Patient Modesty: Volume 45
Doug Capra, a regular contributor to this thread, wrote a comment on November 1 2011 which I inadvertently didn't publish but which I think is valuable for our consideration of two issues related to the patient modesty discussions here. Read it and then read my analysis below. ..Maurice.
Relative to the current discussions -- In past posts, I've referenced an articled called "Not Just Bodies" which is based upon a study of the strategies and/or defense mechanisms doctors use to deal with body issues == which include not just nakedness and modesty, but also horrible accidents and diseases. The profession knows well about these issues and addresses them. A major problem, as I see it, is this: Some of the strategies they use protect them psychologically but do little for or actually psychologically harm the patient. Some doctors never really "get over" this issue but just put up fences to protect themselves. There are also studies out there using medical students showing how they deal with this issue. There are some related studies about nurses. I think a myth within the profession is that these issues can easily be hidden from the patient by covering up using these strategies. I question that. I think many patients pick up on this and it may affect their healing and/or psychological health. Most of us, medical professional or not, are often unaware of the face we are actually "showing" to others. It takes quite a bit of self-reflection and knowledge to be aware of this. My other concern is what I've started to call the "deprofessionalization" of medical care in this country -- for cost saving reasons. I'm not so concerned with what are called mid-levels (PA's and NP's) But the use of all kinds of various initialed (cna, cma, pt's, ma, etc.) nurse assistants, some with little maturity and/or training, in this country is frightening. Some have no actual scope of practice, work under the doctor's license, and can do whatever the doctor is willing to risk. It's this trend that bothers me most and IF, and I emphasize the IF, there's a tendency for people with sexual perversions (or other psychological defects) to enter the medical field, it would be in this area. And these are the people these days doing most of the bedside care and, more and more, even some invasive procedures.By Doug Capra
First, I agree that physicians, in order to emotionally not react or show to the patient that they are not unprofessionally reacting to the patient's nudity, may take on a bland, emotionally neutral affect which demonstrates to the patient a sexually inert physician. And since the physician is sexually inert, he or she expects the patient to be likewise. And particularly, if the patient doesn't verbally complain, the physician thinks that the current behavior is fully acceptable.
I also agree with Doug regarding a certain degree of inadequate screening of the motivations of those entering the medical field and particularly those whose time and money and life investments are truly minimal and perhaps sexual interest values may play a role beyond the desire to be a care provider for the sick.
So who can be called a "peeping Tom", the title of this Volume's graphic, is a matter open to discussion. Perhaps we all are "peeping Toms" or "Little Bo Peeps" at one time or another, but it never should be at the physical or emotional expense of any patient. And that is why I think that discussion and dissemination of the issues of patient physical modesty is so important in the consideration of the best patient care. ..Maurice.
NOTICE: AS OF TODAY DECEMBER 20, 2011 "PATIENT MODESTY: VOLUME 45" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 46
posted by Maurice Bernstein, M.D. @ 2:00:00 PM
147 comments
147 Comments:
According to the CDC, there are over 12 million healthcare workers in the U.S. Not to sound overly dramatic, but it is asking a lot that there should be so much blind faith asked of a person/patient/client when dealing with those numbers.
No, each one of us will not be dealing with all 12 million, but really by being asked to blindly trust a few we are being asked to blindly trust them all. The collective group. The theory of healthcare, not the people inside of it. Just how do we pare that number to an acceptable level of “exceptions to our ethical, moral, and societal norms” and manage to make it "contextual”'? 1? 2? 50? The truth is that (usually) we can’t. We simply choose the ones that are in our area: hardly grounds for any true critical thoughts as to who they really are.
Well over 70 percent of the nurses I interviewed said that their thoughts and motives were simply none of the patients business. It was personal…private…and should be past the scope of anyone caring. So I would wonder: If they are leerers, voyeurs, or peeping toms, are we expected to not care about that either? As long as the job gets done who cares? Just bystanders to our own bodies…………
Just not good enough.
Suzy/swf
Belinda wrote the following yesterday after Volume 44 was closed to comments. ..Maurice.
Maurice, Thanks so much for your response. While I understand what you are saying, the focus of this exercise for me, was to examine the purpose of the behavior of the medical personnel. There was no lesson in teaching that was derived by treating the patient this way. Her bandages were not removed. All that was done, was this doctor showing his "muscle" to abuse this patient, with students probably too dumbfounded to respond. There is a reason for this behavior and it needs to be researched and examined because this is the crux of the problem more often than not. belinda
Well said Suzy
Of those 12 million,over 3 million are registered nurses of
which at any given time over 75,000
every 3 months are being investigated by the individual state
nursing boards for misconduct.
Additionally,it is said that 8-10
percent of all nurses are addicted
or impaired by drugs. Add to that
those who are incompetent and or
have previous felony conviction.
PT
Hello...my first time here. What I have read is quite disturbing to me.
Maurice, you stated
"Further, I refuse to believe any significant number
of healthcare providers are peeping toms."
I have to tell you that each time I have had to disrobe or have an intimate procedure done; I have encountered the 'peepers', from both techs, nurses and doctors - all female.
My first experience was at age 6, when I was told to report to the nurse’s office. When I arrived there, I knocked on the door, and was told to come in. In the room were a female nurse and a girl about my age. The nurse ordered me to take down my pants and underwear. I, like any little boy, stated "there’s a girl here" to she replied "little girls should know what little boys look like". I then stated "no". The nurse then grabbed the front of my pants, pulled them open (elastic waist band) and peered inside my pants. I started to cry hard. She then told me to leave and not tell anyone...which I did, and this is the first time I have told anyone besides my wife. I can't describe to you how much this traumatized me. I spent all of that year crying in class, and still today, 52 years later, I still get very angry when there is gratuitous male, especially young males in movies. I mean showing a male baby's genitals on the huge theatre screen - what for? They certainly would not show a female baby that way. Have you noticed that male genitals are now often shown in movies and the rating is PG, but if a breast is shown, the rating is R. Men are being more and more demeaned in so many walks of life.
When I was 41, I found a lump on my testis. I saw my family doctor (male). He sent me for all the tests. Luckily I had a male ultrasound tech. After the surgery, I almost died in the recovery room (another story). Then I had to go for radiation treatment.
When getting mapped for the radiation treatement, the female tech provided my with a towel - great, I do not have to lay there completely nude, I was so pleased. But did they offer me a male tech - nope! AS she is drawing on my lower and middle abdomen, I had great difficulty with controlling my ticklishness, so my abs were vibrating. At the end she says "great control". She then exits the room; I get dressed and exit to my waiting wife. The tech exits, sees me standing and gives me the once over from top to bottom and bottom to top, while she has this huge pleased smile on her face.
~ W
Continued due to character restriction.
The tech to dose me with radiation was female (again no offer of a male tech). At first she was respectful of my dignity and modesty, but after a few visits she started to act differently. At first she held the towel to cover my genitals in such a way as to afford me privacy while I pulled down my pjs provided by the hospital. But as I stated, her behaviour changed in that she began to hold the towel further away bit by bit on succeeding days. I could tell she wanted to get a view of my penis. It was just written all over her expression and body language. After days of struggling to keep my dignity, I just gave up. She got the peek she wanted and had this 'smile' on her face...yes, another female with one of those smiles. I did not say anything out of fear someone my over dose me on the radiation - probably an unrealistic fear, but still one I had none the less.
The male doctor I used to see (along with my wife) was in with a female patient at first, and then came to my room. I noticed that he had liquid seeping through his pants. Now I was always very uncomfortable with my wife having a male doing pap smears and breast exams on her, I mean the procedure is so intimate, and in a sexual way, but she would not change to a female doctor as she thought he was a good physician. But after what I saw (which was after years of my wife having the physicals), I practically yelled at her to change to a female MD...I was just so more upset than before, I just could not take it anymore. I mean I felt I was having to endure things of a sexual nature being done to my wife by another male. So now we have and MD for her and me (same female MD)...I'm not thrilled at having a female MD, but it is a heck of a lot better than my wife exposing her privates to a male and having a speculum inserted into her. After a number of years, all of a sudden the female md wants to do a rectal on me. I really did not want it, but after she explained the reasons, I said okay. After the rectal exam, she has me stand up and she snaps on some gloves to examine my testis - with me standing and hanging - I don't think so. I was totally shocked. I tell her that I found the lump the first time and that I am perfectly fine with examining my own testis. So she agrees, but as I am sitting there in that ridiculous gown, her eyes keep drifting to my groin. Very uncomfortable situation.
Lot of experiences for one guy, I know, but this is what my experiences have been.
I am scared to death if I get something wrong with me that would require me to go to a hospital or clinic, and be oogled (sp?) by female medical staff, much less have my genitals handled by them.
Boys/men should be seen by same gender, period.
In conclusion to this long post, I think there are far more female and male pervs and voyeurs in the medical system than you think there are. Experiences over the years have proved it to me
Sorry, I was rather upset when writting my post, and made an error. Instead of "I tell her that I found the lump the first time", it should have read - " I found the lump first, not my doctor..."
Thanks
~ W
On Nov. 9th, Anonymous wrote “I'm not thrilled at having a female MD, but it is a heck of a lot better than my wife exposing her privates to a male and having a speculum inserted into her.” He then went on to explain that seeing a female physician has put him in some very uncomfortable situations.
As someone who also has modesty issues I cannot understand why you would not simply seek out a male physician. Simply because you and your wife prefer that she see a female MD does not mean that you have to. Why put yourself through these embarrassing situations when it is not necessary. In addition, if you are seeing a doctor with whom you are not comfortable you are more likely to withhold information and avoid discussing personal issues that are of importance to you.
I’m not writing this to criticize or minimize your modesty issues which I share; but to suggest that you make a change that should be beneficial to both your psychological and your physical well being.
MG
Maurice,
Thanks for moving my post here. What that post was referring to was the article about a doctor publicly stripping a patient to no medical avail and was not only an abuse of power, because nudity of the patient without informed consent, a sexual assault.
The part that I can't accept is the reason that these personnel want to hurt a patient this way.
It is interesting that the illustration at the top of Blog 45 is someone peeping in secret, what happens in the hospital is usually blatant, unabashed and very public without hint of apology or wrongdoing. What is that?
belinda
Here's an interesting article I recommend, written by a male nurse -- "Notes on the Tension Between Privacy and Surveillance in Nursing by Martin Johnson, RN, MSc, PhD.
I find it very well done. When people are sick or recovering in the hospital, they need to be observed. In fact, detailed observation is one of the skills that made modern medicine modern. What's the difference, connotatively, between observation and surveillance? How does a nurse or doctor adequately observe patients and still allow them privacy and modesty? This article addresses some of these issues.
Doug Capra
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No2May05/tpc27_316019.aspx
http://www.nytimes.com/2011/11/08/health/patients-grades-to-affect-hospitals-medicare-reimbursements.html?_r=1
Interesting ideas in this article. I would be interested in who thinks this is good/bad for healthcare and patients in the long run.
Suzy/swf
Just as any other form of consent, if a patient is going to be monitored by video, they have the right to know when and where the camera is and the right to have it removed even if they are told their care might be compromised. Who wants to be washed, dressed, go to the restroom and have it all on videotape.
Consequently, the experiences of patients with regard to their bodily privacy is so in appropriately ignored, why would any person who had been victimized in a hospital or otherwise consent to these practices. It seems a little over the top to most of us.
It is interesting that the focus on sexual abuse with regard to cover up in the college scandal that is now the "flavor of the month" is focusing on cover up.
Nobody has done a study on the lowest of the workers, the health aid, on their reason for choosing that profession, their level of compassion, or...are they doing this job to "get even" when now they have the power and those who might have had it in the past are reduced to the most vulnerable.
There is much work to be done and for me, hospitalization is the last course of resort ever. I know this disturbs Maurice but once victimized...never again.
belinda
Just got finished watching a program about sexual abuse in the VA hospital and a bill pending (introduced by a Senator in NY)to protect victims. It is interesting to note that because there is no reporting system the numbers are low and that the entire area of institutional sexual abuse is being researched. This is encouraging. It is also noted that the abuse is not only of female patients but men too and others involved in the system.
belinda
Swf
What I find disturbing about Medicare
reimbursement regarding patient satisfaction,
plenty. Realize,many welfare health programs
fall under Medicare. Does your opinion matter
if you "have insurance".No!
PT
You may note a few older postings above which you had not seen previously. Unfortunately, I was not made aware by Blogger.com of their presence for moderation when they were originally submitted. I hope this problem clears. I try to get all postings published on the day they are submitted. Keep writing. ..Maurice.
JP today wrote the following to the initial volume "Naked" of this patient modesty thread but, of course, it has been long closed. I have copied JP's comments here. It seems to be a bit "refreshingly" different. ..Maurice.
I am as a patient not burdened with misplaced modesty when it is appropriate to disrobe. It is quite interesting to see the different approaches from different physicians.
Annual check-ups which require the genitals to be examined visually and by touch vary widely. A male doctor examined my penis and testicles reaching under a robe and spending time and effort to protect modesty without first asking the level of modesty I had. The modesty compromised the thoroughness of the exam. A female nurse examined me head to toe and only requested nudity at the appropriate time during genital and anal examination. she was more in tune with my comfort level.
A dermatologist did a head to toe examination, but never requested the removal of my underwear, during the exam. As I lifted the gown on the physicians queue the attending nurse turned away and looked into a corner. I almost laughed out loud it was so comical. I'm sure they think they made me feel more comfortable, but I came away thinking my examination fell short of being complete, skin cancer on the genitals and buttocks is possible and I feel I was not examined thoroughly due to misplaced modesty.
The issue is IMHO a lack of communication and establishment of the patients level of modesty. I believe it is the physicians duty to establish modesty levels before lifting or asking the patient to remove a gown or failing to do so and not doing a complete exam. This could be handled verbally, or maybe one of many questions one is asked to answer when filling out paperwork.
This is one of the most common sense approaches I've read recently on this blog. Yet, many of us have been saying this for volumes, haven't we? People are different. They have different attitudes toward their modesty. It's up to the profession to open communication about this with patients and establish confort levels. If patient comfort levels are too low to allow a necessary exam, that needs to be communicated to the patient so they know the risks. This is at the heart of the whole modesty debate. We think we're an enlightened, open species, but in may ways we still posses some of that old Victorian modesty. Many of us won't even talk openly about this subject unless we are able to hide our identities on the web. It's the "Elephant in the Room." Some in the medical profession have blind spots about this -- they don't want to admit that they themselves have modesty issues about examining patients and thus, as the poster says, the patient doesn't get a thorough exam. Some patients feel this intuitively but are reluctant to say anything to the doctor.
Good post, Maurice. But it really throws this issue back into the hands of the medical professionals -- where I think it primarily belongs.
Modesty issues should also be linked directly to informed consent for those of us who won't proceed with opposite gender care.
It's very important to have caring personnel who understand and would want to bring this issue to the forefront. It's another think to have it take "shape" to protect those who have a background of torture or abuse to help them get the care that they need.
belinda
These are comments to Dr. Bernsteins's re-posting of JP's comments concerning checkups. I am a male who has both a female primary care physician and a female dermatologist. We all know ahead of time that an annual checkup will include visual and tactile checks of the genital/rectal area. With dermatologists, it is less certain what will be done. My dermatologist has each of her new patients fill out a form in the waiting room about how much skin they are comfortable exposing. The form includes the various options. When I first saw her, I filled out the form that I did not wish to undress completely. She never discussed the subject again. Several years later, after learning that skin cancer can occur in places without sun exposure, I asked her to start giving me a 100% skin check. I think her form is an excellent idea but this form should be completed every year in case some patients change their mind just as I did. Physicians are human and many are just as uncomfortable in initiating modesty discussions as are their patients.
I am no longer modest with physicians of either gender. However, I am very uncomfortable in always having to discuss my problems with the physician’s office staff. Few physician offices have male staff. When I first visited a urologist, I had to tell the female staff that I had blood in my semen. No woman ever has to call a male staff member at her gynecologist’s office to explain her reason for visiting. If a gynecologist had male staff, she or he would soon be out of business. For physicians’ offices (especially a urologist’s office) with an all female staff (probably about 95% of offices do), there should be an option for the patient to not explain in detail the reason for the visit.
Gerald
These discussions are most interesting. It is an interesting observation of myself, that, as a person with issues, I have no modesty at all in front of female staff. Yes, groups are more uncomfortable (as in colonoscopy), however, when it's a one on one exam, there is no issue for me.
Gerald is right. If I were male, I would not diclose the issues to the female staff. I would let that staff member know I was uncomfortable and then, when alone with the doctor, I would tell him about how many patients he's probably losing due to no male staff for exams and intimate questions. When it comes to $$'s they're "all ears". Ask the doc how he would feel being examined in the presence of female staff. Nobody likes it. This is like any other business, patients will go where they are comfortable.
An amusing aside. I took my sick pet to the vet. I have noticed on many different occasions that this fairly large practice has no men. I'm dying to ask why but almost afraid of the answer. Don't men deserve to work too?
belinda
Hi Doug,
These comments are directed to your response. One of the other “elephants in the room" to me is this perception that a full body exam is necessary, or it’s necessary to do a male genitalia exam or indeed a prostate/rectal exam.
In fact it usually isn't. (Do some research, especially outside of the US, if you don't believe me).
I think that patients have been conditioned, (or attempted to be conditioned), that unless all the "bits" are looked at, somehow this is less than a full exam. How would most non-medical patients know the answer to that? Patients should be told about what the options are. I do not support the idea of a form where a patient says what amount of exposure they find acceptable. This is something the Doctor should discuss with the patient, to expect the patient to make the decision is just plain lazy in my view. The Doctor should explain what the options are for intimate exams the risks or not in a genuine way, not just attempt to cover themselves by going the easy option.(Whether this is to insist on a "full exam" or leave it up to the patient). This is especially the case as in fact in most cases, there are not clear cut answers and the patient should be involved in that decision making.
It’s not in my view necessarily a matter of modesty, but of informed consent.
Chris
The more I read at allnurses, the more I fear going to the hospital. One would expect that surgery patients are only exposed as is medically necessary, never left naked for no reason. I can speak up for myself but how can I when I'm unconscious?
http://allnurses.com/nursing-news/crna-gets-life-645253.html#post5917881
They will leave you naked on the table in front of a room full of people while you are fully conscience. That's just the way it is and it happens all the time.
I have to agree with annom who commented about the more they read on allnurses the more afraid they are of going to the hospital. While the issue of abuse is the main point of the article, to me the cover up of this and events like the female ENT Dr Sparks in New Mexico is just as concerning. While these are hopefully rare, the larger issue of a "them and us mentality" is perhaps even more concerning. There was a thread awhile back where a nurse made a "tounge in check" comment about talking about a male patients penis (using slang). When she was called to task many nurses jumped all over the posters because they weren't nurses. Very few nurses acknowledged it was inappropriate, most defeneded it as nurses just being human and venting and were more ticked about non nurses wieghing in vs the comment . Unforntuately this "inner circle" mentality is pretty common on the allnurse site. I think it is a very critical issue to this thread. The we and they mentality makes it easy to ignore our modesty even though they value their own modesty very highly. I don't know if the site is representative, from the majority of clinical posts I do believe the site is overwhelmningly true nurses. If this is representative of nurses as a whole, I agree with the annom. it makes me even more aprehensive of medical care and the true "professionalism" of nurses in paticular when it comes to modesty.....alan
Alan, while I agree with you completely, it must be pointed out that this is the mindset of many in the healthcare system, not just the nurses. Although, I will say because they work in a large group, it's almost like a "mob" mentality, where the MD's may share some of this mentality, it's probably a little less common, though not non-existent.
belinda
If this mentality is pervasive in healthcare workers, the more reason to run away!
Doug and I have posted a new article concerned with nursing violations of privacy. The thread is mostly based on the '9 things' all nurses thread.
Take a look and comment.
While this article is pointing out nothing new, the one aspect that is completely ignored are two things. First, what does the knowledge of this kind of behavior do to a patient's mindset? Second, what does the knowledge of this behavior do to someone who has a history of being victimized in a hospital setting prior.
It poses the question that I've been sparring with Maurice. It's not until your mental health becomes more important than your physical health that you will avoid treatment. Or...that you will set protocols that back the medical community into a corner that they must behave or suffer severe financial, ethical and loss of reputation as an institution.
belinda
Where do people get the idea that the masculine and brave thing to do is keep your mouth shut and drop your pants whenever you're told to? Peers, teachers, medical staff and especially nursing staff try to convince us that standing up for ourselves is the cowardly thing to do. It's actually the exact opposite. Standing up for our morals and principles is the honorable and heroic thing to do. I personally would give up my life before I would abandon my morals and dignity.
Why do nurses believe that insulting a man's masculinity is the most constructive way to get him out of his clothes? Stupid lines like "I am a professional" and "you don't have anything I haven't seen before" just make it worse. Haven't most people on Earth "seen it before"? Wouldn't a true professional show some respect to their patient's beliefs? I don't consider anyone a professional if they don't act professionally. Treating patients like a slab of meat, insulting them and pretending to be "gender neutral" is not acting professionally.
Women and minorities have come a long way in recent decades demanding and receiving equal rights, while men's rights have been retreating just as rapidly in the other direction. The men and boys that are considered "brave" and "masculine" because they are too afraid to stand up for themselves against this abuse are leading the way in this steady retreat.
I must disagree with Doug's categorization of "initialed" healthcare workers as less professional. I am currently enrolled in a CNA class that is finishing up its 8-week-long run of classes and laboratory sections. In this course, patient respect and autonomy were emphasized, particularly with respect to privacy. In the lab sections, the emphasis on privacy was reinforced. In the state examination, failure to verbalize, "I'm providing privacy," constitutes a failure of the exam. I have found my training and instructors thorough and strongly focused on professionalism with regard to patient rights. I do not think training consistent with my experiences is inadequate.
What happens in the hospital, long-term care facility, etc. is, in my opinion, a result of the work environment. As Doug wrote, "Some [aides] can do whatever the doctor is willing to risk." He himself acknowledged that aides are under the scope of doctors and their charge nurses. While CNAs are capable of declining requests they are uncomfortable with/untrained to perform, I think it is the rare aide who will go against an order when faced with an embroidered white coat. If anything else, I feel this fear of contradicting doctors is due to self-doubt in a hierarchical medical environment. Even in the posts of Doug and other commenters, nurses are described as “mid-level" and aides are on the low end of the totem pole. (I also wonder if this pervading mentality in healthcare is possibly one of the reasons for situations such as the allnurses forum.)
Furthermore, I feel that the nature of work aides perform put us at higher risk for labels such as "Peeping Toms." Performing tasks such as a bathing that put aides in proximity to nudity is a part of the job, just as are the tasks for physicians in certain specialties like gynecologists. They are not, however, the entire scope of a CNA’s duties. In any healthcare field, there are a variety of motivations that can relate to any part of a job description; why is it that any presumed invasion of privacy by a physician is more easily rationalized as stemming from a medical need?
Thanks for your comments, Maddie. The word professional is an interesting word. Are cna's less "professional" than doctors or nurses. Of course, if you use the word to mean training and education. Do they behave less "professionally?" Not necessarily. That's another use of the word. Profession as a noun vs. Professional as an adjective.
I don't condemn cna's and other aides in general. I recognize how important they are in medicine today. I've been treated by aides frequently and generally have had no problems.
My concern is in today's economy especially, these positions are being sold as "safe" jobs for those out of work -- good working hours, good benefits. I do generally have problems with young people right out of high school taking an 8-week course and then being thrust into positions where they are doing the kinds of procedures that some cna's are allowed to do under some circumstances. I don't believe they always have the necessary supervision. And I do question their maturity in some cases. Before becoming a doctor or nurse, a person has to think seriously about the investment of time and money and soul. There's much a stake. Not so with someone taking an 8-week class, often offered free of charge.
Good care is about good teamwork these days. If the doctors and nurses and working closely and the nurses are working closely with the cna and other staff, patient safety and well-being happening. If the hospital culture is healthy, if staff feel empowered and respected, patient safety and well-being is happening. But that's not happening in some cases. When aides are used as part of a working team, that's fine. When they're used just to save money, that's not fine. And in medical care today, it's too often about following the money.
Hope that clears up my point of view, at least somewhat.
One other point, Maddie. I don't question the quality of your training, that privacy, modesty and patient digntiy is being emphasized. But, as we've discussed on this blog with Dr. Bernstein who trains doctors -- there can be a huge difference between academic or school training and the hidden curriculum, that is, what you learn on the job. Look at it this way. A cna gets 8-weeks worth of training. After six months on the job, that cna has had six months worth of on-the-job training. That's the hidden curriculum. Is that quality training? It depends upon how healthy the culture is at the working site. Is there adequate supervision. In fact, I'll go further. Studies now demonstrate how important "coaching" is for improvement of job quality. Are these new cna's being mentored and coached? Is what they were taught in school about privacy and modesty and patient dignity being reinforced within that particular hospital culture? Or, are they being told -- "Oh, never mind what they taught you, this is how we do it here."
Of course, this all goes for doctors and nurses, too. But, being at the bottom of the hierarchy, cna's and other aides are at a disadvantage. They have little power to change a system that may not be healthy.
I recently had a prostate volume study done at the Radiation Oncology department of a major Northern Virginia Hospital. I had to endure having two young female nurses stare at my uncovered genitals while being examined with a trans-rectal probe. Most unsettling was one nurse's job was to just sit and observe the procedure. She did not introduce herself and no one has ever explained why the entire time she needed to just stared at my uncovered genitals. There was no attempt to cover me and no option for male nurses.
I tried to speak with the Radiation Oncology department head about my procedure. She was not open to my concerns and hostilely stated the nurses were highly trained and I should get over it. She wouldn't address my concern for modesty. They don't hire male nurses.
The procedure had a very negative impact on me. I felt humiliated, embarrassed and violated in my discomfort with the procedure and lack of common courtesy shown to me.
Prior to the procedure I had no experience with hospital treatment of males during an intimate procedure. I was ignorant to the whole problem. Women on the other hand have more experience, unfortunately, at a younger age with the medical system. Perhaps this is why it seems men are less interested. When men start to become involved they are older and not up to making a public issue. I can assure you most are humiliated.
I am young enough and want to be an activist for male dignity in medicine but I don't know exactly how to make an impact. I have written much of the upper management of this large hospital and I am waiting a response. I don't expect much. I want to do more then blog. I see older men and my heart goes out to them knowing what they are in for.
Mark
Mark, if your description of your personal experience is fully representative of what occurred and I have no doubts, I find the behavior of the professionals present simply unprofessional in many respects. I will not condone the behaviors which you described.
My suggestion: Don't simply write to "upper management". Instead, make an appointment and go there and talk to them directly. Return to the blog thread and keep us all informed. ..Maurice.
Hi Mark,
I had a similar experience at a Radiation Therapy Center (RT) and developed a posttraumatic stress disorder. I am a female and all my techs were female except for one male technician but the doctors were male. My modesty and dignity were not respected.
Although women may have more experience in a medical setting, any woman would be equally traumatized by what you and I endured because we are not used to demeaning and humiliating treatment. Prior experience (I’ve given birth to three children, had a back surgery, etc. etc.) did not prepare me for how I was treated in the RT Center as I trusted that I would be treated with dignity like in previous medical situations. So, I was completely blindsided.
After I had recovered somewhat from my treatment (I also had surgery), I hand-delivered an eight-page letter to one of the top administrators (whom I knew personally because my husband has been a physician in this hospital system for 25 years) and I sent a copy of the letter to the CEO of the hospital, who is also a personal friend. I requested a meeting with the doctor in charge of my care as well as the administrator of the facility.
What I recommend to you is this. Look at the contacts on the Patient Bill of Rights that you were given. Write or contact the people listed on this Bill of Rights. I regret that I did not follow this procedure but because of my allegiance to the hospital and administration, I chose to address my concerns “in house.” I would not do it that way again. I think it is good that you have already written the upper management and you HAVE made an impact but don't stop there, pursue the contacts on the Patients Bill of Rights.
Personally I think we should also be writing to the American College of Radiation Oncologists (I just might do that) to make a case for better patient preparation and stronger consideration of patient modesty and dignity.
It is good that you wrote down your complaints, as otherwise they will not go anywhere. Written complaints must be reviewed and addressed. It is best to be respectful, positive and upbeat. The facts will speak for themselves.
You should have been given the names of everyone involved in your care. You should have been asked whether of not you wanted the student to be involved. The key here is “informed consent.” You did not give your informed consent to have an onlooker whose role you did not even know. All of this was very sloppy and careless and inconsiderate and for their convenience. You also did not fully understand the degree to which you were going to have to expose yourself and to whom. You had not given your consent to the manner in which this treatment was carried out.
No one deserves to be treated the way we were. Patients deserve to be treated with dignity and respect. I hope you will write a letter and contact the names on the Patients Bill of Rights. Keep us posted as to what happens.
~Gail
The governing body for radiation
therapy is the ARRT in Minnesota.
Additionally,most states which I
believe is 37,have their own additional governing body. You will
need to look into the state or tell me which state you live in and I will gladly find out for you.
The ARRT in Minnesota will eagerly investigate all issues of
unprofessional conduct among
Radiation therapists.
I will tell you that the "radiation Physicist" or the "radiation oncologist" has nothing and I repeat nothing and no control over how you are treated in the therapy rooms.
That is the responsibility of
the therapists. Before each therapy session you must give consent. On those consents and located exactly in the middle it
asks you do you allow students to observe your therapy session.
If you do not sign that then you
don't have much of a complaint,
however, it is customary for the therapist to introduce the student and ask you if their presence is ok.
The american college of radiation oncologists and radiologists do not have any control per se over therapists. That is not their responsibility.You complaint will be better presented by first submitting a complaint to the director of radiation or oncology for that facility.
ARRT 651-687-0048
PT
PT, I respectfully disagree with you. My physician did not prepare me adequately for what I was to experience, i.e there was poor orientation. I was never asked on any written paper whether or not I consented to a student nor was I asked when I entered the radiation therapy room whether I minded if there was a student in there. There were many things that were done that I did not give permission to.
I believe that leadership comes from the top down. The doctors and administrators were responsible for the culture of insensitivity in this facility.
Every medical specialty has a national governing board and a board of directors. I have not adequately investigated whether this is indeed the American College of Radiation Oncologists or not but I think it might be. Such medical boards will have a board of directors and each of these physicians can be written to individually. The purpose would be to make a point to the individuals who are currently guiding and governing their specialty.
I wrote to the director of the RT facility as did my husband. We also met with the non-physician administrator and later I met with both the physician administrator and my RT doctor.
The ACRO has no governing authority on therapists. Often,
radiation oncologists at many
centers are never there,as they work out of their office.
I know of many radiation oncology
centers whereby the only staff there are a secretary and a therapist. Radiation oncologists
are not required to be there!
Every therapy requires a radiation physicist to calculate dose per prescribed area. Even the
physicists are rarely there.
The process is similiar to chemo
centers. Patients show up on the appointment lists and recieve their chemotherapy,then they leave.
An analogy is perhaps with your GP,they write a script and send you to the pharmacy. If the pharmacy is rude to you,not the GP's problem.
I don't understand how all your dissapointment is with the oncologist when it is the radiation therapist that provides the care and delivers the dose.
The American college of radiation oncologists,who by the way are referred to as ACRO and
their website is www.acro.org is
more a resource center for radiation oncologists,collects fees and offers up to data information on billing and coding,legislative news and up to date information on some cancer research,thats it.
It is not some place to write a complaint about issues you have with the facility.
PT
The fact that people do develop PTSD from these kinds of experience (even without sexual deviance on the part of the staff) is the point. "To Do No Harm". Maurice, I know you're listening. Don't you think this is enough for patients to demand same gender care if that's what they need to feel safe?
belinda
First I would like to thank Gail and Maurice for their replies. Sometimes you just aren't sure if you wrong in your feelings even though they are so strong.
Maurice, I have written to “upper management” and asked for an appointment to discuss male dignity in medicine. I told them they were in a position to make a difference. I will have to work on an agenda in the off chance one response.
The Oncologist did reply with a, “Thank you for the letter. We will be more aware of your concern and will make changes accordingly.” I don't really believe anything will be different.
Gail, I am sorry to hear about your experiences. It sounds we have suffered much of the same from our treatments. I was not diagnosed as having post traumatic stress disorder but I felt so much emotion about the procedure, it played over in my mind hundreds of time. I was very upset. The volume study was preparation for prostate brachytherapy. Just prior to the procedure I canceled. I was told I would be asleep and there would be at least 8 people in the room. If this was the respect I was given when I was awake, I couldn't stand the though of 8 people roaming around me when I was asleep. Of course they would all be female.
In my case I am note sure if the young female observer was a student or not. I was told by the patient advocate that she was supposedly a nurse. She was never introduced or explained. When the doctor lifted my gown and started to prep me for a catheter, the older nurse shot the younger nurse a smiling grin. Not sure what it meant but I am sure it had something to do with my genitals.
I was given a patient request for medical/surgical procedures form where I specifically denied observers, video or photography. I was not given a patients bill of rights. I found one on line and there were no contacts given except for:
Virginia Department of Health,
Office of Licensure and Certification, 9960 Mayland Drive,
Suite 401, Richmond, VA 23233,
and
Office of Quality Monitoring,
The Joint Commission, One Renaissance Blvd., Oakbrook
Terrace, IL 6018
A problem for me is I still have boarder line low/mid risk prostate cancer. Not being able to continue with brachytherapy, external beam radiation is another choice. Unfortunately this requires placing gold markers in the prostate. A procedure just like the volume study. Also, I am sure my activities will tick off the Oncology department.
I do agree contacting groups like the American College of Radiation Oncologists is a good idea. The hospital I went to recently received, “The center is nationally recognized and accredited by the American College of Surgeons. Most recently, in November 2011, xxxx Hospital was the first hospital in Northern Virginia to receive accreditation from the American College of Radiology and The American Society of Radiation Oncology, reflecting the center's quality and patient safety. The center was also nationally recognized in 2009 when it received an Outstanding Achievement Award from the Commission on Cancer.”
REALLY, this is as good as it gets? There should be remediation not handing out awards!
Mark
Belinda, if I could have had a male nurse and no observer I would have been fine. I might have been fine with a respectful female nurse and no observer. I had very high expectations for the professionalism of the medical staff. Now with my experiences and all I have read, I don't trust female nurses. I am sure there are good ones but who knows what you'll get.
Mark
"In this course, patient respect and autonomy were emphasized, particularly with respect to privacy. In the lab sections, the emphasis on privacy was reinforced. In the state examination, failure to verbalize, "I'm providing privacy," constitutes a failure of the exam."
Maddie:
Respectfully, as what usually happens in these dicussions is that we are to be reassured that attention to privacy is being taught. But what is almost always left out is the discussion of what is taught when your gender is considered the breach of rights and privacy violations. As usual, we do not get the gritty truth of the gender issue, just a glossed version of privacy.
Suzy/swf
I take back my comment about not trusting female nurses. I have had several bad experiences but that isn't fair or
right. I am still very upset about my treatment and went overboard. Sorry. I just don't want females for intimate procedures.
Mark
Mark, I sympathize with you completely. Our life experiences changes who we are and how we experience the world around us. I am a writer/researcher into the psycho social aspects of medical care that are detrimental to mental health.
I am willing to speak to you if Maurice will give permission. I think there may be some things that will help you to get the help that you need.
I have been battling severe illness and developed a protocol that helped me. It makes me feel safe. I can help you to develop one that will make you feel safe if you like.
Maurice has an e mail address for me if he would be willing. There is no financial gain in my speaking with you.
belinda
Belinda, I trust what you say about "no financial gain" (I don't want this blog to be a commercial resource) and therefore please e-mail me (?again) your e-mail address and if Mark also writes me, I will provide your address to him. I have continued this thread for all these 6 years because I believed at some point it might become therapeutic. both through simple ventilation (which it has certainly been) but also through visitors supporting each others concerns and as a starting point for discussing advocacy ideas to try to change the system. ..Maurice. (DoktorMo@aol.com)
Maurice,
Your blog is very therapeutic. It is because people feel isolated when they have a negative experience. There is no support group, no place to go, nobody to understand, and no changes to be made. So...for all of these reasons, you have given us a place to share ideas, feelings, possible protocols, human rights, etc.
belinda
Mark -- I posted something earlier that never made it probably for technical reasons. Basically I recommend that you bring with you to your meeting copies of the hospital's mission statement and/or core values. Hold them to the ideals they promise. Also, as someone else suggested, bring with you copies of their patient right's documents that they should give to patients. If they don't have one find a good one online and use it.
The important thing, I think, is for you not to let management run this meeting. Don't let them frame the conversation. You control the discourse. Make sure it's clear to you what the meeting is about -- it's about your dignity, your privacy, respect for your values. That's what it's about. You'll be surprised how they may want to frame the discussion. Don't let them. Get back to what it's about -- you, not them.
Mark, sorry to hear what you went through, unfortunately I and many others on this blog have similar stories, which is why we are here. Suzy and I are actually working on a website which would offer help in these cases, unfortunately it is not running at this point, but we are looking for people to help us develop and eventually operate. I know how you feel, after my experience I was so angry, angry at them, angry at myself for letting it happen and not doing anything. It was my first experience as well, two things, learn from it and don't let it keep you from getting help. What you learn is to be proactive, you can not change what happened, but when you go to your meeting use what happened to you to define what you expect in the future. Let them know what was offensive, why, and what you expect in the future. There are a couple of things, let them know you feel you were mistreated, tell them you need to know what they will do before you decide to continue there or go elsewhere, if there is a lot of pushback let them know you are contacting your insurance carrier to file a complaint and ask them to deny payment. If it is really unacceptable let them know you are going to file a complaint with JACHO. I would wager it won't go that far and you will find they will take it serious. You will find it to be theraputic and allow you to move forward when you take control. You might want to contact some other facilities to see if they could accomodate your wishes, use this in your advantage when you talk to them. Please come back to this site not only to share, but to get support and perhaps you can become part of the website we are working on...I can not tell you how much difference this site and Dr. Sherman's has made to me. Just a side note, for me I was just as upset as you when I went through it, but, I found what went on while I was unconcious was a lot less difficult to deal with than while I was awake, but that was me. If there is one thing we all agree on, we are all different in this area....hang in there, taking control makes it better....alan
One thing I don't understand is why medical "professionals" accuse us more modest people that won't undress for the medical workers of the opposite gender of considering a medical situation a sexual experience. I am a straight male. If I considered a medical situation a sexual experience I certainly wouldn't insist on having only men performing intimate examinations and procedures. Accusing us of thinking it's sexual is just another way of belittling us, and helps to feed their tremendous egos. Embarrassing us into submission seems to be the most common method of trying to force us to comply. Unfortunately it works most of the time.
I see nothing sexual about intimate medical procedures. To me it's all about respect, morals and ethics. Unlike my life outside of a hospital room, the more attractive the medical worker is the more uncomfortable I am with her. In the regular world I'm a bit shy around hot women and I often just tell them what I know they want to hear. In the hospital I won't hesitate to call a woman a pervert if she tries to get me out of my clothes or tries to put her hand down my pants. I'll order her to stay away from me, not matter how cute she is. If they consider that sexual they are just flattering themselves and trying to protect their egos.
Mark, one more suggestion I should have added. Go in with an open mind, I had a similar experience with a sonogram and went in prepared to battle. I could not have been more surprised by they way they responed. The were respect full, they at least acted like they understood and did not once make me feel like I was off or wrong. They sent me a list of changes they made so others would not experience things. The very least they could have done for you was introduce everyone and tell them why each person was there. While it is very possible the 2nd woman was a nurse, id doesn't mean she wasn't there for her training and benefit and had no benefit for you, that is still something you should have asked about...alan
Dr. Sherman and I are writing an article now based upon a study that points out this: Medical professionals are taught strategies to desexualize the clinical encounter, which they should do. Medical professionals don't see the clinical exam as sexually charged -- not to say it couldn't be for some under some circumstances -- but they are taught strategies to mitigate this, to desexualize it. One reason for using gloves. From their point of view, there's nothing sexual involved in the nudity of medical exams and procedures.
Some patients, especially men, do see nudity in medical encounters as sexually charged -- especially when involved with genital exams with members of the opposite gender. But, a significant number of men are homophobic and regard this encounter sexual when dealing with male providers. I think some medical professionals -- especially females -- don't fully understand the psycho-social power behind the penis, it's symbolism and the public, versus private nature of the erection.
I believe perhaps most providers don't accept the fact that a significant number of men, when facing genital exams or procedures -- attach sexual overtones to it. Or, more precise, have sexual feelings. Some providers think that just by saying there's nothing sexual about this -- that this will change everything. It doesn't. What we have here are to different ways of thinking that need to be merged so each side understands where the other is coming from. Patients, too, need to understand how providers think. But providers need to accept patient feelings about this issue -- and not think that they can instantly change powerful cultural/sociological/psychological norms.
I may have written this to this thread previously but to follow up on Doug's last post, I can tell you exactly what male and female medical students are taught when they learn to perform a male genital exam. They are cautioned that some patients may experience an erection during the exam and whether or not the patients openly express concern about the response, the students are to promptly and in a professional manner inform them that the erection is not uncommon in these exams and that it is useful response since it shows that the nerves and blood vessels to the penis are functioning correctly and that disease or disorder of these pathways is therefore unlikely. This valid and constructive response to the erection is felt by the teaching staff to be of value to both the student (later as a doctor) (turns a reflex sexual reaction into a diagnostic result) and to the patient (that the doctor is not looking at the erection as something sexual but more objective as part of the physical examination.) Hopefully, all doctors will carry away this response they learned in school and apply it in every case. To do otherwise and say nothing in response to an erection only exacerbates the doctor's consternation because an unintended erection (which perhaps the patient blames the actions or behavior of the doctor). For the doctor to say nothing will only intensify the suspicion of a sexual event with embarrassment and confusion by the patient as to how to respond.
Yes, if this is a teaching tool to desexualize the genital exam..well..so be it. As medical school teachers, we think it is the correct approach to a potentially embarrassing reaction. ..Maurice.
Thanks for your response, Maurice. I do realize that providers are trying to mitigate the embarrassment by saying what they're taught to say. And I'm not saying it doesn't work in some cases. What I am saying is this: In situations where this may happen, why not ask the patient ahead of time about his comfort level regarding the gender of their provider? Can we just assume that the patient will provide this information on his own? Why can't this be an upfront conversation? I'm also suggesting that the words being said by the provider may have little impact over the emotions being felt by the patient. Body language and tone have much more influence on communication than mere words. And even those elements can't always win over feelings and emotions. I've also read that providers are taught to "give the patient permission" to be embarrassed, i.e. it's okay to be embarrassed. Telling people their feelings are okay doesn't necessarily make those feelings okay.
I don't understand the reasoning behind not bringing this topic up with the patient beforehand and asking how the patient feels about it and how the patient would like to handle it, regarding provider gender. That may be yet another way to mitigate patient embarrassment and humiliation. Does the medical profession believe talking about these issues beforehand somehow makes it worse?
While I have no way to prove or back this, I fully believe the driving factor is economics. I believe economics eliminated male orderlies and given the gender dispairity in nursing I think providers have taken a don't ask don't tell. If you ask them if they have a preference it will require you either accomodate which will likely cost money, or you have to acknowledge you know they care and not provide for them. If you act like it isn't a problem or accomodate in a way that doesn't cost money through lost efficency, you can give the appearance to the patient you care, and make your staff who most really care about the paitient, feel better about what they are doing. Providers accomodate like they want, not what the patient might want becasue it saves money....alan
I was asking my Oncologist why they don't hire men. He said, "can you imagine how embarrassed a woman having a breast procedure would be with a male nurse. Or what if she was to be put asleep?" WHAT? A woman's breast exam would be more embarrassing then my prostate volume study? One male male nurse when she is asleep compared to my 8 female nurses?
Mark
The medical profession has a way of invalidating our feelings. Nobody has the right to do that. After I was sexually abused (as was the opinion/position of a Ph.D. specializing in health psychology) in a hospital and action was taken against those responsible by the hospital, I was told by my doctor (who was not one of the abusing parties) in writing that I was focusing on the wrong things.
That was more than 32 years ago. It's sad to see that absolutely nothing has changed.
Mark, you have every right to insist on what you need to feel safe and not be put in what I considered for myself, to be in a degrading position. That, in itself, is outrageous. The more vocal and insistent you are, the less "wiggle" room you give the establishment, the more likely you will get what you need.
belinda
"Yes, if this is a teaching tool to desexualize the genital exam..well..so be it. As medical school teachers, we think it is the correct approach to a potentially embarrassing reaction. ..Maurice."
What I'm curious about, Maurice -- and I ask this respectfully -- are there any studies that indicate this is the "correct" approach? I have found few medical studies that consider these issues. Most of the studies relative to this come out of the discipline of psychology and sociology. What you've presented is a generic approach, as if this works on all patients. I'm suggesting that the patient should be part of the decision, if he chooses, as to how best to mitigate a potential embarrassing incident. Some men would prefer a female examiner. They'd feel very uncomfortable with this happening in front of a male. Other men would prefer a male. In both cases they would probably be embarrassed -- but the gender of the provider might make it less embarrassing for them
The strategy you describe may be good for the provider: The embarrassing incident happens, the provider says something they believe will help, the provider feels he/she has done something to mitigate the embarrassment. But for whom? For the provider or the patient? How does the provider know how the patient has interpreted this strategy? How does the provider know whether this strategy has worked?
In short, I'm advocating for offering patient choice of gender when situations like this might arise, giving the patient a shared decision making role as to what strategies would mitigate the patient's embarrassment. With men for whom it wouldn't make any difference, certainly giving them a choice wouldn't offend them. With men for whom it would make a difference -- I'm convinced it would be greatly appreciated.
That's my point -- that, and the opinion that I question whether there's any quantitative research that indicates the strategy you suggest as generic works for all or even most men. If the studies are out there, I'd like to see them.
There is a big difference between embarrassment and humiliation. Often being prepared (unless you ask) you do not know who will be attending and what kind of state of undress you may be.
It's a combination of not being informed, having something unexpected happened, feelings of humiliation, that all contribute to psychological trauma. This is a real problem and embarrassment minimizes the extent of psychological damage that can happen when you have that formula of unexpected happenings with humiliation. Should these happen that you would never have consented to if you knew, they are on the part of the patient's perspective, a sexual assault. Clothing removed against someone against their will is a sexual assault. While this may seem an overreach for someone not trained, you must remember that the perception is that of the patient.
Prior to many surgeries, everything is removed to properly prepare the body for surgery just prior to draping. Many times this act is performed in front of the entire OR while the patient is awake or in the ER where they are not only awake, they are in an extremely emotional state to beging with. It's not that these things don't have to happen, it's the way the patient is prepared.
It's the combination of having extra people around of both genders, a young person who is upset at their predicament AND...that they're being publicly stripped in front of many health, police and other medical people who don't need to be there.
How would you feel if your daughter had permanent psychological damage because of voyeurism in the ER? It happens every day and these people feel entitled. This is exactly what the Patient Bill of Rights eludes to but doesn't translate into any practical application.
Then, when you add a few sexual comments about the patients body in front of them, you have a real problem for that patient.
I think I walked around completely outraged over my incident for at least 20 years until I understood better what happened to me, why it happened. The only thing I regret, is that this person and others should have been arrested.
Today, they probably would.
It's time for medicine to put as much thought into these human rights/dignity issues as they do their medical issues because by doing nothing, they are promoting the same mindset, right of entitlement--never on my own watch.
belinda
Doug, I agree. There are a zillion other studies out about a zillion other things but no one really wants to tackle the issues of modesty and dignified treatment in medical settings. And yet, as we are once again reminded by the recent attention being given to the child abuse that happened at Penn State, people can be very traumatized by the way they are treated in regards to their reproductive organs.
There are ways to mitigate some of the trauma with different policies but I don't think the medical community wants to be bothered.
After I made recommendations as to how I had been treated in the RT Center, my doctor, who was clueless said, "We like to hear the patient's perspective." Had they not bothered to hear other patient's perspectives? I was certainly not the first patient at this facility. I think that most patients are too traumatized and embarrassed to say anything and the doctors just don't want to ask. Kind of a "don't ask, don't tell policy." It is less trouble for medical staff to not have to worry about patient modesty.
It is time that someone focuses on this issue and comes up with some recommendations for the dignified treatment of patients.
~Gail
Alan
Economics has nothing to do with this issue, but
rather who does the hiring. Never ever seen a male
human resources director at any hospital. Who are the
directors of all the nursing floors,female nurses.
It doesn't cost any more to hire a male nurse
versus a female nurse, as well as cna's.
Maurice said
" They are cautioned that some patients may
experience an erection during the exam."
I believe nursing students were told this as
well,yet many still resorted to using a steel spoon on their
patients.
PT
Doug, I have no idea whether there are any studies about expressing to the patient the diagnostic value of observing an erection during genital exam except as with the doctor educating the patient about their health in other areas, it is the right thing to do.
I should emphasize something which I have certainly written previously. First, I am sure all doctors understand that the reason the patient has come to the doctor is for the doctor to diagnose and treat a problem that the patient has concern. We would never consider that the reason was for some other purpose until we discovered some indication as we took a history or started an exam.The patient is usually aware of the gender of the physician prior to the meeting and unless the patient is brought in to an emergency room critically ill and needs immediate attention, the patient usually has an opportunity to find a physician of the desired gender. With regard to what is going to happen in an examination, medical students are taught to inform the patient as an examination proceeds as to what will happen next and be attentive to the patient's reaction--- what amounts to a series of informed consents during the exam. Obviously, if the patient objects to what is to happen next in an exam, despite education by the student or doctor, then that rejected part of the exam is not carried out. To do otherwise could legally represent an assault or battery.
No.. we usually don't tell the male patient ahead of time that they may experience an erection during a genital exam because it is truly a rare occurrence and there is no need to have a patient anticipate such a possibly embarrassing event. Do you really think we have to introduce or support the thoughts of the patient that we are about to perform a sexually stimulating procedure? I don't think this is a part of necessary informed consent.
I still think that to the vast majority of doctors believe, because they have never been informed otherwise by their patients, that the reason for the consultation is one of diagnosis and treatment and that this is of such importance that it would trump any modesty issues. Again, patient modesty concerns and professional behavior are taught to the students with respect to various elements in the physical exam but only to be considered as part of the primary goal of diagnosis and appropriate treatment. ..Maurice.
Keeping in line that unexpected behavior or things that happen that are unexpected is the very thing that causes psychological.
It is critically important that it be explained to the patient that xyz procedure can cause an erection in some rare instances and it is not all that uncommon.
This gives the patient the ability to make an informed consent if they want females in the room. They might feel embarrassed, but there is a big difference than being so humiliated that you stop any future invasive exams.
Maurice, we must look past the exam being performed in the moment and look at this whole person and their level of trust and expectation.
belinda
Belinda, you write "we must look past the exam being performed in the moment and look at this whole person and their level of trust and expectation." Yes, in the olden times when physicians could have and did have an hour to spend with the patient, the doctor could begin to access the patient "wholly" and could delve into and begin to understand the patient's true expectations. Now, with visits of 15 minutes or less which includes time for history, physical, concluding and prescription writing if not also at the time documenting the visit, how can the doctor practically and fully understand "trust and expectation" given and expected by the patient? It takes time. It takes questions by the doctor. It takes frank disclosure by the patient what is desired to promote trust and what are the patient's full expectations. Will patients do this while facing their physician or will they fully explain their intent and desires regarding the visit when they fill out the paper in the waiting room requesting the patient to state their reason for the visit?
The problem concerning actions or reactions or non-actions to issues of patient modesty as discussed on this thread is not caused by one party but is multi-factorial and until all parties get together to fix the problem, I suspect it will continue on. ..Maurice.
Dr. Bernstein, I like the response that you teach your students to give, in the event that a man has an erection during an examination. I wonder, though, if it goes far enough? Beyond stating the diagnostic value of his ability to achieve an erection, should it not also include some comment, to assure the patient that this does not indicate sexual arousal on his part? Rather, it is just a normal physical response to certain stimuli?
Don't think for an instant that all men know this. I have seen many comments on other boards stating that a particular man “must have been turned on”, or “must have been enjoying it”, since he had an erection. Such comments don't just come from women, but from men, as well. I even wonder if all healthcare workers, be they male or female, are aware of this fact. I would hope that they are, but is this truly the case?
Mark's post of December 10, at 6:04 AM, made a couple of very interesting points, one of which is related to this. First, he said “I am a straight male. If I considered a medical situation a sexual experience I certainly wouldn't insist on having only men performing intimate examinations and procedures.”
Many men are like Mark, in that they do not view a physical examination in a sexual way. So, imagine how much more than just embarrassed such a man is, if he has an erection while being examined? He desperately does NOT want his examiner to think that he views the experience as a sexual one, but his body seems to be stating otherwise.
Is there some way that this concern, too, could be addressed?
By the way, Mark also said “I see nothing sexual about intimate medical procedures. To me it's all about respect, morals and ethics”. To this, I can only respond “AMEN”.
Maurice, You write "No.. we usually don't tell the male patient ahead of time that they may experience an erection during a genital exam because it is truly a rare occurrence and there is no need to have a patient anticipate such a possibly embarrassing event. Do you really think we have to introduce or support the thoughts of the patient that we are about to perform a sexually stimulating procedure? I don't think this is a part of necessary informed consent."
If one knows that this is a physiological side effect of an exam, one could argue that if the patient knows ahead of time, just like a mature man knows how to control when an erection happens, a patient in this situation can mentally prepare himself and possibly control the outcome. The idea of not informing someone of something that could be so detrimental to their mental health is just as slippery a slope as forgetting to mention that you can get cancer from taking a certain drug, or die from a heart cath.
Who is any doctor to determine what is right or wrong for the patient. Forgetting about the masses, suppose you are the one who has that erection. How would you feel then?
belinda
"The patient is usually aware of the gender of the physician prior to the meeting and unless the patient is brought in to an emergency room critically ill and needs immediate attention, the patient usually has an opportunity to find a physician of the desired gender."
I agree essentially with what you're saying, Maurice. But it's one thing to limit this discussion to a doctor visit for a non emergency physical exam, as you're suggesting -- and other thing to open it up to the kinds of experiences Mark is writing about in the earlier post. I'm speaking more generally, about all kinds of exams where patients usually don't get to choose the gender of their providers.
I would say, though, that American medicine needs to spend more time studying the psycho-social aspects of the patient experience. Much of what I find is studied by psychologists or sociologists, and most of the writing in this area is written by patients.
But in the limited example you're giving, the basic doctor-patient visit, I agree with you in essence. And I also agree that both parties need to get together. We need to have more forums with doctors, nurse and patients together discussing these and other issues.
StayingFit, thanks for reminding me to add that, of course, at the onset of apparent penile erection, our first words are that this is a rare but normal reflex response. We then explain what normal functions the erection represents but we don't make something sexual out of it. By the way, this reaction is truly rare. I don't recall it happening more than a few times in my entire career. But it is important for medical students to learn that this reaction can happen and how to deal with the situation.. especially of concern to the female students.
In response to Belinda who wrote: "If one knows that this is a physiological side effect of an exam, one could argue that if the patient knows ahead of time, just like a mature man knows how to control when an erection happens, a patient in this situation can mentally prepare himself and possibly control the outcome." I really don't think that physicians want to make the genital exam a sexual exercise which could be misinterpreted by the patient as such if we started detailing this rare event at the outset of the exam.
My theory:
Though society has given physicians permission to view and touch the individual's unclothed human body with the individual's specific consent, nevertheless the ongoing professional behavior requirement for physicians to avoid any suggestion of sexual intent or acts probably makes us less likely to bring up the subject to the patient and thus may contribute to the concerns and reactions which has been repeatedly and in detail described on this thread over the years. Any discussion with a patient regarding the issue of sexuality of a physical exam is forbidden. What do you think about my theory? ..Maurice.
I did not have a sexual response to my procedure. Thank goodness because the assurance that “your nerves are ok” wouldn't have helped with my humiliation with the unflinching stare of the two female nurses!
I believe, many of you know more so please weigh in, there are three things going on with a nurse during a procedure that involves the genitals.
1. The nurse is helping the doctor.
This is what you would expect. In my case one nurse did help change the doctors gloves. The second nurse did not help, she only observed. Over all there was little help and lots of staring. I think a male or female could help a doctor equally.
2. The nurse is compassionate and helps care for the patient.
Compassion comes from empathy. I don't believe a 18 to 25 year old female nurse can empathize with a naked male having penal and rectal manipulation because of gender differences. Being female detaches them from what the man is feeling. I believe a male nurse would empathize better just because he is a guy. I have no experience with this but I believe a female nurse may be more compassionate if I was in pain etc.
3. The nurse has a sexual interest or response.
I think both male and female nurses would make some evaluation of the patients genitals. But I believe the male would not be so critical because he is a guy and most likely less interested. A lot of my problem came from the older nurse, who was like 27, giving a smiling grin to the younger nurse who looked 18. This was some sort of sexual response.
So my older nurse got a 1, she did help the doctor. My observing nurse got a zero.
A funny thing is my wife and I have had three children. For each birth there was the doctor and a nurse. For this volume study, which doesn't compare to giving birth, I had a doctor and two nurses.
Mark
Some of this is rehash, but may be new to Mark and others coming to this Blog.
PT economics has a great deal to do with it. Do you honestly think providers have not figured out if the nurse or tech teating a female patient they are more vunerable to a lawsuit than the other way around. Do you honestly think they do not know more women than men will resist or complain than men when they are unhappy or uncomfortable with the gender of their provider? So if you have the choice, provide both gender of providers to suit all or choose one and pretend you don't know. So economics has everything to do with not trying to hire and provide more male providers, it may not cost more for a male but it cuts efficiency, which is money.
Dr. Bernstein, I have just a ton of respect for you and Dr. Sherman for what you are doing BUT, you are seeing things from a providers side. (1)You state patients can choose the gender of their providers, in most cases this is true, HOWEVER, we do not get a choice in who our provider brings into the room with them. This was Mark's issue, not the provider, the fact that there were two female support people. We have no control or knowledge of this (2) I have yet to see a consent, information, or any other form provided by medical personell that asks anything about this issue or even gives space to add anything else that might concern us or might make us comfortable (3) while it is true this should be a two way conversation, the power dynamics that favor the provider place the burden on the provider. While I understand what you are saying, there are area's that indicate providers DO understand mroe than they admit, i.e. how many male mammographers are there?
How is it that the medcical community can recognize female mammographers are more comfortable with same gender techs and not make this connection elsewhere.
Why does the medical community feel the need to train other providers trumps the comfort and right of patients. I don't think this is an indication of providers being bad people, it is an indication of the "blinders" we all put on when we view our side of any issue. Female reporters earnestly justify their right to be in locker rooms. Providers earnestly justify their lack of understanding of patients concerns, the need to impose on patients with students, the vailidty of thier self centerd accomodation of patients and honestly believe they are doing the right thing...without asking the other side, is this right for you? Doesn't make them bad, makes them human, but it doesn't make them right....is asking really to much? Don't have an hour, agreed, asking about their comfort or modesty is to much? the guy at BK asks you want on your burger, and that is for a 99 cent hamburger and a min. wage position...sorry do not agree with you,,,.alan
Relative to this whole discussion: I just watched an episode of "Untold Stories of the ER" on The "Learning" Channel. I put "Learning" in quotes because I question the education value of this particular episode.
Several serious, life and death, cases are happening during this episode. As one might expect, the comic relief case is a man with a priapism. Granted, he did something stupid to get it, but the whole case is treated as a joke. My points:
1. In our culture, men's genitals and any problems related to them are often treated as funny. Look at all the hit in the crotch jokes and videos.
2. Within this episode, a medical student treating the man with a priapism is required to hold the man's genitals to put pressure on the penis. Here we get the whole "homophobic" bit. It's a big joke. The idea of touching another man's genitals is quite humerous to this medical student. Later, the medical student laughs and says that the first thing he did afterwards was wash his hands. So much for professionalism.
3. Can you imagine the same kind of joking and humor portrayed about a woman's genitals during "medical" show like this. Can you imagine a male medical student joking like that after examining a female?
4. Finally, what's most upsetting is this: The real hospital where this took place, and the real doctors involved in this case -- allowed the filming company to frame this case as the comic relief section of this episode. Whether this kind of behavior really exists at ER's is one thing. The point is, these "real" doctors allowed a man's discomfort and suffering to be the butt of a big joke in order to provide some comic relief for an otherwise serious program. This is not so surprising in Culture of the Celebrity. Everyone, even doctors, want their 15 minutes of fame -- even if it's at the expense of suffering patients.
So -- how does all this fit into what we're talking about?
Doug, does anyone want to write to the program producers and the hospital to complain? Priapism is not a joke and neither is displaying unethical, unprofessional behavior as a joke. ..Maurice.
I think writing to the ER show, america's funniest home videos and other shows would be a good idea. It seems shows like afv have an agenda to denigrated men's genitals.
Mark
Maurice: I think we should write. But to the producers? I think not. It's not the program producers I'm most upset with. I don't really expect high professional standards from reality TV and Hollywood. I'm more upset with the hospital and doctors working there who allowed themselves to be used by the media. When programs like this are made, the producers script out the sequences and play with the "reality" of what actually happened, and coach the actors, who are mostly the real medical staff. Reality TV is about plotting stories, creating conflicts, building characters. Producers and writers take the reality and work with it they way the think the public will eat it up. As a side note -- the episode of "Untold Stories of the ER" that followed this one, had yet another man with a priapism that was again used as the comic relief. The man, of course, was show to be a pathetic idiot. He was actually assaulted in his hospital bed by his mistress and his wife. Did did the hospital report that? So much for spousal abuse when a man is at the other end of it.
Again, I am not suggesting that most ER staff are like this. I am suggesting it's unprofessional of them to allow TV producers to use them to create stories like this that make light of men and their suffering. I want to call attention to the cultural/social context within which we are discussing this issue of men and genital exams. How do you think men feel about how they'll be treated in an ER or the hospital after watching episodes like that? These shows reinforce all kinds of negative stereotypes and attitudes. They help shape cultural attitudes toward men and their bodies and their sexuality, attitudes that I can't help but believe also cross over into some of those in the medical profession.
I would write to the TV producers of that show -- but they don't care as long as their ratings are up. It's more important to let those hospitals and doctors know the damage they're doing.
Maurice,
Not only do I disagree with your theory, nobody said that an erectile reaction to probing is sexual at all. And...the idea that a patient might would only further his humiliation.
What is at the crux of the situation is the patient's perception of humiliation and trust that the procedure and what happens are explained properly.
Psychological trauma (and I have said this over and over) can only happen when things are unexpected.
Looking at all of these situations the more a patient knows the less likely they are to be traumatized when something occurs.
Naturally, so many unexpected things can happen that it would be impossible to discuss everything.
Informing a patient of a physical reaction, though rare, might happen, relieves the patient at the time of the "happening" from extreme humiliation to embarrassment. Knowing this might happen takes away the stigma of self blame for the patient furthering the humiliation.
How would one feel after the procedure feeling extremely humiliated because of an involuntary erection, when you find out that the medical team knew that this could happen and didn't tell you?
What do you think that does to ensue trust with your patient? What do you think that does for future procedures with that patient? And, what if that patient could have been spared a lifetime of psychological stress if he had a male team predicated on the knowledge that because he could have an erection, the procedure psychologically would have been intolerable to him?
Knowledge is power. It gives patients the fortitude to have procedures done when they know exactly what to expect. That's why I explain at the beginning what I want, why I want it and the consequences of not being told.
Mentally, withholding information that could cause extreme psychological damage is as bad as not informing the risks of a medication or surgical procedure.
It's amazing to me that while medicine is in the 21st century, these psycho social issues are still in the middle ages and it also seems like plain common sense, sensitivity and feelings have gone out the window since the civil rights act when the medical profession decided to erode everyone's right to privacy.
belinda
In regards to Mark commenting on there having to be 2 nurses present during his exam as compared to only 1 nurse present during his wife's deliveries. I understand completely his puzzlement. I felt the same way about my colonoscopy. I had no idea there would be so many people in the room. The doctor used propofol for sedation so there had to be an anesthesiologist, who was male but he also had a nurse (male also). In addition to them was a nurse, technician and the doctor (all female). It was upsetting to me because I was never given any information about who would be assisting, was never introduced to them, etc. I purposefully chose a female doctor because of modesty concerns. We, especially as new patients, do not know what questions to ask and therefore feel humiliated, surprised or otherwise unprepared about what ends up happening. In my case, similar to Mark, I did not understand the need to have so many people (especially the male nurse anesthetist) in the room for a routine colonoscopy. Nothing was explained to me. I wonder if all this personnel is just another way to hike up the cost and cover possible liability issues. I agree with Belinda, however, that it is the unexpected that often triggers these feelings of being treated disrespectfully (even if unintentionally). I was told afterwards when I did express my concerns that the doctors/nurses do not tell patients all the details because most of them do not want to know: in other words they feel like they are doing the patient a favor by not disclosing everything; they are sparing them the embarrassment since they will ultimately be sedated anyways. There is never a thought that everyone might not feel that way. Some of us do not feel comfortable being "asleep" and not knowing what happened to us or who did what to us, etc. I agree that information should be offered to the patient before any procedure/exam. Just my feelings.
Anonymous, just for reference, I had a colonoscopy several years ago. There was only three people. The male doctor, male nurse and a female anestheologist. She stood at my head.
This was a better experience. I should write the doctor and thank him.
Mark
It is the research that references psychological trauma MUST be unexpected. That's not to say that someone's feelings of embarrassment will go away if they know; they just won't be traumatized.
Once something happens to you, you are now prepared. Make a checklist
I always have a female team for colonoscopy and there are three people in the room, a doctor, nurse, and anethesiologist; that's all.
I also refuse and let the doctor know from the get go; no same gender team no consent. I have never had a problem since that time.
There are many people walking around that have some aspects of PTSD, avoidance, recurrent thoughts, etc. are all part of the process but without history of mental disorders we as patients are kept "in the dark". So, if you're finding yourself avoiding procedures at all cost, it might be an element of PTSD. For me, it's not that. It's about feeling degraded. My awful experience changed the way I feel about the medial profession, level of trust.
Trust is something to be earned. They have not. While I'm always pleasant and personable when I go for a procedure, I'm also steadfast and have walked out of a few procedures when they decided to tell me that a female suddenly wasn't available. That's how they learn; when you are adamant about what you want and why you will get it. If you give them "wiggle room" and you settle not getting what you want, then it's on you.
Sometimes the benefit of the procedure outweighs the modesty issue. For me, it never will.
Let me end with this. I have found that the medical profession is not "out to get us". Knowing what you need, what you expect helps them to satisfy what's important to you and for that...a giant THANK YOU!!!
belinda
Maurice
Why is it that your students are taught that only
male patients might be sexually aroused . Seems to
me this only adds to the bevy of double standards
that men face, not to mention the notion that men
like these kinds of exams.
Are men not looked at as some wierdos from
a porn arcade. Careful my female medical students,
these male patients will get hot and bothered by your
mere presence. So use great caution and have a good
comeback ready at your disposal. Really, is that what
you tell your students.
There is a thread on allnurses titled catherization
expirinces. Yes, that is how they spelled it and one of
the posters mentioned that during urinary catherization
it is best to have a village present. This seems to be the
mentality among these people. How many people does
It take to do a pap smear? How many does it take to
change a lightbulb?
You don' t hear of crowds of people at the gyn
office watching women get their annual pap, yet there
they seem to come out of the woodwork when a male
needs a cath,interesting.
PT
ANONYMOUS WRITES: "I was told afterwards when I did express my concerns that the doctors/nurses do not tell patients all the details because most of them do not want to know: in other words they feel like they are doing the patient a favor by not disclosing everything; they are sparing them the embarrassment since they will ultimately be sedated anyways. There is never a thought that everyone might not feel that way."
I agree with this assessment, and this attitude bothers me more than others. It's almost as if doctors and nurses are taught "scripting," i.e. cliches, generic statements that are supposedly "designed" to make "the" -- all patients -- feel better. My contention is that these are often designed to make the doctor or nurse feel better rather than the patient -- in that now the doctor or nurse can at least say they have done or said something rather than saying or doing nothing. I am not suggesting this is done on purpose out of spite. It's mostly a subconscious defensive response. In fact, I'm beginning to believe that at least half of these modesty problems patients have in medicine are due to the modesty issues of the doctors, nurses and other aides and techs. A significant amount of their behavior and the policy they follow is designed to protect their modesty issues. In regard to the above statement, I wonder whether these polices are really in place to spare the patient embarrassment -- or if they are really in place so the caregiver won't have deal with their embarrassment in having to deal with an embarrassed patient.
Providers shouldn't assume all patients don't want to know the details. They also shouldn't assume all patients want to know the details. I'm a patient who wants to know the details, and I've often found it's like pulling teeth to get those details. Providers are often not used patients pushing for the details and either don't want to give them or feel uncomfortable giving them. Yet Dr. Bernstein is correct in his contention that doctors just don't have the time these days to spent with patients to get this information. I don't know the answer, except what has worked for me, i.e. don't be afraid to bring these topics up with your providers. I either find them to be glad that someone has brought them up, or very uncomfortable discussing them.
"the posters mentioned that during urinary catherization it is best to have a village present. "
If female nurses are afraid of male response and need to humiliate for their perceived safety, this would be another reason for same gender nurse.
PT, you write "Why is it that your students are taught that only
male patients might be sexually aroused " Actually, we don't frame our advice in sexual terms since we don't consider the beginning erection as something other than a reflex but we are concerned that the patient may be embarrassed and without anticipation and knowing what to do about it, so will the students. With regard to female patients having a pelvic exam or procedure, there is no sexual stimulation leading to orgasm or signs of something pleasant occurring, in fact the exam may be discomforting. Students learn by teacher-subjects the professional words to use to relax the patient and allow a thorough exam to continue. ..Maurice.
I was discussing the issues of concern from the male writers to this thread with a female bioethicist. She made the following statement in which she wonders whether the basis for the male concern was whether "women finally having authority positions where women now do the poking and prodding men have always done? I doubt it's the touching, it's the authority position."
Have we discussed this possibility that whatever the nurses or technicians certification or academic history, it really is the fact that they are having access to the man's body in a position of authority? What do think about that suggestion? ..Maurice.
I don't know, Maurice. Ask your female bioethicist if she believes some females have in the past and continue in the future to feel subject to the power behind uncomfortable, embarrassing poking and prodding by male physicians. Why wouldn't some men feel the same? If power is the controlling factor, it goes both ways with both genders. Frankly, I don't think anyone, male or female, particular feels comfortable with poking and prodding in these personal areas. I would also ask the female bioethicist what difference it makes whether it's the "power" element or not. Isn't it more about patient comfort, how the patient feels, what makes the patient more comfortable? As I've said before, do we have to psychoanaylze patients to find out why the prefer one gender over another for these kinds of exams? Women have certainly made their preferences clear when it comes to pelvic exams and birthing environments -- no question about the gender they prefer these days.
I'm sure the power element is valid and goes for both genders when it comes to these exams. Being naked and vulnerable in front of a clothed person makes many people feel powerless. We know this to be a fact. That's why the strategy is and has been used during war, in prison situations, and during military inductions. Get people naked and it's easier to control them because of their powerless vulnerability. I can show you references from doctors who say they were taught that getting people naked makes them easier to control.
I'm curious. Does the female bioethicist think this is only a male thing, this lack of power connection to the gender of the provider?
Maurice
So what you are suggesting is that female patients
are never ever aroused during any medical procedure
and that only said procedures are unpleasant and
uncomfortable for females and not for males.
Naturally, the female bioethicist is speaking from
her female brain as if to say all males of the human
race must now pay the price for all females who have
endured male positions of medical authority.
"She wonders wether the basis for the male concern
was wether women are finally having authority positions
where women are now doing the poking and prodding."
She is a bioethicist and she has to "wonder"! Is this
how she reaches conclusions. A bioethicist is an advocate
for the entire human race,not just half of it!
Apparently, double standards are not part of her
vocabulary
PT
Without knowing the female biethicist I couldn't say how she approaches things, but I would ask if her response is not generated by the fact that many women bring crimes of the past to their viewpoint. Women in the past were treated as 2nd class so this must be the reason, men resent women in power. This is similar to what we hear from some providers isn't it, I am a professional so....the issue becomes more about the provider than the patient. The approach is if I the provider accomodate in a way I feel is appropriate the patient should be fine. The basic fact is, we are taught from the time we are young being naked infront of the opposite gender is embarassing, it is wrong, we will even punish you if you are intentionally naked infront of gender or in public. Being naked infront of same gender is not a big deal, even expected in males (sports locker rooms). While there is the man up mentality, it is not nearly as aggressively pushed as covering yourself infront of opposite gender. Yet, providers have pushed the thought that when we walk through the doors of the facility we are suddenly able to suspend all of this conditioning and when we walk back our waa laa its all back no problems. Some can, many don't, some can't. This is compounded for many by the fact that we feel providers ignore or degrade our feelings, which to us are normal. Why would Mark feel violated, embarassed, or humiliated when we have an extra female watch a cath inserted in his penis and a wand inserted in his rectum, after all she was a nurse whether she was truely involved or not, she might need training. How could he not be fine with that he needed it? Why should be be ok with it, it is about providers not him, it violates everything he has been drilled with for X years. Once again the anaolgy between female sports writers and providers may not be popular, and there are a lot of huge differences, but there is an important similarity, both see the interaction from their side, not the athelete or patients.....alan
I'm suspicious of opinions which are tailored to a given philosophy, in this case feminist ideology. Does your ethicist have any evidence to back up this viewpoint?
I agree with Doug that no matter what the reasons are, and I'm sure they vary for different men, it does not invalidate the men's preferences. It seems to me that the ethicist's opinion is just a way of belittling men. She would not respond similarly to women's preferences.
Just for the record, I was assured that the male anesthesiologist and his male assistant were at the head of the table and on the other side during my colonoscopy and that I was covered with blankets and not exposed (only my buttocks were and only the doctor saw them, supposedly). So, my concern was taken seriously and the doctor and facility did make a quick effort to address it. I can only choose to believe them and think that my modesty and dignity were respected even during sedation. It still bothers me to this day, however, that I do not know exactly what happened during that 30 minutes or so but that is perhaps a different issue: a reaction to being "out" and not liking it, although part of it is because of males being present. I have never had the experience before and now feel like I will never consent to it again unless I need some life-saving operation. I have learned, however, much like Doug: I will definitely ask for more details if I ever have to undergo a medical procedure again and I will not consent until I feel satisfied with the information. It is unfortunate that it takes a negative experience (as a new patient) to realize how much this issue impacts your psyche.
Well there is to be a meeting between myself and about 7 of the hospital administration I wrote to on Jan 3. Boy I feel so out gunned. I am afraid this is going to be bad. But I want to make my point... Wish some of you more eloquent speakers lived in Northern Va.
Mark
Mark, good for you. If you feel you need some coaching from someone who has a 30+ year history with this sort of thing, Maurice has my e mail.
In either case, good luck and we're all rooting for you. Let us know what happens.
belinda
PT, you wrote: "Maurice So what you are suggesting is that female patients are never ever aroused during any medical procedure
and that only said procedures are unpleasant and uncomfortable for females and not for males."
I have never experienced any suggestion or indication that a patient of mine was aroused during a pelvic exam. Further, I have had only a few examples in my career of a man starting to develop a penile erection. I think that a genital and/or rectal exam is not a pleasant or eagerly awaited experience for either gender. It is just that in male patients rarely penile erection may occur and students are taught how to react. ..Maurice.
Mark, they are concerned as they should be.
1. Every patient should be supplied with a Patient's Bill of Rights. It is a violation if you did not receive one
2. Patients must understand what is going to happen during a procedure so that they can give INFORMED CONSENT. If a patient does not give his/her informed consent or does not understand the procedure, it is considered assault.
3. Patients are guaranteed dignified and respectful treatment. That is according to the Patient's Bill of Rights. Make it clear that you do not consider your treatment to have been respectful but instead it was humiliating, demeaning, substandard and UNACCEPTABLE.
4. You should have been given the names and "jobs" of everyone involved in your care. You have every right to know why they needed to be there.
5. You should have been ASKED if you consented to having a student involved in your care. The student should have been identified.
The administrators know these things but may play dumb.
Do not let then patronize or condescend to you. You have every right to complain about the way that you were treated. I would SPECIFICALLY mention the "knowing look" that the one nurse gave to the other. That is inexcusable and those nurses should be reprimanded.
Mark: Hope you get to read this in time, before your meeting.
Remember, you're in control of the issue that's on the table, not this committee of seven. The issue is about you, your dignity, your privacy, your value as a human being. The issue is not about schedules, professionalism, problems in healthcare, or whatever.
Also, the issue may also be (depending upon the atmosphere at this meeting) why you're being hauled up in front of a group of seven medical professionals. If they treat you professionally and humanely, that's one thing; if you're ganged up on -- that then becomes the issue. The issue becomes medical intimidation and bullying. Make sure you focus on not only what's being said, but how it's being communicated to you -- the tone.
Maurice: I do want to add this regarding the comments of the female bioethicist. Joel had it right. Her comments are connected more to feminist ideology than they are to bioethics. Notice how she turns the issue on it's head. It's not about the feelings or dignity of the patient, men in particular-- it's about the power and politics of medicine, i.e. who's in control. The theme of "power" is highly embedded in feminist ideology. I don't know if your quote of her comments are exact, but, she talks about women "finally" having authority positions. "Finally."
Here's what your female bioethicist doesn't seem to "get" -- which a significant number of medical professionals don't seem to get. I quote this from a study out of B.C., Canada called "'Not the swab!' Young men's experiences with STI testing" by Jean A. Shoveller and Rod Knight, et. al. from Sociology and Health & Illness, Vol. 32, No. 1, 2010.
"For most participants STI testing was characterised as a potentially sexualized (as opposed to a strictly clinical) experience. In particular, the genital exam represented a vulnerable and highly sexualized situation...While service providers have training to
neutralise these situations, patients tend to rely on their social context and personal experiences for clues about how to behave. Clearly, the exposure one one's genitalia -- or the 'nude body' -- is never rendered neutral or stripped of cultural values...Thus, the vulnerability of a man's exposed body is fundamental to understanding young men's experience with STI testing...Vulnerability in this context is epitomised by the possibility of an 'unwanted erection,' a situation in which a man is unable to choose between his 'public' and 'private' sexual impulses -- for many young men, this reflex may represent 'a glaring failure of privacy'...and a loss of control over their sexuality (something that may also cause them to question their masculinity."
Based upon findings like this, the ethics are clear -- patients in general, and men in particular, must be allowed to choose, as the article says, the gender of the provider for these kinds of exams. Health care providers can say whatever they want about their "gender neutral" philosophy -- but it goes against cultural norms. Just because providers don't see these exams as sexually charged, that doesn't mean patients, esp. men, don't feel that way about them. It's clear that some, perhaps a great many, do. Frankly, I think a significant number of providers, doctors, nurses, aides, don't consider what's quoted above. They see it only from their side, i.e. this is only a clinical experience. For them, maybe, but not for many patients. They don't "get it." They don't get the unique experience men can have in situations like this, and esp. the symbolic nature of the penis in our culture and how it's connected to men's feelings about their masculinity.
Hi Mark,
Why not raise the issue of the numbers before the meeting? I suggest you could write or email them back and whilst thanking them for agreeing to the meeting, ask them to consider if having 7 or so present isn't a bit intimidating?(You might suggest that you are sure that this wasn't there intention, but you are also sure that they would be keen to make sure that you are confortable in raising very important issues).
You could finish off by asking them to think about how they would ensure that you are able to raise your concerns in a confortable and respectful environment.
Chris
I have had a few conversations and so far they seem genuine in their concern and interest in change. I am hopeful.
Mark
Maurice: I do want to add this regarding the comments of the female bioethicist. Joel had it right. Her comments are connected more to feminist ideology than they are to bioethics. Notice how she turns the issue on it's head. It's not about the feelings or dignity of the patient, men in particular-- it's about the power and politics of medicine, i.e. who's in control. The theme of "power" is highly embedded in feminist ideology. I don't know if your quote of her comments are exact, but, she talks about women "finally" having authority positions. "Finally."
Here's what your female bioethicist doesn't seem to "get" -- which a significant number of medical professionals don't seem to get. I quote this from a study out of B.C., Canada called "'Not the swab!' Young men's experiences with STI testing" by Jean A. Shoveller and Rod Knight, et. al. from Sociology and Health & Illness, Vol. 32, No. 1, 2010.
"For most participants STI testing was characterised as a potentially sexualized (as opposed to a strictly clinical) experience. In particular, the genital exam represented a vulnerable and highly sexualized situation...While service providers have training to neutralise these situations, patients tend to rely on their social context and personal experiences for clues about how to behave. Clearly, the exposure one one's genitalia -- or the 'nude body' -- is never rendered neutral or stripped of cultural values...Thus, the vulnerability of a man's exposed body is fundamental to understanding young men's experience with STI testing...Vulnerability in this context is epitomised by the possibility of an 'unwanted erection,' a situation in which a man is unable to choose between his 'public' and 'private' sexual impulses -- for many young men, this reflex may represent 'a glaring failure of privacy'...and a loss of control over their sexuality (something that may also cause them to question their masculinity."
Based upon findings like this, the ethics are clear -- patients in general, and men in particular, must be allowed to choose, as the article says, the gender of the provider for these kinds of exams. Health care providers can say whatever they want about their "gender neutral" philosophy -- but it goes against cultural norms. Just because providers don't see these exams as sexually charged, that doesn't mean patients, esp. men, don't feel that way about them. It's clear that some, perhaps a great many, do. Frankly, I think a significant number of providers, doctors, nurses, aides, don't consider what's quoted above. They see it only from their side, i.e. this is only a clinical experience. For them, maybe, but not for many patients. They don't "get it." They don't get the unique experience men can have in situations like this, and esp. the symbolic nature of the penis in our culture and how it's connected to men's feelings about their masculinity.
Doug, the words were hers as she wrote them to me. I provided her with an opportunity (with a link to my posting of her words) to write anonymously further about her views. I do think that her introducing the concept of the role of "authority positions" into this modesty issues discussion is certainly a valid one {which really has not been debated here} but certainly may not be the only factor. ..Maurice.
Actually, Maurice, I also think the "authority postions"argument is a valid one. But it has been brought up, at least I've brought it up, several times on this modesty thread. I brought it up pretty much outside the gender discussion, as a general idea in the relationship of patients with doctors. As I recall, you argued against it. I recall you focusing on the patient choosing to come to the doctor and that choice somewhat negated any power difference. I could be wrong, but that's how I remember it. So I do think that for some men having a women in position of power over them when they're naked is significant. Look at The Abu Ghraib Prison Photos, and how women were also used with the Detainees at Guantanamo Bay. It is and has been an intimidation strategy for a long time. It's power used as sexual weapon.
But what's more significant is what I quoted above -- the fact that for men "the possibility of an 'unwanted erection,' a situation in which a man is unable to choose between his 'public' and 'private' sexual impulses." You state that this is rare. But it's the "possibility," the "potential" that is the psychological factor some men face.
What are you thoughts on my last post and the quote from the study?
The reason seven medical professionals want to meet with Mark is to prevent any kind of legal action against the hospital.
I met with a team, they made the decision to change some things, report some people and I made the mistake of not prosecuting the hospital. The reason I say made the mistake, that even though they did some things, I never felt validated; only that they wanted to appease me enough to get me to go away.
belinda
http://www.huffingtonpost.com/richard-c-senelick-md/health-care-privacy_b_1140930.html
Interesting article from a male M.D., who didn't seem to understand the feelings of a patient until his own wife expressed feelings of humiliation. I appreciate the honesty, and wonder how often feelings are overlooked until it happens perhaps not to you, but someone you love and respect.
Note how even as an M.D., he did not want to "upset the apple cart" and encouraged his wife just to get it over with. And note as well, the comments about mentality when it comes to male patients.
Suzy/swf
belinda brings up a good point. The make up of the team of 7 will tell you much about the motivation behind the meeting. If, for example, 2 of those 7 are someone from risk management and a lawyer, then we know what the meeting is really about. Let us know who was at the meeting.
I do not argue that the power dynamic may play a role in some issues, I would not argue that a female in that position may play a role in some, but to jump to the position that a female "finally" in power as the first thought would indicate a feminist mentality first and bioethics second. In Mark's instance the "power" position was a male. I think most of the posters here would agree they would be embarassed and humilated if they accidently were exposed the to the opposite gender in the locker room, if they dove into the pool and lost their suit infront of the opposite gender, if they walked out of their bathroom naked infront of the opposite gender, none of these instances involve a position of power, they involve exposure to the opposite gender. Do women who have problems with exposure to males suffer from the power dynamic, it that the main issue. Does her thought have a place at the table, I believe so, is it the main or one of the main arguements, I don't think so. the fact that it is the first thing that comes to mind for her makes one suspect of her objectivity. Including the term "finally" reinforces that doubt. I have no problem what so ever with a female MD, NP, RN poking and proding me, as long as I am clothed. On multiple occassions I have agreed to allow female students to partcipate in my care, unless I was to be exposed, its the exposure to opposite gender, not the gender that is the issue..alan
Alan, you are correct. However, this power issue is not gender specific. There is (by nature of the relationship) a power differential between a patient and those who care for them.
One could say that the workers at the lowest level (CNA, home health aids, TSA workers etc) are individuals who never had power are now empowered with the most power toward an individual--the power to humiliate someone who is vulnerable.
This is the mindset that is dangerous across the boar with respect to education. Anyone entering a field that gives them that power, I feel, should have to go through a series of psychological examination that will expose their true motives of going into such a field in addition to background checks.
What I have learned on this blog and through life is that we as human beings, fail miserably, lack empathy.
This issues about the opposite gender and bodily exposure is just that. It is not gender specific, it effects all of us and the abuse of power also effects all of us without respect to gender of the offender or the patient.
belinda
Belinda it appears you misunderstood my post. My post was directed to the response of a female biethics professional whose first thought was she wondered if men's issues were not due to women "finally" having the power role. To clarify, I have no doubt the power dynamic is an issue for some, I have no doubt opposite gender increases that issue for some. In this case it happens to be a female bioethics professional who entered the male gender resisting females in positions of authority into the issue. Again, I find it interesting that the first response of a provider is to turn the discussion into what the patient is doing wrong to create this situation. It isn't about the provider violating the patients modesty, or even the patients modesty, it's about the patient displaying chavanistic tendencies toward the female provider who has "finally" reached her rightful place. This plays out in many of these scenerios, it isn't about the patients modesty..its about the new nurses need to learn, it isn't about the patients feeling uncomfortable about their exposure its about the fact that the provider is a professional or has done this many times before...alan
Going into my humiliating procedure I did not ask for male nurses. I was totally unprepared for how totally embarrassing it would be to have this procedure performed on me in front of the two young woman. I didn't know I would be exposed by my doctor with no compassion. I have had other less humiliating procedures with female nurses and it was fine.
So those are my excuses for not requesting same gender nurses. Why should the hospital care if people don't ask. Why don't most men know how bad this will be. Do most women know?
Mark
We have recently talked some about men understanding the embarrassment. I am asking in case this comes up in my meeting. They seem very open and understanding. I am very hopeful but I want to be prepared.
I mentioned here that maybe it's because women have already, unfortunately, have embarrassing experiences at a young age.
Mark
@ Doug "Medical professionals are taught strategies to desexualize the clinical encounter, which they should do. Medical professionals don't see the clinical exam as sexually charged -- not to say it couldn't be for some under some circumstances -- but they are taught strategies to mitigate this, to desexualize it. One reason for using gloves. From their point of view, there's nothing sexual involved in the nudity of medical exams and procedures."
OK, Dr Bernstein, I dare you to tell your med students "If you really believe the above statement is true, remove all of your clothes and put on a gown. Each of your fellow students will now perform the complete exam on YOU"
I would love to see the expression on their faces !
Mark don't beat yourself up, most of us have the same stories. We don't know what to expect and we assume our modesty and emotional status will be a priority. When we find out otherwise we blame oursleves. Instead turn it to a positive. You know now, don't let it happen again and try to make providers aware and acknowledge, you will feel a lot better, let it go and move on take control, you will be surprised what it will do for you..best wishes, alan
It is the event itself that medical school teachers are insisting must be "desexulaized" because the genital exam intent is for screening, diagnosis and treatment (if necessary) and NOT to complete some event whose intent is to be sexually stimulating Now, that doesn't mean the patient doesn't have some sexual connotation to what is occurring and especially men who may rarely develop a penile erection. And that doesn't mean that novice physicians (2nd year med students) don't feel apprehensive that this examination might be considered by the patient as sexual. They do, with various degrees of anxiety. So that is why (at our school in early January) the students are going to be given direct professional instructions from both men and women teacher-subjects about how to behave, what to say and what to do as they examine these subjects. One thing I am sure they are told is not to initiate any discussion of sexuality involved in what is to occur unless the patient brings it up.
Hopefully, our students will carry with them and follow these instructions in the future. ..Maurice.
A few years ago my son had an elective surgery to remove his Adenoids. He was required to take everything off under his gown (what a ridiculous name, it's no more than an apron). I still haven't heard any reason why he had to be naked, since the entire surgery was above the neck and no foley was needed. The only reasons I can imagine are that they wanted to prove their complete power over him for their overwhelming egos or it involved perversion.
Ever since that experience he won't go back to visit a doctor for anything. Chalk up another human life destroyed by the unethical medical world.
SS
Maurice - modesty of a women is in the forefront of a providers mind. The protocol for women considers her modesty and is considered respectful. Modesty for men is at the back of providers mind if they think of it at all. It seems protocol for men is designed to disregard a man's modesty. Do you teach this also?
Mark
Mark, I have given birth to three children and had a back surgery as well as other procedures (colonoscopy, etc) in my life. I was TOTALLY unprepared for what I experienced in the radiation oncology center, like you were. The way they proceeded, the total disregard for modesty and dignity, allowing others to observe etc etc. were shocking to me. There are many ways that this could have been made less traumatic and more sensitive and they need to be told that this is unacceptable. So, NO, women are NOT used to what you experienced either, let me assure you.
And, how would we know if we have never been treated this way before. Never in my wildest imagination would I have suspected that they would be so oblivious to my discomfort. So don't blame yourself that somehow it is YOU who isn't used to being exposed to a variety of strangers in the manner that you were.
Alan, I agree when you write, "Again, I find it interesting that the first response of a provider is to turn the discussion into what the patient is doing wrong to create this situation." After I wrote a letter of complaint to the hospital, filled with recommendations, I was questioned as to whether I had been sexually abused as a child. My response was, "no, I was sexually abused in your radiation treatment center."
Going into a meeting, if one finds their experience traumatic to them, asking for the same gender care is something they can understand.
You must explain that it's not about preference. It's about the patient feeling humiliated.
More complicated for some, and this is something everyone must decide for themselves, how likely are you to have a similar procedure done with the opposite gender present.
It's only by mandating that you need a same gender team that you will get it if there is any extra effort required by the staff.
In my situation, I explained that I was abused, tell them what happened if they ask and based on my experience it's easy sailing or...I walk and take all my business from that hospital and let them know why. Money talks.
belinda
Mark:
You mentioned that women may be more prepared for the embarrassment of certain medical procedures because they most likely have had early encounters of that nature. While this may be true for most (with child bearing, birth control, etc.) it is not true for us all. I never had children and had few medical encounters since I have excellent health. So I was not prepared for the extent of the embarrassment and resentment about lack of information after a fairly recent medical experience. I completely understand, therefore, even as a woman where you are coming from. To me, all these variables only go to illustrate that we are all individuals and have different comfort levels, etc. That is why I have a problem with the way the medical establishment wants to treat all patients the same: just accepting that we are all fine with whatever happens as long as we are getting "care". There is no attempt to treat patients as individuals with different needs, concerns, morals, gender preferences,etc. I truly hope that by meeting with the hospital staff you will at least be able to open their eyes to this fact and I also hope it will help you get past this. I also hope, as Alan does, that you have learned from this and will be better prepared in the future to negotiate what you want to make you feel comfortable.
I really appreciate this group, everyone is so great!
I didn't mean to imply women are more prepared for embarrassment but were more prepared to understand how embarrassing it could be. Then more ready to demand consideration.
I certainly with empathize with everyone.
I also appreciate advise about moving on. Time is helping but at the same time I want to make a difference, at least for now. Holding on to as much of my emotion as I can stand helps provide drive. I will admit it is hard on my wife and family.
Mark
What I see happening is this: Some medical schools, like Dr. Bernstein's, are really trying to deal with and teach the importance of patient modesty. Other medical schools don't have a clue; in fact, but by not teaching this ethic they are in essence diminishing it's importance.
I still claim that, due to the current corporate nature of health care in this country -- the hidden curriculum quickly takes over in hospitals with unhealthy cultures. The process becomes about moving patients in and out of the system quickly. It becomes about efficiency, i.e. treating everyone exactly the same is cheaper. IMO, this is one of the key problems. There seems to be a great abyss in some cases between the humanistic medical education that Dr. Bernstein represents and is trying to integrate into the system -- and the actual practice promoted by the money-grubbing interests with American health care.
Mark, we talk to the students about modesty issues in general as applied to both genders. Of course, there will be differences between genders such as exposure of the chest in men for examination vs exposure of the chest in women. Overall, as I have previously written, we tie in modesty with the need to keep the patient warm, comfortable and not shivering. The intent, overall, is that of emotional and physical comfort but the intent and goal is also the performance of the physical examination under conditions which will provide the most pertinent and most representative (free if artifacts) information about the medical state of the patient.
Doug, I am not sure I would say that Univ. of Southern California Keck School of Medicine is unique in teaching attention to patient modesty. I suspect they all do in different ways. Such attention just has to be paid since we are dealing with live human beings and not cadavers. I would agree, however, the detrimental effects of the student's, intern's and resident's exposure to the "hidden curriculum" later on in the student's learning career and later when they are exposed to the financial and time-limiting issues among others when in later practice. As I have stated in the past, all we can do is implant the best and most ethical ideas and then suggest to the students that they should "speak up" if they find that patient modesty is being ignored in their future clinical experience. But we also know that "speaking up" is painful and worrisome when they must speak up to those who presumably are their senior and are supervising and grading them.
And then the promotion of the "hidden curriculum" can be looked upon in an entirely different direction. It is the patient who doesn't "speak-up" to the doctor about their own modesty concerns that fails to provide the doctor with a clue that modesty in the face of the need for diagnosis and treatment is the most important. That, unfortunately, until reading about some patient's concerns on my blog, was my "hidden curriculum".. that everything was just fine and proceed with the examination! ..Maurice.
Maurice - I have been told by providers at my hospital that the modesty of a women is in the forefront of a providers mind. The protocol for women considers her modesty and is considered respectful. Modesty for men is at the back of providers mind if they think of it at all. I also believe this is wide spread. So why is it like that if male/female modesty is taught equally?
Mark
PART 1 OF 2
Maurice: I'd like to give one view answering Mark's question, if you don't mind.
Mark -- The history of nudity in Western culture, esp. in the last 100 years or so, is very complex. Let me suggest a few trends.
-- In ancient culture, the male nude has been considered a threat, dangerous, and wild, on the one side, and vulnerable, on the other. The female nude has been considered threatening to males in that they are seductive, tempting, suggesting sin.
-- Part of masculinity in Western culture is the notion that men should be comfortable with their nude bodies, not ashamed of them, but rather proud of how they reflect on their masculinity. For women, the notion is that is that they should not be comfortable with their naked bodies, not only because their nudity can cause the "wildness" of men to threaten them, but also because of how men (and other women) have portrayed the taboo aspects of female sexuality -- menstruation, pregnancy, birth, etc. Women often were required to be out of society, especially out of men's sight, during these events.
--- The whole notion of bodily privacy has changed dramatically. That has something, among other things, to do with our move from a more rural society to a more urban one -- with esp. emphasis on indoor plumbing and other innovations. Esp. after WW2, more people became used to individual sleeping quarters, private bathrooms, etc. In the past, it wasn't uncommon for several people to sleep in one bed, and even bathe together in close quarters.
--- Bathing -- Before indoor plumbing people mostly bathed outside in lakes and rivers during warmer weather. Women would often wear some clothing while bathing. Men most always bathed naked, and together with other men. There was little or no self-consciousness. If women passed by, men were expected to cover up, in deference to the female sensibility regarding male nudity. To really annoy the women, men would flash them with no feeling of embarrassment to themselves, but rather to make the women feel embarrassed.
--- The social changes I've described toward nudity changed rapidly. The WW2 and Depression generation, who raised the babyboomers, regarded male nudity and privacy much differently than we do today or did their children.
TO BE CONTINUED
PART 2 OF 2
--- People have commented about the nude photos (from behind) of high school boys showering in Life magazine, or other photos in Life of military recruits lined up nude, shot from the rear. There was no sexuality attached to these photos. Male nudity in those contexts was considered healthy, and quite acceptable, even in family magazines.
--- Much changed with the women's movement and feminism and women in the workforce and women in sports. Women popped up in more places that had been traditionally associated with only men. Most men had accepted male nudity when there were only men around. It was a way of bonding for men. But now, at times, women were present. A good example of this: some of the male military induction procedures during the 1960's and 1970's. Women weren't around for that during WW1 and WW2. Their absence had nothing to do with preserving male modesty; it had to do with preserving female modesty. But the same "old guard" military men who favored health male nudity in these military inductions and who had gone through it in the past with only men around -- now faced a culture that hired women clerks, and aides, and nurses to replace the male medics, doctors and orderlies who had conducted the exams before. These "old guard" officers couldn't stop these females from being hired or inducted into the military. They may not have wanted it, but it was politically incorrect of them to try to stop it.
--- If you doubt all this, check out the first scene in the 1960 Disney movie, Pollyanna. This a Disney movie, a family move designed for children of all ages. The first scene shows a young boy, maybe 10 years old, naked, and swinging on a rope into a pond with other swimming naked boys. Their naked rear ends are clearly visible. That was considered completely nonsexual and healthy in 1960.
--- With all the sex crimes in the news today, pedophilia cases -- it's difficult for us today to view some of these photos in a non sexual way. We can't understand the mindset, the world view of our society's attitude toward nudity even 50 years ago. We can't comprehend it. Look at how common it was for young males to swim nude in high school gym classes as last as the 1970's. I recall being forced to swim nude at YMCA pool as a youngster in the 1950's. Women weren't forced to, just men and young boys. Some people still don't believe that happened. It did and was quite common. The question isn't so much why it happened. The question is why have we forgotten that it even happened, or doubt that it was true. Some people considered it to be part of an urban legend. It shows how much has changed culturally regarding nudity.
So, Mark -- this is a complex topic and I've just touched the surface. This is part of the reason why male modesty today is treated so differently than female modesty. Times have changed but the old attitudes and cliches linger on, as is almost always the case in studying social history. Men's view of nudity has changed, but it hasn't been recognized, and male nudity is still viewed or framed in the context of offending women rather than embarrassing men.
Doug,
While I agree with what you say there is that other component. Title VII that is part of the Civil Rights Act.
Prior to Title VII, hospitals employed orderlies to do all those private things like surgical preps, cath's for men.
Title VII says that an employer cannot discriminate due to race, ethnicity, religion or gender when hiring an employee. There is an exception to that law that has to do with privacy. Ex. when a job is posted as a restroom attendant, the employee will be selected based that their gender will be the same as those using the facility. Somehow, the medical community decided to ignore it.
So, it is your right to have your privacy protected. However, nobody has challenged the medical community to make sweeping changes.
Where they have been challenged is in labor and delivery and mammography. Women spoke up. Women refused the male employees and hospitals were forced to hire same gender care in these departments. However, are we less naked while getting showered, prepped for surgery?
Should the public keep pushing, keep refusing, the hospitals will find employees without work and social change must come and it will if everyone had the same mindset. Unfortunately, for us, they don't.
All we can do is report problems. The biggest problem is when these issues move from embarrassing to traumatic with lasting mental issues creating stress, prohibit healing. Nobody can mend when they feel unsafe, when they don't trust the staff, when their issues are ignored.
Every male has the same rights as every female. If I were in that position ( and I have been) I'd go back to that hospital and tell them that they are breaking the law with your privacy concerns and that you will. I would seek treatment and then tell them how much money the hospital lost.
belinda
Belinda
Women have never spoken up in regards to their
gender preferences with regards to mammography,
L&D, and post-op gyn floors. They never stood outside
of hospitals and clinics holding signs stating women
only should work there. That has never happened, why?
First of all these potential patients would never need
to protest. Those on the inside have quietly taken care of
that,silently and efficiently. With over 98 percent of human
resource directors, labor & delivery and step down post
op floors are managed by female directors.
The same people that keep most nursing floors
feminine only environments are the same people that
ensure men don't work there and particularly their male
patients don't get respectful care for privacy issues.
Same hiring practices,same double standard care
mentality. Hospitals are rather stupid in the marketing
arena but are very adept at keeping secret,mistakes,
hiring discrimination and just bad care.
At one hospital I worked at a female physician
went into a rage and physically assaulted a male trauma
patient. Up on the nursing floor a young women was kept
in her room on suicide watch and managed to set her
mattress on fire and was burned to death.
Would you believe not one of these incidents
made it to the paper.Amazing!
PT
PT, It's important to remember that if we all look, you will find that people of all genders do things that they shouldn't, behave in ways that they shouldn't.
Women have always been protective of their modesty and while there is an element of truth to what you say, I know for a fact that women would not tolerate males doing these intimate procedures. Also, women have gravitated to female ob/gyn's when they became available. It's just a normal progression of things.
I do agree with you that things that happen in hospitals are swept "under the rug" and hidden as much as possible.
Things happen in all arena and crimes/abuses are committed by both genders. Why can't we work together instead of making this a gender war.
belinda
belinda & PT -- I'm just trying to give some social, historical background. I'm not necessarily justifying anything that's going on today. But I do think it's important to try to understand these forces. Cultural forces and much more powerful than most people think. We think we can just overcome them by willing it. May not be that easy. Many of these forces exist under the radar. We don't even realize consciously we following them.
I say that any adult female who utilizes the healthcare
system in this country contributes to a system that
knowingly and systematically discriminates against
male patients.
I would go as far to say it is a criminal enterprise
when you factor in all the inequalities, unfair hiring
practices and unchecked misconduct.
Consider for a moment the busing scenario in the
1960's whereby blacks either had to sit at the back of
the bus or give up their seat for a white person. If you
supported the busing company then you approved of
this practice.
Our healthcare system is engineered and designed
to protect female patients, simply because women do
essentially all the hiring, keep the same policies and
business as usual.
It begs the question,hire more males and the system
reaches equilibrium,otherwise the system will never be
fair to male patients. But then that is how they prefer the
system.
PT
PT, the thing is, why would you think women would realize what men are going through when we have historically not verbalized our concerns. I am in my 50's and recall watching the race riots of the 60's and watching TV, listening to people blaming those involved without having a clue of why. It is not a woman's primary responsiblity to look after us, it is ours. If we want their help, 1st we need to tell them we have a problem and 2. we need to ask. As a whole we remain silent, so why would we blame women for using the system when we do so without protesting ourselves?....alan
Sorry for the several days late publication of several commentaries. I did not receive notification of their arrival. You may want to look back several days to read these comments. ..Maurice.
Alan
What I said was that they contribute, financially
support a system. I do believe they are all aware of
the inequalities as long as it dosen't affect them. When
you think about it there are hospitals for women, hospitals
for children, but not hospitals for men.
PT
PT, You are blaming women for voicing their needs and getting what's important to them and equating that by doing so, we are somehow against the male population.
So, what do you think we should do?
Just forget what's important so that the system seems more equal to you?
What you are saying is that any group of people that stand up to be recognized and make change is discriminating to everyone who doesn't belong to that group or that somehow by doing so we are putting others in danger.
Who's fault is it that men haven't stood up to the system? You have some preconceived notion that women are out to get men. It's the same notion that some women have about men.
What this whole thing is really about is recognizing the privacy and dignity of every individual who uses the healthcare system. Nobody has the right to tell a segment of the population that has suffered the way women have throughout the ages from rape and other types of sexual assault (in numbers that exceed by leaps and bounds the record of male assaults) that they should not have rights. That would put everyone's liberty in jeopardy.
You are a wonderful advocate for men. Let's work together to make a safer healthcare system for all.
belinda
I tried to state this before but the message was lost.
I was asking about why women understood the embarrassment that could occur in these procedures and men don't. I made a guess that women had unfortunately been exposed to bad medical experiences at a younger age. This experience made them more proactive to their needs.
I certain didn't mean to say that women because of these experiences were now ok with it. I don't know how anybody could be ok with the treatment I received. I think both men and women would suffer more each time.
I think the problem of medical disregard of male decency is related to men not speaking up. Why that is what I am trying to understand.
People concerned about the difference in treatment of men need to make a differece.
Mark
"I think the problem of medical disregard of male decency is related to men not speaking up. Why that is what I am trying to understand."
Mark: I don't think it's too difficult to understand. Men don't speak up for at least two major reasons:
1. Most haven't had the experience women have had with intimate exams or procedures. As you suggest, women experience this from an earlier age. So much of the time, men don't really know what's coming, since they haven't had the experience and they're not willing to speak up and ask what's going to happen and who will do it.
2. In our culture, and in Western culture in general, men have been and are taught not to complain, to suck it up, to be a man, to not wine. That behavior is associated with their manhood, with the whole concept of masculinity.
3. Here's a theory -- I think men are actually more modesty than women. In the past, when it was always clear to men that appearing naked in front of women was usually more embarrassing for the woman than it was for the man -- that may have helped with the man's embarrassment because the women was more embarrassed. That's not the always the case anymore, i.e. doctor and nurses who either are not embarrassed, have learned not to be embarrassed, or make believe they are not embarrassed. That makes the patient more embarrassed than the doctor. When one party is more embarrassed than the other, or appears to be, that clearly demonstrates wwhere the power resides. Historically, I think men, having more power of cultural mores, have transferred their embarrassment on to the women, i.e. making it culturally more taboo for women to be seen naked. Men have always been embarrassed, but by transferring that embarrassment to the the female, ti helped them mitigate the embarrassment for them. That's my theory anyway.
Belinda
As I've stated before and I will reiterate again
that it was female nursing staff that has been the voice for
women and in doing so they have initiated mass discrimination against the male population. With that said I have responded to two of your questions.
Men have made requests and the responses
are so stereotypical, "why,you don't have anything that
we haven't seen." Or , "well, we don't have male nurses
on this floor."
Please stop using the rape card,it dosen't apply
here,this is about privacy and respectful care. Personally,
half of all the men who have died in all wars should be
women. Women want freedoms too,therefore they should
pay for them as well.
Here are a few of my suggestions Belinda. Women should have to pay much more for health care,
since they get much more respect for privacy, ie,95
percent female nurses,higher percentages of other
female related staff. There are hospitals for women and
not for men, tack on a one time a year fee to all female
patients. Medical institutions would then use these monies
to create free tuition for prospective male nurses.
Pass laws for male patients since we are the
minority and underserved with regards to privacy in
healthcare.Make a mandatory fine for the owners of
medical blogs and permanent revocation of female
nurses on said blogs who post disrespectful comments
about male patients.
Create a task force at every medical facility
that automatically interviews every male patient
about their concerns for privacy at admission and
discharge.
Now Belinda with that stated I believe that
answered your third question.
PT
PT, I feel you are being too hard on Belinda. She too has suffered indignities by the medical system like you and me. I haven't read every page of this blog but she has been very compassionate about my treatment. I like Belinda and she should be considered an ally. Plus I want a woman's point of view and harsh words will chase them off.
Mark
PT, The only problem with your arguments is that they are not for all; just for some.
The "rape card" is reality. You cannot make rules for only one part of a population. That's now how anything works.
There is a reason that I became a writer/researcher into the psycho social aspects of medical care that are detrimental to mental health.
I do not doubt that there are inequalities with everything but when it comes to individual experience, it is the patient alone.
Your first comment suggested that women not use the healthcare system. Your second comment offers an unequal rule base.
As far as I am concerned, everyone has read both of our postings and mine speak for themselves as well as yours. I do not intend to continue your gender war; it's not about that and it never was for me. Somehow, it is for you and you will find in time, that the systems needs change for all, not some.
Mark, Thanks for your confidence in me. Feel free to contact me off the blog (Maurice has my information) for information on how to best deal with the hospitals.
PT, we get the message but I think you are just proving a point you may not have intended to prove. Misogyny has been around a long time and is still alive and well (look at how women are treated in many Muslim countries). Women have had to fight for equal rights and for respect. Women have had to fight for respectful treatment in the medical arena which may account for the attention we might or might not be getting.
Also, don't forget, women are the ones who bear the next generation and the physical consequences. This is what women's hospitals are about. The historical rate for death in childbirth is around 1 in one hundred.
Mark:
I applaud your standing up for women's comments on this blog. I will continue to follow this discussion even though some posts are so anti-women. I agree, also, that it will take an effort from BOTH sexes to change the system. I do believe that men deserve the same respect as women in health care. I also tend to agree with Doug and you that men are generally not as aware as women of the potential for embarrassment in medical procedures; for the reasons stated above. However, it does still boil down to individual comfort levels. I have asked my husband how he feels about female nurses, etc. in intimate care situtations and he is not all that uncomfortalbe with it. I, on the other hand, am extremely uncomfortable with male care for intimate procedures. And my husband has had some experience in the situation and I do believe that he is telling the truth and not just attempting to "man up". So there is probably some truth in what Belinda says about changing the system: many people do not feel the way we do and if there is not a significant push by a large enough group I cannot see any major changes happening anytime soon. Jean
Hi Belinda, got your email from Maurice and have emailed you. If you haven't gotten anything, check that Maurice has your correct email.
Hi Jean, I am glad you are with us. I hope your husband never has the experiences that have had. I was totally unprepared for how totally embarrassing it would be to have this procedure performed on me in front of the two young woman. Especially the smiling glances and when one pulled up a chair and just stared at my genitals. I know some men and woman say they don't care, but I believe they naive. I don't think it would be healthy for any man or woman to be fine with my experience.
I personally feel women will be part of fix for men. Women, as we have said, are more aware of the problem. They will advocate for the men in their lives, they will try to make the men they know understand that they need to be shown dignity. I know women on this group have shown me compassion and told me their stories and for that I am very thankful.
Mark
Well, some comments here seem to have hit an all time low. I don't see the need for women to defend themselves for being here, anymore than men should. The subject is still "patient modesty" and that includes everyone. Most of us admit male modesty is much much (much) less respected, but there is room for every point of view.
The only sure thing is that one gender's rights will not get any better without the co-operation of the other.
suzy/swf
PT,
I appreciate most of the points you bring up regarding the double standards and the very real female power structure of the operation of hospitals. Especially good was your standing up to the "rape" diversion that was used--I call it the "abuse excuse." You should know that there are those who very much agree with you, and are probably the majority.
Unfortnately, I rarely have access to a computer nowadays. Keep the faith.
--rsl
p.s.: misandry was always and is much more common than misogyny, it just didn't have agency before.
rsl:
Yes, lots of good points are always made….and then lost in the next and next and next volumes. They are then resurrected with much fervor, then lost again until someone wants to malign a group and fracture fine intents.
What are always passed up are the “let’s do something about it” posts. Alan mentioned he and I are crafting a web site that it might get done and out there. We have a few hurdles and would like input from everyone. Any takers?
http://afpmgoals.blogspot.com
I would like to think that the years of blaming could be over so we could start the work of healing. And then the work of changing. And then the work of making a real difference.
Not everyone has to agree on everything; just agree changes need to be made.
Suzy/swf
Suzy, count me IN. I will assist in any way possible.
Gail
I agree with Suzy with regard to the repeated turnover of the worthy points as we move from Volume to Volume. Important conclusions should be
preserved and acted upon if desired rather than losing them and later exposing them as something new. By the way, as you can see by the
number of comments this will be on Volume 45 (141st), we will be moving shortly to Volume 46. So.. keep the ideas alive and don't bury them. ..Maurice.
Belinda said
" PT, you are a wonderful advocate for men"
No I am not. I now believe my efforts would
be more fruitful as an antagonist to women.
My goal is to bring more male nurses into
hospitals, convince males to be mammo
techs.
Mark said
PT,I believe you are being too hard on Belinda.
Belinda made comments that are misleading.Mark,
remember it was women who brought you to
this blog. It was women who were unprofessional
to you.
Maurice
I believe each volume brings forth new facts and
new perspectives for our readers.
rsl:
Always good to see initials I recognize. Thanks
for the kind comments.
Charlotte
Men pay the bulk of health insurance in this
country yet get less bang for their buck. Women
on the other hand consume most of the healthcare
dollars and get the most amenities.
PT
Maurice, It's perfectly fine for you to say that I made misleading comments. However, I cannot take any responsibility or accountability for these comments without identification.
Nor, can I make an adjustment if I agree with you, nor can I defend my comments.
I'm not saying this is the case, but sometimes people write something and that's not what they mean.
I must say that it seems that you are actually contributing to the gender war by identifying that women abused Mark. Why should that matter? Abuse is committed every day by both genders.
Please identify those comments you felt were misleading. Thank you
belinda
PT:
Maybe if women consume most of the healthcare dollars that is why they get the most amenities? Actually, I saw a recent article that showed women pay a higher rate for health insurance than men of equal age. It is just assumed that women generate more cost so they are in turn charged a higher premium. So, that is unfair to women like me who rarely use the system, etc. There are a lot of inequalities in the system for both sexes. As far as women being the ones who disrespected Mark in his medical procedure, I believe his doctor was a male and he obviously did not do anything to make the situation more comfortable for Mark. He was ok with the nurses' behavior. So, as a male he was just as much at fault for letting the disrespect happen.
Mark:
I think that you are definitely correct in that your experience was so profoundly disregarding of your dignity/modesty that it would have had the same impact on anyone. And I do believe that if my husband would have an experience of that nature he probably would also be humiliated even though he has accepted female nurses in the past. It seems that once an experience is so blatently offensive, that is when the issue comes to the surface. I believe that Gail also had this problem. In other words, you both seemed to have had medical experiences in the past, even with opposite gender care, that were acceptable because you were treated with as much respect as possible. It is just the unexpected, "ambushed" experiences that cause the damage. Unfortunately, once that occurs it leaves the patient reluctant to go into any future medical exam/procedure. I guess the positive outcome would be that once this happens, that person can more successfully navigate the system and get what they want/need. Jean
Maurice, I believe I misread the blog; if so, please disregard my most recent post. I must make a note not to post until after morning coffee; sorry for the mistake.
belinda
Belinda, I think you are challenging the wrong individual. As moderator, I am taking a neutral stand on all the discussion except for the points that I think patients should communicate their desires to their physicians, physicians should listen and the point that modesty should never trump a life and death significant examination or procedure.
If your response was to the posting yesterday at 8:52 pm, it was by PT who wrote to Mark "Belinda made comments that are misleading.Mark,
remember it was women who brought you to
this blog. It was women who were unprofessional
to you."
Remember, ethical moderation even as practiced by hospital ethics committees does requires not taking sides but only educating the stakeholders with regards to the facts and facilitating their own discussion so that they can come to their own final decision. I present this thread on my blog, I moderate it and it is up to the visitors and participants to come to their own decisions regarding the issue and its outcomes. ..Maurice.
NOTICE: AS OF TODAY DECEMBER 20, 2011 "PATIENT MODESTY: VOLUME 45" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 46
Post a Comment
<< Home