Bioethics Discussion Blog: Patient Modesty: Volume 36

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Monday, November 01, 2010

Patient Modesty: Volume 36

And the patient modesty issue continues with concerns about which gender is more at risk for modesty abuse and which healthcare provider and provider gender is doing or not doing what.
One solution to the concerns continues now to appear and that is the importance of any patient with modesty concerns to SPEAK UP to the providers and to the system. I can't believe that any patient should find it necessary to avoid a necessary medical workup and treatment because of concerns that their modesty issues will not be attended by the provider. If it ever should come to that, and according to some writing here it has, there is something drastically wrong with the system or perhaps the initiative of the patient to make their wishes known. ..Maurice.

p.s.- I haven't put up a graphic to symbolize the current discussions here. If any of my visitors have found one which would be appropriate and publication allowed with recognition of primary source, I will put it up. I am running out of ideas for a graphic here despite my Google-ing as of Volume 36 !

NOTICE: AS OF TODAY DECEMBER 4, 2010 "PATIENT MODESTY: VOLUME 36" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 37.

139 Comments:

At Monday, November 01, 2010 5:47:00 PM, Blogger Maurice Bernstein, M.D. said...

I find that I created this Patient Modesty: Volume 36 just in time since no comments written today will Blogger.com publish on Volume 35!

To begin this Volume, here is the comment from Anonymous earlier today which was not published on Volume 35.
..Maurice.


"Gladiators were tools for cruelty and entertainment"

Hmmm. For anyone who believes what they read in the allnurses blog and the Voy forums, cruelty and entertainment are very common activities with nurses and other hospital workers. I think gladiators and patients are more similar than you might think, or admit.


Many posters such as "Betsy RN", "Vera" and "Nurse Ratched" check in often and claim to be reputable nurses but they constantly brag about how much they exploit male patients (victims). Even our own "PT" often tells us of the victimization of male patients who he has personally seen suffer unneeded cruelty and humiliation at the hands of medical women, often for entertainment. I for one believe what he says. As for the others I've mentioned, they seem to know enough about nursing specifics and procedures to make me believe they have spent at least some time around hospitals, but I still take what they say with a grain of salt. But who knows, medical women seem to be able to get away with about anything.

 
At Monday, November 01, 2010 7:50:00 PM, Blogger Maurice Bernstein, M.D. said...

I deleted a comment by an Anonymous from Sunday Oct 31 2010 at 5:58 pm from Volume 35 in order to allow one posting of my notification but it didn't work so I am reproducing Anonymous comment here. ..Maurice.



At Sunday, October 31, 2010 5:58:00 PM, Anonymous said...
I don't know that i see a whole lot of similarity between gladiators and patients. All and all I think provider including nurses are compassionate people. I think its more of a case where overtime concern for patient modesty has been replaced concern for bottom line. It was determined female nurses taking care of male patients met less resistance than the other way around and thus the nurse imbalance evolved. Providers convinced others and themselves they were gender nuetral for what they thought was as much for our benefit as theirs when actually it was all for theirs. Gladiators were tools for cruelty and entertainment. Male modesty in paticular has become discounted, the question becomes how do you get enough people to stand up aganist it to facilitate change in a society. Especially difficult in an society that has a hard time seeing males as victims

 
At Tuesday, November 02, 2010 7:38:00 AM, Blogger Billy Rubin said...

Hi Dr. Mo--

I wanted to write something recently about assisted suicide & take issue with one of my former teachers, Dr. Loewy (though I took no issue with his teaching!) but never found the time to gather my thoughts. Just letting you know that we do read 'em out here but may not reply...

For this post, I want to sound a note of caution, because I think wondering aloud "which gender [sic] is more at risk for modesty abuse and which healthcare provider gender [sic] is doing or not doing what" almost sounds willfully ignorant, for the answer can only be that women are at greater risk of violations at the hands of male providers, and secondarily at the hands of female providers. It's a bit like asking who's at greater risk of being a victim of racism in this country--whites or blacks? Isn't the answer to that question obvious? Most people would agree that there are clear-cut examples of reverse racism, but to me it seems the height of silliness to take the isolated examples of whites being victimized by blacks and then asking who gets the short end of the stick in this country.

So too with sex discrimination and the practice of medicine. Reach back into medical history and you don't have to search too hard to find wholesale discrimination against women, often by virtue of their womanhood. You are familiar, I assume, with the state-instituted programs of mass sterilzations of supposedly "feeble-minded" women in the early 20th century as a means of improving the genetic stock of Americans, all of which is well documented in several scholarly works. There was some experimentation with castration, but not nearly to the same degree. And while that was a very long time ago and we've come a long way in terms of general medical ethics, I think it's clear that women still do not have equal standing (especially women from disadvanted backgrounds, economically and educationally) as men in society as a whole, so why should medicine be any different? There are a thousand subtle social signals communicated between doctor and patient about control and power, and those signals are modified to varying degrees by the sex, race, class and education of the participants. To be unaware of those signals can be dangerous for both patient and doctor, but especially for the patient, and doubly so if that patient is less likely to be treated by society as "powerful." I think as a doc you have to be constantly vigilant about that when you walk into a room with a patient, and as a male doc I try to be especially sensitive if I'm dealing with a female patient.

Only once in my career have I had to administer a rape examination, using the kits provided by the State for collection of evidence. It didn't take a genius to realize how difficult it must have been to realize how that patient was feeling after being violated so badly by a man to have yet another man place his hands on her naked and clearly vulnerable body in the sterile and cold confines of an exam room in the pursuit of evidence. She and I got through it together and I tried my very best to do it with as much gentleness as I could. But let me ask this: do you think it more likely that she would have been treated with empathy by a female or male provider? And as a second related question, if you could picture that kind of experience adding to her pain by her being treated badly or in a degrading manner (subtle or otherwise), does the picture that form in your head involve a male MD administering the exam or female MD?

I grant it's an extreme example, but I think there are a multitude of other situations where the signals are sublter and circumstances less dramatic, but the dynamic is fundamentally no different. To assume that this is a problem to the same degree with male patients in the hands of female doctors, nurses or techs is--and I hope I'm not overstating this point, but the word needs to be used--dangerous.
--br

 
At Tuesday, November 02, 2010 9:55:00 AM, Blogger Maurice Bernstein, M.D. said...

Alan wrote today the following to now closed Volume 35. ..Maurice.



Anonymous has left a new comment on your post "Patient Modesty: Volume 35":

I looked at the voy site sometime ago when it came up earlier. While we have no way of verifying it is pretty much a fetish site, one guy even complained some were taking the site to serious and ruining it. I recall the ones you referred to and felt they were not truely providers though I could be wrong. If I had the time I could go through the online medical videos and articles and give the impression I was a provider. The allnurse site has a vast majority of clinical posts which I think give it more validity. And yes there are a few rare posts of just plain cruel responses which are ususally met with criticism, and yes the site does reflect the basis of our complaints here including a double standard, often an us and them mentality, the God complex where they know best for us, the us and them approach for their care, and all sorts of things that I and others feel are wrong. I also see things that are encouraging, a segment of nurses who understand and care, who are symypathetic, I see some sticking up for patients modesty and rights. The biggest thing I see from the allnurse site is a disconnect between what they see as providing accomodation and what we want. They see themselves as gender nuetral we don't, they see using specific words, draping, etc as meeting our needs, we don't. And biggest of all in my opinion, they think its our duty to ask, we thing they should automatcially provide or ask us. There are exceptions of course, there are patients who I am sure are just crude, rude, and unreasonable. I don't want to be lumped in with them anymore than a nurse wants to be lumped in with the exception who intentionally inflicts pain on a patient for their own gratification. focusing on the fringe element doesnt accomplish the larger goal. Just my opinion I don't see providers as being overwhelmingly evil, mean spirited, or malicous. I see them as people who have evolved in a system that has traded patient welfare for bottom line and need to justify it, they don't recognize it, but in my opinion its there.alan

 
At Tuesday, November 02, 2010 10:12:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is a comment by gd written to now closed Volume 35 this morning. ..Maurice.


Everybody seems to be missing it. Cruel and degrading treatment is at the hands of both male and female personnel. Deviants from both genders gravitate to healthcare due to easy access and patient vulnerability.

This is both intolerable and what's really obscene is that the medical community has no formal disciplinary action plan for those who exhibit behaviors that are cruel and degrading to patients.

Due to the amount of damage that can occur to patients, it should be one strike you're out.
gd

 
At Tuesday, November 02, 2010 10:29:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is a comment by Doug/MER written to the now closed Volume 35 this morning. ..Maurice.


Over the years on this blog, I've read modesty complaints about treatment in the ER. I'm sure they happen, and in cases that are not life and death, doctors and nurses need to rexamine their actions. But in real life and death emergencies, modesty takes a back seat in the rush to save lives. I'm not making excuses. I'm just stating a fact. Too often, non medical people don't look at the these life and death situations the way medical professionals do. Don't misunderstand my position. In normal situations modesty needs to be a prime concern. But emergencies are another thing. If you doubt that, read the following article.

http://allnurses.com/nursing-articles/trauma-after-trauma-369379.html

Doug/MER

 
At Tuesday, November 02, 2010 10:33:00 AM, Anonymous Anonymous said...

alan writes: "The biggest thing I see from the allnurse site is a disconnect between what they see as providing accomodation and what we want. They see themselves as gender nuetral we don't..."

Over the years I've written for this and Dr. Sherman's blog, I've learned a lot. I've interviewed many caregivers, experienced care myself, read, researched. I've learned much about the caregiver point of view.

Yes, caregivers see themselves as gender neutral. They must. It's necessary for them to do the work they do. They're expected to work with both genders, sometimes in intimate ways. They can't do their jobs if they don't become comfortable with the bodies of both genders. As I've written on the new blog Dr. Sherman and I have, HOW caregivers become comfortable with bodies is the key. They use different strategies. Some strategies may protect them but make the patient feel less respected or humiliated. Other strategies may result in the patient feeling respected and empowered. Caregivers need to make sure they have a bag full of strategies. One size doesn't fit all.
Are caregivers truly gender neutral. No. None of us is. But caregivers need to make that their goal, their ideal. When caregivers say they are gender neutral, I think, they mean that "it" doesn't bother them anymore. Is that important. You bet! Few patients want a caregiver working on them who exhibits nervousness and fear about doing the job they have to do. That will not help the patient. But some caregivers think that just because they show no fear or nervousness -- that's all that matters to all patients. I think all patients expect that attitude as a given. But that may not be enough -- they may still want same gender care.
Having said that, don't think I'm rejecting basic elements of patient modesty. Caregivers still need to understand that their gender neutral position isn't the position of some patients. Most realize that. They need to realize that their gender neutral ideal is not an entitlement to infringe on the values of patients who don't feel comfortable with opposite gender care.
Doug/MER

 
At Tuesday, November 02, 2010 12:37:00 PM, Anonymous Anonymous said...

br Thank you for your very well put comments regarding female vulnerability in healthcare. I can't wait to see what PT says about this.

Doug/Mer,

I don't necessarily agree with you that medical treatment comes first. Bottom line, what's more important to the patient who values their mental health more than their physical health? The way that the medical system works, sometimes a choice needs to be made. Lawfully, that choice needs to be respected due to competent individuals given right to refuse treatmet.

Someone with a history of sexual abuse would rather be dead than be subjected to opposite gender care where bodily exposure is involved based on the way they feel; they don't want to feel degraded and there's nothing any medical professional can do, no matter how well meaning, how competent that can change this person's view of their world based on their experience nor their feelings of such an experienc.

Also, who is anyone to judge the mental torment that individual might feel based on forced care by opposite gender personnel. To a sexual assault/abuse victim, it's just another sexual assault.

Furthermore, respecting wishes enables those who feel this strongly to go back to healthcare rather than avoid it at all cost.
gd

 
At Tuesday, November 02, 2010 3:54:00 PM, Anonymous Anonymous said...

Dr Bernstein, do you know of any doctor or nurse that had disciplinary action taken against their license for careless/neglectful/deliberate exposure of a patient when it wasn’t medically necessary? If not then maybe the medical community just doesn’t think that it’s that big of a deal and we aren’t going to be taken seriously. I looked at a few of these and didn’t see any.

http://www.bne.state.tx.us/disciplinaryaction/recentaction.html

 
At Tuesday, November 02, 2010 4:26:00 PM, Blogger Joel Sherman said...

I'm not a believer in gender wars, but I think a reply to Billy Rubin's comment is in order.
Yes women are far more liable to assaults in medical situations than men are, but that is not the same as a modesty violation. Assaults are rare; modesty violations happen every day in every hospital. Assaults are criminal. There is no punishment for modesty violations. You are comparing apples to oranges. Everyone recognizes that assaults are illegal; modesty violations go under the wire. I'm against all modesty violations. I don't know how you quantitate them either as what one patient is offended by is perfectly acceptable to another.

Yes historically women have been subject to far more discrimination than men, but that hardly exists anymore in medicine. But the worst discrimination against men no one ever talks about. Tens of thousands of men have been slaughtered in useless wars while women in this country have remained safe. I'm not advocating that we even the score by putting women at the front lines, but the total picture is more complicated than your examples.

 
At Tuesday, November 02, 2010 5:10:00 PM, Anonymous Anonymous said...

gd -- We're talking apples and oranges. I'm talking about someone bring brought into an emergency room,dying, unconscious, unable to give any consent. Saving the life will come first for the doctors and nurses. If they're conscious and refuse treatment, okay. They have that right. But then medical personel must determine whether the patient's mental condition has been affected by their injury. I suppose we could all wear bracelets that say don't treat me even in an emergency if it requires taking off any clothes and exposing me. I suppose we could do that.
You're talking about normal situations in medical practice, and I agree with you about patient rights and autonomy, even if the result will be the patient's death.
But the example I gave was of an life and death emergency room encounter. In cases where people would rather be dead that be treated (for whatever reason), I grant them that right. I also have high expectations that the medical community should go out of their way to help people like that get the treatment they need.

And, my other post was about the gender neutral philosophy from what I see as the caregiver's point of view. They have points of view, too. Patients also have points of view. We all do. Let's try to meet in the middle when that's possible.
MER/Doug

 
At Tuesday, November 02, 2010 7:12:00 PM, Anonymous Anonymous said...

billy ruben, I agree completely with Dr. Sherman. Women are and have been the subject of sexual abuse many times more than males, One can not argue historically women have been the subject of discrimination far more often then males. However, while you may be able to argue as a result they are more sensitive to these issues, there is no way you can argue that females are subjected to violations of modesty more often then males. First off its simple math 95% of nurses are female, 75+ techs are female, 50%+ of all new graduates from med school are female. I have never in my entire life walked into a Dr.'s office and found a single male nurse working there. The most frequent complaint here involves opposite gender exposure. The gender embalance in support staff stacks the deck against males. Then there is the difference in the way male modesty is discounted by society in general as exemptlified in the double standard of reporters in the locker room and prison guard assignment. As far as I know the only case I am aware where discrimination in employment in the medical community is discriminating against males in L&D. So not areguement sexual abuse is far worse than modesty violations, they are as stated apples and oranges.

Doug/MER the problem is the gender nuetral argument while beneficial to providers also gives the an excuse for ignoring the patients point of perspective. The fact that they feel comfortable is great, unfortunately they are taught this makes us comfortable. They are not taught, while you may be comfortable caring for both genders, both genders may not be comfortable with you caring for them. That is the problem with the concept of gender nuetrality, it is focused on the provider not the patient, The fact that they feel comfortable treating both genders gives them an "excuse" for not even asking patients. Yes I want them to be comfortable with both genders for those who don't care, but not if it means they are so comfortable they forget about the fact that they should be focused on patient comfort first, not themselves. If you walked into a McD's and ordered a Big Mac with everything and the cashier said I think you would would be more comfortable with a quarter pounder. We would not take that attitude for a $1.25 burger but we are suppose to take it for something as personal as modesty. Its not about how providers feel its about how patients feel. Them being comfortable is important for us, us being comfortable is more important...if I have to choose, I choose me, I am paying the bill....alan

 
At Tuesday, November 02, 2010 8:31:00 PM, Anonymous Anonymous said...

I agree with Dr. Sherman about br's post -- but I must also say that's good to get another doctor on this blog. br is confusing basic modesty violations with assaults and crimes -- two different things. And he realizes this at the end when br grants that he's using extreme examples -- mass sterilization, rape, racism, castration, etc. Granted, men commit more violent crimes against women. Period. That's not a pleasant fact to admit, but it's true, currently and historically. But men are abused, too. As the Professor Roy F. Baumeister
writes in his speech "Is There Anything Good About Men," -- (http://www.psy.fsu.edu/~baumeistertice/goodaboutmen.htm) -- culture tends to use both men and women to it's own benefit. And you'll find men both at the top and at the bottom in most cultures.
br is quite revealing when writing: "I think as a doc you have to be constantly vigilant about that when you walk into a room with a patient, and as a male doc I try to be especially sensitive if I'm dealing with a female patient."
I'm not sure the reverse is as true, but I'm gratified to see br confronting the power dymanic that exists. Are female doctors and nurses "especially" sensitive treating male patients? I'm sure their sensitive, but "especially" sensitive? Male caregivers have much more at stake -- accusations that could quickly end their careers. Thus, the "especially."
Again, we're not talking about crimes here. We're talking about the day to day modesty violations, lack of concern for gender choices, that patients face within out health care system.
MER/Doug

 
At Wednesday, November 03, 2010 4:46:00 AM, Anonymous María said...

I would like to post a response to comments that alan, and PT have made.
To begin with women are not a "legally protected minority". Or are they? Of course they are! If they're healthcare workers, that is. To them the patient is the lowest form of life, and the very small improvements in modesty for women have not been the result of compassion, only the need to save money. Do you know why the tradition of all nurses being female started? Because they needed to pay them less, which was legal and even socially acceptable at the time. That is well documented, and not the product of feminist imagination. Just as there's a lot of misguided feminism that works against men, there's still a lot of chauvinism that works against women. In a real assault situation, physical sthrengt makes all the difference, and females are really at a disadvantadge. If she's a alone with a male caregiver that really wants to hurt her, she's stuck, while a male will stand a chance, and unlike us, that often don't want to make a fuss, will probably fight the abuse.
The reality is that females are accommodated only if they threaten to cancel procedures or take their business elsewhere, and even then they may still do what they want.
Personally, I'm sick and tired of trying to reason with them, to no avail. Since I heard about ER modesty violations, I ditched them too, and now I luckily have any healthcare whatsoever.
But what enrages me is that the opinion of entitled-mindes caregivers and their followers are so respected, while that of violated patients are not. It is not a matter of numbers, if somebody would parade naked in front of a ddozen nurses and doctors for a few more hours of life, there are others that think and feel they have the right to self determination and ownership of their own body even in the direst emergency.

 
At Wednesday, November 03, 2010 10:02:00 AM, Anonymous Anonymous said...

Thank you Dr Sherman, MER and alan. I feel exactly the same as you concerning br's comment, but I couldn't come up with the right words to share my thoughts. I loved the Big Mac example.

I know this may sound selfish but I'm not really concerned about how women were treated (medically speaking) at any time before I was born. I know they weren't treated as well as they should have been, and if I was talking to a woman from the past I would apologize for how my gender treated her. But the fact is, most women under the age of 50 or 60 never had to endure that unequal treatment. For a thirty year old nurse to complain about how unfairly women were treated 100 years ago doesn't make any sense because she herself likely never had to suffer the indignities her female ancestors had to suffer.

I can't argue against the fact that men can more easily overpower a woman to assault her, but like the other posters I don't think that has anything to do with medical modesty. As a patient, whether conscious or unconscious I don't worry about the possibility that a female nurse might try to get into my bed and force sexual intercourse with me. I can understand how that might be what many female patients are afraid of though. But if we were to compare the number of times a male healthcare worker forcibly raped a female patient to the amount of times that female nurses have inserted urinary catheters in men without their consent it's really no contest.

MER said "I suppose we could all wear bracelets that say don't treat me even in an emergency if it requires taking off any clothes and exposing me."

If that was possible MER I would do it. But I would change it to "Don't treat me even in an emergency if it requires taking off any clothes and exposing me IN FRONT OF WOMEN."

LL

 
At Wednesday, November 03, 2010 10:18:00 AM, Anonymous Anonymous said...

I think the term gender neutral is misleading. Its concept appears to mean different things to caregivers than patients.
To some gender neutral carries implications of androgynous, sexless creatures, able to disrobe gender at the door only to be donned later at will. We might envision eunuch type beings: trying to convince us that they can mentally castrate at will. We may be offended and feel demeaned: patronized because there is no such ability and it is an obvious self-serving con.
Gender neutral to caregivers may simply mean being comfortable working around either nude gender.
So to be fair to both, while most of us agree that medical encounters are not sexual, they are not sexless either.
As an adult woman, I too can be comfortable around either naked gender. It is not a special power, it is a fact of mentally growing up. But that does not mean that every person will be comfortable being naked in front of me.

swf

 
At Wednesday, November 03, 2010 10:45:00 AM, Anonymous Anonymous said...

Well stated María.

Over the last few weeks I have contacted by email eight of the Gastroenterology offices and departments in my area and asked a few simple questions about their colonoscopy procedure. Every one of them quickly sent me a cheerful reply, answering my questions and offering to set up an appointment. I then wrote back to ask about the gender of their nurses, anesthesiologists and technicians, and asked about the possibility of an all-male team. I got one reply that said it was impossible and one from a University hospital about two hundred miles away that said it was possible if I arranged it far ahead of time. The other six haven't sent a reply. The first time I contacted them (before asking about the genders) all of them replied either the same day or the next day, so two weeks later now I'm not expecting to hear from the other six.

Are these the extremes they'll go to in order to avoid answering our questions about gender and modesty? Apparently the subject is so taboo that they would rather lose patients than discuss the forbidden topic of medical modesty and equal rights.

GR

 
At Wednesday, November 03, 2010 10:47:00 AM, Anonymous Anonymous said...

Women are accomodated a majority of the time because numbers are on their side. This is a simple numbers game. If nurses make up 93%of the workforce of course most females and males will get female care. There are more female doctors these days so women have options in that area that didn't exist in the past.

In an emergency when conscious you can still deny care. If you are unconscious they will treat you as needed and appropriate under standard medical guidelines. ER doctors do have some leeway when a brain injury is suspected. In that event they can overrule the patient if they suspect the patient isn't of sound mind at the time.

 
At Wednesday, November 03, 2010 2:35:00 PM, Anonymous Anonymous said...

GR wrote: "Are these the extremes they'll go to in order to avoid answering our questions about gender and modesty? Apparently the subject is so taboo that they would rather lose patients than discuss the forbidden topic of medical modesty and equal rights."

Nice work, GR. That's the kind of advocacy we all need to do. And to answer your question, "yes," some in the health care system will avoid this issue. But not all. I've been surprised how many will talk about it.

But I would keep on those not answering your question. Remind them you haven't heard and expect the courtesy of an answer. Interestingly, they may want to accommodate you but can't and feel embarrassed that they have to tell you that.

If you do decide to go the hospital who offered you an all male team, let the others know why you're not going to them. Let them know why they're losing business. A while back, I made calls to some urologists asking if they had any male medical assistants. Most did and said they would accommodate males. One didn't, but said they had lost the one they had and were looking for one. Men need to be proactive. Let the business interests in the health care system know they'll either gain or lose your business depending how they respect your values. Business. Fortunately, or unfortunately, that seems to be what it's all about these days.
MER/Doug

 
At Wednesday, November 03, 2010 2:36:00 PM, Anonymous Anonymous said...

You should absolutely be able to get a male surgeon and anesthesiologist for your colonoscopy, GR. Neither of these should be an issue. Typically a colonoscopy can be done with three people in room and that would include the surgeon, anesthesiologist, and a nurse. Request no students of any sort to ensure your privacy. I would ask the surgeon directly how many people will be in the room during the procedure and if they are aware if males nurses are available in this area. They could aide you in your quest.

All should respond but if they can't meet your request it could fall to the wayside which is unfortunate and unprofessional. If they can't help you they should send you a quick email to let you know.

 
At Wednesday, November 03, 2010 3:37:00 PM, Anonymous Anonymous said...

I think an important related issue to modesty violations is how empowered nurses are(doctors, too,, but esp. nurses)in reporting these violations. If the "system" or the management punishes them, they won't report.The clinic or hospital culture must support the reporting of these violations. Read this recent article out of the UK:

"Will greater protection for whistleblowers change anything?"
(24 October, 2010)
by Dr Graham Pink who reflects on what’s changed since he became nursing’s best known whistleblower in the 1980s.
Make sure you read the comments after the article, especially the first one which contains a good example of the kind of modesty violation we're talking about on blogs like this. Here's the URL:
http://www.nursingtimes.net/opinion/the-image-of-nursing-the-unskilled-nurse/5020797.article
Doug/MER

 
At Wednesday, November 03, 2010 3:55:00 PM, Anonymous Anonymous said...

MER/Doug I could not agree with you more. I called a local hospital and told them I was looking for a place to get testicular ultrasound and was looking for a male tech, after they tried a little smoke and mirror with we have a male radiologist I asked would he do the procedure, they said no he would read the results. I asked again and they acknowledged they had two techs both female. I thanked them, left my contact info and told them I was going to the neighboring facility as they had a male but if they ever got one be sure to let me know so I could use them in the future. I copied and sent information on patient modesty garments including colonoscopy shorts to another local hospital, told them I had used another facility as I knew the staff at the hospital and was able to get male staff at the competitor. I told them if they would offer to provide them for patients I would use them for future procedures and surgeries. I don't expect that to change anything, just plant the seed. It doesn't seem like we are agble to organize on any significant scale, but we can each start planting the seeds....alan

 
At Thursday, November 04, 2010 1:00:00 AM, Anonymous Anonymous said...

Which would you consider more dear to you in privacy regards,a hipaa violation or a privacy violation such as an intrusion during a medical exam?

Hipaa,health insurance portability
and accountability act of 1996 which is enforced by the office of
civil rights.

The word "accountability". Holding medical facilities accountable for insuring your privacy as far as health information .

Imagine that! It takes a law passed by congress to make medical
facilities "accountable" to respect
your health information.

Imagine if congress passed a law
holding medical facilities
"accountable" for your privacy in
all respects.

I BELIEVE WE NEED ONE!

The hippocratic oath taken by
physicians states "I will respect
the privacy of my patients."

The nurses pledge"I will hold in
confidence all personal matters committed to my keeping in the practice of my calling."

The hospitals promise to patients
of "dignity and respect".

Am I missing something here or
maybe congress is the answer to these problems.


PT

 
At Thursday, November 04, 2010 7:53:00 AM, Anonymous Anonymous said...

Thanks MER, I think I will take your advice and try to keep in contact with the other 6 facilities. If they don't reply to any new emails I'll send them one last email to inform them that "so and so..." facility have promised me an all male team so thanks anyway. I already sent a reply to the University hospital that promised me an all male team and told them how impressed I was that they care so much for their patient's modesty and dignity, and soon I will request an appointment with them.

I think you're right alan. I don't know if I'm the first person to plant a seed at these facilities but I'd like to think I'm at least adding to the already planted seed.

Thanks for all the good advice.

GR

 
At Thursday, November 04, 2010 3:48:00 PM, Anonymous Anonymous said...

Recently hospitalized I needed an echo cardiogram and a stress echo. I arranged these tests through the hospital where I was treated.

When I arrived for my test, I was informed that the female tech had to go home. The male tech came out and offered a chaperone. I thanked him and refuse treatment. Then I wrote a letter to the department stating that not only did they lose my business for these tests, that all future tests would be provided elsewhere. Due to serious health issues, I'm always having expensive tests and if they took a look at my history in their computer, they would only see $$$$ that they lost.

Elsewhere was amazing in accommodating my needs. In response, I wrote a letter to everyone involved, thanking them and also sent a cc to the administrator of the hospital where I received an elegant reply.

Soon I will respond to his letter and request a meeting to advance this modesty issue, making perhaps this hospital the first to recognize the modesty issues and same gender care.
gd

 
At Thursday, November 04, 2010 8:22:00 PM, Anonymous Anonymous said...

Maybe the female tech had just become ill or had a family emergency so they offered a male and a chaperone for your comfort. Why were you so offended by that offer? It was how it should have been handled. You exercised your right to decline which is also completely acceptable. It seems you never had any issues with this place in the past and were happy with your care so your response is extreme in this matter. Why not just schedule again? Emergencies and illnesses do happen.

 
At Thursday, November 04, 2010 10:52:00 PM, Anonymous Anonymous said...

Is it any surprise the Cleveland Clinic comes up on top of many surveys of the best hospitals? They've recently come out with a new style gown for patients, one that acknowledges patient modesty concerns. In fact, at the end of the article I'll refer to here, one of the designers says that patient feedback is basically positive "with mixed feedback with the color. Men feel a little uncomfortable and feel it’s slightly feminine, which is something that surprised me and we’ll be addressing.”
So -- they're even addressing men's concerns here. Any wonder why the Cleveland Clinic gets so many positive reviews? Attention to detail. And patient modesty is not just a detail, but an important one. You'll find the article here:

http://www.newsweek.com/blogs/the-human-condition/2010/08/12/diane-von-furstenberg-s-newest-creation-hospital-gowns.html?from=rss
MER/Doug

 
At Friday, November 05, 2010 12:41:00 AM, Anonymous Anonymous said...

The extra coverage is a plus and room at the top was a great idea, but it's much to feminine a design and color for a man. They should have gone darker to accomodate both sexes or done one for each sex.

 
At Friday, November 05, 2010 1:46:00 AM, Anonymous Anonymous said...

Here's an article about a woman in Britain that drank anti-freeze and presented herself to an ER with a living will stating that she did not want to be saved and was "100 per cent aware of the consequences". The doctors were afraid of being charged with assault if they intervened and allowed her die. It appears the hospital has been cleared legally but there is public uproar about the incident.

I know the story seems a little off topic but to me it is an encouraging sign that indirectly helps the patient modesty cause. With all the chaos caused by this incident and the bad publicity directed towards that hospital I can't see how doctors anywhere could take this subject lightly.

I think it shows that if a patient in the ER or even in non-emergency situations refuses treatment because of opposite-gender patient modesty the hospital staff will do everything possible to get the job done to avoid bad publicity or worse. That may mean tying the patient's arms and legs to the gurney or simply finding same-gender caregivers.

Many people may not want to risk the chance that the hospital staff may just say "Fine, have it your way. There's the exit", but for those die-hard modesty supporters like myself I think it's worth the risk. Reading about all the problems the staff in that hospital in Britain gave themselves by not treating the suicide victim makes me believe a little more that by refusing to strip in front of women the ER staff will feel obligated to respect my modesty and will find a way to accommodate whether they want to or not.

What I wonder about the British woman is why she even showed up to the ER in the first place. She had to have been trying to make some kind of point with her public refusal. Or maybe she just wanted attention. I would love to see a local or even national story about a patient that refused emergency aide from someone of the opposite gender, and eventually the hospital staff was forced to accommodate. What great publicity that would give the patient modesty movement. Who knows, maybe you will all see me in the news soon.

http://www.dailymail.co.uk/news/article-1078439/Woman-swallowed-anti-freeze-dies-refusing-treatment--doctors-feared-assault-claim-saved-her.html

 
At Friday, November 05, 2010 7:25:00 AM, Blogger Joel Sherman said...

An article of mine on patient gender preferences for healthcare has just been published on KevinMD.com. This is a widely read medical blog. Please consider taking a look and adding a comment to increase awareness of the issue.

 
At Friday, November 05, 2010 9:35:00 AM, Blogger Maurice Bernstein, M.D. said...

Great article, Joel. It represents a good beginning to "spread the word"! ..Maurice.

 
At Friday, November 05, 2010 9:56:00 AM, Anonymous Anonymous said...

And a special thanks to Dr. Bernstein for being the first to make a positive comment at the end of that article. Having two doctors back this issue makes big difference on a blog like KevinMD.
Doug/MER

 
At Friday, November 05, 2010 10:01:00 AM, Blogger Maurice Bernstein, M.D. said...

Gosh Doug, thanks for the acknowledgment but I hope it isn't just "advocates for change" that go and read Joel's article, like you and me, but also all "the others". ..Maurice.

 
At Monday, November 08, 2010 4:47:00 PM, Anonymous Anonymous said...

Part 1 of 2

I was recently watching an episode of "Untold Stories of the ER." I had always wondered how they got informed consent from seriously injured or unconscious patients. What caught my attention in this episode was two black young men who had been shot. They were stripped and laid out fully exposed on the exam table as the filming went on -- the appropriate blurring, of course. Turns out they were involved in an alleged gang fight. So -- God help you in the ER if you're a young, African-male who, is assumed to be in a gang fight. There was absolute not attempt to dignify their treatment.

I did a little research. What I found out is shocking. Here's what the Joint Commission says about this filming in the ER:
" It is appropriate to film or videotape patient care activities in the emergency room, provided patients -- or their family members or surrogate decision makers -- give informed consent. In a situation where the patient is comatose or otherwise unable to give informed consent and no surrogate decision maker is available, the hospital may film or videotape itself or retain another to film or videotape patient care activities within a policy stating informed consent is required before that patient's film or videotape can be used for any purpose. Anyone who films or videotapes must sign an appropriate confidentiality commitment."
So -- basically, let's say you enter the emergency room alone with no friends or family. The ER can start filming right way with the intention of asking you later. Everything gets filmed. Everything.
Doug/MER

 
At Monday, November 08, 2010 4:48:00 PM, Anonymous Anonymous said...

Part 2 of 2

So -- what happens if they film you, later ask you for permission, and you say no. Here's what the Joint Commission says:
"The expectation is that the health care organization retains control of the film or videotape until consent is obtained. If consent is not given, then the patient is either removed from the film or videotape or the film or videotape are destroyed."
So -- the ER maintains control of the film, with the patient in it, even if the patient hasn't given informed consent. My interpretation is that the ER can rub out the patient's face and/or otherwise the patient ID, and then use the film however they want.
So -- what happens with "Untold Stories of the ER," I gather, is that the filming starts right away when an interesting case arrives. If relatives are available, they may give consent -- even if they are not listed in an advanced directive. Later the patient is asked for permission.
What if a patient says, not only do I not give you permission to use this film, but I would have never given you permission to film it in the first place? Apparently, patients don't have that right.
And, in all honesty, who really knows what happens to the film if the patient does not give consent. The patient has no control over it.
Here's the source for this information:
http://www.jointcommission.org/AccreditationPrograms/BehavioralHealthCare/Standards/09_FAQs/RI/Patient_Rights_and_Informed.htm
Doug/MER

 
At Monday, November 08, 2010 5:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Doug's printed URL to the Joint Commission may be difficult to use due to formatting issues. Here is an
active LINK to click on. ..Maurice.

 
At Monday, November 08, 2010 6:09:00 PM, Anonymous Anonymous said...

while I know it may not be representative of all nurses or even a majority of nurses but if you want to get a read on at least the attitude of a couple nurses go to all nurses and search I'm so embaressed. An apparently young nurse tells how she got excited/frustrated about a male patient she bathed who look like her ex. A nurse who goes by tyvin made the statement that "the majority of men of a mature age get into having young nurses bath them, they all have these fantasies" when challenged by another poster a nurse going under otanawarn not only sticks up for her but basically says its may be sexist but its true. She challenges the double standard and attacks the poster who challenges her. now this may be a minority of the way nurses feel, but none of the other nurses challenge them. If this has any basis of thought in the female nursing community, its no wonder men have such a problem getting treated with respect. Basically they are saying the majority of men are pervs...again may not be the feelings of many nurses, but they certainly were not condemned like a male making a comment like that...go read it, I couldn't comment but I should would have...the best you can say about these two nurses is they are sexist.

 
At Monday, November 08, 2010 8:02:00 PM, Blogger Hexanchus said...

Doug,

I had the opportunity several months ago to discuss this topic with a management level supervisor of a large local hospital.

He told me if the patient does not consent after the fact, the footage must be destroyed, or if part of a larger film or tape, all footage of that specific patient must be deleted in it's entirety. So no they can;t just blur the faces and use it anyway.

I was also told that if the patient or family objects in any way at the time of filming, all filming of that patient must stop immediately and any footage already recorded must be deleted/destroyed.

As with many things, the laws may vary from state to state, but that's how it is where I live.

 
At Monday, November 08, 2010 11:16:00 PM, Anonymous Anonymous said...

Thanks for that information, Hexanchus. I'm still not comfortable with the situation. Something tells me that ethically the default should be with patient privacy, not with the ER's needs outside saving that patient's life. What happens with programs like "Untold Stories of the ER," -- the patient becomes used for his or her entertainment value, not medical or educational value. And the patient becomes a prop to highlight and promote careers and reputations (of the doctors and hospitals).Does the show pay patients -- especially the ones that can't afford medical treatment? We rarely see the upper middle class or wealthy on those programs (unless they've been in, e.g. a car crash). It's almost the poor. It's like the voyeuristic qualities of all the reality prison shows -- like in the 18th and 19th century when people would pay to go on tours of insane asylums. Reality shows like that ER one make a lot of money because they don't have to pay huge salaries to name stars. That's why reality shows are so popular today. I do understand the need for educating ER doctors and nurses -- but the ethical question is what's the purpose of a a patient? Is he/she an human being with unique value, or a specimen or TV prop. And now, with the web and all, who knows how the films may be used by those few unscrupulous characters. These are the kinds of issues that concern me.
Doug/MER

 
At Tuesday, November 09, 2010 4:26:00 AM, Anonymous Anonymous said...

So, anytime "Untold Stories of the ER" and similar dramas, educational documentaries and in-house video documentation are filmed in the ER, the very least that can happen to an unconscious or unresponsive patient is that MANY non-medical people are allowed to go in and gawk at them and at least temporarily film them? Add that to the number of people that at one time or another get to see the video before it is erased, and the fact that patient modesty and respect is completely unheard of in ERs so there's no hesitance to strip the patient naked and lay him spread eagle in front of anyone that happens to wander by. I can't believe such unethical treatment is condoned in our supposedly "free" and moral society. Don't conscious patients or family members have enough problems to worry about than being forced to kick camera crews out of the room?

I know in many emergency cases the family may accompany the patients to the hospital but my guess is the majority are brought in and work begins before any family arrives. So it's pretty much guaranteed that filming will at least be started. I suppose nobody in the ER cares if the camera crew are the same gender as the naked, spread eagled patient either. UNBELIEVABLE!!!

If I was a spouse or family member that wanted so badly to be with my loved one while he/she is being treated, I would get pretty pissed off if a camera crew was allowed to go in to film it but I wasn't allowed inside during the ordeal. I'm afraid that if I arrived and found out a camera crew was there I would get very violent with them and anyone else that got in the way. Do you think a person can be blamed and punished legally if that were to happen?

I've also wondered about how ERs at or near medical teaching universities are handled. I assume medical and nursing students are allowed to help or observe in the ER. What's the informed consent situation like in those cases? I've heard that when patients voluntarily go to teaching hospitals they are often forced to allow students to observe or participate and are told "that's what happens when you go to a teaching hospital". That's disgusting enough already, but when patients are taken to the ER at those hospitals by ambulance or driven by someone else they usually don't have a choice about whether they want to go to a teaching hospital or not. Isn't it enough that they are victims of accidents or major health problems? Do they also have to be a victim of having unnecessary or unwanted students or camera crews gawking at them against their will, or what would be their will if they were conscious?

 
At Tuesday, November 09, 2010 4:55:00 AM, Anonymous Anonymous said...

"He told me if the patient does not consent after the fact, the footage must be destroyed..."

If that happened to me I would always wonder who had seen it and was it actually destroyed. Even more mental torture patients must go through along with the psychological torture they have already endured being stripped naked and seen and "handled" by a lot of opposite gender hospital workers. Do ANY healthcare professionals care about the psychological well-being of their patients?


"the majority of men of a mature age get into having young nurses bath them, they all have these fantasies"

I'm not of a "mature" age yet but I'm pretty sure that when I am I won't fantasize about being sexually assaulted by dirty perverts. That's not a fantasy to me, it's more like a nightmare.

Since we're sterotyping groups of people I'll add that my opinion is that "the majority of female nurses are whores." I know I couldn't post that or any of these arguments on allnurses.com because they delete any posts that make nurses look bad.

 
At Tuesday, November 09, 2010 7:50:00 AM, Anonymous Anonymous said...

I finally posted the article I mentioned a while ago on

http://patientmodestysolutions.blogspot.com/

As I said, it is the basics but I find more and more women who have honestly never considered male modesty. Some have mentioned it here.
So here is the opportunity to see things with equal eyes.
It's called "Yes Virginia: It's A Prostate Exam". Maybe some could give it a read and let me know if I represented the cause well?

swf

 
At Tuesday, November 09, 2010 10:14:00 AM, Anonymous Anonymous said...

Anonimous, to your comments that "nurses are whores", let me tell you that it depends o n how you define "whore". If by whore you mean sexual intent, or doing it all, no, they're not whores. I know what it really is to be one, for I've really been one.
I used to be friends in the past with a woman who is a nurse in he past (notice I say past), and I found her somewhat perverted. rather than control (what a man may seek) she enjyed the fact that she was allowed to see what no other woman could, unless they worked in the healthcare industry, of course. And she was very, very sexist, in he worst possible way (her comments about particularly "endowed" male patients have been, luckily for me, been witnessed). Of course the fact that I am discreet but have no intention of hiding my past sexual activity was an issue for her. She wanted to see it all without any of he physical and legal con sequences of a real sexual relationship (such as having to get naked herself)! Yes, it was different when she was the patient. And if a man did the same things, or have the same thoughts, he was a perv. More than anything, she was hypocritical.

 
At Tuesday, November 09, 2010 11:32:00 AM, Anonymous Anonymous said...

Here are some other issues I have about this ER filming situation.

-- Most patients don't know about these "rules." They learn about them, if at all, after the fact.
-- In the excitement and emotion of a real trauma, what patient or family member is in any condition to grant any kind of meaningful informed consent.
-- The informed consent should be for the filming to actually begin -- not for it to be maintained and used.
-- The way the Joint Commission words this policy -- "... the hospital may film or videotape itself or retain another to film or videotape patient care activities..." So, essentially, anyone can do the filming. That's how the TV shows get away with it.The hospital "retains" them to do the filming. Based upon that policy, the hospital could "retain" a high school or college film class to do the filming.
-- The Joint Commission policy also states: "In addition, anyone who films or videotapes must sign an appropriate confidentiality commitment." Wow! That makes me feel really comfortable. So -- they sign a paper. So what?
-- Copies of electronic files are easy to obtain these days, often produce multiple copies, and sometimes difficult to destroy. Note that most people don't relize that the newer photocopy machines have hard drives, and record everything that's copied. So, what happens to that machine when it's resold? How do hospital and medical offices make sure the private records of their patients are protected when they get new machines?
-- Relative to this ER issue, filmmakers can now stream what they're filming to a computer so that they're not only recording it on sight, but it's also being recorded on their computer hard drive.
This is an issue that needs to be taken up by legislative bodies in the various states and dealt with.
MER/Doug

 
At Tuesday, November 09, 2010 11:49:00 AM, Blogger Hexanchus said...

Doug,

FWIW, I agree with you completely. It exploits the patients' condition/misfortune to provide entertainment, and in no way directly benefits the patient. As you so clearly pointed out, the only ones it benefits are the media and the hospital.

I don't think filming in the ER or any other medical setting should be allowed without the patient's prior knowledge and approval, especially if it has no direct therapeutic benefit for the patient.

There is a way to sort of avoid it if your state has enacted the POLST paradigm. One of the benefits of the POLST is that you are automatically exempt from "trauma" treatment protocols if you so choose. Because it is a "physicians order" EMS, ER staff, etc. are legally bound to comply with it. Who wants to photograph someone they're not doing anything to.....there's no sensationalism in that.
.....................
Doctor B.,

I don't know if you've previously had a topic here on the POLST paradigm, but given that a significant number of states have signed on to it and more are considering it, it might be a good ethics topic if you haven't already done it.

 
At Tuesday, November 09, 2010 12:09:00 PM, Anonymous Anonymous said...

"Since we're sterotyping groups of people I'll add that my opinion is that "the majority of female nurses are whores."

I just want to distance myself from remarks like this. I'm an not sterotyping people. I'm writing about medical policies and how they can harm medical cultures. Individual people get caught up in these cultures. Call me naive. But I've always believes in the best of humanity, not the worse. I'm not suggesting the worst doesn't exist. But we as humans have the inner nature to be heroic. If someone like Anne Frank can write that she believed people are basically good at heart -- I suppose I can believe that, too.
As far as nurses go, I have great faith and confidence in nurses as a group. They're not perfect. None of us is. I've been clear in the past about my concerns with the nursing profession, but nurses as a group are intelligent, caring and talented people.
I won't let remarks like the one above go by with comment.
Doug/MER

 
At Tuesday, November 09, 2010 1:01:00 PM, Anonymous Anonymous said...

http://allnurses.com/general-nursing-discussion/im-so-embarrassed-514748-page2.html

here's the quote.
"Not to get off the subject at hand but the majority of normal heterosexual male patients of mature age will be or are excited about the prospect of a young female giving them a bed bath; this is a common fantasy when men are in the hospital. Be careful as that guy sounds like a real looooooser."

There were a few comments by an offended poster, but yet again they were warned about deleting further comments.
This is the kind of thing that makes everyone mistrust female nurses.

 
At Tuesday, November 09, 2010 2:34:00 PM, Blogger Maurice Bernstein, M.D. said...

I first want to make it clear that I am against filming or videotaping any activity in a hospital emergency room except 1)for use only in hospital staff education and procedure/safety monitoring. 2)No hospital should permit the recording except as performed by established hospital staff who have usual admission to the emergency room.

From the Joint Commission (at the link previously provided here):
"Can staff of a health care organization film or videotape patient care activities in the Emergency Department?

A. Yes. It is appropriate to film or videotape patient care activities in the emergency room, provided patients -- or their family members or surrogate decision makers -- give informed consent.


It is my opinion that "staff" means "staff" and NOT visitors who sign a confidentiality agreement.

Obviously, hospitals don't consider the emergency room (beyond the waiting room area) a public place since in recent years with HIPAA privacy regulations you will not see the name of patients written on
the room activity boards.

Medical and nursing students are permitted to be present but on individual session approval of the hospital administration for education purposes.

While it might be cheaper for TV movies for whatever purpose to be filmed in a hospital emergency room, I think that patient privacy trumps any such use of the hospital ER and filming can be just a realistic using "standardized patients" in a movie set with a good script to go by. ..Maurice.

 
At Tuesday, November 09, 2010 2:59:00 PM, Anonymous Anonymous said...

My biggest issue with the taping is that it can begin BEFORE the patient or family member can give consent. That's wrong. Taping shouldn't be allowed to begin unless and until consent is obtained.

I also have concerns about the word "staff." I would want clarification on that as I interpret it as Dr. Bernstein does. I do however wonder if in this instance "staff" is being used to cover camera crews as it isn't clear just who is involved and how the filming occurs.

Dr. Lisa

 
At Tuesday, November 09, 2010 3:56:00 PM, Anonymous Anonymous said...

THE truely disturbing part of the allnurse thread is not that the two nurses are so obviously sexist, and so obviously demeaning of males, its that none of the other nurses appear to care or hold themm accountable. Many nurses have problems and are so vocal about stereotypes against nurses, some address the issue of stereotyping male nurses, but they seem fine with stereotyping male patients. Anyone have any idea how to bring this to the nursing associations or allnurse readers. i would truley like to know, is this a widely held opinion of nurses. I am stunned no one except one guy seemed troubled or challenged them. As a 50 something male, I really don;t know that I want to go to a hospital if this is how I am viewed. It's really troubling..anyone know how to respond to this, any nurse out there that can post this question on allnurses?...is this wide spread and why wasn't it challenged if it isnt.alan

 
At Tuesday, November 09, 2010 4:12:00 PM, Anonymous Anonymous said...

Dr. Bernstein wrote: "It is my opinion that "staff" means "staff" and NOT visitors who sign a confidentiality agreement."

I disagree with your interpretation, Maurice At the very least, the Joint Commission policy is ambiguous. Here's what the Joint Commission says:
"...the hospital may film or videotape itself or retain another to film or videotape patient care activities within a policy stating informed consent is required before that patient's film or videotape can be used for any purpose. Anyone who films or videotapes must sign an appropriate confidentiality commitment."

Let's take their comments apart. Basically, we've got two entities mentioned here -- "the hospital" and "another," those they "retain." The "hospital" represents the "staff," the professionals, who must follow certain rules and are under professional codes of conduct. The "another," those the hospital "retains," are not professionals, not under any codes of conduct. That's why the Joint Commission then goes on to say that those "retained" must sign an "appropriate confidentiality commitment." Why would they require the film crew to sign these documents if they were already required to maintain confidentially as hospital staff?
No. The hospital, under Joint Commission policy, is allowed to hire just about anyone to do the filming as long as those retained sign those confidentiality documents.
That's why we see all these ER reality shows with real footage. The hospitals, as the Joint Commission allows, "retains" the TV film crew to do the filming. The crew signs the statements of confidentiality. There are probably other contractual agreements that shares the film itself with the hospital -- so the hospital can use it for training and the film crew can use to to make money.
You're right, Maurice. The "staff" has the right to do the filming, but the "staff" also as the right to "retain" others who are not "staff" to do the filming.
Doug/MER

 
At Tuesday, November 09, 2010 9:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Doug, I don't consider "visitor filmers" even signing confidential agreement papers "staff". And if the Joint Commission considers them "staff" I totally disagree.

By the way, the responses by the Joint Commission is NOT LAW. It would be the Commission's own standards of behavior of a hospital which if followed "to the letter" will provide "safety" to the patient and prevent the Commission from denying the hospital federal funds (Medicare and Medicaid).

Though there may be some benefit for the public to view hospital emergency room activities (since in a sense the public might want to see what their federal funds are accomplishing), I think the presentation of this information to the public is biased by the producer and director since it most like is edited and bears some scripted dialog as an interpretation of what is going on.
So the public will never really see the raw emergency room activity and value with these videos.

"Staff" who are really not staff should stay out of the ER unless, of course, they are the patient! ..Maurice.

 
At Wednesday, November 10, 2010 12:08:00 AM, Blogger Maurice Bernstein, M.D. said...

With regard to POLST,(Physician's Orders for Life Sustaining Treatment) it represents a physician's order which is written and approved by the patient or patient's surrogate based on the patient's wishes at the time it was prepared. When the patient enters the hospital, it is immediately looked upon as a written order for that admission. A POLST, however, is not immutable. It can be changed by the patient or surrogate if the conditions at the time of admission or during the hospitalization changes which no longer represents the condition of the patient anticipated when the POLST was originally written. The new POLST would then be followed and continued upon discharge. It is different than an Advance Directive which is something that is written by the patient and is not itself a physician's order. As I noted the POLST is an order written by the physician with the patient's signed approval and even if the physician is not on the staff of the hospital, it is just as official and is to be carried out just as if it was an in-hospital order written by a staff physician.

The content and intent of the POLST truly deals with life supportive treatment issues. However, reading the California state POLST, if an individual did not want trauma treatment even if appropriate, under the category "Medical Interventions" the physician could check the category "Do not transfer to the hospital for medical interventions" and that should do it..unfortunately only if the individual was carrying a copy of the POLST on their person and readily available to the paramedics. I hope this answers Doug's interest in POLST. ..Maurice.

 
At Wednesday, November 10, 2010 3:19:00 AM, Anonymous Anonymous said...

Very enlightening. I will add No Filming Permitted to that Medic Alert Bracelet.

Found a bracelet that has a screw on top and paper that folds over itself.
This can hold lots of information including your wishes.
gd

 
At Wednesday, November 10, 2010 4:40:00 AM, Anonymous Anonymous said...

Doug/MER,

I wasn't referring to you or anyone else when I posted about what I think about nurses, I was simply agreeing with the anon that posted about that disgusting string on allnurses.com. My point was that we can stereotype nurses just as easily as they can stereotype male patients, based on what we have personally seen and experienced. In my small amount of experience in hospitals I have learned that nurses are the enemy.


So if I understand correctly, anyone can be accepted into the ER to film if they sign a confidentiality agreement? Do medical staff really have the power to exploit their patients for entertainment value? Do you think the hospital gets paid to allow this filming? If so, why don't the "stars" of the show get any of the money? I thought I had heard of most of the unethical things that happen to patients in hospitals, but this is a new low.

 
At Wednesday, November 10, 2010 8:52:00 AM, Anonymous Anonymous said...

Dr. Bernstein, as I recall your wife was a nurse at one time? Is that correct? Would she be able to share anything on the issue. Is it a widely held opinion that men of a "mature" age enjoy, even seek young nurses bathing them and such. Its hard for me to believe this is anymore than a fringe minority at best, but perhaps its one of those stereotypes that has been promoted through the nursing community and is bascially unspoken. The attitude toward male nurses also makes one pause and consider.
Filming in the ER is just blatantly the facility putting their benefit before the patient. To allow this happen to a patient while they are helpless and there for help, often fighting for their life is just unethical no matter how you cut it. Wishard in Indianapolis was featured in one. I wrote to the facility and expressed my disquest that they would allow this, no reply. I don't know if it's editing or permission issue, or what, but if you watch the show you will often see males laid out naked with blurring of the private area with no attempt to put even a towel over them, I don't think I have ever seen a female displayed like that though they do on occasion expose parts which they blurr during treatment. I don't know if that is anywhere close to reality or not. It is TV afterall and its about them and entertainment and of course...money. Regardless, filiming in this way violates everything they claim they are about, patients and doing no harm to patients...truely sad it reflects poorly on the profession as a whole.....alan

 
At Wednesday, November 10, 2010 10:34:00 AM, Blogger Hexanchus said...

Doctor B.,

I was the one that brought up the POLST, not Doug. Fortunately, most states have now implemented POLST registries so you don't necessarily need to carry the document with you - all you need is a medic alert bracelet, wallet card or something similar with POLST and your registration number. EMS can then verify with a quick radio call.

The only two boxes checked on mine under medical interventions are:
Comfort measures only
Do not transfer to hospital for medical interventions

 
At Wednesday, November 10, 2010 10:35:00 AM, Blogger Joel Sherman said...

To remind people, the topic of ER videos has been taken up before on prior discussions here and I have devoted a full topic on my blog to it which summarizes what we've discussed. That includes comments by a man who claimed to be part of the filming crew. The filming crew gets to see all the raw footage. No prior consent is obtained.
Only very few hospitals do this. I'd never go to them. Not surprisingly they are usually in high crime urban areas.

 
At Wednesday, November 10, 2010 11:06:00 AM, Blogger Hexanchus said...

Dr. Bernstein,

You wrote:
"Though there may be some benefit for the public to view hospital emergency room activities (since in a sense the public might want to see what their federal funds are accomplishing), I think the presentation of this information to the public is biased by the producer and director since it most like is edited and bears some scripted dialog as an interpretation of what is going on."

The reality is that there is a significant segment of the "public" that is fascinated by the macabre - as the saying in the media industry goes, "If it bleeds, it leads." They couldn't care less about about any supposed benefit to the public. To them it's all about ratings and market share. Things like truth, honor, respect and "doing what is right" have taken a back seat to sensationalism and getting the story at any cost.

 
At Wednesday, November 10, 2010 11:52:00 AM, Anonymous María said...

MER,
I wasn´t talking about you, or anyone in this blog, just about a sadistic mindset that enjoys control and even humilliation. And female nurses are so guilty as charged as are men. Please I beg you, don't be naive. You still don't believe me??? refuse the same female caregiver twice, and she'll throw a temper tamtrum. This happens with female as patients as well. And Heaven forbids you have an argument with them, because you will almost certainly face retaliation.

 
At Wednesday, November 10, 2010 5:16:00 PM, Anonymous Anonymous said...

Maria and others:
I don't take those comments personally. I just won't be a part of Ad hominem attacks and name calling. It's counterproductive to what we're trying to accomplish. If there are nurses that behave as you say, and I'm sure there are some, they need to be reported, and perhaps fired. That's patient abuse and bullying. We need to be trying to empower patients so they know their rights and will not be intimidated. Patients and their advocates (parents, spouses, friends, relatives) do have some responsibilities. They need to actually read those Patient Bill of Rights documents they're handed, and read the core values of the hospitals they enter. Bullies are cowards. They have no courage. They are extremely insecure. All it really takes is for them to face someone who recognizes them as a bully, confronts them about it, won't back down, and is willing to go over their head and report it. They'll run and hide like the cowards they are. We all owe it to each other to report these bullies. And nurses who observe this kind of behavior not only owe it to the patients to report it, but they also owe it to their profession.

That's a big part of the problem. The medical culture in this country doesn't encourage or support whistle blowers. They give lip service to it but it doesn't happen in reality. I'm not excusing not reporting. But the reality is that good careers can end, years of study and practice can be over quickly, reputations can be ruined. This unhealthy culture must change. And patients, by reporting these incidents, can help change this culture.

I;m writing an article about patient modesty and hospital core values and bills of rights on the blog Dr. Sherman and I started. It should be up in a day or two. Stay tuned.
Mer/Doug

 
At Wednesday, November 10, 2010 10:03:00 PM, Blogger Maurice Bernstein, M.D. said...

Hexanchus, you write "The only two boxes checked on mine [POLST] under medical interventions are:
Comfort measures only
Do not transfer to hospital for medical interventions."

Did you realize what you are rejecting in your request? Let's say you were in an auto accident and were in shock but had an easily reversible surgically treated injury and the shock could not be fully reversed by IV fluids given by the paramedics. Yes, this was a life-threatening condition and you needed life-sustaining treatment for a full recovery. What would your POLST order mean to the paramedics on the scene? Yes, they could give you comfort measures but not restorative treatment without hospitalization. ..Maurice.

 
At Wednesday, November 10, 2010 11:24:00 PM, Blogger Hexanchus said...

Maurice,

I guess I should clarify, our form is slightly different, but the intent is pretty similar. There are 4 sections.
A. CPR
B. Medical Interventions
C. Antibiotics
D. Artificially Administered Nutrition

My selections are:
A - Do not attempt CPR - allow natural death
B - Comfort Measures Only - Patient prefers no transport to hospital for life sustaining treatment. Transfer only if comfort needs cannot be met in current location.
C - No Antibiotics
D - No artificial nutrition by tube

In answer to your question, yes I do fully understand what these selections mean - my PCP and I discussed it thoroughly before executing the POLST. To further qualify, I am middle aged, in reasonably decent health with some chronic but no immediately life threatening conditions. The choices I have made are strictly based on and consistent with my personal beliefs, values and philosophy of life.

My primary reason is to avoid field interventions such as CPR in the event of an MI, which statistically in terms of survival to discharge, is an exercise in futility. I am equally opposed to intubation, and would not consent to it under any circumstances for any reason.

Yes there is some risk in a scenario such as you describe, but all things considered, I am willing to accept that risk in order to gain the protections from unwanted interventions.

 
At Thursday, November 11, 2010 9:48:00 AM, Anonymous Anonymous said...

I want to point out an interesting article about "empathy" written for health care professionals on KevinMD. It's very well done. Here'as a quote from it:

"Patients need understanding and guidance. They need to learn that it’s okay to ask questions and to take charge. They need to learn that they can be empowered, proactive and in charge of their health and well-being no matter who they are. While some patients are savvy, there are patients who feel intimidated to be assertive. They don’t know how to ask questions or to speak up, but they can learn. As professionals we can help them. We can guide them and encourage them to take to charge of their health care."

There are enlightened providers out there who recognize what I talked about in my last post. And note that this article is written by a nurse. As a group,they're much more in touch with this modesty issue. Many recognize that the medical professionals need to take the lead in helping patients speak up and become empowered. Here's the link to this article:
http://www.kevinmd.com/blog/2010/11/deeply-connect-engage-patients-empathy.html
Doug/MER

 
At Friday, November 12, 2010 10:14:00 AM, Anonymous Anonymous said...

Check out my new article -- CORE VALUES AND PATIENT RIGHTS & RESPONSIBILITIES: WHAT THEY “SAY” ABOUT PATIENT MODESTY. Any comments are welcome. You'll find other article about patient modesty on this site by myself and Dr. Joel Sherman.
You'll find it here:
http://patientprivacyreview.blogspot.com/
Doug/MER

 
At Sunday, November 14, 2010 4:07:00 PM, Blogger Maurice Bernstein, M.D. said...

I am carrying on the arguments presented here on to the physician-restricted discussion pages on Medscape. We have had so few physicians give their opinions here on my blog thread that I think it would be appropriate to publish an anonymous response by a urologist on Medscape to a statement of mine to them to give you all at least some professional view.

I wrote, paraphrasing your comments:
"Further, they feel that they have no full control over 'who is watching' when they are sedated and then have amnesia after the procedure about what went on and who was there."

The urologist responded:
"Often times they don't, and appropriately so. In the OR, for example, the day is set based on teams and a carefully prepared schedule. If patient X comes in requesting a male or female or heterosexual or bisexual or black or white... well, sorry. You get the team that has been assigned to that room with that surgeon. That team will be relieved by whoever is relieving them. This is not a la carte service here. Trying to make such accommodations would result in greatly diminished quality of care for everyone."

Now you all may say "well, the quality of care includes attention to patient modesty patient emotional feelings and patient's request."

But I must also defend the urologist since I know that primarily "quality of care for everyone" means safety and clinical benefit" and not gender requests when such requests may be impossible to accommodate and still preserve patient safety and clinical benefit of the procedure.

I have invited physicians to come here to this thread and write directly to us. I hope they do. ..Maurice.

 
At Sunday, November 14, 2010 5:14:00 PM, Anonymous Anonymous said...

Thank you Dr. B, and I hope that they respond too. I would hate that the respected and valued team of doctors take the 'take what you can get' attitude, Because we don't. And we auffer without care. And that should matter to doctors. If it does'nt matter then that is the tale of a selfish empire.

 
At Sunday, November 14, 2010 9:37:00 PM, Anonymous Anonymous said...

"If patient X comes in requesting a male or female or heterosexual or bisexual or black or white..."

I am in great awe of the technical skills and medical knowledge doctor's have. And I can see the point that this doctor is making. But, I am not as impressed with some of the physician communication and thinking skills I encounter. Look at the above statement.

This doctor is equating racial discrimination with patient privacy and modesty. I've gone over this many times. It's not the same. Even the courts have recognized the difference. The cases are easy to find online so I won't waste my time reviewing them now. Saying one wants to be exposed only before a particular gender for private (or religious) reasons is not the same as saying "I don't want a black (or white or Jewish, or Muslim) treating me because I think they are inferior." That's racism. The vast majority of patients who requests same gender care will pleasantly agree to opposite gender care for non intimate procedures.
I'm not sure whether this doctor is just confused, or if he is using the "race" card because it then tends to put patients requesting modesty on the "dark" side. It equates their modesty feelings with racism. Either way, he can make his case without using such faulty reasoning.
Having said that, I personally think expecting same gender OR teams is not reasonable. Still, I don't see much empathy from doctors like this one -- it's as if he's saying just take it or leave it. No need to explain things to the patient. Or Empathaize. Appears like he's not willing to make any attempts to discuss this with patients to try to mitigate their feelings. It's the modesty as a "non issue" attitude, boarding on the old doctor as "God" attitude. At least, that's how his words read to me. I'm not saying that's he's that kind of person he is -- but that how he appears in print.
MER/Doug

 
At Monday, November 15, 2010 4:17:00 AM, Anonymous Anonymous said...

First, I want to qualify my last comment. When I say I believe a same gender team is not reasonable, (most surgeons are still men) I'm talking about complicated surgeries. I'm not talking about office procedures where a doctor may need an assistant, basic exams, etc. Secondly, I reject the "we must follow the schedule" as a general rule that negates any kind of accommodation to patient gender preference. I can see that argument slip from serious, complex surgery (ER, etc.) into any kind of gender accommodation. Third, I'm assuming that that this doctor assumes that neither gender will be accommodated in this regard. Once you open it to one gender, then it becomes a matter of gender equity. Finally, again -- we seem to slip into the OR or ER -- the extreme during this modesty argument. I would like to see how this doctor's OR attitude fits into his overall attitude toward gender preference for patients for intimate exams and procedures. How does he feel about patient preference for provider gender choice in general. Just af ew things to bring up, Maurice, for your discussion. I'm looking forward to hearing this doctor's reply.
MER/Doug

 
At Monday, November 15, 2010 4:46:00 AM, Anonymous Anonymous said...

Perhaps the real issue is that if our privacy were respected and procedures were put into place for private draping, exposure, perhaps patients would be less emphatic about same gender care.

It's the lack of trust based on patient experience and in some cases abuse that has caused this issue to become huge.

The attitude of the doctor posted above is arrogant and I do not place doctors in high esteem. Some are as intelligent as the rest of us; some not. Book learned doesn't mean smart.

A smart doctor recognizes the mental health of patient healing, the privacy of everyone (not just them when they are the patient) and a smart doctor validates patient rights and humane treatment in healthcare. Exposing patients against their will is not humane.
gd

 
At Monday, November 15, 2010 12:06:00 PM, Anonymous Anonymous said...

The doctor was blunt in his response but I also think very honest in his reply. The OR does work in teams and they aren't going to be moving people from their specialties because one person wants male and another female. As breaks come about or shifts end they are covered by other people which makes it even harder to guarante same gender care. Add in that there might be more male surgeons and anesthesiologists and less males on the nursing end and it gets even harder to meet the needs of both.

I do however think the doctor should hear his patients out and explain wy things are as they are in a kind and compassionate manner. Patients deserve to be heard and treated with respect. If they can't be accomodated patients should be told so they can make the decision if they want to proceed or look elsewhere.

In the office setting you could ask for no chaperone and that should be accomodated. I would think the doctor wouldn't have a problem with that. As far as procedures go there are some that need assistance and I don't know who they have on staff.

 
At Monday, November 15, 2010 12:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Notwithstanding all the comments here with a negative and perhaps hopeless tone, it is encouraging to find doctors who are thinking, expressing and acting in the best interest of all their patients, particularly with regard to patient modesty. The following is from an article in eMedicine titled "Techniques of Local Anesthesia for Prostate Procedures and Biopsies" (updated Aug. 18, 2009)
Under the title "Patient Preparation and Positoning" are the following advice:


"Patient comfort is an important factor in transrectal ultrasound-guided prostate biopsy. Respect for the patient's modesty is medicolegally advisable. The following methods are helpful in providing comfort for the patient:


Placing sheets over the patient's legs to allow him to feel some control over an embarrassing situation


Designing the examining room layout to minimize the chance of someone opening the door and seeing the patient in an embarrassing position


Positioning the examining table so that the patient's private body areas are not visible from the door


Having doors that open in a manner that prevents the patient from being seen by a visitor until the door is completely opened (provides a time delay for any misdirected visitor to stop if errantly entering the room)


Having curtains in front of the door so that the patient feels less vulnerable


Setting the temperature of the examining room at a level that accommodates a partially clothed patient"

Now it is simply the matter of carrying out this advice. ..Maurice.

 
At Monday, November 15, 2010 3:06:00 PM, Anonymous Anonymous said...

Please explain this one, Maurice:

"Having doors that open in a manner that prevents the patient from being seen by a visitor until the door is completely opened (provides a time delay for any misdirected visitor to stop if errantly entering the room)"

They're talking about the OR, right? Who might a "visitor" be? Or a "misdirected visitor?" This does show attention to the issue, but I don't quite understand the context of the statement above.
Doug/MER

 
At Monday, November 15, 2010 3:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Doug, although I can't answer your question for sure, the entire article was about for prostate biopsy via the rectal route under local anesthesia and the segment I copied was about positioning of the patient. I would assume this procedure could be carried out in a small non-operating room environment which might be just off a hallway where clinic visitors were passing. You are correct though with regard to operating rooms since in the usual operating room environment, casual visitors don't wander in the adjacent hallways and those individuals who are present must be properly gowned. ..Maurice.

 
At Tuesday, November 16, 2010 10:26:00 AM, Anonymous Anonymous said...

Yes, Maurice, it is encouraging to see this addressed in an article. On the other hand, it seems unbelievable to many outside the medical profession that these common sense behaviors have to be codified. I would suggest this of both hospitals and patients.
HOSPITALS -- On your web page, have photos of some of the exam rooms to give patients a good idea of the kind of privacy you offer. Show them the curtains, where the door is, how the exam table is arranged. Make it clear on the website that you respect their privacy and modesty and will protect them. Encourage patients to talk with you about their feelings. Bring this topic out into the open.
PATIENTS -- If you are able, ask for and visit the specific room where the procedure will take place. Look yourself for these privacy/modesty protections. Make sure they're in place. Discuss the conditions under which you'll feel comfortable with the procedure with those in charge. Don't be led around with a ring through your nose. Take charge.
Doug/MER

 
At Tuesday, November 16, 2010 11:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Doug, I have a question for you and the others here and it deals with a point I have repeatedly made both here and on the other sites where I have written. And it all is related to the practicality of the medical system to respond to patient's gender requests regarding medical/surgical attention. However, with regard to the question I am about to pose, I doubt anyone really has the answer.

Statistically, how representative of the entire male patient population (let's say in the United States) are the responses to the patient modesty issue on this blog?
As you can easily see over these 36 or so volumes, virtually all comments are in favor of gender selection of a spectrum of healthcare providers who are performing a spectrum of duties (though most involve modesty sensitive areas of the body).

Now, how does this apply to change in the system to the benefit of these male patient? Well, if the number of men with the patient modesty concerns posted here was small, in fact a tiny portion of all the male patients, there would be little impact, if much at all, on the medical care system but also these men would be consider statistical outliers and their requests probably wouldn't be acknowledged. But what if what is written here is representative of a huge proportion of all male patients and if this was known by the medical system it would make a giant impact on attention to these men but a significant impairment of the system's care process at this time if the request were attempted to be followed.

So this is analogous to a medical disease and prognosis that we physicians regularly deal with. We can' make a diagnosis nor present the patient with an outlook for the future without facts. In the case of patient modesty issues as presented on this blog and elsewhere, the question is "what are the facts"? As you see and can consider from my comments above, the statistical facts are critical in predicting what may happen. Does anyone know the statistical facts and I mean facts not guesswork? ..Maurice.

 
At Tuesday, November 16, 2010 12:32:00 PM, Anonymous Anonymous said...

"Does anyone know the statistical facts and I mean facts not guesswork?"

I have more to say about your comments which I'll post later -- but to answer the question above. The answer is "no," There are some studies that have been quoted throughout the volumes. But I haven't found a study that is representative. Most are poorly done and focus on a specific area. Most surveys involve women's health. Modesty is very contextual, which I'll get into more in a later post. You won't get the answers with simple pencil and paper surveys. You need to have detailed interviews, case histories along with the simple surveys. That takes time and money and the real interest in the issue. That interest, within the medical profession, doesn't seem to exist. The best studies I've found have been done by sociologists.
MER/Doug

 
At Wednesday, November 17, 2010 11:30:00 AM, Anonymous Anonymous said...

"Placing sheets over the patient's legs to allow him to feel some control over an embarrassing situation"

That just doesn't make any sense to me, unless the patient is cold. Seems like every excuse I've heard from "professionals" about the patient being seen naked say they're never naked because their legs, arms, chest or back might be partially covered. I can understand a woman wanting her chest covered, but does anybody really feel better with the opposite gender staring at and touching their privates by having their legs or arms covered? There might be some patients who are overweight or covered with acne or rashes that might feel better being covered, but does anyone here care if their bare arms or legs are covered?

I like the curtains idea and the door situation just seems like common sense. But if any healthcare professional actually does care about their patient's well-being the only answer is getting same-gender caregivers.

 
At Thursday, November 18, 2010 5:13:00 AM, Anonymous Anonymous said...

For anyone who has donned a hospital gown sans all other clothing, there is a feeling of nakedness, vulnerability. You would feel quite naked also if your entire body were exposed only covered by a small piece of cloth over strategic areas.

Covering the legs and only exposing a small area (even if it is an intimate one) disembodies the exposed atomical part. Covering the legs gives the patient the sense that their dignity is being perserved, reinforces the medical aspect of the exposure and might make said patient feel less vulnerable; less naked.
gd

 
At Thursday, November 18, 2010 8:33:00 AM, Blogger Lilly said...

This is a routine in hospital, but still do not know why, suppose that is hygienic but really do not think it a degradation or humillacioon, I think first of all health care is paramount and if for them is more comfortable, and take good care of the patient's back.

Lilly Abbott
Findrxonline

 
At Thursday, November 18, 2010 10:37:00 AM, Anonymous María said...

gd, I think you're actually wrong, being all covered except for a body part (the genitalia, I guess?) actually draws attention to that part... Why do you think that strippers keep their privates covered right until the shocking moment of exposing them???
This issue only highlights the lack of respect medical providers give human nudity, and is not going to be solved until the very real reasons for always using (or wanting to use) same gender caregivers are acnowdledged.

 
At Thursday, November 18, 2010 3:07:00 PM, Anonymous Anonymous said...

Everyone has a right to their feelings about what they need to feel comfortable. It's not about right or wrong. It's all a matter of perception, previous experience and what makes a patient feel comfortable. Everyone's perceptions are different. For you, it's wrong; for someone else it might be right.
This is a very complicated issue.
gd

 
At Thursday, November 18, 2010 4:12:00 PM, Anonymous Anonymous said...

If a patient wasn't draped during exams they would be nude from the waist down. A drape in a pelvic exam would frontally cover the genitals but leave them uncovered as needed. Same is done in uro exams. The patients shouldn't be left nude. There is no reason for it. Both sexes should be draped regardless of same or opposite gender care.

 
At Friday, November 19, 2010 12:48:00 PM, Anonymous Anonymous said...

I have seen video's of the transrectal and read read men's accounts of going through it. It never really struck me until this thread how this proceedure and womens pelvic exams are handled differently. While I have never had one I had a vasectomy and two scrotal ultra sounds and have never been draped of even offered a gown. Just told to strip from the waist down and aly on the table. On the other had every thing I have seen shows women draped with a blanket that creates a "tent" over their legs and bottom. Once again, if a male urologist would do this and have the nurse stand at the head of the patient it might provide a little comfort or feeling of some respect for privancy vs just being laid out there for all to see. Dr. Bernstein are all transrectals done in stirups or are some done on the patients side? A friend of mine had a scope of his bladder, talked about how humiliated he was when the young nurse started to prep him by injecting numbing solution into his penis, then excused herself and returned with a second older female nurse and explained, sorry I have never done this before and wanted to make sure I got it right...seems like the little things that COULD be done by the Dr. aren't for times sake vs patients benefit. Slightly off the subject but related to the perception of male modesty. There is an article on msn about the airport screening, there was a cartoon with a female screener, two female and one male traveler behind the scanning screen. The two females were trying to cover themselves, the male was holding his coat open with a big smile and a black out strip placed over his privates...just another subtle indication of at least part of the problem for men.

 
At Sunday, November 21, 2010 10:31:00 PM, Anonymous Anonymous said...

Spend any time on a general nursing
floor and you will see how things
are often played out. A group of nursing students are asked to pick a patient. The first to be picked
are 1) young male patients.
2) middle aged patients
And last to be picked are the elderly,obese with psych issues.
Never fails.

It took the commamnder,a full bird
colonel of the army mepcom to issue
commands that people are to recieve
privacy during medical inducton
exams. Dosen't that seem absolutely absurd. That a colonel
with no medical training needed
to tell physicians to respect the
privacy of his patients.
Think ahout how pathetic it must
sound that these physicians simply
could not do their job.

Look at the number of level 1 trauma patients who as young men
are often never covered up after
the trauma is over,yet female trauma patients are covered up immediately.

And finally,why is it that many of
these military physicians never
use or list their credentials.
In fact,they hide the fact that they were ever in the military.
Interesting.


PT

 
At Tuesday, November 23, 2010 12:21:00 PM, Anonymous Anonymous said...

Did anyone else notice that these new invasive pat downs occur right out in public? Yes, I know they offer you a privacy room but most just want to get it over with so its done right there in full view of everyone. They could have setup a simple privacy screen, but they don’t. Its just like how en mass sports physicals for males were performed in the past, assembly line efficiency, different stations for various exams, no privacy screen. All that’s missing is when they say “turn your head and cough.”

 
At Tuesday, November 23, 2010 1:55:00 PM, Blogger Maurice Bernstein, M.D. said...

I was waiting till someone brought up the TSA pat-downs. I guess the philosophy of TSA is similar to what I think most physicians feel regarding their exams, the potential benefits outweigh the transient modesty issues. What do you think? ..Maurice.

 
At Tuesday, November 23, 2010 3:17:00 PM, Blogger Hexanchus said...

Maurice,

I think the term "security theater" describers it pretty well.

Both the body imaging scanners and enhanced pat downs likely violate the 4th amendment unlawful search and privacy rights. Several lawsuits have already been filed and more are coming.

Many people (about 20% of travelers according to the polls), including myself, will simply no longer fly commercial airlines if it comes down to that. While it may be less convenient, I can always drive - and if it's too far to drive, as a pilot I can always rent a plane and fly myself. The added costs will just get passed on to my clients - a number of whom are, ironically, government agencies

IMHO they're attacking it from the wrong end. Instead of harassing ODC's (ordinary decent citizens) with more invasive screening methods of doubtful value, they need to take a chapter from the Israeli's book and focus on gathering intelligence and profiling where justified. What they are doing is reactive - what they really need to do is be proactive.

 
At Tuesday, November 23, 2010 3:28:00 PM, Anonymous Anonymous said...

Ridiculous! Bottom line, the X ray machines are a violation of our 4th amendment rights and the pat downs are nothing more than a sexual assault if they are done against your will. Furthermore, it has been established that explosives hidden in a body cavity or that does not have an edge will not be detected by those x ray machines. It's interesting that Chertoff owns a piece of the company that supplies those machines. It's Haliburton all over again.

The question nobody is addressing is that there are other technologies that are not so personally invasive that will do a better job detecting explosive material both plastic and metal. It's a puffer machine that blows air and if there's any microscopic evidence of explosive material an alarm will buzz.

And...for previous victims of sexual assault, this is an outrage and I for one won't fly at all until something is done and will vote every incumbent out of office regardless of party affiliation.
gd

 
At Tuesday, November 23, 2010 4:57:00 PM, Anonymous Anonymous said...

My concerns with the pat downs:
1. The whole general concept of any government forcing people to allow their genitals to be touched in order to travel is abhorrent. It strikes of totalitarian regimes we all know about.
2. Having said that, so far, it looks like few people are opting for the pat downs. They’re going through the scanners.
3. What’s important is why people are opting for the scanners instead of the invasive pat downs. If they're doing it because they “trust” the government’s assertion that there’s no harm in the radiation, that’s one thing. But if they’re acquiescing only because they’re afraid to face the pat down, that’s a kind of intimidation that doesn’t belonging in democratic republics. We don’t need a situation where American citizens are afraid of people in uniforms in their own country when they want to travel.
3. There as also a rumor that one reason for these invasive pat downs was because the TSA knew that most people, rather than face such an embarrassing public event, would “opt” for the scanners. We may never know how “official” that was, whether it was a hidden “policy” or just a rumor. But the idea is frightening.
4. Regarding how safe the scanners are. Anyone who reads history, should know enough not to just trust any government when they say something is safe. History has shown us, many years after an event, how governments (yes, our government, too) swore up and down that something was safe and then later it was found not to be safe. Sometimes this was due to ignorance on their part. Sometimes these were outright lies.
5. As several people have asked, what’s the next step in airport security regarding searches? There’s not too much further they can go. Terrorists in other countries have already put devices up their anal cavities. What happens when this occurs in the U.S. We will move to full-cavity body searches at airports? Sounds far-fetched, but where else can you go after pat downs like this.
Doug/MER

 
At Tuesday, November 23, 2010 7:49:00 PM, Anonymous Anonymous said...

At Dr. Rob’s blog “Musings of a Distractible Mind - Thoughts of a moderately strange (yet not harmful) primary care physician” he writes on the subject of sports physicals. He wonders why physicians are so fixated on the hernia exam. He writes “It is hilarious to see boys react to their first hernia check.” And he also adds “for maximum humiliation of boys, we try to use only female examiners for this.” Why would doctors WANT to humiliate little boys? They would never do that to little girls. Do you think he is just trying to be funny or is he half funny, half serious? - - - Dismayed.

http://distractible.org/2010/08/05/whats-a-duck-got-to-do-with-it/

 
At Tuesday, November 23, 2010 8:36:00 PM, Anonymous Anonymous said...

HAHA

I haven't flown in years and don't anticipate doing so,however,
this issue with the airlines just
might add fire to the issue.It just
may ignite a bombshell that we all
want. Now if only they can strip
search everyone in the open I'll
finally say,"now you know what a
military induction physical is
like."


PT

 
At Tuesday, November 23, 2010 8:52:00 PM, Blogger Maurice Bernstein, M.D. said...

You all may be interested in reading this article today on the CNN website titled "Doctors question TSA's use of pat downs, body scans". Of particular interest is the presence of urostomy bags or other "foreign bodies" which are hidden or imbedded within the patient who has these items as part of their therapy and medical management. I think this whole issue of what TSA is doing and its impact on the public is very relative to the issue of these threads on "Patient Modesty". ..Maurice.

 
At Tuesday, November 23, 2010 9:18:00 PM, Anonymous Anonymous said...

I think this whole issue of what TSA is doing and its impact on the public is very relative to the issue of these threads on "Patient Modesty". ..Maurice.

I agree with you, Maurice. We've wondered off and on about public sentiments regarding modesty, privacy, exposure, etc. Now we're getting a relevant indication. It's not perfect, but there is analogy. Providers think of patients as "choosing" them and the gender of their staffs and the procedures. Although that's true, it's not completely true. People don't choose to get sick; they don't choose the necessity of having to go through certain procedures. Of course, they can choose illness and death, but that's not realistic. The government sees airflight as a choice. For some it is. They can drive. But for others, it's either fly or don't go. And don't go may not not seeing mothers, fathers, children, etc. Yes, passengers can choose not to go, but in our current culture, although flying is not a right, technically, it certainly can tie in to "life, liberty and the pursuit of happiness." Both of these issues now involve possible exposure, humiliation, embarrassment and touching involving genitals and other private areas. I do believe we're getting an indication of how modest a good number of people are in our culture.
MER/Doug

 
At Wednesday, November 24, 2010 11:00:00 PM, Anonymous Anonymous said...

"Covering the legs gives the patient the sense that their dignity is being perserved, reinforces the medical aspect of the exposure and might make said patient feel less vulnerable; less naked."

What? That doesn't make any sense. How many people care if their legs are exposed? The only people I know that care about their legs being hidden from sight have terrible cellulite. The whole point about being draped for most people is covering the genitals. If the nurses and others see your genitals who the heck are you hiding your body from? There's no point in being draped in the first place if everyone involved with your care see your genitals.

 
At Wednesday, November 24, 2010 11:23:00 PM, Anonymous Anonymous said...

"While I have never had one I had a vasectomy and two scrotal ultra sounds and have never been draped of even offered a gown. Just told to strip from the waist down and aly on the table.", "A friend of mine had a scope of his bladder, talked about how humiliated he was when the young nurse started to prep him by injecting numbing solution into his penis, then excused herself and returned with a second older female nurse and explained, sorry I have never done this before and wanted to make sure I got it right".

Why would any human being put up with that? Don't you people have any pride, any self-respect? Why would anyone put up with being treated like an animal? Like a mindless blob with no sense of humanity? And the worst part is we have to pay them a lot of money for them to treat us like that. We have to pay a doctor's salary for them to send in teenage girls to sexually assault us. Doesn't anyone see what's going on here?

 
At Thursday, November 25, 2010 12:05:00 AM, Anonymous Anonymous said...

When the genitals are the focus of the exam, someone has to see them. Draping and following professional medical protocol takes away any sexual aspect of the exam, covers what can be. When the genitals are not involved in the exam, I agree with you.

Example..a woman laboring in childbirth feels much less exposed if her legs are completely draped leaving only the necessary area exposed, vs. laying on the table legs pulled back exposing every bit of her. The complete nakedness is a much more vulnerable state. This is why they offer drapes in the gynecologist's office.

I would also say I'm a strong proponent for a complete drape where the only person who views the patient is the doctor.

You are entitled to your opinion, as everyone else but it's important that just because your views are different from others, that you reserve judgment.
gd

 
At Thursday, November 25, 2010 4:42:00 AM, Anonymous María said...

I'm sorry to tell you that, but behind draping there's the same distorted thinking going on as with chaperones. IMHO, it only adds to the humilliation of the patient, rather than lessening it. Once your genitalia is exposed, everything the rest of the world cannot see is in full view, maybe even for ancilliary personnel of the opposite gender. (It's the person doing the draping many people doesn't want to be exposed to, in the first place).
But everyone should also wonder why are caregivers so eager to drape young and good-looking people as well... I think that, just like chaperoning, it's done more to protect the doctor against allegations of sexual misconduct and protect their morale, not the patient's. Which in fact shows a lot of disrespect.

 
At Thursday, November 25, 2010 5:59:00 AM, Anonymous Anonymous said...

It would be interesting to know where this "draping psychology" is coming from? Does it come from studies done with patients who are asked these kinds of questions specifically? Or, do these
statements of "fact" about how patients feel come from "assumptions." I'm not assuming one way or the other -- I'd just like to know. It's one thing to drape someone a certain way because the provider "thinks" it makes the patient feel better. It's one thing to drape people for warmth, which is understandable. But how do we know how patients feel about this?
Doug/MER

 
At Thursday, November 25, 2010 10:23:00 AM, Anonymous Anonymous said...

Doug,

I think it depends. I can tell you there's nothing warm about the paper drape they give you at the gynecologist's office. In that case, I'm sure it's for the comfort of the patient. Even though they know they're exposed, they can't seem themselves. In other instances it may be for warmth, or keep an area clean
gd

 
At Friday, November 26, 2010 4:12:00 AM, Anonymous Anonymous said...

I agree with Maria (if I understood her correctly). If everything is draped except the genitals then the genitals stick out even more. They would be the only thing that anybody in the room can see very clearly. I know it's important for the doctor to see it that way but not the numerous "assistants".

I believe that if the genitals are the focus of the exam there should never be opposite gender people in the room. It's humiliating enough to have same gender people staring at your genitals.

gd wrote "I would also say I'm a strong proponent for a complete drape where the only person who views the patient is the doctor." I agree with that completely. Unfortunately I believe most doctors are "above" prepping, catheterizing and draping the patient themselves.

 
At Friday, November 26, 2010 4:46:00 AM, Anonymous Anonymous said...

"He wonders why physicians are so fixated on the hernia exam."

I've always wondered that myself. Have there been any documented problems in the past concerning student athletes who have suffered from hernia problems due to playing high school sports? I would think other examinations would be just as important (or unimportant), such as kidney x-rays, hemorrhoid checks, colonoscopies, prostate exams, MRIs, EKGs, etc. like they do in professional sports. To me all seem useless for a teenager if they don't have any symptoms, but why hernia checks and no others? And what qualifies the school nurse to "assist" (observe)? Aren't boys capable of lowering their shorts themselves? Is it so important for her to know what every male student's penis looks like?

I also will never understand why so many schools hire females to give hernia exams. If they have to hire an outsider to give the students a physical exam why not show some respect and some common sense and hire a male to give the boys their exams? What do the schools have to lose by doing that? Are male examiners more expensive than female examiners? Is it really the school's duty to decide that the boys need to learn to "suck it in" and "take it like a man?"

 
At Friday, November 26, 2010 9:05:00 PM, Anonymous Anonymous said...

I agree with the anon above. As a woman, if after curtains are closed/blinds are pulled/ drapes are set/ and doors are closed and a man is still standing there to do something intimate to me I will always feel degraded and disrespected. Really less than human. If that happens then something went terribly wrong with my communication skills about same gender care! Don't go through all that trouble to protect my modesty and then pop a man between my legs, because THAT is part of what I am protecting myself from.

 
At Saturday, November 27, 2010 6:26:00 AM, Anonymous Anonymous said...

Everyone has a right to their privacy rights. When you explain what you need, it's necessary to tell them that if they can't provide same gender care, you are refusing the treatment. It's also important (because I've seen same gender care requested and they accommodate with doctors and nurses and then send in an opposite gender technician).
Should they then violate your privacy rights, (and they probably won't if they know you know the law), at least you have the basis for a hefty lawsuit. There was case when a pregnant woman having a C section told the staff in advance no men in the room. A male nurse tended to her needs and she filed a suit and lost. The suit was taken to a higher court and the court ruled that the hospital had the right to tell her to go elsewhere but they did not have the right to violate her needs. She won!
gd

 
At Sunday, November 28, 2010 2:17:00 PM, Anonymous Anonymous said...

I agree with gd and the other few anonymous contributors above; privacy is important, and gender care is a right that must be maintained. However, the comments above have focused primarily on the gender of the patient. Has anyone considered how religious and cultural views affect the patient/physician relationship?

It is especially important with patients of different religious and cultural values, ie. Hindu and Muslim women. These women often veil themselves from men or avoid eye contact in order to fulfill cultural and religious obligations to purity. It is imperative that these women get the respect of male doctors, have the right to a female physician, and achieve clear communication.

In light of the question of gender, religion, and cultural values, I think the arguments presented in previous blogs seem more complicated. How can bioethics solve this problem?

 
At Sunday, November 28, 2010 3:22:00 PM, Anonymous Anonymous said...

Looks like a few of the regulars here have posted on Dr Rob’s blog . PT’s post got deleted but Minutemoon and Dr Rob got into a discussion. Dr Rob appears clueless:

“You are taking all of this far more seriously than the boys and their parents do. Girls are treated with more respect because historically they've been treated with far less. That's all I will do to dignify your response. You are getting upset about what is a non-issue on a blog post that is meant to be more humor than anything.”

Did you catch that? He admits that in modern day healthcare, girl’s modesty is respected more than boys. Where did this attitude come from?

So men need to speak up right? Well when Minutemoon did, Dr Rob threatens to shutdown all comments.

 
At Sunday, November 28, 2010 5:51:00 PM, Anonymous Anonymous said...

If my man allowed a female to be intimate with him then our relationship will change. If you here consider me an "outlier" or "extreme" then I don't really care. I know most of my female friends now have a very different plutonic relationship (if it lasts)
with there partner after such acts. We are glad you are fine but every decision has a consequence, and breaking intimacy promises are one of them.
Seek whatever caregiver gender makes you comfortable, but if you disregard your spouse then you will have a problem. Like it or not, we are women in the know and we know how human female nurses are. If you do it, don't justify it. Live with it and face the consequences.
If you do not believe me, ask yourself if you are a 40-60 y/o male who has been getting more tests than you used to and are many of those employees woman?
Sorry, but we spent our married lives saying no to the men who were always trying to get at us because we were faithful. If you can't do the same then have a happy life where your woman now considers you just friends.

 
At Sunday, November 28, 2010 9:55:00 PM, Anonymous Anonymous said...

gd

Can you site the case you mentioned above? Can't seem to find it.
Thanx....

swf

 
At Monday, November 29, 2010 2:07:00 AM, Anonymous Anonymous said...

Can someone please explain informed consent? I know there are many things that medical personnel do to us while under general anesthesia that are usually kept a secret. Why don't we as patients deserve to know exactly what is going to happen to us when we're asleep and can't defend ourselves?

If we're going to be totally exposed by at least one woman, often teenagers, who will scrub us, shave us from nipple to knee and catheterize us, why don't we have the right to know? Very often "observers" or "assistants" will be present without our permission. Can that really be considered INFORMED consent? How do hospitals legally get away with that?

I know there are even very experienced patients that never learn that teenage girls are prepping them, often with many observers. They don't know that they are layed out naked on a bed or table with various people walking in and out while leaving the door open. They never hear that sales reps, students and other unnecessary people are staring at them totally exposed.

Who is it that decides whether or not a patient has the right to know what's happening to their body?

Also, why is it that even when we're conscious the "caregivers" (for lack of a better word) TELL us instead of ASKING us before violating our bodies? Most of them ASSUME that patients believe they're angels send from God and don't have the slightest problem allowing them to do anything they want to our bodies. When three women enter the room to catheterize us we better darn well allow them to do it. No choice, no permission necessary.

They believe that since we gave a doctor or surgean permission to access our bodies that everyone else in the building also has permission. That is so unethical and should be against the law. We may come to trust our doctor but that doesn't mean we trust everyone else in the building. Many of us do some research on different doctors before ultimately choosing one but we usually know nothing about his support staff. Education, experience and knowledge of their possible criminal past is an important thing for patients to know about their nurses, aides, etc but usually we know nothing about them.

 
At Monday, November 29, 2010 2:29:00 AM, Anonymous Anonymous said...

Amen to the last few comments.

"Don't go through all that trouble to protect my modesty and then pop a man between my legs, because THAT is part of what I am protecting myself from."

Exactly my belief! From a man's standpoint with female attendants.

"The suit was taken to a higher court and the court ruled that the hospital had the right to tell her to go elsewhere but they did not have the right to violate her needs. She won!"

I'd bet my life savings a male patient will never win a case like that.

"Seek whatever caregiver gender makes you comfortable, but if you disregard your spouse then you will have a problem."

I totally agree. Accepting female caregivers for intimate procedures is the same as cheating on my wife, and I will never do that. I wonder how many marriages have been destroyed by uncaring and disrespectful medical staff.

 
At Monday, November 29, 2010 2:48:00 AM, Anonymous Anonymous said...

Am I the only one that believes that medical "gowns" should be called "aprons"? I've seen my wive's gowns, but medical gowns look much more like the apron she was wearing in the kitchen tonight. I have never seen an actual gown that only has two ties in the back or front to prevent any accidental exposure.

Even if medical gowns did look more like real gowns, can't we come up with a better name for them. Men don't want to admit they wear gowns. For welding or painting we wear smocks, or overcoats. I think we are forced to wear "gowns" in medical settings in order to take away whatever pride we may have left and make us feel completely subservient. It's more difficult for us to stand up for our rights and our masculinity when we're wearing that silly gown. And everyone in the medical world knows it.

 
At Monday, November 29, 2010 5:21:00 AM, Anonymous Anonymous said...

swf here's the link

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

 
At Monday, November 29, 2010 10:12:00 AM, Anonymous Anonymous said...

Until they fix the gown problem, why not wear your own slacks or ask for some scrubs. Most hospitals are accommodating. You can alway refuse to remove your slacks. They can't force you by law. You have the right to refuse any treatment whatsoever.
gd

 
At Monday, November 29, 2010 10:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from 2:17pm yesterday, concluded the comment with "In light of the question of gender, religion, and cultural values, I think the arguments presented in previous blogs seem more complicated. How can bioethics solve this problem?"

Bioethics and ethics discipline itself cannot solve all problems that deal with the interaction between people. Religion and cultural values in one place often can trump what is considered elsewhere as ethical. ..Maurice.

 
At Tuesday, November 30, 2010 4:10:00 AM, Anonymous Anonymous said...

Bottom line....I think it has very much to do with respect. While not everybody's cultural values are understood by all, it is innate in our soulful beings that we don't want to be treated disrespectfully and nobody feels good about (being) feeling humiliated. These issues should be discussed as a very part of healthcare just as important as the physical aspects of the medical examination.

Bioethics and discipline is a start and quite frankly, misconduct is mainly ignored. That's how the medical community can help--by asking the right questions, accommodating patients and their rights. The argument that it's too expensive and that hospitals are not staffed is getting a bit old.
gd

 
At Tuesday, November 30, 2010 10:38:00 AM, Anonymous Anonymous said...

I just had to post this link from allnurses. It represents a horrible example of lack of communication and patient modesty violations in the ER. And people wonder why and how some patients become traumatized in medical situations? And by the way, this is an example of one of the good things allnurses does -- by revealing violations like this and admitting to this tendency. Here's the URL:
http://allnurses.com/general-nursing-discussion/seriously-518865.html
Doug/MER

 
At Tuesday, November 30, 2010 2:12:00 PM, Anonymous Anonymous said...

Humiliation renders people speechless and they implode or dissociate. Deafness was probably only part of the problem. The treatment this woman received was cruel and degrading. I wonder if any complaints were filed and if the woman protested to the public stripping.
gd

 
At Tuesday, November 30, 2010 8:04:00 PM, Blogger Maurice Bernstein, M.D. said...

You recall that I had put up on a physician-restricted discussion section of Medscape the need for some patients to ask for and obtain healthcare providers of a gender selected by the patient. Here is another response, this time by a gastroenterologist who will remain anonymous here. By the way "concierge medicine practices" are those where for a yearly fee, the patient gets extra services from the physician such as physician phone calls, house calls, longer visits, shorter waiting times and other services less likely to be provided for those in regular medical office practices. ..Maurice.
"These pts probably should get into concierge medicine practices. If there is enough demand, that might change how doctors practice and hospitals deliver care in regards to this. There is not much chance for them in this current medical care system. With the health care reform coming, I will be surprised if this issue get much traction.
This study suggest that this issue if not that big in general pt population. Rates of screening colonoscopy are not increased when women are offered a female endoscopist in a health promotion outreach program." http://www.sciencedaily.com/releases/2010/11/101111160542.htm

 
At Wednesday, December 01, 2010 5:03:00 AM, Anonymous Anonymous said...

Here is a survey that says something different. Also, it's not just the gender of the physician but the other parties in the room.

http://www.giejournal.org/article/S0016-5107(05)00540-7/abstract

 
At Wednesday, December 01, 2010 10:21:00 AM, Anonymous Anonymous said...

What I find most interesting and yet missing from this recent discussion is this: Why absolutely no mention of men's preferences in these studies? Why just female preferences? One principle of argumentation is to at least mention other points of view, concede certain points, to give your position more integrity. Here are some possible reasons for no mention of male preferences here:
1. There are so many studies already done about male preferences that mentioning them would just be redundant. Anyone believe that? I don't.
2. It's just assumed that either males don't care one way or the other (because they rarely complain) or that it doesn't really matter if they do mind because they'll go along with whatever we want -- if they actually agree to have the exam.
3. Women are the deep pocket in American medicine. They use medical services more than men. They make the appointments for their families, including their spouses. They make most medical decisions for men. Men aren't really interested in their health. Those are the assumptions, so...Follow the money.
4. Male preferences? What's that? The whole idea of accommodating males in exams like this is so under the radar that those conducting studies like this don't even consider the issue.
The fact that you don't even find a sentence in these studies or articles comparing female preferences to male preferences, even an acknowledgment that males may have preferences -- this, again is the deafening elephant in the room of American medical culture.
Doug/MER

 
At Wednesday, December 01, 2010 11:53:00 AM, Anonymous Anonymous said...

Doug/MER

I had a bit of a different spin on the motives, noting the absense of male preferences as well.
It seems (to me)the underlying point was not to exclude men, but rather to denounce the accepted notion that females actually do have a preference. What does that accomplish?
A) It convinces caregivers that this notion of female modesty does not exist in certain specialties, so stop feeding the fire.
B) Women may read these type of study results and become convinced that the modesty issue is childish and they are such a minority that soon they will no longer matter and 'give up'.
**C)IT WOULD THEN stop the movement to give male modesty any validity: vitually stopping it before it starts.
If you discredit female modesty then male modesty will not even be discussed!
Their problem is solved, and the medical community is peaceful again.

Consider our past posts that state "If one gender does not have options then neither should the other". Although the motives behind it may be different, the end result would be the same.

swf

 
At Wednesday, December 01, 2010 12:16:00 PM, Blogger Jean said...

In reference to the gender preference discussion for colonoscopies: I did notice that the article stated that most endoscopists were male so maybe that was one reason that they did not consider male preferences as that wouldn't be as much of an issue (with same gender). However, they only mention the endoscopist and not the gender of the rest of the team, which would definitely come into play for males as well as females. I often wonder where they find the participants for these surveys. I have asked all my sisters and female friends and they all say they would definitely prefer a female endoscopist IF they chose to have the exam. Maybe they are missing a whole population of opinions by asking only individuals who are already in a medical setting instead of polling a sample of the general population. They may find that a large percentage of individuals that forego the colonoscopy exam do so out of embarrassment, some of which would be alleviated by having guarantee of a same gender TEAM.

 
At Thursday, December 02, 2010 1:00:00 AM, Anonymous Anonymous said...

OKay I'll just say it. It seems as though many in the medical industry simply get off by having someone's body under their control, having access to very intimate,embarrassing or just personal information.
What bothers me is that the modesty issues everyone has been bringing up seems to be absolute common sense.I suppose if i got off and thought it was funny to watch a kid be humiliated during a hernia exam or wanted to checkout the blonde getting her breast examined I wouldn't want a patient having control of who just got to freely walk in and out of the room either because it would ruin my free show.The last thing i want is a man having an advocate looking out for his wishes so I couldn't just "wait until their under"and then do lord knows what anyway.

I won't even bring up all the nonsense on allnurses.It just confirms everything on here that we have been talking about.
But let one of them become the patient and all of a sudden private parts better be covered,gender matters,doors must be closed, spectators are not allowed . But be just a regular patient X and your trip to the ER ends up on facebook, twitter, a blog and a prime time reality show before you can even button your pants up.

upside down

 
At Thursday, December 02, 2010 2:22:00 PM, Anonymous María said...

Upside Down is to be commended for is comment (he seems male to me). I have had disagreements with MER in the past, but unlike him I think nurses are'n Godlike figures and many times they're just bullies. If you piss them off badly enough , they'll show you who's boss!!! Occassionnally, the bullying happens within the profession too, "eating their own young". It may become a survival mechanism, whistle blowers are hated, if they dare do anything at all, which they often don't, because they might lose their jobs, w the profession, to begin with, attracts narcissistic and attention driven people, and turn into bullies people that otherwise may not have been so cruel. B esides they're cowards, because patient vulneravility is part of the allure.
BTW, I hate the people who complain "I clean poop for " (meaning very low pay) (Sic, all nurses). If you don't really like doing that, get another job, and you might even make a little bit more, and be happier... I am really frightened about letting such a resentful person like that touching, or even coming close to me.

 
At Thursday, December 02, 2010 5:29:00 PM, Anonymous Anonymous said...

Maria,
What you are talking about is a form of abuse. It would be interesting to do a study on behaviors in nursing. I have heard from professionals "off the record" that abuse and humiliation are part of "teaching lessons to uncooperative patients".
Anyone who humiliates or degrades a patient should be eliminated from the profession....permanently and registered as a sex offender.
gd

 
At Thursday, December 02, 2010 5:31:00 PM, Anonymous Anonymous said...

"I have had disagreements with MER in the past, but unlike him I think nurses are'n Godlike figures and many times they're just bullies."

Maria -- Please don't attempt to sum up my point of view with nonsense tweets like what's written above. Life is much more complicated.
I've never claimed that nurses are Godlike. In fact, most nurses I know resent that kind of stereotype, the Angel of Mercy myth. I do try not to stereotype them like you and others sometimes do. People are people and need to be judged individually. Ironic, isn't it, that on this blog we're claiming that patients are unique and have different attitudes toward their modesty and thus need to be treated individually by the medical profession, not stereotyped. At the same time, you and others feel quite justified stereotyping a whole profession based upon your personal biases. Yes, some nurses are bullies. So are some police, some judges, some plumbers. Every profession has its bad apples. But the bad apples don't represent the norm.
Doug/MER

 
At Thursday, December 02, 2010 6:55:00 PM, Anonymous Anonymous said...

Doug/MER i agree, we are as diverse on the patient side as they are on the provider side. But...if you look at the majority of polls, you will find Nurses at the top of the trust scale. While there are some posts where some nurses come off as condensending and and holier than thou on allnurses, by and large I fine more of them to be understanding of our concerns, the issue I see is it is more economically advantagous to ignore gender for the system and nurses go along with the status quo rather than challenge it. It's not so much they disagree with our concerns, its more they are not going to be proactive with our concerns. If we ask they will most of the time do what they can, but they will not be our advocates like we want them to. Go to allnurses, open the tab a the top labeled nurses, then to male nurses and to double standard. There are two interesting observations, the thread starts out about discrimination against male nurses, becomes about female patients, BUT by and large, most nurses recognize and validate accomodation based on the desire for sale gender for intimate procedures. there are the exceptions and I find it interesting that they try to draw paraells betwee racism and gender preference for exposure, but just as often other nurses call them on it. I find the glass half full in that many have no issue with accomoidating patients, you may find it half empty that all don't. ...perspective....alan

 
At Thursday, December 02, 2010 9:35:00 PM, Blogger Maurice Bernstein, M.D. said...

Though I realize that the urologist on Medscape does not necessarily represent the view of all physicians, I was taken aback by the assertion that I was pandering those who are writing to my blog thread and by simply presenting their views on a physician-restricted discussion website.

Just to give you a tone of the kind of response I got from this physician:

"What world are your blogger followers living in and why do you pander to them? "


and then followed on another posting with:

"You are directing the discussion and in fact promoting this concept by posting about it. It's like Fox News saying they're not saying Obama wasn't born in the US... just allowing it to be discussed. Get real and stop hiding. "


I defend my position taken on my blog. I have never stated that I fully agree with the views stated on these Volumes, in fact, I have expressed my views that, along with I believe is consistent with that of other physicians, to avoid diagnosis and treatment, especially
for clinically significant illnesses because of modesty issues, to me is irrational. Nevertheless, I think that the views of most who write here is worthy of further discussion and dissemination of the concerns. That is why I have repeatedly suggested that patients with these modesty issues should go beyond this blog and spread their words and develop advocacy groups if desired.

Does this represent "pandering"?
I doubt it. As I said I don't know how representative this urologist is of other physicians but I wanted to show you the challenges some of you will face. ..Maurice.

 
At Thursday, December 02, 2010 10:05:00 PM, Anonymous Anonymous said...

Maurice: Thank you for posting those responses from the urologist on your Medscape discussion. I hope this doesn't represent the norm out there. You write: "but I wanted to show you the challenges some of you will face."
I'd like to reverse that statement. Let's show doctors like that how much of a challenge they will face. Patient rights, basic dignity, respect -- they can't ignore this. They can't ignore what's written in the core value statements of their hospitals nor on the patient right policy statements. They can't ignore their oaths. The tone of this doctor's statement is the old doctor as "God" attitude. I would suggest that once confronted with this issue in a reasonable, intelligent fashion by a patient who isn't afraid to back down, these doctors will think twice. Once they confront a patient who will bring this out into the open, write letters to their employeers, to licensing boards, to the Joint Commission, to the newspaper -- they'll quickly back down. Why do I know this? Because they're hiding behind their Medscape blog, refusing to even discuss it with patients.
What world to patients live in? The real world. Read any good book on the history of American medicine and American hospitals and you'll read about the secret, almost gnostic culture of medicine. Hospitals are institutions, and attitudes like the one this doctor shows move these institutions closer to what sociologists call total institutions. It's about power. It's about control. It's about egos.
Thanks again for giving us insight into the "hidden" curriculum, those secret chambers within hospitals where discussions happen that patients are rarely privy to.
I urge patients on this blog to become really proactive and not to be intimidated by attitudes and tones like that. Confront these doctors firmly but politely, assertively yet civilly, intelligently. Force them to reconsider why they became doctors in the first place.
Doug/MER

 
At Friday, December 03, 2010 3:19:00 AM, Anonymous Anonymous said...

Nice comments upside down and Maria. I totally agree with upside down's post and most of what Maria said. It's difficult to keep from stereotyping nurses because I agree with what someone said, what kind of person chooses a profession where they know they'll have complete control over innocent people that usually can't defend themselves, including seeing and touching any part of their body they want, and can physically and psychologically torture them at will? I exclude doctors from this in the most part because I believe they are true professionals (except maybe male ObGyns and female Urologists).

Everytime I hear a nurse or other so-called "medical professional" say they entered the medical field because they care about and want to help people I just laugh. If they care so much about people why do they refuse to help people in need if they don't have the money to pay them? Do they really mean that they care about and want to help RICH people? I'm aware that ERs are usually different, but why only medical emergencies? Is it any wonder why people flock to the ER for every stubbed toe or case of the sniffles? If medical care was available to everyone, even in non-emergency situations the ER wouldn't be such a chaotic mess. How can anyone that "cares about people" turn so many of them away?

Like Maria I really question the motives of the nurses that complain that all they do is clean up poop. If they dislike the job and are making slightly more than minimum wage why are they there? Total conrol over helpless people and perverted minds is all I can come up with.

 
At Friday, December 03, 2010 3:46:00 AM, Anonymous Anonymous said...

Dr Bernstein is to be commended for what he does here. Thank you for all the work you do to stick up for all of us, the little people. Standing up to the unethical doctors takes a lot of guts. You are fair and unbiased towards the not-so-enlightened members of your profession but you're not afraid to defend your constituents, the abused patients.

Thank you for not getting disillusioned by the many negative comments expressed here (including mine). Though there are many insults directed towards the people of your profession I believe the vast majority of the guests here have nothing but respect for you (and Dr Sherman on the other blog) and really appreciate your keeping this blog going.

I think I can speak for most of the guests here when I say that the urologist on the Medscape discussion is way out of line with his insults towards you, and his accusations couldn't be further from the truth.

 
At Friday, December 03, 2010 5:22:00 AM, Anonymous Anonymous said...

This may seem a little off topic, but it does have to do with respect and attempting to equal the playing field between doctors and patients.

I had an extensive test done at practice connected with a large teaching hospital. After the test was completed I asked the exit staff for a copy of the results. They looked at me as if I had three heads and called over a supervisor who informed me if I wanted a copy it would cost $1.32 per page.

They are treating the test result like a medical record.

Why don't they understand that they are cutting off the hand that feeds him. My reply was that I will get the test results and I will not pay for them.

There is a difference between obtaining a test result (that becomes part of your medical record) and asking for medical records in general. I already paid for this test. Additionally, they have no problem sending a copy of that test to the ordering physician. They are discriminating against patients. They are not looking at the bigger picture and that picture is that if I take my medical needs to another hospital they will lose thousands and thousands of dollars. Vocalizing our needs, equality in the form of respect.

It's always been my attitude that I pay doctors to diagnose, recommend treatments and offer me other options should I ask and be a partner in healthcare. Why is this so difficult?
gd

 
At Friday, December 03, 2010 5:32:00 AM, Anonymous Anonymous said...

Is anybody familiar with the legality of a patient's right to self-defense in the ER, and how far one can go to defend oneself? I remember reading about this earlier in the blog but I don't remember when it was. I dislike violence of any kind but when it comes to defending myself I believe that sometimes a minimum amount of violence can be used if absolutely necessary. ER employees often believe that their opinion of what's best for a patient overrides what the patient believes. Apparently the importance of a patient's moral beliefs or traditions is to be determined by the medical professionals and not by the patient. Anytime a patient refuses care when help is clearly needed his or her mental competence is put up for debate and the possibility of forcing medical attention against his or her will is considered.

Outside of the medical facility we have the right to defend ourselves from physical or sexual assaults by any means necessary, at least to a certain extent. I've heard countless stories about people, particularly women who have killed or permanently injured attackers and are aquitted of any wrongdoing. Why should it be any different in a medical setting?

For example, if an innocent person was confronted by one or more people in the street or other setting and they stripped him or her naked against their will and shoved something up their rear end it would be considered sodomy, among other things. But if those people were wearing scrubs it would be considered a harmless medical procedure, done for his or her own good. It seems that once a person walks or is taken over the hospital threshold they have entered a different world where human rights and respect are not considered and people are not permitted to speak for themselves or decide their own fate.

Apparently all medical workers are beyond reproach and are immune to the laws of the common people. If we refuse to take their orders we might as well be defying God. One case in point was the experience of a construction worker that was hit in the head with a board and was taken to the ER. He was forced against his will to have of all things a rectal exam. He smacked the doctor trying to force it on him and was arrested. Would he be punished for hitting someone in self-defense outside the confines of the ER? I doubt it, unless maybe it was a woman. He lost the lawsuit against the hospital. Here is the article.

http://www.naturalnews.com/023301.html

The writer makes some terrific points. One observation she had was that "the story doesn't seem to make sense. If the patient was truly unable to make an informed decision about his medical care, why were misdemeanor assault charges filed against him for hitting the doctor? Surely a patient who was incapable of rational thought should not be held accountable if he were truly not thinking clearly and only acting out due to an injury? Curiously, they all thought he was thinking clearly enough to have him arrested for his actions but not clearly enough to have the right to informed consent concerning his care."

I think it would be quite easy for the medical staff to force a rectal exam or other ridiculous procedures on anyone they want because they always have the loophole that says they can decide that the patient (victim) was, in their opinion, incapable of making their own decisions.

If we can fight to protect ourselves from harm in the real world we should also have that right inside the confines of a medical facility. Medical professionals aren't "above the law", or at least they shouldn't be. That goes for medical women as well.

 
At Friday, December 03, 2010 9:21:00 AM, Anonymous Anonymous said...

Dr. Bernstein:

It is interesting that female modesty has long been accepted, but when it seems male modesty may be making some headway then they want the whole discussion ignored/ended.
Sounds like you are taking some heat for having an open forum like this, and the fact that it is still open speaks to your credit as an ethicist. I have to wonder why showing both sides of a discussion is considered pandering when it is truely just a debate. I understand that very few people from the medical arena take part in this debate, but isn't that their choice? It wouldn't take much time or effort to tell us that they think we are delusional and have no respect for our concerns.
In my opinion posted to Doud/MER above, I mentioned that physicians are expecting one another to "stop feeding the fire".
For some, I guess this really is the message.
Thanx for giving us the 'other side'.

swf

 
At Friday, December 03, 2010 10:52:00 AM, Blogger Hexanchus said...

anonymous 5:32am:

It depends. The laws differ from state to state, but most allow an individual to use "reasonable force" to defend themselves. You don't cede these rights just because you're in a hospital or ER. That said, you need to be very careful here.

Generally speaking, a procedure can not be forced upon a patient without their consent. To do so is an act of assault or battery depending on the laws of the state. There are some exceptions - usually either a specific, narrow circumstance specified by law, or a court order signed by a judge.

Your best and first line of defense should be communication, both verbal and written.

1. Tell them in no uncertain terms that they may not perform any test/treatment/procedure or administer any medication without your specific consent.
2. When they give you the admitting form to sign, write that on the form before you sign it - if they try to tell you that you can't, ignore them.
3. Tell them that any attempt to do so without your consent is legally an assault, that you have the right under law to use reasonable force to defend yourself against an assault, and that you will aggressively pursue both criminal and regulatory board action against anyone that makes such any such attempt.
4. If they attempt to question your mental competence or capacity to make decisions, tell them you dispute their position and want an immediate hearing before a judge. In most jurisdictions, only a court can make a determination of competence or capacity of a person to make decisions on their own behalf.

I read the information on the NY gentleman's situation a while back, and actually had the opportunity to discuss it with a friend that also happens to be a judge on a US Circuit Court of Appeals. The result of our discussion was essentially that he should have filed a criminal complaint instead of a civil suit. In order to prevail in a civil suit, you have to be able to prove damages, but for a criminal complaint only provide evidence the law was broken.

FYI, the criminal assault charges against that patient were dismissed.

 
At Friday, December 03, 2010 10:50:00 PM, Anonymous Anonymous said...

The post by Upside down was excellent and well written.

Male patient examinations have
always been a spectator event
from little boys getting hernia
exams,military induction physicals
to level 1 trauma's.

My experience working in healthcare
is that this behavior is something
of a tradition. The fact that private patient information placed
on the internet confirms this
longstanding behavior.


There are several examples of this
on Dr Shermans site. I'll refer you
to nurses placing pictures of the
x-rays on the internet that show a vibrator stuck in the rectum of a male patient.

Yes,female patients on occasion will present to the er with a vibrator stuck in their rectum,
however,you will never hear or
see about their hipaa being violated.

Personally,I believe that all patients should have their privacy
respected for whatever reasons they
present to the er.

Why are men continually excluded?


PT

 
At Friday, December 03, 2010 11:34:00 PM, Anonymous Anonymous said...

PT, your points are well taken, however, women's privacy is not respected once you're out of a doctor's office and in the hospital environment. Nor is it respected in nursing homes. I realize how frustrating it is and I also recognize the unequal treatment of male modesty concerns, however, it's no cake walk for women either.
gd

 
At Saturday, December 04, 2010 10:16:00 AM, Anonymous Anonymous said...

PT -- I do agree fully with your last post. Part of the problem is the "tradition," but some of these "traditions" are quite recent -- such as having females assistants and note takers present during military exams for men. This wasn't the case during WW2 and earlier. I think much of this came out of 1960's women's rights movement. The right for females to do certain jobs trumped the rights of men to have privacy. We still see that today, esp. in prisons, locker rooms and in some military exams. Did you read the article on my and Dr. Sherman's blog about German military exams? In his book called Medical Rape Lars Petersson goes into how young boys are socialized to appearing naked in front of women for medical exams quite early in life. As I've said before, I think this is part of a conscious resocializaton program in many countries, part of the "gender neutral" mentality of medical professionals. You'll find Petersson's article here:
http://patientprivacyreview.blogspot.com/
Doug/MER

 
At Saturday, December 04, 2010 3:26:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY DECEMBER 4, 2010 "PATIENT MODESTY: VOLUME 36" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 37.

 

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