Bioethics Discussion Blog: Patient Modesty: Volume 37

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Saturday, December 04, 2010

Patient Modesty: Volume 37

..and the story continues. For those who haven't been following this thread over the years, the story is one of patient bodily modesty and the need by some for gender selection of their healthcare providers. This need is apparently often not satisfied by physicians or other parts of the medical system, particularly in the case of male patients who desire a male provider. There are other aspects of the patient modesty issue that have been discussed including the inability of the patient to be assured that his or her modesty concerns will be attended to during operations or other procedures where modesty sensitive parts of the patient's body could be exposed to unknown persons of a gender unacceptable to the patient. If you haven't been here before and have an entirely different view, please be welcome to express that view here. As usual, keep the comments constructive and civil but write. ..Maurice.

NOTICE: AS OF TODAY JANUARY 8, 2011 "PATIENT MODESTY: VOLUME 37" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 38.

147 Comments:

At Saturday, December 04, 2010 6:41:00 PM, Anonymous Anonymous said...

My wife and I don't really consider ourselves modest types, but we are moral types.
If we agreed to opposite gender intimant care, we would consider that cheating on our spouse. If providers knew how much damage they caused relationships would they even care?

pstr

 
At Saturday, December 04, 2010 11:15:00 PM, Anonymous Anonymous said...

gd

Don't see your point as nurses,er registration,er techs
and ultrasound techs represent
over 95% as female. That's a
cakewalk for you!

Imagine a male patient
being admitted to an micu(medical
intensive care unit) whereby the
entire nurses bathroom is covered
with full nude foldouts from playgirl magazine.
Lets reverse the roles,
you a female patient and all the nurses male with the porn switched
to female.Put yourself in that
scenario.


PT

 
At Sunday, December 05, 2010 8:26:00 AM, Blogger ~Charlotte said...

PT, I don't understand your comment. Are you saying that you know that the nurses bathroom in the hospital where you were admitted was covered with nude men from Playgirl magazine?
I think it is important that we all support each other in the issues of modesty, you seem angry at women patients because nurses tend to be women.
Because of recent treatment for a sarcoma, I have had PETs and MRIs where my technicians were all men. I also had a surgery which was done by a gynecological oncologist/surgeon and an orthopedic surgeon. The anesthesiologist was male, the two surgeons were male, in fact every doctor except one was male since I went for a second opinion and was examined by 4 more male physicians. My two radiation oncologists were also male as there are no female radiation oncologists at the facility. I did not have any other choice. In fact, our hospital has four gynecological oncologists, all of them are male. Again, I had no choice.
I don't think we should be in a contest about which sex "has it worse" but try to come up with some suggestions and solutions on how to make the medical experience more sensitive for all of us.

 
At Sunday, December 05, 2010 10:30:00 AM, Anonymous Anonymous said...

I think you're right Charlotte, you shouldn't have to put up with that just as men shouldn't in similar situations. It would be nice to trade half of the healthcare women from the facilities in my area for half the men in your facilities.

In my area I've heard of three male gynocologists and the rest are female. That's three male gynocologists too many if you ask me. Also in my local investigation I've only been able to locate one female Urologist in the entire state. Surely there are more that don't feel the need to advertise but that's still pretty good odds that both genders will have their choice of gender for these specialists. The negative part is that nearly all the support staff from all the doctors and specialists I've found are women.

What I don't understand is that in their advertising several specialists and other doctors seem to make clear the fact that they are the same gender as the future patients they seek, but don't mention the gender of their assistants until it's too late. I've had to ask some very specific questions to get to the truth. Does anyone think that should be considered false advertising?

 
At Sunday, December 05, 2010 11:43:00 AM, Blogger Maurice Bernstein, M.D. said...

This blog's new threads automatically also get published on my Facebook page. A retired surgeon who is one of my "friends", apparently read the introduction to Volume 37 and then wrote on my Facebook page the following and I thought my visitors here would be interested in what he wrote. ..Maurice.


"When I was an intern, I was assigned to a senior resident in surgery named Warren Hagen. He was so strict about patient modesty and dignity that he would not allow anyone to touch the patient's bedding or person without asking permission. He would not allow any of the medical staff to use the patient's first name. Only the area being examined could be exposed. I was so impressed with this that I followed it, and taught medical students and interns the same concerns, for the rest of my career. Teaching by example is very powerful."

 
At Sunday, December 05, 2010 3:50:00 PM, Anonymous Anonymous said...

I want to add that I am concerned with patient modesty both MALE and FEMALE. I also want to add that I am also concerned with the modesty of adolescent teens.This group often gets looked upon simply as "kids" so their modesty concerns like many others are brushed off and neglected (by staff as well as by parents in many cases). I believe in these cases there is a great deal of added humiliation because now are you not only dealing with various staff coming in and out, staring, touching,your body,genitals,buttocks exposed,asking embarrassing questions this is OFTEN happening with a mother,father in the room which may be beyond humilaiting leaving the adoloescent terribly ashamed.A teen in this case may have even less of an ability to speak up.This age group even more so than adults have no idea what to expect when they go into these places.I can't imagine that a 15 year old boy wants his entire backside exposed with his mother standing less than 5 feet away much less a room filled with interns. This patient is probably more concerned and traumatized by being undressed and on display far more than the reason for the medical visit in the first place.
I know what it's like to have your modesty violated NEEDLESSLY. I support anyone male or female who wants to see changes that will help the medical staff get done what needs to be done while protecting the DIGNITY of the patient.

upside down

 
At Sunday, December 05, 2010 3:53:00 PM, Blogger ~Charlotte said...

Dr. Bernstein, thank you for posting about your doctor friend and his concern for patient modest, he is a doctor to be respected. My recent medical problems were exacerbated by some gross modesty violations. My husband, a surgeon of more than 30 years was entirely supportive of me in my distress over what happened to me. He INSISTS on draping his patients as soon as possible in the operating room and preserving their dignity and modesty. He was angered/distressed/disappointed that I was treated so insensitively.

 
At Wednesday, December 08, 2010 5:01:00 AM, Anonymous Anonymous said...

"I was so impressed with this that I followed it, and taught medical students and interns the same concerns, for the rest of my career. Teaching by example is very powerful."

What an outstanding teacher your friend is! I hope his students one day pass on his excellent lessons to their students or co-workers. And kudos to Warren Hagen for his excellent work.

Unfortunately the idea of "Teaching by example is very powerful" can also be a very negative thing. The professors that don't care about modesty and don't have any respect for their patients also pass that along, especially in nursing schools. I'm grateful there are at least a few good professors that teach the importance of dignity and respect, but I'm afraid they are in the minority.

I strongly agree with upside down. I had a terrible medical experience when I was a teenager. The cruel, dishonest and unethical nurses treated me so badly that the incident still haunts me today. Thanks to those horrible nurses I haven't visited a doctor in more than twenty years and going to the ER for any reason is completely out of the question. I have suffered and will continue to suffer from injuries rather than go to the hospital.

I wonder if those nurses ever thought about the psychological damage they caused me and other patients. I imagine if they knew how traumatized I was by their treatment they would have just told me to grow up and possibly flicked my penis with a spoon just to get their point across.

I try hard not to believe that all nurses are evil because of the torture I received from those two, but it's very difficult. I doubt I'll ever be able to trust nurses again, or the doctors and hospitals that employ them.

 
At Wednesday, December 08, 2010 1:23:00 PM, Anonymous María said...

My apologies to MER, what I was saying was not so much about your oinion, which I respect, but about the fact that many behave like bullies.... BTW, I have a big explanation to give, which is about a cultural problem, I belong to what many of you know as the Latino culture here, and many nurses are indeed patronising, because they believe that unlike they behave in a certain way, they are not maternal enough. Anywy, whatever your gender, if you're not assertive, you won't be listened to, even less accommodated.

 
At Wednesday, December 08, 2010 2:05:00 PM, Anonymous Anonymous said...

I accept your apology, Maria. And now you've explained your position with some real personal experience that puts it into a reasonable context.
I can think of four possible methods to deal with what you describe.
1. More communication and cultural training for nurses.
2. More patients who are willing to speak up, civilly, and point out this tendency to be condescending, patronizing, or bullying precisely when it is happening. Like most of us, the nurse may not even realize she's behaving that way.
3. More professional observations of nurses working with patients to determine how the nurse is being perceived by the patient.
4. Detailed exit interviews with patients asking specific questions about how they perceived their treatment.
Maybe a combination of all these and some others might help. But, as I said before, my experiences has been that most nurses try their best to respect patient dignity. I'm not implying that they always do it correctly. They're not perfect. But I believe their intentions are mostly good. This may mean some might need more mentoring and training. This also may mean that a small percentage should get out of nursing and find a different occupation.
MER/Doug

 
At Wednesday, December 08, 2010 2:10:00 PM, Blogger Hexanchus said...

"Anyway, whatever your gender, if you're not assertive, you won't be listened to, even less accommodated."

Maria, I agree! Regardless of what should be, it's not going to happen unless we, as patients, stand up and demand it.

 
At Wednesday, December 08, 2010 8:05:00 PM, Anonymous Anonymous said...

Just curious if anyone here is familair with the CEBU HOSPITAL SCANDAL ( if you like you can google it) if not here is a quick recap.
A male patient has to go to the ER because of a rectal foreign object that requires surgery. Long story short the guy is put under for surgery and tons of staff (UNNECCASARY) enter the room all laughing,joking ,taking cell phone pics,and eventually VIDEO of his surgery is uploaded onto YOUTUBE by one of the "medical professionals" and this is how the patient learns about it.

WHERE in the world was ONE person looking out for the well being of this patient. The staff as far as I'm concerned acted like monsters and humilated this man who was already in an embarrassing situation.
This happened in the Phillipnes but how often do things like this happen here in the US. Perhaps for fear of losing a liscence,fines,being fired,sued a doc/nurse will not post video on YOUTUBE but in the last volume someone mentioned the nurses who posted a patients XRAYS on their facebook page that involved a sex toy.Things like this happen all the time.
I'm not saying any of this to be graphic but I'm saying protection is needed it seems from hospital staff in many cases.
What is so hard about patient dignity and modesty that these people need training?
Doesn't an 8 year old know to knock on a door if it's closed? I'm repeating myself but closing doors,curtains , asking permission if a student wants to observe. Please stop passing off every clerk and secratary as an "assistant." If you are a CNA or MA stop referring to yourself as a nurse....the list goes on and on...........

I want to know how to put certain policies and protocal in place so each individual patient doesnt have to go through this nonsense ......

We are talking about healthcare and modesty afterall. How is the elderly person suppose to speak up when dignity is violated.How was the man in the Phillipines to speak up when the room became filled with staff laughing when he is knocked out for surgery. How does a teen who has no idea 4 observers are about to walk into the room to watch an intimate exam speak up when that teen has been taught his/her whole life that the hospital staff is "their to help." How is a woman who is in the middle of giving birth suppose to speak up when someone who is "learning" just strolls in because they know that if asked she would have said NO.( I read this on a medical site where this student flat out said he didn't ask because he knew if he did the answer would have been no dring a birth)How is a patient just in a car accident, afraid,badly injured and in shock suppose to speak out that she doesnt want a camera crew for a TV show filming her. Why in the world should she even have to!!!!!
It seems like when you recieve medical care you are simply OPTED IN to whatever it is they feel like doing and its the sick,injured,afraid,frail,naked,
pregnant,elderly,unconsience patients responsiblility to OPT OUT.

Things have to change , each individual patient shouldn't have to go through this simply to recieve medical care.

 
At Wednesday, December 08, 2010 8:08:00 PM, Anonymous Anonymous said...

The post referring to the cebu hospital scandal was written by "upside down".......sorry forgot to sign

 
At Friday, December 10, 2010 1:19:00 PM, Blogger Hexanchus said...

Warning! This should probably be considered a "vent", and might be a little long, but I believe it is relevant to the topic being discussed here. Yesterday, we had an encounter with our wonderful medical system that still makes me livid when I think about it.

You might recall me mentioning in passing a while back my niece that graduated from college with a degree in engineering (and now works with me - sharp kid...I didn't want one of my competitors grabbing her). Well, she has a 17 year old younger sister that is a senior in HS. Late afternoon yesterday, I get a call from the trainer at her HS - her parents are out of town at a conference & I'm the next one on the call list (we all travel frequently and have had MPA's for each others kids forever). She twisted her ankle in lacrosse practice - trainer says it looks like a mild sprain, but we probably should get it checked out, so I grab her older sister and we pick her up at the HS - called her PCP's office & they recommend we take her to urgency care to get it looked at, so off we go. Get there, do the paperwork & soon get shown to a cubicle.

cont'd......

 
At Friday, December 10, 2010 2:08:00 PM, Blogger Hexanchus said...

....part the 2nd.....

Nurse & aide show up and say they need to get some preliminary stuff done and ask her sister and I to step out for a minute (she's got a clipboard and I figure she wants to ask some questions privately).

We're standing just outside the curtain, a minute or so goes by and then we hear my younger niece say "what?", "why?"...then a little louder an emphatic "NO", "STOP" and a screamed "Sis, Uncle Hex, HELP!". Needless to say, we both quickly enter the cubicle to find the nurse and aide trying to forcibly remove her clothing and my niece resisting vehemently. My niece gets between the aide and her sister and I state loudly "Take your hands off of her - what the hell is going on here?"

Nurse says "We need to undress her so the intern can completely examine her".
My response: "For a mild ankle sprain, what kind of an idiot are you?"
Nurse: "Those were his orders."
Me: "Then he's either a bigger idiot or a pervert!"

There were some other personnel in the hall, I turned to one and told them emphatically that there's been a physical assault on a minor female patient by staff members, and I wanted whoever was in charge of the clinic, the intern's supervisor and security here now!

To make a long story short, they tried to play it down as "just a misunderstanding" & when we wouldn't back down threatened to call the police as we were "causing a disturbance". My reply was: "Don't bother, let me." I pulled out my cell, dialed 911. identified myself (I've been a reserve sheriff's deputy for many years) and requested a unit be dispatched to investigate an assault by clinical employees on a minor female & that eye witnesses were present.

Based on the statements from my nieces, myself and a couple other witnesses that were in the hall and overheard the screams, both the nurse and aide were cited for misdemeanor assault and ordered to appear in court next week to be arraigned. The administrator tried to interfere until they threatened to arrest her for obstruction of justice.

My sister (the RN) is madder than I am and has vowed to go after their licenses.

So much for respecting a patient's rights, autonomy and dignity.

And a situation that probably could have bees handled administratively will now be an issue of criminal prosecution and licensing sanctions. Maybe it will teach them a lesson........

 
At Friday, December 10, 2010 2:26:00 PM, Blogger Hexanchus said...

...Part the 2nd......

The nurse & an aide show up, say they have to get some preliminary information and ask my other niece and I to step out for a second, so we go into the hall outside the curtain. The nurse has a clipboard, so I figure they want to ask her some questions in private. After a minute or so, we hear my niece say "What?", then "Why?", followed by an emphatic "NO!", then "STOP!", and a screamed "Sis, Uncle, Hex, HELP!"

Needless to say, her sister and I quickly entered the cubicle, only to find the nurse & aide forcibly trying to remove my injured niece's clothing and my niece resisting vehemently. My older niece gets between the aide & her sister, and I yelled "Take your hands off of her! What the hell is going on here?"

Nurse: "We have to have her undress so the intern can completely examine her."
Me: "For a mild ankle sprain, what kind of an idiot are you?"
Nurse: "Those were his instructions."
Me: "Then he's either an even bigger idiot or a pervert."

There are a couple other staff members standing there, I turned to one and said emphatically "There's been an assault by staff on a minor female. I want the supervisor of this clinic, the doctor that supervises that intern and security here now!".


cont'd........

 
At Friday, December 10, 2010 2:43:00 PM, Blogger Hexanchus said...

..part the 3rd.....

Everyone shows up, the story is related and they try to play it off as a simple misunderstanding. I tell them "What part of NO and STOP didn't they understand?" When we refused to back down, the admin. threatened to call the police and claim we were creating a disturbance. I told her " Don't bother, let me.", then pulled out my cell, dialed 911, identified myself (I've been a reserve sheriff deputy for many years) and asked them to send a unit to take a report of a physical assault on a minor female by clinic personnel, with witnesses.

Police arrived, and based on the statements of my nieces, myself and a couple other witnesses that were in the hall and overheard everything, cited the nurse and aide for misdemeanor assault - they have to appear in court next week for arraignment. The admin tried to interfere and they threatened her with arrest for obstruction of justice.

My sister (the RN) is hotter than I am and has vowed to go after their licenses, and she's not kidding. (My older niece wanted to castrate the intern, but I think we talked her out of that....)

So much for respect for patient's rights, dignity and autonomy.

And a situation that probably could have been handled administratively, will now become a criminal and licensing sanction action. Maybe they'll learn something from it.

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

Good for you, Hex. The main issue is the meaning of the words "No" and "Stop." Forcibly undressing somebody for a sprained ankle? That's assault.

But this is also what happens when there is no written policy regarding patient modesty, esp. for simple injuries. When there's no written policy then everybody pretty much does what he or she wants. The "hidden" curriculum takes over. What you may hear is that this was just a fluke happening, that it was just this intern's way of doing things. You can bet if he did it in your case he's ordered it before. And the aides and nurses have, in the past, either forced or intimidated patients to undress as well. Where's the supervision of this intern? Where's the common sense? Oh, We were just following orders. Where's the patient advocacy? Where's the training? Where's the clear policy about patient modesty when minor injuries are involved? Apparently, patient autonomy and rights mean nothing when a relatively health patient can say "No" and "Stop" and then still be forcibly undressed.
Keep us informed as to what happens in this case.
MER/Doug

 
At Friday, December 10, 2010 10:55:00 PM, Blogger Hexanchus said...

Sorry for the duplication - when I originally posted the 2nd part, I got a "too many characters" error, so I thought it didn't post & broke it into parts 2 & 3....

 
At Saturday, December 11, 2010 7:36:00 AM, Anonymous Anonymous said...

Great work Hex! The more we refuse to allow that unethical treatment the easier it will be to force them to make some changes.

Your niece wasn't intimidated and stood up for herself really well. Did she get that from her uncle Hex?

During that experience did you get the feeling that you would have got the same results if it was your nephew instead of your niece? I know many people will say that if it happens to a girl it's a "horrible thing to do to a young, innocent girl", but when it happens to a boy he should "be a man" because they are "medical professionals". Nothing against your niece of course, or any other female victim.

 
At Saturday, December 11, 2010 8:15:00 AM, Anonymous Anonymous said...

Wow, I just saw the video from the Cebu Hospital Scandal. When the object was finally removed the OR looked like an NFL locker room after winning the Superbowl. I was waiting for them to break out the champagne and squirt it all over the place. I wonder if after the cameras stopped rolling they dumped a gatoraid cooler over the surgeon's head.

What surprised me was how well they had him draped. I would think after all the other unethical and unprofessional behavior they exhibited that they would have him laying completely undraped on a table in the middle of the waiting room.

I have no doubt that this kind of thing happens sometimes in the U.S., but Americans (as far as we know) have been smart enough to leave their cameras at home.

 
At Saturday, December 11, 2010 11:15:00 AM, Anonymous Anonymous said...

Hexanchus:
I am very impressed with your neice for standing up for her body. It's hard for so many adults, let alone minors! The other neice was brave as well, for protecting her. And finally your 911 call was so surprising that I actually blurted a word or two outloud..
We teach our kids No means NO, I guess we have to remind a few adults as well. I am so glad that you didn't react and put your hands on anyone allowing them to make this about you.
Well done.
I have to wonder how often law enforcement is willing to look at things from the patient's side rather than attempt to turn an actual (valid)assalt and/or battery into a misunderstanding. Many people just assume that the offenders will be justified in their actions most of the time, even when an assalt is clear.

Thanx for sharing your family's experience with us.

swf

 
At Saturday, December 11, 2010 11:27:00 AM, Blogger ~Charlotte said...

I also just briefly checked the Cebu scandal also. It is awful to hear the laughing and see the spectacle that the doctors and nurses etc. made of this situation.
My husband is a doctor and was in a Chicago medical school in the late 1970s. His curriculum included a learning seminar by the chief forensic pathologist in Chicago at that time. There were many strange and shocking stories about ways that people had died and also about things that had been done to people similar to the situation at the Cebu Hospital. No one took a jocular or ridiculing attitude. These situations were viewed with concern and some sadness and horror and always privacy for the patient. There was never a "circus" attitude but one of concern for the patient. What has happened that these medical professionals show such disrespect for another human being?

 
At Saturday, December 11, 2010 3:25:00 PM, Anonymous Anonymous said...

Hex's case is a good example of how poor communication, in this case "no" communication, can often end up in court. "Acting" upon patients, "doing" things to patients -- is not the same as "talking" with patients.
"Acting" upon patients when possible must be accompanied with "talking" with patients.

In Hex's case, the patient is certainly capable of intelligent discussion and should be an essential part of any action done to her. But no. She's not regarded as a person. She's a thing to be acted upon.
At what point in these encounters, from the doctor's point of view, do patients become "just bodies," or "things?" At that point, there's no need to talk to the patient, ask questions, seek opinions, etc. Unfortunately, this happens all to often in medicine. Patients who are fully awake, alert and capable of making decisions are just acted upon as objects with no communication.
There's a scene in the film "The Doctor," when the doctor, now a patient (played by William Hurt) is being wheeled down the hallway. Two doctors beside him are talking about him and his case as if he isn't even there. He speaks up and provides them with his opinion of his case. The two doctors are shocked at this, with the deer in the headlights expressions on their faces. Hurt as the doctor says something like: "Yes! It walks and talks and has an opinion." He's learning what it means to be on the other side of the system.
MER/Doug

 
At Saturday, December 11, 2010 7:12:00 PM, Anonymous Anonymous said...

Well concerning the CebU Scandal. I have to say it was as "dramatic" as it was simply because a staff member posted it online.
Of course this was in a dff country so I have no idea what their policy/privacy rules are.
My point is that it wouldnt suprise me at all if this type of behaviour from staff is common (yes in the U.S) but it remains unknown to the patient and/or family members simply because it happens behind closed doors even though apparently anyone and everyone was allowed to walk right through those doors simply for their entertainment.
Whether it was posted online or not this was a horrible way to treat and degrade a patient.
And again for many any docs/nurses who would draw the line at not taking or posting video its for the sake of saving their OWN career it has very little or nothng to do with respect for the patient. Thats pretty scary.
upsde down

 
At Saturday, December 11, 2010 9:41:00 PM, Anonymous Anonymous said...

Mer said

"This may also mean that a small
percentage should get out of nursing and find a different occupation."

I have been looking at that precentage for some time now and
have decided it is no small
percentage.

If one looks at the number of rn's,lpn's and cna'a each quarter
that are reprimanded it is staggering. There are enough to staff to man large medical centers and yet were are only talking about a group in for state for one quarter.

Don't forget all those that are impaired which many put estimates as high as 10%.


I wouldn't be surprised if we are dealing with numbers as high a 40-50%.


PT

 
At Saturday, December 11, 2010 11:00:00 PM, Blogger Maurice Bernstein, M.D. said...

I can't be sure if what I am about to write is pertinent to Hexanchus' story.

Teaching 2nd year medical students, I can inform this thread that they do perform a complete history and physical (no pelvics)on hospitalized patients even those who had been previously examined by interns and residents and even those who are stable and about to be discharged home. Nevertheless, each student and/or myself gets permission directly from the patient for their examination. If the patient says "no" (though a rare occurrence), the student leaves and the patient is not examined.

I can imagine that an intern might be required to perform some degree of a screening complete physical exam on an ER patient with a mild injury which would require the patient to be undressed. However, if the patient refused, the patient would still be treated but the refusal would be noted in the chart. Performing an exam on a patient with decisional capacity to refuse and indeed had refused could amount to legal battery. ..Maurice.

 
At Sunday, December 12, 2010 12:13:00 PM, Blogger Hexanchus said...

Dr. Bernstein,

I could see where this might be the case in an ER, but this was urgency care, not the ER. It's next to the ER, but has it's own separate area & staff. Patients are mostly what my wife & sister call "walkie, talkies" - patients with minor injuries and illnesses that may need treatment, but for whom the ER would be major overkill. They're typically used for after hours care when the PCP offices are closed.

Any exams are targeted on the complaint. In the half dozen or so times I have been to an urgency care, they have never done or requested to do a complete history and physical - come to think of it, in the few times I've been in an ER (mostly minor stuff before they had urgency care)they never did either.

In my niece's case it was a minor sprain of her ankle - we only went to the urgency care because the trainer recommended we have it looked at & possibly x-rayed just in case. She was warm-ups over her lacrosse uniform, so the ankle was easily accessible for examination without removing any clothing. Her vitals (temp & BP) were done when we checked her in.

When I asked her about the conversation with the nurse & aide immediately prior to the incident, she said the nurse asked her if she had hurt herself anywhere else when she fell. My niece told her that she did not fall, that she just twisted her ankle. She said the nurse essentially ignored her response and told her she had to get undressed so the doctor could examine her. That's when she said "What?" - nurse repeated she must get undressed, which is when my niece said "Why, it's just my ankle". At this point the nurse started to try to remove my niece's warm ups - when my niece said "No.....Stop" she was physically resisting having her clothing removed and the aide grabbed and held her wrist, trying to assist the nurse. That's when the "Help" came and we went to her assistance.

At this point the intern hadn't even seen her yet. I didn't know this at the time, but the reason my other niece wanted to castrate the intern, was another young female employee don't know who) told her "Good for your sister for standing up for herself - that intern always likes to completely examine the young pretty females". Good thing I didn't know, or he may have wound up wearing his gonads for a necktie.

 
At Sunday, December 12, 2010 12:54:00 PM, Anonymous Anonymous said...

Hex write: "another young female employee don't know who) told her "Good for your sister for standing up for herself - that intern always likes to completely examine the young pretty females."

See -- this a a huge problem in medicine. In some cases, the unhealthy culture severely discourages employees from reporting this kind of abuse. So -- this intern's proclivities were known by others. They probably talked about it in the lounge. Did they joke about it? Did they report their suspicions to anyone? I realize there's a risk in reporting something like this. But look at the outcome here. Examine the result of employee silence. Perhaps health care needs secret shoppers to infiltrate medical establishments to get a gage on the health of the culture. Apparently, you only learn of the disease, if you'll excuse the metaphor, when the patient is on his deathbed.
Doug/MER

 
At Sunday, December 12, 2010 2:39:00 PM, Blogger Hexanchus said...

MER,

Like I said, I don't know who told her that, and it's probably a good thing I didn't know about it at the time - found this out last night when we all had dinner together. My niece thinks she remembers part of a name and does know what she looks like - I told her to write it all down so she could refer to it when we talk to the detectives, which we're supposed to do tomorrow or Tuesday.

When my wife (also an RN - she went to nursing school with my sister - that's how I met her), found out, she was really PO'd. She said that never, in over 30 years of nursing has she ever even thought of doing anything like that, and anyone that ever tried it on her watch would be toast. If a patient says no, you simply document and move on.

When the two of them started comparing notes and talking strategy I gracefully backed away - learned a long time ago that when those two get really hot and focused on something the best thing to do is stay out of the line of fire.....

My wife works for the organization that owns this facility, and I know she called the DON, DOM and risk management supervisor at home to give them a heads up. None had a clue - turns out the supervisor apparently didn't promptly report the incident as policy requires. I suspect that the feces is going to impact the rotating ventilation device big time.

 
At Sunday, December 12, 2010 3:19:00 PM, Blogger Hexanchus said...

SWF,

Thanks for your kind words. My niece is a pretty tough cookie - hey, she plays lacrosse (just the thought of a bunch of girls on a field swinging sticks around makes me cringe). Actually, all our kids are. I was very proud of the way both nieces handled themselves on Thursday, and made it a point to tell them so.

Regarding my 911 call, it was purely preemptive. When the supervisor made noises about calling to report us creating a disturbance, I knew she was mostly bluffing to try to get us to let it go away. Thing is, I've never been intimidated by threats - when threatened, my focus is on doing whatever it takes to neutralize the threat. When I upped the ante by pulling out my phone and making the call myself, the look on her face could best be described as "Oh crap!".

As to laying my hands on someone, it would never happen unless I was physically attacked first or the assault on my niece had continued, and even then I would only use whatever force was necessary to neutralize the threat. The voice can be a powerful weapon when used properly, and I have been trained how to use it. In this instance, it had the desired effect.

My sister, myself and our spouses were all raised to be independent self thinkers and have tried to raise our kids the same way. We've taught them from an early age that they can come to any of us at any time to discuss something or ask questions, and that no topic is taboo or off limits. We've also been very careful to delineate what we know (facts) from what we think (opinions) and encouraged them to think for themselves and form their own conclusions.

It's worked pretty well so far......

 
At Thursday, December 16, 2010 9:24:00 PM, Anonymous Elizabeth said...

I'm Australian and we don't have the thorough annual physical exams that many Americans accept as necessary for good health.
I've never had anything like that exam. Usually my GP is so busy she deals with my complaint and I'm out the door, there is no time for fishing expeditions.
Can I just ask what this physical would have involved? Was she being asked to undress down to her bra and pants or completely naked in a gown or covered by a sheet?
Given her injury, her blood pressure and pulse had been checked, what else would be necessary? Surely with a sprained ankle, a Dr wouldn't be doing breast exams or palpating the abdomen?
What was he intending to do and wouldn't he have to justify what he was doing - tie it to the injury?
Congratulations to your niece, it's a difficult thing to stand up to doctors and medical people, you're in their environment and many people are too intimidated to refuse or object...
I've always felt the comprehensive exams that many Americans seem to accept as necessary every year leave you wide open to abuse - where are the barriers, if anything goes?

 
At Thursday, December 16, 2010 9:51:00 PM, Blogger Hexanchus said...

Update:

It's been an interesting week. Monday we all got separate phone interviews, basically just to confirm our statements from the evening of the incident, plus my niece was asked if she still wanted charges brought & she told them yes. Also on Monday, my sister contacted the BON and started the formal complaint process regarding the assault on my niece. (Since my wife works for the parent organization of this facility, other than making the initial calls to advise them of the situation, she's avoiding any direct involvement in order to avoid any appearance of a conflict of interest.)

The hearing to determine if charges should proceed was Wed. After hearing the witnesses' statements, the judge deemed the evidence sufficient and both the LPN and PCT were formally charged with misdemeanor assault (punishable by up to a year in jail if convicted), ordered to report to the booking facility to by photographed and finger printed, then released on recog. They did have an attorney with them and entered pleas of not guilty.

After the hearing, their attorney spoke with the prosecutor, who then spoke with us. Oddly enough, it appears they're taking the equivalent of a Nuremberg defense - not that it would fly in a case like this. He asked my niece if she would be OK with some kind of a plea bargain in order to avoid the hassle of a trial (he said with the evidence, odds of a conviction were about 95%). She told him that she didn't want to see their lives ruined, but they had to plead guilty to something and must have some kind of meaningful punishment. He said they'd see what could be worked out & get back to us. Guess we'll see what happens.......

 
At Friday, December 17, 2010 5:01:00 AM, Anonymous Anonymous said...

Hex, your niece is my hero. Great job, I assume you were a great influence. It sounds like both offenders were women, right? It would be great to see you win the case based on two supposed "professionals" assaulting a "patient" rather than making it all about gender. I imagine that gender makes no difference to you in this case but I think it would matter to some jurors. But gender aside, I think you have a great case and I wish you all the best.

 
At Friday, December 17, 2010 5:31:00 AM, Anonymous Anonymous said...

I had a situation in a teaching hospital - the patient was an older lady for whom I had healthcare power of attorney.

She was naked, exposed in her bed because the aide was cleaning up the bed. She sounded in some sort of distress, and the (female) attending and I went in. The attending stood at the head of the bed, and looked at her face. I looked to the side.

A male resident came in and stood at the foot of the bed, looking right at her completely naked. I asked the patient if it was OK that he was there. She said "No". I asked him to leave. He refused, saying "I'm a doctor, I've seen them before". I repeated my request, asking nicely, and he still refused. He was not doing anything, just observing. Eventually the attending heard the argument, and told him to step out.

He may have "seen them before" - but he hadn't seen HERS and she didn't want him to. We threw the jerk off her case.

Tracy2

 
At Friday, December 17, 2010 7:06:00 AM, Anonymous Anonymous said...

You might want to sue the hospital and make settlement a provision that these people are fired and that licenses are revoked
gd

 
At Friday, December 17, 2010 9:17:00 AM, Blogger Hexanchus said...

Elizabeth,

All good questions - unfortunately we don't have the answers since it never got that far. She was never actually seen by the intern. When the LPN told her to undress and she refused is when they tried to forcibly remove her clothing and when her sister and I intervened, bringing everything to a swift halt. There was a gown laying on the exam table, so I assume they intended her to wear that.

The only thing we have to go on is the statement by another employee to my other niece stating "that intern always likes to completely examine the young pretty females". As Doug/MER said, this intern's proclivities were undoubtedly known by others and probably talked/joked about in the lounge. I find this really disturbing.

I can assure you that the questions you posed and others are going to be asked. My sister is seriously pi$$ed off - she's in "mama bear protecting her cub" mode, and won't stop pushing until she gets answers. Fortunately, she knows how to focus that energy and use it to best effect.

The funny thing is, this particular cub has teeth. I've been a student of martial arts for more than three decades, and part time instructor for over two. As her long time sensei and frequent sparring partner, I can assure you that had the situation escalated to the point she felt seriously physically threatened, even with a sprained ankle she could have easily neutralized any threat from both the LPN & PCT without breaking a sweat - I've had the bruises to prove it. We're all glad it never came to that.

 
At Friday, December 17, 2010 10:10:00 AM, Blogger BJTNT said...

Hexanchus,
Kudos to you, your niece, and sister. You're doing everything right. How about calling the local newspaper[s] and TV station[s] for a story. Since it involves a young female athlete, they could be interested. The story will show future patients how to react.
BJTNT

 
At Friday, December 17, 2010 12:00:00 PM, Anonymous Anonymous said...

Best of luck, Hexanchus, to all members of your family that are involved. It is a rather ominous task of making sure the punishment fits the crime...and in whose eyes justice is satisfied.
I do agree with 'gd' that licenses need to be revoked. One can survive a lost career,( I know some will argue with me on that) and just like everyone else in life, will have to move on with the aftermath of accounting for distructive choices in life. Anyone whose purpose in healthcare is to serve their own agenda, no matter what, and attempt to justify those actions should not be in this career path anyway.We all know what people who have no respect for boundaries are capable of. JMHO.

An aside but I believe it is germane to actions we see posted here.
My conversations with caregivers on blogs, email, and direct, seem to be heading in one direction. They say advocates,patients/clients, and even doctors can do what they want but will never 'win'. Hmmm......
So advancing respectful options in healthcare is a loss to them. I have to wonder, what do they think they are losing? Power? Control? The ability to do what ever they want with no questions asked?
And what would us 'winning' mean to them? Respectful options that we should not have? A voice in types of care that should not be heard?
It is shameful to use our bodies as a power struggle of winning and losing, and I think a rather childish display of selfish foot stomping. I can't put into words how petty this stance is.
Change is not loss, it is a natural evolution of expectations and need.

Soapboxing over.

swf

 
At Friday, December 17, 2010 12:36:00 PM, Blogger Jean said...

Elizabeth,
I am an American and, quite frankly, I don't understand why so many people here feel the need to go to the doctor on a yearly basis, even when they feel fine. People are like sheep; they are constantly being told how important it is to get these screenings (pap smears, pelvic exams, mammograms, colonoscopies, etc.)so they just follow along. I think a lot of it is scare tactics on the medical community's side. Instead I wish they would concentrate more on what people can do to prevent these diseases through lifestyle choices. Also, it seems most of these screening exams are the sort that a lot of us more modest types find extremely difficult to undergo. Why can't research work on developing less invasive and embarrassing ways to test, such as blood tests and more sensitive DNA stool tests. Also, it would probably save health care dollars if they assessed each patient's individual, true risk instead of insisting that everyone have these exams. Personally, I only go to the doctor when I am not feeling well, which is very seldom. I do not like to live my life in fear that I may have some undetected disease and I refuse to live a medically controlled life.

 
At Friday, December 17, 2010 1:06:00 PM, Anonymous Anonymous said...

Hex:

As you go through this ordeal, you have an opportunity to make some changes in the system. If I may suggest, see if you can enforce a written policy about how certain exams are done. For example, the policy would make it clear that getting someone naked in a gown for things like a sprained ankle, would under normal conditions be completely unnecessary and against policy. If a doctor decided to do that, they would have to, in writing, justify why it would be essential. Most hospitals will resist this kind of written policy -- but you have the upper hand here, thus the opportunity to get it done. A policy like this would make sure that under almost all circumstances, Dr. X and Dr. Y, regardless of their "preferences" would not be allowed to differ in how they did exams like that just because they prefered to do it that way. Right now, in most hospitals, many doctors and nurses do many things regarding patient modesty based upon their own comfort and preferences, not necessarily upon how they were trained officially. They may have been taught certain procedures in class, but once on the job, the hidden curriculum took over. That needs to change.
MER/Doug

 
At Friday, December 17, 2010 2:57:00 PM, Blogger Maurice Bernstein, M.D. said...

While I see merit in some standards for the extent of a physical exam on patients, particularly in the case and the history of the alleged requests by that physician under discussion, I think that one has to be careful about setting up such standards since the only one who has the final responsibility for the diagnosis is the patient's physician and to tell the doctor "how much" of a physical will yield the information necessary for a diagnosis on all patients is being over-simplistic regarding the multitude of variables and possible co-factors in every case. Whether the physician has "gone overboard" with the physical is difficult to determine without all the facts.

No teacher, as far as I know, would teach a student "you can only do this and that for such a chief complaint and nothing more!" On the other hand, students are taught "STOP" and explain and listen if a patient refuses a certain part of the examination. They are taught if the final answer is "NO!", the student had better not proceed without accepting the legal and professional consequences. ..Maurice.

 
At Friday, December 17, 2010 4:21:00 PM, Anonymous Anonymous said...

I see your point, Maurice, and it has merit. However, I don't see why a doctor can't say to a patient:
"You have a sprained ankle. Normally, under such circumstances, our policy is that you don't need to get into a gown and have a full examination. But, for these reasons ______, I recommend strongly that this be done."
Then, if the patient refuses, it's noted and the doctor is covered. The policy doesn't back the doctor against the wall. What it does, is force the doctor to communicate with the patient,explain the policy, and then justify why he/she wants to go against the policy.
MER/Doug

 
At Friday, December 17, 2010 6:21:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree: communication and documentation---that's the way to go and not by "forcible" examination. ..Maurice.

 
At Friday, December 17, 2010 8:04:00 PM, Anonymous Anonymous said...

The medical system needs to make professionals more accountable for their behavior. An article called "Naked" appeared a few years ago I believe in JAMA. It talked about how there are no protocols for undressing and that each doctor has their own system. This creates a problem for patients who often don't realize there is an impropriety until it's over. Then they bear the brunt of burden that there were complicit in such misconduct in that they didn't have the fortitude to say no. The consequences as in the case in discussion could have turned into a sexual assault.

Any medical professional who commits an act that will detrimentally influence the mental health of a patient should have their license revoked much in the same way that medical malpractice occurs.

Just because you can't see it, mental trauma can be even more devastating and in the long run effect the physical health of a patient. This is a serious issue that most of the medical industry would like to ignore. I just don't understand why.
gd

 
At Friday, December 17, 2010 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

gd, interesting that you brought this up, but the article to which you are referring "Naked" written by Atui Gawande. M.D.in the New England Journal of Medicine August 18, 2005 was, in fact, the article referred to by me as I started this entire 5 1/2 year series of Volumes with the beginning title "Naked" based on that article. It is most interesting to go back to that initial thread and read what the visitors were writing at the time.
If you have some comment to a specific response, you can copy what was written and write about it here. That Volume "Naked" was closed for further comments a long time ago. ..Maurice. p.s.- the most popular thread on my blog of currently a bit over 800 topics. I wonder why.. perhaps a more controversial topic and yet as one reads through the volumes, there doesn't seem to be much controversy between those who are writing.

 
At Friday, December 17, 2010 9:54:00 PM, Anonymous Anonymous said...

Maurice: The reference to the article "Naked" combined with Hexanchus's incident, have emphasized to me what I've been consistently saying is the foundational problem -- poor communication. Gawande complains about fumbling around with gowns and bras and underwear -- but where is the communication, the simple discussion between doctor and patient about what the doctor needs to do and see, how the patient feels about it, and how to do it? It isn't there. He just complains and jokes about their being no protocol.
Hexanchus's case further emphasizes the problem. From his description, there appeared to be no communication between the patient and the various caregivers. The doctor said to his assistants -- "Get her naked and gowned." So the nurses or cna's told her "Get naked and gowned." Her answer, "No." Their response -- force. Where's the discussion, the communication, the explanation?
I still claim that most of these modesty violations could be solved with better (or even "any") communication -- with the responsibility falling upon the provider to read a patient's concern or discomfort over modesty, empathize, and open discussion.
MER/Doug

 
At Saturday, December 18, 2010 8:54:00 AM, Anonymous Anonymous said...

Thanks, Maurice. I think they said it all very well.

I would like to comment that if there can be medical procedure for different ailments, why not extend the procedure to the psycho social aspects as a matter of protocol. That way, the doctors are protected from allegations of impropriety, patients know what to expect and the very structure of the system will alleviate many of the problems including the case discussed here.
gd

 
At Saturday, December 18, 2010 11:50:00 AM, Blogger Maurice Bernstein, M.D. said...

I am not sure if I had written this sometime in the distant past on these threads, but it wouldn't hurt to bring it up again to demonstrate that as teachers of second year medical students we try to instill in them professional behavior when they deal with sensitive (genital)patient modesty issues. One deals with the use of appropriate language. The other deals with the process of the examination itself as taught to the students by subject-teachers (men and women who teach the students how to perform the pelvic, male genitalia and breast exams as the student does the exam on the teacher.) So here are some important language lessions we teach the students:
"table" instead of "bed"
"please disrobe" instead of "get undressed, please take your gown off..(et cetera)"
"Thank you" if the patient performed the requested task.
"I am going to touch you now"
"Parts of this exam may be a bit uncomfortable, but nothing should hurt. I will alert you to the portions of the exam that might cause a bit of discomfort; if at any time you feel pain, please let me know and we will see how we may remedy it."
“This might be a bit uncomfortable”
“Palpate or examine with my fingertips” rather than “feel”,
“Footrest” instead of “Stirrups”
A speculum has “Bills” not “Blades”
“Remove or withdraw” rather than “pull out”
“Please relax your knees” rather than “open your legs for me; spread your legs”
“External genitalia” rather than “down there”
“Penis, scrotum, testicle, buttocks, rectum, genitalia, vagina” – please refer to anatomy by the proper name, never use “it” in place of the correct term, as in “please move it to the side”.
“Please cradle or hold the testicle (or penis)” rather than “grab your testicle or penis”
“Place your feet shoulder width apart” rather than “open your legs for me; spread your legs”
“Please turn to face that table and rest your elbows on the table” rather than “turn around and bend over” – for male exam, the act of placing elbows on the table will automatically provide for the best positioning in the rectal exam.

All I can say is we try to do the best in teaching students to perform the exams in a professional, effective and yet modesty-sensitive way while educating the patient along the way so the patient knows why something is being done and why and what discomfort, if any, the patient may experience.

Now, what happens to all this teaching in the years after medical school.. well, only you as patients will know the answer to that one. ..Maurice.

 
At Saturday, December 18, 2010 1:41:00 PM, Anonymous María said...

Kudos to Hexanchus!!! I wish that, This over time, things improve. This "I do everything that way because it's the way I've always done them" is just plain wrong. Hope they get what they deserve!!!
As for Dr. Bernstein, I wonder why he closed that particular thread, it was one of my favorites and I looked for it for days to no avail.
Keep us posted!!!

 
At Saturday, December 18, 2010 1:59:00 PM, Blogger Maurice Bernstein, M.D. said...

Maria, "Naked" was closed because after over 300 comments, as I recall,Blogger.com was not publishing more. Also I got reports from visitors that it would be easier to scroll on some "weak" computers if the number of comments were less. ..Maurice.

 
At Saturday, December 18, 2010 3:06:00 PM, Blogger Hexanchus said...

Things have gotten a little more interesting. Got a call yesterday from someone at the facility where the incident occurred - said they are investigating the circumstances surrounding the incident and would like us to meet with the DOM, DON & facility manager (they also apparently left messages for my nieces, but hadn't spoken with them yet). I told them that I wasn't sure how appropriate that would be, given we are witnesses in the resulting criminal case against two of their employees, but would check. Called the prosecutor and asked - they had no problem with it as long as we don't discuss any specifics related to the criminal case, any questions along those lines should be referred to the prosecutor. Kicked it around with my nieces & sister, and we decided to go ahead, so I called them & told them we would, subject to the limitations of discussion the prosecutor requested. They're going to set a meeting up for early this coming week.

I'm thinking this might be an opportunity to open a dialog - we'll see how it goes....

 
At Saturday, December 18, 2010 5:39:00 PM, Anonymous Anonymous said...

Maurice. As I've said before, I applaud your work in training medical students in this subject. I'm sure it's done at some other schools too, but I question whether it's the norm. What happens after medical school? I think perhaps a few forces take over:
1. The hidden curriculum -- what they learn on the job. Every occupation and profession has an underground curriculum -- "Okay. I don't care what they taught you in school -- this is how we do it here."
2. Some elements of the hidden curriculum are good; some are damaging. It varies from hospital to hospital depending on the general health of the culture at each institution.
3. I think over the years other forces enter the picture -- the first, routine. Doctors are socialized to "see" differently. What they "see" is relevant. What is not relevant to them, they don't "see" anymore. Nakedness becomes one of those routine things they just don't see anymore because to them it isn't relevant.
4. Why isn't it relevant? Another force enters the picture -- the power dynamic between doctor and patient. That, I think becomes less relevant in the doctor's eyes, and they don't
"see" it. In their years of experience, few if any patients complain about modesty or modesty violations. What does that teach the doctor? That it doesn't matter to patients. Not only is nudity not relevant to them anymore, but because patients don't speak up, even if it matters -- doctors assume it is not relevant to the patient.
Now, when I say "the doctor" I'm not saying "all" doctors feel this way. Life is more complicated. And there are many other issues to, including all those factors that are causing our health care system to be under stress.
Just some thoughts.
MER/Doug

 
At Saturday, December 18, 2010 8:02:00 PM, Blogger Maurice Bernstein, M.D. said...

My understanding is that this approach to the teaching of the genital exam is a standard practice in medical schools in the United States. I would like to be informed if I am in error. ..Maurice.

 
At Saturday, December 18, 2010 8:22:00 PM, Blogger Maurice Bernstein, M.D. said...

Some of my visitors might be interested in the experiences of genital teaching assistants (GTA)on this blog both by the author and by the comments by his visitors. Again, what is described is the same as in my school but unlike the author, all the GTAs are trained and could do the teaching without the attendance of a physician. A most interesting and worth while occupation. ..Maurice.

 
At Saturday, December 18, 2010 10:58:00 PM, Anonymous Anonymous said...

A question about these standardized patients. I take it one of their functions is to not only help the students feel more comfortable with these kinds of exams, but also prepare them to do them correctly. They guide and giving feedback from the patient perspective? Is that correct? If that's correct, I take it that the SP's are comfortable themselves with opposite gender student-doctors working with them.
So...I wonder. The students, males and females, are training with patients who are comfortable with opposite gender care. Do they ever train with standardized patients who are, or who act as if they are, not comfortable with opposite gender care? If not, I wonder how the students get used to dealing with real opposite gender patients who may not be comfortable with opposite gender doctors for these kinds of exams?
MER/Doug

 
At Sunday, December 19, 2010 5:31:00 AM, Anonymous Anonymous said...

"Good for your sister for standing up for herself - that intern always likes to completely examine the young pretty females". Good thing I didn't know, or he may have wound up wearing his gonads for a necktie.

@Hexanchus,
It's been bothering me and I can't help wondering, were this your nephew and an orderly said to your other nephew the same thing about a female intern who loved to examine "young handsome males," would you have been so impassioned about decorating her with her gonads? (This, BTW, is a more common scenario.)

If not, why not?

—rsl

 
At Sunday, December 19, 2010 6:02:00 AM, Anonymous Anonymous said...

"The other deals with the process of the examination itself as taught to the students by subject-teachers (men and women who teach the students how to perform the pelvic, male genitalia and breast exams as the student does the exam on the teacher.)"

Wow! Does that really happen? I've always thought most professors in Med schools and nursing schools are, like the students, too arrogant and "important" to demonstrate intimate exams and procedures on themselves.


"Do they ever train with standardized patients who are, or who act as if they are, not comfortable with opposite gender care?"

That would be an excellent method to open the students' eyes to reality, although I find it difficult to believe that most students haven't at some point in their lives given some thought to their own modesty. The problem I see with this method though is that in many cases I can see the subject of the professor's lesson wouldn't be how to identify problems and communicate with the patient, it would be how to trick the patient into allowing full access or humiliate them into keeping their mouths shut.


"Just because you can't see it, mental trauma can be even more devastating and in the long run effect the physical health of a patient."

True, and very well said.

 
At Sunday, December 19, 2010 7:53:00 AM, Blogger Maurice Bernstein, M.D. said...

Doug, my only experience is with 2nd year students of both genders at their first and only session examining male teachers. (I have not attended the pelvic exam of female teachers.) This is the first time these students are inspecting and palpating a stranger's genitals and so far have only partially learned the technique on paper (in their minds) and now they have to "do it for real". This is a nervous time for virtually every student,male or female,learning how to talk to the patient and how to do it and is definitely not the time to face a teacher unwilling to be examined even as a learning experience. Though this may be their single experience in this live exam during their second year, they do have the opportunity to practice on plastic models with a physician's (mine) assistance and I can tell them what "no" or patient reluctance might mean. Otherwise, the bulk of their actual experience performing these genital exams on patient will occur in the 3rd and 4th year clerkships on the hospital wards and presumably they will get experience and teaching then about communicating with patients who are uncomfortable with the opposite gender examiner.
..Maurice.

 
At Sunday, December 19, 2010 12:05:00 PM, Anonymous Anonymous said...

Thanks for you answer, Maurice. I think it might be useful, once these 2nd year students get the basic procedure down, for them to work with some standardized patients who are good actors, who can demonstrate reluctance to be examined by opposite gender doctors, who act embarrassed or humiliated. Some of them could act it out nonverbally to see if the students could pick it up on their feelings and open up discussion. Just an idea.
I also want to clarify what I wrote earlier when I talked about Hex's case and used the expressions "Get her naked and into a gown." I'm not suggesting that the doctor or assistants used those words. What I'm suggesting is that may be what the patient "heard."
What you describe, the vocabulary students are learning, is excellent teaching. Words are not just words -- they can become actions, too. But when people are engaged in communication, and emotion plays an important role. the words used play little role in what is communicated. Body language and tone make up what people read primarily. I refer to the research of Albert Mehrabian.
My point is this: Yes, students need to be taught the correct vocabulary and how important it is. But what needs to be emphasized to them is that in such situations, their patients may not really be listening. The patients are watching and feeling. The words themselves will carry little weight as far as what is being communicated. Body language and tone of voice will be the primary vehicle for communication.
Doug/MER

 
At Sunday, December 19, 2010 7:08:00 PM, Blogger Hexanchus said...

rsl,

My comment that you referred to is metaphorical. I would never resort to physical force except in defense of an imminent threat - there are much better ways to deal with things like this.

The comment made to my niece indicated that the reason for the exams by this intern may not have been completely medical in nature. In situations like this, the gender of either the provider or patient are irrelevant - the issue is the possibility of inappropriate motives or behavior on the part of the provider. I'd be just as upset with any provider, regardless of the gender of either the provider or patient. Wrong is wrong.

 
At Sunday, December 19, 2010 7:09:00 PM, Blogger Hexanchus said...

Doug/MER,

I'll ask her what her thoughts were....

 
At Monday, December 20, 2010 2:21:00 PM, Anonymous Elizabeth said...

Jean, You're more likely IMO to remain healthy and happy adopting that attitude. Can I ask though, how easy has it been to get healthcare?
On another forum lots of American women have mentioned they're effectively locked out of most healthcare if they decline well-woman exams. They can't get the Pill, HRT, migraine meds, steroid creams for skin complaints etc - even a woman with a kidney issue (which meant pregnancy seriously endangered her health) was refused the Pill after she declined a well-woman exam - she fell pregnant and sought legal advice, but subsequently miscarried...
I find it astounding that a woman's health could be jeopardized for an exam that is of such poor clinical value that it's not even recommended in many countries. It's never even been mentioned to me - I wouldn't permit it anyway. Also, cervical cancer is rare and informed consent is required for all cancer screening, you can't legally or ethically demand cancer screening. There are risks with all cancer screening and we all have different risk profiles, that's why it must be the patient's choice.

It seems many American women now receive health care overseas, get the Pill and antibiotics from online pharmacies or use condoms and natural methods that don't require a script...a few even choose not to have relationships resenting the "issues" and loss of control it creates for them or they're psychologically damaged or/and have been put off sex after very bad experiences. (unnecessary cone biopsies, traumatized by well-woman exams "required" for the Pill etc)
This is a serious state of affairs when women have two choices - submit to unnecessary, possibly harmful exams and optional testing OR go it alone. How can that be permitted in America? If I were reading about a number of other countries, I wouldn't be surprised, but America!
I'm not America-bashing, far from it, I have American colleagues/friends and have visited your country several times, my younger sister even studied in the States for 4 years...
But what is going on in women's healthcare - it sounds like an extreme regime intent on harming and controlling as many women as possible??
Jean, how have you managed? I do as you do, see the Dr when I need to, which is infrequent. I don't participate in cervical or breast cancer screening - informed decisions. I'm certainly not locked out of health care, my Dr has simply made a note on my file.

 
At Monday, December 20, 2010 2:47:00 PM, Anonymous Elizabeth said...

Hex, Good luck with your action, hopefully, that will shake up the system. The staff were either poorly trained, unsuitable for that work or are fed by a climate that does not respect patient rights, modesty, privacy and dignity.
We really can make a huge difference if we complain, so many people just walk away with the pain of it all...
I believe breaches of dignity and privacy stay with us - you only have to raise the topic and it's amazing that some people go back to childhood experiences in large teaching hospitals or when they gave birth 40 years ago. These things matter...
Taking action will force change and stand as a warning to others.
As far as that Dr is concerned, I do think young and attractive people are the most vulnerable in the medical setting. Our indignity and exposure may generate all sorts of thoughts and feelings in medical staff, but wanting to take advantage of someone in a predatory way - it's usually the young, attractive and often reserved/shy as well...
At University there was a very attractive woman who was also quite shy, she got the lot - stalkers, flashers, assaulted several times (not raped, thank goodness) and her family Dr clearly had a separate agenda for her visits. He'd have to be more careful these days - not even routine breast exams are recommended here, so he'd be required to explain why that exam was necessary...(if she complained)
Knowing your victim becomes important, but you can never be sure when a reserved person might fight back...
The easiest way for a Dr to take advantage here would be pressuring a woman to have cervical screening when she came in with her sprained ankle, but once again, he'd have to be careful not to coerce or intimidate or use extreme pressure. Of course, it would be his word against her word and many doctors here don't use chaperones. Some doctors here may feel more brazen with pap tests because the Govt actually pays them to reach targets (undisclosed to women) - so he could say he was "encouraging" her, as the Govt has asked him to do - opportunistic screening.

I think your niece is amazing, so many of us are intimidated in a medical setting. It's hard to speak up, refuse, object, at any age, let alone a teenager.
Maintaining control in the consult room is very important. I shopped around for a Dr I respect, who also respects my right to choose. I also feel on an equal footing with her. I wouldn't see a Dr who talked over me or lectured/ordered me to have this or that and to use coercion, he/she wouldn't see me for dust as I left their surgery!
We all need to talk to each other as well - I think American women should create a list of the doctors who still hold the Pill until the woman agrees to unrelated and irrelevant exams/tests - & stay away from the doctors who do the wrong thing - reward the ethical doctors - when these "requirements" mean less income rather than more income, that will encourage change. It works at the moment because most doctors have banded together leaving women with few options...but there are still some American doctors who respect a woman's right to choose and don't make unethical demands.

 
At Monday, December 20, 2010 10:52:00 PM, Blogger Hexanchus said...

Doug/MER,

I spoke with my niece tonight - we have a meeting late tomorrow morning with the honchos from the facility where the incident occurred, so we got together to make sure we knew what items we specifically want to bring up and decide how that will happen.

When I asked her what went through her head when the LPN told her she had to get undressed, the answer was not what you'd expect - she said she was offended. The LPN had just asked her if she hurt herself anywhere else when she fell, and my niece told her in response that she did not fall, just twisted her ankle. The LPN ignored her response and told her she had to get undressed to be examined by the doctor for other injuries. She said she felt like the nurse was questioning her integrity and calling her a liar. It greatly offended her sense of honor, and she was somewhat PO'd by it.

She refused, and when they tried to force the issue, she said she reverted to training: resisted verbally initially, called for help from others (she knew we were right outside the curtain), physically resisted having her clothes removed by pushing their hands away and mentally went to center. She said that she was not yet concerned for her own safety, because she knew she could deal with it if it became a threat, and since her sister & I entered immediately, it never got quite that close.

RE: the meeting
When we agreed last Friday to meet with them, subject to certain conditions at the request of the prosecutor, we gave them some dates & times that would work for us - they contacted us today & had chosen mid-morning tomorrow from our list. I'm not exactly sure what their intent is, but I can make some educated guesses. As I said earlier, we got together this evening to make sure we were all on the same page and how to bring up the issues we want addressed. I'll let you know how it goes.....

 
At Tuesday, December 21, 2010 1:08:00 AM, Anonymous Anonymous said...

Hexanchus wrote: " The LPN had just asked her if she hurt herself anywhere else when she fell, and my niece told her in response that she did not fall, just twisted her ankle. The LPN ignored her response and told her she had to get undressed to be examined by the doctor for other injuries."

I was just talking with an advanced EMT today, and he commented that if the patient complained of pain anywhere else they might do a full exam. But it seems clear that this wasn't the case. They asked. She answered.
Almost sounds like either they just asked because it was routine, but it was so routine that they didn't even listen. Either that, or it was just a rhetorical question -- the answer didn't matter to them because their protocol was to do a full exam anyway. Regardless, it's seems clear that there was little attempt to communicate anything about what they planned to do and why.
Let us know how the meeting goes.
MER/Doug

 
At Tuesday, December 21, 2010 3:14:00 PM, Anonymous Anonymous said...

I think doctors here in America should pay attention and learn from the Australian medical system. I feel bad for all that women go through just to keep a supply of necessary pills.

As a young man I was forced to choose an unethical medical exam or lose something very important to me. In my case it was a hernia exam given by a female doctor and the female school nurse. Without the exam I couldn't play school sports, and I was, and still am a sports fanatic. Ultimately I chose not to submit myself to their unethical requirements and played on city league teams instead. The city leagues used common sense and allowed us to go to our own doctors and only once did I have to get a hernia exam, from my male pediatrician. I hear now that school administrations aren't as bullheaded as they used to be. I still don't understand the need for hernia exams for teenagers but it sounds like any athlete can go to their own doctor now.

Sorry for changing the subject but hearing about women being required to go through worthless exams for birth control sounds so much like the requirement that boys are forced to go through just to be allowed to play sports. I think there are more than a few school nurses that look forward to football or basketball season to come around.

To anyone from Australia:
Do you have any idea if boys in Australia are required to receive a silly hernia exam as a pre-requisite to play school sports?

 
At Wednesday, December 22, 2010 5:21:00 AM, Blogger Jean said...

Elizabeth: In response to your question about how I "navigate" the health care system without submitting to well women exams, I am menopausal so am no longer in need of birth control and I managed to go through the change without HRT. After all, it is just a natural thing for women to go through and I think most can manage it without drugs. I am thankfully very healthy and am not on any prescriptions. I have managed to stay away from doctors by eating right, exercising, not smoking, etc. My dislike of doctors has been enough of an incentive to adopt this lifestyle. But years ago when I was on the pill I also had to submit to the pap smear, breast exam thing every year to get the prescription. Back then I didn't know any better to question the whole process. I just thought it was something I "had" to do. And even though I had a woman doctor each exam was extremely difficult and embarrassing for me to go through and they didn't get any easier just because I had to do them every year. Once I decided to get a tubal ligation I never went back for another exam and that has been almost 20 years. And I'm still alive and healthy, by the way. I have had to go to the doctor just a few times for minor things and was not coerced into a well woman exam on those occasions. I think it all depends on what you are seeing the doctor for and perhaps what doctor you happen to choose as to whether or not you get pressured into those other exams. My sisters and friends also are the same as me when it comes to this doctor stuff. Some individuals just buy into the whole screening thing because it is so stessed as being important and people get fearful and follow along instead of using their heads and figuring out what is best for them. I think despite the other forums you are reading there is still a lot of freedom and access to health care on one's own terms here in the U.S. One just needs to be informed and decisive about how they want to use the system (not overuse it!)

 
At Wednesday, December 22, 2010 4:30:00 PM, Anonymous Anonymous said...

Jean, you live in a different US than I do. I didn't realize how I'd been bullied until I read the "unnecessary.." blog. But when you go in for an earache and the main topic of conversation is about needing a pap, that's bullying. I was in the ER for high altitude sickness, they offered to do a pap... not kidding. tear

 
At Wednesday, December 22, 2010 10:32:00 PM, Anonymous Anonymous said...

"To anyone from Australia:
Do you have any idea if boys in Australia are required to receive a silly hernia exam as a pre-requisite to play school sports?"

I am from Australia and generally the answer is no. Children attending school are required usually to complete a medical questionaire as part of enrollment, thats so the school is aware of any particular medical issues; but usually unless there are specific reasons for a particular child, no examination is requred prior to playing sport. (At least in the governemnt system, others would have to answer for "private" schools)

Hernia exams are not routine for teenage medical exams anyway, to my knowledge.

Hope that helps

Chris

 
At Thursday, December 23, 2010 12:10:00 AM, Anonymous Anonymous said...

Many here tend to bring up
australia as a comparison,why?
This is the united states and
personally I couldn't care less
how healthcare is distributed in
australia.Dosen't affect me!

Secondly,to the posters regarding
the issue with the injured ankle
at the urgent care.
1) Interns don't work in urgent
care facilities.
2) If this were a real case it might end up with the chief medical
officer,not the don.
3)If a patient enters a facility
with a twisted ankle,it has to be
assumed that the patient may have
fallen and as such further examination be warranted.
4) A twisted ankle in some cases
can result in a proximal fibular
fracture.That just inferior to the
knee.
5)Prosecutors have a lot more to
do than listen to families complain
about privacy issues. In other words they generally DON'T meet
with families over anything!


PT

 
At Thursday, December 23, 2010 5:37:00 AM, Anonymous Anonymous said...

Thanks for the comment Chris. I'm thinking maybe I should move to Australia, they seem to have a lot more common sense there.

To "tear", what "unnecessary" blog are you referring to?

 
At Thursday, December 23, 2010 6:22:00 AM, Anonymous Anonymous said...

Dr Bernstein, if you were working in a hospital and a male patient arrived with a serious health problem that involved getting completely undressed, but he refused to do so in front of a female hospital worker, what extremes would you go to to help him? For example, a man arrived with an injury on or near his genitals but informed the staff politely or impolitely that he could only accept help (while undressed) from a male doctor, nurse, etc, and male nurses were difficult or impossible to find at that time or place. How much effort would you make to find someone suitable, which might include yourself for something menial like inserting a foley?

I guess what I mean is, would your conscience allow you to turn away a patient in need if he refused to let a woman see or touch his exposed genitals, and there was any possibility of finding a male somewhere or doing yourself what you normally assign a nurse to do? Or maybe send in another male doctor?
CJ

 
At Thursday, December 23, 2010 7:45:00 AM, Blogger Jean said...

It is really unbelievable to me that a pap smear would be offered when you presented with an ear ache or high altitude sickness. I hope you refused. I just wish more women would educate themselves on the value of the pap smear and what their own risk for cervical cancer is so that they could make more informed health care choices. I know that I am glad I started reading these blogs. If I do have to go to a doctor in the future I feel like I will be better prepared to make the experience one that is more favorable to me. I still think the better way to approach any cancer screenings would be for the doctor to honestly assess the individual's risk factors and recommend/advise based on that. But then again they would probably have to spend more time with the patient which doesn't seem to be a priority these days (for a number of reasons). I also think a lot of doctors want to screen everyone and cover all their bases to assure that they are not sued and also to improve the detection/survival rates for some cancers, however small they may be. I just don't think patients are informed enough and maybe some of them just don't want to be. But before I agree to have my body poked and prodded in all sorts of ways I do like to know the absolute value of it all for me and not the value for the general population.

 
At Thursday, December 23, 2010 8:59:00 AM, Blogger Hexanchus said...

PT,

You are totally off base on all counts. In the past I've ignored your sanctimonious BS, but feel I need to respond. You need to read before you spout off an subjects you don't know anything about.

1. This urgency care facility is part of a small hospital complex - it's attached to the ER and does use interns.
2. DOM = Director of Medicine, who is the chief medical officer - again, read the post. DON was also involved because the assault was committed by a LPN & PCT, which are under their direct supervision.
3. Patient stated she had not fallen - that should have been the end of it.
4. Totally irrelevant to the case at hand. Mild sprain - no other symptoms. The only reason we went was because the trainer at the HS recommended it, "just in case".
5. Prosecutors do indeed meet with witnesses in a criminal assault case - in this case the witnesses happen to be family members. It has absolutely nothing to do with privacy issues.

 
At Thursday, December 23, 2010 10:02:00 AM, Blogger Hexanchus said...

Sorry I didn't follow up sooner - been busy trying to get some project reports out.

The meeting with the folks at the health care facility on Tues., was interesting. They have opened an internal investigation into the incident. Most of the questions they had for us were pretty straightforward.

We also had a chance to ask them some questions. One was about the policy for the H&P that are done in urgency care. Their answer was pretty much what Dr. Bernstein said is typical - there is no "policy" and it's pretty much up to the physician - although they did say because they deal with relatively minor issues, the expectation is that the H&P would be targeted to the specific complaint unless otherwise indicated.

We also asked about their informed consent policy, and what is supposed to happen when a patient says "NO". They do have a policy on this - they're supposed to ask again to confirm, then document the refusal and move on accordingly. We suggested that given the incident that occurred, some of their staff might need a refresher on this and they said they would look into it.

The last question we had was regarding the intern's apparent proclivity for "completely examining the pretty, young females". This one caught them completely off guard. My niece related the comment made to her by one of the staff members, and they asked if she could identify that person. She said she could, but was concerned about getting her in trouble. I then suggested that instead of singling out a specific individual, they might want to individually interview all of the staff. Make it clear to them that they aren't in any kind of trouble, and all they want is the truth - see if a pattern emerges....and they also might want to review all of the patient cases this intern has treated the past few months to see if there's any pattern there as well, i.e., male vs. female & younger vs. older.

As expected, the elephant in the room was the unasked question if my sister/niece were considering pursing any additional action against the facility. My sister addressed it pretty well - she told them she knew they were probably wondering if they were considering any further legal action, and that it depends. If it appears that the facility did a fair and complete investigation and took appropriate action based on the results, then it was highly unlikely. On the other hand, if it looked like a white-wash job, they might consider it. My niece popped in with "All I want is for this to never to happen to anyone else - make that happen."

It ended pretty positively - now I guess we wait & see if they follow through.

 
At Thursday, December 23, 2010 11:38:00 AM, Anonymous Anonymous said...

hexanchus

Free standing urgent care centers are privately owned and must be staffed by a physician although the md or do does not
necessarily have to be there.
The pa's must have a prescribing authority for narcotics
and supervision by a physician.
A free standing urgent care
center really is not an appropriate
training medium for an intern.

My sanctimonious bs is backed
up by 35 years of healthcare exp. I
know a fake story when I read one.


PT

 
At Thursday, December 23, 2010 12:59:00 PM, Blogger Maurice Bernstein, M.D. said...

Whether any of the anonymous stories (no way to document validity) on this blog written by anonymous individuals are real or not, nobody will know (but the author) but are, I suppose, acceptable if they contribute to discussion by suggesting a possible scenario. What is unacceptable is one visitor attacking each other personally and not just the viewpoint. I really want to continue to read the comments of both Hexanchus and PT...so cool it! ..Maurice.

 
At Thursday, December 23, 2010 1:15:00 PM, Anonymous Anonymous said...

I'm so happy to see action being taken forward concerning the niece with the ankle.
Do what's best for her and the family its also wonderful the part about not wanting to see it happen to any other patients thats amazing of her.
I can't help but think though how much I DO WANT HEADS TO ROLL OVER THIS.
I'll be the first to admit that this is pretty selfish of me because when my incident happened I did not speak up out of shock and humiliation and of course simply being caught off guard and doing what the staff asked of me because they are "here to help"( I was a teen at the time)
I have lived with that humiliation for years now like many other people.
I am SO happy for your niece and just want the staff to take this sort of thing SERIOUSLY so they know just liking to examine the young pretty ones will land you in a whole lot of legal trouble.

I have many issues with medical care in general. I have no clue what these people are thinking
I know because many patients don't know the ins and outs of things so they just do what they are told thinking medically its needed.

Just a few examaples. Several years back I went to the dentist for a cleaning whenever the woman noticed I had my wisdom teeth she told me I should have them pulled I asked her why and she said " well you have insurance so you might as well have it done.
Okay I meant a MEDICAL reason so I asked her again and I was told that "no good could come out of it." Uhm wow.....why in the world would I just randomly have teeth pulled when Its not needed. This same lady tells me about a test that I need to test for oral cancer and she told me that insurance does not cover it but it would be 100 plus for the test....etc.....I have a terrible habit of biting the inside of my cheeks so I thought perhaps I had did some type of damage (again I have no medical background) so for some reason they actually scheduled me to come back to take this test and hand me paperwork and I was freaking out (again they were using the word CANCER).. I went home and actually read who was at risk for this type of cancer it has to do with age,family history and if you were a smoker. I was not in ANY of the categories for anyone who should be screened.

I have had MANY incidences with the whole medical world that simply make no sense at all. What bothers me the most are the people (I myself at one point) just went along. One doc even wrote me a persciption for the morning after pill when I simply went in to be seen for a skin problem. I said I did NOT want it and the doctor said......"well you never know" and handed me the prescription.( I have a feeling I fit some sort of profile for that one...lol)race,income etc.....the point is that I was there for my SKIN.

Once went to see a doc because I had a wart on the bottom of my foot...( now I know this may sound odd but I had never had a wart before I had no idea what is was esp on my foot) ...this doctor sends me to another doctor.....I'll give you the short version Once I realized what it was I simply went to the drug store and bought on of those kits for less than 6 dollars. My goodness you're a doctor why cant you just tell me "its a wart" did you really have to farm me out to another doctor who then wanted me to come back for 5 to 6 more vistits just to freeze this thing off my foot when I can go to the drugstore spend 6 bucks and be good to go..again this is the short version)
This whole industry is insane and the medical breakthroughs and accomplishments are fantastic but it just seem like when it comes to treating and relating to ACTUAL HUMAN BEINGS this industry is a nightmare. I feel like TO many get off on seeing "the pretty young ones .
I'm so happy that this young woman is a success story how many other pateints would have ended up undressed, and in stirrups,on display,humilaiated with post traumatic stress disorder over a twisted ankle.Absolutely Ridiculous!

upside down

 
At Thursday, December 23, 2010 1:23:00 PM, Blogger Maurice Bernstein, M.D. said...

Earlier today, CJ wrote:
Dr Bernstein, if you were working in a hospital and a male patient arrived with a serious health problem that involved getting completely undressed, but he refused to do so in front of a female hospital worker, what extremes would you go to to help him?

In an non-emergency situation, I would arrange for the patient to undress and put on a gown in private or if help was needed to provide a male helper. A patient brought in clothed in an emergency room, potentially critically injured, removing clothing for examination should not be attempted by the patient nor anyone else without the skill and knowledge of handling a trauma patient. Gender of the operator in this situation is immaterial to the process but for patient comfort, there would be an attempt by all to cover quickly the sensitive areas, in all cases, for patient modesty.

A week ago, I was participating in a free clinic as physician and had a male patient who needed a urethral culture but the culture media would not be available until sometime this week. I was told by the clinic manager, the patient should return and the urethral swab would be done by a competent female nurse. Instantly and even without talking to the patient about the matter, I advised the manager to arrange for a male physician to perform the swabbing. He said he would see that my request was fulfilled. ..Maurice.

 
At Thursday, December 23, 2010 3:47:00 PM, Anonymous Anonymous said...

A UCC can be free standing but it can also be owned by a hospital. Both exist. The fees are often higher when associated with a hospital. For those owned by a hospital some patients will go directly to the UCC and others will go to the ER and be directed to the UCC instead.

I'm not so sure the woman who made the comment about the intern was being honest or had a bone to pick with the intern. Time will tell. If she is voicing this opinion to patients she should absolutely have made management aware of it as well. I have no doubt their response to her comment at the meeting was genuine. I'm sure they will go and check and see if staff have complained about this intern and what was done about it. Clearly it didn't reach levels that it should have if this issue was bought to management's attention.

Further examination might have been warranted here. That nor the gown seem inappropriate. Some patients don't even realize they have hurt other areas so a gown and better look at say the back and knee would have been appropriate here. A pelvic wouldn't have been. That doesn't mean your niece doesn't have the right to say no to a gown or further examination. She does. The nurse's error was that she didn't document and move on as she should have.

Working in a UCC the intern will have seen all ages and both sexes hundreds of times over again. That will be easy to prove. What they will look at is if he was consistent when dealing with both sexes and all ages with those presenting with complaints similiar to your niece. If he does have a standard he follows here he will be in the clear. If it turns out there were complaints and there is a pattern in place they will deal with it as they are now on notice.

Tell your niece to rest easy because this won't happen again at this facility. You can be sure those involved have been reprimanded. Others have been made crystal clear on the fact to document and move on. I'm sure this was done almost immediately after the incident. If there has been pressure on the staff on the past it doesn't exist anymore. It won't happen again here.

 
At Thursday, December 23, 2010 7:32:00 PM, Blogger Hexanchus said...

Dr. Bernstein,

My sincere apologies to you and everyone else here - I can only plead fatigue as a result of too much work and not enough sleep. In the future I will simply consider the source and ignore any comments, which is what I have always done in the past and should have done this time.

Truly, we all wish the incident with my niece had not occurred in the first place. It has consumed far too much time that could have been used for far more productive purposes.

 
At Friday, December 24, 2010 6:24:00 AM, Anonymous Anonymous said...

"Gender of the operator in this situation is immaterial to the process but for patient comfort, there would be an attempt by all to cover quickly the sensitive areas, in all cases, for patient modesty."

I guess I should make whatever arrangements are necessary to never be taken to an ER, where respect and dignity for patients mean nothing to the providers. Three seconds or three hours, exposed is exposed to opposite gender people. They would have to use several men to tie down my hands and feet and then sedate me. That's the only way perverted female nurses would ever undress me. You can be sure there would be a few broken noses and black eyes in the process. The only time I would accept "gender neutrality" would be not caring whether the people I beat up while defending myself from an ER sexual assault are male or female. Unless they're ONLY males, in which case I wouldn't need to defend myself.

If I am ever taken in unconscious and find out that perverts stripped and fondled me there will definitely be pay back for their assault.

 
At Friday, December 24, 2010 6:43:00 AM, Anonymous Anonymous said...

Thanks for all the updates Hexanchus. I'm very curious to hear what happens next. The problem they had with your niece, and I'm sure similar problems happen all the time everywhere, seems to be the fact that she wasn't given a choice. Healthcare professionals don't seem to understand that we have enough intelligence to think for ourselves, and can make our own decisions. I find that very insulting. Not only do they believe they are blessed with the power of God (including nurses), but they seem to think that everyone that didn't go to med school or nursing school are brainless morons that aren't capable of thinking for themselves. They also try to take advantage of their home court advantage, knowing that nobody on their turf would never dare say "NO" and mean it.

 
At Friday, December 24, 2010 10:18:00 AM, Anonymous Anonymous said...

If I attempted to strip someone, let alone a minor, after being told NO and STOP, I would have to pay a serious price and they should too. No lessons will be learned until examples are set and these people realize they are just like everyone else. I think they should be lucky to get out of this not having to register as sex offenders. The rest of us would.

 
At Friday, December 24, 2010 11:52:00 AM, Blogger Maurice Bernstein, M.D. said...

I hope we don't belabor an inappropriate point. The point regarding describing the act as a sex-act and the offender as a sex offender requires some proof regarding apparent intent and the behavior itself as representing a sexual act. One doesn't have to be labelled a "sex-offender" by being found guilty for legal battery in a case like that described by Hexanchus. ..Maurice.

 
At Friday, December 24, 2010 12:02:00 PM, Blogger Maurice Bernstein, M.D. said...

To amr who today tried to write something on Volume 35. No, the subject thread is not 'dead' but yes the Volume 35 along with Volume 36 and all the previous Volumes are no longer having comments published. Welcome, amr, to currently active Volume 37!

By the way, if you have some technical question or question about my moderation or publication, don't attempt to write it to the blog but just e-mail me at
doktormo@aol.com

I will answer you through your own e-mail address. ..Maurice.

 
At Friday, December 24, 2010 1:12:00 PM, Anonymous Anonymous said...

Maurice,

While the medical industry may not see this behavior as a sexual assault, the patient would. Being stripped against one's will (regardless of the reason) is an assault of a sexual nature based on patient perspective and patients who have been abused in this way suffer from PTSD the same way that sexual assault victims due, due to the extreme humiliation and loss of control issues. An comparison could be made if someone were hit by a car by accident or if it was intentional. The result is the same as in extreme emotional distress of having someone strip you against your will causing extreme humiliation, powerlessness and all the same emotional ramifications as rape
gd.
gd

 
At Friday, December 24, 2010 6:17:00 PM, Anonymous Anonymous said...

I totally agree with the person who made the comment that many HEALTHCARE workers feel like if you did not attend medical/nursing school that you are somehow you are a complete idiot.
I have had the "pleasure" of running into several of these people. It's like your either a nurse or you flip burgers or are a prostitute on the weekends.
I also agree with the way some of these exams and procedures "FEEL" to a patient to be undressed and put in such embarrassing positions aainst your will can defiantely "feel" like you have been sexually assaulted. That's definately the way that I feel. Being in that position many times EVEN WHEN ITS MEDICALLY UNNECCASSRY is the worst.I was reading a blog last night about unnecassary PAP smears.
I get that medical people feel like well this is just how it's done but there are SO MANY patients that are dealing with the feelings of PTSD,humilaition and simply would rather go without medical care than to step into one of these facilities again. Obviously something is SO wrong.
I think the advancements and breakthroughs in medicine are absolutely phenominal but sadly when it comes to staff involvement with patients as feeling, thinking, human beings it all falls apart.

 
At Saturday, December 25, 2010 1:49:00 AM, Blogger Hexanchus said...

gd,

I agree with Dr. Bernstein that the acts against my niece were not in any way a sexual assault, and a charge like that would never fly. It is being treated as a case of simple misdemeanor assault, which I believe is the correct charge. (note: the crime differs from State to State - in some it's called battery, but in ours it's defined as assault)

I don't expect it will end up going to trial - most likely there will be a plea bargain to a reduced charge, which is very common around here. We'll just have to wait and see - it will probably be weeks before we hear anything.

 
At Saturday, December 25, 2010 6:10:00 AM, Anonymous Anonymous said...

I've read through the volumes of this blog and it sounds like there are many brave people here who won't stand for opposite-gender intimate care or strip searches, and have had the guts to refuse. To those people, how have the healthcare professionals generally reacted to your refusals?

I have very little hospital experience myself (due to my modesty) but I have read through many medical ethics blogs. Generally it sounds like the male professionals with female patients usually excuse themselves politely with no questions asked and send in a female professional to accomodate the modest female patient. Meanwhile in the majority of experiences I've read concerning a male patient that is uncomfortable with a female professional seeing him undressed or poking around in his privates, the woman throws a temper tantrum, belittles the patient's masculinity, acts very offended and starts throwing out the usual phrases such as "I'm a professional" and "you don't have anything I haven't seen before". Sometimes they tell outright lies like "There are no men here to do it" (when it's known that there are) and "in my career you're the first patient that has refused to undress for me or had any kind of problem with it".

To anyone of either gender, what kinds of reactions have you seen from providers when you've done nothing more than try to defend your modesty or morality? How far have you gone to protect it?

The last time a female healthcare professional tried to get me out of my clothes I politely told her I'm more comfortable with a male provider if I need to undress. She rolled her eyes at me but left without an argument. By the sound of it I think I got out of it pretty easily compared to most of the horror stories I've heard and read.

I would be interested to hear some other people's experiences to find out if the bad experiences are common or if they are exagerated.

 
At Saturday, December 25, 2010 6:57:00 AM, Anonymous Anonymous said...

Good points anonymous. These issues are so complex because we are complex beings with different life experiences.

It probably would be prudent to have a psychological questionaire, just like your medical history when you go to a doctor that talks about your sensibilities and feelings about intimate procedures. Ex. for some, a chaperone make patients feel better and for others, it's another pair of eyes.

One point you made stuck in my head and that was about feelings of embarrassment when an examination is normal based on when one is not (like the example we've been talking about).

Getting back to the article, "Naked", if their were procedures for different kinds of exams that patients could read about in the "what to expect" category, then each individual could take responsibility and either "get ready" for the exam, or speak to someone about accomplishing the end result for the doctor but may have to go about it a different way. If patients knew what to expect, they will not be traumatized.

There is much more at stake here than an upset patient. When patients are not listened to and procedures are done against their will, it erodes trust, causes severe psychological symptoms and these patients avoid healthcare at all costs. You would think that the medical community would care but they don't.
gd

 
At Sunday, December 26, 2010 3:59:00 AM, Anonymous Anonymous said...

I believe that the chaperone is for the benefit of the healthcare provider, rather than there to make the patient more comfortable.

They are there as a witness, to say that no sexual abuse occurred.

I'm sure it's said that it's for the benefit of the patient, but I honestly believe it is as I stated above. I remember when that started - there never used to be chaperone's.

I'm one who finds it an extra set of eyes - but have been told by some medical staff that doctors will not do an exam without a chaperone, as I said, because of their "liability".

I do sympathise actually.

 
At Sunday, December 26, 2010 10:08:00 AM, Anonymous Anonymous said...

I see their point and yours, although I do not necessarily sympathize. The doctor/patient relationship is built on trust. If one or the other doesn't trust, then there is no relationship. The doctor has the right to say they don't examine without a chaperone, and the patient has the right to say adios. There are still many doctors who do not examine patients with a chaperone, especially same gender doctor/patient especially in the areas of gynecology and gastroenterology. They are the kind of doctors that I go to. And...any office that won't accept my privacy as a condition does not have the priviledge of having me as a patient.
gd

 
At Sunday, December 26, 2010 12:11:00 PM, Anonymous Anonymous said...

I am having a second hip replacement shortly. I was very traumatized by the process of the first replacement. I decided that this time would be different. Last time, post operatively, I was stressed by not knowing my state of undress/exposure during the actual procedure and who (in terms of females) were present during any state of undress. I faced a wall of silence and evasion akin to trying to nail down mercury.

This time I spoke at length to the (different) surgeon who was MUCH more forthcoming. He told me up front that any paper underwear is removed to allow disinfecting of the entire area including the perineum. He did not avoid issues or tell me direct lies. I responded by saying I did not want any female staff involved until I had been prepped and draped and then afterwards, wanted the females to retire while i was moved to the recovery room.

The female nurses in pre assessment were besides themselves with anger that he had agreed to this for me. They felt even if this were possible, they would not avoid a female aneathsetist or assistant for me, again I insisted that ALL staff in theatre MUST be male, I am clearly asking for the earth as far as they are concerned. No all male team, no procedure - simple as that. I also intend to remain awake so I will not allow them to tell me one thing and do another.

 
At Sunday, December 26, 2010 2:19:00 PM, Anonymous Anonymous said...

My elderly mother-in-law needed a hip replacement and the anethesia department agreed to do an epidural block instead of general and they and I felt it was safer. So, you might be able to arrange being awake for the entire procedure. I had two c Sections this way. You feel pressure; no pain at all.
gd

 
At Sunday, December 26, 2010 5:08:00 PM, Anonymous Anonymous said...

To Anon of 12/26/10 12:11 its a good thing you asked because according to a post on allnurses "We take a gown completely off for hip replacements and back surgeries...." You will be completely exposes for a time to the people in the OR.

http://allnurses.com/operating-room-nursing/patient-modesty-concerns-196068.html#post1977971

I admire the 2nd doc for being truthful about the exposure and also for him agreeing to your request for an all male staff. The attitude of the nurses however is astonishing. Male nurses don't react that way when a female patient refuses them.

 
At Monday, December 27, 2010 4:52:00 AM, Anonymous Anonymous said...

It is extremely common for women to request all female teams, note how casually it is mentioned in this diary entry from UK;

http://www.staffnurse.com/nursing-news-articles/student-nurse-blog-year-3-week-34-3594.html

 
At Tuesday, December 28, 2010 8:25:00 AM, Anonymous Anonymous said...

To anon who needs a hip replacement.
Excellent work! You did exactly what I would do. We can't let them intimidate us or say one thing and do another. The female nurses believe we are in their territory and we must submit to anything and everything they desire. They basically expect us to sign over our power of attorney (of our body) to them. Upon entrance of their universe our body is no longer our own and realistically we have no say in what happens to it.

Most establishments will try to assure us that we have a part in the planning of our treatment, but by keeping us in the dark about what will happen when we're unconscious they're depriving us of informed consent and making decisions behind our backs. Decisions that if properly informed many of us would refuse or try to change. They decide in the most part that our morals are not important, and they refuse to respect our modesty, dignity and religious views.

The definition of "respect" should be what each individual patient believes, not what the facility's management believes or how it is defined in medical textbooks. To me the idea of sending female nurses or assistants in to strip male patients naked, do whatever it is they usually do to our genitals and then quickly drape us is NOT treating us with respect, especially when we make it clear to them that we have a problem with it. To promise us they will treat our body with respect after we're sedated and then do whatever they want to it when we can't defend ourselves should be considered battery and those who order it or allow it should be made criminally negligent.

If doctors, nurses and administrators see nothing wrong or unethical with what they do to us behind our backs why do they feel the need to keep so much of it a secret? Why don't our opinions about what should or shouldn't be done to our body matter? Are their opinions set in stone and our differing opinions wrong?

It doesn't surprise me when I hear that healthcare professionals make the worst patients. They know what could happen to them while unconscious so they take whatever precautions are necessary to make sure they aren't treated as disrespectfully as they treat their patients. Their own modesty and dignity are extremely important and MUST be respected.

In an honest society the definition of the word "hypocrite" in the Webster's dictionary would have a picture of a nurse next to it.

 
At Tuesday, December 28, 2010 11:52:00 AM, Anonymous Anonymous said...

"Upon entrance of their universe our body is no longer our own and realistically we have no say in what happens to it."

You can say that again Anon. It's difficult for inexperienced patients to understand that once they walk through the hospital doors they are no longer free thinking humans, they're essentially livestock.

 
At Tuesday, December 28, 2010 1:53:00 PM, Blogger Joel Sherman said...

My article on chaperones from my companion blog has been chosen for publication on KevinMD.blog. This is a widely viewed medical blog, read by both physicians and patients. Please feel free to go there and add your comments.

 
At Thursday, December 30, 2010 12:13:00 AM, Anonymous Anonymous said...

"In an honest society the definition of the word "hypocrite"
in the Webster's dictionary would
have a picture of a nurse next to it."

So true! I have heard female
nurses say,"If I ever need a foley,
it needs to be done by a female
nurse only." Yet,these same nurses
wouldn't dream of accomodating male patients. This goes beyond
hypocritical.


PT

 
At Thursday, December 30, 2010 6:22:00 AM, Anonymous María said...

I almost never have tried to talk to Dr. Bernstein himself, but why not reopen the thread "Naked"???
It was by far one of the most commented ones... At any rate, it dealt with the subject pretty accurately.

 
At Thursday, December 30, 2010 9:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Maria, as I recall there were over 300 comments there and we were having trouble with Blogger.com in publishing additional comments. Since then, I have limited the number of comments on each Volume to 120-130 and it seems satisfactory. You can bring up a topic from the stream of conversation from "Naked" to this Volume if you desire.

On another matter, what do my visitors think about the relationship of patient age to the presence or absence of the modesty issues described in these Volumes?
Is modesty more of a problem in the young, middle aged or aged? Or do you think that it is a concern of virtually all age groups. I can't tell from all the postings here the answer to that question since I really don't recall my visitors stating their ages. ..Maurice.

 
At Friday, December 31, 2010 2:55:00 AM, Anonymous Anonymous said...

Dr B

Age and modesty generally would be irrevelant and as I've reiterated on several occasions
of which I'm certain our readers
would agree,modesty alone would
not prompt such responses that
you see here.
Rather,it is the lack of respect and unprofessional behaviors that are of issue here
compounded with the fact that male
patients are additionally
faced with the ire of a double
standard.


PT

 
At Friday, December 31, 2010 5:43:00 AM, Anonymous Anonymous said...

Hi Maurice,
I can tell you from reading that it seems research shows young people and particularly teenagers have the most problem and that these issues seem to diminish with age.

However, life experience paints a a clearer picture. To me, there is a distinct difference between modesty issues and feeling degraded. Nobody regardless of age wants to feel that way. So, the issue of modesty is really based on it's context, individual life experience and the behavior of healthcare professionals that at the current time have no guidelines for behaviors.

I don't think this issue would have become so pronounced if the behaviors of people we trusted was respectful. It's because of inappropriate bodily exposure, deviance, gawking and unprofessional or deliberate humiliating circumstances that have caused this issue in the first place. The other elephant in the room is that gender preferences with the use of orderlies for men, and nurses for women with intimate preps has gone out the window. There is currently no line of decency and the medical community could care less as a whole. That's why there is this blog and that's why we're all talking. Thank you again for the opportunity. Happy New Year all!!!
gd

 
At Friday, December 31, 2010 11:39:00 AM, Anonymous Anonymous said...

I'm agreeing with the last two posters, Maurice. Modesty issues are deeply contextual and closely connected to good or bad communication from the provider -- and, related closely to what we simply call courtesy and consideration and manners. As patients work their way through the health care "system" -- from phone call to receptionist to nurse to doctor to procedure team to the OR, etc. -- patients develop a "feeling" that they are safe or not safe, that they are respected or not respected. The health care system can lose them early on in this continuum -- right at the phone call or at the receptionist's desk. If patients feel safe and respected along the way, when the modesty issue arises (and if the provider communicates well at that point), modesty will be of less concern with most patients.
As far as age considerations -- yes, some research indicates teens and young people are more sensitive. But this research doesn't seem to have any affect on how boys are treated during sports or other exams. But as I've stated in our emails, I haven't found what I consider to be good studies in this area. Most studies that deal with gender choice or modesty do not, in my opinion, ask the right questions. Modesty is very contextual. The questions need to be more nuanced than they are in most studies.
MER/Doug

 
At Saturday, January 01, 2011 3:19:00 AM, Anonymous Anonymous said...

It's not always a double standard. I posted the story earlier, where a male resident actually said "I'm a doctor, I've seen them before" to an old lady who objected to him staring at her naked. He refused to leave the room, even after being asked repeatedly until the attending finally noticed and told him to leave.

I wonder, do any medical professionals here know what likely happened to him? We did inform his supervisor.

A sense of feeling safe - that was such an excellent point. Some medical practices make one feel almost like a friend (in a professional way) - one gets the impressions that they truly care about the person's well-being, feelings as well as physical.

Others seem to foster an attitude of superiority, and talk down to patients. Oddly though, there is one practice where we go where the staff isn't so great, but the doctor is terrific. Unusual combination though.

 
At Saturday, January 01, 2011 1:17:00 PM, Anonymous Anonymous said...

"Some medical practices make one feel almost like a friend (in a professional way) - one gets the impressions that they truly care about the person's well-being, feelings as well as physical."

To a significant degree, this can be studied and quantified. Analyze behaviors. What are they doing? What are they saying? What are their practices, procedures, routines? Look into the details of the operation. Use what sociologists call positive deviance i.e. find out where it's being done right in the midst of where it isn't. Then study those places that get extremely high ratings from patients. What are they doing right?
This isn't a mystery. It can be studied and best practices can be determined.
MER/Doug

 
At Saturday, January 01, 2011 3:10:00 PM, Anonymous Anonymous said...

" Some medical practices make one feel almost like a friend (in a professional way) - one gets the impressions that they truly care about the person's well-being, feelings as well as physical."

Patients/people/clients need to know that there are still respectful systems out there, who value clients and human needs. Unfortunately, people often give up and settle for the type of care someone feels like giving: rules that they have set up that one must follow unconditionaly if one expects to receive their care. Why? Faith and Fear.
How often have we heard people say "the Doctor is a jerk but(s)he is the best (insert specialty) in the world"? These patients are willing to endure horrible interactions in order to receive the 'very best care' and by not doing so are afraid of losing this care. According to this theory, all of the 'very best' not only live miraculously in my state...but amazingly in my very hometown. I'm sure every state has the "very best' as well.

Faith in the best, and fear of losing it.

What these blogs have given people (besides a stunning wealth of information) is: permission.
Permission to ask questions and expect answers. Permission to expect a level of respect that they deserve. Permission to tear themselves away from harmful healthcare relationships. And permission to seek great care and dignity at the same time.

swf

 
At Saturday, January 01, 2011 11:18:00 PM, Anonymous Anonymous said...

swf,
I'm glad that you find that this blog gives you permission. I, on the other hand, never felt that permission was needed. After all, I'm the cash carrying customer and I have always been empowered. However, if this is what this blog does for some people, it's a great thing to feel empowered no matter how you got there. I do pose this question and it's not an adversarial one. Why is it, that you suppose, that people feel that they needed permission in the first place. It would seem that it's the difference between whether your "toes have been stepped on hard enough" and when they have, (and depending on personality type too) the reaction varies.

 
At Sunday, January 02, 2011 11:17:00 AM, Anonymous Anonymous said...

Anon 1/01

I don't find your question adversarial at all.
To be clear, I have always believed in 'my body my choice'.
I realize I am pretty defiant about that, (some say overly) but again my choice. So the permission I spoke of was not about my choices.
Regarding your question: Part of it (in my experience) is how they view caregivers as authority figures. Not to be petty, but as an example I would compare the police/prison analogy to the caregiver/hospital situation. Do what you are told and leave when they say. Some people develope this belief on their own, but many are taught it growing up.
So, the more people put healthcare workers into perspective (we are all just human beings) the more people realize an equality exists on a human level. It takes away the power fear and leaves people with permission to speak up.
Why do they finally speak up?
I have found that,,yes...there is usually a trigger, but it is not always a medical experience. Disrespect in any area of life can cause someone to redefine boundaries.
I'm not sure if I answered your question. (?)

swf

 
At Sunday, January 02, 2011 12:56:00 PM, Anonymous Anonymous said...

I don't want to get too philosophical here (I've written about this before on this and other blogs). But, as Anonymous suggests, this is question of power and authority.
I've read a good deal of Michel Foucault. It's no accident that his books cover topics like power, authority, knowledge, prisons and punishment, sexuality, and clinics and hospitals. As a social historian, he has studied prisons, hospitals and clinics closely. This is about how these institutions developed within Western culture and how power and authority fit into the equation -- how knowledge is power and, specifically, how medical knowledge represents tremendous power over those who don't have it. I don't agree with everything Foucault writes, but I think he's pretty much on the mark on this issue. If you want more info about Foucault, read:
http://en.wikipedia.org/wiki/Michel_Foucault
Doug/MER

 
At Sunday, January 02, 2011 6:19:00 PM, Anonymous Anonymous said...

There is a really distrubing article that can be accessed on allnurse, go to the site and search the thread MALE NURSE NEED CHAPERONES it has a Dec 2010 date (there are several threads on this). Look to the side topics, there is one that says nurse fired for reporting Drs inappropriate behavior, or you can go to page 6 and there is a link as well though the side topic has two articles on the event. A female surgeon a Ear, nose & Throat Dr. was discipline for doing "genital exams" on males while they were out. The case that put the whistle blower over the edge and reported it was when she pulled an unconcious male patients penis out of his boxers and slapped it several times saying bad boy, bad boy to the amusement of an all female OR staff. The nurse reported it to the hospital who did nothing, she then reported ot to the state. Long story shortened the nurse was ultimately fired for a different reason and the female surgeon was required to have a chaperone, not allowed to do any intimate exams and guess what, rehired by the hospital. If this had been a male Dr. slapping the vagina of an unconcious female patient while an all male OR staff laughed, there is no way he would have kept his liscense much less his job. You really need to read it, it is really distrubing. While it won't matter I am going to write the hospital and express my utter disquest for them employing someone like this. And we are to trust the medical system? This undermines trust and reflects poorly on not only the Dr and Hospital but all people in the medical profession

 
At Sunday, January 02, 2011 8:54:00 PM, Anonymous Anonymous said...

Dougmer:
anonymous did't suggest "this is a question of power and authority'.
They said they have "always been empowered."
Not the same.Empowered people don't see authority.

pstr

 
At Monday, January 03, 2011 12:07:00 AM, Anonymous Anonymous said...

pstr -- This is what anonymous wrote:
"Part of it (in my experience) is how they view caregivers as authority figures. Not to be petty, but as an example I would compare the police/prison analogy to the caregiver/hospital situation. Do what you are told and leave when they say. Some people develope this belief on their own, but many are taught it growing up."

I wasn't referring to anonymous specifically, but to the example he used above. Power, authority. People who don't have the view expressed above are in the minority, I believe. Most patients accept the authority of those in hospitals (some without question), and just obey. It's a blind trust. A leap of faith. That's why, I think, if that trust is lost, if it's betrayed, the fall is great.
MER/Doug

 
At Monday, January 03, 2011 3:19:00 AM, Anonymous Anonymous said...

The thing about being impowered is - sometimes you really aren't. Sometimes there is a big imbalance in power.

Say you're in a more rural area, and there is only one doctor in the specialty you need. Say there is only one doctor's office nearby, that takes your insurance. Say you're a pain patient, and need controlled pain meds. You don't have a lot of choices there - you need the doctor, and they don't need you.

And the worst of all - if you are hospitalized. Maybe you came through the ER, and are just assigned a doctor. Maybe your personal physicial doesn't come to the hospital, and you are assigned a hospitalist. You are pretty much stuck. Unless you (from your hospital room) can find some other doctor to accept you, you cannot fire the attending doctor - even if you think you are getting bad care, or are being treated very disrespectfully. I think it is quite a failing in the system, that once in the hospital, you are trapped. This does happen - I've seen it happen several times. It's a nightmare.

 
At Monday, January 03, 2011 4:45:00 AM, Anonymous Anonymous said...

I have noticed through experience and research that, although there have been many exeptions, the general feeling in healthcare establishments is that it is wrong to send a male nurse or aide to examine or care for an undressed female patient. Especially alone in the room with the door closed. Given the fact that the vast majority of nurses and aides are women, I've still seen a hesitance or refusal to send in men even when the men are available.

From this I take the understanding that the majority believe it is unethical. If so, why isn't it unethical to do the same to men, especially when requested? They are knowingly treating male patients unethically, and they couldn't care less about it. I have heard countless experiences where there are qualified men available to catheterize a male patient, or something similar, but instead of treating the patient with respect they'll send a woman in to do it and send the man off on some other errand.

Is it considered alright to treat us so unethically just because we were born with a penis? Does the lack of a penis make a person more worthy of respect? Like I have already written, I know there are many exeptions to this, especially involving giving birth in some places, but focus on the vast majority of cases.

Is it believed that no man has the self-control to keep himself from molesting or raping a female patient if he is left alone with her and the door is closed? Are women the only true "professionals" that can control themselves and keep sexual thoughts out of their minds?

 
At Monday, January 03, 2011 4:52:00 AM, Anonymous Anonymous said...

pstr, you are correct. I don't see authority; not when these figures are to your detriment. If they are respectful to me; I am to them. It's a mirror image.

If patients take the power position, let the authority figures know you understand the law and your strong positions of what you want and don't and...that they understand that you know how they can be penalized, you will be treated differently. It's been working fabulously for me.

 
At Monday, January 03, 2011 6:51:00 AM, Anonymous Anonymous said...

swf, you answered the question beautifully! Thank you
gd

 
At Monday, January 03, 2011 9:13:00 AM, Blogger Hexanchus said...

Anonymous 1/3 - 3:19am

You wrote:
"Unless you (from your hospital room) can find some other doctor to accept you, you cannot fire the attending doctor - even if you think you are getting bad care, or are being treated very disrespectfully."

Actually, you can. The patient has the absolute right to refuse care from any provider. You simply put in writing that effective immediately you withdraw any and all consent to treatment from that provider, their involvement in your case is to cease immediately, and you will pursue legal redress, both civil and criminal, if they do not comply. Sign & date it, witnessed if possible, and demand that it be included in your record and noted on your chart.

 
At Monday, January 03, 2011 10:43:00 AM, Anonymous María said...

I'm a woman who ellegedly lacks credibility for pointing out that, no, women cannot sometimes control their sexual thoughts, although they may (or may not!!!, in an awful number of cases) control their behavior...There, I said it. We aren't morally superior.
On the other hand, some male posters don't seem to believe female caregivers can be very disrespectful to female patients too, especially if they're frustrated, feel disrespected themselves or are plain jealous for any reason.That's why boths sides would be better off if we ended this nonsensical gender war!
If each gender is caught up in their agenda, we lose perspective of the main problem. We may win a battle but we lose he war.

 
At Monday, January 03, 2011 3:56:00 PM, Anonymous Anonymous said...

Thanx gd!
On a personal note..I actually received some "feedback" mail on my use of the word "permission". I think most of us here realize that it was a concept, not a bestowal.

pstr:
I believe you are confusing two different posters. (?)
I (not anon) did say "Part of it (in my experience) is how they view caregivers as authority figures."
I think it is important to note that many of these people feel otherwise empowered in their lives. The power dynamics in the medical community is rather unique.


swf

 
At Monday, January 03, 2011 10:00:00 PM, Blogger Maurice Bernstein, M.D. said...

I wrote this tonight as a comment on the chaperone topic set by Dr. Sherman on KevinMD.com website .

I am going to teach a workshop tomorrow for two groups of 6 second year medical students. The workshop will be to teach on plastic models how to perform a pelvic exam on a woman and a genitalia exam on a man along with a rectal exam on both genders. The students will have an opportunity later this month on performing these examinations on real teacher-subjects. In preparation for tomorrow, I have looked at our physical exam textbook “Bates Guide to the Physical Examination” (Lippincott) currently the 10th Edition. I wanted to see exactly what is written about chaperones, the current topic here, and when and how they are used. Here are the instructions as written in Bates.

For examination of the male genitalia: “Request an assistant to accompany you”. It is not clear whether this is directed to a nervous student or general advice but no gender of the examiner is indicated.
For the pelvic exam of a female:”Note that male examiners should be accompanied by female chaperones. Female examiners should also be assisted if the patient is physically or emotionally disturbed and to facilitate the examination.”

What am I going to teach the two groups? Well, based on the discussion here it seems a bit up in the air. I think that the consensus of physicians here performing a pelvic exam should be to continue with the tradition of a female chaperone with a male physician most often within the exam room. However, if the patient objects to a chaperone, the objection should at least be documented in the chart. For a pelvic exam by a female doctor, it is up to concerns of the doctor and the desires of the patient.

With regard to the male genitalia exam, it is up to the patient to decide if the female physician should call in a male chaperone. One issue in this regard which has not been described here but which might motivate a female doctor requesting a chaperone would be that of the “spontaneous” penile erection which occasionally can occur and whether the doctor has confidence that she can deal with the situation without being ruffled or concerned about uneducated accusations by the patient. Any further suggestions for me for tomorrow? ..Maurice.

 
At Monday, January 03, 2011 10:18:00 PM, Anonymous Anonymous said...

If the doctor doesn't think she can deal with this kind of "situation" perhaps she is not yet ready to do these kinds of exams and should request another doctor do the exam who feels comfortable abiding by the patient's request for no chaperone. What should not happen is for the female doctor to force or intimidate a reluctant male patient to have a chaperone solely for the doctor's comfort.
MER/Doug

 
At Tuesday, January 04, 2011 2:47:00 AM, Anonymous Anonymous said...

Thanks Hex (I am Anonymous 1/3 - 3:19am)

I understand, legally. The hospitals do tell you that you can't. I actually did mange that once - we said "We won't allow him in the room, and we won't take any order he writes". There were specialists on the case. No one liked it, but they had really messed up the care (both the doctor and the hospital) so they had a bit of motivation. Some nurse finally told me of a hospitalist group, and they took over.

Another time was a nightmare. It was an iatrogenic injury for a start, so doctors were reluctant in the first place. The doctor refused to call any consults, and was actually physically intimidating us, to a point where a nurse came in the room to chaperone him whenever he visited, and the patient did refuse to let him touch him. It was a small hospital, and we couldn't get another doctor. We couldn't end up in the hospital with NO doctor. Couldn't really leave AMA, or insurance wouldn't pay for future care, and the patient was quite ill. Every time I tried to arrange a transfer to another hospital, this doctor would talk to them, and the transfer wouldn't happen.

While you are of course correct from a legal standpoint, a person can get trapped anyway, for practical reasons.

In this case, we made enough ruckus the doctor finally discharged him. However, he stopped medications so abruptly, that we barely made it to the next ER before the patient started seizing.

But thank you for the information about how to do it officially - I hope I'll never need that information, but it's good to have.

I'm sorry, I guess this is going off the topic of privacy, so I'll stop and let this get back on topic.

 
At Tuesday, January 04, 2011 2:52:00 AM, Anonymous Anonymous said...

It's probably a good bet to teach that both doctor and patient be comfortable with these intimate exams. That means that the medical student must search their own soul for their comfort zone. I do realize that it might vary from patient to patient regardless of gender. What I don't know is whether there needs to be a "blanket" policy. Just like patients need to feel safe so do physicians. So...what happens when a doctor sees someone who makes them feel uncomfortable but that's not the norm. Can they change policy? Does there have to be a blanket one?
gd

 
At Tuesday, January 04, 2011 5:11:00 AM, Anonymous Anonymous said...

At my nephew's recent sports physical he was told that although hernia exams are required by the school, there is a better chance of a student athlete having cancer than a hernia. Does this ring true to anyone?

I am tempted to believe it's true because I've never in my life heard of a jr high or high school student being diagnosed with a hernia, but I've known many young cancer patients. Though I don't condone prostate exams or colonoscopies for all student athletes, I don't see a hernia exam as being any more important. Why cause so much humiliation for absolutely no reason? Why include an unqualified school nurse?

Mandated hernia exams seem to me to be more of a rite of passage for student athletes than a medical necessity. Apparently if they're not "brave" enough to let the school nurse fondle their genitals they aren't strong enough to play school sports. (those that don't have the time or money to visit a medical doctor) It also seems like a way to reward the school nurse for her usually boring job.

In nearly every other way we are moving into the 21st century, it's time to get rid of this barbaric rite of passage. Doesn't anyone in our school systems have any common sense?

 
At Tuesday, January 04, 2011 9:00:00 AM, Anonymous Anonymous said...

Dr. Bernstein notes:
"I think that the consensus of physicians here performing a pelvic exam should be to continue with the tradition of a female chaperone with a male physician most often within the exam room."
"With regard to the male genitalia exam, it is up to the patient to decide if the female physician should call in a male chaperone."

So once again, what would another year of future doctors and patients be taught?
A) Female patients should not trust male doctors, and male doctors should be afraid of being alone with female patients.
However:
B) Male patients should trust female doctors, and female doctors should not be afraid of being alone with male patients.
This reasoning is exactly why male modesty will never be respected. The medical arena wants to continue the concept that women are a benign, almost sexless presence and therefore can be used safely in intimate situations with either gender. They want men to believe that being exposed in front of female providers should be a non-experience: since women in medicine are so sexually passive that they are practically a third androgynous gender.
This is why 90% of nurses will always be women, and men will not get the choices they deserve.

Women do not exist in an intimate vacuum, devoid of all erotic notions. They are sexual creatures, just like men. I'm not suggesting we are all predetors, but we are not genderless either.
Until we as women own up to our sexual natures: that we are as intimately moved as men: this medical gender lie will never present men with honest choices for dignified and respectful healthcare.

swf

 
At Tuesday, January 04, 2011 2:22:00 PM, Anonymous Anonymous said...

swf,
Statistics show that 90% of sex offenders are male; it's as simple as that. I do agree that women are not genderless and we all belong to the species human. Part of being human is that we are all sexual beings.

For me, a chaperone is just another pair of eyes and I wouldn't want it and would welcome an exam by a male doctor that I trusted without one.

You can be treated in a degrading manner by either sex provider as we again are all human and I do not think that perversions are resigned to just one gender or the other. Female abusers exist, so do male.

So, getting back to Dr. Bernstein's premise on teaching, please advise how you feel about the idea that medical treatment is a partnership between doctor and patient and what steps could/should be taken to make the other feel safe and comfortable. Sometimes that means chaperone, sometimes it means no chaperone and it's all in the eye of the beholder whether doctor or patient.
gd

 
At Tuesday, January 04, 2011 4:28:00 PM, Anonymous Anonymous said...

swf..outstanding, just outstanding. I liken the plight male nurses and male patients are facing to the civil rights and womens suffage movements. Until those brave front runners were willing to stand up to the status quo with full knowledge and the willingness to pay the price for challenging the status quo, nothing was going to change. Martin Luther King paid the ultimate price, Susan B Anthony siffer ridicule, but they opened the door for others to change the world they lived in. The medical care system is willing to continue to ignore, even justify the discrimination against male patients and nurses due to fear of being sued. Protecting the bottomline is more important than protecting the rights. I don't know how it changes until male patients and providers change their attitudes and start making themselves heard in voice and in the court rooms. That takes a culture shift like the civil rights and the womens movement where men realize it is righr for them to challenge rather than accept...swf...that was awesome...alan

 
At Tuesday, January 04, 2011 8:29:00 PM, Anonymous Anonymous said...

Women get hernias as well and with that we should line them up nude in front of a male nurse and the male gym teacher.
They can then go home crying to their mom who may have been one of those perverted clerks at the military
mep induction center.Spending her day
leering at young men recieving a
medical physical. That would be poetic
justice.
But then maybe just maybe her son
recieved a hernia exam when instead
they should check these young people
for scoliosis which by the way is
virtually never picked up on until
its too late.


PT

 
At Tuesday, January 04, 2011 8:46:00 PM, Anonymous Anonymous said...

This is just another example of why this blog is so important to many people. Here is a link to an all nurses thread. You might want to "check out" LauraB (originally posted by I'm a wonderer). This disgraceful behavior and worse occurs every day in the hospital. Why is this permitted?

http://allnurses.com/operating-room-nursing/patient-modesty-concerns-196068-page19.html

gd

 
At Thursday, January 06, 2011 7:26:00 PM, Anonymous Anonymous said...

Breaking (good) News:

Appeals court: Cross-gender strip searches of inmates ruled unconstitutional.

http://caselaw.findlaw.com/us-9th-circuit/1551295.html

 
At Thursday, January 06, 2011 8:23:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous, thanks for the link to this current decision. However, the decision of the majority in the 9th Circuit Court of Appeals was no different than other Appeals court cases over the years that decided that cross gender "strip" searches (hands touching bare skin) except in the case of an emergency was a violation of the 4th Amendment to the Constitution. This is not new and this is the established law. The issue which was the point of contention with the decision is whether this was not a strip search but actually a "pat down" (through clothing albeit thin shorts) in which cross gender examination is permitted under law without there being an emergency.
Therefore, unfortunately nothing was new with regard to cross gender searches which is still permitted as "pat downs" through the inmates clothing. I would agree, if men are not allowed to "pat down" women inmates why should women be allowed to "pat down" males? As for strip searches, routine cross gender examination is still a Constitutional "no-no". ..Maurice.

 
At Thursday, January 06, 2011 9:03:00 PM, Blogger Joel Sherman said...

Dr. B, that reference was first posted by me on my blog where Anon saw it.
But I'm not sure your interpretation is correct. The court rejected the theory that this was a pat down and not a strip search just because he was wearing thin pink underwear, standard issue in this prison thanks to the warden. They put the emphasis on the fact that it was a 'humiliating event.' I don't know that it's illegal for male officers to do pat downs on women, though laws may vary from state to state. I'll have to read through the entire decision.

 
At Thursday, January 06, 2011 9:58:00 PM, Blogger Maurice Bernstein, M.D. said...

From the Appeals Court Ruling:
"A peripheral equal protection issue was in the air because of the text of Maricopa County's Contraband Control Policy (Contraband Policy) distinguishing between male and female inmates when a frisk search is involved. According to the Contraband Policy, “[m]ale inmates may be frisk searched by either male or female officers[,]” but”[f]emale inmates will only be searched by female officers, absent exigent circumstances.”

"The Contraband Policy defines a frisk search as “[c]arefully examining an inmate by inspecting his clothing, and feeling the contours of his clothed body ․ “

Actually, the equal protection issue of the Contraband Policy was not considered because the Policy wasn't challenged by the litigant.

This Policy obviously was that of one county in California and I don't know whether it is followed elsewhere, though this would be important information regarding the inequality in treatment of the sexes with regard to "pat downs".

Joel, I agree that the main point of the case was whether the examination was one of a "pat down" or "frisk search" (apparently the same, through the patient's clothing) or whether it was a virtual "strip search" because of the minimal coverings the inmate was wearing. If that is the case and since the cross gender "strip search" is prohibited by law, I am not sure that this Appeals Court ruling does anything with regard to denying cross gender "pat downs". ..Maurice.

 
At Thursday, January 06, 2011 10:34:00 PM, Anonymous Anonymous said...

After reading through this decision, I see this as only a partial victory. The real issue was not brought up or dealt with: If all citizens are equal with equal protections, why are inmates treated differently based on sex? Their policy was male inmates can be searched by either males or females but female inmates can only be searched by females.

 
At Thursday, January 06, 2011 10:56:00 PM, Anonymous Anonymous said...

I read the whole decision. I'm not really impressed. The man won his case, but, as the decisions says, his victory was based upon a very narrow consideration. Read the last several paragraphs of the document, and you'll see that the court:
-- Generally defers to prison administration to make these decisions.
-- Agrees with prison claims that by keeping female guards away, it would upset the entire prison schedule and cause safety issues.
-- Has no problem with female guards wandering by as part of their duties while male guards strip search male inmates,
-- Tends to look a these issues very specifically, but generally agrees that if female guards could not do these things they would not be able to compete with men in the prison system.
-- Any consideration for male inmates is negated in an "emergency." This case was very obviously not an emergency -- but the courts otherwise give great leeway to the prison system to define an "emergency."
The man won his case. But I don't really see any major changes in how this issue is perceived by the courts.
Doug/MER

 
At Friday, January 07, 2011 1:43:00 AM, Anonymous Anonymous said...

http://www.12thcoa.courts.state.tx.us/opinions/htmlopinion.asp?OpinionId=5989

Just read the above decision (which Texas keeps moving) and then tell me if cross gender strip searches occur on a daily basis?

 
At Friday, January 07, 2011 7:26:00 AM, Anonymous Anonymous said...

Ask the US military,usmepcom about
their strip searches with women present. We weren't even prisoners,
just a bunch of young guys joining
the service for our country!


PT

 
At Friday, January 07, 2011 10:12:00 AM, Anonymous Anonymous said...

This quote from the last case cited. And this individual is a Muslim man. His religious beliefs were not even protected. What does that say about any other man?

'Here, we must defer to the decisions of prison officials who, in light of equal employment opportunity laws, considered their budget and their personnel pool and determined the best manner in which to allocate these resources... Finally, Appellees' evidence shows that strip searches by male corrections officers are not an available alternative due to the large number of strip searches required and limited availability of male staff members... Prison officials are not required by the Constitution to sacrifice legitimate penological objectives in favor of a male inmate's request to not be seen in the nude by female corrections officers...Conversely, Appellant is not relieved, by the right of free exercise, from submitting to strip searches by female corrections officers.. Accordingly, Appellees established that they did not violate Appellant's rights guaranteed by the Free Exercise Clause of the First Amendment...'
Doug/MER

 
At Friday, January 07, 2011 10:36:00 AM, Anonymous Anonymous said...

The Texas inmate argued opposite gender searches/viewing violated his 1st amendment right of freedom of religion. The Arizona inmate argued opposite gender searches/viewing violated his 4th amendment right against unreasonable searches. Neither argued the treatment (search/viewing) was deliberately humiliating and therefore cruel, violating the 8th amendment. Neither argued the policy that both males and females searched males but females only searched female inmates violated the equal protection clause of the 14th amendment.

I think lawyers like to argue about the minutia because they bill by the hour. The lawyers argue the differences between a frisk, a pat down, a strip search, whether being stripped to just your boxer shorts is really a strip search, whether using the back of the hand or front to search makes a difference, whether a person with their name on the back of their t-shirt is a stranger or not, performing a search versus observing a search, a hundred topics to argue about yet they don’t address the real issue.

The central issue is the basic human right of people to shield their naked bodies from the view of strangers, especially those of the opposite sex. Fortunately the judges did indeed reiterate this basic human right in the decision. The parallels of this legal battle and what we patients battle for in medical care are obvious. Only difference is a patient can leave, an inmate can’t.

 
At Friday, January 07, 2011 4:03:00 PM, Anonymous Anonymous said...

This article appeared today in the
Arizona Republic.

Search declared unconstitutional

A federal appeals court in San
Francisco has ruled that a strip search of a male arizona inmate by a female guard was unconstitutional.
In a 6-5 decision,the 9th US
circuit court of appeals of charles
boyd at a minimum-security jail in
maricopa county was a "humiliating event" that violated his rights.
The court determined that cross-gender searches of intimate areas violate the constitutional ban on unreasonable searches. The sheriff's
office now requires a supervisor's presence for strip searches and that officers and inmates be of the same sex.


PT

 
At Saturday, January 08, 2011 5:29:00 AM, Anonymous Anonymous said...

As Annon. Fri stated this case was argued under freedom from unreasonable search compared to religion and curel and inhumane which had been ruled against. Further the court did not say the arguement of equal treatment under the law was not a valid arguement, they said the planiff did not properly introduce the issue from the start. They actually said the issue of equal protection "hung in the air" indicating it was a valid concern and issue that they could not address as it was not properly brought into the proceedings. I think there were many positive take aways from this...restating modesty especially with the opposite gender is basic right/instinct of our western culture. Recognizing that a reasonable accomodation was required in non-emergency situation, recognizing these searchs are demeaning and should only be done with great care and on limited basis. All and all the majority was right on, the minority chose to give the facilities way more leeway in determining what they needed to do to make the facility function. They ignored individual issues and tried to justify that premis by selectively choosing what to site. For example, the facility tried to say it was a pat down, then a frisk though their policy clearly said it involved a fully clothed prisioner though they may be required to remove their shoes and socks. While one could always ask for more, it was a step in the right direction and opened the door for further progress....alan

 
At Saturday, January 08, 2011 8:40:00 AM, Anonymous Anonymous said...

Here's a link to well a written article on this ruling from a political organization. The author brings up many interesting points.

http://www.caivn.org/article/2011/01/08/cross-gender-strip-searches-ruled-unconstitutional

I still think the ruling didn't fully address all the issues, especially the unequal protection issue. The vote was also 6-5 so it was 1 vote away from going the other way. Not a good sign IMO.

 
At Saturday, January 08, 2011 8:58:00 AM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY JANUARY 8, 2011 "PATIENT MODESTY: VOLUME 37" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 38.

 

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