Bioethics Discussion Blog: Patient Modesty: Volume 31

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Tuesday, January 26, 2010

Patient Modesty: Volume 31



Patient modesty may cause concern from something as simple as the above graphic or it may be associated with behaviors of medical staff while examining or doing procedures which raise questions regarding unprofessional behavior. We continue here on Volume 31 with followup from the previous volumes regarding approaches to respond to these concerns. ..Maurice.

NOTICE: AS OF TODAY FEBRUARY 19, 2010 "PATIENT MODESTY: VOLUME 31 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 32.

136 Comments:

At Wednesday, January 27, 2010 4:05:00 AM, Anonymous Anonymous said...

I wish I could get a bullhorn and shout to every person walking in or being taken into every clinic and hospital that they CAN make choices. They should be assertive and not take no as an answer. Until a large percentage of patients have the guts to stand up for themselves medical "professionals" will continue to abuse us. Nurses and aides will continue to "assume" we are OK with their lack of respect.

 
At Wednesday, January 27, 2010 9:14:00 AM, Anonymous Anonymous said...

So why don't you??? Not a bullhorn, but as an example>>>millions of people belong to facebook and you CAN start your own group! One of you men should start a "Men against opposite gender intimate care" and get fellow fellows to join. Who know what will happen once the group is out there. The problem is, if people are too embaresed to put themselves on the line to start a group in public, they are too embarased to speak up to nurses! I chalange each guy here to do this.

 
At Wednesday, January 27, 2010 3:02:00 PM, Anonymous Anonymous said...

Its interesting to take notice of the illustration Dr. B is using,the gown. Personally,its
basically a dress and as such
insulting for men to wear as
patients. Does it carry a sexual
connotation or is it just archaic?
All men should be offered pants
along with the gown. I've seen them at some hospitals yet interesting to note that they're all not always offered
to male patients. I wonder why!



PT

 
At Wednesday, January 27, 2010 3:31:00 PM, Anonymous Anonymous said...

PT
Ask for two gowns. One to wear as in the photo and then another on top the other way around. That's what I have done.
NP

 
At Wednesday, January 27, 2010 6:06:00 PM, Anonymous Anonymous said...

PT -- Both men and women hate the gown. In specific cases, something like the gown may be necessary for specific care. But generally, the medical system can do much better. Remember, this whole thread began with Dr. Bernstein posting the article "Naked" by Atul Gawande, M.D., M.P.H. Among other things, he writes about how awkward it is for a doctor sometimes working around that gown.
Finding more humanistic, modesty ways to work with varieties of the "gown" is a simple, tangible way hospitals and clinics begin to move to patient comfort in terms of modesty. I've noticed some clinics (and hospitals) do use solid, substantial, full-covering gowns. It often makes the patient feel more safe, secure, respected, and human. Dealing with gowns will not solve the problem, but it is one step in a multi-step process.
MER

 
At Thursday, January 28, 2010 12:53:00 AM, Anonymous Anonymous said...

NP - That's a good idea to help body modesty but it won't help to make men feel less feminine wearing "dresses".

 
At Thursday, January 28, 2010 2:42:00 PM, Anonymous Anonymous said...

NP

One gown,two gowns still equals
a dress! The fact remains in that
it does little for you when you are asked to move(slide)from your
bed to a table be it in radiology,
cat scan or nuclear medicine.
Additionally,if one wants to
examine your abdomen at which point the gown needs to be lifted
in which case pants would be beneficial.
Providing all patients with
pants in addition to the gown will
help a long ways in regards to unnecessary exposure. I've seen more cases of this than I care to
mention.


PT

 
At Thursday, January 28, 2010 3:49:00 PM, Anonymous Anonymous said...

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines narcissistic personality disorder (in Axis II Cluster B) as:[1]

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. requires excessive admiration
5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8. is often envious of others or believes others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes
Wikipedea ref. Narcissistic Personality Disorder
You only need 5 to be diagnosed with NPD. Most nurses have more. Perhaps there is a medical reason for female nurses entitlement syndrome after all.

 
At Thursday, January 28, 2010 8:32:00 PM, Anonymous Anonymous said...

Interesting comments about NPD. I've read a number of instances where nurses would deliberately place their patients
in a code by administering excessive drugs just for attention. I've seen many perform
outside the scope of their license
and question orders from physicians.
One can only imagine how one
with such a personality would bully
someones privacy.


PT

 
At Thursday, January 28, 2010 10:13:00 PM, Anonymous Anonymous said...

PT
When I had an MRI they told me I could keep my underpants on under the gown.
NP

 
At Friday, January 29, 2010 9:20:00 AM, Blogger swf said...

NP
"Rules" are certainly different everywhere, and it makes one wonder what is neccessary and what really is not.
I wore a tee and drawstring pants to all 4 MRI's. Only once was I asked to undress and put on a gown. I asked him why, and I was told the only reason was metal. I wasn't wearing any metal (because I read the info ahead of time) and stayed in what I came in.
So this reflects on hospitals too. If you take items with you, they can not really justify why you can not wear them. So many times it is not really a rule to only wear a gown, it's just that that is all they have.

 
At Friday, January 29, 2010 9:35:00 AM, Anonymous Anonymous said...

You don't need to wear a gown when having an MRI. All you have to do is make sure that your street clothes have no metal. For women: sports bra and for both genders, slacks without zippers.

Should they give you a hard time tell them you'll have it done at another facility where you know you don't have to undress.
gd

 
At Friday, January 29, 2010 4:24:00 PM, Anonymous Anonymous said...

NP

Not really sure the relevance of your underwear in MRI. Certainly
you don't want to have an MRI if
you have a pacemaker,neuro stimulator,removable dentures,nor
intrathecal or epidural subcutaneous devices,better known as pumps.


PT

 
At Saturday, January 30, 2010 2:58:00 AM, Anonymous Anonymous said...

PT
"One gown,two gowns still equals
a dress! The fact remains in that
it does little for you when you are asked to move(slide)from your
bed to a table be it in radiology,
cat scan or nuclear medicine.
Additionally,if one wants to
examine your abdomen at which point the gown needs to be lifted
in which case pants would be beneficial.
Providing all patients with
pants in addition to the gown will
help a long ways in regards to unnecessary exposure. I've seen more cases of this than I care to
mention."
I am just relating my experience of an MRI which I would presume is similar to a cat scan, radiology etc. And the fact is, unlike what you have witnessed, I didn't have to worry about "unnecessary exposure" because I kept my underware on when I slid on the MRI bed.
NP

 
At Saturday, January 30, 2010 12:30:00 PM, Blogger swf said...

If modesty is a point of concern, I wonder why most people do not just take matters into their own hands. Healthcare can correct me if I am wrong, but most of my inquires find that for many proceedures, tests, and recoveries, total exposure is really not necessary, or even laying naked under a flimsy gown. Does everyone in the hospital need 24 hour split second access to our genitals? Most of the time....no.
If you are wearing pajama pants or sweat pants/shorts are they really going to tell you to take them off? I have only ever seen that happen once and the patient said no.
Barring an emergency, lot's of hospitals have sites that tell you what to bring, and most say something comfortable to leave and sleep in. If you really have any doubts, check out the pediatric section and they will tell you that one of the most frightening things for children is exposure in the gown....so bring pajama pants.
So is all of this randam exposure really neccessary? No...but kids can not handle it and "adults can".
What does this really tell us?
"You can wear it but you gotta bring it."
If hospitals were only humanitarian institutions, they would provide us with more modesty. But as financial institutions they will not go out of their way to provide anything more than what is neccessary in cost.
If you are upset that they don't provide it, then bring it. Don't assume you can't wear it either, because usually there is no reason to roam the halls or get out of bed exposed.
Take a bag. Be bold, it is your body.
Personally, I keep an emergency bag in my car anyway. (Breaking down in snowstorms here is common)
Toss in a list of medications and emergency contacts and you are prepared.

 
At Saturday, January 30, 2010 2:07:00 PM, Anonymous Anonymous said...

swf -- You're right on with your advice. But, as we've discussed on this blog, there are reasons why people don't challenge the status quo in hospitals and other institutions where they feel (maybe only a "perception," but perceptions are powerful) powerless.
So, as you suggest -- a major key is patient education. But that won't be easy. People like to complain but then do nothing about the problem. That's human nature.
The other part of the key is the education of medical professionals, esp. making them aware of how they must teach their subordinates (med. assts., cna's)what is acceptable and what isn't The professionals must take charge of and accept responsibility for the overall work place ambiance. This has got to work both ways. Patients need to take their portion of responsibility. But institutions and professions who claim to follow codes of ethics that talk about human dignity and respect -- they need to take their portion of responsibility as well.
They can't just claim that patients need to speak up and ask or bring what they want to wear.
But as I've said before, I still believe the prime responsibility leans toward medical professionals. They have the knowledge and the power (perceived or real -- Remember, perception can become reality). The patients are on alien turf, sometimes in a weak psychological and physical state. I've quoted in past posts studies that show how most people just do what they're told depending upon the context, which includes the situation, the power of authority, the environment.
I think the irony is that the best way to educate medical professionals is for patients to stand up for themselves and insist upon getting the modesty treatment that makes them most comfortable.
MER

 
At Saturday, January 30, 2010 6:58:00 PM, Blogger swf said...

Mer
I agree with your point about human nature. People do love to complain about injustice while doing very little to correct it. And "there are reasons why people don't challenge the status quo in hospitals and other institutions where they feel (maybe only a "perception," but perceptions are powerful) powerless."
While I agree, I would like to point out that impowered patients are better patients. Patients who feel like they have some control and respect ask more questions, are in a frame of mind to understand care instructions, and leave knowing that they understand their role in continuing their own care.
An embarrassed or humiliated patient will leave quickly, will be angry, not listen well to doctors and instructions, and often be confused about what happened or what their disgnosis or continuing care really is. This alone should lead healthcare toward better patient relations, and that includes what the patient perceives as respect.

As far as the patient:perhaps we need to do a little de-constructing, and educate people that respecting someones abilities is not the same as considering them an authority figure.

 
At Saturday, January 30, 2010 10:41:00 PM, Anonymous Anonymous said...

Patient mindset should be...I pay you for a service. Your job is to diagnose, explain treatment options with benefits and detriments. Together we should establish a plan of action. It's that simple.

Just because someone doesn't have a medical degree doesn't mean they are less intelligent than the physician.

I do not consider anyone in the medical profession an authority figure. The buck stops and starts with me.

This mindset establishes great doctor/patient relationships putting things on a more equal basis, gives control to the patient and leaves both participants with a positive mindset, action plan and relationship. Should a doctor not want to have this kind of cooperation and mutual respect is the wrong doctor for me.
gd

 
At Sunday, January 31, 2010 7:13:00 AM, Anonymous Anonymous said...

Great idea swf. Thanks.

 
At Sunday, January 31, 2010 6:48:00 PM, Blogger Maurice Bernstein, M.D. said...

I haven’t been to the clothesfreeforum.com for a long while, so I returned to look again for comments about patient modesty. For your interest, I found a several questions asked by naturists about the concern they had about how their doctors would respond to their requests. There was one answer by a physician member of the forum.

I have a feeling that naturists may also be concerned, as those writing to my blog, about how physicians will respond to their personal requests... however,in their case, nudity. Though I provided a couple comment on the gown, notice how the gown may be an issue for them also.

These postings were on the site and dated March 2006. ..Maurice.


“I am going to a new skin doctor next week and I want to know how to let her know that I would rather be nude during the exam than wear a gown and have the doctor move the gown around to keep me covered. One of the doctors I had before did that and missed a few moles. The doctor I just left had me in a gown while taking down information. When he started the exam, the gown was pulled down and just covered my lap. When I stood up, I removed the gown and the rest of the exam was done in the nude. I gust feel that it should be up to the patient on what to wear or not. If doctors (after I let them know that i would remove all of my clothing) insist on me covering up I feel that they are not comfortable.”


“Just read an email from a friend, it said" why do the doctors always go out of the room when your disrobing, when they are gonna see you naked anyway"! go figure!!”


“While living in the US, I never understood the gown thing. Never made any sense to me!”


..and from the physician:


"OK, I've been practicing medicine for 25 years so here goes.

In training physicians are taught to respect patient privacy and authority (yes, I know, some forget; that's another matter). Many patients feel vulnerable and not in control at the doctor's office, and being unclothed (for most) heightens that feeling. And, most patients are modest about being naked and prefer to be covered. From a physical exam perspective I'd prefer if my patients wore nothing at all, but this is not what the patients want and, in this instance, what they want is what they get. It's surprisingly tough to get patients to take off even the minimum necessary; I tell them (clearly and slowly) to remove everything but underpants and put on the gown, and then come back to find many still wearing t-shirts, pantyhose, bras, slips, or even the gown on top of all their clothes!

So excuse your physician for treating you the way 99% of the rest of the patients want to be treated. You'll likely find that the doctor really doesn't really care; if you don't want to wear a gown, the best way to let that be known is to leave it on the chair.

Regardless of whether you are gowned or not, if you are getting a skin exam you should make sure that the physician sees "every square inch of your skin" (to quote my dermatology instructor) and should not hesitate to point out any missed areas - especially those tricky areas you can't see for yourself.

Finally, why does the doctor leave the room while you undress? We go outside to dictate our note quickly before we forget what you said.”

 
At Monday, February 01, 2010 4:14:00 PM, Anonymous Anonymous said...

I have found the solution to everyone's concern about patient modesty, its RoboNurse!

http://www.nursingjobs.org/blog/robot-nurses-the-problems-remain-unacceptable.htm

Note the single post below the article. - Chris-

 
At Monday, February 01, 2010 9:32:00 PM, Anonymous Anonymous said...

"Finally, why does the doctor leave the room while you undress? We go outside to dictate our note quickly before we forget what you said.”
My thoughts are that it could feel like a strip tease if the doctor is there while you disrobe. Surely that is why they don't watch?
NP

 
At Monday, February 01, 2010 10:16:00 PM, Blogger amr said...

This is a followup to the Dr. Sparks story. Please not the $$ appeal she makes to her patients, complaining (implying) that what happened to her was unfair and that it was a bad thing for her patients. This comes from OutpatientSurgery.org email. I still am amazed that all she got was a slap on the wrist and she wasn't criminally prosecuted. At the very least her license should have been revoked. The point is that she clearly has not remorse for her actions.

-- amr

Insurer Drops ENT Who Gave Genital Exams

A postscript to last month's story on the ENT surgeon who allegedly gave unconscious male patients genital exams without their consent: United Health Care has dropped her as an in-network provider.

As a result, patients of Twana Sparks, MD, at the Gila Regional Medical Center in Silver City, N.M., must either pay more to continue to see her or drive hours to the next nearest ear, nose and throat specialist.

The state medical board had placed restrictions on Dr. Sparks's license after investigating allegations that she had unnecessarily examined the genitals of some of her male patients while they were under anesthesia in the OR.

In a letter to her patients dated Dec. 3, 2009, Sparks wrote, "Any visit to me will be more expensive to you. My restrictions have nothing to do with my skills as a physician or surgeon."

Dan O'Connor

 
At Tuesday, February 02, 2010 6:33:00 AM, Anonymous Anonymous said...

Finally, Sparks has to pay for her unethical actions. I avoid going to female doctors if nudity might be involved, but I never would have thought I had to worry about a perverted ear, nose and throat specialist. Even though the government failed to do it's job prosecuting her at least the insurance company has some common sense. Good to hear.

GR

 
At Tuesday, February 02, 2010 11:56:00 AM, Anonymous Anonymous said...

The doctor isn't paying any debt here but the patients sure are. They will now pay more to see her versus driving hours to see another ENT. Patients will go to her because while in pain no one will go hours for a visit. Add in the cost and time involved and many patients are stuck. She makes out great in this deal. I would love to see another ENT open shop in that town and I hope someone does soon. The hospital should be interviewing left and right for another ENT but they didn't pay any price here either so their no incentive for them to do so. It's really a travesty.

Dr. Lisa

 
At Tuesday, February 02, 2010 2:00:00 PM, Blogger amr said...

Dr. Lisa,

Sparks was chief of staff at the hospital. At least the med board did something and the insurance company did what they could.

Another excerpt from the original article I posted earlier:

It was no secret among the surgical staff at Gila
Regional that Dr. Sparks had a curious practice of
performing genital exams on many of her male
patients while they were under anesthesia.
“Umm, doctor, that’s a long way from the throat,”
was one of the running jokes amongst OR staffers.
“Now I realize that ENT stands for Ears, Nuts and
Testicles,” was another.

My question is: What good is the medical board if they don't have the "testicles" to have revoked her license? And what the hell is going on with Gila Regional that they let this behavior continue? As I see it, there is very possibly a class action law suit against both the hospital and the doctor. And again, why hasn't a criminal complaint been filed?

This is another black eye on the ENTIRE medical community. If you can't police your own, who is truly to be trusted.

A question to you Dr. Lisa. Have you ever had the misfortune to witness inappropriate behavior by doctors or other staff. If so, what was the behavior and what if anything was done about it?

Thank you for responding in advance,

-- amr

 
At Tuesday, February 02, 2010 3:38:00 PM, Blogger swf said...

After reading the articles about this, obviously the doctor was often surrounded by people, and it never seemed to make much difference in her behavior. I have to wonder if a chaperone would really make much difference now.
And seriously....a doctor who has to take a polygragh test every 4 months to prove she is not up to her tricks? Disturbing.

 
At Tuesday, February 02, 2010 3:39:00 PM, Anonymous Anonymous said...

In regards to the Sparks case not
only did she perform unnecessary
genital exams,but did not note it
in the patients chart.Additionally,
in some cases it was noted that she
drew artistic designs on patients
which to me certainly points to a
much needed psych exam on her part.
This case in many ways parallels
the behavior of a New York physician whose medical license was revoked. Personally,I would avoid her at all costs!
The fact that her behavior continued for so long speaks volumes about the ethics of many
involved in patient care at that
facility.


PT

 
At Tuesday, February 02, 2010 3:41:00 PM, Anonymous Anonymous said...

The insurance company handled the situation the best of all concerned. They dropped her as they should have. The hospital should have fired her and her license should have been revoked. She was lucky that no patients came forward after the whistle was blown. The patients wouldn't have been aware of what happened as they were under, but none even came forward to complain they were outraged these exams were performed and they could have been someone that was victimized. I'm not so sure her victims weren't specifically chosen based on their natiionality which makes it all the more despicable.

I have never witnessed inappropriate exams done to males or pelvics done in the OR without consent. The doctors I have worked with have all held themselves to a high standard. There were some during my training that I felt could have been more gentle and less gruff but they weren't inappropriate. I have never had one complaint made about ancillary staff to date either. I would absolutely speak up if need be.

Pay attention to how your doctors run their offices. If they are polite and professional there chances are good it carries over to their behavior in the OR as well. Do they allow interruptions during the exam? Have they even taken a call during your visit? Do they close the door behind them? Are you provided with a gown or drape as needed? Do they meet with you privately even for a few minutes each visit? These things are all very telling.

Dr. Lisa

 
At Tuesday, February 02, 2010 4:03:00 PM, Anonymous Anonymous said...

The culture of the hospital is disconcerting. Many doctors and nurses knew this was happening and didn't speak up. I'm sure many feared for their jobs and rightfully so. The one who finally did speak up was fired and is now suing. Sounds like she has a good case but that doesn't mean she will prevail. It's disgusting that people are afraid of retribution for doing what is right.

Dr. Lisa

 
At Wednesday, February 03, 2010 9:15:00 AM, Anonymous Anonymous said...

Just for perspective, the medical board in Dr Sparks’ case acted as they usually do, they censored the doctor but didn't revoke her license. It's not surprising. Boards are reluctant to revoke physicians' licenses for non violent first offenses. This doctor apparently didn't realize just how egregious her behavior was, doing it repetitively in front of witnesses.
What also should have happened is that the state board that regulates hospitals should have censored this hospital for not protecting the patient. To me that is more troubling than one doctor’s outrageous behavior. The sanctions against Dr Sparks will have a profoundly negative effect on her career.

 
At Wednesday, February 03, 2010 12:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Dr. Sherman informed me that the comment 9:15am today by Anonymous was from him. Thanks for your feedback on the Spark's case. ..Maurice.

 
At Wednesday, February 03, 2010 2:14:00 PM, Blogger amr said...

Dr. Lisa, Thank you very much for your feedback. Your comments on how to read the Doctor's office makes so much sense to me. And I'm happy to hear that you have not witnessed bad behavior.

Moving on to a slightly different topic, here is a LINK to the ACPE.ORG (American College of Physician Executives) - Special Report: 2009 Doctor-Nurse Behavior Survey. There are several links to articles on this page.

To my read, these articles show quite clearly that not only is the tenor of allnurses blog entries regarding a caustic workplace affirmed, but also they reaffirm that many doctors exhibit unprofessional behavior and tend to get away with it. (Think Sparks.)

So, if all of this petty back biting is going on, where does respect for the patient fall into the scheme of this work place environment that we as patients depend upon for our life. And is it no wonder that respect for any/all patients (including modesty) concerns are apparently secondary to the business of medicine.

Change of subject again: Colonoscopies. On YouTube, there are several examples of the test from Japan. 1. The pt is awake; 2. They wear shorts that do the job of covering up the body.

--amr

 
At Wednesday, February 03, 2010 3:42:00 PM, Anonymous Anonymous said...

The incidents regarding the Sparks
case will affect her financially
in the long run. She will have to
pay for the psychometric tests out
of her pocket as well as other
conditions the State medical board
outlines. She will have to hire her
own chaperone I suspect at the hospital although she may find someone at the hospital or her clinic to do this.
She has most certainly distanced
herself from perhaps most of her male colleagues and has proven to
be a liability for the hospital.
I'm not sure how she is able to
face those people on a daily basis.


PT

 
At Wednesday, February 03, 2010 3:58:00 PM, Anonymous Anonymous said...

"This doctor apparently didn't realize just how egregious her behavior was, doing it repetitively in front of witnesses."
Seriously? I mean I thought doctors were supposed to be intelligent and all.
NP.

 
At Thursday, February 04, 2010 6:38:00 AM, Anonymous Anonymous said...

They are never responsible, accountable. It's almost like they are brainwashed and can't understand their actions. Could it be just sheer arrogance? They also protect each other to their patient's detriment. Frankly, it's obscene.
Once you are mistreated and won't put up with it, then you are the difficult patient! It's time they examined what makes a patient difficult?
gd

 
At Thursday, February 04, 2010 11:51:00 AM, Anonymous Anonymous said...

"This doctor apparently didn't realize just how egregious her behavior was, doing it repetitively in front of witnesses."

As with others who commented on this sentence, I can't understand where this poster is coming from. Someone in the doctor's position who "doesn't realize" what he/she is doing, needs serious intervention -- whether it be a psych consult, firing, reeducation or whatever. Frankly, those who participated in this outrage and said nothing, they need a serious intervention as well. Their behavior, though understandable, is not acceptable. Read the book I mentioned in past posts -- "The Lucifer Effect" -- theorizing as to how good people can be influenced to do bad things.

Personally, I would never trust a hospital that allowed a doctor like this to continuing practicing under any circumstances. It seems like everyone along the hierarchy needs some reeducation, including the hospital CEO, Board of Directors, and the medical licensing board. Sad.

This doctor has some serious psych/power/sexuality issues that may not coincide with her moral/ethical right to continuing practicing as a doctor. Note that she said the her punishments have nothing to do with her "ability." Interesting. Depends upon how you define "ability." As far as I'm concerned, "ability" doesn't limit itself to technical "ability;" it also concerns moral/ethical "ability," and the "ability" to empathize with other human beings. Unfortunately, there are people who are defective in this area, and I'm not sure how much "education" can affect them.
MER

 
At Thursday, February 04, 2010 12:50:00 PM, Blogger Maurice Bernstein, M.D. said...

I rejected the following for publication by Anonymous this morning. I am including the statement now but as an example of a potentially ad hominem remark.

" Although I really dislike Dr. Lisa for what she is I agree with her most recent comments.

This statement is ambiguous and isn't part of a civil commentary.
We have no idea whether the writer is disliking a fellow visitor for gender, for occupation as a physician, for her specialty, for her other previous comments or for what. The writer knows nothing about her personally, her behaviors or most anything else just as we don't know anything about this unsigned anonymous writer. There is no value to that statement and again I want to caution all who intend to write that way that this will be the last example of this kind of expression I will release for viewing. Also, we may finally be getting a space on hospital.com to present patient modesty views. Writers who present comments which are uncivil and ad hominem to anyone will be risking the loss of this route for all of us to broadcast important views to the public and the medical system. ..Maurice.

 
At Thursday, February 04, 2010 5:54:00 PM, Anonymous Anonymous said...

"Once you are mistreated and won't put up with it, then you are the difficult patient! It's time they examined what makes a patient difficult?"
You are so right gd.
If you are a pregnant female they will also infer that you are "mentally unstable" too. My old OB who dismissed me wrote many untruths about me in my file. But he was clever enough to not put it in his own hand writing lest he be accused of falsifying records. The new OB, to his credit, asked to hear my side of the story and after that assured me twice that we would get on fine (which we did). So he could see that it wasn't me that was difficult, it was the previous OB who had major ego issues.
NP

 
At Friday, February 05, 2010 4:08:00 AM, Anonymous Anonymous said...

The Dr. Sparks whistle blower should be considered a hero. Instead she is blacklisted by the people who should be looking out for the welfare of all patients. I really feel bad for the people living in that geographical area and have no choice but go to that horrible hospital.

Mary

 
At Friday, February 05, 2010 11:02:00 AM, Anonymous Anonymous said...

This from a thread on allnurses.com

"I always respect my pt's privacy, which I have found in doing my clinicals is seldom done. 4 nights now I have been at my hospital clinicals and 9 out of 10 times the nurses and docs are not pulling the curtain or shutting the door. Even passes the hall while an aide was toileting someone and the door was wide open. I am not like that at all. I will close the curtain when I am doing anything with my Pt. you never know when something might happen."

This is a realistic, reliable thread, in my opinion. Worth a read. Comments like this back up the patient "perception" that there are many modesty violations within hospitals -- and that caregivers get so wrapped up in their routine that they forget the difference between how they feel about nudity and how their patients feel about it. Note that this is written by a nursing student doing clinicals. I wonder how long it will take the hidden curriculum to take over her world view? I hope it doesn't happen, but I'm not optimistic.

You can access this thread at:
http://allnurses.com/general-nursing-student/bathing-classmates-other-452358-page12.html#post4109361

MER

 
At Friday, February 05, 2010 7:20:00 PM, Blogger Maurice Bernstein, M.D. said...

Though I am not sure that hospital.com has the "5 Tips for Patients of Hospitals" section dated December 17 2009 as a location for my visitors to write their pieces regarding patient modesty, the topic there seems pertinent and there is an opportunity for entering a comment.
The "5 Tips" I think we all can agree are worthy tips:
1. Speak up!
2. Write it down
3. Keep an advocate
4. Clarify everything
5. Ask questions

So it says at the end.. "Leave a Reply".
It does request a name (required) and a e-mail address ("will not be published")

I'll start it out. But please, write in a civil and constructive manner otherwise this whole opportunity will be wasted. ..Maurice.

 
At Friday, February 05, 2010 7:39:00 PM, Blogger Maurice Bernstein, M.D. said...

I wrote to the "5 Tips" page:
All the tips are worthy tips for patients to keep in mind and attempt to follow when hospitalized. With regard to “speaking up”, I would not limit the communication only with the “hospital physician” and not simply “symptoms and history”. I would recommend that the patient feels free to “speak up” to all healthcare providers who come to attend the patient or even caretakers of the hospital room. And the topics should also include all aspects of the experience within the hospital bed, hospital room and elsewhere within the hospital where a patient is taken. These topics should include patient desires and patient concerns and observations both of the good care and also the aspects of living in a hospital that causes distress to the patient. Granted hospitals are busy institutions but both the emotional/psychologic health of each patient should be considered and as best possible attended to in addition to the physical health. ..Maurice.

 
At Saturday, February 06, 2010 1:41:00 AM, Anonymous Anonymous said...

Someone made a comment on why the doctor leaves the room while patients are dressing or undressing and the comment was...they run out of the room to jot down notes before they forget.

What about that medical professionals should leave the room promoting the clinical aspects of the examination and de-sexualizing the encounter.

It's one thing to have to briefly be exposed to an examination and quite another having someone watch you when you're preparing for that exam.
gd

 
At Saturday, February 06, 2010 2:09:00 AM, Anonymous Anonymous said...

I have two legal questions that may seem off-topic but they are related to patient modesty and medical ethics. If I (being a man) were to go up to a woman on the street and tore off all of her clothes, what would I be charged with? Sexual assault? Second question, what if that woman had been shot in the leg? What would I be charged with?

I relate those two questions with experiences I had in hospitals, one a non-emergency and one an emergency. Both times I resisted being stripped, and was stripped naked against my will. For the emergency I didn't have the strength to resist and the non-emergency I was promised I wouldn't be stripped after I was unconscious, but then was.

What gives nurses the power to do that and not be prosecuted?

GRE

 
At Saturday, February 06, 2010 12:50:00 PM, Blogger swf said...

GRE:
I too have ask lawyers to produce actual documentation providing exact legalese as to the rights of medical staff to our bodies. Not being a lawyer, perhaps someone here might be able to site such documentaion, because to date I have found none that is not crafted by the medical community in some way. Which leads us to believe that the entire medical 'entitlements' are purely based on perception and how the medical community at large has crafted thier own authority.
There are cases where it has been challenged, but cases rarely lead to a written law.
With almost any other human behavior towards another human and/or their property,there are laws governing what is appropriate, what is not, and consequenses. Besides a few agencies, it seems we are left on our own to test the waters of deciding for ourselves what we consider a violation of our bodies.

 
At Saturday, February 06, 2010 1:17:00 PM, Blogger Maurice Bernstein, M.D. said...

swf, the legal name for unauthorized touching of a patient's body is battery. The authorization is by the patient or legal surrogate or appropriate touching is assumed in the case of a life vs death emergency when the patient is unable to give authorization. Of course, the facts, circumstances and intent is all considered when a judgment about battery is made. Doctors should all be aware of the issue of battery and I would have expected Dr. Sparks to have been aware. But, then we don't know all the facts, detailed circumstances and her intent. ..Maurice.

 
At Saturday, February 06, 2010 1:34:00 PM, Blogger swf said...

Thank you Dr. B.

It seems that the "unauthorized touching of a patient's body"
happens frequently. In which case, battery charges should be happening frequently too.

But since " the facts, circumstances and intent is all considered when a judgment about battery is made", patients rights to their body again become legally vague, and again back at the mercy of the medical communities own authority.

 
At Saturday, February 06, 2010 1:52:00 PM, Anonymous Anonymous said...

It gets complicated when we start talking about ER situations. Not being a lawyer, I will say I think in some senses the law is pretty clear in terms of batter as Dr. Bernstein related. The patient is alert and has full mental capacity and says yes or no. Pretty clear. Or, the legal surrogate says yes or no. Again, pretty clear. But, we need to put ourselves into the shoes of a doctor or nurse who has the knowledge to assess that the no decision may probably result in death -- and wondering whether that's the real intent of the patient.
In emergencies, many factors must be taken into consideration.
1. Even if the patient appears alert, how alert is the patient, really and how much capacity really exists depending upon the injury.
2. If the patient appears alert but the doctor judges that the injury in some way is affecting the patient's capacity, the doctor may make a decision in favor of saving the life rather than obeying the patient. I would hope so.
3. In emergencies especially, with a patient perhaps not thinking clearly -- I would lean toward the doctor knowing more about the condition of the patient than the patient. If the patient doesn't know his/her condition, and there's no time for "informed" consent, I would surmise that most doctors would move toward a life saving action. Again, I would hope so.
4. Might the doctor or nurse at times make a mistake regarding patient capacity in emergencies? Of course. But if mistakes will be made at times, isn't it better to err in favor of life than death?
5. This doesn't mean that modesty doesn't matter or should be ignored in emergencies. But it does place modesty lower down on a priority list. And, in the rush of decision making, it opens professionals up to potential mistakes regarding patient consent -- because they're focused on saving the patient's life.
6. This is why, when I debate or discuss patient modesty with medical professionals -- even though they quite frequently reduce the issue to the ER and other emergencies, I always defer to them on that for the present and bring the subject back to ordinary, everyday exams and procedures.
SIDENOTE -- I've taken many CPR and first responder course over the years. In one class recently, I brought up the topic of modesty and removing clothing, especially with women. The instructor dodged the question -- but came up to me later and said this in essence: We've been told not do discuss this in these classes. We're afraid that if people become too conscious of this issue it may prevent them from either learning or doing CPR or other emergency care.
Interesting. To me, it showed how much body privacy, modesty, nakedness, etc. is the elephant in the room in our society. It helped explain why hospitals don't face this issue directly with patients. I think they believe that bringing it up may turn it into more of a problem that it already is. So -- it's not that they don't recognize the issue -- they may believe that to focus too much on it may make it worse. And that perspective is not entirely untrue -- with some people, not everyone.
MER

 
At Saturday, February 06, 2010 3:29:00 PM, Anonymous Anonymous said...

If you wonder why patient modesty is sometimes so low down on the priority list in health care, listen to this youtube bit called "If Air Travel Worked Like Health Care." If this doesn't make you laugh, nothing will.
MER

http://www.youtube.com/watch?v=5J67xJKpB6c

 
At Saturday, February 06, 2010 3:44:00 PM, Anonymous Anonymous said...

MER, great comments. However, by ignoring the issue, they are ignoring patient needs. They are invalidating our autonomy as intelligent human beings. It is just another insult.

There have been individuals blogging here who would rather die than be exposed to opposite gender care. Why should their needs be ignored if they are competent adults who have had life altering experiences and view the world differently than the mainstream?
gd

 
At Saturday, February 06, 2010 3:49:00 PM, Blogger Maurice Bernstein, M.D. said...

No! It makes me cry.. ..that I am part of this system! ..Maurice.

p.s.-Here is the clickable link
http://www.youtube.com/watch?v=5J67xJKpB6c

 
At Saturday, February 06, 2010 10:34:00 PM, Blogger Maurice Bernstein, M.D. said...

From today's New York Times.

In Texas, a Trial and Possible Prison Time for Reporting a Doctor

KERMIT, Tex. — It occurred to Anne Mitchell as she was writing the letter that she might lose her job, which is why she chose not to sign it. But it was beyond her conception that she would be indicted and threatened with 10 years in prison for doing what she knew a nurse must: inform state regulators that a doctor at her rural hospital was practicing bad medicine.


Read the entire article at the above link. Gee! the story sounds very familiar. ..Maurice.

 
At Sunday, February 07, 2010 1:57:00 AM, Anonymous Anonymous said...

Thanks so much for all the responses. What do you think, if an emergency physician decides that a patient isn't capable of making their own decisions how far can patients go to defend themselves? I read awhile ago about an emergency patient that refused to accept a rectal exam and defended himself by pushing someone down that was trying to force his clothes off (or something like that). He was charged and convicted of some type of assault.

If people are judged unfit to decide what happens to them in the ER wouldn't they also be deemed unfit to control their defensive actions? How far can we go to defend ourselves in that type of situation? Thanks again for all the responses.

GRE

 
At Sunday, February 07, 2010 9:01:00 AM, Anonymous Anonymous said...

A volume or so back (could be last volume), I wrote a two-part entry about how our attitudes toward nudity have changed within the last 40-50 years or so based on studies by Ruth Barcan in her book Nudity: A Cultural Anatomy. On an allnurses thread, nurses talk about working with each other while training, whether they give bed baths to each other or do other procedures on classmates. Most nurses are appalled by this activity. Some older nurses say it was part of training when they were young. Others question that.
I think at least three things have changed:
1. Authority figures -- people are less likely to trust and/or unquestioningly obey authority figures in today's society, especially in classroom situations-- and especially young people.
2. There are few, but still more men in nurse training today which might make female student working with student more embarrassing. Most comments on this thread, seems to me, are from female nurses.
3. But I still believe that a major factors is that our attitudes toward showing and allowing access to our bodies has changed for some of the reasons I quoted in that old post. A significant number of young nurses training today may not feel as comfortable about body issues as did older nurses. I could be way off, and I admit it, because it seems counterintuitive. We think we as a culture are much more open to these body issues. We consider ourselves "liberated."I don't believe we are. In fact, in many instances, I think we've returned to some older more Puritanical attitudes.
You can find the allnurses discussion here if you're interested.

http://allnurses.com/general-nursing-student/bathing-classmates-other-452358-page13.html#post4112450

MER

 
At Sunday, February 07, 2010 1:09:00 PM, Blogger amr said...

Dr. B,

Thank you for the NYT article. I would like to proffer the notion that the doctors protect their own. It is systemic. In watching my extended family of doctors, they are clearly reticent to pass judgment upon their own, even when a family member has been the victim of malpractice. I believe that this is one of the unwritten laws within the community of doctors. "By the grace of God go I"

This leads, in my mind, directly to the "protected status" that doctors enjoy. It takes a great deal to upend a doctor, regardless of their behavior.

But I see, as an outsider looking in, a common thread that is shared between you and my in-laws (you are not that much different in age from my father-in-law, but it is also shared by those docs of my generation). That thread is to always think in terms of giving your fellow doctor an out, a pass, or the benefit of the doubt. It is part of a life long experience that you share, the ethos of medicine if you will.

In your blog entry of 2/16 regarding Sparks you write:

"Doctors should all be aware of the issue of battery and I would have expected Dr. Sparks to have been aware. But, then we don't know all the facts, detailed circumstances and her intent."

I agree with your first sentence and assert that your second sentence is providing the "pass" that doctors give each other. Without realizing it however you, under the umbrella of being "fair and balanced", have fallen into the ethos that I speak of and that you have lived within throughout professional life.

In my blog entry I quoted from the article about Sparks that she, after the operation, ungloved, reached into the underwear of her pt, grabbed his penis, and proceed to play with it and make jokes.

My point Doctor is this: What possible "intent" could you supply in order to justify her behavior as appropriate? Taking this to another societal context, if a teacher of our young is suspected of improper attention to a student, they are removed first, then questions are asked. "Intent" is not an reason to mitigate behavior in the above example. The behavior is considered way out of bounds. So too clearly was Sparks behavior way out of bounds. If you had "expected" Sparks to be aware that her behavior was battery, then what possible "facts and detailed circumstances" would be germane for you to bring "intent" into the equation, especially since this behavior occurred unchecked for quite some time?

Thus, sir, by the grace of God go I.

Respectfully submitted for your consideration without malice or "intent" of ad-hominum.


--amr

 
At Sunday, February 07, 2010 1:38:00 PM, Blogger amr said...

Mer,

You reminded me of an NPR piece I heard the other day.

Nude Sunbathing Falls Out of Fashion In France

The links on this and the audio are quite interesting along with the commentary by readers.

--amr

 
At Sunday, February 07, 2010 2:36:00 PM, Blogger swf said...

I agree with MER on the attitudes of authority figures changing, and will continue to change. Often we find the rules and actions of 'society' are not really based on the majority. They are based on the accepted, which changes with each generation.
Now, how this reflects on the accepted entitlements of medicine...
Personally, I believe medicine (Doctors)is still a respected field. The complex art of diagnosing and curing/helping the human body is quite amazing and noble. But, it is not as mysterious as it used to be. Past generations were in awe of medicine, as abilities, vaccines, and incredible equipment were being developed almost daily. Who was the average person in comparison to such vast knowledge? Who were they to question what they were told and who told them? In short, if they could help you then do whatever they said.
Now the average person can be more informed. They can still show respect, but in general are not awed. This changes how caregivers are viewed, because medicine and the average 'joe' have finally collided. As people live longer, home healthcare is common. Many take the role of nurse, cna, na, with loved ones. Injections, equipement, catheters, meds., can be a part of daily living and very basic training. People leave hospitals sooner, so a spouse may often take on those roles. In short: while doctors are still our go-to providers, many people feel as if they on a peer level with staff. It is much easier to question a peer and tell them no. And quite frankly, we all know so many people going through healthcare education that it seems as if almost everyone is in healthcare. These people can no longer justify entitlements because they are exceptions, because they are now most of our friends, neighbors, partners, spouses, and children. They are us.

 
At Sunday, February 07, 2010 5:36:00 PM, Blogger Maurice Bernstein, M.D. said...

amr, you certainly may be critical of my comment "But, then we don't know all the facts, detailed circumstances and her intent." On the other hand what we all are aware of is a story written in the New Mexico newspaper. Should I, sitting in California and never attended the legal proceedings (or whatever you call them)and have had no access to hear both sides or to read any legal documents, should I make a statement that "we indeed know all the facts and the facts clearly are consistent with criminal battery"?
I am not defending the behavior as described in the newspaper or on these threads. If absolutely true, regardless of any physician's skills and the community needs, that physician is unprofessional at a minimum and could be called worse and would have clearly overstepped legal bounds and needs a significant punishment. However, I am simply saying I am not Dr. Sparks judge and jury. ..Maurice.

 
At Sunday, February 07, 2010 8:23:00 PM, Anonymous Anonymous said...

Every person who has had a negative emotional experience with medical personnel loses respect for the profession when it becomes apparent that these people who we held in such high esteem are ignorant, arrogant and sometimes purposefully abusive.

That's not to say that one can respect an individual, however, when looking at it through these eyes, they need to earn my respect but will never earn my trust..not completely. It's time to look at the reasons, it's time to be accountable and when those who do treat others the way they want to be treated need to "out" those who don't before the public trust is permanently eroded.

These attitudes ignoring bodily privacy are damaging their profession, the patient's and their own reputations.
gd

 
At Sunday, February 07, 2010 9:14:00 PM, Anonymous Anonymous said...

Tiffin Ohio

Police: Tech took secret nude
photos of women.

A medical-center technician
secretly captured dozens of photos
and videos of women and girls
undressing during exams.
Jaime AGuirre,43,worked as an
ultrasound tech. Bond was set at
$750,000 for Aguirre of nearby willard.

I am as always distured by instances such as this and the
Sparks case. Many believe these
are rare and isolated instances.

They are not and such instances
occur fairly frequently. Its an
issue of perception,out of sight ,out of mind. Fact is most
of these occurrences are rarely
reported to the news media. Most
never make it out from the walls
of the hospital. Few if any are
even aware of the behavioral issues,or for one reason or another
will not report it.


PT

 
At Monday, February 08, 2010 8:56:00 AM, Anonymous Anonymous said...

Thank you PT. The treatment of some patients borders on cruel and degrading and extremely mentally damaging to those who trusted the medical community. It is similar to those abuses in the Catholic church or incest where the misconduct comes from those we instill trust.

How can patients heal from that kind of treatment where bodily exposure is sometimes unavoidable?
This, I believe, is a true reflection of those who want same gender care. It should be an option and the medical community should take special care of these individuals.
gd

 
At Monday, February 08, 2010 12:09:00 PM, Anonymous Anonymous said...

gd part 2 of comment 8:56 a.m.
And...how can a patient heal when this misconduct is ongoing. There is no foundation for patients who have previously been victimized. These actions are sexual assault. Isn't it asking too much for those effected to be forced to remove their clothing in mixed gender settings like the ER of OR?
gd

 
At Monday, February 08, 2010 12:15:00 PM, Anonymous Anonymous said...

To get an idea, to some extent, of how we got where we are in medicine, especially in hospitals design and delivery -- watch this video from the 1950's called "Dream Hospital." Note the themes and, specifically, pay attention to the last sentence in the program.
Technologically, we've made tremendous progress. Patient comfort is a consideration in this video. But listen and watch between the lines and images.
MER

http://www.youtube.com/watch?v=fKBy1aKC7OE

 
At Monday, February 08, 2010 3:21:00 PM, Anonymous Anonymous said...

I'd like to contribute to some of
the comments that AMR has made
regarding the Sparks case. Much of
her behavior considered unprofessional never made it to the
New Mexico state medical board.
I've seen this in other cases of
physicians I've personally known
that were reprimanded whereby some
acts were never reported. Would it
have made any difference in the level of punishment dished out by
the board,we'll never know.


PT

 
At Monday, February 08, 2010 6:10:00 PM, Anonymous Anonymous said...

amr,
Thanks for that link about topless sunbathing. Now I understand an older male gynecologist's essay I read on the web some time ago about the "sexual revolution". He noticed that younger women were preferring female gynecologists and he equated that as going backwards after the sexual revolution. I think he misses the point. Being sexually liberated is being free to expose your body OR NOT to whom you want.
NP

 
At Monday, February 08, 2010 8:29:00 PM, Blogger amr said...

PT,

This is interesting about Sparks. Could you tell us more about the nature of your statement regarding Sparks? What items did not make it to the board, and how did you come by this information?

Thanks,

--amr

 
At Monday, February 08, 2010 10:56:00 PM, Blogger Rev.FRED said...

Seeking a male urologist, I found one sixty miles away, affiliatd with my hospital of choice. The specialist advertizes on his website: "Because many urological conditions are accompanied by social discomfort or embarrassment, he emphasizes sensitivity and discretion when dealing with all of his patient's concerns." Elsewhere, the doctor states, "This commitment means we work harder and smarter than our competition." Calling his office in order to establish how my demand for same gender provider for possible intimate procedures and care would be accommodated, I was immediately alarmed to find out that the urologist had an all female nursing staff. Questioning the female office manager, that if I had a urinary infection which necessitated a foley catheter, who would insert it, to uphold my modesty standards, living up to this pledge of "sensitivity and discretion," I was informed to my surprise--that the doctor himself performs the procedure! Also, it was stated by a receptionist when I called to make an appointment, that it is unusual for a nurse to be in the room, when the doctor sees his male patients! Without meeting this doctor, I applaud his endeavors to safeguard his male patients' privacy and dignity. The next hurdle that I will have to jump, how do I negotiate with this doctor, that should I need a procedure, test, scan, or care outside his office, my insistence on same gender provider? My strategy is to request that on his prescriptions, that he endorse "patient seeks same gender provider". This written statement informs the facility that the concern has been discussed with the patient, increasing the likelihood of the facility's accommodation. Since I'm good at wrestling alligators, I would schedule my own appointments for the procedure, test, scan, or care, discussing this matter, at the supervisory level. Any papers I would sign would include approval contingent upon same gender provision. Does anyone have any ideas as to how I work out a solution with this new doctor, at my first visit, who indicates a tendency to embrace male modesty?--REV.FRED

 
At Tuesday, February 09, 2010 12:33:00 AM, Anonymous Anonymous said...

"Being sexually liberated is being free to expose your body OR NOT to whom you want."

That's right. Associated with that are the men and boys that feel like they're tough and masculine when they allow female medical personel to do intimate things to them or observe it being done, even when they're secretly feeling abused and humiliated. How does that make them feel tough? All it proves to me is they are cowards that are too afraid to stand up for themselves or too afraid of what others might think. True courage and toughness to me is not letting anyone push me around and do something to my body that I'm not comfortable with.

Allowing medical women to do what they want to my body is like being sent to prison for something I didn't do without putting up some kind of legal fight. It's like just standing there when a bully is punching me in the face and not trying to defend myself. It isn't masculinity or maturity.

GR

 
At Tuesday, February 09, 2010 12:56:00 AM, Anonymous Anonymous said...

Rev. Fred, if all of the nursing staff are women and it is unusual for a nurse to be in the room, when the doctor sees his male patients, what's the point of even having nurses? Does he do all procedures by himself? Does he have a lot of female patients?

Most of the Urological exams and procedures I've heard of CAN be done alone but I've heard there's almost always an assistant whether she's needed or not. If this doctor is what he seems to be I think you stumbled upon a gold mine. He deserves to have his name and practice announced on this blog and advertized everywhere.

I am a bit skeptical though because some procedures can't be done alone and the nurses are there for some reason. Please keep us informed.

By the way, I like the majority of the most recent comments I've read here. Many people, intelligent people seem to have the same thoughts I do about patient modesty. Let's hope our enthusiasm can spread.

LG

 
At Tuesday, February 09, 2010 3:10:00 AM, Anonymous Anonymous said...

I've been thinking about why there's such a heavy turnover in nursing. Why so many nurses seem to fizzle out and quit nursing. I think a large percentage get into nursing for the nudity and genital fondling. Their job is very exciting at first but after awhile they start to lose interest.

1. As I've often heard, some nurses get so accustomed to seeing naked patients that nudity and fondling become boring to them.
2. They realize the perks in nursing aren't worth all the butt wiping and long hours.
3. They learn that the vast majority of the patients they are seeing naked are old, unattractive and overweight.

Maybe two or all three reasons apply to some nurses.

Horace

 
At Tuesday, February 09, 2010 4:54:00 AM, Anonymous Anonymous said...

Yes, simply tell him based on your life experience during medical procedures, that you find opposite gender care a threat to your dignity as a "man of the cloth" and will not be able to proceed unless a same gender team can be created.

Tell him that insensitive care in the past has caused much distress raising your blood pressure to abnormal levels (check this out, it probably does) and that, in itself is a health threat.

It seems like he's sensitive to the problem but even he is unwilling to state same gender care accommodations upon request. Interesting isn't it?

Good luck
gd

 
At Tuesday, February 09, 2010 6:22:00 AM, Anonymous Anonymous said...

People have a right to know who sees them naked and who puts their hands on their genitals. How can anybody with a conscience do such intimate things to someone's body and expect that person to never know who they are? It should be considered modesty rape when that happens. I just don't understand how such unethical things are allowed to happen this day and age.

 
At Tuesday, February 09, 2010 9:50:00 AM, Anonymous Anonymous said...

Horace, you are allowed your own opinion, however... Stating that thet majority of nurses get into nursing so they can look at naked people and fondle them is at best sensationalistic and without observable merit. That type of statement only detracts from the discussion-doesn't add to it. To me, the matter is the medical community should make an effort to accomadate those who object to opposite gender care ( for whatever reason). Though , I still contend it does matter in life and death situations-but those situations are so minute compared to all of the daily interaction between the medical community and the public that it is really beside the point. Personally, I just want good care and could not care less about the gender of the provider-but there should be an option for those who do care. I would think that the open market would take care of this problem-but obviously, it isn't yet doing so.

Dean

 
At Tuesday, February 09, 2010 10:45:00 AM, Anonymous Anonymous said...

A very interesting comment on that allnurses thread I mentioned a few posts back. The basic discussion is about nurse training and whether they do or should do procedures on themselves in training.

"I agree about something that is related to what you are saying, and that is the culture of nursing heavily reflects typical "female" values. I'm not gonna set myself up to be royally flamed by saying anything more about that, but if you imagine what some of these skills lab experiences would be like if 95% of students were male instead of female, it would be vastly different. In that sense there is institutionalized sexism, yes."

After that, the discussion got nasty and the staff shut it down. By the way, in this case I fully understand why they shut it down -- the discussion was getting out of control.

The topics of religion, race and gender are hot topics. One has to be careful. I've tried, tactfully, to point out in past posts the basic point the above comment is making. It's interesting -- no one, males nor females, question the fact the the American armed forces represent male cultural values and that the few females within that culture find it sometimes difficult to coexist. That's an accepted fact. The same could be true to other male dominated occupations -- firefighting, police work, prison guards, etc. We're always reading about this "institutionalized" sexism when it comes to male dominated occupations.

But when one suggests that a work force, like nursing, that's 95 percent female, may promote female cultural values that may result in closed, sometimes sexist attitudes, one sometimes gets shut down. As we've discussed on this thread -- the gender imbalance in nursing is a major contributor to the unwelcome feeling some men feel when they enter this society.
Don't misunderstand me -- I said "some" men. Those on this thread that are seriously against any kind of opposite gender care for themselves, must recognize that:
1. Some men and women prefer opposite gender care for many different reasons.
2. Some men and women are indifferent to the gender of the caregiver.
3. Some men and women would just prefer not to know who's doing what to them when they are unconscious. That's their survival strategy, the way they confront and deal with embarrassment.
There's nothing wrong with any of these attitudes, just as there's nothing wrong or pathological about people who want same gender care.
And, I must personally reject the comment from an anonymous poster: " I think a large percentage get into nursing for the nudity and genital fondling." People are free to hold their own opinions. But that opinion is so far from my view of this issue that I feel I have very little in common with this individual. We must just agree to disagree.
Here's the thread I'm referring to, if you're interested:
http://allnurses.com/general-nursing-student/bathing-classmates-other-452358-page15.html#post4115684

MER

 
At Tuesday, February 09, 2010 11:31:00 AM, Anonymous Anonymous said...

The Michael Jackson autopsy report leak shows that the medical community doesn’t have any respect for your privacy or modesty even after you are dead. Isn’t a person’s medical information and details about the intimate parts of their body private even when they are dead? What does reporting that MJ was uncirc’d got to do with the cause of death? Heard it on the radio last night and again today.

Dwight

 
At Tuesday, February 09, 2010 12:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Good point Dwight but I understand that a coroner's autopsy report is a governmental public record and especially so if the record is to be used in a court prosecution. Sorry, when one is a subject for the coroner, there is no privacy or HIPAA regulations. What you should ask is of what significance is it to the public to know whether the deceased had been circumcised. Ethically, I would want to know what intent or motivation has led the news media to broadcast that particular information. I frankly would have like to know how black were the lungs of an individual who probably lived most of his life in Southern California's smog environment. ..Maurice.

 
At Tuesday, February 09, 2010 1:41:00 PM, Anonymous Anonymous said...

I want same gender care simply because I dont like women. No other motive, no other agenda, I simply dont want anything to do with them.

My motive is irrelevant, it is my wish which is paramount. I would not consent to any procedure which involved women in the room while I am undressed.

Women now have it ALL their own way, political correctness, positive discrimination etc, we have exceeded their right to equality by quite some way. It is about time we took stock and decided enough is enough.

 
At Tuesday, February 09, 2010 2:12:00 PM, Blogger Rev.FRED said...

Making another call to the urologist's office to verify that I heard right the safeguarding of patient dignity, the woman answering the phone, was the office manager, who instantly recognized my voice. Reiterating that the female nurse is never in the room when the doctor is with the male patient, and that intimate procedures are performed by him alone, she stressed that she didn't know what more she could say to explain this policy. She reminded me, the I face a different scenario in the hospital, which will need to be negotiated with the doctor. Relating that I shared his position, without mention of name or location on this medical blog, and some of the positive feedback received, she couldn't believe that her boss's practice is at all unusual! Finding another website which supplies information regarding physicians, the source states that this urologist has been in practice for 30 years. I will share a detailed outcome of my appointment set for two weeks from today. Without a co-pay for any office visit, the initial appointment to a specialist is very pricey--but it will be worth every penny of investment.-REV.FRED

 
At Tuesday, February 09, 2010 3:57:00 PM, Blogger Maurice Bernstein, M.D. said...

MC Kean wrote the following today to our closed Volume 29 but I thought the comment and particularly the value of the link made it important to copy and publish on this active Volume. What do you think? ..Maurice.

Someone said, "Every patient has the right to control what care they receive and from whom - all they have to do is assert them." Just wanted to set the record straight. Surgery, colonoscopy, most any intimate procedure done under conscious or full sedation is an opportunity for medical staff to have their way rather than follow your orders. Here is the most useful tool I have ever found in the last two years of research post my own repeated violation to the point where I have serious PTSD. It is a very useful "List of Patient Orders" written by a surgeon who also happens to be an informed consent advocate. You can simply copy and check off what you want. It also gives you hints as to concerns you should have, but do not know you should have. Anyway, hope this helps.

http://www.informedconsent.org/orders.html

 
At Tuesday, February 09, 2010 4:43:00 PM, Anonymous Anonymous said...

Some of that list is standard and should absolutely take place. No questions asked. Other items wouldn't even be remotely considered. This eye surgeon should know that. It is irresponsible to suggest that all these things can and will take place. It is setting patients up to fail with unrealistic expectations. Hand this in and no surgeon or hospital would ever accept them as a patient without crossing out quite a few items on the list. Some of it is flat out false. It's frightening if a medical doctor actually wrote it.

 
At Tuesday, February 09, 2010 5:54:00 PM, Anonymous Anonymous said...

So try to help us instead. What can we expect will be honored on a list like this?

 
At Tuesday, February 09, 2010 9:08:00 PM, Anonymous Anonymous said...

They will do nothing. At the very best you'll get lied to.

Good luck Rev. Fred. You will be in my thoughts and prayers for a great result and a victory of hope that there are people out there who "do get it!".
gd

 
At Wednesday, February 10, 2010 8:40:00 AM, Blogger swf said...

To Anon 1:41PM

Has there ever been an instance(s) where you had to negotiate intimate care? (Such as Rev. Fred is facing, or colonoscopy, or pre-operative prep)
And, was simply saying "no" enough to get all male staff for these proceedures? If not, it would be nice to share your tactics with other men on this blog so they would know how to negotiate these options too.
Personally, whether you like women or not is not my concern, but your knack for always getting all male care would be interesting.

 
At Wednesday, February 10, 2010 2:39:00 PM, Anonymous Anonymous said...

Maurice,
If there is such paranoia that something unethical will be done to the patient while unconscious, is there any reason why operations cannot be done with an epidural? I think that would be a better request than giving a list of demands.
NP

 
At Wednesday, February 10, 2010 3:02:00 PM, Anonymous Anonymous said...

AMR


Regarding the sparks case,according to one witness she struck a patients genitals several
times repeatedly and stated "bad boy,bad boy." Apparently,an anesthiologist who witnessed this
back tracked and denied it.
Personally,I feel this case
should have been treated as a
criminal case and everyone involved
should have been interrogated and
polygraphed.As I previously mentioned,it speaks volumes with
regards to ethics or better yet
the lack of it.


PT

 
At Wednesday, February 10, 2010 3:33:00 PM, Anonymous Anonymous said...

SWF


I find it very concerning that
one has to "negotiate" intimate
care. Do women have to negotiate for female mammographers?. There is
no need to,why should men? Patients
have the right to refuse medical care and the right to decide who
provides it.


An example,suppose you are in the emergency room or on a patient care floor. A female nurse
enters your room and states that she needs to insert a foley catheter. You ask who ordered it
and why. Personally,i'd refuse a catheter unless it was an absolute
emergency for reasons of infection
and it is an established fact that
many foley catheters are unncessary.
Yet,to make my point I'll
continue with "I'd like a male nurse to provide the intimate care"
at which point she should comply professionaly and state "I'll get
you a male nurse for the procedure." On the other hand she
might return with her charge nurse
and/or state that I'm capable and
professional.
Your response to this is
"I never said you were unprofessional,I've had one too many experiences of unprofessionalism and by the way,
that's what the last female nurse said." I'm absolutely certain you've never encountered a male
mammographer have you,why are we having this conversation!"

That should end it right there,
does the waitress argue with you how you want your steak cooked. No
patient have have to argue with their caregiver on what makes them
comfortable and if so they should
be reported.


PT

 
At Wednesday, February 10, 2010 3:41:00 PM, Blogger Maurice Bernstein, M.D. said...

NP, as I have noted before on these threads, I have witnessed many surgeries (including with my medical students) and NEVER have I seen any unprofessional or criminal behavior that has been discussed here. I have watched draping and undraping patients in a very careful manner to avoid unnecessary exposure and to prevent chilling. I wish, instead of moaning and groaning about what is thought might be happening when the patient is in the OR, I wish it were possible for my visitors to actually see for themselves as I have. Of course, rare unprofessional behavior as exceptions to my observations still occur and those who act in this manner should be punished.

As far as use of epidural anesthesia is concerned, that would depend on the anatomical location of the operation (e.g. at what spinal level), the pathology the duration of the surgery and other factors relative to the medical status of the patient. ..Maurice.

 
At Wednesday, February 10, 2010 3:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Oops! With regard to my previous "NEVER", I have to take that back. I think I have noted somewhere on this blog that I, as an intern on orthopedic surgery, was at the operating table during the operation when a surgeon got angry with one of the nurses at the table and threw a scalpel at her, fortunately missing her. My introduction to surgery! ..Maurice.

 
At Wednesday, February 10, 2010 4:23:00 PM, Anonymous Anonymous said...

Some surgeries can be done with an epidural, NP. It depends on the surgery site as well as a few other health factors. It can be a nice alternative for the right patient.

Dr. Lisa

 
At Wednesday, February 10, 2010 7:59:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, considering the occurrence of a conscious patient undergoing an epidural block anesthesia interesting questions arise pertinent to the discussions having been presented here.

While lying on the operating table and able communicate verbally if desired, what would or should be the actions of the patient, if fully awake and not also sedated? Would it be simply to observe what is being done to him or her and to observe who is there and their activities and monitor their behaviors but not to speak out during the surgery itself? Should the patient have the opportunity to ask questions, or make requests or make statements and give orders? And, if so, in what context: issues of self-modesty, unpleasant behavior of others in the room or, in fact, dealing with the operative procedure itself? In other words, how will "being awake" be used by the patient? ..Maurice.

 
At Thursday, February 11, 2010 7:31:00 AM, Blogger swf said...

PT:

I think I have said all along that I agree with that theory. I agree whether you are male or female, in all instances in life where someone has assumed entitlements to your body, it doen't make it so. Whether in or out of the medical system, up to and including actions in daily life, just because someone WANTS to do something to us, doesn't mean we have to let them. Many many people have a problem not only with modesty, but also the presumed force of misplaced power regarding the actions of people who simply assume that because it is alright with them it is alright with us.
I have also all along said that our bodies belong to us, and perhaps the last area where one might feel that ownership (of your body) is the only thing that you can really count on in life..everything else can be taken or lost through no fault of our own.
But, if it were that simple we wouldn't need this blog or any others. In the meantime we do find ourselves in the position of negotiating, explaining, and defending the very rights of ownership and access to our body.
And, many women here see that the playing field of rights are not equal at all, which is why I advocate strongly for men and their right to say no.
So NO, in a perfect world we should not have to negotiate such things, but since we do.......
if the ANON has techniques to acomplishing all male care then there is nothing wrong with asking them to enlighten us. They can choose to not help advocacy if they want.

 
At Thursday, February 11, 2010 10:08:00 AM, Anonymous Anonymous said...

Good question, Maurice. My guess, and it's only a guess, is that most patients would not want to be awake and unsedated during any kind of extensive or serious surgery. I've had minor surgery where I've been awake but sedated. A drape was pulled up in front of me so I couldn't see the operation. I'm not sure being awake and sedated was any better than being out. Being fully alert is one thing. But the sedation makes one feel light headed and out of it enough so you're not really with it.
Those on this thread who have real issues with being unconscious without an advocate may want to be awake and alert. But I don't think that's the case with most people. I've found a significant number of patients who are clear that they don't want to know what's going on. They trust their surgeon enough they believe he/she will not allow anything unethical to happen. And I believe that will be the case the vast majority of the time. I know. I know. There are exceptions. But they are exceptions. And I also accept the fact that when these exceptions happen, too many of those other medical professionals who observe it are unwilling to report it. Sad, but true.
MER

 
At Thursday, February 11, 2010 10:48:00 AM, Blogger Hexanchus said...

Dr. Bernstein,

You wrote "In other words, how will "being awake" be used by the patient?"

The location, i.e. the operating room, has no bearing on any of the rights of a conscious, awake patient to ask questions, make decisions, etc. regarding their medical treatment. This is probably why many surgeons prefer the patient to be under general anesthesia or sedated, even for minor procedures where it isn't at all necessary - they don't want to have to deal with it.

Regional or local anesthesia, or a combination thereof, are viable alternatives for many types of surgery, not just the minor stuff. There's a surgeon in India that has performed over 400 open heart surgeries, including CABG's and valve replacements on bypass, on wide awake patients using a combination thoracic epidural and local anesthesia.

If a patient wants to consider the alternative of regional/local anesthesia, it's something that needs to be discussed with the surgeon ahead of time.

 
At Thursday, February 11, 2010 4:00:00 PM, Anonymous Anonymous said...

A humorous article about paper gowns, why doctors use them and why patients hate them.

http://blogs.webmd.com/all-ears/2006/11/paper-or-cloth-examination-gowns.html

 
At Thursday, February 11, 2010 5:39:00 PM, Anonymous Anonymous said...

Patients getting an epidural would be sedated but not completely under. It should be enough to keep them free of anxiety and agitation.

Dr. Lisa

 
At Thursday, February 11, 2010 10:48:00 PM, Blogger Hexanchus said...

Dr. Lisa,

You wrote "Patients getting an epidural would be sedated but not completely under. It should be enough to keep them free of anxiety and agitation."

This is not necessarily true, and I say this from personal experience. Over the last 35 years I've had four surgeries that involved a combination of regional and/or local anesthesia, and had no sedation of any kind for any of them - I was completely wide awake and alert.

In each case I discussed it ahead of time with the surgeon, and once they understood my reasons for refusing sedation, they were fine with it.

 
At Friday, February 12, 2010 8:08:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous wrote the following this morning. I deleted the attached link which currently goes only to a list of advertisers. ..Maurice.

Maternity patients having C Section are not sedated at all. It is an extremely vulnerable time due to restraints placed on arms, a body that won't move. You are at their disposal and many women suffer pscyhological damage from having their gown removed for prepping in front of the entire OR team without being told.

 
At Friday, February 12, 2010 3:32:00 PM, Anonymous Anonymous said...

Horrible story and an extreme example but it is another scenario where staff stood up for patients and paid a price. For as long as there is retribution many will be afraid to speak out against the ills they witness. The only good thing is that his name is out there and it serves as a warning to patients in town just like the Dr. Sparks case did. The problem is that it is still not enough.

http://www.nytimes.com/2010/02/12/us/12nurses.html?ref=todayspaper

Dr. Lisa

 
At Friday, February 12, 2010 4:10:00 PM, Anonymous Anonymous said...

The gown really doesn't need to be completely removed for a c-section. I have only witnessed the gown being moved up high under the bust so the breasts were never exposed. I'm sorry you weren't prepared and updated as things went along. You should have been.

Dr. Lisa

 
At Friday, February 12, 2010 4:18:00 PM, Anonymous Anonymous said...

I forgot to add a sedative wouldn't be given in a c-section. If one was needed they would wait until the baby was out.

Epidurals could be done without a sedative in other surgeries but my experience has been they give them something in IV prior to keep the patient calm. You could still be awake and alert even with the sedative. The goal wouldn't be to knock the patient out but that doesn't mean the sedative is mandatory. You could discuss it with your surgeon. Sorry for any confusion I caused, Hex.

Dr. Lisa

 
At Friday, February 12, 2010 5:46:00 PM, Anonymous Anonymous said...

I have had 3 c sections, but I have never had my arms restrained. I don't think many women realize that they actually are stripped and prepped. As of course you cannot see or feel anything. I only have learnt that this happens from this blog after the fact. However, I have to say that when it was being done to me, only the OR team necessary were around me. The others werw a respectable distance away.
NP.

 
At Friday, February 12, 2010 11:09:00 PM, Anonymous Anonymous said...

Dr Lisa,
With respect to Dr. Arafiles case, did the whistleblower speak to a lawyer before reporting to the medical board? The prosecution seems to have made two points of their case - one is she used confidential file numbers on patients while reporting and second is that she had a vendetta against the doctor. Would a lawyer have been able to counsel her into a safe way of reporting malpractice.

In India, our supreme courts have recently given an additional edge to doctors as far as malpractice suits are concerned. Previously, if a patient or their relatives wish to file a complaint against the doctors, the complaint must be studied and approved by a panel of doctors. Now, the supreme court has stated that a doctor is not responsible for death or any other adverse result on the patient because of his judgement unless he clearly showed incompetence in his care. That is, if a doctor took a decision that differed from another doctor's and the patient died, the doc is not responsible.

It is still too early to see what reaction patient advocate groups will have. But I can understand strong protests. Now, even if the doc made a mistake, he can't be prosecuted/punished etc unless it is proved that he is incompetent. On the other hand, this decision came due to the increasing number of cases against doctors by patients and their relatives. Everyone wants to sue their doctor even genuinely good doctors and now we end up here.

This probably has nothing to do with patient modesty but just wanted to share with you people in the US whats happening on the other side of this planet.
------SKI

 
At Saturday, February 13, 2010 3:26:00 AM, Anonymous Anonymous said...

"They trust their surgeon enough they believe he/she will not allow anything unethical to happen. And I believe that will be the case the vast majority of the time."

It depends on your definition of "nothing unethical". To me and many others, having any opposite gender person see or touch my private parts is unethical. I know I can't trust any doctor to keep that from happening.

Allowing female nurses, aides and techs to shave me, scrub me, disrobe me, dress me, bathe me, catheterize me and observe my body are all considered ethical to most if not all doctors and surgeans. When I express to them that I disagree I am considered crazy and a bad patient.

So I have to disagree with the notion that most doctors won't allow unethical things to happen to me. Even when he is aware of a patients feelings the doctor or surgean spends very little time with the patient and just turns him over to the nursing staff. To me that is like leading a lamb to the slaughter. Most head nurses I've heard of would just laugh at a sincere doctor anyway and do things their own way. The easy way.

 
At Saturday, February 13, 2010 8:00:00 AM, Anonymous Anonymous said...

I recently had knee surgery. They had me undress and put on a gown and when the nurse came back in, she handed me a pen and said to write "Yes" on the knee for surgery and "No" on the other.

I did as she instructed and also wrote "NO!" on my penis.

As I was recovering in my room afterwards, even though I was pretty foggy, several nurses came in to look and laugh. Ultimatly, I think every nurse on the floor knew about it.

 
At Sunday, February 14, 2010 12:37:00 AM, Anonymous Anonymous said...

Dr Maurice and Dr Lisa,
How would you feel about operating on conscious patients?
NP

 
At Sunday, February 14, 2010 9:53:00 AM, Blogger Maurice Bernstein, M.D. said...

I am not a surgeon but if I was removing a tumor from the brain of a patient, I would surely want the patient conscious so that I could be sure that I could communicate with the patient and have the patient respond so I could be sure I was not cutting out critical areas of brain sensation or motor function. ..Maurice.

 
At Sunday, February 14, 2010 2:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous sent the following today. I would advise going to the link to read about a newly designed patient gown. ..Maurice.

from the UK


http://news.bbc.co.uk/1/hi/health/8505625.stm

 
At Sunday, February 14, 2010 7:51:00 PM, Anonymous Anonymous said...

With healthcare facilities across
the nation continually looking to
save money, designer gowns are
certainly not on their list for
patient comfort.

Fact is,that is the last thing on
their list. Ever ask a major medical facility what they spend
on laundered items. Ask them what
they spend on scrubs just to maintain an adequate supply.That
dosent include linens such as sheets,blankets and pillow cases.


PT

 
At Sunday, February 14, 2010 9:34:00 PM, Anonymous Anonymous said...

Dr Maurice, I don't mean c sections or brain surgery when it is routine to be conscious. I mean if a patient has modesty issues or other trust issues with the medical profession. Would you, if you were a surgeon be OK with a patient wanting to be conscious?
NP

 
At Monday, February 15, 2010 12:07:00 AM, Anonymous Anonymous said...

PT --

The gown problem seems relatively simple -- at least to me. Every patient who considers this important purchases one or two of these modesty gowns and brings them with them to the clinic or hospital.
Simple. Here it is. This is what I'm wearing.
MER

 
At Monday, February 15, 2010 5:22:00 AM, Anonymous Anonymous said...

"The prosecution seems to have made two points of their case - one is she used confidential file numbers on patients while reporting and second is that she had a vendetta against the doctor."

Don't most nurses have vendettas against doctors? In my experience doctors and nurses go together as well as cats and mice.

 
At Monday, February 15, 2010 7:38:00 AM, Anonymous Anonymous said...

A conscious patient is no more in control than an unconscious patient. As a matter of fact, a conscious patient who has unexpected things happen to them that involve their modesty and they have expressed their concerns is much more likely to suffer psychological trauma.

Things happen so quickly that before you have a chance to react, your naked, humiliated, violated and furious. Some develop ptsd. These violations are akin to forced stripping in public.
gd

 
At Monday, February 15, 2010 8:00:00 AM, Anonymous Anonymous said...

http://www.danleemedical.com/index.asp?pageID=230&folderID=168

Danlee Medical sells 'modesty shorts" for exams and special colonoscopy shorts for frontal coverage. There are lots of online places to buy 'modesty gowns' made fuller cut and material that is not thin and practically see-thru.
I even found some (very old) sewing patterns to make your own.
Doctor's offices do not seem to have a problem with bringing your own, but I have not as yet tested the waters in a hospital.

 
At Monday, February 15, 2010 12:35:00 PM, Blogger Rev.FRED said...

Good new! The Council of American Islamic Relations has issued a fatwa (religious teaching), that it is morally unacceptable for Muslim men and women, to submit to airport body scanners. The ten high ranking scholars voted unanimously, upholding Islamic rules regarding nudity and the opposite gender, other than with one's spouse. The North American Council would be the equivalent to a House of Bishops. European Islamic ruling bodies are expected to re-enforce the position taken by the American conference. The Transportation Security Administration does make a concession and permits a physical pat down performed by TSA employees of the same gender as the passengers in a private screening area, available upon request. I plan on writing to the Islamic Council to applaud their action; it will create greater discussion in the society related to privacy and modesty. Some of you may want to follow-up with a commendation. Also, I will seek out a regional fundamentalist Muslim congregation, and inquire where its people have located doctors and hospitals, sensitive to their perspective on same gender patient care. Since I subscribe to a theo-centric worldview, it is my belief that God has sent increasing numbers of Muslims to Western nations, to challenge our post-Christian secular hedonism, which I am afraid has infiltrated the medical industry. The clash of civilizations is now being designated as the clash of sexual civilizations. I think I know who is going to win this show-down. I hope I live long enough, to see it come to pass.--REV.FRED

 
At Monday, February 15, 2010 8:53:00 PM, Blogger Suzy said...

Reading and participating in this blog has clarified something to me. Patient modesty seems to be a common reason why many people avoid medical care altogether.

It is certainly the reason why I have not seen a doctor in years. In my eyes, a doctor's office, clinic or hospital just isn't a safe place for me.

 
At Monday, February 15, 2010 9:40:00 PM, Blogger Maurice Bernstein, M.D. said...

NP wrote me yesterday "Dr Maurice... if a patient has modesty issues or other trust issues with the medical profession...Would you, if you were a surgeon be OK with a patient wanting to be conscious?"

As a physician of whatever specialty, I would want to do whatever is in my patient's best interest. Best interest would be determined by what the patient considered as for their own best interest and what evidence-based or established standards of practice allowed. I would try to accommodate the patient but if the patient insisted against evidence-based or standards of practice which could bring harm to the patient, I would not oblige the patient. Nobody ever told me that it was my professional duty to, without hesitation and in face of contra-indications, follow every request of a patient. NP, that is my answer to your question. ..Maurice.

 
At Monday, February 15, 2010 11:44:00 PM, Anonymous Anonymous said...

MER


I agree 100%,however,if
you ever have to make an emergency
visit to the ER you won't have that luxury. If I ever know in advance of some hospitalization
I'll bring my own pajamas.


PT

 
At Tuesday, February 16, 2010 12:08:00 AM, Anonymous Anonymous said...

Today I spoke with a nurse who had
a mammogram.At the completion of
her mammogram she recieved a red
rose. Apparently,every patient
recieves a red rose at this
particular hospital at the completion of their mammogram.
The overall ratio of female to
male breast cancer is 100 to 1.That
is slightly less than 1% of all
men will get breast cancer.Not to
mention some will in their lifetime
have gynecomastia,an increase in the amount of breast tissue. This
in itself often necessitates a
mammogram.
Now my question is this? Will a
male patient that needs a mammogram
at this hospital recieve a red rose
or will he just get stares in the
waiting room?
Lets reverse the roles and assume that for a moment there were
such a thing as a male mammographer.Do you still see the
female patients recieving a red rose from the male mammographer or
in our double standard society would that be inappropriate. No more so than for a male patient who
just underwent a prostate biopsy to
recieve a cigar from an all female
surgery team.


PT

 
At Tuesday, February 16, 2010 1:47:00 AM, Anonymous Anonymous said...

"The Council of American Islamic Relations has issued a fatwa (religious teaching), that it is morally unacceptable for Muslim men and women, to submit to airport body scanners."

It's nice to hear someone is standing up for our rights, but aren't Muslims the primary reason we have to have these anti-terrorist safety precautions? What's the point in screening everyone else when Muslims are the biggest worry? Maybe the authorities will realize that and not put the rest of us through it either. It's pointless.

 
At Tuesday, February 16, 2010 5:21:00 AM, Anonymous Anonymous said...

Rev Fred,
I am a little surprised to read your post. The religious practice of issuing Fatwas is a very often misused tool of strength among the Islamic clergy. Fatwas have been issued against education of girls, employment of women and various other aspects that may be an uplift to women and society. Islamic countries have horrendous human rights records and I have seen quite a bit of it here in India among the Muslim community. To welcome the trend of issuing fatwas into the US is something you might want to think over. In this particular case, it may be in line with the cause of patient modesty but the institutionalized suppression of women that is very common in Islamic society is very disturbing if you choose to read about it or get to know about it.
-----SKI

 
At Tuesday, February 16, 2010 9:32:00 AM, Blogger swf said...

Going back to being awake while in the OR. How effective is an awake patient? Is it because people feel that by being awake caregivers then are subject to greater accountability? I guess I'm really asking...once things are in motion, drapes are thrown up, and medication has started, how much control does one have? If opposite gender does enter the room, what is the time line to insist that the gender be changed before meds wear off and can/can't be started again? How many people are (really)willing to stop the entire process once started if they find that something has not gone as gender-planned? Has anyone here ever had to stop a situation once started?
It is one thing to control an office visit or facility. But once a proceedure begins, one has to be prepared in some way to handle changes and stay in control.

 
At Tuesday, February 16, 2010 9:44:00 AM, Anonymous Anonymous said...

I completely agree Suzy. I don't trust the medical community to do what's best for me or treat me with respect even when I'm conscious and alert. The only way they'll get me unconscious is if they take me to the ER in several pieces. Even then I know they won't treat my body with respect.

 
At Tuesday, February 16, 2010 11:13:00 AM, Anonymous Anonymous said...

A very interesting comment on an allnurse thread.

"This thread is a great reminder to think about how we deal with patients. It's so easy over time to get your standard phrases and responses that you use, that just roll off your tongue without even thinking about it. There are so many things I would do differently since having my mother go through terminal cancer. .. it's quite astonishing how rare it is to find a good nurse when you're on the patient/family side. The things that make someone a "good nurse" when you're sick aren't necessarily the same things you think when you're a nurse with no experience on the other side."

We've talked about these kinds of pat phrases used with modesty issues -- "We're all professionals, etc." Although there's nothing about modesty on this thread, you will see it demonstrated that nurses --
1. Do learn from personal experiences as a patient.
2. Are aware that some of the phrases they use may not be appropriate.
3. As a group are sensitive to how their patients feel.

Done correctly and civilly, it might work on occasion to remind them of this if they use one of those phrases on you. Of course, it depends upon the nurses tone and your tone as to how successful this interaction could be.

You can read this thread at:
http://allnurses.com/general-nursing-discussion/nursey-things-youll-456279.html
MER

 
At Tuesday, February 16, 2010 5:23:00 PM, Anonymous Anonymous said...

MER


My opinion of allnurses is
essentially this.They have in the
past assumed that they were a private and closed society.They
assumed that all that was said
was in secret from the public.
I have in the past seen posts
made that tested their thoughts
and as such poked holes in the
"we're all so professional" mentality when it came to attitudes
towards opposite gender care,etc.
That being said I'm sure you've noticed a change within their site in the last couple years. They have become wise in
that regards and are posting threads that project this so evolved and caring demeanor. Its
a rouse! I don't buy any of it.
Don't get me wrong,I'm not
disagreeing with your comments but
merely adding to them. Yes,they do
learn from personal experiences as
a patient but realize they let
everybody know they are a nurse when they are the patient and in essence that is their shield,their
security blanket so to speak as if
to say,you can't do the things to
me that I do to my patients!


PT

 
At Wednesday, February 17, 2010 8:37:00 AM, Anonymous Anonymous said...

can't I where a loose tube top for an ekg?? I hate being so exposed to anyone, even women and i'm a female!!!!

 
At Wednesday, February 17, 2010 7:14:00 PM, Blogger Rev.FRED said...

Islam, like any major religion, is characterized by local, regional, national, and cultural colorization. Catholicism in the U.S. is different than that which is practiced in Latin America, France, or the Congo. Agreed. For the North American Islamic Council to unanimously uphold the inappropriateness of requiring its male and female adherents to submit to full body scanning as a security measure, will create discussion of modesty issues in the wider society. Many nations with large Islamic populations would not have airport scanners, making this a matter for conversation. The ruling that men as well as women are not to be viewed by the opposite gender officers indicates that modesty is a concern for both sexes. If we are seeking to push the medical industry to address patient privacy and dignity, the presence of Muslims may force hospitals and health professionals to make accommodations, beneficial for us all. As with any cause, we need to enlist as many allies in our camp, as possible, if we seek a workable solution.-REV.FRED

 
At Thursday, February 18, 2010 7:54:00 AM, Anonymous Anonymous said...

The medical people want us to believe that it doen't count if we expose ourselves to them only other regular people? There are over 8 million of them! Cmon, where do we draw the line? My husbands body belongs to me and 4 million other women who want to get at it for a living? My body belongs to my husband any any man wearing scrubs?
Don't tell us anymore not to be jealous. They do not deserve the priviledge of taking our body away from us because they want to. What happened to our morals in america??

Genie

 
At Thursday, February 18, 2010 8:38:00 AM, Anonymous Anonymous said...

Rev Fred,
The Islamic clergy will issue against a fatwa against anything which breaks their hold over the community. They would issue a fatwa against you if they found you to be threat to their domination. An example:

In Islam, a virgin is promised a place in Paradise on death. So in Iran, virgin girls are not executed as they are. Why? Because the clergy find it appalling that someone they want to execute would go to paradise. The girls are married to a guard who then rapes them on the wedding night. The next day, the raped bride is no longer a virgin and can be executed without any complication. How convenient.

In a religion which is supposed to protect modesty, where is modesty now? If you wish to speak to members of the Muslim community, by all means do so. But, anyone who issues a fatwa is most likely a radical and if you wish to collaborate with them in your cause of patient modesty, all I can say is watch your back.

This blog is not a Muslim bashing blog and neither am I a Muslim basher. I just feel this cause would greatly benefit from level-headed thinking, tolerance and good sharp legal acumen. Radicalism will only trash it.
----SKI

 
At Thursday, February 18, 2010 11:13:00 AM, Anonymous Anonymous said...

I believe anyone can refuse the scanner and opt for a same gender pat down instead. Do what is more comfortable for you.

 
At Thursday, February 18, 2010 12:28:00 PM, Blogger amr said...

To anon who wrote "no" on his penis.

Ok, to be perfectly honest, I lol when I read your post. It is not the norm and people are people and they do gossip. It was out of the ordinary and that will be noted. It doesn't make it right. It is my guess that they mistook your writings to mean: "Don't operate here" vs what you probably meant was, do not touch.

What your post does do though in light of this blog is point out that:

1. Even with knee surgery, your body is exposed
2. "Woaa inappropriate" allnurses blog entry is again validated
3. This behavior clearly goes on all the time.

Dr. B. you have recently noted that you have never seen inappropriate behavior. Could it be that personnel are on their best behavior around you or your students. Also, could you put off a vibe that tells people they had better behave?


--amr

 
At Thursday, February 18, 2010 1:38:00 PM, Blogger swf said...

Is the '5 tips' where we should be commenting at the hospital site...and are they published as they are here? I do not see any, including yours Doctor. Perhaps I am just a bad navigator....

 
At Thursday, February 18, 2010 1:43:00 PM, Blogger Maurice Bernstein, M.D. said...

amr, I don't exude any particular vibes. I think that the reason I have not witnessed bad behavior of physicians is that though I admitted patients to the hospital, most of my activity was in the clinic setting. The ones that see bad or questionable physician behavior are the hospital nursing staff and I am sure those working in the operating rooms. By the way, bad behavior by doctors or nurses is a "no no" for the hospital accrediting Joint Commission. ..Maurice.

 
At Thursday, February 18, 2010 9:48:00 PM, Anonymous Anonymous said...

See,hear and speak no evil is
essentially the motto. Throwing
surgical instruments at least
among orthopaedists is commonplace.
I certainly would not want to be in that room let alone be the
patient.

Doctors have a horrible track record
www.news-medical.net/news/2004/09/02/4479.aspx


PT

 
At Friday, February 19, 2010 4:20:00 AM, Anonymous Anonymous said...

Rev Fred, I agree that any talk about patient modesty is good as long as it is positive.

amr, I know what you're saying. Why would a penis ever be seen at any time during a knee surgery? I had two ACL surgeries thirteen years ago and I was never seen in anything less than basketball shorts and no shirt. The shorts weren't my idea, I was told before both surgeries that I should wear shorts to the surgery under my gown. If his story is true why would even one person see what he had written on his penis? I wonder. It sounds like there was some under-handed (or under-gown) activity going on there. Interesting observations.

LG

 
At Friday, February 19, 2010 5:53:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY FEBRUARY 19, 2010 "PATIENT MODESTY: VOLUME 31 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 32

 

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