Patient Modesty: Volume 41
I think I have tried to bring up this aspect of patient modesty in the distant past volumes. It has to do with the psychodynamics which lead to genital/female breast modesty in examination or procedures carried out by healthcare providers of the opposite gender. This modesty is particularly of importance if the modesty leads to failure to diagnose and failure to treat. Why is it that some patients have this modesty issue and some don't? Is there any relationship to childhood experiences which left some psychic trauma? Could it be somehow related to lack of self-confidence or even an expression of depression. Cultural and religious pressures may also play a role in some patients. Or should we say that patient modesty has no particular cause but is a stand-alone phenomenon of human behavior and should be treated as such and there should be no reason to dissect it for cause or causes? Just asking... ..Maurice.
NOTICE: AS OF TODAY JUNE 29, 2011 "PATIENT MODESTY: VOLUME 41" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 42.
posted by Maurice Bernstein, M.D. @ 7:50:00 PM
157 comments
157 Comments:
Goggle Egyptian women protesters forced to take virginity tests.I'll read the posts. AL
Anonymous (AL)wrote the following to Volume 40 after I closed the Volume to further comments. What follows is the entire posting. ..Maurice.
This is to Dr. Bernstein.Would you say now that Colin didn't speak up and now he's moaning about it.How about it is inappropriate to put gender preference on the exam form.You stated the appropriate time is when you talk to the doctor.Nurse takes male patient back to room and tells patient to take everything off and the doctor will see you shortly.Patient sitting naked on table waiting for doctor.Door opens and in walks female doctor with 2 other females in tow.You think that is the appropriate time to discuss modesty issue's?Patient states their modesty violation.Most of us agree.Your response.I don't have the facts but I see nothing inappropriate done here.Do I trust the health care profession.NO.Do I think you are on our side.NO.You have been the host of this blog for 6 years now.You of all people should understand.Colin did nothing wrong except to trust his physican.He pored out his heart and soul to his physican.It took alot of courage to tell his physican about his modesty issue's and all he did was belittle and further humiliate a patient in need.gd is right.You don't get it.That doctor is the one that betrayed the trust Colin put in him.All this over what.A couple of strokes of the scheduling pen.First procedure of the day so no one is busy yet.Enough of my rant.Colin,I wish you nothing but the best.I truly hope everything works out for you. GOD BLESS AL
With regard to AL's posting about Egyptian females and the virginity examinations by the Egyptian military, this really is not pertinent to patients and modesty issues. Further discussion of what appears have been inhumane behavior on the part of the military for specious explanations would be, to me, inappropriate for further discussion on this thread.
With regard to AL's initial posting today, I am not defending Colin's doctors or others involved with his request. I only hope for the best outcome for Colin and I agree, as suggested by Doug and others, for Colin to continue to look for healthcare providers who will abide with his request so that he can be provided with the appropriate treatment for his cancer.
If I held animosity about the issue or the manner of discussions presented on my blog regarding patient modesty, I would not have continued it for 6 years and now beginning Volume 41. ..Maurice.
Poor Colin. I am sorry for his pain.
In answer to Maurice's questions about childhood, I had humiliating medical procedures done to me throughout childhood and this has left me with severe medical modesty issues. I've had major operations with men present but thankfully I'm one of those people that can let go once I'm under anesthesia; it's when I'm awake that I care about. Obviously, though, Colin feels even even more sensitive about it all.
Locked in my mind are each and every medical incident and although I've had counseling, they remain to haunt and disturb me, sexually and emotionally. I can well understand why Colin says he'd rather die than have more of these memories.
I am being brutally honest about my own psyche here in hopes of helping others to understand.
Anne
The obscenity is that Colin has to go to this extent. The very idea that medical professionals don't understand the psychological mindset of those who need the same gender care is the point. I must say that I have a medical provider who was a rape victim. I only see this provider once a year, however, on a recent visit she said to me, "I look forward to every visit with you. You are one of the few who get it". I had always discussed my work with her as the modesty issue came into play at one point. It was interesting how this well known surgeon let her hair down. It was inspiring and the reason that gives the work I do "teeth". Hopefully, one day everyone will understand and these gender issues will change.
gd
I, too, had an initial extremely bad situation and have been subjected to re-traumatization due to the medical models and standard of care and disregard to provider gender; especially in a group setting such as the OR or ER
gd
In regards to Dr. Bernstein’s questions of modesty origin, apparently no one knows for sure but likely, the level of modesty results first from the individual’s specific psychology and how it deals with a myriad of combined experiences. I don’t think self confidence is at issue as much as self-consciousness. I don’t believe modesty it is a stand-alone phenomenon and whether or not we dissect it for cause or causes, it should be recognized as an extremely serious and sensitive issue that some people apparently are willing to die for.
In saying that, I hope and pray that Colin will get the medical help that he needs. If there is no other way than to have a female in the room, don’t deny yourself the treatment that you need. Life is a gift. Don’t let some insensitive !*##!* rob you of it. I think that Doug and Al gave Colin some great advice that he should try. I would throw in this: The team concept of that meeting was designed to dissuade him and they made sure that he was well outnumbered. Never go into a fight alone. Assemble your team of friends, family members or any advocate that you have. Take your attorney. Don’t let them bully you. Take Doug’s advice and let your advocate speak for you and throw the questions back at them. Many times, when the numbers are even, you’ll find people less likely to play tough guy. They may or may not facilitate your need but they’ll be careful how they go about it if you bring your team. Besides, they can't be the only game in town and if they are, try another town. Tell them you'll take your money elsewhere.
Back to Dr Bernstein’s questions, I do believe that childhood experiences have an impact on ones outlook and affect your level of modesty. I well remember being held down by several nurses who forced a Foley catheter in me when I was nine years old. I vowed that I would never let that happen again and I have never trusted medical staff since. I did not allow a female medical provider to see me unclothed for another forty years. However, after so much time had passed and I was advanced in age and maturity, thinking nothing of it, I went to a doctor for a problem that required a brief look at my pelvic area. The doctor was a female and she was extremely professional. However, immediately after the examination, I sat down right in front of her and began to cry. The next day, I remained upset for several hours and was depressed for several weeks. I realized then that I had a deep self consciousness and high level of modesty that I believe was from the trauma experienced as a child. Since then, I have been an advocate for patient modesty. Especially considering that people go without treatment because of it.
In regards to Al’s statement “Nurse takes male patient back to room and tells patient to take everything off and the doctor will see you shortly. Patient sitting naked on table waiting for doctor. Door opens and in walks female doctor with 2 other females in tow. Don’t put up with that for one minute. You tell them no. To begin with, Men should always carry a pair of gym shorts. When the nurse tells me to remove the clothes and put on the gown, I put on the gym shorts and then the gown. If I need to expose myself for a necessary examination then the shorts can come off in two seconds if I want them off. I'll make the decision not them. Otherwise, when the female doctor with 2 other females in tow comes in, I‘m covered and ready to make the rules. People without their clothes are less likely to fight. That’s one of the games that medical staff play on patients. Don’t go for it.
Warmouth
Once one is violated in a healthcare setting, if the violation is bad enough, one will never allow that to happen again. Trust has been eroded. How do you restore trust when the medical profession lies to patient about what to expect, violates their beliefs, invalidates their concerns and hides the ramifications of patient trauma. The answer....they don't. That is what this blog is about and I would stick my neck out to say that every single blogger who feels adamant about this modesty issues and a bad experience somewhere and the level of that experience, so severe that the only protection one has is to say NO
gd
GD, you make a good point about trust. I hope that there are many readers of this blog who can learn from the posters.
Patients need to be there own doctor, not only from the technical standpoint, but also management of their medical operations visits.
Our campaign of education to young people is worth the time we spent baring our souls.
BJTNT
The medical community never asks why people have modesty issues. They ask why PATIENTS have modesty issues, as if the two are not the same.
Modesty is well studied. Societal norms, religious influence, upbringing, and personal values all play an active part in how we view and/or protect our bodies. Why then is it confusing that when a person suddenly becomes a patient all of their beliefs do not change to suit the beliefs of the personnel around them?
The idea that gender should not matter in a medical situation is just that: an idea, a belief, a theory. We are not dealing with facts…..we are dealing with the emotions of the players on the medical stage. They believe, they feel, they don’t agree.
We are free not to view their moral or ethical opinions as facts.
More often than not people are modest with intimate situations, therefore: more often than not patients are modest about intimate situations. To be modest is not a rare event, but perhaps to brave enough to talk about it is.
Patients need to stop being treated as if modesty stems from secret dark and hidden places or tragic and lurid events. They shouldn't feel as if modesty needs to have an explanation any more than having no modesty need to be justified.
Sometimes a cigar is just a cigar.
If, as Dr. Bernstein suggested, it were simply "that patient modesty has no particular cause but is a stand-alone phenomenon of human behavior and should be treated as such and there should be no reason to dissect it for cause or causes” then perhaps those on the medical stage would stop ‘acting’ as if we need to excuse behavior that does not align with theirs.
swf
modesty = lack of trust toward
medical community
PT
PT, here are other folks views of "modesty" as written in the FreeDictionary
..Maurice.
As humbly as a guest who knows himself too late —Hart Crane
Humility is like underwear, essential but indecent if it shows —Helen Nielsen, Reader’s Digest, March, 1959
If you really were a hero … you made it sound routine and unglamorous, like shrugging off a ninety-yard touchdown run as “Good luck and good blocking” —Dan Wakefield
I looked as if I were trying to melt into the scenery and become invisible, like a giraffe standing motionless among sunlit leaves —Christopher Isherwood
Modest as a flower —Ella Wheeler Wilcox
Modest as justice —William Shakespeare
Modesty is like virtue; suspected only when it is advertised —Douglas Malloch
Modesty like a diver gathers pearls by keeping his head low —Punch
Modesty’s at times its own reward, like virtue —Lord Byron
You know, on reviewing what the other folks say about "modesty", I think a good take-away suggestion which supports the suggestions being made here in support of Colin's issue:
"Modesty is like virtue; suspected only when it is advertised —Douglas Malloch"
Isn't that the first step in resolving the issue?: ADVERTISE!! ..Maurice.
There are those on this blog who have issues but would find compromise or "let go" of their "modesty" stance if the illness or problem the person felt was great than this issue.
I know that I and others have brought up previous so called reasons. They cannot be invalidated. And...for those of us who have the most severe aversion to exposing themselves, it would seem that there was a very good reason and root for the change in attitude especially if that wasn't always the case with medical issues.
I remember myself before and after. I was a different person. I remember going to infertility specialists and seeing so many people never asking about the gender of the provider; not an issue and never cared. Then something happened that turned my world upside down and these modesty reasons have roots. Issues that have roots based on sexual assault or abuse seem to have more polarized feelings about their own modesty. That being said, isn't always the case. Religious preferences are very strong as well.
They come from mistrust, that the way they see their world now is different and, if the abuse happened in a hospital or medical setting where everybody is always a stranger, why would you trust?
The medical community has a responsibility too. There are practices (some of which are no longer in practice; some are) where they strip people naked and display them publicly for medical teaching. This would happen very often to disabled women. They would think nothing of bringing in a group of medical students and asking a woman in labor to spread her legs so that they can watch the exam without so much as asking. Now they ask. Now they have the Patient Bill of Rights . It was established because of all the damage to patients that their practices invited. It is now the biggest joke when it comes to informed consent and patient dignity.
People who have had these kinds of experiences or worse would never put themselves in this kind of position to trust and let whomever the professional is to do whatever. And...there is still so much abuse of power, purposefully humiliating patients as a means of punishment or making them submissive, that the medical community must step up an acknowledge that they too, have a hand in why people don't trust.
Until the medical community acknowledges there is a problem, acknowledges that people have individual PRIVATE reasons and that these reasons are justified, within their privacy rights that are now the law (and that Title VII has provided), until the time that the medical community can bully it's way, nothing will change. And..the only way to change it is by every one who cares this issue say no and explain, get their family members to say no for support. Until the medical community feels it where it hurts nothing will change.
A passive person by nature, I'm writing all of this not from my own ideas, but from looking at bodies of social change from the civil rights movement, political movement, and basic human psychology.
Complaining wont do it, telling them your medical needs will. Unfortunately, some of us will have to disclose things we don't want to, but again, it's a choice and I have chosen to make it very clear what I want, why I want and have been successful in both walking away from those institutions who will not honor my needs and letting them know to taking care of myself.
gd
Dr. Bernstein,
There are different types of modesty. The quotes you reference are, in my opinion, addressing behavioral modesty, or what we might call humility.
Physical/body modesty is something entirely different.
Colin,
Our thoughts are with you, and I hope you find a solution to your situation. Doug & others have made some good suggestions you might want to follow up on.....
Hex
For as long as this thread has been running we start thinking we are just rehashing everything and there is nothing left to say. SWF your first paragraph of your last post was really profound. Medical providers do not question why people have modesty issues, they questions why patients do, as if they are two seperate people, as if when we walk through the door of a medical facility we are suddenly transformed. Even Dr. Bernstein whom I feel really does care, as a provider has admitted not understanding how the context of the interaction does not change modesty. One has to remember the context for the provider and the context for the patient is different. It is hardly just another day at the office for us. Likewise, when providers become patients the context theoretically the same, but many will say, and probably more feel but won't say its different. They use its different becasue I know them or they ask and get accomodation since they know people. So great observation SWF, the light bulb went on for that one...alan
I had some rather wonderful news today. I had made a complaint about the way I had been dealt with about my request for an all male team. Apparently it was not an issue. They can do it. They always could do it. The Doctor just didn't want to admit it to me when i saw him.
The only issue now relates to care on the ward following my treatment, i may have to wait for a male nurse to become available if i go into urinary retention.
Hardly a major problem as far as I am concerned.
I will be having an all male team for the OR and thus will be having my treatment.
MANY THANKS FOR ALL YOUR SUPPORT
Colin, so glad to hear! Your perseverance is a victory for all of us. Please keep us posted as to how things are going.
~Gail
May God Bless you Colin with a speedy recovery, and May God Bless everyone who has taken the time to post here, it makes a difference, and especially Dr's Sherman & Bernstein, you two have made a great difference in lives you will never know. Alan
That’s great news Colin. I had said a special prayer for you. This gives us all encouragement and as you could tell, we were all concerned about you. Please let us know how it goes.
Warmouth
I am still trying to get some naturists from the Clothes Free Forum to present their views here. Some of you may recall that a couple of years ago or so, CSM, a naturist presented his views here. I went back to the Forum today to encourage further participation on my blog by others.
On 6/11/2009, an individual identified as Agde communicated the following to me on the Forum. I think this gives a bit of insight in the way at least one naturist sees the psychodynamics of what we are discussing here. ..Maurice.
On gender, I guess I am absolutist in the opposite sense -- it would be absolutely of no concern to me if the entire medical core were female. On delaying or ignoring personal care on the basis of gender concerns, for me this is consciously irrational behavior like smoking. As long as we're diverting resources, perhaps as a quid pro quo for being responsive to their type of modesty, we could require participation in gender seminars?
It occurs to me that the way the blog has defined modesty is linked to an unspoken definition of intimacy. One side of the coin has to do with caregiver misbehavior or private thoughts, the other side with the patient "showing" something they associate exclusively with intimacy. In both cases for them, the initial intimacy line gets crossed by disrobing. A second line gets crossed if the doctor/nurse touches the patient. In general for naturists, the second line is the first line of intimacy -- explaining their corresponding rituals and now they unconsciously evaluate whether a physician is being respectful. Anyway, the definition of what constitutes intimacy is a pscho-social knot that naturists work through, and I suspect medical professionals as well, but I have no idea how your bloggers can untangle their feelings on intimacy in order to see why others have such difficulty grasping their assumptions about modesty.
Interesting comment from the naturalist, Maurice. Of course, the naturalist assumes his/her position is the norm and is the "natural." Note that he says that naturalists and medical professionals have "worked through" this issue, suggesting to me that the naturalist's norm is the absence of shame, embarrassment, modesty. Is the perfect society one in which there is no bodily shame, embarrassment -- no modesty? I do think this is a common assumption.
But, this is an assumption only, a theory, a position that is not backed by a study of human society through the ages. Modesty is a universal. Now, what people are modest about varies from culture to culture. Some cultures may urinate and defecate in public. No shame there. Other cultures may find that a violation of modesty, but walk around nude. But every culture has some behaviors that they consider private and intimate.
A note on Colin's situation -- I'm glad things worked out for him, but I'm even more disturbed at the meeting he had to go through. The fact that he learned that accommodation "really" wasn't a problem, vividly demonstrates how intimidation is sometimes used in medicine to get people to go along with the program. Now, I can see an "intervention" in some cases. I suppose you could call that intimidation. But, in this case, it appears the "committee" knew all along that accommodation could be possible but decided to use intimidation to get around it. But...and here's the kicker...apparently Colin made a formal complaint about how he was treated. That's what seems to changed minds. Put it in writing. The medical "system" doesn't really want a fight about modesty issues, esp. if it's on paper and may go public and includes words like dignity, respect, and discrimination.
That's the lesson learned here.
Doug/MER
Wishing Colin all the best for a great result, speedy recovery and a feeling of pride that he not only achieved his goals, but now alerted his providers how important this issue can be to many! Congratulations!
gd
Very impressive Colin: standing up for your convictions and finding care that is acceptable to you and your beliefs. Wishing you a speedy recovery and the very best of health......swf
With a few exceptions (that we find in Dr.s Bernstein and Sherman) medicine as a group will tell us that it's "O.K." to have convictions as long as we are willing to let them go when it's time to stand up for them. It is no wonder that we are a nation of passive yet often angry patients. It is dehumanizing to take away the will of a person, and replace it with....well..nothing.
Colin, Congrats ! (Now for some cold water.)
How do you feel about this doc operating on you after you "bested" him. Have you spoken to him since? Have you squared things away with him? What I have seen of docs at least in the US, when you cross them, they are not happy to work with you any longer.
Dr. B, you said recently: "If I held animosity about the issue or the manner of discussions presented on my blog regarding patient modesty, I would not have continued it for 6 years and now beginning Volume 41."
You are "good people". I am and have been impressed by the time and effort you have spent herein. Thus, when I have used you as an example of a doc who "in his gut" doesn't get it, that would be true of all of the docs in my family as well. That doesn't make them any less committed to society. In the end, unless someone has experienced viscerally the "modesty" issue, it is very hard to "relate".
Again, thanks for keeping this blog going. I know that it helped me personally.
amr
I am sure that as an adolescent/ young adult I had quite important modesty issues, probably deriving partly from a conservative upbringing, but these have fallen away over the years.
It is a matter of profound indifference to me in a medical context whether I am attended by male or female professionals. My concern is that they are competent, accurate in their determinations and constructive in advice. I have been examined by male and (once) female proctologists and none of those was any less disagreeable than another. I have also undergone the “cough please” routine with a female doctor holding my testicles. No problem, and no embarrassment.
For most of my now quite lengthy adult life I have been a nudist where climate and circumstances permit and probably this influences my indifference to who views me in whatever state of (un)dress.
mlx.
mix, thank you so much for joining the discussion here. (Are you from the Clothes Free Forum?)
What goes through your mind when you are inspected but also touched by a female doctor? Do you have confidence that the whole event is free of sexual contemplation or acts by the doctor and that what is happening is nothing more than a strictly medical evaluation or treatment?
To my other visitors: As you know it has been rare on these Volumes to have someone expressing a contrary view to the majority here. But we should want to hear and dissect that other view. So let's proceed with a challenging discussion but remember: civility! ..Maurice.
Again, thanks mix for coming. ..Maurice.
Maurice
Regarding "other folks view
of modesty." The word has a number
of meanings. Please review
//en.wikipedia.org/wiki/modesty
Standards of modesty are aspects of the culture of a country
or people at a given point in time.
Notice how humility and
modesty are are often used together.
Behavior,manner or appearance intended to avoid impropriety or
indecency.
Yet modesty in the medical sense
rarely reflects on the medical
community.
Trust and modesty in the medical
sense are codependent,yet poorly
understood or just ignored.
PT
Maurice, you are welcome to my input. Yes I am a follower of ClothesFree Forum. I was interested to read your comments there some time back. I would never have imagined the subject of modesty in medical situations giving rise to 41 volumes of comments!
To answer your question, yes I have always had confidence in encounters and check-ups with female doctors that no sexual innuendo whatever was involved and that the procedure was strictly professional.
mlx.
It's wonderful to be free of these types of issues in a medical setting.
However, here's the difference. Someone who doesn't have issues and is a nudist does so at their own free will. In the nudist setting there is no power differential, there is no bullying to remove your clothes.
Those you do have issues, also have the right to their free will. Their free will suggests that this is not acceptable and because this issue goes to the fundamentals of personhood and the outcome of forcing patients has such a negative and permanent psychological effect (especially for someone who was previously forced to remove their clothes for any reason) this issue should be medically paramount because "to do no harm" should still be the mandate of medicine and it is not where this issue is concerned.
We all hold medical professionals in the highest esteem. When we find that their ethics fall short, or their idea of bullying patients takes hold, then we lose respect, we lose trust. Then we have nothing and refusing treatment is the only option. This problem was created by the medical community in part for their total disregard of autonomy and informed consent. The Patient Bill of Rights proves it and how disgraceful that is it completely ignored and we, as the paying public accept this???
gd
Who knows why some people are more modest than others, even when it comes to medical exposure. It is such a many faceted issue. As mix stated, he was brought up conservatively and was modest at one time but seemed to change so maybe some people hold on to morals they were brought up with and others don't. But I think it is more than just that. I was also brought up in a devout Catholic household where modesty was considered a virtue but as an adult I seem to have carried it to a greater degree than my other siblings. I do not even feel comfortable dressing in a revealing fashion. It is such a hard thing to explain; feeling this way about exposing oneself, even to doctors, nurses, etc. Even though by reason I know that it is a necessary part of some medical intervention I still cannot feel comfortable with the whole idea. It does help, however, to have same gender care.
I have never really felt like it was a sexually related feeling. There may be a bit of a feeling of shame or embarrassment to it all. Also, to me the thought of being unclothed and examined, poked, prodded, operated on, etc. by others that are totally clothed is mortifying. It's almost like I feel on display. Maybe it is a feeling of vulnerability or loss of control. I have sometimes jokingly told people that I wouldn't mind as much if the others were unclothed as well. Does anyone else feel this way? I actually wish I wasn't like this because I am the one who suffers from the anxiety but as one earlier post stated, it's how I am and I can't necessarily explain it but I just want to be heard and respected and worked with to find agreeable solutions. Jean
the concept of trust and the importance to the dynamics of the provider/patient. When a patient as in Colin's case, says this is really important to me, I need this, and they are treated or percieve they are being treated as if these concerns are not important or irrational, what does that do to that trust dynamic. Patients are increasingly being told to get involved in their health, while it may not be what the providers mean, if the patient brings forward a concern like this and feels they are dismissed or even demeaned for it, what does that do to that relationship, is it likely to be open for discussion. I think the dynamics are changing, at one time Dr's were almost revered as being somehting higher than human but not quite a God. I remember as a kid my mom making us dress in our Sunday best for a visit to the Dr. Still a lot of respect for the medical profession, but not quite what it used to, it is in transition.....alan
I'm another nudist (naturists, we like to call ourselves) and no, I don't have problems with medical personnel of either gender seeing me naked or touching me or whatever. We say our philosophy is all about "acceptance of the body" and with that thought, if someone's helping me and not hurting me, I'm as happy out of clothes as in them.
In fact my doctor is male and I've thought he goes to more trouble than he needs to, in order not to see any more than some people might say he should. But I'm sure that he's conforming to some standard procedure, and I don't make a fuss about it. The doctor shouldn't make the patient uncomfortable, but neither should the patient do it to the doctor!
I've got my outlook, but I have to accept that there are some people out there who have major concerns about being seen nude, either caused by past trauma or "just because". I wouldn't advocate making them uncomfortable or keeping them away from medical treatment, and say they should think like me and get over it. It's certainly not that simple.
Maybe doctors should ask their patients "How much do you care about nudity?" But then people would think they were being evaluated on how much they trust the doctor, so it would be another source of stress.
When you speak to those who work in (legal) brothels, many believe that the idea of intercourse is as natural and normal to them as nudity is to nudists. A biological function that does not necessarily involve emotions and intimacy. It is a business transaction between professional and client, involving contract services and payment. When they go home to a partner that they share a life, a love, and intimate emotional bonds with then intercourse (or any other biological exchange) suddenly transforms into a loving and sexual experience.
This is not unlike what nurses will say when they explain the difference between nudity and genital contact at work vs the transformation of sexuality when they go home to a partner.
Are not the two justifications innately the same?
And as long as we are asking ourselves to consider the idea of intimacy vs benign and natural nudity, shouldn't we consider all biological functions as neutrally benign as well?
Otherwise, that is social hypocrisy.
Let's accept the premise that "Are not the two justifications innately the same?" Then using the analogy of the legal brothel, I would guess that both parties expose their genitals in the brothel. Therefore, if the medical staff will expose their genitals, so will I. After all it's just a business transaction and "no big deal".
BJTNT
I can connect with Alan's post at 09:38. It was certainly true when I was a child that our family doctor was considered on a different plane from normal people (along with the clergy) and one was expected to dress up on going to see him. He also made house calls when required.
I recall on one occasion having to give a suppository to my daughter who would I guess have been about 9/10. No idea why - it was probably a suggestion (order!) from her grandmother. Anyway, there was no way she would let my wife do it so I was called in to administer the capsule and it caused a fuss as if a limb was about to be cut off. Modesty? Certainly our young daughter thought it was an unwarranted intimate intrusion. Can such things have longer term effects on a person's psyche? I don't know but would be interested to see comments on that. I would not venture to ask my daughter today if she remembers the occasion.
mlx.
The problem is that you are comparing the brothel workers to the medical personnel; not the patient nor the customer. So, the justification isn't there at all.
When you are the patient and the power differential is there (as made so aware by Jean), it's a completely different situation.
You being comfortable being nude is the point. Think about what would humiliate you beyond belief and then pretend that to get medical care you had to humiliate yourself to get that care. Pretend every time you had to humiliate yourself you wished you were dead. Now, that's a comparison.
Besides, benign and natural nudity is not the way of our society. Nudity to most is not benign or natural in public and, if it is it's your choice; not others
gd
gd
While we are talking about inconsistancies, why is it we say it is perfectly fine for providers of opposite gender to view a patient nude without asking, assuming implied consent, we will even accept a certain degree of intimidation as providers attempt to "convince" patients, or we can say like it or not atheletes and prisoners must accept being exposed while showering and dressing to the opposite gender, but if one of our naturalist friends chose to swim nude at 99% of the nations beaches, they would be arrested. Seems a bit odd doesn't it, you can force someone to accept being exposed but you arrest someone who is willingfully nude.
Under what circumstances could a naturalist feel embarrassed at being nude? Is that possible? How about in a POW situation? Or in an prison situation? How about where the nudity is forced, where there is ridicule and humiliation. Are these possibilities? It's not so much the nudity, I think, as it is the context of the nudity. I can see some people on this blog who would prefer same gender intimate care -- I can see some of these people at least trying a nudity colony. It's a choice situation and in the context of other people who have also made that choice.
What also may bother people within the medical context, is a strategy used by caregivers that does work for some people but not others. That strategy is the "elephant in the room" strategy, i.e. just ignore the issue, pretend it doesn't exist. Make believe that all is just fine, that everything is completely normal, etc. Be nonchalant. Now, I'm not saying the caregivers should necessarily make a big thing of nakedness, but with some people, bringing up the subject, acknowledging the embarrassment, the possible humiliation -- that would make things better. At least facing the elephant eye to eye, not pretending that he isn't in the room at all. I think to many caregivers have been taught/socialized to pretend it's all normal because that's "supposed" to put the patient at ease?
Then, there 's the other issue we keep getting back to -- observers, students, unnecessary people in the room, open doors and curtains, etc.
By the way, I wonder how many nudists would feel if their colonies were just open to the public, the public being people who refused to get nude also. How about some non nudists, clothed, "shadowing" nudist for a day? What make make the nudist colony work is the connected value of naturalism among those who are there. They all have the same perspective. In medical situations, we have various cultures who have various perspectives.
Doug/MER
I guess the one thing which we largely overlook during our discussions on this blog, is the impact our decisions have on our loved ones. By my all or nothing stand over an all male team recently, my wife felt quite excluded from the decision making process and questioned if my modesty/dignity was more important to me than staying alive to be with her. It is yet another of the arm twisting emotional blackmail that the medical system indirectly relies upon to persuade people like me to comply. The Doctor even asked me in front of her if her views had been taken into account and had i taken them seriously.
I would like to add to Doug's comments with the telling of an actual experience: what if you were required to undress in front of a team of technicians in a large, unsecured radiation/oncology room with large viewing windows; required to lay naked from the waist down in the frog-leg position in front of this mixed gender group including a student (who appeared to be high school age) and you are introduced to an opposite gender doctor for the first time by another opposite gender doctor while you are laying there. Oh, I don't want to forget that anyone is allowed to come and go from the room as they please and that photographs are taken of your exposed area while you lay there. This is the "elephant in the room" strategy. No one really tells you what is going to happen to you, it just sort of happens.............
GD I don't disagree with you. However, the excuses are the same whether used by either profession. My point was that you will hear the same from either worker, and the choice to believe either is up to the person. I stand by the statement.
Personal dignity is not a joint decision. What is important is a proper explanation to loved ones why one's position is steadfast. After learning why, no loving partner would try to force the other into something that could negatively effect the mental health of the other. The people asking these questions are selfish and I ask every one of them to "put the shoe on the other foot".
gd
Colin,
Think of it this way - had you not taken the stand you did, you had little or no chance of having your request met. Yours is not an immediate life or death situation so time is on your side, and by standing up to them you get both the treatment you need and to have it done in a way that is respectful of your values. You always had the option of modifying your position if there was absolutely no other alternative.
The reality is that unless they are forced to do otherwise, the providers will default to doing what they are used to and most comfortable with, not necessarily what is best for the patient - that is simply human nature.
Unfortunately, at times, it is necessary that the physician/patient relationship be somewhat adversarial. This cuts both ways - it applies not only to the physician that won't give up their paternalistic ideology, but to the patient that demands unnecessary tests, treatments or medications that are not in their best interests.
GD, I understand your point that personal dignity is not a joint decision. However, to say that the "people asking these questions are selfish" ( if I understand the meanning of that line-which I am not sure I do)is a stretch. Colin's wife loves him and it is very understandable that she could be upset by a potential decision by her husband that could cost THEM the rest of their lives together. For someone who, if I remember right, has asked for discretion on how people are viewed for what they believe and feel, it seems you are giving short shrift to Colin's wife feelings. She has a right to her feelings just as you and Colin do. To deny those feelings seems to me to be the selfish act you describe in her. I applaud Colin for bringing the subject up-it obviosly lies heavy on his mind. Dean
For those who have not read it My Angels Are Come by Art Stump is an interesting read and related to this issue. While written about his journey battling prostate cancer the issue of privacy, modesty, & respect and the lack of the same is a big part of it. He has a featured thread on Dr. Shermans site that is a good read as well. I want to post a section of that here that I think is key to this thread. When speaking of the hospital gowns we all hate, and providers know we hate he states. "It's all to easy for the casual interlopers, and perhaps seasoned healthcare professionals as well, to fail to appreciate the degree to which modesty and privacy foster a sense of identity and security in most people. In this culture the surrender of one's clothing is a dramatic reversal of a basic norm. It is precieved by many-patients and non-patients alike-as a sign of vulnerability, a tacit admission of submission and acquiescence.
The fact of the matter is that the barely sufficient "hospital gowns" used universally in the medical community are not patient clothing at all. Rather they are less than palatable accommodations ENDURED by patients as a courtesy to their healthcare providers"
Is this not the basis of many, though not all of our arguments. How many of us have ENDURED the presence of an additional person duing an intimate exam or procedure to accomodate providers. How many have ENDURED opposite gender when we were more comfortable with same gender and same gender was available. An example I have used, I requested Dr only when I had my vasectomy. Several of my friends used the same Dr and were humiliated when he had his nurse, whom we all know and socialize with, assist.
Many people endure these things and then become angry at themselves and providers. I have a very hard time believing providers do not know how much patients hate those gowns, look through the greeting card section and see people making fun of them, and yet they are universally used when not required for the convience of providers. A Dr can perform a vasectomy without a nurse if asked, but doesn't, how can he not know a vasectomy is a very intimate and embaressing thing for many men. And so, the issue of trust comes in as a motivation for good providers to value patient modesty. If I can't trust you to respect my modesty and what it means to people, why should I truely trust you. If you make me endure these things for your convenience, why would I not think you will do the same in the physical aspects of my care? alan
The crime of indecent exposure in most states is a
misdemeanor and in california for example, requires
one to be a lifetime registered sex offender. In most
states the second offense is a felony with long jail time.
Men by the way are not the only ones convicted of
these crimes. Certainly to deliberately expose oneself
involves sexual gratification. On the flip side of this is
voyeurism, a psychosexual disorder where one derives
sexual pleasure and gratification from looking at naked
bodies and genital organs of others.
It is very easy to lump the above mentioned in the
same category as nudists and as such I see no benefit
as it relates to patients and medical privacy. If nudists
see no problem with people looking at their naked bodies
how do they feel about their private medical information.
Do they care if hipaa violations occur, that is their private
medical information is disseminated freely to anyone. Many
of these groups will use words like freedom and liberated
simply to hide their real goal of sexual gratification.
After all many in religion have used the church as a means of cloaking their real intent, to molest young boys.
It's almost as if to say, see we don't care then why
should you.
PT
First, you might want to review the past 4 days postings because you may have missed a few since while on a few days vacation, I did not moderate the postings in the order in which the comments were received. The dates on each posting is the date they were originally submitted.
Second, if "mix" or any other naturists is still around on this thread, I have more questions.
As a conclusion would you say that the difference between naturists and others is that others find a sexual connotation to any exposure to others of certain parts of their bodies but naturists find no such relationship in this regard? Thus they don't feel sexually abused in any way by such exposure? Would such a difference apply only if the naturist exposes the naked body to other naturists, clothed or unclothed or do they feel comfortable exposing their bodies to the general public if they could?
How do naturists feel about allowing others to observe micturition (urination) or defecation (bowel movement)?
..Just wondering. ..Maurice.
Are you posing these questions to me specifically
Maurice? We certainly can debate the subject,however,
consider that many naturists include their children
In these events which is considered child abuse and
child pornography.
PT
PT, no I was referring the questions to any naturist present. However, PT, to your last comment, I see on the Clothes Free Forum that "families" (including children)are encouraged to come to some of the clothes free activities. If bringing children was illegal and parents could lose their guardianship of their own children, why are these family sessions advertised? ..Maurice.
By the way, in order for me (and hopefully for my visitors) to better understand the dynamics of patient modesty, I am still looking forward to get folks other than naturists who remove their clothing in front of others such as art models, pornography movie actors and even sex workers to write here how they personally deal with the specific issue of bodily exposure in a medical diagnostic or therapeutic context. As some of you may recall, we did have one art model some time back. I really would like to get more representation from those classes of occupation to try to balance our understanding of the issue in terms of the human response.
Does anyone here know of someone that fits these occupations and could help me get their insight? ..Maurice.
Maurice
Anyone can advertise,question is do they bring their
children. Wouldn't this be a perfect scenario for a
pedophile to view nude children. Why do you think they
advertise,hey bring your children,let's make it a family
affair. Hey,bring your dog too. Heck they're already
nude.
Visit Nudisthallofshame.info/Frederick.HTML
Then there is this one just like the other thousands
of other arrests.
www.myfoxaustin.com/dpp/news/local/041610-FBI
Child porn made at Bastrop nudist camp.
These people go to these camps, etc on their own free
will.
There are no core values posted on the walls of
nudists camps,but there are at hospitals and medical
facilities. Sadly, at hospitals you might as well be at
a nudist camp as most have never heard of core values,
let alone the words dignity,respect.
PT
I agree with Jean (6/8/11) and appreciate how well you worded your comment.
Why is modesty so painful? Where does the hurt come from?
I would never, under any circumstances, allow myself to be intimately examined by a medical practitioner of the opposite sex. I'm not religious, and I had no childhood traumas, but there are plenty of medics of my own sex (male) and I would demand that someone examining or treating me was also male. This is a right many women take for granted, so what's sauce for the goose, as they say...
"Why is modesty so painful?" "Where does the hurt come from?" In addition to the people that Dr. B. requested participate, I would also like to see phychologists involved, specifically re: the two above questions posed by the June 11, 1:41 PM poster.
BJTNT
On June 8 2011, Doug wrote: "Under what circumstances could a naturalist feel embarrassed at being nude?" It is interesting, on reading the commentaries on the topic "Being nude at the Doctors" at the Clothes Free Forum (many, many comments between 2009 and the present on this topic) I would say that it isn't the patient's embarrassment but the concern that the doctor will be embarrassed at the patient's nudity and fail to perform a thorough examination.
For example one response from last June: "My GP and her PA are both women. I think that they would be very offended if they came into the room to do the exam and I was sitting there in the nude waiting for them. Being at the doctors office is a professional occasion and it is not the time to either practice your belief of nudity or to try to force it on others. You need to honor the wishes of the office staff, if they request that you put on a gown, put on a gown. My Doctor has me strip down to my underwear and I can put on a gown if I get cold. When she has to do a prostate or genital exam she calls in a nurse to be in the room while doing so. (I guess this is for her legal protection) This action alone tells me that she would not appreciate me sitting there naked while she did her exam. ... My feeling is that I am paying a professional to do a medical exam and give me medical and health information to allow me to live a long and healthy life which I can do so either naked or clothed, I am not there to have an hour of 'naked time'".
On perusing the comments on the Forum, I find common threads: !) the lack of sexual implications in the medical examination and 2) the need to protect the doctor from embarrassment regarding the exposed patient, which protection should lead to a more thorough and less cursory examination. ..Maurice.
Maurice: Now you're getting into the nature of embarrassment and the rituals involved. One way in which embarrassment occurs is when a ritual, usual an unspoken one, is violated. If only one person is supposed to be talking during the ritual, and someone else speaks up, that can cause embarrassment on the part of both parties, esp. the one who spoke up, even if he/she didn't realize the ritual was being broken. As you can see, this scenario can easily be fit into medical situations. If the doctor/nurse knows the ritual, and the patient doesn't, and it isn't communicated to the patient, and then the patient breaks the rules, embarrassment can result. This fits into your anecdote above about the patient feeling comfortable being naked and the doctor not feeling comfortable. And it fits easily with men who don't have much modesty relating to female nurses who are offended by the man's lack of modesty.
As I've written about in previous posts, this is the case of the "elephant in the room" issue. The elephant in this case being the "unwritten rules" that exist in many clinics and hospitals about protocols and procedures. If communication isn't taking place between caregiver and patient, the situation is set up for embarrassment of many different types to happen. Much of this comes from Goffman's research, which I've cited in past posts.
Doug/MER
To answer Maurice’s questions at 08:31 June 11, I think it is correct that genuine and regular naturists will not find any automatic sexual connotation in the exposure of body parts to others, but it depends on context. A social swim meet is clearly different from an intimate picnic or visit to a deserted beach with a partner or potential partner. That is the same whether the parties are clothed or not, though the stimulus is probably going to be greater on the latter occasions if they are naked.
I have certainly not felt any form of sexual abuse from the exposure of my body and it is not of concern to me if there are clothed people nearby, in circumstances where to be naked is reasonable or customary. (Evidently my definition of that might differ from that of some others). But I have no wish to cause unnecessary offence so I am relatively discreet as to where and in front of whom I shed my clothes, and I would not walk around town naked even if there were no risk of arrest or fine.
As far as urination is concerned, if I am far from civilization and need to do so in mixed company I would turn away but not hide. I have always had a slow bladder and at a crowded urinal (maybe a sports club) it seems to get worse, perhaps feeling guilty about being slow when there is a queue waiting. But I have the same problem on a train or plane when alone so it has nothing to do with shyness but in that case with movement. Defecation is a much more intimate matter and I do like peace and quiet. As we do not lock bathroom doors at home my wife occasionally enters and that does slightly bother me as I have no wish to converse while about my business.
One thing that does make me uncomfortable is the thought of a full body massage administered by another male. I like a massage and when well given find it very therapeutic but would always ask for a masseuse, even though I cannot really justify this.
mlx.
mix, if you are still returning here, could you tell us your understanding of the legal implications of families bringing their children to clothes free events (in response to PT's comments today.) ..Maurice.
As someone who remembers "before" and after" that I was always comfortable during examinations. It was not until after something happened regarding cruel and degrading treatment combined with (punished) sexual misconduct on the part of the staff that I vowed this would never happen to me again...and it won't.
gd
I can completely sympathise with anyone who, like gd, has experienced cruel and degrading treatment and sexual misconduct at the hands of medical providers. There is no excuse for this. I do not know how frequent it may be but, from comments here it seems too frequent. I make the qualification that what constitutes such treatment may vary according to the recipient but I am relieved to say I have never had even a suggestion of a similar experience.
I am not qualified to comment on the legal implications of families taking children to clothes-free events/places. In a purely social context it should not be an issue but evidently it may depend on country/State and on what self-designated whistle-blowers report. Any society whose legislation allows a person observed peeing into a bush in the back country to be registered as a sex offender, or permits children to be removed from their parents because they took snapshots of Baby in the bath is in my opinion not only paranoid but insane. mlx.
Dr. Bernstein, a comment you made a week or so back has had me thinking. I have pondered the comment that the "context" of nudity in the medical situation changes opposite gender exposure from the social norms we live by the other 95% of our lives. I have thought about this alot since then. While I completely agree with you that the context does change the situation, who gets to define what that change creates a hugh difference between patients and providers. I personally believe providers have been "allowed" to define what the context means. Does the context mean patients give up everything they apply to "normal" life or does the patient give up certain aspects. The other thing that plays in here is why and for whose benefit, the patient or the provider. My personal feeling is the forfiture of modesty by the patient is more for the benefit of the provider than the patient. Male orderlies were eliminated for the benefit of the hospitals bottom line, not for the patient. Gender nuetrality makes it easier and cheaper for the provider to schedule and thus increases efficiency. You have as I recall agreed female reporters in male locker rooms is wrong, yet reporters use basically the same arguements medical providers do, I am a professional, it's part of my job it's no big deal, etc. and in both instances, the clothed people define what the context of nudity means. I don't expect this to change your mind, but I would be interested to hear your thoughts on the concept that providers define what the context of exposure in the medical arena without asking or possibly considering what the context means to patients. This is somewhat reversed when I and some of the others on this thread feel the context of a medical student gaining skills and knowledge makes them shedding their modesty to be the subject of such exam. You obviously disagree, but who gets to set what the context means, why is our feeling that students should be fine in that context any less valid than providers defining what it means to patients. While providers may have the power to impose their version, does it really make it any more vaild....alan
alan, physical modesty on the part of the patient in the context of a medical examination or medical procedure is, for the majority of physicians or other care providers not IGNORED but, as with me until the responses to this thread changed my view, UNDERESTIMATED. I am sure it is not ignored since it is discussed repeatedly in medical training which I can verify at my level of teaching first and second year students. The concept that we professionals do hold is that both the patient and doctor desire the same goal: the diagnosis, treatment and cure of the patient's illness. We physicians also hold (and obviously a misconception) that patients will generally not allow modesty to trump the attempt at a proper diagnosis and effective treatment. Our learning is to facilitate this common objective but with attention to ways that degrees of modesty still can be maintained.
And remember, what the naturists write about physician's personal embarrassment of the unclothed is certainly correct. That tendency for physician embarrassment along with the physician's learned concern about subjecting the patient to unnecessary bodily exposure makes it reasonable to expect that physicians may as a reaction rush through the exam or procedure to the patient's medical detriment.
In response,alan, to your initial concern does "the'context'of nudity in the medical situation changes opposite gender exposure from the social norms we live by the other 95% of our lives." My answer should be "YES, but not necessarily full nudity but needed degrees of bodily exposure if our common goals of diagnosis and cure are to be reached." ..Maurice.
Apparently, a nurse may need to touch your genitals (no foley involved) even if the surgery is for an injured elbow. The patients were all male. The nurse was found not guilty. The nurse was male too.
http://www.themorningbulletin.com.au/story/2011/05/31/witness-saw-nurse-touch-boys-genitals-court/
We need to define that slippery word, "modest" in the context of nudity. A patient may not be modest exposing him/herself to a trusted doctor, male or female. The gender may not matter. But...then enters the chaperone. New context. Modesty emerges. Or, the door gets opened during an exam and a strange head pops in. Modesty. A man go to a urologist, knowing his genitals will be seen and not thinking too much about it because his urologist is a male. Then, the doctor brings in a female assistant. Modesty. Modesty isn't a "thing" that exists statically. It changes as the situation changes. Granted, there may be a minority of people who are bodily modest in all circumstances. But most people are modest and not modest, depending upon the context. The idea of modesty moves along a continuum depending upon various circumstances -- for most people, that is.
Doug/MER
Dr. Bernstein, sometimes I am not good at expressing and sometimes my thoughts develop with the exchange of ideas so I hope you don't take this as arguing with you, that is not the intent. I agree the context does change exposure, where I think we depart is on how that context changes how we deal with it. I don't think providers ignore modesty, I do however feel providers choose to at times offer solutions that are more for their benefit than that of the patient. I would be interested in your thoughts, do you feel providers knowing most patients will compromise their modesty becasue of the context, make the decisions on how to deal with it in a manner that benefits providers while addressing the issue. I feel to a degree providers use the knowledge that patients will consent to things they normally would not becasue of the context and use this information to benefit their scheduling, practice, and how they go about their day. I have used the example before: I think most people, providers & patients alike would say they understand a man getting a vasectomy is a very personal and intimate procedure. Most men that I know have spoken of how uncomfortable it was having a nurse present, several said she did very little and saw no need for her to be there. I and those who asked had Dr only for the procedure. To me, this seems to be the Dr. has to know the presence of a female is uncomfortable for the patient, but the contxt makes it acceptable for the Dr. to subject the man to her presence to make it incrementally easier for him. Do providers ignore modesty completly no, do they provide what THEY think is acceptable..yes I think they do, do they consider the patient..yes I think to a they do but provide in a manner that works for them, my question is...does knowing the patient will, becasue of the context of the exposure accept less accomodation than they would like, cause the provider to offer accomodation that while less than the patient wants or would feel comfortable offer accomodation to fit providers wants and needs for scheduling and such even though it is less than what patients prefer. Do you feel to some degree providers knowningly compromise patient modesty for the benefit of the providers wants and needs and justify it in their minds with the context makes it acceptable. Again, I think it has a certain amount of similarity to reporters saying the context of their presence makes it ok ignoring there are alternatives that would be better for the players. Not saying the situations are anywhere close in importance, but the reasoning for providing alternatives that benefit the clothed persons the similar approaches...claiming gender nuetrality benefits providers much more than it does patients....alan
Doug,
It may seem like semantics but I don't think so.
Patients agree that they need diagnostic procedures, etc where their bodily privacy is concerned. They can and do abandon that privacy right in order to be cared for.
What you are talking about isn't modesty, it's the violation of their privacy with their expectation of privacy.
Because the consequences are so dire for some when this happens, this is a discussion for every doctor to have with every patient telling them what to expect regarding their privacy during procedures. Someone cannot be traumatized when they expect something even if they are uncomfortable.
What is traumatic for them is when their expectation is violated causing them to feel humiliated. Humiliation carries it's own category of mental health problems and this is the reason and bona fide requirement that these gender issues issues be raised.
It is time for me to come from behind gd and identify myself by my name...
Belinda
writer/researcher
"What you are talking about isn't modesty, it's the violation of their privacy with their expectation of privacy."
Thanks for your comments, Belinda. Yes, much of this is about meeting or not meeting expectations. This lack of communication represents a great abyss in the doctor/patient relationship. You write: "Because the consequences are so dire for some when this happens, this is a discussion for every doctor to have with every patient telling them what to expect regarding their privacy during procedures."
Don't we all agree with this ideal. But in my research, and my experience as a patient, this is a topic that the doctor almost never, if ever, brings up. And most patients are either reluctant to bring it up, or don't have a clue as to the degree of modesty they may have to surrender during especially intimate procedures.
I think alan has come up with some interesting questions. The culture of medicine evolved from a very paternalistic power relationship between doctor and patient. It was a relationship between, among other things,between knowledge and lack of knowledge. This has changed and/or is changing to a significant degree.
You write: "Patients agree that they need diagnostic procedures, etc where their bodily privacy is concerned. They can and do abandon that privacy right in order to be cared for."
Correct as far as it goes. But as you note, the precise boundaries of this exposure is rarely specified by the doctor. Who will be on the "team?" Who will be present?" Will there be a chaperone? If so, what gender? At least twice in my experience, if I hadn't asked whether observers/students would be involved, I either wouldn't have been told, or would have been "asked" as I was being wheeled into surgery. That's unacceptable. Some patients may indeed "abandon" what we call "privacy" rights, but a significant number of them are later surprised because the expectation of what we mean by privacy/modesty is not the same for the doctor or system as it is for the patient.
To sum up, all this comes down to communication. And I still agree that too often certain questions are not asked because the answers are generally known, and the askers don't want to hear the answers, perhaps because they can't meet the expectations that the answers will demand.
Doug/MER
alan, you ask "do you feel providers knowing most patients will compromise their modesty becasue of the context, make the decisions on how to deal with it in a manner that benefits providers while addressing the issue." Yes, with limitation of time and at times resources, best use of time and efficiency of resources may lead to routines which to some may appear to benefit only the providers but in a way is really also benefiting the physician's other patients whom he or she is responsible.
What I just wrote also I think answers your next question: "does knowing the patient will, becasue of the context of the exposure accept less accomodation than they would like, cause the provider to offer accomodation that while less than the patient wants or would feel comfortable offer accomodation to fit providers wants and needs for scheduling and such even though it is less than what patients prefer?"
I'm sure I have experienced the same assumptions and I think most doctors do too. For example, for a female breast exam for a symptom for which the patient came to me with concern, I have never called in and waited for a female chaperon to attend. I assumed she came with the intent for me to examine her in a thorough and efficient manner and that was that. In other words, I thought, for whatever modesty she had in exposure of her breasts to others, she put modesty aside for this exam. Well, after reading all the comments on this thread, I may have been ignorant about what was going on. (By the way, medical standards of practice for female pelvic exam by a male physician requires a chaperon.)
I hope I have answered your questions. ..Maurice.
Hi Maurice:
I keep reading that chaperons are "required" but I've had a pelvic exam done by a man (gay nurse/it was obvious) at a city clinic and never offered a chaperon. Also had a male private infectious disease doc exam my genitals and he never offered a chaperon. And what makes breasts less of a sexual area than genitals anyway? It should at least be on the same par. Do you think our society has become desensitized to breasts and so fails to treat them as sexual parts?
Anne
This is an excellent, detailed article on providing privacy for women during pelvic exams in the UK. This should be made law in the US. I'm not sure they ever use the word modesty,though, which may be why health care providers don't find this site often enough...I think they just use the word privacy. Anne
www.rcn.org.uk/__data/assets/pdf_file/0011/78698/003036.pdf
EUREKA! For the first time in weeks, I just made clearance for entry into this blog. I suppose my computer fails me like healthcare!We are celebrating with Colin, a reversal of decision, now authorizing an all-mate surgical team for an intimate operation. Some questions to ponder: Has not the surgeon and hospital eroded its credibility by its vascillation, intimidation, and deviousness? I would not want this individual to hold a scapel over me, for there is uncertainty as to what other possible hurdles I may have to jump or deceptions await me! I would tell "the professionals" and the facility to go suck eggs, broadcast negative publicity, and find an alternative site!The ultimate values of the system are profit and expediency! As a "non-prophet" (spelling intentional)institution, the administration understands money, when all other argumentation ceases to carry water.-REV.FRED
I think one main point that medical providers either downplay or deny is the fact that PTSD symptoms can arise in medical settings whether a patient has a history of abuse or not. According to research, genital medical procedures can be stressful enough to produce PTSD symptoms.
Factors which seem to predispose to the development of PTSD in medical settings were shown to include: feelings of powerlessness and loss of control; lack of consent; lack of information; perceived lack of sympathy in the examiner; and the experience of physical pain.
How many people have experienced some or all of the factors listed above at one time or another? Paternalism promotes a particular style in the way medicine is delivered and this has been shown in some patients to cause trauma (ptsd). Doctors expect patients to be passive and compliant and that has been a longstanding tradition.
Many participants on this blog are communicating that their modesty/privacy issues and previous experiences have been traumatic. However, medical providers fail to fully acknowledge and accept the validity of this and its implications.
Often medical providers suggest that a traumatic response is irrational given the context in which providers define (but not patients). This has grave effects on the emotional and physical health of some patients.
Re: The recently link sent by anonymous about providing privacy for women undergoing pelvic exams in the UK. Note the next to the last paragraph in the entire document:
"Some women will request to only be examined by a female and this should be respected. If a female
clinician has been requested but is unavailable,
alternative arrangements may have to be made. In
emergency situations, where no female clinicians are
available, sensible and practicable measures must be
taken."
Gender is pretty much ignored as a factor in ths document until the very end. And, note the last sentence...which means? It really means nothing. It's a way of putting words together to create a sentence that really doesn't say anything -- which indicates the discomfort with this situation. The obvious answer is to make sure there's a gender mix on staff and that it's embedded in the schedule.
But anonymous is right. This document could easily be edited to include all intimate kinds of exams for both genders. But you probably won't find one of these written with men only in mind. And I would suggest that a man going through some of the kinds of prostate cancer procedures faces situations as intimate as a pelvic is for a female.
Doug/MER
Therapist, you write "According to research, genital medical procedures can be stressful enough to produce PTSD symptoms". Can you provide a reference in the literature that we can use to go further into the subject. I assume that the symptoms are sub-acute and chronic rather than simply acutely at the time of the procedure. In the latter case, the response would not be "post" traumatic. ..Maurice.
Here's the link taken from a medical journal. http://www.springerlink.com/content/h885378g19128025/
There's a gap in the literature concerning this topic and I am looking for studies on the onset of PTSD following medical procedures.
Dr Bernstein wrote:
"I assume that the symptoms are sub-acute and chronic rather than simply acutely at the time of the procedure. In the latter case, the response would not be "post" traumatic."
PTSD arises in response to a traumatic event or a perceived traumatic event, etc. In some cases on this blog, it appears that PTSD arose after a perceived threat to one's physical integrity. This is listed as one cause in the DSM-IV-TR. This threat is very real for the person experiencing it. The symptoms may arise immediately following the event or the onset could be delayed days, months or even years. Also, see complex ptsd. The symptoms can range from mild to severe and last for any period of time. The symptom presentation varies between people.
Triggers that remind someone of the trauma might result in avoiding medical settings. Just talking about it can be really hard for some people.
Posted here:
http://patientmodestysolutions.blogspot.com/2010/11/yes-virginia-its-prostate-exam.html
is a rather intimate example showing how PTSD can color every aspect in life, including medical situations.
swf
alan:
Your June 12th comment was stunning. The struggle of context vs reality is an issue I have battled with, but could never put into words as well as you.
It seems that when you cross an arbitrary line, you are expected to embody no traits of who you actually are, but are allowed to become that person again once you move those few inches back to your own side of that line.
Dr. Bernstein's comments were insightful as well, and gives us a rare view that perhaps the medical arena did not realize the weight of issues that people "should" but could not leave at the door.
swf
That's an interesting article swf. We have to be careful in distinguishing between embarrassment, feelings of humiliation and actual PTSD. They are different. Men might avoid medical settings due to fear of embarrassment or humiliation, but not have PTSD.
Dr. Bernstein, it does answer my questions, it is not a surprise, nor do I think it is diabolical or completely indefensible. Like it or not cost is part of the healthcare system. There is a Dr shortage which will only grow. Time becomes a very scarce resource, one that can not be manufactured. I think it is important for everyone to realize this. Providers in my opinion know they are compromising patient comfort in the area of modesty for the benefit of time and money. While I wish it were different, this is not hard to understand. They are balancing many things. They need to justify what they are being forced to compromise, is it really so hard to see how this would end up shorting the patient in this area for the concept of a larger good. While we would prefer they ask, knowing they are trying to address this balance of time & money vs accomodation makes it a little easier to accept that we are going to have to stand up for ourselves as whether we feel it is misguided or not, they may actually just be trying to accomplish what they see as a greater benefit. If they spend an extra 5 minutes on 10 patients for modesty, they loose an hour a day, an hour they could be seeing 3,4,5 more patients, if they spend $30/hr for a male nurse, thats $65-70,000 a year they can not invest elsewhere that could benefit patients. Now, I am not saying it is right, but I can accept that more than they have no idea it is an issue. I can also see how as Dr. Bernstein has said, they have no idea the intensity or extent of modesty becasue we have not spoken up. it is the idea they have no idea I struggle with. One must als realize there are two different aspects of pratices and hospitals, business and care. Often the business aspects dictates staffing levels and other things that impact this issue, and often that may conflice with care providers. So, to me it all boils down to I need to speak up for myself and continue to educate them. Understanding motivation is very important to accepting and planning a response....just my thoughts...alan
"We have to be careful in distinguishing between embarrassment, feelings of humiliation and actual PTSD. They are different. Men might avoid medical settings due to fear of embarrassment or humiliation, but not have PTSD."
That is true, however the comments 22-25 show the degree that a person would go (who has PTSD) to avoid mecical care once they feel "re-offended" by the medical system.
swf
Thanks swf for pointing out those replies. They convey detrimental effects that can be caused by dismissive healthcare providers in regards to bodily privacy.
The disclosure by many who post here that past abuse by the medical community is the reason they now want same gender healthcare providers got me thinking. The medical community is famous for studies that identify certain foods, habits or behavior as putting someone at higher risk of a particular disease. Does anyone know if any studies have been conducted that indicate having same gender or a specific gender healthcare provider(s) lowers the risk of a patient being abused? Pat
When someone has a traumatic event, it changes the way they see the world. One can avoid due to PTSD, but after careful examination and interviews with health psychologists, I can tell you that the problem isn't always the avoidance of PTSD. It's bigger than that.
Someone like me who was abused in a healthcare setting had elements of psychological trauma but not all of them. My incicent happened a very long time ago.
Now I'm left with the remnants of that care. It changed how I see the world, what I think of healthcare in general. I've taken control of my health, used the legal system to my advantage and refuse opposite gender care always.
It's not about avoidance; it's about going any length not to feel humiliated and degraded; a very different side of things.
The difference between me and the general public is that most are unaware of the awful things that sometimes go on in healthcare settings. Once you know, you won't go near it just like you wouldn't hit yourself twice in the foot with a hammer.
Belinda
alan, 3 of your postings to Volume 40 somehow got into my blog "spam box" and I wasn't checking that box regularly. I apologize to you and the others who may have valued your comments at the time. I have now published them in their chronological locations within Volume 40 : May 15, May 17 and May 25 2011. ..Maurice.
No problem Dr. Bernstein, I just appreciate all the time and effort you put into this. Continuing the thought process regarding providers giving accomodation that benefits their schedule and the effiency of their practices. For me, if this were acknowledged, I could accept it and have less problem with that acknowledgement than what I feel is the less than truthful practice of acting like providers have no idea it's an issue at all or worse yet, like I am wierd or odd for caring. The fact that I feel they have to know but act like they don't, or act like I am the problem adds another demension of casting doubt on trust. In the instance I have put forth here, I had to have a scrotal ultrasound, a female tech did the procedure, when we went out to the reception area and she told a female patient she had to go on break and the only tech on duty was male so if she felt more comfortable and could wait 10 minutes....I was ready to just accept the embarassment and get on until I realized there were options, they just didn't care enough to make the effort, and perhaps more important she obviously knew it was an issue for patients becasue she was actively trying to accomodate another patient with the same situation. I was furious and felt betrayed and lied to. I vowed it was my last visit to the Dr until this and Dr Sherman's site made me realize I had options. For me, the simple truthful acknowledgement they were trying to work a tight schedule and needed to do it this way would have meade it easier to take.
Dr. Bernstein, I agree with you in another area. The woman who comes to you for a breast exam comes expecting to expose them to you, just as I know when i go to my Dr for a physical I will expose myself for the hernia check. Don't like it but know it is part of the deal so I can accept it without a lot of concern. However, if the Dr. suddenly brings in a nurse while he does the exam the whole scenerio changes. Same with your scenerio, the patient comes in expecting to expose her breasts to you as part of the treatment, but if you were going to bring in a male med student you would feel the need to ask her if its ok, or if you were to bring in a male nurse for a chaperone the whole scenerio changes. I truely thing the vast majority of the issues we are talking about here are along that line. We come to a Dr. most often by choice, knowing to some degree what to expect. When it comes to nurses and support people we don't have that choice or as good of understanding of what to expect. This is especially a problem when we feel we our preferences are not a concern or worse ignored. We look at our Dr as the leader of this group, and when they allow oru modesty to be violated by allowing nurses and staff to be present when not absolutely needed or without asking, or fail to "protect" us on referral, we often blame the entire system, including our Dr. I really don't feel exposure to the Dr's we choose is near the issue allowing other people to be present...alan
Very well said Belinda. You are so on target. I can definitely relate to what you’re saying. Although my experience was likely minor compared to what you may have endured, I have had my share of anxiety over it. Because of my experience, It changed how I see the world as well and what I think of healthcare in general. I can never look at health care staff without suspicion and distrust. Even when I see health care workers in public places between shifts dressed in their very identifiable scrubs, I always view them as evil and am very uncomfortable around them. I simply don’t like them and I don’t want them near me. I so wish that I viewed them as life savers and caring people as my mother taught me but it just doesn‘t happen that way in my mind.
Warmouth
Warmouth
Forgive me as I've been doing
some research and as such forgot to
respond to your request. As you may
know virtually all state nursing
boards essentially align themselves
in regards to sexual impropriety.
The florida state nursing board
has a lot of problems right now with
budget constraints,nurse impostors
and boundary violations. Their site
is certainly not user friendly but
I'd like to refer you to this site.
It is the florida state medical board and will certainly answer most
of your questions.
www.fsmb.org-pdf-GROL-Sexual%20boundaries
Finally,i'd like to mirror what
you said about people in public wearing scrubs. There is a site that
has discussions on this very topic
and due to the graphic nature,hate
and profanity I will not list it.
In short the site mentions nurses
stopping at the grocery store,malls
and so forth in their scrubs "after"
work. The concerns are germs and
other material that their scrubs
carry into various establishments.
In my opinion,its just tacky and
most probably an attempt to say,look
at me. What I think really
disturbing is when they advertise
it on their bumper,"I'm a nurse" or
"have you hugged a nurse today."
When I see that I make a rapid
attempt to pass them as I don't want
to keep reading that and yes i
despise their presence in public too!
PT
PT, I have to include here my opinion about scrubs and white coats and the unnecessary use of these items of clothing which are regularly inappropriately used in the medical profession and may set some wrong understanding in the general public and who knows may contribute to some of the modesty issues discussed here.
I am sick and tired of seeing white clinical coats and scrubs on TV news programs or on programs where professionals are presenting medical information. I also see folks in such attire outside of a medical office or hospital..perhaps in a local diner.
There is no practical need except for some egotism and it is certainly unsanitary. Yes, regular street dress has been found unsanitary during clinical examinations or of course surgery but no putting back on street dress and walking out with scrubs shows something about uncaring and egocentric professionals. ..Maurice.
Read Paul Fussell's "Uniforms: Why we are what we wear" to see how symbolic and evocative dress can be. In medicine, white coats have lost their meaning -- as have scrubs. They used to represent something, that is, they attached some meaning and status to the person wearing them. Today, even housekeeping wears scrubs in some hospitals. You used to be able to tell a nurse by her uniform. No more. I think nurses often get blamed for the behavior of patient techs, cna's, medical assistants, and other medical workers. Most of the time you can't tell the difference, and half the time their name tags are turned around so you can see neither the name nor the title.
Uniforms and dress represent an important part of any profession. The medical profession often complains about losing the public's respect -- but part of the equation is in dress. It's not all about how we dress. But it can't be ignored.
Doug/MER
Warmouth, I can understand how you're feeling as for a long time I felt that way too. Hopefully, you'll get to a point when you can look through them without seeing anything unless you are once again the patient.
Now I look at each one as an individual and talk to them wit probling questions to get an idea of where their "heads are at".
Just an aside...I do not ever wear a hospital gown. No matter what the procedure from colonoscopy, mammograpy or in patient. It was what I was wearig when my incident occurred and is like have crawling worms all over my body to me. Besides, it idenitifies me as "patient" and while that's exactly why I'm there, I refuse to identify the power differential. Actually, there is no more power differential because I take the lead, explain what I have to. I have not yet met a doctor who said anything but, "You're exactly right". None of them want to be put "on the record" with this book that I'm writing.
Let's try to all take care of ourselves. I'm sure is saddens Maurice to hear that many of our avoidance issues have to do with complete violation of our privacy, misconduct causing the "gender problem" that the medical community faces.
I've said it before this....is the Foundation of the Patient Bill or Rights that the medical community is so arrogant to completely ignore when it comes to patient dignity.
It takes time to learn how to take it back but everyone can and should.
belinda
Doug, the posts on uniform struck a different cord in my mind. As I posted above, I truely believe many or perhaps most of the issues we discuss here are from or atleast tied to nurses/support. Whether that be from their unwelcome presence or from their direct actions. Going to the issue of uniforms and not being able to tell who is who, should we as patients not expect to follow the mantra, "to whom much is given, much is expected". If we are to hold Dr's and to a lesser degree nurses at a higher level, give them a greater degree of trust and freedom to make decisions for us on modesty and our health, should they not be expected to assume some level of responsiblity for othe staff. For example who does a CNA answer to. In my business ultimately the buck stops on my desk. I accept responsiblity (and liablity) for anything my employees do. Should we be willing to fully excuse Dr's and nurses for the actions of those under their guidance. In the Dr's office they are absolutely responsible as most of the time they actually actively supervise and are responsible for them being there. What are peoples thoughts on many of the issues coming from supporting staff and what responsiblity would you place on Dr's and or nurses for them and their actions....alan
Just as important is what the hospital gown represents. A vehichle for de-personalisation, creating a subordinate, diminutive role. I just posted something about gowns and why I won't wear them and forgot this most important issue.
Need a CT scan, MRI just make sure no metal. You can even wear a sports bra if you're female in most cases.
Colonoscopy, Iwear my own clothing.
Mammography, I wear my own clothing. It can be done if you know what to wear, when.
belinda
Belinda, what a good explanation of why hospital gowns are so objectionable. I have read that many men [including me]are more comfortable in their shorts than hospital gowns. I now know why.
BJTNT
Sorry to be a frequent poster here but Trisha Torrey does a site on patient empowerment. A year ago she wrote an article that basically told men to suck it up and get over their modesty. It touched off a stream of responses that took her by surprise and she walked it back. She is doing a revisit with fathers day, good read and a place to reply if you get a chance.
The gowns are iconic of the lack of concern for how the patient feels compared to the economics of medical care. It is also an example of how we as patients just ASSUME we have to wear them and follow like sheep adding to the problem. I always thought I had no choice until my father, a frequent flyer in the hospital wore some sweats in, one of the nurses commented "those aren't hospital issue" to which he replied, when the hospital issues something that makes sense I will wear it...she just shrugged, walked off and not another word was said. If there is one thing the 2.5 years on this thread has taught me is not to assume anything, ask for yourself becasue no one else will....alan
To Belinda: How were you able to wear your own clothes for a colonoscopy and what did you wear? My colonoscopy experience was so distressing that it led me to this blog. Any help/suggestions as to what I can do if I ever submit to this procedure again (doubtful!) would be appreciated.
I think, as seems to be the opinion of many on this blog, that we do understand when going to a doctor that some exposure may be necessary to get a diagnosis and we accept that, especially since we have chosen the doctor and are able to pick their gender if that is an issue. The problem is when we are referred to other providers/facilities for procedures, exams, etc. When you are new to the "system" you do not know what questions to ask and do not know what to expect. That is when a lot of us are thrown into a situation that is uncomfortable to us and we may feel like we just have to accept it (at least that one, first time)to get the treatment we need. Only afterwards do we realize how upsetting it was and as a result we either avoid care or, hopefully, go into further encounters more empowered. That's where this blog has helped me. I never thought to make requests or question things. Didn't know I could. So I have this blog to thank for that. But I would imagine that a lot of folks are bothered by this whole issue but just avoid medical care because they haven't researched and found that there are others out there that know better ways to address this problem (like on this blog). I don't think we'll ever know the number of people that fit into this category because of that. It may be a bigger problem than some think, especially those in the medical community. Jean
Jean,
You tell them that you require wearing your own clothing. As long as your pants are off and they can access your body, it won't be a problem. If they refuse, then you refuse and try another doctor. I have had no problem. The main issue is that if you give any incling that you'll give in, you lose. It's as simple as that. Any long shirt or even a long skirt as long as it provides the proper access will work.
belinda
If you google colonoscopy or surgery shorts you will find they actually make disposable shorts for colonoscopies. They have an opening in the back but other than that look like regular shorts. Now, one would think given the inexpensive nature ($5-7) it would be standard practice for furnish these for patients who are paying $1,200-2,000 or more for this procedure providing the patient the option of wearing $7.00 colonoscopy shorts that might make them feel more comfortable. Another example of things that COULD be done that are inexpensive and easy to accomplish but are not and give the patient that feeling that providers just do not care. Is there any valid defense for not offering these?.....alan
We have posted Suzy's (swf) article on gender wars, a highly pertinent subject on this blog.
Take a look and add your comments.
there is an article on allnurse that may give a glimspe into the other side of this. Go to allnurses.com on the side is an article THAT MOMENT, it tells of a nurse who was in training and invited in with several others to watch a wound vac put on the leg of an obese male, she tells of walking in and getting all caught up in the size of the wound and all that was going on. She said suddenly she heard the man cry out in pain and it hit her that the giant wound on the leg she was so thrilled to watch was attached to a person. She tells of how easy it is to get caught up in the mechanics and forget about treating the whole person. I think this is a very common issue on the provider side and one that Dr. Bernstein has alluded to. Its a good read if you have time
There is actually a better article on all nurses under
the male nursing forum "ever have a female patient
refuse you because of your gender".
One poster, male nurse stated that female nurses are
brutal when talking about male patients genitals.
I am not surprised either as on nursesean's site I've
heard this before.
According to state nursing boards it is considered
unprofessional conduct under the guidelines of
sexual impropriety to make sexually demeaning comments
" About or To a patient".
You might think a nurse or anyone might appear
professional in some procedure,however, are they professional when they make derogatory sexually
demeaning comments about you to another nurse or
co-worker.
According to state nursing boards this type of behavior
can result in license revocation. Is this common behavior
among all female nurses regarding their male patients.
If you were a female patient undergoing a sensitive
intimate procedure would you be happy to know if
the male physician made demeaning sexual comments
behind your back to another physician or co-worker.
PT
The last time I went to a male doctor that's exactly what happened to me. I will not go into the crude expression or the way he said it but apparently, shortly after giving birth the hormones had not returned. The commment compared me to an old woman and was extremely humiliating.
This is someone who knew my previous history. This same physician during the early months of the pregnancy ripped the paper gown to do a breast exam (without warning) instead of asking me to turn the gown around while he stepped out for a moment.
According to a health psychologist, ripping a gown off a person's body is a violent act (except in utter emergency). I question the reason or purpose for such action other than abuse of power and arrogance.
Because I was a high risk patient,and didn't get to the obstetrician until my fourth month, the nurse instructed me to put the gown open in the back.
That's the day ingrained in my mind when I said....never again.
I will say, though that once a female surgeon did the same thing and while it was traumatic, it didn't feel as degrading as if the physician was male.
While I do go to male doctors for many things, never when there is the possibility of intimate care.
belinda
I was recently having trouble getting my local (as in 50 miles away) hospital to give me an all male team for a prostate brachytherapy procedure. They eventually relented. I live in the UK and in the meantime, i had approached every other provider within a 300 mile radius (basically every provider in England and Wales) to ask the same question.
I felt that it was at least worth sowing the seeds of the demand for all male teams. In general the more senior person I connected with, the better the response, when I spoke to nurse specialists (mainly female but some males) they were universally hostile to my request, ( I guess they were "protecting" their job).
Out of about 35 centres, I found about 8 who (even if not immediately) agreed to provide an all male team. I made sure every centre were made aware of the demand and I hope other men in the UK will take advantage of this seed sowing should they require brachytherapy.
Appallingly, the High Dose Rate Brachytherapy in the UK is only performed in about 10 specialist centres, almost universally, by virtually all female teams. Those of you who are aware of HDR Prostate Brachytherapy will be aware of just how humiliating a procedure it is, let alone if performed by a group of females! What is it that enters the mind of such females to seek out specialism in such a humiliating male procedure? The demise of males in L&D and Obs is happening at a fast rate, so why are these females thinking it is ok to subject men to their presence in such humiliating procedures?
Political correctness has a lot to answer for.
Colin, you mentioning "political correctness" makes me wonder also whether the form of the healthcare system (for example contrasting between the United States and UK) might make a difference in how the healthcare gender selection issue describe on our thread might be mitigated. That is, whether it might be easier in one system compared with the other, if those in charge would actually try to mitigate. ..Maurice.
surprisingly, the group that most readily agreed to accommodate me were private health care providers (as in pay rather than our NHS).
Significantly, our NHS has all manner of rules and guidelines regarding patient modesty and dignity which can be used to pressure them.
The provider who eventually agreed provide an all male team, did so because I complained on the grounds of sexual discrimination.
My main point of my recent posting was to encourage people who feel that things need to change, to actively put the idea in the minds of as many providers as possible.
I really wish that I did not have prostate cancer. I really wish I did not have to do all this. The reality is that I do and as a consequence, I intend 2 make myself a total pain in the Butt of as many providers as possible.
The issue of staff wanting to control the situation and make me take what they want to offer is "history" as far as I am concerned.
Proactive, belligerent action is the way forward, swallow your pride, be up front and DEMAND what you want. I have done so and feel so much happier as a result.
Colin, thanks for describing your experience. And thanks for supporting what I have written about repeatedly on this thread: "Don't just moan and groan within a Volume of Patient Modesty but become an activist for your concerns and SPEAK UP!" That necessity will be with us until sometime in the future when the system is changed and a patient can have gender selection easily and as routine as scheduling the visit in the first place. Again, thanks. ..Maurice.
Thankyou Colin for moving modesty awareness up a notch.Here's a man who has a future of prostate cancer treatments,yet you took the time to call 35 centers to ask the question.After making the first few calls and getting hostile responses,alot of people would have just given up.NOT COLIN.It's refreshing to see the trouble you went thru to help your brothers and sisters.Again,THANKS COLIN.And I agree,proactive,belligerent action is the way to go if necessary to get results.I quess money talks on both sides of the pond. Best of luck. AL
I noticed that Trish Torrey has posted a revisit to the male modesty issue on her patient empowerment blog in honor of Father's Day. It basically says the same thing about "sucking it up" and being responsible with a few caveats thrown in about advocating for yourself to get the care you want. Some of you may want to visit and add a comment. You ladies may also want to note the comment the nurse made about the general acceptance of male nurses in L&D. Jean
Colin,
A hearty congratulations. You're in the right framework now and will be helping others.
I mentioned on a previous post that when can't get what I want, I file a complaint stating I've taken my business elsewhere and so far they've lost XXX amount of revenue.
If enough people did that, things would change.
Also, you mentioned "swallowing your pride". I'd like to think of it this way. It is because you have pride and feel worthy of important accommodation that meets your needs, and...that you've had the courage to speak up, that you should feel very proud. I'm proud that you've taken this stance. Welcome to my world!
belinda
I'm new to your blog and first want to say your longstanding efforts towards establishing dignity and rights to all patients, and particularly male patients is admirable and amazing. I'm a longstanding compliance officer at a large medical center and hopefully I can contribute a different perspective to the general issue of providing same gender care for patients that request it. (I realize this post is a bit off the current topic.) I'll elaborate later on some of my statements but from my experience attempting to change the culture, actions and female/male mix of floor nurses by individual patients complaining to the hospital is a long slow battle. Not that it isn't valuable, but there are many additional and effective avenues to accomplish change which I'll discuss. Money talks. Hospital Administration is focused on daily patient census, not the patient. The Chief Nurse Executive is focused on patient throughput. Productivity is king. She pushes this pressure to her female nurse managers. They push this on the nurses. Complaints about nursing issues in most cases would simply be given to nursing Management to handle and can disappear quietly there (with no resolution). What gets a hospital's attention (because it can almost immediately impact the bottom line) is when the regulatory agencies come calling. That means the CMS (Center for Medicare and Medicaid Services), your State licensing agency, and the accrediting entity the hospital most likely uses (e.g. The Joint Commission). All of these agencies have patient rights standards that support privacy, dignity and respect for all patients. Many of the experiences I've just read about (reading the previous discussions here and on related blogs) clearly violate many regulations and would be subject to scrutiny if complaints REACHED THESE regulatory bodies. If the complaint reports particularly egregious acts by the nurses (e.g., the humiliation, badgering, total disregard for a patient's rights, unnecessary exposures and other unconsented actions that could be sexual abuse as defined by state laws ) this could immediately place a hospital on track for termination from participation in Medicare. This gets the attention of the Board, the CEO and everyone on down. Suddenly the culture will change. I'll continue this discussion on the next post as I'm worried about running out of space. - Compliance PhD
It good to hear the other side [see June 20, 2011, 6:56 PM]. How do I say my response without being too critical? We don't want to discourage posters with different positions.
The justification is what I expected and is self-serving and condescending. In other words, dream on patients/posters, but don't expect any changes.
BJTNT
Compliance PhD, thank you so much for not only simply visiting here but starting your contribution by writing your understanding of the systemic problems involved. You may not realize how I have tried over the years to get some representative of a medical institution to provide this thread with a view from their side of the patient-institution relationship. But to no avail..until you have spontaneously arrived.
I must say, and perhaps others will correct me if this is a misinterpretation, that many who write on this thread regarding patient modesty are concerned that medical regulatory agencies are not fully assuming the patient advocacy that my visitors expect. My visitors are concerned that there may be a lack of interest or a lack of intent by regulatory agencies to act on patient complaints and to go to these agencies and complain will be a fruitless exercise. (Again, correct me if this is a misinterpretation of what some of you folks have written.)
Compliance PhD, as I hope you have noticed reading this thread, I am taking the position of fully accepting the concerns on patient modesty expressed here but I really don't know the magnitude of the problem in terms of the number of patients where modesty is so intense that critical diagnosis and treatment opportunities will be rejected without attention to the modesty requests. Nevertheless, I think this is an issue in the medical system that should be investigated and attended to. Again, thanks. ..Maurice.
To BJTNT -- To which post are you referring? Not to Compliance PhD I hope. Compliance PhD is very clear about how to change the culture, i.e. complain to the RIGHT places. That's the key. That's a principle for all kinds of complaints. Too many people complain to the wrong people and then wonder why nothing happens. Granted, another principle is to begin your complaints with those involved with the problem. But Compliance PhD is making it clear that, in most cases, this may cause some surface changes -- but if you really want to begin to change the whole culture, you need to complain to the people and agencies that have power over the institutions, power to shut them down. I see this as not only confirming information, but very useful.
Doug/MER
In regard to regulatory agencies: several years ago when I was stripped from the waist up by a respiratory therapist in ICU with the curtains open, etc...I did complain to the agency that licenses these people. It was his word against mine and I could not prove anything so nothing was done to reprimand this man. I also complained to the state agency that licensed hospitals about some other matters and they sent out an investigator one time. They could find no "proof" to validate my claims so that was it. Maybe things have changed since then, but I have no faith in these agencies. Lor
CompliancePHD
You are correct on all comments and a complaint
to the joint commission can be initiated quickly online,
however,the complaint is only brought to the attention
of the facility once a year. On the calendar date that
the joint commission is scheduled to visit. Thus your
complaint can sit for a year.
I never suggest sending a complaint to the director
of the unit where the complaint occurred and as you
mentioned it can disappear. Rather,send the complaint
to the CEO of the hospital. The complaint will then be
read and forwarded to the director,manager.
I do have one question for you compliancePHD. As
you may know Medicare and Medicaid have many rules
and regulations regarding patients that are retired, on
limited income and receive medical aid.
How would that agency benefit me should I have a
complaint against a hospital that involves a privacy
Issue considering that I have medical insurance,insurance
That is provided to me through my employer.
PT
Doug, you have been "right on" in the past, so I probably misread the Compliance PhD's comments. Medical facilities are run like bureaucracies which are poor business models for the benefit of customers/patients. Bureaucracies have many employees with titles and their own fiefdoms. Where is the management to ensure cooperation among the fiefdoms with the goal of satisfing the customer/patient? Too often, compliance officers, ombudsmen, quality assurance, etc. are window dressing.
BJTNT
PS - I just don't see much beyond lip service to the customer/patient in medical operations. Someday I hope to write about attending CA medical board meetings - what a facade.
CompliancePHD, welcome it is great to have somone from the other side. First let me say, this is an emotional and painful issue for many posters, some more than others. As such some of the responses may be a little rough, I hope you will understand that and not be so offended to stop posting. We need your insight. I have contended that some if not much of the problem we face is the result of the business side of medicine driving the practice side of medicine. I in no way fully excuse providers for not doing more and choosing to take the don't ask don't tell, however...many want to fit in and take the company line. That is another issued. A couple questions, do you feel that the medical community business and or providers actully know more about the issue of patient and modesty issues paticular gender but act like they are not aware to achieve the goals you set out above? Two, what would you suggest we do to be proactive going into the hospital to increase the odds of a positive experience if we say prefer same gender. Once again, welcome and thanks for joining....alan
I apologize for not responding sooner - I seem to be inept at mastering the word verification and another post last night was lost.
Alan - from my experience at a large medical center I don't think the medical community is very aware of the patient modesty issue at all. I'm embarrassed to say that even though I've been in the business a long time it took an experience at another healthcare provider earlier this year for the patient modesty issue to strike home in my head. Since then I've begun dialog with many at our medical center and I've found many key people are rather clueless, and a few note we've gotten more requests for same gender care lately (so they have some idea). So I have much work to do on this issue at my institution.
PT - no the Joint doesn't batch complaints. The current practice, in place for several years, is to forward complaints to the institution for response almost real time (everything is via the internet now). Regarding privacy issues. The Office for Civil Rights is the lead agency for investigating HIPAA like privacy issues. I'm assuming you are referring to bodily privacy issues however. Hospitals that participate in Medicare must follow the hospital Conditions of Participation (I can give you a reference in a later post). There is a large section on patient rights, including privacy. This in fact is what drives the Joint Commission and state agencies to have similar standards. These patient rights including privacy standards are applicable to ALL patients in the Medicare participating hospitals. If you are patient in such a hospital you have these patient rights regardless of insurance.
Lor - I am sorry for your mistreatment. Yes sometimes individual complaints cannot be substantiated. I hope you don't have need of this again, but in the future it is critical to include as many facts as you can remember (was a nurse watching, or was a student present, what did the nurse say when you told her/him, etc.). Also complaining to others immediately such as a Social Worker (who are trained to report abuse) or a patient advocate (who document conversations) can get something recorded that the surveyor can review when they present. That often can help tease out what really happened. (I realize in an ICU your recollection and options may have been limited). And although you did not get adequate resolution should a second complaint of a similar nature about the RT be received it could be problematic for the hospital. I sympathize with your frustration, but I still would recommend a patient report inappropriate care to regulatory agencies. - Compliance PhD
Dr. Bernstein – sorry for the delay – I lost a few posts yesterday and today owing to ineptitude. Yes - Regulatory agencies will take the reports seriously. Generally if the complaint falls under one or more of their standards/regs it MUST be investigated. BTW - there doesn't seem to be much of a statue of limitation on quality of care complaints - I've handled complaint investigations by gov't agencies for events as far back as three years. So I would encourage any readers that have suffered injustices in hospitals where their rights were ignored and they suffered mental, physical, and/or sexual abuse within the past year or two to complain in detail to agencies. “In detail” means facts to the best of your recollection about inappropriate activities, actions, procedures, names of bad "actors" if known, dates, times, the locations within the hospital, quotes of belittling statements as appropriate, denied requests, denied modifications in care, inappropriate viewing by members not involved in the care, etc. Government agencies will present unannounced to the hospital and review the complainant's medical record and hospital policies and documents, staffing records, along with other similar hospital patient's medical records to see if they can substantiate the complainants allegations of denied rights and abuse.
Joint Commission surveyors consist of a team of experienced nurses and physicians for the most part - that is - a team of individuals that practiced during the past couple decades when little thought, let alone consideration, was given to male modesty and privacy rights in hospitals. So I believe the Joint Commission teams I've encountered were unwittingly blinded to this male modesty and discrimination issue. However, the Joint Commission has been good to respond to new issues that affect patient care. I think if male patients who have been mistreated/discriminated against in hospitals would begin writing complaints to the Joint Commission and detailing their experience, coupled with noting they have the same right to their intimate care choices as women do in that same hospital, and describing how they were humiliated, abused, etc. the Joint Commission would begin to take note. (So would CMS and the State licensing board.)
Each complaint that has merit under Joint Commission standards is forwarded promptly via an online web page to the hospital in question for response and submission of corrective action plans as necessary. Complaints against a hospital can cause further specific investigations at the next triennial survey. Multiple complaints on the same issue for the same hospital or a complaint of an egregious violation (like some I've read on various posts) would lead to a prompt unannounced survey. From personal experience I can tell you this puts stress on a hospital and change can occur.
I also will note that in my experience women file complaints much more frequently than men! It is important for us men to recognize when something happened that is inappropriate and violates rights we are entitled too it MUST be reported to those agencies that oversee hospitals or else the hospital will have little to no incentive to evolve.
Also realize complaints to the Joint Commission or CMS or the State licensing agency bring into play more than just nursing personnel of the hospital to investigate the circumstances of what happened. Quality personnel, Compliance personnel, Risk personnel, the CEO, some members of the medical staff leadership, HR, and sometimes the Board can learn of the complaints and the issues at hand. Some of these people will appreciate the problem and help drive responsible corrections, especially if they see the same complaints repeatedly. It is not a futile effort. - Compliance PhD
Compliance PhD, thanks for your perspective on the problem. We need more input from institutions. I have written on this subject, and the article has been reprinted elsewhere. I'd appreciate your reviewing it and commenting on whether you agree with the approach I outline.
First I'd like to thank Compliance Phd for your input.We need all the help we can get on this issue.I do have a question for you.I have posted several experience's with my wife's 1 year struggle with Lymphoma.It started with a visit to the nearest ER.(about 25 miles away)Every time she asked for a female she was told they were either unavailable or they didn't have any.Luckily,there was no exposure at the ER.After 2 days she was told she had Lymphoma and needed a Oncologist.Once again,she asked for a female.Their response was there are none.She asked about the 10 females that are in the phone book and on the internet.Their response.Their not in our health care group.Thats when we left.The other group gave her all female physicians.We didn't know it at the time,but my quess is in the next year her health care bills came to about $750,000.Now the question.What would the management of your hospital think if they knew 3/4 of a million just walked out the door because you wouldn't give her female care.Do you think telling the upper management would have done any good or that they would even care.Because of our experience there,I tell everyone I know to go someplace else.Also,I just read because of a patient shortage, they had a personal reduction.Do you think the two might have a connection? Thanks AL
Al - your question is a good one. Having worked with (and survived) many medical center CFOs and COOs I can tell you they are most focused on their current business plan for growth. If they haven't identified Onc as an area to target they could easily dismiss your letter with "nothing we could do, we don't have female oncologists on staff and its not a focus area anyway". If Onc was an area they wished to target for growth than they might factor this into a future business plan (maybe recruit a female oncologist for the next fiscal year if there seemed to be demand for one.) But it wouldn't prompt fast action either way. For better or worse that is just how this business runs. That is why I advocate, when applicable, utilizing regulatory agencies to help prompt recognition of deficiencies in the current hospital operation. Sounds like you were able to find a tolerable treatment solution for you and your wife. Regardless, I wish your wife good health. -Compliance PhD
Dr. Sherman - that is a great article you wrote. Let me add a few things regarding a hospital visit (as you covered a physician office visit well.) I would most definitely say complaints at the time of incident are very valuable. Unfortunately often patients are intimidated, fearful, confused and/or don't feel empowered to complain. But if they can - it can make a difference for the rest of the stay. All patients are given some type of Patient Rights document at registration or early in their inpatient stay (but not necessarily in an ED visit though). That Patient Rights document should list (in addition to all their rights) multiple phone numbers including one for the State licensing agency, the Joint Commission, a grievance line, and possibly a patient safety line. It may also list a Compliance Hot Line. All of these can be used immediately as needed. Also, many hospitals have House Managers. They manage real time the nurse staffing and patient flow. They are there 24x7 and would be a good person to demand to talk too about gender specific care. If they aren't sure of the patient's rights they usually check with someone who is. Many patients call down to Administration and leave a complaint. Many patients call the operator and ask for the Risk Manager (this is a good strategy). Some even ask for the Compliance Officer (also a good strategy). As for calling the Patient Advocates - they generally call and work with the unit Nurse Manager. If the Nurse Manager doesn't appreciate your issue or doesn't feel it has merit you may have to try the others I listed. Lastly if you do not get prompt resolution you should indicate "I want to file a grievance". The Patient Rights will tell you who to call to file a grievance. And even if you do this and do not get reasonable resolution you will have increased chances that gov't surveyors will find deficiencies when they investigate your complaints.
For those who are interested here is a link to the hospital Conditions of Participation with the interpretive guidelines (for a general acute care hospital): http://www.cms.gov/downloads/som107ap_a_hospitals.pdf
The text below each standard indicates the meaning and the interpretation of this Federal regulation. Look at all the Patient Rights starting at (42CFR) 482.13. It is easy for a hospital to get tripped up on these, especially if a patient is demanding a seemingly new paradigm for care and front line staff dismiss it and/or belittle the requests. - Compliance PhD
Compliance PHD,
I want to join the others in welcoming you to this discussion and thank you for the valuable insights and information you have already provided.
The CMS document reference you provided is quite interesting - particularly the references to 42CFR482.13.
While 42CFR482.13(c)(1) outlines the basic concepts of patients' rights, I find 42CFR482.13(c)(2) particularly interesting and applicable to the discussion here. I believe the statement "Additionally, this standard is intended to provide protection for the patient’s emotional health and safety as well as his/her physical safety. Respect, dignity and comfort would be components of an emotionally safe environment." of particular relevance. Potentially 482.13 (c)(3) could also come into play if they try to intimidate a patient into going along with them, as intimidation that results in mental anguish is specifically defined as abuse.
Thank you again for a very useful resource that anyone concerned with these issues should familiarize themselves with. I'd recommend everyone that participates here read this document. If cutting & pasting the link given doesn't work directly, go to the CMS home page and enter the document name "som107ap_a_hospitals.pdf" in the search box and that will take you to it.
I can just see the look on their face when a patient informs them they want to file a grievance for violation of their rights under 42CFR482.13! Priceless!
Hex
Good point, Hex. Again, I want to thank Compliance PhD for providing us with this essential information. So -- this is it, folks. If you don't want to be proactive or confrontational, you'll have to put up with the status quo. But, if, as Hex suggests, you carry a copy of this section of the provided document with you to any hospital that accepts Medicare or Medicaid money (which is just about everyone) -- you have the ammunition to get accommodated.
There is another issue I see: I'm not sure how post patients would feel about a hospital if they had to really fight them to get accommodated. How would you feel if you perceived that they were treating you reluctantly because they had to, just because you complained? How would you feel if you perceived that they really resented you because you forced them to comply? I think a significant number of patients would then prefer to find another hospital. On the other hand, if that's all you can get, reluctant treatment with accommodation, that I'd go with it. But I might also then send them a letter expressing that's how you felt.
Doug/MER
Speaking of being proactive every potential hospital patient needs to know about the forms they will sign at the time of a non-emergent admission. The patient or their personal representative will sign a financial responsibility form (and other forms at the patient registration/admitting department or at the bed side sometimes). But that financial responsibility form is actually much more than that. Usually it is a couple pages long with several other important items that you actually CONSENT for when signing the form. This form is known as the Conditions of Admission (CoA). One of the first paragraphs of that CoA says the hospital will provide general duty nursing care. Of course this is a natural thing for a hospital to have to do - but you consent to this general nursing care. There is no mention of gender preference of the staff providing the general nursing care. This is a good time to indicate you wish a specific gender for intimate nursing care if you have that preference. If possible you should note this on the form. This may surprise the admitting clerk, but at least you will have DOCUMENTED, on a survivable form, your request for this type of privacy. If you are being admitted to a teaching hospital there will be another paragraph in the CoA that indicates what type of "students" may be participating in your care. It may note that the hospital has doctors in training (residents), medical students, nursing students, etc. You acknowledge the participation of these students by signing. Of course you can later refuse the medical students, nursing students, the therapy students, etc. as they really are not part of the care team but the doctor in training may be your only doctor on some shifts (unless you have a private physician from the community that is taking full responsibility for your inpatient care). Of course, doctors don't provide the intimate care as often as the nurses, technicians, etc. so if the participation of particular gender residents is a concern you might address your modesty issues with the resident when you actually see him/her (he or she could swap with a colleague if necessary) or you may find they will only be rounding and not providing intimate care. Unfortunately the check-in at a hospital is a very stressful time and so it is understandable that patients really aren't aware of all "the fine print". Something to know the next time you end up in a hospital. - Compliance PhD
Someone mentioned the house supervisor,yes it is true that
they are there 24/7. Risk management,
patient advocate and most all of
administration go home at 3:30.
CompliancePHD, again thanks for your
valuable input. There are a few
hospitals in this country that do
"NOT" accept medicare and medicaid,
and therefore don't have to play by
their rules. But,they are very very
few in number.
Previously,you mentioned that the
"joint commission,(jcaho) gives real
time feedback on patient complaints".
Hospital participation with the
joint commission is voluntary and
as such they only use the joint
commission as a feedback tool.
Here are the (5) things that might
occur should you file a complaint
with the joint commission.
1) Asking the organization for a
written response.
2)Conducting an immediate for-cause
survey at the organization to eval
the issue.
3)Including your info in a database
for future consideration.
4)Determining that the issues are
not related to the concerns of
the joint commission.
5) promptly throw your complaint in
the trash.
Of course the last one I made up,but
most likely true cause those people
who work at the joint commission really couldn't care less about
"YOU" the patient.
They show up at the facilty(hopital)
once a year to get donuts and their
butts kissed. They look at each individual pixis unit,check the code
carts in the intensive care units.
Then coffee and more donuts offered by administration,more butt kissing.I've watched these people for over 30 years in this horse and pony show.
What a tough job.In the final analysis all the hospital cares about
is the accreditation. Yet, 90% of all
patients really don't know if their
hospital is accredited or not. If
they are it really means nothing.
Yes,i have complained to the joint
commission and when you do all you get
is computer generated e-mail and a
reference number. They don't contact
you on the result,nothing. Neither
will they discuss anything with you.
The only thing a hospital cares about is George Washington and his pic on that dollar bill.
PT
Question for you Compliance PhD -- You write: "This form is known as the Conditions of Admission (CoA)."
It seems to me that, quite often, the reception at the front desk who asks you to sign this form says something like "This form just says you'll allow us to communicate with your insurance company," or something like that. The implication it's all about financial responsibility.
So, would it be wise to ask the receptionist something like this: "Is there anything on this form that isn't about insurance or money. Is there anything about medical care or who is allowed to care for me?"
Would they be obliged to explain the form in more detail to you? And if they left out this important information after you asked, would that make the informed consent questionable?
Doug/MER
Compliance PhD Several things you wrote caught my attention.Please don't take offense to my post.That is not my intent.I believe you are truly on our side.You stated you are a longstanding compliance officer at a large medical center.You also said,it took an experience at another healthcare provider earlier this year for the patient modesty issue to strike home in my head.Why didn't you use your medical center? We hear alot about medical professionals getting their care at a different facility than where they work.Was the issue a modesty violation?You also said most management is clueless to patient modesty.It almost sounds like the clinical side is the doctors and nurses playground.They do whatever they want unless they are challenged.Then you get the attitude that you would dare challenge them.At that point your trust is quickly eroding.I think complaining after the fact falls on deaf ears.Thats why if they won't listen and agree to your requests,walk out and file the proper complaints with the proper organizations.Health permitting.Thanks Compliance PhD for all your helpful infomation.I hope with a combined effort , we CAN make the system change. Thanks AL
And AL, I too have a question for Compliance PhD:
You seem to stress the approach of individual patient's contacting institutional authorities or regulatory bodies with their experience and concerns as an attempt to mitigate their own personal concerns and hopefully change systems. What you didn't mention is your opinion of any role of creating a patient modesty advocacy group or groups as a means to spread the word but also develop more clout than single individuals with the individual attempts.
For some time now, as I consider the modesty issues described on these many Volumes important to my visitors but also that the issues may represent an ignorance or defect in the healthcare system. I have suggested the development of advocacy group or groups. In your opinion, is this a realistic approach and one that will facilitate my visitors attempts for change? Thanks for any response on this matter. ..Maurice.
Dr. Bernstein. Could you please clarify something for me.You stated,I have suggested the development of advocacy group or groups.Does group mean one nation wide group,and does groups imply numerous groups in numerous cities?Who would be in control of these groups?Please don't say people in the medical field.I think if this was handled right,it is a excellent idea.I think this blog is full of willing volunteers. Thankyou for all you do. AL
AL, sorry for the confusion. I named you since you had asked Compliance PhD a question and I indicated that I also had a question for our new visitor.
As those who have been reading this thread for a while may recollect I have been suggesting repeatedly against simply "moaning and groaning" on this blog but being activistic in the sense of forming a advocacy group. I recall that a blog was started by others to attempt such a group but I didn't get any information that anything came out of that new blog. Perhaps others can inform us about that.
No, I wasn't implying that you had written about such a venture. ..Maurice.
Dr Bernstein, I could not agree more that it is time to start some sort of advocacy group. The personal modesty/dignity/sensitivity violations that I experienced have made me think frequently, sometimes almost daily about writing to various boards and organizations such as the American College of Obstetricians and Gynecologists, the Society of Gynecologic Oncologists and the American Society of Radiation Oncologists just for starters (I am sure other folks would have organizations to add to this short list.) I think that an advocacy group with a well-thought out statement pertaining to the issues that are discussed on this blog would at least be a start. Such an advocacy group could make various professional organizations, hospitals and health care professionals aware that there are patient groups that do indeed care about how they are treated regarding the areas of modesty, same-gender care and human dignity.
~Gail
Here's one way to handle a modesty/privacy violation. It's worth reading. Of course, this is a woman patient talking to a male doctor. I wonder how the same strategy would be taken if a male patient said as much to a female doctor or nurse. Gender communication certainly is complicated, isn't it? Anyway, sometimes we need a good laugh.
http://katesaid.wordpress.com/2010/04/16/take-off-your-pants/
Doug/MER
Doug/MER - Too often the registration receptionist either has been coached on what to say or only has canned phrases to explain the CoA and other paperwork. From my experience they don't have any deep understanding of the content or meaning. But for sure one of those forms the patient signs has consent for general nursing care and an explanation that students may be involved. Patients need to be aware and not rely on the explanation of a clerk.
This brings up another point and that is front line healthcare workers get little to no training in regulations, standards, and patient rights. Dr. Bernstein and others can speak to what they teach at medical school but you can bet in nursing school, tech schools, community colleges, etc. they aren't attempting to teach patient rights to their students (they don't have such an instructor or knowledge themselves). Hospitals never wish to commit to the cost of whole scale training of these people on isses that are not on their radar. And with the front line staff being so busy, taking care of so many patients, with never being adequately trained/coach on patient rights, and in fact perhaps being taught outright or by example that males don't have modesty issues or care about privacy it is certainly easy to understand why problems arise. So as a patient you need to know your rights and assert your rights at all steps of the care process (before, during, and after if necessary). - Compliance PhD
Al - I needed an outpatient intimate procedure that my hospital and medical center has moved away from providing (I guess they currently don't value male outpatient services as much a female services!) Personally I wouldn't have issues receiving care at my own hospital and medical center as I could assert my rights rather easily and I know so many of the nurses, physicians, etc. that I know it would be professional and dignified care, at the very least.
On your other point about the clinical side you can see my comment to Doug/MER. From my experience the front line staff that a patient interacts with get inadequate training on patient rights, dignity, modesty, etc. They end up being pushed for productivity and having to do so much to protect their license without a decent understanding of regs, laws, rights, etc. I know this because I'm always defusing what I call "urban myths" that get asked to me by nurses. There is a whole culture and training of nursing that has existed for a long time and is not decaying away very quickly...
As for when a patient should assert their rights - at all steps of the healthcare experience (before, during and after if necessary). - Compliance PhD
Dr. Bernstein - an advocacy group would be an excellent approach. I have personally dealt with many advocacy groups asserting rights for patients at our hospital and medical center. Person with disabilities often have advocacy groups assisting them. This can grease the wheels for an individual's visit through the hospital (although having done this for so long we pretty much know how to provide equal access to persons with disabilities). And after time with enough such patients the institution may start to address the root causes to achieving compliance all the time.
I think where it would be even more valuable long term is to have the advocacy groups writing open letters to CMS, The Joint Commission, State licensing agencies, nursing schools, medical schools, etc. to get the right to bodily privacy issue into their consciousness and ultimately into their survey process and/or training/education. Once the issues become appreciated above the hospitals, it will be "enforced" in the hospitals and they in turn will have to operationalize it to the benefit of all patients.
And one last comment. It really isn't hard to address the equal access to same gender care for modesty issues in moderate to large hospital/medical centers. The number of nurses, aides, etc. hired each month and each year is significant and if an institution made a commitment to diversifying the gender of their intimate care givers they could do that rather quickly with no increased costs (because of natural turnover). If they didn't want to hire huge numbers of male intimate care givers than they could create "swat" teams of a few males on duty each shift to assist with caths, preps, bathing, showers, etc. Not hard to address these issues if they get the motivation to do it! (Smaller rural hospital might be challenged to pull this off however) -Compliance PhD
Shame, embarrassement, humility, modesty, trust, power, vulnerability, humiliation... I have been away from this forum for awhile and am catching up, but the themes are familiar and I still don't grasp what any of this has substantively to do with the gender of patients or health care providers. If a person (ie. patient) has had a really bad experience with a certain gender person in their life that should of course be considered as a significant psycho-medical consideration for structuring treatment. If a person (eg. doctor or nurse) treats another person (ie. patient) with anything less than impeccable respect, then that is a significant lasp of professional ethics and an efficient grievance process should be in place. But otherwise if a person (eg. patient) just dislikes or distrusts a person (eg. the health care provider) a priori on the basis of their gender, it is still prejudice, not just preference.
Am joining in here as a naturist so apologies for responding to older posts like: "Seems a bit odd doesn't it, you can force someone to accept being exposed but you arrest someone who is willingfully [sic] nude." These are two facets of "consent". The latter is based on lack of consent by others to see someone nude -- which we naturists do indeed find at best "odd" and at worst a violation of the right of every citizen to sovereignty over their own body. The former is also a question of sovereignty over one's own body and to whom it is exposed, but it is based on lack of consent by the owner of the body. Perhaps if we agreed on the sovereign body principle, we could both be happier with the consolidated logic.
On "Under what circumstances could a naturalist [sic] feel embarrassed at being nude?...I wonder how nudists would feel if their colonies were just open to the public, the public being people who refused to get nude also..." a couple of points. It's clear from the examples that it's the ridicule or hounding that is the worry, not nudity per se. Naturists just add clothing according to the activity, and don't when unnecessary. Would we feel odd in a bikini at the office? Sure. Embarrassed being seen nude by co-workers after work at the company swimming pool. Not at all. Nude when taking care of my body at the doctor's office? Makes sense to me. Meantime, I'm more than happy to share any space with people who "refuse to get nude" -- your choice, my choice, personal sovereignty, everybody happy! Ridicule the quality of my work or my less than Adonis body, then I'll get upset! :)
(Quick aside: Kids are fully part of naturist activities. Teens often get self-conscious due to hormonal turbulence, but recover. Adults rediscover their inner kid.)
So the "modesty" discussion actually comes back to respect, power relationships, and personal sovereignty. But after reading to the bottom of this volume, including good points on adjusting for cultural diversity, protecting private medical information, dysfunctional gowns, complex hospital admin and regulation, etc, I still don't see what gender really has to do with anything.
CSM/Agde
CSM I think the biggest issue I have with many naturalist I have read is they choose to place their view of normal on others but resent being judged themselves for their beliefs. Of course with your beliefs about nudity it would not be unexpected that you have a different view from those with modesty concerns. Gender plays a part in it becasue to the vast majority of society gender and nudity are a consideration. We spend the majority of our lives under the belief that being nude with same gender is normal (locker rooms, rest rooms,etc) and being nude infront of the opposite gender is embarassing other than a few situations (spouse, girlfriend, sex etc). While I appreciate hearing your thoughts and experiences as a naturalist, I don't really think you are in the position to judge what role opposite gender nudity plays for many of the posters here. I do not mean that as disrespectful, but I don't think as a 55 year old male I have a grasp of what a 13 year old girl feels either....alan
there is an interesting article that relates on MSN about a Muslim female who is fighting the Internationa Wieghtlifting Federation. The rules call for a partcipants ares amd legs to be bare so the judge can verify they are locked to complete a lift. She has chosen to be disqualified from partcipating rather than bare her arms and legs while waiting for appeal. Several organizations including the US Olympic Comm. are involved. Now to most of us showing one's arms is no big deal. We do however have more consideration for her argument as it is on religous grounds. Is this reasonable, does it make sense, some say yes some say no, is it really that different than what we are arguing here. Does it have to make senses to everyone to be a valid concern, one that deserves consideration and perhpas accomodation? She is asking to wear leggings and a tighter fitting sleeve to accomodate. While I understand the argument that it is a religous issue, is religous belief's more valid than deep seated feelings of a person. I am a Christian, I have belief's and interpetations of what I have been taught. Should I be able to say the Muslim woman should not be accomodated becasue her beliefs do not align with mine, her concerns are silly and I don't see the need for it? Yet, we will allow the medical community to define what they see as reasonable for our modesty and allow others to make us feel like we are the odd ones for expressing our concerns, even though I would argue we are more to one degree or another the silent majority than the minority. CSM, out of curiosity, do naturalist share bathrooms and showers or are they segregated by gender? I have never seen that addressed. alan
alan - The term for what you are referring to is naturist. Naturalists study flora and fauna. And yes, naturists may frequently share showers and bathrooms. If everyone is naked anyway there is not a lot to hide. mlx
mix, I am surprised when you wrote " And yes, naturists may frequently share showers and bathrooms. If everyone is naked anyway there is not a lot to hide." I thought that sharing toilet activities was not so much a matter of gender or physical modesty as much as it was a matter of "toilet privacy" or, indeed, "toilet secrecy". What is privacy and secrecy and doesn't it differ from modesty? Anyone see any merit in my concern about the proper description term? ..Maurice.
Mix
hypothetical scenario
Among your medications are insulin and metformin,you are a severe diabetic. You don't take your medications regularly and you don't
follow a diet. Your neighbors found
you unconscious in your driveway.
You wake up in the icu at the
local hospital on a ventilator and
four point restraints. You tried to
extubate yourself,but theres just
one catch. You are fully clothed
and everyone else is nude. The
physicians,nurss,respiratory techs,
all nude but you.
You already have on your clothes
and 2 blankets,yet you notice the
curtains are open and people are
walking by staring at you. In comes
a 20 something year old nude female
nurse with a blanket to cover you.
Thats three blankets now plus
your clothing,its just not right.How
dare they treat me like this you
think to yourself. The poor treatment,
the indignity wrong all wrong.But then
its a hospital,an institution and its
their game not yours. Too bad,too bad.
Tell us mix,how does that make you
feel.
PT
Dr. Bernstein:
If I read your comment correctly:
"I am surprised when you wrote " And yes, naturists may frequently share showers and bathrooms. If everyone is naked anyway there is not a lot to hide." I thought that sharing toilet activities was not so much a matter of gender or physical modesty as much as it was a matter of "toilet privacy" or, indeed, "toilet secrecy".
then would that mean that you are not surprised when someone is willing to publicly expose bodily nudity, but surprised that they are willing to publicly expose bodily functions?
And keeping in mind that people are often asked to do both in a medical setting, do you have more empathy for someone in one situation over another? Or, does 'medical context' apply to no modesty or privacy in both situations?
What I was trying to express is that I thought that the exposing of ones body and the exposing on ones "bodily functions" were independent of each other. What mix wrote seems to tie the two types of exposure together rather than consider them independent conditions. ..Maurice.
Dr. Bernstein:
I see your point. My point was the surprise you find in one and perhaps not the other. But as you said, you consider one issue separate from the other, whereas others would rank them in the same catagory.
Modesty, as I see it, is the moral compass each person holds to determine what is appropriate in a private vs public stituation. That can be further honed to same vs mixed gender situations publicly and privately..
Secrecy has its own motives and agendas, not always attached to a modesty issue but usually attatched to a protective or truthful issue.
In short....I see both as modesty/privacy issues. I can not really attatch 'secrecy' to either.
swf
Maurice
It was not my intention to suggest that naturist venues have toilets lined up in open rows, Ancient Roman-style. Naturists can value their privacy for certain things as much as anyone. But in an environment where nudity is accepted and normal there is little reason to segregate showers and wash basins by gender. Male urinals might be separate or behind a screen.
You should remember that naturism tends to be practised in warm climates and that in many cases, in Europe at least, facilities may be fairly rustic. Showers might sometimes be in the open air for example. But it all depends on where you may be. In spa facilities which are not strictly naturist but where nudity is the norm, you would expect to find gender-separated changing rooms but showers beside the sauna and steam room for use by both sexes.
PT: I am not sure of the purpose behind the scenario you present. Were I in that situation I imagine that I would wish a) I felt better and b) that someone would de-restrain me.
mlx
I seems to me that a common thread among most of these posts is what is and isn't embarassing including modesty is defined by the individual and often judged differently by others who apply their definition to them. The medical profession uses context to apply that to patients, naturist assume others are wrong for applying their version of normal to others who have modesty concerns. The odd thing is often it is the majority that is judged odd by the minority vs the other way around. I have no issue with someon who enjoyse the alternative style, I don't think they are wrong just different, yet often it seems they judge those whith modesty concerns. I would bet the vast majority of patients who enter the medical environment have modesty concerns at some level, yet those who express it seem to be considered outliers.
The issue as I see it is not to deny that virtually everyone entering the medical system as a patient has physical modesty to some degree and that physicians should be aware of this and keep this in mind with regard to the physician’s behavior. What I see as important to diagnosis and treatment is that patients should not allow modesty issues to trump the desire of the patient to be treated and cured of their symptoms and disorder but to allow the doctor to exercise his or her skills. Wouldn’t an analogous situation be that of a plumber or electrician who must enter a home to fix a problem but the home is messy and not in an appearance that a householder would feel comfortable about to show off to guests? Yet the householder’s goal for that plumber or electrician is to complete the job successfully and will put aside the concerns about the home’s physical appearance.
The electrician or plumber will usually use their skills to successfully complete the job and not be concerned about the mess. Wouldn’t this analogy hold for the physician and patient interaction? Or maybe the embarrassment about a “messy home” is not the same as the embarrassment of bodily exposure. Perhaps someone can think of a better analogy pertinent to the point I am trying to make.. or perhaps there is none. ..Maurice.
Mix
The hypothetical scenario I presented.
Well,it was a synthetic description
at an attempt of role reversal.I simply wanted to put you in our world
but opposite of your terms. I asked
you how did that make you feel.
Botanists hate being referred to as
naturalists. You refer to yourself as
a naturist as opposed to practicing
nudism. Does being referred to as a
nudist conjure negative connotations
or are you happy with either.
PT
"but to allow the doctor to exercise his or her skills."
Your assumption seems to be that the doctor can't exercise his or her skills and still maintain the patient's modesty. That may be the case in some situations. But why assume that. I agree -- your analogy of the plumber is not good analogy. But, the same principle applies. So...a plumber must be messy to do his/her job? Can't do it without making a mess?
I suppose you could make a case that where's the focus -- on the mess or the plumbing. Or, on the treatment or on the modesty. In medicine, can you assume that the physical treatment is separate from the emotional treatment? Although the plumber's mess is not really a part of the process, i.e. it has no influence on whether the job is done, or even done well or successful -- the doctor's "success" is not just physical, is it? It's also psychological, emotional, even spiritual. We're dealing not only with a mind, but some would say a soul.
Perhaps the question should be -- How can we both treat the patient and preserve his or her modesty? Should we assume it can never be done? Or can we assume it can be done? If we hope to solve the problem, the patient has to be part of the solution -- which seems rarely to be the case in medicine. Example: "This urological procedure can be quite embarrassing for some patients. Here's what will happen." The doctor explains the procedure, and esp. who will be involved. "Now," the doctor says, "How can we preserve your modesty here? What can we do to make you feel less vulnerable, safer, and respected. How can we preserve your dignity and still get the job done?"
So -- make the patient part of the solution. Don't regard the patient as the obstacle to be overcome, which is too often the case. You may not be able to please some patients. But just asking, making them part of the procedure, may ease them enough to better accept the situation.
Does that make sense, Maurice?
Doug/MER
Doug, perhaps you misread my analogy: "an analogous situation be that of a plumber or electrician who must enter a home to fix a problem but the home is messy and not in an appearance that a householder would feel comfortable about to show off to guests"
The plumber is not the one to make the mess but enters a house which is already messy and under other circumstances, the householder would have been embarrassed to have admitted a guest to enter without first cleaning up the home. Yet, when there is a urgent need for the plumber's skill, the embarrassment is necessarily suppressed. If the householder shows embarrassment, the plumber can say "Don't fret, my goal is to fix the toilet and not be critical of your housekeeping."
With regard to your final question:
Yes, I fully agree "But just asking, making them part of the procedure, may ease them enough to better accept the situation." ..Maurice.
Doug's last comment is the best solution yet...that the doc should make the patient part of the process, asking how to make them comfortable, etc. The only problem is that doctors think differently and although they quote that "the patient's modesty and dignity must be preserved," in reality they still think its about them (the docs) and they still assume that everyone sheds their dignity (and clothes) willingly in medical settings. I should know, I'm dating a doctor now and he thinks differently than patients. Period. Even though he's been a patient many times himself. Anne
Maurice: I see your point now. But that analogy assumes the major problem is with image, body image. I'm not sure that's what it's all about. It's part of the issue, certainly, but I think there are other reasons. I'mm not sure, though, that there's too much comparison with how we feel about our own bodies. It's the package, the skin that surrounds who we are. It's not who we are, for sure. But it's our doorway, or mirror to the world. It's how we take in sensations. How we feel about this, I'm beginning to believe more and more, has more to do with how we're treated, the assumptions being made about how we feel. That's why I think being asked, feeling that our modesty is being considered. "Our" modesty. Not what the caregiver thinks about how we feel. How we actually feel. Being asked shows a kind of respect for patient dignity that may perhaps make the patient feel the kind of respect that then makes them feel more comfortable. That alone may, with some patients, allow the kind of opposite gender care they otherwise wouldn't want. They still may feel uncomfortable and embarrassed to some extent. But I think in most cases, true empathy and respect can trump modesty.
Doug/MER
Doug
Doug/MER: Good post – very well put.
PT: I see, but that role reversal does not work. I would not be concerned about such details. Now if, in the same circumstances, I were naked and in restraints and open to the view of all, then I REALLY would be quite as upset as any other contributor here, simply because I would consider it patient abuse. But I would not consider it automatic abuse to have my intimate parts examined by a medical practitioner of either gender. Evidently some people would.
Naturism/nudism seem to be pretty much interchangeable these days and I do not feel a negative connotation to either term, although I prefer naturism. Nudism, to my mind, has some implication of living naked full-time (or mostly). I have no philosophical dedication to the practice in that way but adopt it for comfort when temperature/humidity render it unpleasant to wear clothes or the nature of the activity make it natural, e.g. swimming. MLX
Well, we are over 150 Comments on this Volume 41 and so it is time to move on to Volume 42. I wrote the following as an introduction to the Volume 42:
"I am awaiting the essay of a former second year female medical student to place on this Volume's front page. She had her future hopes of obtaining an M.D. and PhD degree dashed when her medical school allegedly refused to accommodate her request to avoid performing male genitalia, rectal and female pelvic exams later in her second year as part of physical exam teaching and to avoid the OB-Gyn clerkship in the 3rd year. Her requests were based on her own personal anxiety but also for her personal philosophic reasons against performing these intrusive procedures which also challenged her own and the patient's modesty and sexual concerns. I will write nothing further and await her presentation. I think her story will be particularly pertinent to this thread. ..Maurice."
By the way, both Dr. Sherman and I have been aware of this student for some time and have tried to be supportive towards her concerns.
NOTICE: AS OF TODAY JUNE 29, 2011 "PATIENT MODESTY: VOLUME 41" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 42.
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