excellent site "Sexual Abuse of Males: Prevalence, possible lasting effects and resources" by Jim Hopper, Ph.D., a psychologist. As you will see, this site contains statistics and documentation. I want to re-read the site and follow up on some references. Let me know what you think. ..Maurice.
I find the topic interesting from an academic point of view, but still, if a male has been sexually abused by his mother or another woman, and it causes him to feel more comfortable with a male caregiver -- or, as Marjorie said, causes him to relive the trauma with a female caregiver -- ou causes him to be hostile toward female caregivers...
-- Will he or has he talked about it?
Must he include this information in his history when he goes to the hospital for some minor surgery?
What difference will it make if the staffing is all female, and/or if the hospital culture doesn't recognize gender choice as a significant factor in patient care?
Will he be asked, regardless of what information he gives the hospital, which gender he prefers for intimate care?
To me, these are the relevant questions. It would be interesting to get a number of how many men have been abused, but even with that number, I don't see it changing the hospital culture.
The more I look into this subject, the more I see that gender is the elephant in the room within hospital culture. It doesn't exist, at least its significance in patient comfort and well being is rarely acknowledged, discussed, researched or written about. I've done brief reviews of several nursing textbooks and find little or nothing addressed on this subject. If it is brought up, it emphasizes the insignificance of gender, from the caregiver point of view.
The accepted world view in the medical world is that gender doesn't matter, especially when it comes to men. Knowing how many men have been sexually abused by their mothers, although a worthwhile venture, will not begin to cure the medical world of its blindness in this area. Frankly, I think there are a significant number of men who were not abused in any way by their mothers who would prefer male rather than female caregivers for intimate procedures. It would be fascinating to learn why. But this whole approach seems to view this kind of choice as a symptom or illness that needs to be cured -- which also seems to be part of the hospital culture. If men are embarrassed (or women), resocialize or cure them to accept what the medical world feels is appropriate and fits into their value system.
MER
Maurice,
I don't understand why you would insist on studying the etiology of patient modesty when opposite sex modesty is the norm in this society. It might be more fruitful to examine the lack of modesty in some patients. Commonly, cross-gender modesty is not pathological.
--rsl
rsl, to be frank.. in a way cross gender modesty is pathological in the sense that, as described by a number of visitors to these volumes, medical care and attention for what might turn out to be important illnesses to care and attend to early would be rejected without the selected gender healthcare provider. Yes, we all have modesty particularly if we are not naturists, but for modesty to trump attention to ones health, to me that is a pathologic behavior. On the other hand, calling it pathologic doesn't point fingers to what or who is primarily responsible for the creating the circumstances to lead to the pathology. It could be that the medical system is so unaware, unthinking and entrenched in its methods that it is uncaring in this regard. It could be that questionable behavior of certain healthcare individuals has prejudiced the opinion of many patients It also could be that, as begun discussion here, beyond common general modesty concerns there is a sexual abuse history of one sort or another in the patient which has contributed to the patient's decision.
In any event, one patients life or function impaired because of a delay in diagnosis or treatment because of the issue of modesty is a pathologic condition that demands solution. ..Maurice.
I would have to agree with you, Maurice. If a patient refuses to seek life-saving care due to fear of the gender of the caregiver, that would a condition needing cure. On the other hand, if the health care system, and individual caregivers, know this is a problem with some patients and refuse to do something from their end about it, that is also a pathology within the culture that needs fixing -- which I think you imply in your last comment. But we do know that within the human brain, emotion often trumps reason -- so it should be no surprise that people may risk their lives due to concern for specific gender care.
MER
Just for the record, The male gyno story I wrote about above actually wasn't regaled in a sleazy way. The Dr feigned naivety and he said it was the nurse with him who explained what had happened.
NP.
Happy New Year to all,
I subscribe to an on-line e-magazine entitled OutPatient Surgery. Over the years I have learned quite a bit about the goings on behind the curtain by reading this journal. In the following article: The ENT Surgeon Who Gave Genital Exams, appears to be Bernstein-like "documentation" from a national trade journal of a female ENT surgeon fondling male patient genitals in the OR, in full view of the OR staff. This behavior went on for years with the full knowledge of hospital administration. Apparently, the whistle blower got fired and the MD is still practicing.
It appears that the administration condoned regular sexual assault upon pts. (I wonder why the CRNA who reported the doc to the medical board did not also contact the local police.) Apparently the hospital looked the other way because of all of the revenue this particular doc brought into the hospital.
This article helps to bluster the body of "stories" read about in allnurses et al. What is disturbing about this article is that the medical boards protect their own. They do not operate in the best interest of the patient. This goes to the basic "trust" issue that has been discussed many times in these blogs.
Dr. B: It is hard to shift to the discussion to "solving" this problem of trust, when your profession clearly protects it own. There is no solution other than federal laws. This issue is like the banking industry. Reform will not come from within.
--amr
Interesting, somebody has a patent on a genital covering garment for surgery.
http://www.patentstorm.us/patents/5832535/description.html
NP
Dr. Bernstein,
If you're looking for a "smoking gun" in terms of a reason for patients wanting their privacy and modesty respected, I don't think sexual abuse is it. Sure there are some cases where it has undoubtedly been a significant contributing factor, but I doubt if it is a causative factor in a significant percentage of those with privacy/modesty concerns.
Rather, I believe that MER touched on a far more likely cause - "The accepted world view in the medical world is that gender doesn't matter, especially when it comes to men......If men are embarrassed (or women), resocialize or cure them to accept what the medical world feels is appropriate and fits into their value system." We're back to the demi-God complex. Who died and appointed them God?
As rsl noted, cross gender bodily modesty is the norm in our society, a cultural value if you will. As with any culture, the degree of importance on any particular value can vary widely with the individual. For the medical world to expect everyone to be able to just turn that off like throwing a switch is unrealistic. Now couple that with with the physical, mental and verbal abuse, condescending attitude and general lack of respect for their personal values or feelings that they get from some health care workers and I think you might have a better etiology.
People are affected in different ways. At one extreme, some just go along with it outwardly, yet it turns into an internal conflict that festers and eats away at them - classical PTSD. At the other extreme, they get to the point where they're mad as hell and aren't going to take it any more, and become aggressive and confrontational in an attempt to take back control. The majority, I believe, lie somewhere in between - they just want their values and rights respected and to be treated fairly.
Unfortunately, as MER pointed out, the medical world/hospital culture doesn't recognize gender choice as a significant factor in patient care. Pressure from patients can force them to acknowledge it on a case by case basis, but unless/until the medical world takes a hard look in the mirror and realizes they are the problem, I don't expect anything to change on a major scale.
For that to happen, I believe it's going to have to threaten the "business" of medicine, be it through bad publicity, loss of revenue due to people taking their business elsewhere, legal action, or some combination thereof.
Americans realize they live in a supposedly free country and don't like taking orders from anyone, especially people they have no respect for. Nurses and assistants demand respect and obedience from the patients but they don't deserve it. I think it's safe to say that most people respect doctors but unfortunately doctors send in their thugs to do most of the work. They also often use "assistants" when clearly the "assistant" isn't needed.
Even the thugs have their own thugs. Doctors push most of their work onto nurses and the nurses in turn push most of their work onto nurse's assistants, who aren't qualified to do it. When will doctors realize their mistakes and put a rest to the chaos? When, if ever, will ethics and morals begin to be considered even half as important as money and power?
To Anoymous who posted January 08, 2010 3:12:00 AM,
I don't believe it's a question of these assistants "deserving" respect. We all deserve respect unless we've done something to lose it.
To me, it goes to the concept of "earning" respect. Some caregivers live in a world where the kind of respect we're talking about, that is, giving in them complete access to the most intimate parts of our bodies -- some caregivers believe that they deserve that respect just because they work in a hospital and wear scrubs. They live in a culture that's so busy, where patients are moved in and moved out so rapidly, where staffing is so short -- that they have gotten into the habit of just doing what they need to do without even trying to earn the trust and respect that many patients either require or would certainly appreciate. The attitude is that, just by entering the hospital and signing a few papers, the patient has agreed to or given informed consent, to whatever needs to be done whatever way it needs to be done by whoever happens to be assigned to do it.
I read recently where some nursing assistants were commenting that, to them, viewing and touching personal body parts (penis, vagina)was to them like view our touching feet or hands. It was no big thing to them. These comments were written to sooth patient concern, to assure patients that they didn't really see what they were seeing. I don't deny that's how some of them might feel after awhile.
But I will tell you this -- to a patient, their penis or vagina is not a foot or hand. It's a very personal part of their being that, as Dr. Groopman stated in an article I posted, can have significant and very symbolic meanings. I recently found a nursing textbook (published in 2008) that actually discuss this in the chapter on intimate care related specifically to men. Of course, where do you think it was published? -- in the UK. I'll post info on this soon, because I still don't believe these issues about "gender" are taught in American medical education. rt
Until caregivers start seriously looking at this issue from the patient's point of view instead of from their own perspective, and until hospitals start hiring and staffing to deal with it -- and until medical teachers, mentors and leaders in the profession start insisting these changes happen -- patients will continually have to either put up with this or fight it out on an individual basis. But even if a small number fight it out on the ground level, the profession will become more and more aware of the difference between how they see things (and what they don't see) and how patients see things (and what patients see).
That last comment written to the anonymous poster was written by me, MER. Forgot to sign it.
MER
NOTICE: AS OF TODAY JANUARY 9, 2010 "PATIENT MODESTY: VOLUME 29 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 30. ..Maurice.
I hope I'm not beating a dead horse here, but reading the comments from the understandably resentful men re modesty (Really prefer the word privacy), I really can't believe this isn't pay back from female nurses for gynecology. Women who still submit to these exams from male gynos. have tremendous issues from justifying letting a man not their husband or lover do such things to them. This is why they maturity bait other women who chose female gynos, or who just question the gyno ind. altogether. I always knew if I allowed such things to happen to me I'd become like these women myself.
If you're interested, visit groups like Against gyn exams, and read up on the history of medical marquis de sade. J Marion Sims, "father of gynecology." Or look into creeps like Robt. Latou Dickinson. The level of entitlement medicine had to women's bodies/sexuality is not to be taken lightly.
That said I fully support BOTH men and women who want bodily privacy within medicine. And I wish male nurses would stop whining about not be allowed in ob/gyn, stop bathing women like my mother when they are in the hospital, and instead help the men on here who would like some privacy. Although I suspect it's moronic hospital management behind this insanity not the nurses themselves. The same way for some reason podiatrists are forced to do pelvic exams in med school. BNW
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