Bioethics Discussion Blog: Patient Modesty: Volume 30

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

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Saturday, January 09, 2010

Patient Modesty: Volume 30



The discussion of patient physical modesty concerns continues, particularly related to the genital areas, and its relationship to medical examination and procedures performed or observed by individual healthcare providers of the opposite gender. In Volume 29, an attempt was made to introduce the issue of whether some significant behaviors of mothers toward their sons might contribute to the cross gender modesty concerns raised by male visitors here. Whether or not that possible relationship is continued to be discussed here, the need is to continue to comment about and work out approaches to mitigate the concerns but to the patient's benefit. One of the approaches is to "spread the 'word' (concerns)" directly to the medical system. In this regard, I want to remind my visitors of what I wrote on Volume 29:

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.

I have not received word that anyone here has taken advantage of this offer by hospital.com. I strongly suggest that my visitors do participate.
..Maurice.

Graphic: Photograph of painting by Albert Edelfelt, 1877 Ateneum Art Museum, Helsinki Finland and published on Wikipedia in the public domain.
Queen Blanche of Norway and Sweden with Prince (later King) Hacon, a fantasy painting.

NOTICE: AS OF TODAY JANUARY 26, 2010 "PATIENT MODESTY: VOLUME 30 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 31

130 Comments:

At Sunday, January 10, 2010 8:40:00 AM, Anonymous Anonymous said...

Why is it that a man that gets naked outside of the hospital or his home is considered a psychopath, and a man that won't get naked in front of any woman that feels like being in the room at the hospital or doctors office is also considered a psychopath?

 
At Sunday, January 10, 2010 9:21:00 AM, Blogger Maurice Bernstein, M.D. said...

Let me duplicate here what I wrote on Volume 29 three days ago:

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.


I am not calling anyone a "psychopath" in the usual medico-legal definition of that term. What I am saying that to have a patient's life or function impaired by a modesty issue regardless of the cause is a "pathologic condition" which should be remedied. ..Maurice.

 
At Sunday, January 10, 2010 9:39:00 AM, Anonymous Anonymous said...

No one called anyone a psychopath. Drop the drama.

 
At Sunday, January 10, 2010 11:06:00 AM, Blogger amr said...

Dr. B

Regarding Hospital.com. I just spent about 10 minutes trying to find where this blog is that you refer to. I am sure that it is there, but it is not sufficiently exposed (pun intended) to be accessible. Perhaps you could provide a more direct link.


--amr

 
At Sunday, January 10, 2010 11:29:00 AM, Blogger Maurice Bernstein, M.D. said...

amr, I have been in communication with MER and he will be communicating with the editor of hospital.com to present an introduction and the setting up of a section on that site for presentation of views regarding patient modesty. He will get back to all of us regarding how we can access that section. ..Maurice.

 
At Sunday, January 10, 2010 10:05:00 PM, Anonymous Anonymous said...

Amr

I have heard about this Dr sparks,the ENT surgeon who gave
unrelated testicular exams on all
her male patients. I've checked
her file at the N.M state medical
board. An Advocate that I mentioned
would stop this kind of unprofessional behavior.


In USA today recently

More than 12 percent of children in juvenile prisons are sexually
victimized,according to a justice department survey out thursday and
the vast majoriety of cases involve boys and female staff at the facility. The rate of sexual victimination is more than seven timts higher than indicated by a
2008 justice department report.
The study reports and lists the
juvenile centers located around th united states where yound boys
are being sexually victimized by
female staff.
Recently,in Phoenix Arizona there is a class action suit brought about by non violent inmates who were strip searched
and chained to each other.
New york was forced to ban the practice of stripping detainees accused of minor offenses after a lawsuit led to a nearly $50 million dollar settlement
by jail inmates who were stripped.
Be careful medical industry,your
next.


PT

 
At Monday, January 11, 2010 10:22:00 PM, Blogger Maurice Bernstein, M.D. said...

For whatever this survey data is worth in this discussion of patient modesty, here is the latest USA TODAY/GALLOP POLL regarding the air travelers' response regarding TSA full-body scanners.

WASHINGTON — Air travelers strongly approve of the government's use of body scanners at the nation's airports even if the machines compromise privacy, a USA TODAY/Gallup poll finds.
...

In the poll, 78% of respondents said they approved of using the scanners, and 67% said they are comfortable being examined by one. Eighty-four percent said the machines would help stop terrorists from carrying explosives onto airplanes. The survey was taken Jan. 5-6 of 542 adults who have flown at least twice in the past year.


I suppose that in the case of air-travelers the benefit of a safe trip trumps any anonymous modesty. Could this reflect a patient public's view that treating a disease and resolving symptoms trump any modesty issues? I have a feeling I am going to get some strong responses from my visitors on that one! ..Maurice.

 
At Tuesday, January 12, 2010 9:59:00 AM, Anonymous Anonymous said...

Maurice: Interesting study. I think a connection can be made as you've suggested. I wonder if the survey separated attitudes regarding body scans in general and blanket body scans. I would think many would be against blanket, arbitrary scans. Is it divided by gender? Informal surveys I've done suggest women are less likely to agree to these scans than men. But I do think this is at least an indication of how people feel about modesty vs. life-threatening events. It's the context again. And, it's whether people feel they are being treated respectfully and with dignity. How these scans are done, in public or in private, may make a big difference. There may also be a connection between these attitudes and group physical exams. If these scans are done in public, a group psychology develops, and that becomes part of the formula.
MER

 
At Tuesday, January 12, 2010 10:39:00 AM, Anonymous Anonymous said...

Psychologically, the people who approved of the scanners resemble badly injured ER patients, putting safety concerns far ahead of modesty, liberty, or even common sense. Rewording my post from vol. 29:

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 virtual mannequin for viewing by screeners.

According to Jeffrey Rosen's The Naked Crowd, when made aware of the availability of this machine, a small minority of non-exhibitionist people inexplicably still chose the machine that stripped them bare--even controlling for convenience. This is the same survival-oriented siege mentality seen in trauma wards.
--rsl

 
At Tuesday, January 12, 2010 2:28:00 PM, Anonymous Anonymous said...

I personally would much prefer to be scanned at the airport than to be gawked at by female nurses and aides. The airport scanners appear to keep the people that are scanned fairly anonymous. In the pictures I've seen of the scans the faces are too blury to recognize. Also as someone commented, the people watching the scans are in a seperate room and don't even see the scanees in person.

In a hospital it's impossible to remain anonymous. You're dealing with the nurses face to face. A nurse or aide will talk to you, look at your penis, then your face, then your penis, and that is much more personal and unethical than being a blur on a black and white TV screen.

I know we're not here to compare the two, but some people are making a bigger deal about the airport scanners than they do about teenage nurse's aides handling their private parts. I'm as hardcore a modesty advocate as you'll ever meet but the airport scanners just don't seem to be such a big deal.

CC

 
At Wednesday, January 13, 2010 4:16:00 AM, Anonymous Anonymous said...

Walking through a body scanner is consenting to the privacy invasion. Consent must also be given in a healthcare setting. Those adamant about their privacy rights will not fly; just as those who will not seek healthcare due to treatment that many consider degrading.

What could it be that keeps people away? Could it be.....feeling degraded and humiliated....duh

They took a sampling of about 500 people; hardly a study, then they fill the public with propaganda that everyone is fine with this privacy invasion. And...when the airlines start losing money they will look into every possibility except the one in front of their noses. A finer day I can't wait to see
gd

 
At Wednesday, January 13, 2010 10:25:00 AM, Anonymous Anonymous said...

The January 2010 issue of the American Medical Assn. Journal of Ethics is focused on nursing. Have you started a thread on this, Maurice? There are several very interesting articles. One of the most interesting is "The Medical Team Model, the Feminization of Medicine, and the Nurse’s Role" by Lisa Rowen, DNSc, RN.
Although this doesn't address the modesty issue, it does underscore the importance of gender in our culture, even in the hospital culture. This article focuses mostly how gender affects doctor-nurse relationships.
Medicine seems to recognize more readily the importance of gender when it comes to relationships within the system, e.g. doctor-nurse; doctor-doctor; nurse-nurse. They seem to be less aware or concerned with gender issues between doctor/nurse-patient. Maurice, you must have some contacts at that journal? How about an issue dedicated to gender issues as they relate to patients?
Here's the link to this article, and the link to the entire journal online:

http://virtualmentor.ama-assn.org/2010/01/oped1-1001.html

http://virtualmentor.ama-assn.org/2010/01/pdf/vm-1001.pdf
MER

 
At Wednesday, January 13, 2010 10:40:00 AM, Anonymous Anonymous said...

Another article in the January 2010 issue of the American Medical Assn. Journal of Ethics is "Gender Diversity and Nurse-Physician Relationships" by Beth Ulrich, EdD, RN. Although this article, again, focuses on how gender affects relationships within the system, it does suggest how gender diversity within the system is necessary for a gender diverse society. Hidden beneath the covers are many patient-related gender issues, including modesty. The article also does address percentages of males and females in medicine in different fields, as well as other professions. Here's a link to this article:

http://virtualmentor.ama-assn.org/2010/01/msoc1-1001.html
MER

 
At Wednesday, January 13, 2010 11:25:00 AM, Blogger Maurice Bernstein, M.D. said...

MER thanks for the URLs. I haven't looked at Virtual Mentor in the past month or so but I have written an article there back in November 2008 as I recall.

Yes, I do have a thread titled "Feminization of Medicine: Good or Bad" started Feb 28 2009. I think I will add the links to Virtual Mentor there since they would be pertinent to that thread.

In these days of medical system reform and the addition of many more patients into the formal system, there will be the need for more general physicians and it may well be the female physicians will be more likely to fill that need.

The working relationship between male and female physician and their professionals of opposite gender is quite interesting as well as physician working relationships with male or female nursing staff.

..Maurice.

 
At Wednesday, January 13, 2010 11:39:00 AM, Blogger Maurice Bernstein, M.D. said...

Oops! Time flies! Actually my contribution to Virtual Mentor was in March 2007 if anyone is interested. ..Maurice.

 
At Wednesday, January 13, 2010 11:40:00 AM, Anonymous Anonymous said...

If there’s one thing that women can’t do as well as men more than anything else, it’s be a doctor.

Men have been being doctors since the beginning of time. Thousands of men throughout history have devoted their lives to it in such a way that the wake of their mantastic sacrifices reverberate all throughout history — which is every man’s true goal.

Every woman’s true goal is to make everyone around her sorry for everything they ever did.
First let me be clear on something. A doctor is someone who deals in medicine, prescriptions, surgery — things of a medical nature for which an expensive education and a government licensed certification are required. Things that do not make you a doctor are dealings in: yoga, herbs, Feng Shui and massage therapy. This is an important distinction to make because women are good at all those things. Women are attracted to that kind of feel good, new age, weirdo malarkey like flies to pigs and pigs to poop. However, while they may be good at them, none of those things have any kind of medical use or purpose — except to waste time.

They don’t make you a doctor either. That’s why there’s no abbreviation for guru, like Gr. Bobby Sinclair. You can touch your ankle to the back of your head? That’s great, but the state medical board doesn’t give a crap and neither does anyone with a broken ass.

Being a doctor is a high pressure job where lives hang in the balance every day and one screw up can cost you even worse — millions of dollars. High pressure? Have you ever seen a women drive a car to a sporting event? Good luck, she won’t ever do it because the extreme pressure of waiting in a line and letting jerks cut her off would make her head explode. Watch a woman drive in traffic. The moment she senses any pressure at all — and I mean any, something as simple as changing lanes — she crumbles like a card house built out of Graham crackers.

When it comes to pressure, women are a complete joke. Women can handle pressure as well as they handle giving birth — pathetically and while looking for the nearest man to scream at and/or physically abuse the whole time.

I’m sure I don’t even need to say that being a doctor also requires logic and problem solving skills. Women have none of those. The only thing women should be doing in a hospital is wearing nurse outfits. That doesn’t mean they should be nurses either, just wear the outfits.

 
At Wednesday, January 13, 2010 12:17:00 PM, Blogger Maurice Bernstein, M.D. said...

I allowed this last commentary by Anonymous today at 11:40am to be published simply as an example of undocumented sexism bias. I find none of the criticisms of women as physicians valid. My daily experience has also included female medical students where I find no difference in their capacity to face first and second year medical school pressures, stresses and challenges.
Again, I stress that discussions here should not be demanding that we accept undocumented and generalized stereotypical descriptions. Yes, there are some women physicians who are just as unprofessional as some of their male counterparts but that is how people present but certainly not all people, especially of one gender. So let's not make such comments since they are not helpful or realistic. Yes, there may be some abilities of females to be interested in and tolerate certain areas of medicine then men. You can read about it on the "Feminization of Medicine" thread which I provided the link in a previous comment. ..Maurice.

 
At Wednesday, January 13, 2010 12:30:00 PM, Anonymous Anonymous said...

Is that comment above meant to be a joke? I cannot believe that in this day and age people exist who hold such unmitigated sexist attitudes.
I am a male and concerned about patient privacy and dignity; that does not mean that I support such generalised rubbish being said about 50% of the population.
More than happy for further posts of this kind to be blocked.
Chris

 
At Wednesday, January 13, 2010 3:18:00 PM, Anonymous Anonymous said...

There is a lot of truth as far as
comments made by the anonymous
contributor at 11:40 AM. I've just
obtained a copy of the Nov.2009
issue of the Arizona state board
regulatory journal which lists cna,
lpn and rn disciplinary actions over a three month period.The
violations and the numbers involved
are very concerning.


Furthermore,I've looked into the
New Mexico medical board regarding
the behavior of Dr. Twana Sparks,
the ENT who was performing genital exams of unconscious male patients
for post-op ears,nose or throat surgery.Additionally,she wrote messages and created artistic images on their bodies without obtaining prior informed consent,as
if someone would consent to that anyway!

The executive director of the N.M
state medical board is by the way a
female with no medical degree. It
appears that Dr. Sparks needs a chaperone over the age of 18 years
for any patient interaction in the
office or surgery.She will need to
undergo polygraph examinations
and see a female psychotherapist
for her unprofessional conduct
towards unconscious male patients.

Anyone remember the crazy female
astronaut who drove cross country
with a diaper on?


PT

 
At Wednesday, January 13, 2010 5:28:00 PM, Anonymous Anonymous said...

Let me relate a recent experience I had in hospital in Tennessee. I went to the ER with chest pains feeling I had a heart issue coming on. The ER staff was very professional and treated with complete dignity and respect. As the EKG was inconclusive they kept me overnight in the ER and scheduled a heart stress test for me in the morning.
The test was completed by a male nurse in the cardiac unit (I’m a guy). The male nurse allowed 10 or better females in the room during the test. Most of the ladies were talking with one lady assistant about her recent honeymoon. Heck he even had his wife in the room during the test. As I was in a hospital gown the only moon that I was concerned about was mine (my naked rear end hanging out). He also left the door to the public hallway open again with my rear end on display. When I had enough and request some privacy the male nurse got belligerent he said “...this was a hospital and modesty was not an issue…” I asserted my rights and he closed the door asked the other ladies not required to leave.
I filed a complaint with the patient advocate they addressed the issue with the nurse and he got arrogant and belligerent with them. I was shortly discharged with a clean test and nothing wrong with my heart and told to follow up with my family doctor. I filed a complaint with the hospital and got an apologetic letter.
Now fast forward five weeks I’m back in the ER with the same symptoms. Only this time they find arterial block and place a stent in my heart I find that most likely I have heart damage as it was not take care of the first time. I wonder because I stood up for my right to privacy did the prior nurse miss report the test. However I’ll have my day on this as I’m an attorney by profession, while I don’t specialize in medical mal-practice. I have friends that do and I’m going after this nurse with the full force of the law I have contacted the district a attorney to consider initiating a criminal investigation.
If more men had stood up for their rights to privacy guys like this nurse would not be in the business.

JB

 
At Wednesday, January 13, 2010 7:25:00 PM, Anonymous Anonymous said...

Sorry PT,

PT.
I don't think the examples you give justify the anon comments above at all.
This person made a series of generalisations about all women EG:
"When it comes to pressure, women are a complete joke" or
"I’m sure I don’t even need to say that being a doctor also requires logic and problem solving skills. Women have none of those. The only thing women should be doing in a hospital is wearing nurse outfits."

I am sorry I don't see exmaples of unprofessional behaviour as being justification for those and other comments made.
It is not logical or sensible to go from specific examples to generalisations about females, abilities emotional capacities etc. Further the examples you gave, whilst distrurbing to me, don't demostrate truth of the anon comments and generalisations anyway.

Chris

 
At Wednesday, January 13, 2010 7:45:00 PM, Anonymous Anonymous said...

Anybody remember all the male rapists both in and out of the medical profession!

Come on folks, pointing fingers is not the answer nor a solution.

Medical ethics need to be upheld for both genders. Furthermore, let's hold the medical community accountable for covering up their shame.
gd

 
At Wednesday, January 13, 2010 8:45:00 PM, Blogger Maurice Bernstein, M.D. said...

JB, I don't want to appear to be making light of what you went through, but one may say you certainly underwent a "stress" test---both physically but also emotionally.

My question is whether your stress test included an echocardiogram (so-called "stress echo" and whether that "nurse" was actually the technician who carried out the echocardiogram procedure. The reason I ask is that the valid information obtained from that procedure has to do with the performance of the technician in the placement of the transducer on the chest and the selection of appropriate segments of information to be part of the data that the cardiologist will look at and read.
If the technician is upset, not paying attention and thus not following and performing a strict protocol, the tech may miss data and thus provide incomplete data to the cardiologist which could lead to a diagnosis of normality when normality did not exist. This is just a supposition on my part.

A response such as "this is a hospital and modesty is not an issue" is a ridiculous excuse. Being a patient in a hospital does not eliminate all professional concerns about patient modesty under all circumstances. And you have every right to complain when your procedure becomes a "show" without your permission. I hope the tech was fired and good luck on your further legal plans. ..Maurice.

 
At Wednesday, January 13, 2010 9:05:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I have to say that any implied generalizations from these isolated cases including one that is not even related to professional medical behavior is becoming now inappropriate on my discussion blog. I think that the lady ENT's behavior is worthless in trying to extend a criticism to all lady physicians or to all ENT physicians or any other groups within the healthcare profession.

I get lists of physicians in California quarterly who have been penalized and/or license revoked for unprofessional behavior and yet I would be surprised to learn that these lists represent only a tiny reflection of gross and rampant unprofessional behavior of physicians throughout the entire state of California or in other states. The same, I suspect, would apply to other healthcare providers. I would say if there was truly virtually universal gross unprofessional behavior and negligence was going on in healthcare throughout the country, our government is missing the boat if all they are doing is trying to include the uninsured into insurance programs and trying to improve healthcare at a lower cost and totally ignoring the most important issue: getting rid of all those doctors, nurses, aids and techs who are embarrassing and denigrating our entire healthcare system.

Let's nevermore write about isolated cases and then generalize to a system-wide status without documentation that would support such a generalization. ..Maurice.

 
At Wednesday, January 13, 2010 9:15:00 PM, Anonymous Anonymous said...

Hello all,
Happy New Year [probably a little late :)]. I moved to another city in India and a new job so didn't do much blogging in the past two weeks.

As for the rather ridiculous article by Dr. Suchitra that mothers should do testicular exams on their sons and teach them to masturbate when they get aroused is too far fetched even to be a plot for a pornographic movie (in India at least). Testicular exams aren't even done regularly as part of physical exams. For that matter very few go for regular physical exams. In India, it is "If it ain't broke don't fix it" with health. Plus, in India there is a substantial proportion of people who prefer Homeopathy or Ayurveda as opposed to the traditional medicine most of you westerners follow. So, intimate procedures are performed when a person complains of problems in those areas or is in for surgery around that area.

As for JB's post, I too have a similar tale. As a requirement of my new job, I had to undergo a medical exam in any of the hospitals the company had listed. The lack of privacy given to male patients was appalling. While I was having my stress test, other patients were in the room (all male) and were having their blood pressure and medical history taken. Isn't something like medical history confidential? The curious part was the hospital has a feedback link on their site which doesn't work. Emails sent to an email ID listed on their site bounce back. I'll write to their admin people soon.
--------SKI

 
At Wednesday, January 13, 2010 9:36:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks SKI for returning and giving us your impression from India about the "doctor's advice". Did you comment about the lack of privacy at the time of your exam or did you feel it was inappropriate as the "victim" of an employment exam to complain? ..Maurice.

 
At Thursday, January 14, 2010 3:10:00 AM, Anonymous Anonymous said...

JB are you blaming the room full of women on the male nurse? Why not hold all the unnecessary women accountable? Why didn't you speak up while it was happening? Why didn't you put your underwear back on? Was the male nurse so powerful that nothing you could say or do could get the women out?

 
At Thursday, January 14, 2010 8:02:00 AM, Blogger Geoffrey said...

Just a quick note about the whole-body imaging scanners being installed in many airports nationally and now internationally. Unlike the TV monitors that display luggage going through the x-ray machines which fellow travelers may be able to view while going through a security check, operators and monitors are removed from view of fellow travelers as they are located in a different area/room so as to disassociate themselves from the person being scanned. Operators communicate with the guard assisting the scanee in the security area by radio to identify issues of concern. New software has altered imaging on the display monitor to reduce body features while maintaining identification of potential threats located on the person.

With regard to the comment "when the airlines start losing money they will look into every possibility except the one in front of their noses." No TSA worker will force you to go through a scanner. You can choose to undergo a pat-down. However, if you thought the scanner was a violation of your privacy, wait until you experience the thorough pat-downs being given since the Christmas Day airline event. Since the explosive material was located in the crotch area of the accused, expect a careful examination of your most sensitive areas, since terrorists believe TSA screeners will forgo them. After that, I expect most will choose the quick scanning process. It's your choice. Or...perhaps you'll choose to take the bus next time.

GH

 
At Thursday, January 14, 2010 10:37:00 AM, Anonymous Anonymous said...

If the male nurse invited them in the room and that was who was conducting the test JB was right to approach that worker with his needs. The women didn't walk in uninvited but were bought in by the male nurse. The male nurse might have been instructing students or perhaps precepting new employees for so many to enter. This is another reason why it is important to communicate before the exam what your needs and expectations are.

Even if the male nurse was precepting or working with students that day he should have told the patient and introduced them. It's unprofessional to do otherwise.

JB did speak up when it was happening and was met with a rude response. He is now in the process of following up.

 
At Thursday, January 14, 2010 10:44:00 AM, Anonymous Anonymous said...

In today's New York Times: "Doctors report that about one in six patients is “difficult.” The study focused on 113 doctors in a larger group, the ones who most frequently reported these “difficult encounters.” Those doctors were more likely to be younger and female.
Now -- first -- I'm interested in all kinds of gender issues, especially in medicine. I'm not interested in gender wars. I say this because, after I post something like this, some post inevitably interprets my intentions as somehow bashing women or female doctors. I'm not.
There may be some gender reasons for this statistic. Or, it's more likely that the controlling factor here is the youth of the doctor, lack of experience.

An editorial with the article suggested that doctors need better training to cope with the psychological challenges of caring for patients. I would agree -- but I'd say the real training needed is in communication skills. The editorial also suggested that doctors should focus on identifying a patient’s expectations at the beginning of a visit. But that requires more time and, again, better communication skills. The editorial also reminds us that dealing with difficulty signifies mastery rather than weakness. I would agree, and that applies to all occupations and professions.
But I would add this. I believe doctors need to reexamine their definition of "difficult patient," perhaps in terms of what might be considered normal human behavior in some kinds of doctor-patient encounters. To the doctor, these encounters are normal, everyday, routine work. To the patient, they may be unique, threatening, embarrassing, humiliating and/or stressful. I think there may be a serious doctor-patient disconnect when it comes to the concept of "routine." Doctors need to understand, not just intellectually, but emotionally as well -- how "routine" for them isn't necessarily "routine" for the patient. To a large extent, that's empathy. I don't know how you can teach empathy. That most likely comes life experiences, and fits better into some personality types than others. Here's the link to the article:
http://well.blogs.nytimes.com/2009/02/26/annoying-patient-or-difficult-doctor/
MER

 
At Thursday, January 14, 2010 3:31:00 PM, Anonymous Anonymous said...

Chris


I said there is alot of truth
about the generalizations of the anonymous poster at 11:40 AM.I,as
well as others are entilted to their opinions.If it were a perfect world this blog wouldn't exist then,would it.


JB

You either had an echo cardiogram or a nuclear stress test. It sounds to me like you had
a nuclear stress test. An echo
cardiogram could be done at the
bedside. A nuclear stress test
is done in the nuclear medicine
department by a nuclear medicine
technologist.An isotope is first
injected via an iv. There is a resting scan,then the stress scan
which is done with you on a treadmill for a short period.

In each phase of the nuclear medicine stress test you are under
a large camera.The test is usually
called a myocardial perfusion scan.
The male performing the procedure was not a nurse,but a
nuclear medicine technologist.There
might be a respiratory therapist
in the room and sometimes,only
sometimes a pa that is an assistant
to the cardiologist. You should have been given privacy for this
procedure. Furthermore,you were injected with a radioactive isotope
called thallium-201,a radioisotope
which would make your sweat,urine
and other body secretions radioactive for a short time. There
should not for this reason be a lot of people loitering around in
nuclear medicine departments!
I would advise you to write at
least to hospital administration
about your privacy concerns and
secondly to this facility. I'm
sure they would like to hear about it.
Tennessee Dept of health
615-532-3202

Nuclear medicine technology
Certification board
404-315-1739


PT

 
At Thursday, January 14, 2010 4:27:00 PM, Anonymous Anonymous said...

MER perhaps younger female drs have a problem with being perceived with having some kind of authority. As woman who has worked in hospitality, I have had to ask a male colleague occasionally for assistance in dealing with others (usually a male) because patrons are more willing to argue with a female than a male if they don't agree with our management's policies. I'm sure it's also physical thing (me being very small statured).
To anon, re the rant against females. I'm not sure that you are aware that giving birth is excruciating? It's not about handling pressure.
NP

 
At Thursday, January 14, 2010 8:14:00 PM, Blogger Maurice Bernstein, M.D. said...

cc I didn't allow your comment with link to be published out of computer safety concerns. When I clicked on your link, my browser warned me: "The website at www.yourfilehost.com contains elements from the site www.zenerect.com, which appears to host malware – software that can hurt your computer or otherwise operate without your consent." Sorry. ..Maurice.

 
At Friday, January 15, 2010 9:44:00 AM, Anonymous Anonymous said...

NP -- With almost everybody in scrubs these days, I can see your point. Who is who? In reading the blogs, I note some resentment among some nurses that male nurses get more respect than female nurses, from both doctors and patients. Sometimes, male nurses are taken to be doctors. I've read complaints that some patients see the male nurse as a doctor and the female doctor as a nurse. What you say really makes sense -- and these gender stereotypes could be the controlling factor here.
MER

 
At Friday, January 15, 2010 6:09:00 PM, Anonymous Anonymous said...

A female patient refusing a male doctor is "excersizing her rights". A male patient that doesn't want a female doctor is "difficult".

 
At Saturday, January 16, 2010 11:18:00 AM, Anonymous Anonymous said...

Don't really see why this is all so hard to understand and needs to be torn apart and analized.
I always have:
Chosen who sees me naked
Chosen who touches my body
Any one who does this against my will is doing something illegal. Period. Anyone.
Go to school to be a nurse if you want, but my body is still mine, not yours.
These people want the right to do what they want to you just because they want to? Bizarre. Stop letting them. It is just a job. It is just a person. Grow up and say no.

N O

 
At Sunday, January 17, 2010 1:13:00 AM, Anonymous Anonymous said...

Right on N O! I agree. No matter how entitled they believe they are we can stop them. If a woman takes advantage of me when I'm unconscious I will make sure afterwards that she will wish she never got into nursing.

 
At Sunday, January 17, 2010 1:13:00 PM, Anonymous Anonymous said...

To N O

There's a good deal of truth in what you write. Patients need to take more control over what happens to them. But I can't help assume, perhaps incorrectly, several things based upon your brief post. Please do correct me if I'm wrong. Here's what I'm wondering:
-- Have you had serious health care issues involving intimate care? If you haven't, that may explain why you haven't had problems in this area.
-- If you have had serious health care problems involving intimate care -- apparently you've figured out strategies and techniques to get what you want. You have experience. Besides just saying this is what you want (I do assume it isn't always available), how do you succeed?
-- It could be that you have a lot of money and/or power. In our culture, and with medicine being so money-drive, that will almost always get you what you want.
-- Or you have excellent health care insurance. That can make a difference.
-- And/or you live in an area where there's a lot of competition for health care money and thus, many choices.
-- And/or, you live in an area where modesty issues, for cultural reasons, are much more respected, especially for men.
You seem to be getting what you want, unlike many men expression opinions and telling stories on this blog.
What's the context of your success -- besides just being blunt/direct/demanding? Assuming what you want isn't always available, how does it work for you?
I do agree that if more men would make their values known in a respectful, confident and politely assertive manner -- many would get accommodation. Is that what you do, and what do you do when you run into problems?
MER

 
At Sunday, January 17, 2010 7:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Just to let all my visitors know that MER had written to the editor of
hospital.com describing the issues we wanted presented at that website but so far neither he nor I have received a response. Yesterday, I wrote again, myself. Hopefully, we will have some information for you about writing to that site. ..Maurice.

 
At Sunday, January 17, 2010 9:28:00 PM, Anonymous Anonymous said...

Maurice said

"PT,I have to say that any generalizations from these isolated
cases including one that is not even related to professional medical behavior is becoming now
innapropriate on my discussion blog. I think that the lady ENT's
behavior is worthless in trying to extend a criticism to all lady
physicians or to all ENT physicians
or any other groups within the medical profession."


What makes you think these are isolated cases? Is it that perhaps
you don't often see these types of
articles. Certainly,it is in the best interests of the medical community to keep a lid on such
behaviors so as not to lose public
trust. If you've read the article
closely,you would have most certainly agreed that the behavior
went on for some time. Furthermore,
it appears that no one was willing to stand up and be these patients
advocates,even the anesthiologist
turned his head. Was it due to these patients being of the male gender that caused such little fanfare.


Long before women enter healthcare their ideals with reference to modesty and privacy are already cast. Textbooks make
little reference to providing respect for privacy concerns among
the genders,yet,the mentality defaults to their learned behavior.
That behavior or ideals conveyed and verbalized is their governing body. That the privacy of
women is sacred,but not men.
Now,realize that perhaps you've
not heard it verbalized and if not
that is because it has been verbalized subtly and acted on
for a number of decades.

The results of such actions are
no male mammographers,no male ma's,no male rn's at urology clinics and outpatient surgery centers. Why have they initiated
such change. Are all males perverted,therefore only women at
these facilities.
If you've been to obgyn.net you
will see the face of obgyn changing
dramatically over the next ten years.

My advice to your students,choose your specialities
carefully.



PT

 
At Sunday, January 17, 2010 9:58:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, my point is that it is unfair to pick one case or 10 cases of women physicians who misbehave and then extrapolate their behavior to all women physicians, just as it would be unfair to do the same for male physicians. ..Maurice.

 
At Sunday, January 17, 2010 11:25:00 PM, Anonymous Anonymous said...

I think that it is interesting that the woman ENT Dr is a lesbian. It seems then she had some kind of issues with men. So even though she was abusing them sexually it wasn't for some sexual gratification? More so that it was to humiliate. Anyone else care to psychoanalyze? It will be interesting to see her defense.
NP

 
At Monday, January 18, 2010 3:58:00 AM, Anonymous Anonymous said...

Nobody, especially people in the medical care industry want to believe or admit that women can be unethical or perverted. Why are women treated like gods? It's just ridiculous!

 
At Monday, January 18, 2010 9:26:00 AM, Blogger amr said...

Dr. B, you said:

"PT, my point is that it is unfair to pick one case or 10 c,ases of women physicians who misbehave and then extrapolate their behavior to all women physicians, just as it would be unfair to do the same for male physicians. ..Maurice."

When I joined the conversation on this blogs now several years ago, I said that I would be asking you questions for thought and to challenge thinking, and I might use your own thoughts as a reference point. Although you only consider yourself a "moderator", I think your body of commentary makes you a contributor, and perhaps the most important contributor. In that I mean that you have given us insight into the struggles of an insider struggling to see the problem, which is better than most in your profession.

Although you have come a very long way, you also point the way to the major problem. You still believe that this a marginalized problem and only important for those patients that find it important, and not a problem with how medicine is practiced (or taught). Perhaps the most telling of these commentaries was an off-handed entry you made some time ago which you said in effect: "Wouldn't it be nice if nudity wasn't such an issue. It would be better for everyone."

Putting a "face" on the problem:

In watching what is happening in Haiti, the news has begun to focus on individual stories of survival, or not, in order to symbolize the plight of the many and to personalize the story. So too, do politicians put a "face" on national policy issues in order to illustrate the points they wish to make.

You have totally missed the point that the Dr. Sparks story serves merely to put a "face" on the problem, and is not the true focus of the article, nor was it MY purpose in bringing the article to the blog. My purpose to provide insider documentation that:

1. The article is written by the editor-in-chief of a magazine whose audience is meant for the medical industry and not for the general population.
2. No criminal filing was made on the offending doc, although her behavior was allowed to continue unabated for a long time
3. It is clear that the administration was totally aware of the criminal activity and deliberately turned a blind eye. It is not the truly bad behavior of the doc that is so disturbing about this article, the real story is how that behavior was widely known within the hospital and was still condoned by the hospital with the clear implication that this doctor brought a lot of money into the institution, and that was more important than protecting the patient. And in the end this doc gets a slap on the wrist and is still making money for the hospital while the whistle blower was fired.
4. The physical privacy of patients are further compromised by the requirement that a chaperone be present (to protect the patient).

This criminal behavior should have been stopped immediately and this doc should have been prosecuted. The indictment is on the collective institution of the medical field.

The fact that you missed this is frankly a window into the problem as a whole.

-amr (to be cont in next entry)

 
At Monday, January 18, 2010 9:29:00 AM, Blogger amr said...

- Cont.

There are other "faces" on the problem that have come up on this blog, including all of the personal stories:

· Dr. Sherman telling the story about looking at his wife's xray and another doc coming up to him and saying: "Look at those knockers"

· The allnurses "whoa innapropreate" blog entry. (The whistle blower was castigated and eventually had to leave the hospital - I know this in that I have had email contact with her.)

· Dr. Sherman within the last year "seeing" for the first time a patient inappropriately exposed during a bed bath. He said that this would never had registered with him before these blogs. When he brought it to the charge nurse's attention, the takeaway was that she wasn't surprised, its common, and it is not a policy priority.

· The story about the peds surgeon that was a big wheel at the hospital, and no one was willing to confront him about his practice of putting smiley faces the penis' of his young pts.

· All teaching hospitals (at a minimum) forcing pts to give consent to being filmed or photographed, including now cameras in the ICU

· Hospitals allowing for profit film companies to film naked patients in the ER and OR

· Non-consensual pelvic and rectal exams on pts asleep in the OR before surgery

· The hidden curriculum is still alive and well

· The female patient early on in these blogs who wrote to you upset to find that she was exposed in the OR and didn't know that was going to happen. She was disturbed to find that monitor leads under her gown and the gown she was not wearing was different than the one she went into surgery with.

· Nurse blogging about being in surgery and hearing docs comment on her breasts.

· I could go on, but this is enough for now

· Your commentary recently about the virtual strip searches: If I understand your position, you point out that a majority of people polled are "ok" with it because security trumps modesty. I see it differently. I do not consider 20-30% of the population that is "not" ok with it as being an insignificant "minority" and therefore justifying the attitude toward physical modesty issues by the vast majority in the medical field. In this regard, if the medical profession was doing harm to 20% of the population because of the physical privacy issue, it is ok(?) because it is a minority? Or is it ok to impose the views of the majority on the minority? To further generalize, are you saying that your profession is justifying the behavior of not respecting a pts physical privacy as being in the best good of society, so it is therefore acceptable?

You might not be saying this, but in fact this has been the justification for many of the violations above that I have enumerated. However, it troubles me that for many of these behaviors above mentioned, you have either not condemned, or you have justified them away as being out-lyers.

Therefore, Dr. B, I submit that continuing to put a "face" on these problems (on this blog) continues to be as important as attempting to discuss ways to fix the problem.

-amr

 
At Monday, January 18, 2010 9:30:00 AM, Blogger swf said...

"Why are women treated like gods? It's just ridiculous!"
I believe gods is a little extreme. It is more an exploitation of authoratative power, and we have been conditioned over the last century to accept it. It is a slow process to change, and those who have it are unwilling to let it go easily.
Why? Because most people have a tendency to do as they are told.
Whether it is because it is easier to just do it and get it over with, or a reluctance to cause 'trouble', people simply have put up with the 'good patient' mentality. Is it any wonder that it is so hard to change years of entitlement attitudes when millions of people never complained about it until recently?
Here is where I agree with PT:
"Long before women enter healthcare their ideals with reference to modesty and privacy are already cast."
While I believe it takes alot of nerve to just assume entitlements to people bodies, apparently they will assume we don't have a problem unless we say something, or they have the right until we say no.
I'm not saying this is O.K., I'm saying that if it is true then we need to know it in order to change it.
I have spent alot of years saying that it is unfair....but the medical mentality has never been "Geez you are right swf, let's change it!". So, we can't expect it to be easy.

 
At Monday, January 18, 2010 3:19:00 PM, Blogger Maurice Bernstein, M.D. said...

amr, I don't have time right now to write more in response to your thoughtful comments, however I would like to explain what you describe as my believing what is mostly written to these volumes represents a "marginalized problem."

Remember, I have repeatedly stated that I have never been made aware of the modesty issues discussed here until these volumes were up and running. And that is the truth and I suspect many other physicians, if not most, are also not aware. With that information in mind, what should I make about the representation of the general patient public regarding all the comments made here by those who have come here, followed the conversations and have written? I have no proof whatsoever that what is written here or on some of the other blogs is truly a majority or generalized opinion. People who write here are unhappy with the situation and I don't blame them because if I had their personal concerns about how they are treated, I would be unhappy too. But I can judge the issue only by those who write. How do I know for sure, statistically, that those visitors do not hold a minority view within the entire patient population. I don't. And therefore, for the current time, yes, I do believe this is a "marginalized problem." However, at no time have I demonstrated that I don't recognize that there is a problem for my visitor and at no time did I write that the problem need not be attended to and mitigated to the benefit of all. I have been calling for activism in this regard from way back to the earlier volumes as you know by having read them. This would not be the behavior of a moderator who was uncaring of those who have been complaining.

And yes, I do hope there can be education of healthcare providers and systems that these concerns exist and they begin to understand and help to fix the system. That is why I initiated the attempt to get your issues presented on hospital.com so that the system has the opportunity to be educated. Unfortunately, there has been no further response to the request by me or subsequently by MER.

I hope I have explained my position. ..Maurice.

 
At Monday, January 18, 2010 3:22:00 PM, Anonymous Anonymous said...

Maurice said


"PT,my point is that it is unfair to pick one case or 10 cases of women physicians who misbehave and then extraploate their behavior to
all women physicians,just as it would be unfair to do the same for
male physicians."

But you see Maurice,the bulk of
the female populace have already
extraploated the behaviors of a few
men and not just by verbalization,
rather by action.
Thats why there are no male
mammographers,no male nurses or
male ma's at urologists offices.
The writing is on the wall even
for male gyno's and in fact if you
look at gender in obgyn residency
programs, they are predominantly
all women.
One more thing Maurice,you
referred to the ENT physician,
Dr Sparks as a lady. I would not!


PT

 
At Monday, January 18, 2010 5:47:00 PM, Anonymous Anonymous said...

PT Where is your logic? You complain that that there are no male nurses or ma's at urologists offices and at the same time you are lamenting the demise of the male gyne. (And if that, as a man, bothers you I am thinking that you have some very strange issues that you need to address). Don't you, like I want both genders to have the choice available of male/female drs,nurses, technicians? Or do you want everything to be run by men again?
NP

 
At Tuesday, January 19, 2010 3:17:00 AM, Anonymous Anonymous said...

NP. My understanding of PT's comment is that people have seen a problem with male gynos and it is now being "improved" by having mostly women in the field. But nobody cares about "improving" Urology clinics or men's rights. Men just have to continue suffering indignities and nothing is being done to change it. What's being done for the goose ISN'T being done for the gander.

cc

 
At Tuesday, January 19, 2010 4:36:00 AM, Anonymous Anonymous said...

I am 100% for patient modesty to respected but I change my opinion on air port security screening regarding full body scanners. Flying is not a RIGHT it is a Privilege. I feel in this day and age we Americans confuse the difference. There are several different methods to travel by car,bus,train and boat. As Americans we want instant gratification and flying to a destination is the closest measure to that. This issue is so far from patient modesty I am a little confused that it is even being brought up. Most in these rooms say they will forsake patient modesty in a emergency situation, well a potential bomb blowing up a plane would be considered a emergency after the fact.

Daniel...

 
At Tuesday, January 19, 2010 7:08:00 AM, Anonymous Anonymous said...

First came women's rights, then black rights, now it's time for men's rights.

 
At Tuesday, January 19, 2010 7:35:00 AM, Anonymous Anonymous said...

I work in a hospital, and recently witnessed an interesting incident. A 14 year old boy needed a routine procedure. He was under general anesthesia, and needed a catheter placed just for the duration of the procedure. As we pulled down the sheet to put in the catheter, the nurse (middle age, attractive) was very impressed by the size of his penis. She kept talking about how impressive it was for a kid his age and talked about how nice it looked - she called it "clean and fresh."

As she put in the catheter he got an erection (he was asleep at this point) and she commented that he was "set for life." She then went to the OR room next door to have one of the other nurses take a look. The other nurse was impressed as well, talked about how nice it looked, and said it helped her "get her mojo back" seeing it.

I was amazed seeing them going on about this young kid's penis. They were obviously impressed and at least a little aroused. So for those of you who don't think nurses look, talk to each other, show off each other's patients, and enjoy the view, think again - I witnessed it first hand.

 
At Tuesday, January 19, 2010 9:45:00 AM, Blogger Maurice Bernstein, M.D. said...

And so, Anonymous from 7:35am today, what did you do about what you saw? Did you find both nurses behavior unprofessional and uncalled for? Did you admonish them for their behavior or report their behavior to superiors? There is virtually no excuse for doing nothing about it but only recalling the incident to present on a blog as some witnessed example of two nurses behavior. ..Maurice.

 
At Tuesday, January 19, 2010 11:21:00 AM, Anonymous Anonymous said...

So you were in the OR and saw all this happen and decided to report about it here versus bring it to a superior's attention? You are part of the problem if that is the case. What was your role in the surgery? If this realy did happen as you say why would you not take action and protect the patients?

 
At Tuesday, January 19, 2010 12:48:00 PM, Anonymous Anonymous said...

From the link below ---“Let me make it clear that no one — not the state medical board, not a single patient or anyone at Gila Regional Medical Center — has accused Dr. Sparks of abusing or harming any patient,' Solove said

Dr Sparks actions were reprehensible. If that isn’t abuse I don’t know what is. But what is worse is out of all those who knew about or witnessed Dr Sparks do these things only ONE person blew the whistle on her. That is a terrible indictment against the medical profession. It just makes me sick.

http://www.scdailypress.com/ee/silvercitydailypress/index.php?curDate=20100114&index=02&pageToLoad=showFreeArticle.php&type=art

 
At Tuesday, January 19, 2010 1:38:00 PM, Blogger Maurice Bernstein, M.D. said...

I am not making a judgment about the facts of the Dr. Sparks case nor the disposition, however in the article there was mention that she was performing an examination outside of the anatomic ear, nose and throat area. Of course, I don't know what her intent was and it may have been non-professional as suggested by the medical board's decision. However, I wanted to point out that all physicians, including ENT surgeons, should have the capacity to perform at least a superficial, general but necessary pre-operative physical evaluation (vital signs, lungs, heart and abdomen) if that is the physician's intent, particularly if there is no general physician or internist available to perform the examination. This is what I teach and we all learn to do this in medical school and beyond whether we become GPs or surgeons. ..Maurice.

 
At Tuesday, January 19, 2010 2:55:00 PM, Blogger amr said...

Dr. B,
Thanks for your clarification. My contention is that there is a minority but it is a larger percentage than say 1%. I was under the impression that the your statement of marginalization as it pertains to the airport xray machine meant that since you have never experienced the problem and the docs you have interfaced with over the years did not see the problem (if you even ever talked about it), that therefore the problem must not exist.

It is the case in science that one must first be made aware of a situation before it can be studied. I believe that given the almost singularity of your blog, the problem is small, or perhaps vastly underreported.

I find it interesting that hospital.com is backing away from the blog. Knowing why really would be interesting to find out.

Dr. Sparks:

The link to the news article is very interesting when compared to the "insider" article I provided. In the beginning of the article, it really smells like her lawyer is trying to pull the "money" card and rehabilitating her client.

With respect to the general exam, of course you are correct.

But it is clear that a genital exam AFTER surgery (not a general exam) for an ENT surgery is mighty strange. Again, it is the fact that many people in the hospital were aware of her "examinations", and that went on for quite some time, is the real scary part to me. And as you see in an extract of the article below, Sparks was chief of staff at the time.

The unauthorized genital exams and the doodling went on for years. And nobody said or did anything
about it.

Until July 17, 2007.

That’s when Alison Garner had seen enough and
couldn’t keep quiet any longer.
According to Ms. Garner, who administered the
anesthetic for this case, and another witness, Dr.
Sparks, then chief of staff at the hospital, had just finished
performing a tympanoplasty with mastoidectomy
on a Hispanic male in his mid-30s. After applying
the dressing, Dr. Sparks threw back the covers on the
patient, reached into the fly of his boxer shorts,
pulled out his penis and held it in her ungloved hand
toward the ceiling. Dr. Sparks noticed fluid-filled
vesicles indicative of a sexually transmitted disease
on the right side of the shaft and yelled, “Oh, gross!”
She then slapped the head of the penis 3 times to
shouts of, “Bad boy, bad boy, bad boy.” The all-female
OR team laughed. All except Ms. Garner.
“Everyone heard her and everyone saw her positioned
in the location of the penis at the OR table,”
say Ms. Garner. “I gave all of them the fish eye and
we said nothing.”
Unable to sleep that night — “I have somebody
who’s asleep on the table and I’m supposed to be
their advocate and I didn’t do anything and didn’t
say anything?” — Ms. Garner says she reported what
she says she saw Dr. Sparks do the next morning to
Mark Donnell, MD, the director of anesthesia, who,
according to Ms. Garner, laughed and said, “Oh,
wait, is Twana doing one of her exams again?”

-------

To: Anon who witnessed the inappropriate behavior in the OR.
Thanks for writing about your observations. A few questions to you.
1. What is your role in the OR and how long have you been doing it?
2. Was this the first time you have seen bad behavior? If not, how often does it happen and in general what does the "bad" behavior consist of?
3. What occurred that brought you to this blog?

Thanks,

-- amr

 
At Tuesday, January 19, 2010 3:46:00 PM, Blogger Maurice Bernstein, M.D. said...

I have received repeated chastising comments to the Anonymous from 7:35am this morning from anonymous writer or writers which I find as excessive and have decided not to publish them. My comment at 9:45am today to Anonymous was all that was necessary in my opinion. Go back and read it.

Now for some good news:
The editor of hospital.com wrote me this morning and included the following:
"I've actually just spoken with my CEO regarding the discussion section. We should be putting something up within the coming days. I will keep you posted on this."

A caution to my visitors-- when we get that section open on hospital.com to educate the public, doctors and hospitals and the system about your patient modesty and gender selection concerns, I want you to write in a CIVIL manner and without UNDOCUMENTED generalizations like some have written here in the past. The goal of the writings to hospital.com must be for education and NOT spewing accusations or innuendos. Otherwise, I can almost be certain that you will lose that potential resource for making your concerns more widely known. Don't waste this chance. Remember, I am sure many who will read what you write will have been like me when I started these threads, totally uneducated about your specific concerns. You will certainly lose them if you are not careful how you express yourselves. You can discuss in future posting here whether you agree or disagree with my warning to you. Thank you for your attention and with the results of participation in hospital.com, good luck! ..Maurice.

 
At Tuesday, January 19, 2010 5:20:00 PM, Blogger amr said...

Dr. B,

That is great news about hospital.com. I would add my voice to yours regarding the civility of the dialogue. Please avoid personal or general attacks. If personal stories are told, discuss what happened and how it made you feel, rather than "attacking". Assume that our "new" audience is truly ignorant and is not aware of the harm that is being caused. Start out with that assumption, and a dialogue just might ensue.

Regarding the chastising comments: It might be of interest to publish one of them and/or to briefly summarize their gist.

--amr

 
At Tuesday, January 19, 2010 5:52:00 PM, Blogger Maurice Bernstein, M.D. said...

I want to correct a typo in the last paragraph of my previous posting today.

"I want you to write in a CIVIL manner and without UNDOCUMENTED generalizations like some have written here in the past."

The word like should read unlike. Thanks. ..Maurice.

 
At Tuesday, January 19, 2010 7:14:00 PM, Anonymous Anonymous said...

I see you point cc but I don't believe things improved for women because suddenly the medical profession started worrying about women's modesty or rights per se. It was consumer driven. Female gynos found themselves busier than male gynos. Male med students started to notice this and decided to go into a specialty where they are wanted more and can make more $$$.
Unfortunately because men will never be as big consumers as women of medical services (not being able to have babies etc) I think it is going to be an uphill battle to try to change things. Unless you get more men involved in this issue.
NP

 
At Tuesday, January 19, 2010 7:52:00 PM, Anonymous Anonymous said...

NP


I'm making a comparison,thats
my logic.


PT

 
At Wednesday, January 20, 2010 5:06:00 AM, Anonymous Anonymous said...

"I am sure many who will read what you write will have been like me when I started these threads, totally uneducated about your specific concerns."

I just don't get it. Doctors are supposed to be some of the most intelligent people in our society, yet many don't seem to have any common sense at all. Isn't the understanding of modesty, dignity and respect for other human beings chiseled into our human DNA? I think even the worst people in history understand it, they just choose not to respect it. Doctors may believe they don't need to show this respect but to play dumb and say they don't understand it is just ludicrous.

Many (but not all) doctors expect their modesty and dignity to be respected when they are the patients, so how can they possibly not understand that other people feel the same way? Intelligent people can't possibly not understand modesty and dignity. Are they completely blind? Do they not see what's going on around them? Haven't they ever been in a "men only" or "women only" restroom or locker room? Do they commonly see people marching naked through the streets and nobody caring? If they hear even one person complain about it should they not then become aware of it, if they hadn't already?

I honestly believe that all doctors are perfectly aware of modesty concerns well before they became doctors. They just believe themselves to be better than normal human beings. I'm not saying patients shouldn't be exposed in front of doctors, it's often completely necessary. But to disregard people's modesty and dignity by exposing them to opposite gender nurses and others is unexcusable, especially without prior permission from the patient. To "assume" consent is just wrong.

I don't expect nurses or aides to be considered among the most intelligent people in our society because if they had any intelligence they would be doctors. But I do expect them to have at least a moderate amount of common sense. Unfortunately most don't seem to meet my expectations. But the truth is, they do understand modesty concerns, they just don't care. Again it's the God complex and they think they're better than normal humans beings, and they're ENTITLED to do or see anything they want. They're just hippocrates.

Doctors are usually chosen, but nurses and aides aren't. It's just unethical for doctors to pass on the patients' trust and consent for nudity to nurses and other "caregivers". And to deny the knowledge of a human being's basic understanding of modesty just isn't believable.

GL

 
At Wednesday, January 20, 2010 8:40:00 AM, Blogger amr said...

At the risk of getting in trouble with contributors to this blog, the last entry by “GL” is a perfect example of the type of generalized “attack” that will likely shut down the hospital.com blog, and is of the type that Dr. B was referring to. Although I tend to agree in general with some of the thoughts expressed, the tenor of the entry will more likely end, rather that further the conversation with the very audience we wish to reach.

Let the flamming (of me) begin. ;-)

--amr

 
At Wednesday, January 20, 2010 9:30:00 AM, Anonymous Anonymous said...

But the fact is, GL didn't post there, he/she posted here. Can't we still express SOME frustration here? We are talking about stripping for a strangers happiness and income, and loosing the rights to our own body after all. Some of us think that is unimaginably bizzare!

N O

 
At Wednesday, January 20, 2010 3:35:00 PM, Anonymous Anonymous said...

Maurice said


"However,I wanted to point out that all physicians,including ENT
surgeons,should have the capacity to perform at least a superficial,
general but necessary pre-operative
physical evaluation(vital signs,
lungs,abdomen)etc."


Prior to having surgery its appropriate and necessary to at
least have a chest xray,basic
metabolic panel or a cmp,pt,ptt
and inr. Platelets are included
in a bmp and cmp.
H and P (history and physical)
are often done by the referring
physician and often a requirement
"BEFORE" the patient goes to surgery. Note that the State Medical Board of New Mexico acknowleded that this ENT performed genital exams on
patients after their ear,nose or
throat surgery and that such exams were never noted in the chart,despite the fact that they were innapropriate and unnecessary.

Lets reverse the roles for a moment and look at the scenario
if the ENT was male and all the
patients were female. Would you need to perform a gyn exam on women
post-op for ENT surgery. Of course
not and no more so if the patients
were male.

Personally,I can't but wonder
if the leniency of her punishment
was somehow related to the patients
being of hispanic or native desent.


PT

 
At Wednesday, January 20, 2010 5:03:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I was making a general statement about the potential capacity for a surgical specialist to be able to perform an evaluative physical exam outside of their area of expertise. This has nothing to do with the facts of what Dr. Sparks did or didn't do. By the way, if she performed what her lawyer might call a genital exam, I too would wonder for what medical benefit she would have done that particularly after a procedure. For your information there are genital infections which could be related to infections in the ENT area such as herpes.

PT, if I may be critical of your conclusion "Personally,I can't but wonder
if the leniency of her punishment
was somehow related to the patients
being of hispanic or native desent"
I am not sure if you have explained how you got from "leniency" to the "descent". Just something to clear up. ..Maurice.

 
At Wednesday, January 20, 2010 8:44:00 PM, Anonymous Anonymous said...

Maurice said

"For your information there are genital infections which could be related to infections in the ENT
area such as herpes."



Absolutely, as I'm more than
familiar with the HSV-type1 and
type 2 and all the more reason
to have an H and P "BEFORE" one
has surgery. Particularly when
there is concern for Epstein-barr,a nasopharyngeal carcinoma.
I would most certainly hope a
thorough exam was done before,not
immediately after the surgery!


I'm suggesting the ENT recieved
leniency on the basis of her patients were of mexican american
or native descent.
Would the outcome be any different if her patients were all
white men and the institution were
accredited.
It certainly mattered to Dr Zarkin when her performed artistic
work on his female patients,his
license was revoked.
//news.bbc.co.uk/2/hi/americas/631565.stm


PT

 
At Thursday, January 21, 2010 7:22:00 AM, Anonymous Anonymous said...

It wasn't lenient because her patients were of mexican american
or native descent. It was lenient because she is a woman. Can it be more obvious?

 
At Thursday, January 21, 2010 9:11:00 AM, Blogger amr said...

PT, try again please with the link.

--amr

 
At Thursday, January 21, 2010 12:46:00 PM, Anonymous Anonymous said...

@7.22--
leniency because she was a woman and her victims male
--rsl

 
At Thursday, January 21, 2010 2:31:00 PM, Anonymous Anonymous said...

After all I`ve seen here, I felt compelled to write. I see this issue from a completely different perspective: I have extensive sexual experience and have been a sex worker for many years. And let me tell you: female nurses and doctors are, in no small proportion, pathetic. I am not generalizing. And I beg, swear, believe me: they obviously treat patient differently, like the rest of society, ACCORDING TO THEIR GENDER. With males, they are more often amazed or even sexually aroused, and they have no business using male patients, especially unconscious ones, for their sexual satisfaction... But, HEAR ME OUT: with females, they do it more often than not because of sheer envy. As a job requirement, I am tanned, young slender and I have a good figure. One very old nurse once made a very nasty comment about how I don`t have absolutely no demarcatrion lines in my bikini area, as it is completely tanned and even pulled my gown to show it to a male nurse that happened to be passing...By the way it was the OB-GYN area. I can swear I am not making this up. They`re not better than anyone; on the contrary...we sex workers cannot knock anyone down, and at the least misbehaviour, we pay the price. A very steep one. We have to give something very personal of us, and unlike the nurse-patient relkationship in which the nurse knows loads about the patient that even his spouse doesn`t know but not the other way round... And we cannot get away without showing our goods... There is no issue with consent; rather I have been subject to a lot of violence and done things I don`t want. And no, some things don`t depend on context. Do you think that a young, beautiful, woman completely exposed stops being so just because she's in hospital??? And no matter what they say, male nurses, in particular do notice. They grin when they look at you then just talk about you with their (only male, usually) mates over a beer at a bar. Please stop the gender war. With cross-gender care, be it by doctors or nurses, both sexes lose either way.

SEX WORKER

 
At Thursday, January 21, 2010 3:37:00 PM, Anonymous Anonymous said...

Amr

Do a yahoo search for Dr Zarkin,
regarding his practice in Yew York.



PT

 
At Thursday, January 21, 2010 4:15:00 PM, Anonymous medrecgal said...

All I could think after reading some of the comments here is "what is wrong with some people?". The sweeping generalizations that are made, particularly in regards to women as physicians, are rather crass and incredibly sexist in my opinion. This is the kind of stuff you expect to hear in the halls of a high school, not in a civilized ethics discussion on another physician's blog. As for Anon 11:40, what planet is he living on? I'm sorry, but that's the most wretched commentary I've ever read on this blog, or anywhere else for that matter. Thanks, Dr. Bernstein, for negating it. There are ways to maintain your modesty and dignity as a patient that have nothing whatsoever to do with the gender of the health care provider (no matter what the particular occupation is, be it nurse, physician, aide, PA, or whatever).

Can you perhaps offer some insight into how people develop such hangups and convictions regarding gender roles? Seems like for all the strides women have made over the last 50 years or so, there is still a whole lot of stereotyping going on out in the world. Does gender really matter THAT much? And if it does, why? Competence in a job/career/profession isn't carried on a person's sex chromosomes.

 
At Thursday, January 21, 2010 5:22:00 PM, Anonymous Anonymous said...

Can't we get over the male /female thing and move on???? It doesn't help.

 
At Thursday, January 21, 2010 5:36:00 PM, Anonymous Anonymous said...

What happened to Alan?

 
At Thursday, January 21, 2010 7:22:00 PM, Anonymous Anonymous said...

“In a predominantly clothed society, there is a shared, if tacit, recognition that clothes carry something not only of personality but also of humanness itself.” So writes Ruth Barcan in her 2004 book Nudity: A Cultural Anatomy.
There are few occupations or profession in our society that require people or bodies to get naked. Police, prison guards, airport security, funeral directors, doctors, nurses, and other medical personal. Note I said “require.” Some of this nudity may be forced as with police and prisons. Other kinds of nudity imply some kind of informed consent. But when it comes to the kinds of potential modesty violations we’ve discussed on this blog, what really constitutes “informed consent?”
“In our societies,” Barcan writes, “clothing records and symbolizes both an individual life history and sociality (and therefore humanness) itself. Thus, the stripping away of clothes has the potential to symbolize the stripping away of sociality and even of humanness.”
Barcan interviewed a funeral director who told her that in Australia (where the author is from) bodies are always buried clothed or, if no clothes are provided, in a shroud-like cloth. Clothing is seen as “a very important part of how his staff continue to treat the corpse as a human person.” I believe we could say this of American society as well.
In interviewing a medical technician who cuts up and prepares human bodies for medical students and research, Barcan comments on the “layered conception” of the human body that these people may have. It’s complicated. Referring to this particular medical technician , Barcan writes: “Her job involves embalming bodies, turning them from human person into medical specimen. The removal of clothing is an important marker in this ontological change, removal of both individuality (a particular history, an identifiable social position) and humanness (part of the transition from person to specimen).”
I’m not suggesting that those highly trained medical professionals don’t understand this (doctors and nurses) or haven’t been academically trained about this – although I question how much time is actually spent reflecting upon and discussing this issue from a personal standpoint – and reading seminal texts like Barcan’s. But I will suggest that in the routine business of everyday clinic and hospital work, nudity becomes mundane and for some, a non issue, an invisibility. They may notice patient discomfort, especially with opposite gender intimate care, but neither find the time not the correct gendered staff to mitigate patient stress or embarrassment. “They’ll get over it,” becomes the excuse – and some patients may. On the other hand, there can be a fine line between person and specimen, and unhealthy working conditions can push good caregivers over that line toward unintentional dehumanization.
A key to this process of potential dehumanization is that proverbial piece of cloth most patients have come to despise – the hospital gown. Barcan writes about how the medical technical above looks upon this flimsy article of elemental clothing. “Psychologically, she said, it is an easier process to strip the bodies of their clothes when the person arrives from a hospital rather than from a home or nursing home; the hospital gown has already helped to departicularize the body, and the transition from individual to human to specimen has already begun.”
Medical professionals need to closely examine their attitude and philosophy regarding the use of these gowns. Can they be redesigned for better modesty? When are they absolutely necessary for medical reasons and when can they be replaced by hospital underwear, shorts or pajamas? We can’t solve all these problems all at once – but it seems to me that we can start with a more humane approach to in-hospital clothing with a reexamination of the traditional hospital gown.
MER

 
At Thursday, January 21, 2010 9:33:00 PM, Blogger Maurice Bernstein, M.D. said...

I am publishing this comment from an anonymous visitor this evening because I wanted to edit out the last word written which to me sounded like an ad hominem expression. Several things about this commentary: first, there is no associated consistent pseudonym or initials associated with the writer. Second, truly, it is not necessary to create a made-up scenario to make a point. The point can be expressed clearly in a less inflammatory way. Third, and most importantly, if you look at all the thousands of postings on these patient modesty threads from the beginning, the vast, vast majority all are directed toward one general view. There are attempts by a few others (such as today) to express a different view. Inflammatory and derogatory and uncivil comments by some may discourage any visitors who do want to say something different. This doesn't mean what they say should be ignored in the discussion, it does mean that there should arise a rational, non-inflammatory discourse about the different view.

Please get into the habit of writing in a civil and educative manner. This is particularly important when the website hospital.com opens a segment for contribution on patient modesty and gender selection on their site. Maybe MER can write more about this important factor if we want to be able to participate on that site.

Thanks for your attention. ..Maurice.


So I suppose "medrecgal" you have a male gyno with two or three male nurses while you lay there naked and spread eagle. Then you have no problem when two male student nurses let themselves in to "observe" and later a male receptionist sticks his head in the door to relay an unimportant message to the doctor and gets a good five second stare at you. You just lay there naked and say "It's OK because it's medical".

Yeah right. It would be totally different if you were the person being naked while all those men stare at you. I'm sure that wouldn't be acceptable to you. It's only OK when YOU are fully clothed and doing the staring. Try putting yourself in their shoes sometime [deleted].

 
At Thursday, January 21, 2010 10:43:00 PM, Anonymous Anonymous said...

Part 1 of 2

“The modern social contract,” writes Ruth Barcan in Nudity: A Cultural Anatomy, “deems that one has a right to be protected from the nudity of others.”
There was a recent case somewhere in the Pacific Northwest. Maybe someone here can find the specific incident and note it for us. A woman claimed it was her right to walk around naked. The town couldn’t find any law that forbade her, so they did pass an ordinance outlawing her escapades – for the protection of the public, especially children. As I recall, the town set the age limit on walking around nude at 8 years old. Beyond that age, it would be against the law.
“Women and children,” Barcan writes, “have been deemed to be in special need of protection from adult nudity (even though children are also accorded greater freedom to be nude, and women, as carers, have traditionally had closer contact with certain kinds of naked bodies: infants, sick or elderly people). Women and children have been considered more vulnerable to its {nudity} powers, a ‘weakness’ whose positive guise is feminine modesty.” I’ve written in past posts about a tradition in the history of nursing of more concern about the female nurses sensibilities in working with naked men than there is with how the naked men might feel by having a female doing intimate care. The focus culturally has been on protecting the female against the male nude.
As Barcan writes, females traditionally having “closer contact” with the sick and elderly is one thing. We’ve talked about the difference between the ER, LTC, ICU, etc. Many men accept or more readily tolerate opposite gender care in emergencies or when the are very sick. But what about the various cases we’ve heard about non critical opposite gender intimate care – what about medical pubic hair shaving?
Barcan discusses the social history of pubic hair shaving. Greek women shaved their pubic hair. The men did not. Greek men did shave their legs, but male pubic hair was considered highly erotic. Note that in Greek statuary, we see women without and men with highly stylized pubic hair. Customs in Rome varied. After the Crusades, European women adopted the depilation practices of the Middle East. Catherine de Medici later terminated that, and from then on it became a minority practice. Art, during these periods, however, never showed pubic hair, especially on women. During the women’s movement of the 1960’s, not shaving became a mark of independence and freedom for women. “Depilation can (in part) be read as a form of enforced ‘domestication’ that makes women more ‘nude’ than ‘naked’ – bringing her into culture,” writes Barcan.

 
At Thursday, January 21, 2010 10:44:00 PM, Anonymous Anonymous said...

Part 2 of 2

Body parts can be highly symbolic.
“A hairy male body has signified virility, power and sometimes nobility,” Barcan writes. In our culture, we consider women with too much body hair as masculinized, especially if the hair is in the “wrong” places. More to the point of this blog, according to Barcan, “Compulsory depilation can also serve as a ritual device facilitating entry into and subordination to a particular institution.” Thus, military conscripts or prisoners having their heads shaved.
How about hospital shaving? What about shaving women’s pubic hair in labor? Anthropologist Robbie Davis-Floyd sees this as more ritual than rational. It separates the “patient” from the everyday world. I would suggest the same is true for what used to be the nipple to knees shave for men, too. More ritual than rational. The rational was to offset infection. Note today that this kind of shaving is not the norm – clipping only in the area to be operated on is more the standard. Shaving is said to have the potential to cause more infection. “Pubic shaving separates the laboring woman from her former conceptions of her body, and, like the gown, further marks her as being in a liminal state and as belonging to the hospital” – this, according to Davis-Floyd. The same could be said of what happens to men when their pubic hair is shaved.
My point – Much has been written about pubic shaving of women for labor and its psychological, sociological, philosophical meanings. Little if anything has been written about pubic shaving of men – how, if done especially by a female, it can represent to some men demasculinization, if, indeed pubic hair can represent virility and power as suggested. Like the gown, shaving pubic hair for both men and women can certainly represent the transition from person to object, from autonomy to possession by the hospital.
Medical professionals must pay more attention to the highly symbolic nature of the genitals and pubic hair.
MER

 
At Friday, January 22, 2010 12:40:00 AM, Anonymous Anonymous said...

Some of the newest hippocritical nurses.

http://allnurses.com/lpn-lvn-corner/nursing-students-nudity-310533.html

Includes "It's not that I have an issue with other peoples nudity - no problem at all. It's more the thought of my nudity..., I am a little modest I will admit" and "I'm with you! Others people's nudity doesn't bother me but I'm not dropping trou..."

Further proof that they are aware of modesty issues but it doesn't matter as long as it's not THEIR nudity.

 
At Friday, January 22, 2010 2:49:00 AM, Anonymous Anonymous said...

I'm all for having medical professionals comment on this blog, but I can do without reading the comments of an alleged medical "professional" critisizing modest and often abused patients for their "hangups".

---------------------------------
"there is still a whole lot of stereotyping going on out in the world."

I agree. The stereotype that men don't care about modesty is one of them.

sssssssssss

 
At Friday, January 22, 2010 3:15:00 AM, Anonymous Anonymous said...

medrecgal said "There are ways to maintain your modesty and dignity as a patient that have nothing whatsoever to do with the gender of the health care provider (no matter what the particular occupation is, be it nurse, physician, aide, PA, or whatever)."

What exactly do you mean by that? I don't think many people are hung up on the gender of their caregiver if no nudity is involved. There might be a few people in the world that don't want someone of a particular gender because they are sexist or don't trust that gender but very few clothed patients care about the gender of the nurse that's taking their vitals or the tech that's taking an x-ray of their wrist. Is that what you're talking about medrecgal?

Or are you talking about those that are worried about their modesty and dignity by having their privates exposed? If that's the case then I'd like to hear about your proposals to let them maintain their modesty and dignity. The argument that the patients can be MOSTLY covered doesn't cut it. Having most of my body covered while part of my genitals are exposed doesn't do anything to help my modesty. Exposed is exposed. Even if it's only one square inch at a time.

There are some ways of avoiding overexposure in many situations, such as having an "assistant" or chaparone turn their back during genital exposure (you don't need to stare at the patient to take notes or squeeze lubricant onto the doctor's finger). Many times the doctor really doesn't need anyone else in the examining room. I would love to hear other suggestions.

Paul

 
At Friday, January 22, 2010 4:07:00 AM, Anonymous Anonymous said...

I see what you're saying MER. Having your pubic hair shaved off isn't just about exposure. While being shaved you're put into a position that reminds you of a mother changing her baby's diaper, so the patient not only feels like a child but he also looks like a prepubescent child when she's finished. I can't think of anything more demeaning than having a female teenaged CNA shave me like that. To me that's worse than death. Asleep or awake, it makes no difference. Having no hair takes every ounce of masculinity away. I understand that for a few types of surgery it really is necessary but for God's sake don't humiliate us by sending a young female to do it. The ideal situation for me (and it doesn't seem like too much to ask) would to be for a man to shave me after I'm unconscious. Without an audience.

I've been wondering what happened to Alan too. And leemac.

LG

 
At Friday, January 22, 2010 7:53:00 AM, Anonymous Anonymous said...

If you are shaved or clipped in the OR it will never be without an audience. There will always be at least one doctor and one nurse and one tech or one doctor and two nurses there at that time. That's how the OR is set up. You could try and arrange for a male to shave and prep you. Most of the time all prepping is done when the patient is unconscious so that part shouldnn't be an issue.

 
At Friday, January 22, 2010 10:04:00 AM, Blogger swf said...

I wonder if I am reading Medrecgal's post the same as others are. The first and over riding question was why Anon considered women less capable, not stating that they should be more entitled as caregivers than male caregivers. Personally, Anon's was a post I chose not to respond to, but Medrecgal's point is a valid one if Anon offended them. And if true, my choice (as a female) to go to a female doctor would result in substandard care, which I know I am not getting.
As to the second point "There are ways to maintain your modesty and dignity as a patient that have nothing whatsoever to do with the gender of the health care provider (no matter what the particular occupation)":
Medrecgal: Many people equate modesty and dignity with privacy and choice as to which gender sees and touches them while exposed. No amount of caution or draping will help, because the opposite gender even being there is the actual problem. Since we supposedly maintain ownership of our body, it should be everyone's choice as to who IS entitled to it, not just who WANTS to be entitled to it. Pretty simple. Gender matters, as it does in any other situation involving nudity.
"Can you perhaps offer some insight into how people develop such hangups and convictions regarding gender roles?" Again, I could be wrong, but it sounds like a comment on Anon's perception of women, and less about taking men's rights away.
And finally:"Does gender really matter THAT much? And if it does, why?" Why not just answer the question instead of bashing them for asking? For all we know, they don't care who sees them naked in a medical situation. So if we do....tell them why. For most of us it is pretty obvious, but maybe for some it is not.
Feel free to correct me if I am wrong in how I read all of this.

 
At Friday, January 22, 2010 10:42:00 AM, Anonymous Anonymous said...

Most of the time all prepping is done when the patient is unconscious so that part shouldnn't be an issue.

How is that not an issue?

 
At Friday, January 22, 2010 10:55:00 AM, Anonymous Anonymous said...

To Anonymous who posted 22 Jan 7:53:00 AM who wrote: " Most of the time all prepping is done when the patient is unconscious so that part shouldnn't be an issue."

Why "shouldn't" it be an issue for some people?

What's interesting about your comment, which I don't doubt is accurate -- is your use of the word "shouldn't." I know from interviews, that some patients prefer it that way -- they want to be knocked out and not know anything about who does what. But can we assume that this is how everyone feels? I also know from interviews that some patients are shocked when they find out what actually happens once they're knocked out, and some object to opposite gender exposure even when they're not conscious. When they find out what happened, they're angry and humiliated.

Whether it "should" or "shouldn't," isn't the real issue. Whether it "does," or "doesn't" -- is the real issue. Apparently, the assumption the medical community makes is that once the patient is "out, nothing really matters because they'll never really know, and/or if the patient doesn't object, it they consent. Or if the patient find out later and objects, "Well, they'll get over it." One question is, if they do object, would it make any difference?"

What I observe is this: Hospitals, doctors, nurses use strategies that they believe help mitigate patient stress and embarrassment, like keeping emotional distance, not getting close, not even meeting the patient before any procedure. These are mostly done with good intentions but also done to make their work easier. They either assume that these strategies work for everyone, or have just gotten into the habit, or have decided that, for efficiency sake, this is how we're just going to do it.
To say that certain feelings "shouldn't" matter, is not realistic. Our feelings "are;" they're not "shouldn't." We don't often have control over them. Are these modesty feelings a pathology? "Should" we regard them as not normal? Unnatural? Apparently, within some hospital cultures, this is the world view -- at least for the "patients," the "others." Not necessarily for those in charge.
I'm just asking caregivers to question this world view, to look at it from different perspectives.
MER

 
At Friday, January 22, 2010 1:46:00 PM, Anonymous Anonymous said...

I don't usually like the allnurses site references here I find them self indulgent and petty people but this one was good and pretty currant

http://allnurses.com/cna-nursing-assistant/concerned-mother-question-439112-page5.html

5 pages and Cul2 made good modesty points. read to the end I think we are making headway.

 
At Friday, January 22, 2010 3:25:00 PM, Blogger Rev.FRED said...

Two years ago,I had a left inguinal hernia operation; was rolled into the operating-room still awake; found myself encircled by ten females, moved onto the table, my gown was lifted, and discussion was made about shaving me! I am not imagining this! I was degraded, and regard the incident as unforgivable, and will never under any circumstance return to this particular hospital for anything! In addition, while being transported, the two women wheeling my guerney imagined me to be one of the staff physicianS,and snickered that now I was the patient! (I had repeatedly heard over the years that a doctor at this facility was my look-a-like!) Prior to release, a female nurse insisted that she examine my incision. Frightened like a little boy, with tears in my eyes, I sought to cup my hands over my privates, and permitted her to check me out. I am crying as I type this blog; this sort of indignity is foreign to my life experience. I am a man consecrated to personal holiness, and have sought to live a consistent celibate life. I will never permit anything ever to happen to me, like this again.-REV. FRED

 
At Friday, January 22, 2010 3:35:00 PM, Anonymous Anonymous said...

It's not an issue in this case because the poster said they would prefer to be unconscious for the clipping. They wouldn't need to worry about that need being met in this case.

 
At Friday, January 22, 2010 3:40:00 PM, Anonymous Anonymous said...

If you wanted to be awake for the clipping I'm sure you could ask. Whether the need would be met or not I don't know. I would think they could do the clipping if the anesthesiologist agreed to it. That is who turns the patient over to the OR team. I don't think most would have a problem complying here.

 
At Friday, January 22, 2010 3:52:00 PM, Anonymous Anonymous said...

I'd like to see a minimum age of 18before CNAs can apply for jobs in the field. I still can't fathom why this isn't a legal issue where minors are concerned. They can be made aware of private information pertaining to patients, but given their age they can't be held to any contractual obligations.

 
At Friday, January 22, 2010 4:56:00 PM, Anonymous Anonymous said...

I have to second swf. I have had intimate care with both male and female providers but predominately female. When I have had males, it has been unavoidable. However, even though I have never had any bad experiences with a male provider and it has always been of the utmost professional standard. And even though I have had some less than professional experiences with female providers, I still have felt that my modesty and dignity was violated more with a male provider because they are male. Full stop. And no I have never been sexually abused.
NP

 
At Friday, January 22, 2010 5:46:00 PM, Blogger Maurice Bernstein, M.D. said...

PLEASE, PLEASE.. All you ANONYMOUS contributors or is it just ONE.. please end your contribution with some consistent pseudonym or initials. It is most important to understand what one or each of you are writing if we knew if the writing was by which or all, if you know what I mean. Really, what you write will be more understandable by simply identifying yourself with some pseudonym.

Sometimes, I am tempted to reject all postings which are posted anonymously without some sort of identification. Should I? What do the rest of you think? ..Maurice.

 
At Friday, January 22, 2010 6:58:00 PM, Anonymous Anonymous said...

Why can't the patient shave at home before the operation? I know some women do before a C section or giving birth.
NP

 
At Friday, January 22, 2010 7:16:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is a link to a 1983 NY Times article discussing the dangers of shaving within the operative areas. Let's see if we can find more recent evidence-based answers to the question of necessity and safety. Incidentally, according to the article, a study showed that shaving 24 hours or more before the procedure increased the rate of infection to more than 20% from 3.1% if done immediately before surgery.

In a way perhaps echoing some of what has been described here, in the article is the following:

Shaving can also be just another personal indignity the patient must undergo. In 1961, Dr. J. Russell Elkinton, then the editor of the Annals of Internal Medicine, described his experience before a hernia operation: ''Few procedures, short of the scheduled surgery, require greater trust in the manual dexterity of one's fellow man as he, the orderly, wields the razor around one's most vulnerable parts.'' ..Maurice.

 
At Friday, January 22, 2010 7:42:00 PM, Anonymous Anonymous said...

You will see shaving for some surgeries but for most we have seen a big move towards clipping. Much less chance for infection. We also see less thorough shaves as well. In a c-section pubic line is often the only thing done. And for vaginal births no shave is necessary. If your doctor requests it I would question it. It's a very antiquated practice.

 
At Friday, January 22, 2010 9:00:00 PM, Anonymous Anonymous said...

So -- extensive OR shaving is now a "very antiquated practice."

I ask the health care world -- what are some other medically unnecessary rituals involving nudity that patients undergo today that might be considered an antiquated practice 10 or 20 years from now? How much of medical nudity is ritual and how much is a quantified medical necessity? How much is for the convenience of the institution? How much is to "initiate" the patient into the hospital world, with the subtle message that "we're" in change now? What role does the gown play in these rituals of medical nudity? How often is that gown medically necessary?
Think about it.
MER

 
At Friday, January 22, 2010 9:19:00 PM, Anonymous Anonymous said...

What I stated was shaving all pubic hair for a vaginal birth is a very antiquated practice. Shaving other areas can very much be a surgical necessity. Please don't take what I said out of context. Thank you.

I don't like the design of current hospital gowns and hopefully one day some we will see some with a little more coverage around back. Gowns can be a necessity for many patients and many situations. I have seen many patients also wear their own pajamas and sweats when the situation allows it. Ask.

 
At Friday, January 22, 2010 9:29:00 PM, Blogger Maurice Bernstein, M.D. said...

How much exposure of your body do you really want? Read these excerpts from the original article in the August 18, 2005 issue of the New England Journal of Medicine by Atul Gawande MD titled "Naked" and which started this whole series of Volumes on patient modesty back in 2005.

There is an exquisite and fascinating scene in Kandahar, a movie set in Afghanistan under the Taliban regime, in which a male physician is asked to examine a female patient. They are separated by an opaque screen. Behind it, the woman is covered from head to toe by her burka. The two do not talk directly to each other. The patient's young son serves as the go-between. She has a stomachache, he says.

"Does she throw up her food?" the doctor asks.

"Do you throw up your food?" the boy asks.

"No," the woman says, perfectly audibly, but the doctor waits as if he has not heard.

"No," the boy tells him.

For the exam, the doctor has cut a two-inch circle in the screen. "Tell her to come closer," he says. The boy does. She brings her mouth to the opening, and through it he looks inside. "Have her bring her eye to the hole," he says. And so the exam goes. Such, apparently, can be the demands of decency.


Atul then goes on to describe how as he started out on his surgical career tried to examine a patient with their clothes on, pulling up or pushing down clothing in the examining attempt but it was so awkward...

There were, I will admit, some awkward moments. I had an instinctive aversion to examination gowns. At our clinic they are made of either thin, ill-fitting cloth or thin, ill-fitting paper. They seem designed to leave patients exposed and cold. I decided to examine my patients while they were in their street clothes. If a patient with gallstones wore a shirt she could untuck for the abdominal exam, this worked fine. But then I'd encounter a patient in stockings and a dress, and the next thing I knew, I had her dress bunched up around her head, her tights around her knees, and both of us wondering what the hell was going on. An exam for a breast lump one could manage, in theory: the woman could unhook her brassiere and lift or unbutton her shirt. But in practice, it just seemed weird. Even checking pulses could be a problem. Pant legs could not be pushed up high enough. Try pulling them down over shoes, however, and . . . forget it. I finally began to have patients change into the damn gowns. (I haven't, however, asked men to do so nearly as often as women.)


Notice, Atul treated the male patient differently. I'm not sure what was his rationale. In any event, I think the paper or cloth gown is still here for a while. ..Maurice.

 
At Friday, January 22, 2010 10:45:00 PM, Anonymous Anonymous said...

I didn't mean to come across harsh, MER. I'm sorry if I did.

 
At Saturday, January 23, 2010 5:03:00 AM, Anonymous Anonymous said...

"You will see shaving for some surgeries but for most we have seen a big move towards clipping."

Interesting to know but in regards to patient modesty it makes no difference.

--------------------------------
"Many people equate modesty and dignity with privacy and choice as to which gender sees and touches them while exposed. No amount of caution or draping will help, because the opposite gender even being there is the actual problem. Since we supposedly maintain ownership of our body, it should be everyone's choice as to who IS entitled to it, not just who WANTS to be entitled to it"

EXACTLY my point.

---------------------------------
REV. FRED - Thanks for sharing your experience. It helps those of us that haven't experienced that type of despicable situation to be prepared for it BEFORE it happens so we can plan our moral strategy.

-----------------------------
"If you wanted to be awake for the clipping I'm sure you could ask."

The only reason I would want to be conscious for that is because I probably will never trust anyone in the medical world and would want to make sure it was done by a man without an audience. Being unconscious is preferable if I know I could trust them.

LG

 
At Saturday, January 23, 2010 5:20:00 AM, Anonymous Anonymous said...

"Few procedures, short of the scheduled surgery, require greater trust in the manual dexterity of one's fellow man as he, the orderly, wields the razor around one's most vulnerable parts."

If only orderlies still existed we wouldn't have many of the problems we have today. But he's right, which really makes me wonder why the most uneducated, youngest and inexperienced medical workers are the ones we have to trust to do that. It just blows my mind why that ridiculous practice (CNAs doing it) is still happening today. Throw in the fact that most of the CNAs are young females. How can the most humiliating procedures in medical care be given to teenage girls?

sssssssssssss

 
At Saturday, January 23, 2010 7:36:00 AM, Anonymous Anonymous said...

Anybody ever experience a doctor ripping a paper gown without patient permission--a devastating experience for some
gd

 
At Saturday, January 23, 2010 9:35:00 AM, Anonymous Anonymous said...

You could requst a male, LG. The prepping in the OR is never done with only one person present. Typically there are three people present at that time one of whom will be a doctor.

 
At Saturday, January 23, 2010 9:37:00 AM, Anonymous Anonymous said...

The people prepping in the OR aren't CNAs so don't let tha worry you.

 
At Saturday, January 23, 2010 12:08:00 PM, Anonymous Anonymous said...

I bring up the whole topic of pubic hair shaving for two reasons:
1. It represents a very personal, symbolic area of the body. I referenced a quote by Groopman earlier about how important symbolism is when dealing when dealing with human body parts medically.
2. The question of patient comfort and informed consent. When patients go into surgery, they're often told about being "prepped" beforehand. But, in my experience, they are not told the details of "prepping" -- what will happen and who will do what. Three times in my experience, I wasn't told about observers. I had to bring it up beforehand -- and the lesson I learned is that if you don't bring it up, you may not even be asked -- or if you are asked, you'll be on your back in a gown when they "request" your consent.

Now, as I've acknowledged, some patients just don't want to know. That makes them more comfortable. Some patients don't know what they don't know and don't know what to ask to determine if what they don't know will make any difference. Some patients don't care. Others do.
I sometimes think that some kinds of informed consent come down to basic manners and courtesy.
When you have strange visitors to your home, and they appears warm and thirsty, do you ask if they'd like something to drink? Or, do you say, if they're thirsty they'll ask. Most of us ask. We realize that in a strange situation some people feel uncomfortable asking for what will actually make them feel comfortable. When I'm taking people out to dinner, if I don't know them well, I sometimes remind them that anything on the menu is okay to order. Some people feel funny ordering what they want because they think it might be too expensive.
Courtesy. Respect. Open communication. Get it out on the table. If true patient comfort and true informed consent is a value, caregivers ask about these issues at some point in the process. I know, there's not enough time. I know, we're all too busy. I know, they'll get over it. I know, we're all professionals here. I know, I've seen one I've seen them all. Let's stop making excuses and get down to a real values clarification exercise. We emphasize what we value. If we value something we don't just say we value it, it's shows up in our behavior. We walk the talk.
That's why a good start might be to see if we can get hospitals do adopt gender preferences statements and protocols. At least this actually sets down gender choice and modesty as a value -- in print.
Maurice -- did you ever run that patient gender preference policy by your board? I ran it by a few hospital boards and it seems to have been tossed into limbo.
MER

 
At Saturday, January 23, 2010 2:19:00 PM, Anonymous Anonymous said...

gd -
I am a female who had a male dermatologist rip my gown when doing a full body exam. All he said was that he needed to check my chest, and then suddenly ripped open the top front of the gown, but made sure my breasts stayed covered (I realized later he must have had practice with this). So, no, it wasn't disturbing, just strange. He explained most everything he was doing (with a young female attendant in the room, supposedly taking notes, of course), except when he unexpectly pulled my underwear down in back for a quick check. When he checked my belly, he did warn me, and didn't expose my pubic area.
For what it's worth, I actually feel more comfortable with older male doctors than I do with female doctors of any age.
pc

 
At Saturday, January 23, 2010 3:14:00 PM, Anonymous Anonymous said...

"I'd like to see a minimum age of 18before CNAs can apply for jobs in the field. I still can't fathom why this isn't a legal issue where minors are concerned."

I agree. It is amazing what they can get away with. That's why I've already decided to take my own life before being sent to one of those retirement prisons. No ninth grade girls will be bathing me or changing my clothes. I'm afraid of what I might try to do to one if she tried (violence, not sexual).

And did you notice on the allnurses string that all the worry was about the young CNAs, not the poor victims. Nobody cares how they feel as long as the CNA is happy and comfortable. Such BS. Won't ANYONE EVER care about the retirement home victims and the hospital victims. Will they ever matter or will they continue to be just the practice victims? God I hate the medical world for all their hypocrism and cruelty.

GR

 
At Saturday, January 23, 2010 6:05:00 PM, Anonymous Anonymous said...

Part 1 of 2

Attitudes toward nudity have changed throughout history. Some changes have been noted in our culture within the last several decades. We can see an example of this when we look at adolescent attitudes toward showering in groups after PE class. Ruth Barcan, in her book Nudity: A Cultural Anatomy, notes that students in the U.S.“have been known to use civil liberties legislation to resist showering after gym class at school.” Some just prefer to cake on deodorant, or, with their parents assent, be driven home to shower there. Barcan reports that anecdotal evidence suggests the same attitude in Australia. High school teachers report that on camping or sports trips, students are reluctant to undress or shower in front of each other. Perhaps advertising has influenced body image, she suggests – but it seems clear that “contemporary urban society is becoming more and more obsessed with privacy and individualism.” Barcan claims that young people are more aware of sexual orientation questions, and that some scholars believe that anxiety over homosexuality “has led students to become more modest about showering in public.” These attitudes are beginning to and already have been reflected in public architecture – with individualized shower stalls in new swimming areas, etc. Even domestic architecture reflects this – younger people have been know to be surprised that there are no locks on bathrooms in some older homes.
“Despite the persistence of a gendered equation between sex and immorality,” Barcan writes, “discomfort with nudity needs to be understood as part of the broader question of our relations to our body in postmodern culture.” Embarrassment and shame isn’t necessarily related to sexual parts. Her interviews with PE teachers, suggests that young people are as much ashamed by “flab” as by sexual parts. For adolescent girls, this often involves the embarrassment associated with floppy breasts. This shouldn’t be surprising. Today’s “canons of ‘acceptable’ body types now focus not just on weight and thinness, but on the tautness and tightness of flesh, which should not be allowed to bulge, wobble or become flabby.” Adolescent girls are quite aware of this. Most of the PE teachers she interviewed said that teasing is relative rare – that most of the self-consciousness “came from students’ own internalized ideas about their body.” Barcan refers to Nobert Elias and Foucault’s theories of “discipline” that suggest one of the hallmark’s of modern culture’s relationship with the body “is an increasingly potent and effective ‘internalized’ surveillance." We are very inward looking regarding our body types, very critical about how we appear to others.

Although most of the research seems to be with females, Barcan writes: “While these pressures may be particularly intense for women, they are increasingly being applied (and felt) by men.”
MER

 
At Saturday, January 23, 2010 6:06:00 PM, Anonymous Anonymous said...

Part 2 of 2

How does all this apply to medical modesty? I think it’s pretty clear. Caregivers often associate naked embarrassment with sexual embarrassment. Although the two can be closely connected, they can also be far apart. Body image, for both men and women, seems to play an important role. And it’s not even so much what the caregiver thinks, it’s mostly how we think ourselves about how our body compares with the “perfect” or “good looking” body that the advertising world is selling us. When a caregiver tells a patient that he/she's "seen it all," how does the patient interpret that? How does the patients body compare with that "all" seen by the caregiver?

Frankly, this attitude belongs to caregivers, too. How do they view the naked bodies they see? How do they feel about the obese, the ugly, the flabby? They are influenced by advertising culture to the same extent as are their patients. Are certain body types (and diseases) “stigmatized” in the medical community? Do patients know or surmise certain negative attitudes their caregivers may hold but not express openly? How does this relate to how patients may feel about exposure in contexts that are often rushed with time at a premium and in front of complete strangers?
Just some questions while trying to understand what’s going on.
MER

 
At Saturday, January 23, 2010 7:17:00 PM, Anonymous Anonymous said...

Part 2 of 2

How does all this apply to medical modesty? I think it’s pretty clear. Caregivers often associate naked embarrassment with sexual embarrassment. Although the two can be closely connected, they can also be far apart. Body image, for both men and women, seems to play an important role. And it’s not even so much what the caregiver thinks, it’s mostly how we think ourselves about how our body compares with the “perfect” or “good looking” body that the advertising world is selling us. When a caregiver tells a patient that he/she's "seen it all," how does the patient interpret that? How does the patients body compare with that "all" seen by the caregiver?

Frankly, this attitude belongs to caregivers, too. How do they view the naked bodies they see? How do they feel about the obese, the ugly, the flabby? They are influenced by advertising culture to the same extent as are their patients. Are certain body types (and diseases) “stigmatized” in the medical community? Do patients know or surmise certain negative attitudes their caregivers may hold but not express openly? How does this relate to how patients may feel about exposure in contexts that are often rushed with time at a premium and in front of complete strangers? Just some questions while trying to understand what’s going on.
MER

 
At Saturday, January 23, 2010 8:42:00 PM, Blogger Maurice Bernstein, M.D. said...

MER what you write is just GREAT! I wish that your dissertation would be something that all medical students would understand and consider as they start out in their medical careers. Unfortunately, I am not aware that anything in this context is formally described to them. We teach them "modesty" in very superficial, generalized terms. Modesty is not dissected as you have done. They anatomically dissect the human body but really bodily modesty in the sense you write is left to chance. Thanks. ..Maurice.

 
At Saturday, January 23, 2010 11:19:00 PM, Anonymous Anonymous said...

To the anonymous poster Jan.23,0937
a.m. who said,

"The people prepping in the OR arn't CNA's so don't let tha worry
you."


You are correct,they are not
CNA's,but rather surgical technicians,technologists whose training entails much less than a CNA. My opinion of training time
is irrevelent regarding the expected professional behavior
of individuals.


PT

 
At Sunday, January 24, 2010 12:28:00 AM, Anonymous Anonymous said...

"The people prepping in the OR aren't CNAs so don't let tha worry you."

Yeah but most pubic hair shaving is done by CNAs beforehand. Usually young women.

 
At Sunday, January 24, 2010 8:04:00 AM, Anonymous Anonymous said...

All the prepping I have received has been in the OR. Why isn't yours being done in an OR setting by people specifically trained for the job? I would question that.

 
At Sunday, January 24, 2010 12:19:00 PM, Blogger swf said...

Mer:
Interesting background information as to the evolution and psychology of society and the naked form. For anyone who has read books such as the Old Testament for historic value on the laws of conduct, we see that clothing was a sort of punishment, and the exposing of oneself thereafter resulted in shame and humiliation. This is not a religious comment, moreover, a point to show that the covering of our bodies and who it is appropriate to expose it to is so important (sacred) that many societies considered it the first law/edict/commandment ever made. Thousands of years later the stigma of shame and humilation about exposing ourselves is still part of "cilivized" human behavior.

*But my question:
"Caregivers often associate naked embarrassment with sexual embarrassment." Are you saying that this is an actual misconception or a conscious tool used to attempt to mitigate? Are they themselves confused as to the difference, or are they using the "this is not sexual" tool to attempt to override this persons apprehension of exposure. If genuine, I would have to wonder what conditioning happened in their lives to assume that most people equate bodily modesty only with sexuality, and therefore what virtuous tools allow them to rise above all other people's "basic intincts".
If contrived, I would be offended at the deviousness of it.

 
At Sunday, January 24, 2010 1:04:00 PM, Anonymous Anonymous said...

I found this blog by accident. It sure does sound like some folks in the US have had a bad experience, but perspective is very important. I wonder as well whether part of it is a/ the American healthcare system which just sees patients as items to be ticked off and b/ Cultural moeurs. Certainly in Europe Americans are viewed as being extremely prudish as regards nudity - medical or otherwise.

I live in the UK and for what it's worth my experiences in both the public and private system are good. I was treated professionally and with respect. I've been examined intimately three times.

1/ General medical scan (company benefit). I was given a full length dressing gown and told to keep my underwear on (I would have taken it off for an exam of this sort without prompting!) I was given a choice of a male or female doctor and I chose male. Once the bodily exam started it was all done behind a screen. I was asked to remove the dressing gown but not underwear. The testicular exam was done last and the doctor asked me to remove my underwear. Very quick and then I was told to put them on again whilst the doctor left the screening area. Consummate professionalism.

2/ I developed thrush but not realising what it was I panicked and thought I had a sexually transmitted disease. I summoned up courage to attend a clinic quivering like a jelly. The waiting was worse than the exam. No choice of gender so I saw a female doctor. Without being politically incorrect, she seemed very butch, in other words I thought she was probably a lesbian (and the area the clinic was in was known for its large gay population)and I have to say as a male I found this strangely reassuring. She was very factual in her questioning which I actually liked as for something like that I'm not sure I would have wanted small talk and sympathy. The exam was done quickly or so it seemed. The doctor was very reassuring and told I could have seen my GP but she understood why I panicked. She prescribed cream there and then and told me I could have full STD checks and that it would be advisable to ask my general doctor to check for diabetes as this can apparently often cause thrush in men.

3/ My third experience was an exam for a hernia. Again very professional. No choice of specialist but this time I saw a male. A female nurse accompanied me which worried me slightly. Nothing to worry about at all. The consulting room had an antechamber where you could hear someone come in if that was a concern to you. The exam was done by the consultant only behind a screen. I was fully clothed throughout just pulling my underwear down and only at the last minute did the consultant briefly pull down my underwear to examine my testicle area. He then left the screening area to let me get dressed again and told me to take my time.

A few lessons I think.
Allow the patient to dress themselves without the doctor present.

Full nudity and intimate exams right at the end of the procedures.

For me personally as a man if it is purely an intimate exam be factual and do it as quickly as possible.

I hope this is helpful to others.

KR

 
At Sunday, January 24, 2010 3:15:00 PM, Anonymous Anonymous said...

swf you wonder if "most people equate bodily modesty only with sexuality". I think that many do. Having perused blogs where people have discussed having male gyno/obs, I have encountered this perception. For example if a woman has said that she doesn't want a male gyno because she doesn't want a man looking at her naked, others have attacked her with comments along the lines of "do you think that your vagina is that special to the gyno?" In other words do you think that you will arouse him. I'm sure if a nun said she was uncomfortable in that situation that people wouldn't accuse her of that. But somehow unless you are a nun or a Muslim, you are not allowed to be modest.
NP

 
At Sunday, January 24, 2010 7:53:00 PM, Anonymous Anonymous said...

swf asks me: ""Caregivers often associate naked embarrassment with sexual embarrassment." Are you saying that this is an actual misconception or a conscious tool used to attempt to mitigate?

I think NP presents a pretty good explanation. Probably a combination of all that you suggest is going on. Along with NP, as I read the blogs, I see the same strategy (if that's what it is) used -- assuming that the patient is afraid that the caregiver will be aroused or think sexual thoughts. I don't know whether those caregivers who use that strategy really believe that's how patients feel, or whether they've learned that it's a successful strategy to end communication, thus allowing them to get their work done.
The power of habit. We tend to do what works for us. That's usually good for us. In the context of our discussion, caregivers doing what works best for them -- sometimes that's good for the patient, sometimes it isn't.

 
At Monday, January 25, 2010 9:31:00 AM, Blogger swf said...

And here is where it starts to sound like a bit of a game, instead of a misunderstanding. Deception, half-truths, coersion, and tools to end conversations are not characteristics we think of in a field that is supposed to be respected and trusted almost beyond all others.

 
At Monday, January 25, 2010 10:46:00 AM, Anonymous Anonymous said...

swf -- Game playing is part of our social make up. Read Ervin Goffman and others about this. When we buy a car, go grocery shopping, go on a date, go to a party, etc. -- we role play to some extent and play social games. So, it's normal that this would occur within the medical world. It's just that the stakes are so much higher in medicine. In a healthy game playing situation, we can play win-win. That sometimes happens in medical situations. But when "time" and "money" become controlling factors, combined with a patient who is at disadvantage psychologically and physically a -- a caregiver may be more focused on getting the job done quickly and moving on to the next job. The caregiver has had much more experience playing these "games," within these medical contexts. Staffing or time may not allow a "win-win" resolution. So it's just easier to use strategies that have been proven to work to win the game and get on with work. I think this is what's happening to a significant degree. It's amazing how we as human beings can rationalize and justify what we do as being the right thing to protect us from the realization that we may not be doing the right thing.
MER

 
At Monday, January 25, 2010 1:08:00 PM, Blogger m said...

I find it interesting that fear plays into all many experiences of sacrificing modesty. Fear of terrorist attack results in travelers acquiescing to full body scans when in fact TSA admitted that full body scan technology would NOT have discerned the explosives on the Christmas Day bomber. Fear of not getting a job results in an applicant not insisting on respect and privacy from a nurse during a medical exam. It goes on and on. Patients in particular have been trained over time to be in awe of the medical profession, intimidated by the language and practices and as a result, blindly just give up their individual rights. I wonder if this was how the Bush administration learned that they could get away with anything if they created enough fear.

 
At Monday, January 25, 2010 11:32:00 PM, Blogger Hexanchus said...

MER,

You wrote "The caregiver has had much more experience playing these "games," within these medical contexts. Staffing or time may not allow a "win-win" resolution. So it's just easier to use strategies that have been proven to work to win the game and get on with work.".

Interesting point....so maybe patients need to change the rules of the game. Ultimately, a patient can say "NO" to anything they're not comfortable with.

Patients concerned with these issues need to learn how to stand up for themselves. Don't know if you've read it, but something I'd strongly recommend to anyone interested in learning how to better stand up for themselves is a book called "Verbal Judo" by Dr. George Thompson. It's an excellent resource IMHO.

 
At Tuesday, January 26, 2010 10:13:00 AM, Anonymous Anonymous said...

On National Public Radio (NPR) this morning (Tuesday, Jan 26) -- a story about occupational therapy jobs out of L.A. In the midst of the story, the fact that only 10 percent of OT's are male. The fact that there's a conscious attempt to recruit more males into OT. Also, mentioned that need for me men is because "maybe" some men would prefer a male OT for tasks like using the bathroom. An actually use of the word "dignity" within this context.
I'm not surprised that caregivers are aware of this problem. They know. What encourages me is this elephant is now being dragged out of the closet into the room and out on to the street. I think the word used was "maybe" or "perhaps" men would prefer a male OT for this intimate care -- the use of that word suggests to me that, within the OT field, it's not a "maybe" or "perhaps." They "know" that many men would prefer a male OT. I read this as more men asking for male help. But, there's still a reluctance to come right out and say that there is a demand for this change.
This is good news. And I think it's an indicator that more men are speaking up and that the medical profession is beginning to respond.
I'd like to hear more stories like this if anyone out there can find them. I think there out there.
MER

 
At Tuesday, January 26, 2010 10:40:00 AM, Anonymous Anonymous said...

To Hexanchus:

Yes, patients need to change the rules. First, patients need to recognize the nature of this game playing. Patients need to be willing to play this game, first as a team member, trying to get a win-win resolution -- or, if resisted, as a competitor, seeking to win.
By speaking up, patients are challenging one of the major rules regarding body modesty -- that rule, patients don't speak up. They're too embarrassed, socialized, intimidated.
You may get what you want. If not, you'll get some kind of resistance -- civil, rude or something in between.
By challenging that resistance, you're breaking another rule. That rule -- patients are supposed to just give in when challenged.
You break another rule by asking pointed questions like "You mean there isn't a male nurse in this entire hospital who can do this procedure?" or "What does the mission statement of this hospital say about dignity, and how do you define dignity" or "How would you feel if you were in the hospital lying naked on a bed, etc?" You break the rules by asking questions like this -- patients aren't supposed to ask pointed, challenging questions.
So, yes, Hexanchus -- patients need to change these rules. But there's a risk. You may very well, and quite rapidly, become labeled the "bad" patient. But, if you stand your ground, and keep working your way up the food chain to the supervisors, you may get your request. Or, and don't forget this, you may get your request immediately in some of the more enlightened hospitals.
And I think they are beginning to do so -- but you won't see this in print. But there are stories like the NPR one I quoted that indicate more patients are demanding same gender intimate care, especially more men.
Yes, patients need to speak up.
MER

 
At Tuesday, January 26, 2010 11:53:00 AM, Blogger swf said...

"The caregiver has had much more experience playing these "games," within these medical contexts."

This is part of my point, and I find the acceptance of it disturbing. We are not talking about small societal roles/games to acquire a date or get a good deal. We are talking about deceptive/coersive tactics where one person considers their lie of more benifit to them than the truth. Tricking the patient, in a sense, for monetary gain through deception.

What the medical community has stated they expect from us: To be honest, concise, forthcoming despite embarrassment, trust, respect.
We should expect (and get) nothing less in return.

And yes, I would like to be able to educate every single person that you are allowed to say "no"..
but so many people still consider medical staff to be authority figures, and act as if they are in jail or a prison camp.

 
At Tuesday, January 26, 2010 8:23:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY JANUARY 26, 2010 "PATIENT MODESTY: VOLUME 30 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 31

 

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