Patient Modesty: Volume 47
We continue here the discussion regarding how the concerns about healthcare provider gender selection by patients and ways for the patient to be more comfortable with those who attend them can be brought to the attention of all those who provide service and maintain the status quo in the healthcare system. ..Maurice.
ADDENDUM (1-16-2012) On this date, PT, a long-time writer to this thread on Patient Modesty, wrote the following comment which includes a potentially valuable suggestion for a method for those who want to change the current medical system regarding patient modesty and caregiver gender selection. This is what he wrote:
Alan said
" Rosa parks was a single woman who started
a movement with a single act of resistance,Malcolm X
took another path and my style is more like Rosa parks
than Malcolm."
My style is more like Genghis Khan until I
realized that the pen is mightier than the sword. My idea
to solve this issue is a 40 step process, meaning I have
put together 40 different avenues of approach over a
period of about 10 months.
Here is the first avenue, visit www.change.org
to start a petition. Now I suggest you start perhaps at a
hospital or clinic that you in the past had concerns with.
Others around the world will join the petition
and to be effective use multiple facilities in each city. Keep
in mind this is a medium to bring our concerns forward. The
first of many mediums we will use as I suggested in volume
46 of Dr. B's blog.
PT
NOTICE: AS OF TODAY FEBRUARY 20, 2012 "PATIENT MODESTY: VOLUME 47" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 48
Graphic: From Google image resource modified by me with Picasa3.
posted by Maurice Bernstein, M.D. @ 5:46:00 PM
152 comments
152 Comments:
Today, Jack wrote the following to the blog thread "I Hate Doctors: Chapter 3" which I thought might be pertinent to issues that have been discussed on this modesty blog. In order to maintain a notion of civil language on my blog, as moderator, I edited out some language but I think most readers will get the ideas presented. ..Maurice.
Holy [DELETED]ing [DELETED] people. I can't tell whether you are just angry people of what the [DELETED] is wrong with you. You expect doctors to figure out every single thing that is [DELETED]ing wrong with you then bitch and moan when they don't because you haven't been to see them in 10 [DELETED]ing years. [DELETED]ing hell this seems to be the blog for whiney little asshole who are either jealous they failed at life. And by the way it's probably not your doctor thats the problem it's probably YOU. Stop [DELETED]ing bitching if you never visit your doctor, never tell them anything and completely stonewall them when they ask questions and things. Oh and to the person who said they got "violated" during a pelvic exam and thinks there pediatrician is a pedophile and plots to kill your mother and can't be in a relationship, GROW THE [DELETED] UP. The genitals is just another body part that needs routine check ups to stop lots of harmful diseases. Your pediatrician isn't a [DELETED]ing pedophile he's a professional who was concerned for your health and was merely doing a routine check up so stop [DELETED]ing whining because you turned it into an ordeal 20 times bigger than it had to be. And while maybe a tiny portion are assholes most doctors are cautious because [DELETED]wits like you people will sue them to the ground if they say one [DELETED]ing thing wrong so seriously take a good [DELETED]ing look at yourself and ask, is it my fault or theirs. [DELETED]ing bunch of whiners.
Signed, Jack Perstein
Oh..one more thing. It looks like Jack has, by his missive here, met the request on the graphic of this Volume to "speak up!" I guess there are, at least, two views about which to speak up. He took one which I really haven't seen here much on this thread. ..Maurice.
Speak up. Yes -- on that note Jack is correct. But here's where he and others are complete wrong: "The genitals is just another body part that needs routine check ups to stop lots of harmful diseases.
I've written about this on past posts. The genitals possess tremendous symbolism -- definitely in Western culture and probably in most cultures. Historically, we haven't worn the clothes we wear just for protection from the elements. Go back to some of the earliest Western literature -- the story of Adam and Eve. After eating the apple, why were they ashamed to be naked? Why did the feel the need to cover themselves? There's more meaning to the old fig leaf over the genitals than people think.
Is it healthy to feel good about your body, and to be comfortable naked? Yes. Is it part of human nature to have embarrassment and shame associated with the genitals? Yes. How one feels about being nude in front of others depends upon the context, and upon how those the nude person is around feels about seeing some in the nude. I'm convinced that nudists wouldn't feel comfortable walking around naked if most people view them viewed them in negative and sexual ways. They feel comfortable because they're naked around people who feel comfortable with naked people. Most people in our culture don't feel comfortable being naked around people who are clothed.
I am a little curious, after reading this rant with all of the deletions why would anyone expect to take him serious. I can go find a guy with tin foil wrapped on his head to prevent alien abduction to support my position, but it wouldn't provide any proof of anything. What we are seeing here are for the most part people speaking about how how THEY feel about their experiences not condemning those who do not feel as they do. On the other hand, I do agree with Dr. Bernstein that people need to step up, speak up, or shut up. Suzy started a site which I have tried to support and we tossed it out ther for partcipation with no takers. If you have other efforts in the works like PT great (though to be honest PT I am a little aprehensive as to what you have in mind)...but preaching to the choir accomplishes little...alan
Now I can't say if the pediatrician who forced a pelvic exam on me at the age of 5 was a pedo or not, but I can tell you he was a well known crack addict for many years and was dating my Junior High P.E. couch who was also a crack addict. Please fall off your high horse.
One thing I would suggest though is maybe a pamphlet for each practice since there's no standards so the patient knows exactly what will happy. Will it be a cold metal speculum or a plastic one? will you be forced to have a pelvic exam to get birth control? Can you bring your own robe? Can you have your husband in the room with you? These are important things panicky patients may not be able to discuss.
Nekura,
I don't think that everyone who has modesty concerns should be labeled "panicky" insinuating that there is something wrong with people who have concerns.
As a matter of fact, it's normal to have questions about the unexpected.
What would make sense if protocols were established regarding chaperone policy, what to expect, and instructions on how to move forward and who to contact for clarification and negotiation.
Remember...the problem isn't that there is something wrong with us. The problem is that there is something wrong with the system that effected us in a negative way necessitating the need for a look at practices and what could be done better.
belinda
I agree with Alan.
Why would anyone take a rant like that seriously? Perhaps Jack is impressed by his own expletives, but I don't believe the vast majority of people would be.
I totally agree that people need to speak up for themselves and take an active roll in managing their medical care - in fact I have been advocating exactly that since the first time I posted here.
For me it goes beyond modesty. It's also something I've been doing for many years - since the day I very nearly died because a medical resident, without informing me, gave me a medication that I was allergic to. And it wasn't an honest mistake - the drug allergy was documented in my chart and he ordered and administered it anyway, over the vehement objection of a nurse who refused to do so, I might add. Within 90 seconds I stopped breathing. His excuse was that a lot of people say they're allergic because they don't like the side effects. It was a wake up call for me - hopefully others won't need one like it, as I wouldn't wish that on anyone.
And for those that think it couldn't happen to them, I'd suggest they think again. Recently released results of a study done for the federal government indicate that the odds of a hospital patient being the victim of a medical error are 1 in 3.
I just don't get society. First off, I don't believe any opposite gender nudity other than your spouse can be considered ethical. What I don't get is why sometimes opposite gender nudity is considered OK in our society, sometimes it's considered bad, and sometimes it's forced. If I were to drop my pants in front of an 18 year old girl in the street or at school I could get arrested, serve jailtime and have my future destroyed. If that same 18 year old girl is later wearing scrubs though it's not only expected of me to get naked for her but it's quite possibly forced on me.
In a scenario that's off-topic on this blog but very similar, if I were to drop my drawers in front of a six year old girl in normal life I would be sent to prison, hated by everyone and be considered a sexual deviant for the rest of my life. But if I'm in a men's locker room changing or showering and a father brought his six year old daughter in with him, it's not only OK but I would be considered immature and an anti-single-parent jerk if I objected. Same situation if I was an athlete and a female reporter decided to enter and watch me shower. If I object to that I could be sued and possibly kicked off the team.
Is "sexual intentions" the difference? How do we truly know what any medical person's intentions are when they join the medical world? Are we to believe that medical workers and female reporters never have sexual thoughts on their minds when they take advantage of their jobs to see naked men? How about men that really enjoy being seen by female nurses, as well as female reporters and young girls in the locker room? Many men intentionally set it up to happen that way. Are they any more innocent than those that flash women in public?
I've never been in any of those situations and I don't ever intend to be, but this subject just really bothers me. Why are reporters, young girls or mothers inside men's locker rooms, or women wearing scrubs any more entitled to men's nudity than everybody else? How can the act of getting naked in front of a woman or even a young girl be evil if you're inside one particular room or building but expected to happen in front of the same woman or girl in another building?
The only consistant fact about all these scenarios is that the naked man is NEVER considered the victim.
GR
Alan said
" Rosa parks was a single woman who started
a movement with a single act of resistance,Malcolm X
took another path and my style is more like Rosa parks
than Malcolm."
My style is more like Genghis Khan until I
realized that the pen is mightier than the sword. My idea
to solve this issue is a 40 step process, meaning I have
put together 40 different avenues of approach over a
period of about 10 months.
Here is the first avenue, visit www.change.org
to start a petition. Now I suggest you start perhaps at a
hospital or clinic that you in the past had concerns with.
Others around the world will join the petition
and to be effective use multiple facilities in each city. Keep
in mind this is a medium to bring our concerns forward. The
first of many mediums we will use as I suggested in volume
46 of Dr. B's blog.
PT
PT, a great suggestion! Speak up with your pen!!..(well, actually with your e-mail and those of others who agree with you.)
Go to Change.Org (Note: with this link, you just click and don't have to type it into your computer.)
You must read the entire website including the "About & Tools" at the bottom of the page.
Good luck! ..Maurice.
As you may have noted, I put PT's latest comment up as an Addendum to my introduction to this Volume. ..Maurice.
GR writes: "How can the act of getting naked in front of a woman or even a young girl be evil if you're inside one particular room or building but expected to happen in front of the same woman or girl in another building?"
As I've written in past posts, it's cultural, esp. within Western culture. I'm not justifying it. I'm not saying it's right. But here it is, as I interpret it from cultural history.
Opposite gender nudity in Western culture has a focus on offending the female. The focus isn't on embarrassing the male. The assumptions suggested that, in medical situations, men should be grateful that women are willing to risk offense to themselves by viewing a naked man. At one time, nudity was very class oriented. The lower classes, servants, were considered not worthy of attention. They were, in essence, invisible. The upper class talked about the most private affairs around them. Thus, aristocratic men were not offended by having female servants take care of them when they were ill -- or appearing nude in front of servants, even females. The sentiments of female servants were not considered important by society. They weren't worthy of being offended.
Let's go back to Homer's Odyssey. Odysseus, naked and exhausted, is tossed ashore on Scheria. Nearby, princess Nausicaa and her maids are washing their clothes. They discover Odysseus. Seeing a wild and naked man, the maids run away screaming, but Nausicaa stays and helps Odysseus. Odysseus is actually afraid that his nudity will offend or frighten the princess. That could mean death for him in strange land. That's where the focus is -- on his nakedness offending the woman. He's grateful that she isn't offended by his nakedness and helps him.
Some have criticized me for wasting my time on past attitudes. I offer no apology. We can never completely escape the cultural past. We can try and become successful in many areas -- but not completely -- unless you revert to 1984-style brainwashing. GR -- I'm not saying this is right, or moral, or ethical in today's world. I'm just suggesting that this is how we came to be where we are today. I think it's important to understand this.
You all may be interested in reading the current conversation going on at present on my blog thread "I Hate Doctors: Chapter 3". ..Maurice.
Part 1
Doug:
Although we cannot argue the facts of history, we can see it from another perspective.
“Opposite gender nudity in Western culture has a focus on offending the female. The focus isn't on embarrassing the male.”
Let’s consider that our “Western Culture” came to us from other cultures, when many years ago the focus became the sacredness of male nudity vs the almost non-existent belief in the sanctity of female nudity. I refer a bit to the religious cultures since politics, religion, and laws were firmly entrenched in one another. From Paganism to Judaism, the public perception of the nude male form changed from artistic, to unacceptable, when the notion that Man was created in the image of God(s) and Woman in the image of earthly ‘man’. Male nudity became sacred….so holy that there were laws to protect the bodies of men. Hebrew/Israelite, (as well as many others) women could have their hands cut off simply by accidentally brushing against male genitals. The embarrassment and humiliation was for the man: the guilt and punishment was on the woman.
I have no doubt that women throughout the ages had to run screaming from a naked man, washed ashore or otherwise. They were conditioned to believe that the stakes and punishment for not were fairly high.
Part 2
We can skip a few years and see how female nudity in life, art, and pornography led to a lack of respect for the female form in general, and the acceptance of it almost in daily life. While things are swaying a bit in culture, men still feel the “group” humiliation of public exposure in art, film, and pornography whereas women must simply accept it.
Women fought back where they could, and that was (despite what the culture showed them) that at least in the medical arena their bodies belonged to them. They would choose exposure and care on their own terms. And this is where I believe PT has a valid point….it was sanctioned from the inside: women rallied together however covertly to protect each other.
So this is where many will not agree with me. A sort of ‘girls club’ was formed. Not on a conspiracy level, but more of a wink and nod. In this arena women could (very publicly!) have the power and advantage over men, and enter the sacred halls of the nude male form. I’ve interviewed many female nurses, and one theme always emerges if you let them speak long enough….””We can go and/or do what most women can’t”. (However not true).
My disappointment lies with these types of women. Those who fought so hard for respect for their own bodies, but would blatantly and (I believe cowardly) not fight to give that dignity to men as well.
Guys…break the ‘girls club’ mentality. It won’t be easy, but respect will not happen until you do.
The writer of the last 2 part commentary, please identify yourself with either your name or a consistent pseudonym, so we know to whom to reply. Thanks. ..Maurice.
oops...
Suzy
Suzy: Good points. I don't disagree. That's part of what we've inherited, too. I also agree with your concept of the "girls club" attitude that I also see among the nursing culture.
Belinda, absolutely! – “Remember...the problem isn't that there is something wrong with us. The problem is that there is something wrong with the system that effected us in a negative way necessitating the need for a look at practices and what could be done better.”
GR – Great observations, society has real problems. I was in Kohls the other day buying pants. When I went to try them on I found young women were in the men’s changing room helping boy friends try on clothing. Try doing that in the women’s changing room.
Doug – I appreciate and respect your efforts for men’s modesty but I too believe your history and YMCA posts aren’t helpful. Each time you post it I feel so beaten down, which I don’t think is your goal. Why do you say that you think it’s important to understand the history and we will never escape it? What civil rights movement, or any movement, went forward staring at the past? I think it is important to look forward to what we want.
Suzy – Thanks for your post. It is a very different way to view the past.
Suzy and Alan – I am willing to help with your efforts. I have gone to your site twice and like what you have but don’t see how to help. Suzy, you asked about the name of the hospital I have been talking to. I am not sure if they are good or bad yet. They listened to me and agreed to make changes but will they? I am not sure how to rate them yet.
Mark
Mark and others, let's not name institutional or other medical system names on this blog generally for comments regarding behavior to patients and particularly negative comments without the institution notified first and given an opportunity to respond and certainly not if there is a question as to how to describe the behavior as "good or bad". It is all about being ethically "fair" and "just" to these institutions and also for my blog to avoid libel legal action. ..Maurice.
Mark writes: "Doug – I appreciate and respect your efforts for men’s modesty but I too believe your history and YMCA posts aren’t helpful. Each time you post it I feel so beaten down, which I don’t think is your goal. Why do you say that you think it’s important to understand the history and we will never escape it? What civil rights movement, or any movement, went forward staring at the past? I think it is important to look forward to what we want."
You're right, Mark. I certainly don't intend to make you or others feel beaten down. I would hope it would give you energy to change things. I'm not saying we can never escape it. What I'm describing happened in a different world. Many significant changes have happened all around us. Rather than feeling beaten down, why not feel constructively angry. Fight. I was at a meeting the other day about health issues, and I pointed out that there are 2 offices of women's health in Washington, D.C. None for men. When I point this out, I was "constructively angry." Not shrill. But upset at the discrimination. The bill for an office of men's health has been consistently defeated year after year. After the meeting, two women approached me and said they were not aware of that issue and we discussed it. They were in favor of getting a federal office of men's health.
We all want to change "things." How we got where we are is important in the debate. To advocate, to debate this, it really helps to know this information and use it strategically to build your case. Yes, that's how it was. But that's not how it has to be forever. Let's change it.
the reason there is no 'mens' health office in washington dc is because all modern healthcare is predicated on men being the norm and women being deviants from the norm. the state of being a man is normal the state of being a woman is not according to the medical establishment.
As Mark said, I also have gone to the advocacy site and do not see a way to actually help. So many of us see health care providers on an infrequent basis: it would be difficult to get any kind of solid idea about which providers/institutions would respect patient modesty/gender choice. For instance, Mark said the facility he had the meeting with said they would address his concerns and make changes but how to know if that actually happens? Unless you are a "frequent flyer" it may be hard to know. I also addressed some concerns about an experience I had and the administrator was very quick to respond and reassure me of their committment to respect patient privacy/modesty and she even said she would address one of my concerns with the nursing staff and make changes. But who knows if that ever happened? So, Alan and Suzy, what ways do you suggest that we can help?
Also, Doug I find it encouraging that it was 2 women that approached you about the need for a federal men's health office. There just seems to be a feeling sometimes on this blog that women (especially those employed in health care) are not open to men being afforded the same modesty and/or health care considerations as women. I really think that most women are compassionate and that if more of them are made aware of men's feelings in this area they would see that we (women) are willling to work with men to help them gain respectful treatment. I know I fall into that category. I just see it as a human right and not one gender based. Jean
Mark,
I agree with Doug.
In a nutshell, knowledge is power. In order to effect change in any system, it's important to not only know where it is currently, but how it got there in the first place.In the words of Santayna, "Those who ignore the past are condemned to repeat it."
There's nothing wrong with an "I'm mad as hell and I'm not going to take it anymore" attitude as long as you use that anger constructively. Emotions can be a very powerful driving force, but are a two edged sword. It's important to channel that energy into a logical and calculated plan of action designed with malice and forethought.
That's the real difference between what Doug calls "constructive anger" (the term I prefer is righteous anger) and an irrational, overemotional outburst. With the former you have a decent chance of at least being listened to, but with the latter the odds are very good that you'll simply be dismissed as some kind of irrational crackpot, regardless of how valid your position may be.
Mark:
I know it sounds token, but sometimes we have to understand a bit of how we got to where we are to know how to make the changes it takes to get where we want to be. We know that not all change is good: certainly the patient/provider relationship hasn't always moved forward for the better. If we see how that evolved, then we can find stronger and better paths to take.
Thanx for visiting the site. If you want to help but are not sure how...leave a comment there and let us know. We can start that dialog, and let you know where we are and what we need. If you ( or anyone here) wants to be involved, let us know you are there, and we will let you know how you can help.
As Dr. Bernstein has always said...it is surprising what a little communication can do.
Suzy
Mark, my daughter once told me I am e-paired so if we can figure out how to get your email address, we are going start doing some work on the website and are considering using email vs blog for speed, not 100% Suzy is really the driving force on the whole site and the technology. Suzy can your give some direction on how to capture Marks email without showing it to the world.
Britt, one of the congressmen who actually sponsored the last try at establishing a Department of Men's Health lives in my state. I had conversations with him on his efforts. The problem he said is the view is men don't need help, men are advantaged so they can fend for themselves. This despite the fact that men seek medical help less and later then women, which contributes to the difference in life spans, a span that has actually grown over the past decade. While you see this as slap against womankind it is actually against men. they can take care of themselves, mens health issues are less of a concern. Our local TV ran a series on breast cancer in Nov....Nov is prostate cancer awareness month...nothing on prostate cancer....the reason there isn't a department for mens health is men are not seen as needing help, and we die younger as a result....alan
I have created a gmail account of the form xxx.bioethics@gmail.com. For me instead of xxx I used mark. I think these names may be easy to get. So if anyone wants to email me...
Jean - I may have mentioned this before. The chief executive nurse for the hospital I went to admitted that for women, modesty was at the forefront of their minds. For men it is at the back of their mind if they thought at all about it! She admitted it was wrong and hopes to change it.
Mark
Mark:
I hope the chief executive nurse sees that men's modesty is given the same priority as women's. It seems a little unbelievable that she admitted that women were afforded more consideration than men when it comes to modesty but at least she ageed that it was not right. I only wish more people, both women and men, would start voicing these concerns with providers because it may open their eyes and perhaps would help (slowly) change the culture. I know that some here are trying to take a more proactive effort at addressing this issue but it seems like such a daunting task with so many doctors, hospitals, providers, etc. It seems to me that it may be easier for people as individuals to advocate/negotiate for themselves in the culture that currently exists, for the time being anyways. I think until there is a better balance of sexes in all areas of medicine (nursing, techs, doctors, etc.) we will continue to have this problem. In the meantime, efforts such as Doug questioning the lack of a federal men's health office may go a long way in changing embedded thinking about gender in health care. Jean
Right now I'm involved with three healthcare committees in my community. I don't hesitate to bring up these modesty topics at meetings -- within the proper contexts. I repeat -- within the relevant contexts. If one just rants about patient modesty without understanding how to communicate it to medical professionals -- it's a waste of time.
Serving on these committees, working with doctors and nurses and administrators, has opened my eyes to how health care is run and where the priorities are. The vast majority of professionals are good people, caring people who want to help other people. But they do see things from inside the system, not always from the patients point of view.
I provide them with articles, some of Joel Sherman's and mine, as well as articles from professional medical journals that back up what we're saying about how many patients feel about their modesty. I'm finding them open and willing to institute change. With all the problems in healthcare today, medical professionals are focused on efficiency, money, patient safety, the Joint Commission, customer satisfaction surveys, etc. I find that no one is really advocating for these modesty issues. But when I do, and connect my arguments to how attention to patient modesty will affect their focus issues, and how that will in turn help with customer satisfaction and the bottom line -- I find they listen.
So -- one strategy I suggest is for those on this blog who really care to affect change -- get on your local health committees. You can make a difference.
Doug:
How did you find your community health committees and how did you get on them? I am not aware of any such thing in my neck of the woods. I live in a rural area but am close to a large city with a well known medical center (where I would probably go if I needed any major care). Jean
Jean: Most hospitals, esp. the larger ones, have community advisory committees. When health surveys are done in communities, those hospitals also create committees to review the questions and the method of conducting the surveys. Go to the hospitals and ask about these committees. Find out who the chairs are. Call the chairs. Frankly, most of the committees are actively seeking community members who want to devote the time. They need community feedback.
By the way, hospital ethics committees are also looking for community members. They will participate with the other ethics committee members in hospital policy formation from the ethical principles point of view as well as ethics consultation regarding specific hospital cases. With regard to inequality in attention to desires of one patient gender compared to another, that inequality might be a matter of deviation from the ethical principle of justice. However, one could also argue that the problem is an operational issue, systemic in nature, that first has to be mitigated and not primarily one of intentional unethical behavior. ..Maurice.
Working on committees like this, gets you a seat at the table, and gives you a better picture of the issues in health care today. It also gives you a chance to pursue this issue in a context that actually get things done.
i don't know if i am allowed to write this personal a comment. if i exceed the rules please just delete me. in January 2009 my wife got breast cancer. she was given chemo, lump removal and radiation. she is apparently free of cancer. my thanks to all concerned.
now for the problem. we chose to have only female providers. there is no place on the admission forms to check off females only. on our initial visit we both asked the lead dr for female help only, and after some discussion were told YES. i soon learned that yes meant that on every procedure i had to plead loud and long for YES to be yes. this was hard on my wife and extremely hard on me.
other factors are that my wife can see a male dr only as a medium transference experance and she is dissocative almost to the point of dual personalty. the bad person gets to store all the difficult things in life. the happy personalty gets to present herself as the everything is all right, perfect church member with no problems.
it would have been impossible to keep her on an even mental state if male caregivers had been involved. as it was we had several times during the year when both people tried to be active. this usually involves three to ten days of sleep in a very dark room. with some encouragement the happy person comes out and will not remember the other person.
please medical people, if i can gut up the courage to ask for female help, do it.
gwc
A bioethicist on a bioethics listserv to which I subscribe reminds us all with the following:
"Attitudes toward physical exams changed over time. Plato (Republic II) thought
no true physician would do physicals, by actually touching the patient – b/c the
physician cured the patient by using his mind, not his body.
History taking was very important, persuading the patient what to do was
important, (Laws 4) but not physicals."
..Maurice.
Yesterday I accompanied a family member to a surgeon's office for an exam for a hernia in the groin area.
A student came into the room and asked if it would be okay to speak to him.
After speaking for awhile, she said that she would leave to give him some privacy and that she would be back when it was time for the exam.
Her right of entitlement was evident and it was then that I referred her to this blog and told her that it would have been more acceptable if she asked if she could attend the exam. She explained that there is always more than one person in the room and that's when I told her that it wasn't the case, and that it was up to the patient.
She looked as if she were going to cry and was extremely upset. I wasn't rude, didn't yell at her; just put her in her place.
Apparently, that's how they are taught. They know they have to inform you so instead of asking for permission, or stating that their education was important and that they would appreciate it (not that it would ever change my mind, but...would make it more difficult to say no for some), they decided to take the posture of someone who was already a practicing medical worker.
She was about 20, the patient 65 year old male. It was the lack of respect and of that entitlement that I found extremely offensive and a posture that isn't going to get them what they need.
belinda
belinda -- Yes, and another technique taught to some medical students -- at some level, either the academic or hidden curriculum is this example:
An RN or LPN ( or MD) comes in with a student and says: "Hello, I'm Dr. so and so and this is Jim/Jane. He/she will be assisting me today."
I know this to be true because I've experienced and, and I've been told buy doctors and nurses that it is a technique they learn to avoid what they consider to be problems, i.e. the patient not wanting a student or observer.
And it needs to be confronted directly just as you did. But the reaction of your student, upset, almost crying, now reverses the whole relationship. It now becomes about the student and not the patient. And it turns the patient or patient advocate into the enemy.
Maurice -- This is a kind of model that needs to be changed and addressed in medical operation. I know you teach your students to ask patient permission, and I'm sure many other medical educators do, too. But to a significant extent, in the hospital/clinic setting, some begin develop that entitlement attitude and learn, in the hidden curriculum, that to avoid any discussion about this issue with the patient, you use techniques like this. They consider it a technique. Some may consider it soft intimidation or even dishonesty. One problem is that, when caught like the case above, they have no where to go because they know what they did was not right. Another problem is that they're rarely confronted as with the case above and thus learn through experience that they can get away with this and that it works.
Doug,
I have also had happen what you speak about. A great technique is to tell the person at the desk when you sing in is that you want no students. That way, what we went through yesterday doesn't occur.
I should include a chapter in my book about how I treat the medical community and what works to get exactly what you want and how you want while maintaining a relationship. So important, to be polite, personable but firm in your decisions, expectations and needs. When you do that the medical practitioner will respect you as a free thinking person and it puts you both in a mutual understanding and equal footing in your healthcare.
belinda
Belinda, you said, “Remember...the problem isn't that there is something wrong with us. The problem is that there is something wrong with the system that effected us in a negative way necessitating the need for a look at practices and what could be done better”
I had an ultrasound on my thyroid. I wore a scoop neck shirt so I wouldn’t have to take off my shirt. The male tech tucked a towel into the top of my shirt. I wasn’t expecting it and felt very uncomfortable with that action. Then he planted his arm right down the middle of my chest! I was afraid to breathe. I didn’t want my chest moving up and down. The only thing that moved doing the test was his hand maneuvering the wand over my neck.
6 months later, I had to have another one and asked for a female tech. She tucked the towel in without telling me and I still was uncomfortable! She moved her arm w/ her hand. I like the guy’s technique much better.
Is this a gender problem?
Is the problem them or me?
I would have liked to have known in advance if I was going to need to remove my shirt. I would like them to ASK to tuck a towel in my shirt. Overall, it seems like my problem.
I’ve cancelled an appointment with a cardiologist 3 times. If I’m not comfortable with a thyroid ultrasound, what’s going to happen at a cardiologist office?? What can I do? The appointment takes an hour. What happens in an hour? Do I have to take off my shirt?
~tear
Anonymous -- You're not the problem. The problem in your case seems to be poor communication. These techs need to let people know what they're going to do before they do it to help them feel more comfortable. Some could even say, "Now I'm going to...Is this alright?" The good ones do that.
belinda -- We agree on many things. I just want to make it clear that I'm not always against medical students working with me. It's all contextual. It depends upon what's being done to me, and, even more importantly, how I'm approached. I can assure you, if I'm not approached respectfully, i.e. asked permission to have a medical student work with me, I will not allow it and I will explain why. For me, that's the key.
I think what may be happening in some cases is this: Many initial forms patients sign say that they will allow students to work with them under the supervision of their doctor. It's just on the form. It usually isn't explained or discussed. Thus, caregivers just assume that they don't need to ask.
However, some forms patients sign state specifically that patients may turn down student care. Some doctors and their students just assume that if the patient is informed so and so is a student, and patients don't say no, then it's okay. But those caregivers who don't inform the patient a student is involved, how can the patient have the option to turn them down?
My story: Retired from the USAF in 2005 after 23 years as a pilot. Therefore, I'm quite familiar with thorough and intrusive annual flight physicals. The only time I was ever placed in a position that I felt uncomfortable in the AF was with a female flight surgeon. While just in my underwear for my annual physical, she asked if I had any issues below the waist that I needed to discuss and I replied no. I don't know if she could sense my uneasiness or not, but I really respected her for the way she handled the exam. Contrast my positive experience with military medical care with my post AF career flying internationally for a widely recognized airline and the civilian medical care I've received since. In 2007, I experienced an incident at home that required an ER visit and multiple cardiac tests over the ensuing six weeks. When the problem was finally identified, my cardiologist (a female by the way and always respectful of my dignity) referred me to a large hospital in a city three hours away for a cardiac catheterization procedure. I check into the hospital at O dark thirty and before you know it I'm lying nude on a gurney underneath a sheet. In no time, a young female nurse wheels me into a room adjoining the OR and explains that she will be prepping me for the procedure. While not comfortable, it's just the two of us and I decide to suck it up and deal with it. She proceeds to shave my groin in the femoral artery area while never completely exposing my genitals for which I'm really grateful. Soon thereafter, a male nurse walks in (obviously senior to her) and comments that he needs to confirm that she prepped me properly. He pulls the sheet down past my knees and I'm now completely exposed with the female nurse watching. I've got my eyes shut and I silently endure the humiliation and embarrassment while he comments that her prep job is inadequate but he needs a third opinion. In the meantime, I'm thinking just give me the damn sedative they promised and I'll feel fine. He leaves and thankfully the nurse who shaved me pulls the sheet down. We wait another 15 minutes or so before the phone rings and I'm being wheeled into the OR. The OR has approximately 10 folks in it but I'm thinking the worst is over, they will soon administer the sedative, and I'll no longer care. Besides, I fly jets and I can deal with this! Once I'm placed into the position required, the male nurse comments to the chief nurse (female) that he believes my prep is inadequate. She proceeds to pull the sheet down off my chest to my knees once again and confirms my worst fear. While exposed to this room full of "professionals" I'm shaved from my waistline down to include the right side of my genitals and inner thigh. I ask the male nurse about the promised sedative while this is occurring; he laughs and says "soon, you just lay there and relax." I endure this humiliation silently completely exposed to these "professionals" praying for this nightmare to end. In any case, the cardiologists show up, I'm administered the sedative, they do their thing, and the next thing I know, I'm recovering in a private room with my family at my side. I regained my FAA Class I medical after the obligatory wait and continue flying today. I complained to the cardiologist the next day about what transpired. He initially defended their conduct citing some drivel about surgical hygiene until I pulled the sheet down (I was apparently draped when he entered the OR) and showed him. He immediately apologized and assured me it would not happen again. Conclusion to follow.
F1114ever
What I learned from this is that male nurses can be just as insensitive to a patient's modesty and dignity as females can. It's unfair to stereotype either. That said, I will never allow myself to be placed in such a degrading and embarrassing position again. To this day, I agonize over what happened to me and regret not climbing off that damn table and walking out with just the sheet wrapped around me. This blog has armed me for any future medical encounter where my wishes are not being respected. Some of the following are from previous posts--thank you!
"For personal comfort, when dealing with intimate medical issues, I specifically chose a male Doctor. Why do you assume its ok for a female assistant to be present?"
You would never expect a female patient to submit to an intimate examination or procedure with a male assistant without asking first. I expect the same consideration.
"Your failure to ask is presumptuous, condescending, and unprofessional."
"My preference has nothing to do with your professionalism, what you've seen or the procedures you've accomplished before. I am a professional too and more importantly the patient; my personal comfort and dignity are the only things that matter".
"I'm sorry, but what part of "no" didn't you understand - the "n" or the "o"?
"For me personally, the gender of my doctor when I need to be undressed or talk about very personal health problems is important."
"Being seen undressed by male nurses and orderlies for me isn't much different than changing my clothes in the male locker room at the gym."
"But undressing for women (I'm not married to), which includes nurses and medical assistants, is very uncomfortable."
"Embarrassed compliance doesn't equal informed consent."
"Who will be present for the procedure and why; simply observing is unacceptable."
"Once the door closes it stays closed or I'm leaving."
F1114ever
I am trying to discuss male dignity in medicine on a prostate cancer blog.
http://csn.cancer.org/node/223394#comment-1187592
It is amazing how some regulars criticize my views and state I should put on a blindfold. I ask why shouldn't those of us who care have choices about our dignity. No one answers but I get comments like "get a life." A few comment that they agree it shouldn't be that way but the regulars are quite loud in disagreement.
Is this male machoism?
Mark
Mark
High probability that some of these regulars
are female and not male!
PT
It is machoism, I think -- I had to suffer so you do too. Deal with it. Actually, this may be how they're dealing with the humiliation they had to endure. Or, to be fair to them, maybe they were anticipating embarrassment and humiliation and it didn't happen and that's what's behind their attacks. But, to ridicule and contradict other people's values-- assuming those values are not destructive and don't harm other people -- to ridicule them is rude and uncaring in itself. But apparently, they feel the need to confirm their experience by attacking opposing attitudes.
Everyone has a right to their feelings. PT, this is NOT about gender and never will be. I would say that we have a pretty even split between male and female bloggers. We are all complaining.
What it is...is a right to dignity,and respect.
what everyone on here can do to understand themselves better is to ask yourself why you feel the way that you do. How did you feel before you had a bad experience? Or..perhaps religious training or other type of experience is causing you to feel the way you do. Our feelings are always based on our personalities and experiences.
What happens though is that these "professionals" sometimes decide that our feelings are unjustified, or "not normal" without understanding our experience. Nobody has a right to judge. It is for ourselves to judge.
Speaking of such, would I consider my feelings normal? Looking from the outside, probably not. However, if they knew my experience, understood how I felt, they would all understand that it's entirely, normal, justified, and a signal of sound mental health to do whatever I needed to get those health goals accomplished. Besides, I don't really care what anyone thinks anymore.
belinda
F1114eveer wrote, "To this day, I agonize over what happened to me and regret not climbing off that damn table and walking out with just the sheet wrapped around me." that's almost word for word what I wrote in my journal after an angiogram. I asked The All Important Too Busy For Details Female Cardiologist who was going to be in the room for the angiogram. She said 2 people. There were 4. I asked what was going to happen?. She explained the technical stuff, giving me a colorful brochure. She never mentioned someone would throw the gown up, past my chest line and leave me like that as they walk across the operating room to talk about the movies w/ the male coworker.
Then I go for the thyroid ultrasound, which seems like it should be so easy, it’s my neck! and someone reaches into my shirt to tuck a towel and lays their arm on my chest. And it’s not an "intimate" exam. I wasn’t ready.
So next year when I need another ultrasound, do I tell them in advance not to tuck the towel unless they tell me first? You know what they'll label me.
Not knowing what will happen at the cardiologist is keeping me from going. It's hard to defend yourself when you don't see it coming.
Belinda
The site is a prostate cancer forum! Why would women visit and comment on a cancer forum for men,
you tell me? Most of these problems are gender based,
a perfect example of this is a prostate forum operated
by women. I believe you can visit the site by doing a
google search "20 things women should know about
prostate cancer"
Their idea is to set up a cancer screening site
with all women physicians. Now, tell me Belinda, what
if I set up a breast cancer screening site with only male
physicians and an optional mammography exam performed
by male mammographers if and only if male mammo techs
existed,which they don't.
Wouldn't you think that would reach the limit of
maximum stupidity? Absolutely, but,if you are the male
patient. It's OK, according to probably all women, in which
case it is a gender problem. For us males,women are the
problem.
PT
F1114ever - I am sorry to hear about you bad experience. I too had a bad experience that I wish I had been able to leave. It seems impossible when your totally naked to advocate for yourself. You just hope to get through it and be done.
My understanding is the doctor is typically a contractor to the hospital and has no real say in hospital protocol. I wrote a letter to the hospital CEO, chief executive nurse, head of radiation oncology, patient advocate and the doctor a single page explanation and asked for a meeting. I had a meeting with them and they listened and thanked me for being the "male dignity poster child." They said men don't complain and it felt good to try and make a difference.
Mark
PT, I can understand that you see this as a gender issue because of your experience. I was speaking in the broader sense of this entire blog. This is not a male only blog, with males who have been hurt by the system. It seems that you would want all women to suffer because you did at the hands of a women. That's simply not fair to women who have experienced the same indignities that you have.
My experience involved both men and women and I look at the issue as a "right of entitlement" that the medical profession has and my need for same gender care under my right for privacy based on my experience.
Both genders are responsible for the violations we speak about. Both genders are victims of those experiences.
I also agree with you about how they set up the screening. I would get as many men as possible to call and make and appointment and then have them ask those important questions and have them all cancel their appointments, telling them why. Would they get the message then?
belinda
The venue site number 2 and 3 are
www.ipetitions.com
www.thepetitionsite.com
PT
PT:
I have looked all over the petition site.....have you started a petition yet?
Yes, have you?
PT
Mark:
I agree with Doug, and there certainly is a lot more to this issue than people can guess. On the extreme side, I have seen this issue come between families, friends, and even marriages.
People who are not used to discussing this will feel that you have questioned their morals, ethics, and perhaps motives..and feel cornered that they have to defend themselves. It's very common to get the "shut up and go away" attitude. For some it would mean reliving years of humiliation: for others it may mean facing years of the same. If they have prepared themselves for that future, or managed to deal with it from the past, then they certainly do not want it out in the open to deal with again.
And that's the problem. People keep hiding it instead of bringing it out in the open, where it can actually be discussed and resolved.
PT:
It wasn't a challenge: it was a question. I actually thought I might like to read it.
We are pleased to announce that Dr Bernstein has contributed an article on teaching medical students about patient modesty. Please take a look and add your comments.
I took it as a challenge as I would hope everyone on here
would participate as well rather than continually complain.
I have a theory as to why people don't want solutions,
they enjoy the state of affairs as they are. For female
patients, they reap the benefits of inequities towards
men. For female staff, it promotes the power trip and it
is a free Chippendales show.
For many men who like exposing themselves to female
staff and for them an evolving fetish. There is something
called the false claims act which essentially governs medical institutions from fraud and deceit. Yet it works
against patients who commit fraud as well.
Once knew of a patient who received an order for a
testicular ultrasound and in one day he went to seven different facilities for the same exam. He was charged
with fraud and given jail time.
My point is that at some point in these mens lives it
was female staff who in fact gave these men this
fetish by perhaps during a military induction physical
or another medical procedure whereby the nursing
presence was unnecessary.
Yet interestingly, women can't fathom why these same
men flash their daughters wearing only a trench coat. I
could provide some statistics state by state on this
problem and I'm sure everyone would be shocked by
the numbers.
PT
Mark, while not sure of the cardiologist's business relationship with the hospital in question, I do know that the procedure performed was pioneered by him and that (at the time) this hospital was one of the few in the nation where it was offered. Once he saw the degree that I was prepped and the circumstances it was conducted under, there was no doubt in my mind that he could affect change. Whether that actually happened I'm not sure but I like to think that it did. Frankly, what happened to me is minor concerned with what other guys (& gals) have endured at the hands of these "professionals." I fully expected to be exposed to the OR team but not in the manner or duration it occurred. My issue: the prepping was supposed to occur in a relatively private setting with one nurse. Instead, I was wheeled into the OR and two nurses decided to make it a public spectacle for a room full of people. Who they were and why they were there bugs me to this day. And for me personally, if they would have administered the sedative earlier I likely wouldn't care. I think I can handle opposite gender care if it's just the two of us but still prefer male. This issue is important to me now because I recently needed to see an urologist for the first time in 11 years whose office staff is entirely female. When making the appointment the following happened:
• Receptionist asked why I needed the appointment. I replied I shouldn't be required to share intimate medical information with her and clearly indicated my reluctance. She refused to respect my wishes and continued to solicit details.
• When I informed her that I wasn't comfortable discussing my symptoms' she "laughed and said she had heard it all before."
• Heard before is not relevant to my appointment nor was the context of the discussion humorous.
• She stated the information was essential to scheduling the appropriate appointment.
• Telephone receptionist determining appointment length is disturbing.
• Simply unacceptable and unprofessional.
Now, maybe I'm being overly sensitive to this but I explicitly selected a male urologist because my symptoms are uniquely male. I wouldn't be comfortable discussing these with a female urologist and certainly not a receptionist of either gender. Her sense of entitlement to the personal details of why I needed the appointment was to me breathtaking. That incident and the ensuing appointment with the same male urologist from 11 years ago led me to this blog. I shared my concerns with the good Doctor and he summarily dismissed them. His dismissal, the makeup of the staff, and my trepidation about potential future exams or tests that may result really had me on edge. I spoke with the office manager, shared my concerns, and stated that I would be glad to discuss these directly with the Doctor if he desired. My offer was ignored and I've since changed to another male urologist with the same practice that was highly recommended. My mistake this time was the same that I committed in 2007 with the cardiac procedure in the OR; I failed to speak my mind. Of course I've only recently realized this after discovering this thread. The hypocrisy that we guys are expected to submit ourselves to is simply stunning. This is a double standard that I refuse to subject myself to any longer. Any claims to the contrary are disingenuous at best.
The information and recommendations I've gleaned from reading this blog have done two things. One, I'm now armed to deal with my worst medical fears in a respectful but firm manner. Two, my son who is 18 will soon enter college and hopes to fly fighters in the USAF like his Dad. He will soon endure his first complete and thorough physical exam. The difference is he now knows the choice of gender for the examiner and chaperone or assistant presence is his to make.
F1114ever
F1114ever, as Moderator, I am pleased to know that this long running thread has been of help to you and others. Of course, this help was generated by the comments of my other visitors and not specifically by myself.
I must however speak to your concerns you describe about your experience with your urologist's receptionist. In a physician's office with many patients to schedule, her requests for your personal information is necessary for the office to function properly for your benefit and those of the other scheduled patients. She has heard what is bothering you many, many times previously from others and though her "heard it all before" is a bit annoyingly trite, you, as the patient, must realize that she is looked upon by the doctor as part of the diagnosis and treating team and is not the same as the worker who cleans the office after hours.
Thanks for permitting us access to a bit of your personal history. ..Maurice.
I'm not sure I can accept that, Dr. B. Many receptionists are not professional and are poorly trained. It is grossly insensitive for receptionists to be demanding intimate information. It is clearly one factor which keeps men away from doctors. We are working on an article which has documentation about this. The purpose of the initial appointment is to define the problem and it is unlikely that any urologist couldn't handle it.
I've seen many doctors over the years and I have never been asked for intimate details by a receptionist. It is just not necessary for an initial appointment and unprofessional in my opinion.
Well, Joel, it depends on how one defines "intimate details". Asking a urology patient how often he observes blood in his semen on masturbation I think is definitely intimate, having no scheduling significance and might be appropriately asked by the physician. However, if the question is related to the duration of a general chief complaint "I have been passing blood" might tell the receptionist about the appropriateness of the visit and urgency. Perhaps, in your specialty, a receptionist asking if the chest pain occurs while engaging in sex would be "intimate". I must say, in my clinical experience in general internal medicine, I have never heard that my receptionist had asked inappropriate questions to my patients. ..Maurice.
It's all part of the bigger picture, Maurice. Try to imagine a male receptionist asking these kinds of questions (described by F1114ever) to a female patient at an OB-GYN office. Of course, first you have to try to imagine a male receptions in general, and, more specifically, one hired at an OB-GYN office. That would be difficult enough. But assuming you could find a male receptionist in such a situation -- what would happen if a female patient expressed the concerns F1114ever did? Do you think she'd get the same kind of response F1114ever got? I doubt it.
Here's what I mean by the bigger picture. Just yesterday my wife and I were at a resort area, heavy tourism. We had to use the public rest rooms. I went into the male, she into the female restrooms. When I came out I asked her -- Did your stalls have doors installed on them? Yes, of course, she said. Oh -- the stalls in the male rest room were designed not to have doors. It's not as if they were broken or taken off -- they were designed for lack of privacy.
Now, some of you may find this off topic. But it isn't. It's right on topic. This is how men's modesty is often regarded in our culture. Here we see the attitude embedded in architecture and design. It's one thing in our culture for men to shower together in large groups. Most men accept this. Is it actually accepted that men need to do the kinds of private activities one will do on the toilet in front of other men? These double standards are so embedded in our culture that many people don't even notice them anymore. What F1114ever and others experience is one aspect of this issue. I agree with Joel on this one. I've heard several men complain about what F1114ever refers to. If they purposely pick a male doctor for a male problem, they don't want to talk with a female receptionist about it. It's not the receptionist's fault. It's the doctor's fault. He needs to begin to understand this issue. This isn't brain surgery or rocket science. It's basic human psychology with an emphasis on empathy.
Dr Bernstein, while I truly admire what you've done here and respect your opinion, in this case I disagree. I tried to describe the nature of the conversation with the word "entitlement" but cannot adequately convey the tone she used. The mere fact that I resisted obviously offended her and the resulting tone and words used was clearly to impose compliance. I'm not one to respond favorably to coercion. My personal dignity trumps her desire. Don't confuse reluctance to speak to the details with refusal to provide any info. I had seen this urologist 11 years earlier and clearly indicated I needed the appointment due to a recurrence of symptoms. If the lack of info provided resulted in insufficient exam time and corresponding follow up appointment, that's a risk I'm willing to accept. The treatment team consists of the Doctor and whoever else we jointly agree should be included. The telephone receptionist is ancillary support. With respect to how one defines my "intimate details", I do. Your receptionist may very well have asked "inappropriate questions" of patients. That fact that you haven't heard them doesn't surprise me; you wouldn't unless the patient complained directly to you. Inappropriate is a subjective term. In my case they were inappropriate. Finally, I cannot imagine I would ever be hesitant to share my internal medicine symptoms with the receptionist. Urology symptoms are intensely personal, others may feel differently. Finally, I'm surprised at your response considering the nature of this blog! I apologize for the tone, no disrespect intended.
F1114ever
"you, as the patient, must realize that she is looked upon by the doctor as part of the diagnosis and treating team and is not the same as the worker who cleans the office after hours."
I could be wrong, Maurice, but I certainly don't, and if asked, I don't think the vast majority of patients consider the receptionist to be part of the diagnosis and treating "team." If what you say is true, i.e. most doctors consider this to be true, then I consider the whole notion to be part of what I call the "deprofessionalization" of medical care in this country. In my opinion, doctors can't realistically "share" their medical professional status with their office staff. Their professional status is very different that that of receptionists and clerks. It may be necessary for have access to personal information in print or on computers, but to consider them actual medical "team" members is not professional. Granted, they are above the cleaning staff. They do need access to personal information to do their work. But -- I can't imagine my doctor telling me that his receptionist is part of my medical diagnosis and treating team. I consider them important staff, the would not approve of them in any way connected with my diagnosis or treatment. And I think most patients would feel the same way.
It all comes down to privacy. People don't want to announce in the office in front of others what their complaint is, their birthdate or disclose information to someone who is not medically trained.
A receptionist should not be privy to medical information about the patient. It dosen't influence their job unless the patient tells the receptionist that it's an emergency.
That patient should then be forwarded to the nurse to give an explanation to the doctor.
It is very empowering to say no and ask to speak to a nurse or the doctor. If patients would only remember, and if done properly, that they are in charge, things would be better. Once you receive poor treatment from the system, it's so easy.
belinda
It is my opinion that medical personnel are brainwashed in their training. That's why, I too, am sometimes surprised at Maurice's comments. It seems that I think we're all on the same page and then Maurice says something that makes it seem to me that he "doesn't get it".
Because Maurice, your intent and dedication is sincere, is the reason I think brainwashing is included in medical training and once you come out of that training, you are a product of that education.
If medical personnel would pretend on every interaction that they were the patient, perhaps, a little of that brainwashing would erode.
We are all products of our experience and the medical professional training is not exempt. My opinion was not personal, but rather an attempt to understand the lack of empathy or understanding that Doug, I and others have expressed on this blog.
belinda
Since there are no male mammographers, no male
nurses working in L&D and certainly no male nurses
working in post-op gyn floors one can certainly conclude
that male patient privacy is disregarded.
You will get that impression wether you are a female
nurse or the female patient. If you are a female patient
receiving chemotherapy, you are allowed one free wig
from the American cancer society. This information will
be given to you on your second visit to the infusion site.
At this infusion site the Cancer society representative will also tell you that no males are allowed in any female
wig fitting sessions. Not even their husbands. If you are
a male patient receiving chemotherapy not such wigs
will be provided to you.
Now that is the opinion of the Cancer society,not
mine. Many men look good bald, I certainly don't judge
them. What I am suggesting is perhaps some men would
like a wig during chemotherapy. I suppose that in the
end men with cancer are expected to crawl into a hole
and die.
PT
Dear all,
I do commend Dr. B's continuation of this blog.
As he wrote in his blog article recently: "The student's personal modesty is apparent as they become patient subjects for their classmates to examine.", it would seem that "the system" generally beats this empathy out of the "profession". By profession, I mean all actors, not just MD's.
When I first joined this blog several years ago, my sense was that Dr. B represents the prevailing intellect of the industry. I still believe that to be the case. Coming from a family of docs on my wife's side, (good people all) a similar attitude prevails. This represents essentially 3 generations of practicing doctors. It is very hard to change what is taught. Remember, non-consensual pelvic exams were the "norm" until recently, and may still be (under the radar).
Until and if I hear Dr. B talking about how he has changed his teaching modesty issues and a tectonic changes occurs throughout the teaching institutions, little will change.
That is not to say that all docs lack this empathy. Recently I changed to an new internist. My wife was at the consult. When it came time for the physical exam he made a big point of asking if it was alright if she stayed in the room. When it came time for the DRE, he again asked me if she should stay or step out.
But he did leave the door open when he stepped out to get a different blood pressure cuff. However, I was covered at the time and the consult room was at the end of the hall.
--amr
To all: Beyond their personal idiosyncrasies, most doctors, like me, are finally only a product of their personal education and personal experience. As I have written here many times previously, I have, in the past 6 1/2 years been personally educated by the writings on this patient modesty thread about patients' feelings about the subject and their view of the behavior of the medical system.
This education for me has been a surprise since beyond my own experience in medicine and the approach medical school instructors teach patient modesty, I really was not aware previously of many of the feelings that have been expressed here. And including my office practice experience and my personal experience as a patient, I was not aware of patient views with regard to the current discussion. This doesn't mean I, at once, or will in the future, arbitrarily reject what I have recently learned just as I don't reject out of hand the concerns expressed to me by my patients. In fact, I have repeatedly in the past encouraged advocacy approaches by my visitors of their patient modesty and gender concerns including speaking up and speaking out (please note the title of the current graphic and some of the previous ones).
With regard to the current discussion, I am still unaware of what is meant by those writing as "intimate". I also would like to point out that in some offices the receptionist may also be doing the insurance billing and would have access and knowledge of the patient's case.
I hope this posting helps to clarify to my visitors my view of what all is written here. ..Maurice.
Dr. B, I'm not sure why you don't understand the meaning of intimate in regards to this conversation. One of the most common reasons for men to see a urologist is because of erectile dysfunction. Most men don't want to talk about this with their physician let alone with the receptionist. Having trouble urinating is also an embarrassing symptom for many men.
What's hard to comprehend about all that? It seems to me that years of this blog have been on similar topics. Do most women feel comfortable talking about fertility problems with strangers? It's no different.
Dr Bernstein, "intimate" means information of a very personal nature; urology symptons meet that standard. From a patient perspective, that's information shared with a medical "professional" I'm comfortable with. A telephone receptionist of either gender will never meet that professional standard, regardless of training received. Their training, i.e. methods, standards, and certification is not shared with the patient. We've heard it before; "its ok, I'm a professional" is also one of the trite phrases used by staff to coerce patients. I'm well aware clerical staff may have access to my personal information. That doesn't mean I'm comfortable discussing these issues with same nor should it be required for scheduling purposes. My opinion of course. I really appreciate everything you do regarding this issue and thank you for listening!
F1114ever
I think it's safe to say that intimate would include the following:
genital exposure,rectal exposure, issues involving the sexual organs or sexual behavior, and anything else of a personal nature involving the sexual organs or mental health issues of a patient. Things that are extremely sensitive and personal to anyone.
belinda
Dr. B states: "This doesn't mean I, at once, or will in the future, arbitrarily reject what I have recently learned just as I don't reject out of hand the concerns expressed to me by my patients."
I have been reading then involved with this blog since mid-2006. It has helped me and my wife tremendously deal with these issues.
However, if the last several years of this blog has not moved you to see that there is a problem and there should be some formal discussion in the proper circles, how can we as pts expect there to be improvement on this any time soon. After writing my above entry, I did a search on non-consensual pelvic exams, and indeed, it appears that any female pt should concern themselves with this assault on their person should they receive gyn surgery in a teaching hospital. There has been discussion about this for years, and still the medical community ignores the outcry. If the medical profession continues to generally defend this practice, what importance is a little physical exposure.
Although the following link shows that there is some improvement re pelvic exams, it does appear that we have a long way to go: Unwanted pelvic exams
-amr
I lie to the receptionist and the parade of women who want to take my history. I just tell them something I am comfortable with. When the doctor comes in I tell him what's going on. He said it was common for men to do this for personal issues.
This isn't good but it is either lie or don't go.
Mark
I'm reading all these posts and it seems that I'm not the only one who feels that there is some kind of disconnect with MD's and other professionals. So...there has to be something in their education causing this shift in mindset. Maurice, Can you shed any light onto this.
Mark--good job!
belinda
I'm not saying that what's comfortable for me should dictate standard industry practice. If other patients want to share intimate medical details with the receptionist, that is certainly their prerogative. I'm relatively comfortable that most don't. How about something along the lines of:
"Sir/Ma'am, I completely understand how you feel. If you choose to do so, I might be able to schedule the appropriate time with the Doctor. If not, I'll schedule just the standard office visit or you can talk to a Nurse if you prefer."
Such interaction clearly establishes the receptionist respects my limits but offers reasoned logic on why doing otherwise might be to my advantage.
Mark suggests simply describing symptoms that he's comfortable with. My problem with that approach is the issue is swept under the rug. This approach works individually but collectively we patients gain nothing. And, there are no urology symptoms innocuous enough that I would be comfortable discussing with the receptionist. The hypocrisy is his Doctor recognizes his patients concerns but either will not or cannot affect change.
The amazing thing is we haven't even arrived at the office for the scheduled appointment and the minefield that awaits the patient behind the supposedly closed doors with supporting staff.
F1114ever
Just to let you all know that I have been introducing the matters about physical modesty and gender selection to my current group of 6 2nd year medical students and have referred them to my blog. Also, last Thursday I instructed a group 10 first year medical students in their very first workshop regarding the performance of a physical examination. I told them about the physical modesty and gender issues brought to my attention on my blog.
I am considering how to present to the Introduction to Clinical Medicine faculty these same issues that the visitors to this thread have raised. I want the students and the faculty to "be aware", be educated, about the modesty/gender views expressed here. That is the first step but a necessary step. Of course, dissemination of the education beyond my medical school is a more difficult action. Despite writing 2 pieces to the American Medical Association News, I have received no evidence that any of those "200,000" physician readers paid any attention and none apparently has written here. I was thinking of writing to the Academic Medicine journal but whether it would be published I don't know.
I still think it would be the best approach for you all to start an advocacy group. Start by following PT's suggestion of utilizing the petition site and see what following you get.
Keep on writing here.. but don't continue simply "writing to the choir".. do something else! ..Maurice.
"The amazing thing is we haven't even arrived at the office for the scheduled appointment and the minefield that awaits the patient behind the supposedly closed doors with supporting staff."
This is relatively new in medicine, the idea of so many supporting staff. It wasn't that long ago that, when one went to the hospital, one faced doctors, nurses, maybe some nurse assistants, and maybe one or two techs, xray, etc. Now days one faces dozens of different kinds of medical technicians, medical assistants, patient techs, cna's, people who want this information and that information, etc. I think it's no accident that, as this situation has occurred, the need for privacy controls like HIPAA came into being.
As Dr. B has indicated, many if not most doctors today consider all this support staff to be part of the medical "team." Some may belong in that category. Others may not. But doctors (and nurses) who are considered medical professionals, want to pass on in their name, their professional status, it seems, down to even office clerks and receptionists. This watering down of the concept of "medical professional," seems to be part of the problem we're discussing. For many, having intimate discussions with the doctors of their choice is no problem. Many have no problem with nurses. It's when you start getting below that professional status that some begin to have problems.
Everyone wearing scrubs in a hospital or clinic setting is not a medical professional, although most or may seem to consider themselves to be. And apparently, some doctors and nurses grant them that status, too. And it's getting more difficult for patients to tell who is who, because they're all in scrubs.
Dr Bernstein, invite real patients (both genders) to discuss this issue with students. They can tell the students what happened to them, how they felt as it occurred, how they addressed the issue (if at all), and the response received. A frank question and answer session should follow. As the moderator, ensure embarrassing and humiliating issues are frankly addressed. These students are young adults in the formative years of their medical education. Some sort of visceral impact must occur to make an emotional impression, something I sense is lacking in medical school. I'm positive you will find enough patients (volunteers) willing to share their experiences if you simply ask. Anything less is just a dry academic presentation by a professor.
F1114ever
I find it kind of hard to believe that receptionist or appointment clerk could be considered part of the "diagnostic team". They have neither the training or experience. If they ask and the patient says it's personal and they would prefer to only discuss it with the doctor, then they should accept that and move on.
Oh and F1114ever, I've got the perfect response ready next time someone pulls the arrogant "I'm a professional" approach, to wit:
"So are all the hookers down on (insert name of local red light district), but I have no intention of discussing it with them either."
Maurice, thank you so much for all of your efforts.
I just wanted to point out that you cannot look into a problem unless you look into both sides of that problem.
Your second year medical students will not know of the educational brainwashing that I was talking about and your colleagues may not understand that this may have happened.
I think it interesting to do a study with attitudes about physical modesty for students BEFORE they start their medical training and another when they are finished. It might say volumes. If that is the case, the entire teaching protocol may need to be modified.
Thanks so much for your hard work, for listening and acting upon so much of what we say.
belinda
"Few, Some, Many, Most or All"--the use of one of these descriptive terms applied to the patient population who maintain the views on modesty and gender being written on this blog that the students will face in their ongoing careers represents my dilemma for teaching. After never, myself, experiencing (and I think in common with other physicians) these views presented here previously and without any statistical survey to indicate the population size, I wonder what I should tell them except to say that all patients should be treated with dignity and respect and to be attentive to the general modesty issues, including the concept of privacy that the medical schools have been teaching over the years.
My concern is about "over-reach" with regard to modesty and gender in the sense of the physician bringing this up in the first visit to the surprise of a patient who is apparently primarily seriously concerned about the significance of their symptoms and a talk about modesty would represent a distraction.
Is the issue of modesty and gender a serious concern for a "few" (those who are writing to our blogs)or should we teach and practice as though "most" or "all" patients can be considered as accepting what is written here and need attention and mitigation of their unheard requests? ..Maurice.
Maurice - why not treat all patients with modesty? Don't train future doctors two protocols, one of dignity and one of disregard. If there were two protocols the medical system would abuse a patient until they understood the horrors of medicine and started advocating. Consider the patient from the start. Don't just treat the disease.
Mark
Informed consent means understanding what is going to happen during a procedure and to make an informed decision about that course of treatment.
Outside of the medical arena behaviors such as forced stripping (that would include patients who didn't know what was about to happen to them)and inside the medical arena knowing that certain procedures require bodily exposure, it would seem to me that informed consent would consider the following and look something like this:
"Your procedure will require you to be in a state of undress. There will be X amount of medical professionals in the room consisting of both genders. You will be awake." Keep going discussing the rest of the medical protocol and then ask if the patient has any questions.
What you have accomplished is informing the patient what to expect and laying the groundwork and putting the responsibility on the patient to object.
Two things are then accomplished.
First, the patient may feel embarrassed but will not be traumatized (unless something disrespectful happens during the state of undress). Second, you are telling them what to expect from the entire experience.
If medical personnel would consider this overreach perhaps it's that they don't want the patient to know; to me, that sounds unethical.
belinda
Mark, what we all teach the medical students is NOT two protocols but one: " all patients should be treated with dignity and respect and to be attentive to the general modesty issues, including the concept of privacy." That's it. And then we attempt to monitor the students to see that this teaching is actually practiced. As I previously noted here, my experience is that all medical students in the first and second year follow this teaching. What we don't do is to have our students start out with a disclosure: "I am about to perform a physical examination on you and that requires that portions of your body will be uncovered and bare." We all assume that a mature patient will have already anticipated this fact. However, as we go through the various bodily systems, the patient is told like the following example: "and now I will examine your chest, are you comfortable?" Obviously if the patient refuses even after education, the students are aware not to act despite the patient's dissent.
I have no control over what happens to their behavior later on but the students know that we expect them to report to the offender and/or a neutral (not their superior) instructor if they witness a violation. ..Maurice.
Dr. Bernstein:
On Doug and Dr. Sherman's site I reposted this part of your article.
"“Nevertheless, examination of their groins is seemingly a restricted area by both genders. Some students will only allow same gender students to be their examiners.”
It seems (though unwittingly) students present their own opportunities to open the doors for these discussions of modesty and respect, and even gender. While the specific questions I asked of you were within that discussion, I find that it ties to your currant discussion here as well.
Yes, it would be nice to present statistics on the percentages of patients who have modesty and gender concerns, but is it really necessary when you already have a room full of students with the same issues? These people represent a random part of the population of patients as well. But unlike "regular" patients, they have a bit of a heads up of expectations that we would not have. They know what examinations will entail/ they have time to emotionally prepare for what is to come, and yet: within that preparation they still maintain their own feelings of embarrassment and reservation. So, could you not use THEM for their own statistical data base? Wouldn't percentages of a random number of students equate to a random number of patients? If virtually all consider their groins a "seemingly restricted area" then wouldn't it be reasonable to assume that virtually all "people" feel the same as well? And if some students will only allow same gender examination, then an equal calculation of "people" would feel the same as well. If they represent a random percentage of population (which they are) then one can translate the math into reasonable calculations of the thousands of patients who will and do feel the same.
Until we have clear data....it seems that in the meantime you have a room full of your very own statitics.
Recent amr posted a link that described unconsented pelvic exams on women who were asleep for surgery by med students. Just when you think it can't get worse...
http://www.theunnecesarean.com/blog/2010/8/30/medical-student-wont-perform-pelvic-exams-on-anesthetized-pa.html
Please go read it.
This is rape that is required by medical schools. If the patient is asleep or awake and lied to, like a male rectal exam where the student claimed to be assisting, is rape. I am sure it happens more or less at all teaching hospitals.
So the first two years a student is taught how to give appropriate exams. The next two years they are participants in raping patients. How can we expect to create doctors that respect patients after this?
Mark
Suzy, your last posting held a reasonable conclusion except I am not sure that the 2nd year medical student of either gender really are representative of the general patient population. First, they are not sick..they have no symptoms that are causing them distress and need physical examination to diagnose. Second, and most importantly, I think, is the fact that they are living the medical school year together in a group of the same 6 and this daily purely academic collegial relationship makes them shy regarding degrees of intimacy. This isn't quite the same as the patient's occasional clinical visit with the doctor or other healthcare providers. This continuous special collegial but non-intimate relationship may play a role in how they respond to performing or allowing certain physical exams on each other. I am sure that all students, clearly knowledgeable what is needed for diagnosis in the physical exam would not be adverse to intimate exams by their own personal physician. I would rather look to statistics derived from a true patient population other than medical students.
With regard to Mark's last comment, I personally don't think that if students perform pelvic or rectal exams on patients without the patient's specific consent constitutes rape. It could, however, be legally interpreted as criminal assault and battery. All schools who still encourage pelvic exams by medical students on patients without specific consent should put a stop to an unethical and I believe unlawful behavior. There is no excuse, including the need for medical student education, for this practice to continue. ..Maurice.
Maurice -- I agree with Suzy. I think you do have a relatively representative sample with your medical students. I think you should start gathering stats, even if they may not represent the general public. Some patients are uncomfortable with caregivers they know working with them on intimate procedures. Some caregivers feel uncomfortable working with patients they know. Yet some patients feel more comfortable with caregivers they know, and some caregivers feel a special connection working with patients they know personally. It's all individual. That whole dynamic could be discussed with your students. Frankly, I don't agree that because they know each other and study and work together necessarily makes them more modest with each other. For some that may be the case, but not for all. But, as some have pointed out in the past, if these medical students can't trust each other with their bodies, how do they think patients feel dealing with strange caregivers? They should seriously think about that.
Question for your, Maurice. At sometime in their medical training, are students required to write a detailed medical history/memoir of themselves? This would incude all memories of medical encounters from a young age; hospitalizations, not only their own, but those of friends or relatives; their personal experiences with doctors and nurses; their worst and best medical encounters; stories, good and bad, they've heard about medical encounters from friends and relatives, etc.?
If not, I wonder why. This kind of self-analysis might give them more insight into how they feel about medical care, where those feelings and attitudes came from, and it would also get them to consider personally the difference between the best care they've had and the worst care they've had. What made the good care good and the bad care bad?
Maurice, I agree with Dough and Suzy too. You mention that these students are not sick. Being seriously ill (and I am) has no reflection on one's personal value system to privacy and dignity.
Here you have a random sampling of individuals. All that they share in common is that they are in the same class. While there may be a component of knowing each other, the basic sensitivities are broad-based enough to make the assumption that some or most people are not happy with opposite gender care and bodily exposure in front of the opposite sex.
belinda
Dr. B,
You wrote: "I personally don't think that if students perform pelvic or rectal exams on patients without the patient's specific consent constitutes rape."
We agree that it is assault and this practice should be banned. Since it is still practiced, and maybe even at your medical school, have you given thought to discussing this issue with your med students and what they should do if they see this taking place?
See the following article: Anesthesiologist Loses License for Touching Patients' Breasts. Here the touching was inappropriate. He lost his privileges to practice, but he was not prosecuted.
I get and appreciate that you consider this practice to wrong and criminal. However I believe the practice is also rape.
You are rightfully nuanced in your choice of words which is good. Using the phrase: "without the patient's specific consent", is the excuse commonly used by those defending the practice of non-consensual pelvic exams. "General" consent was given by the hospital release form (the form that if not signed by the pt would mean that they would not be treated). Therefore according to the logic, the "specifics" of "care" are not required to be discussed.
Thus you might be defining medical students and their teachers as a protected class and above the law. Please refer to the Clark University in MA web site regarding the Definition of Rape, Sexual Assault and Related Terms. In the web site it specifically states:
Rape is also a legal term that is defined in Massachusetts by three elements:
○ Penetration of ANY orifice by ANY object,
○ Force or threat of force, or
○ Sexual contact against the will of the victim.
Consent cannot be given (legally) if a person is impaired, intoxicated, drugged, underage, mentally challenged, unconscious, or asleep.
I think you will find that most colleges today have web pages such as these with essentially the same message. See the USC Policy: Policy and Procedures on Sexual Misconduct and Sexual Assault.
If a medical professional has not explicitly asked permission and received consent, they are committing rape under the law - if not morally, then ethically."Intent" of the touching is not a carved out exception.
Bluntly, anesthesia is the ultimate date-rape drug.
Respectfully,
-amr
Perhaps Dr Twana Sparks,the ent in New Mexico
would like to comment on this subject. I have written
a letter to her asking her to visit this blog. I have written
that operating room as well and asked how their nursing
staff turned the other cheek as well for years on their
patients.
PT
I am not going to argue the point of representative or not, I would however challenge whether medical students should be given any consideration becasue they know each other. I think not, first off they will spend the rest of their lives trying to convince us they are all just body parts arm, breasts, penis, vagina, leg...just parts without qualification. Second any additional feeling of being uncomfortable by them should be offset by the fact that they are in a familiar setting and it is something they do all the time so they should be more used to it than a person who rarely visits the office/facility and rarely is around nude people. And while they are students and perhaps not as seasoned as older providers, that doesn't seem it be an issue when they are forced on patients. And then their is the argument that most providers have used, it is important for these students to get experience and perhaps the overall benefit to society trumps and individuals right to not be exposed to them. And last but not least, when it is a patient the argument that these are professionals a focus's not on the patient but the provider, why now is it on the patient when they are a student. It really is an us and them mentality. It is the same throughout the system as this very issue was the topic of a heated debate on all nurses who were asked to WEAR BATHING SUITS to class to practice bed baths. If providers are not willing to take that leap of faith when they are "patients", how hypocritical for them to expect patients to when they are the provider.
Earlier discussion, a friend of my daughters wears scrubs to work as a receptionist for our local Dr. her medical training 0, she took online classes in clerical duties. I agree for efficency asking the caller for info on why they are calling makes sense and is not totally unreasonable, however it should be clear that if there is any hesitancy they should be given the option to book without. I also do the bait and switch on the call in. Reason for the visit on the phone, I need to have the Dr. check this or that for me, real reason, Dr. I what can I expect if I have a vasectomy....the Dr. may see a high school girl who can do basic accounting as part of his medical team priviledged to ask these things...but I don't....alan
I really welcome all your comments about medical student teaching, but I have to say unless you have had the responsibility to teach 2nd year medical students and understand their emotional status in this phase of their medical education, we may have to educate them a bit differently than that suggested here. They are currently under great emotional stress as they are on the verge of exams which will determine if they are allowed to continue their medical education without having to go back a year. They are currently under emotional stress anticipating the 3rd and 4th years when they leave the safety and control of the classroom and go into their hospital ward clerkships. We faculty understand this stress and that is why, though we would like them to examine each other perhaps more fully as practice, we are very much attuned to their modesty concerns, whatever they may present to us, at this point of their education and we will not be demanding of them. This is not the right time for the education including surveys you all have provided (beyond the basics regarding modesty as I have previously written) that those writing here has suggested. The best time for further detailing the issues of modesty and gender is when the students are in their clerkships and are daily faced with and interacting with one patient and then another. And the best teachers would be the patients themselves who, if they would speak up, would make the greatest impact.
I hope you all don't feel that I am ignoring your approach but knowing what I know in the practice of teaching 2nd year students learning physical exam, this is not the right time. ..Maurice.
Dr. Bernstein:
I wonder if what you are telling us is that your students are already so stressed, exhausted, emotionally spent, and on the breaking edge that you believe a discussion about how patients may feel about them would pose either an educational or emotional stumbling block?
Suzy, a few days ago I wrote here the following: "I have been introducing the matters about physical modesty and gender selection to my current group of 6 2nd year medical students and have referred them to my blog. Also, last Thursday I instructed a group 10 first year medical students in their very first workshop regarding the performance of a physical examination. I told them about the physical modesty and gender issues brought to my attention on my blog."
We have had no group or individual student discussion about their own feelings of physical modesty nor perform any oral or written survey.
As I had written on Dr.Sherman and Doug's blog "It is not that we have knowingly diminished a concern for patient modesty but after presenting the general instructions to attend to modesty which generally deal with draping or undraping the patient, touching the patient and using the proper professional words, there is generally no further didactic activity on this topic. What remains is for the instructor to simply monitor the students for following the instructions. Uniformly, we find they do."
I can encourage them to look at the blog thread and if they do talk about it to us if they desire but for the present without further discussion with the faculty that is the extent to which I feel is appropriate for these students. ..Maurice.
Dr. Bernstein I have a lot of respect for you and what you have done here for us. I appreciate that you continually challenge us to do something not just complain so I hope you take this in that same thread. You are missing the point because you are a provider at heart. Is the stress of a med student greater than that of a patient who may or may not be facing a life altering medical condiction, and yet the thought is the patient should ignore thier modesty because of the context of the situation. Yet you are now saying we should make allowances for students concerns for modesty because they are under stress, suddenly the context, the need becomes secondary to their mental state. This issue is in the eye of the beholder, and claiming patients should be expected to walk away from their modesty due to the importance of the task at hand...but students (providers) should be given leeway because of their situation. Granted medical school and repeating a term is stressful, but nothing compared to someone whose very life or livlihood may be at stake. Sorry Dr. bernstein, just as we can not fully understand your students side, you as a provider have lost the ability to truely see if from our side. I see no difference between expecting a patient to shed their inhibitions and asking med students...we are all people with the same concerns regardless whether we are students or patients.....alam
But Alan, I continue to have no indication from past or even current medical practice that what is being described here is the predominant view and feeling of patients who come because of illness. It is not that I am trying to diminish the concerns documented here but without statistical survey and without having had any feedback from patients over the years regarding personal modesty, I still have doubts about the total patient population extent of what has been written here all these years.
For example, in a free clinic in which I have been also participating for the past 8 years, though most of the patients are Hispanic and I have to use an interpreter, I have never heard any modesty concerns. Specifically, a few weeks ago and then even today, I had examined two women who needed a breast exam. My interpreters were on both occasion males. Before they bared their breasts, I had asked each via the interpreter whether they would rather have a female interpreter in the room during that exam. Both patients said "no" and that they were comfortable with myself and the current interpreter.
Again, it is not that I am trying to diminish the individual concerns of those writing here and certainly each of you deserve attention and attempt at mitigation of your concerns by your healthcare providers.. but I still wonder if this is a general concern of most all patients as they are being attended for their symptoms. Should I just make that assumption of universality based on those who come here and write or should I ask for the statistical facts? If the concern is for a minority perhaps all that we are teaching the students may be adequate. Keep writing and let me know your views--certainly my patients have been quiet about this. ..Maurice.
Maurice, how can you have any doubts? Just ask your students. They feel like we do. You are taking an example of one person and comparing it to the volumes of people who come to the hospital.
It's time for that research to be done and like I said before, it seems like those who work in the medical community have a real emotional disconnect on this subject; an absolute refusal invalidating everyone here.
You can invalidate all you want. The problem is the white elephant is in the room and this should be a paramount subject in medicine because the effects of the actions of many cause deep emotional wounds that don't always heal. The Patient Bill of Rights is the proof that people are being harmed.
Why not take a trip to the assigned risk part of the hospital and do an inquiry there. They will be able to validate our experience. Our laws have been written to protect patient dignity and most often ignored due to the arrogance of the profession.
belinda
"Specifically, a few weeks ago and then even today, I had examined two women who needed a breast exam. My interpreters were on both occasion males. Before they bared their breasts, I had asked each via the interpreter whether they would rather have a female interpreter in the room during that exam. Both patients said "no" and that they were comfortable with myself and the current interpreter."
The key here, Maurice, as I see it, is that you asked. You sought patient preference. In your opinion, is that standard practice? Is that something you did in the past or have done since learning the concerns on this blog?
Here again, speaking without being there, but is there statistical evidence that medical students are more than just uncomfortable with the situation or is it just assumed? Do the vast majority of the students specifically tell you it is truamatic for them and will cause unreasonable stress or do you sense this or look for clues? Just as you indicated some students were comfortable and some not being examined, the same holds for paitents. I would guess there probably isn't much statistical data on how students feel about this, but certain assumptions are made and cosideration given. Now further consider, who would be most likely to feel free to express their concern, a student who has almost daily interaction with instuctors and staff or a patient who walks in and meets a provider for the first time and is suddenly faced with this on the spot? As a male, I have never ever been asked if it mattered even when it was obvious I was stressing. I was having a procedure done at a facility, sitting in the prep room in my to short, open backed, thread bear gown the nurse took my blood pressure and asked do you normally have high blood pressure because it is really high. I told her no, she asked are you really nervous about the procedure, I told her not the procedure? I responded "just all of the prep and embarassing things leading up to it. She smiled and said thats normal and away she went. I believe in your eyes your observation is right, but do providers have blinders that filter out the patients discomfort as they focus on the physical, is the discomfort discounted to get to the task at hand, and is that discomfort more evident and of a concern when it is a fellow provider i.e. a student, especially when the task is teaching. I feel this is the case and is normal, we have more concern for those we know and identify with. Point of perspective changes how we see the same issue. I think its the old tale of three blind men describing an elephant. If you asked your students for volunteers and they FELT their grade MAY be influenced, would it affect their apparent willingness? If instead of a breast exam you were doing a pelvic exam, would you have used a male to interpet or do you think the women might have felt differently? ...just my thoughts but I don't see the students feelings any differently than patients, they are just more evident and of a concern to providers....alan
Doug, no..I might disappoint you and others but my example of requesting for patient preference was not related to what I have learned on this blog thread. In my entire clinical career, it has never been my practice (and I believe most other physicians) to provide a female chaperone just for a breast exam. And patients have never and I mean never requested one. Yes, of course, for every pelvic exam I have always had a female chaperone present during the exam and this is an essential standard of practice for all physicians. However, to have a male interpreter or some other male in the room while I am examining a woman's breast is another matter and would always require the permission of the patient and that is exactly why I asked the patient and offered the patient the presence of a female interpreter. By the way, in the patient I examined yesterday, after my exam,I also, as a routine, asked her permission for a male surgeon in the office to now come in for a consultative exam and she agreed. Now, in the 2 examples I described, I had followed both patients for a period of time and perhaps a certain degree of trust was involved in their decisions. Doug, I hope this answers your question. ..Maurice.
Alan, I think any modesty issues with the 2nd year medical students is purely situational and is due to their relationship to their colleagues and also their new learning relationship with patients where they also show their concerns for modesty (often failing to ask for or take off the patient's stockings as an example.) I doubt they would avoid a necessary examination simply out of modesty.
I may go ahead and ask my 6 2nd year students to write me their answer to the following simple question: "Do you have any personal modesty concerns if your physician of opposite gender is about to perform on you an intimate examination or procedure as part of a workup or would you feel generally comfortable?" Alan, is that a satisfactory question? ..Maurice.
I want to point something out that Mark brought up in one of his first posts. He commented that it was the male nurse that didn't protect his modesty, who seemed to take it for granted. I think that's an important observation. Just because a patient requests and gets same gender care, that doesn't necessarily translate to compassionate, dignified treatment. My position on on this blog has not only been to advocate for those who want same gender care -- but also to maintain that, for me at least, the most important element is to be treated with respect and dignity, as an individual and not as an object. That can be done by caregivers of both genders. I'll continue to advocate for more male nurses, elimination of the double standard, respect for patient autonomy as far as modesty is concerned. But getting what you want (same gender care) doesn't always translate into getting what you want ( respect and dignity).
*Disclaimer: the following post in no way suggests that all patients who have gender, respect, or dignity issues have suffered any type of abuse in or out of the medical system!*
Doug, I absolutely agree.
I received a series of emails not too long ago, and I will site 3 examples. This is perhaps anecdotal, sorry, but I don’t know how else to make the point.
One series from a male who will only accept female intimate care due to a rather grotesque and heinous attack by male perpetrators.
One series from a woman who suffered much the same. But because she felt she was not protected and shielded from this abuse by the females in her life that she trusted to protect her from these circumstances, she refuses female intimate care.
One series from a woman who does not really care about gender, as long as she is approached in certain ways…( I don’t have room for the entire list) …talk to her before you touch her in any and all ways, try to make sure she can always see the provider no matter what they are doing, and no “audience” of any sort.
So again we see that it is only when people feel comfortable enough to communicate what dignity and respect mean to them that it will ever be truly served.
Whether it’s a med student who objects to peers, or a patient who objects to observers, or someone whose needs are gender specific:
Reasons are reasons
are reason are reasons.........
No more is less important. No more or less valid. No more or less weighted. No more or less why.
Dr. Bernstein I am not sure we can ask A question that would truely shed light on this issue. For one thing I would suggest that your students, being future providers, when asked a hypothetical question will answer as they think they are expected to. Surely by now they have the concept that they are to be gender nuetral in thier minds. I would suggest that they would answer accordningly. My suggestion would be to present them with the following "we are thinking of having you pair up or get in small groups to practice intimate exams and each of you would be expected to play the patient at sometime, would you feel more comfortable in same sex pairs/groups or would you be just as comfortable in mixed groups?" This puts a little more pressure on for a truthful answer since it MIGHT happen. And, familiarity would be the same with opposite or same gender pairings. However I would antcipate you would once again feel this was the result of familiarity vs gender. So, to be honest I don't know that it would tell or convince either of us either way. I would suggest asking "If we were to schedule you for a pelvic/genital exam would you rather be scheduled with same gender or would you have no preference as to gender? Also I think when you narrow the focus down to people avoiding care you narrow it down to tightly, similar to comparing all modesty to life threatening in the ER. I for one have delayed tests and cares specifically because of this issue but eventually gave in. There can be a lot of negative consequences beside completely avoiding care, delaying and extreme stress or anxiety come to mind. And while they may or may not cause loss of life, I would ask, why would it be acceptable to subject patients to emotional truama when it could be avoided.
Doug, I think most of us would agree respect or disrespect is not gender specific. However, let me ask Mark or F111 (by the way, thanks for serving your country), I don't recall who posted it, if the sheet had been thrown back the same way, if you had been subject to the same treatment, and everyone in the room had been male, would it have been just as bad or less troubling....alan
Doug
Regarding Mark and his comments referring to
the male nurse. I too have seen that only to a small
degree. Consider, male nurses are subjected to the
culture, the notion that male patient privacy is not
respected. Both in nursing school and in clinical
settings and after awhile I believe they become
perhaps somewhat jaded. The idea seems prevalent
that for one male to advocate for another male in this
regard is unmasculine.
PT
Alan, I am not sure that my 6 students in the group I teach are representative of the number of medical students in the United States which is at least 10,000 times the size of my group (more than 60,000). I also don't think that whatever I teach about patient modesty to my 6 students will make any impact on the issues described on this thread..at least not for the majority of patients in this country. Finally, although I see the point you are making about the questions you proposed, as the students' teacher, I can't present these questions to them since they imply that the course faculty may be contemplating these exercises and we are not.
I really don't think that to most quickly and efficiently change the medical system to make the system aware of the modesty/gender concerns of some size group of patients will require another more direct advocacy approach which will involve changing society's attention to physical modesty and gender equality in medicine and how the society supports men in medicine beyond work as physicians than some change in student education of my 6 students or working simply through attempting to change how all medical students in the U.S. are taught. ..Maurice.
Could not agree more Dr. Bernstein, I don't think taking this issue to your 6 students would serve a purpose. The greater benefit is to put the thought on the table in the provider community that what students and providers feel when they are the patient or asked to be examined in class may not really be different from what their patients feel, it may he justification. There is an inner circle mentality that is apparent to many patients, but not nesecarily to providers...still in the camp that providers are by and large great people, but tend to place their perspective as fact rather than their opinion.
Actually in my case it was the male doctor. I was surprised as a man he didn't empathize with me. In later conversations he seemed to have no idea that I was embarrassed and humiliated by his callus treatment. I personally believe a male nurse would typically relate to another man. It is why often ask questions about what happens in the later years of doctor training. What happens to doctors that they can't empathize anymore?
Mark
Just a correction to my last posting's last paragraph. Scratch out the "don't" in the first line. ..Maurice.
ANON:
6 Med students will come into contact with thousands of patients in their lifetime. One small lesson never forgotten could greatly reduce hundreds of tramatic experiences. That is a purpose greater than advocacy....it is the purpose of humanity.
Alan, serving was truly an honor--thank you. With respect to "if the sheet had been thrown back the same way, if you had been subject to the same treatment, and everyone in the room had been male, would it have been just as bad or less troubling?" JUST AS BAD. The whole chaperone/observer thing is downright creepy. As I indicated early, I can handle opposite gender intimate care (a doctor OR registered nurse) if it's my decision (advance knowledge) and just the two of us. If two providers are present, its situation dependent. The assistant must actively participate in the exam/procedure; standing around observing is a nonstarter. PRIOR to the exam/procedure informed consent is nonnegotiable. I will no longer subject myself to surprises by medical personnel. Short answer, any medical "professional," regardless of gender, who is not actively participating in my care, is not welcome. Unconscious or sedated is another issue entirely.
The bottom-line: most patients never give these issues any thought until the door opens, bare ass naked, and in walk the entourage. That's a difficult time to stand your ground. I'm convinced most providers intentionally operate that way because it's expedient. And, they truly don't give a damn about our thoughts, feelings, or emotions regarding these issues.
DonMD from allnurses.com said it best: "All patients need to be treated as if they are the most modest person on the planet. You won't cause emotional harm if you treat the less modest person with the utmost regard for privacy. But you'll harm a lot if you treat every guy patient based on the myth that guys don't mind being seen naked, or it's no big deal." Obviously, his comment applies to both genders.
F1114ever
Love that comment from DonMD. It very simply provides an answer to all the concerns here and if all providers viewed patients in this way we would perhaps not even be commenting here! And, by the way, I realize some do not have issues with this if they are sedated/unconscious but to me that is just as bad, if not worse (not knowing) and the DonMD standard should also be applied to surgical/sedated procedures. Jean
Sorry I was the post annon on the 4th and forgot so sign. I do agree with Dr. Bernstein that it would not be best to require students to partcipate if they are opposed, and I would not expect a Dr. to "trick" them by proposing they are going to do this if they weren't. My point was that if they were made aware, and it was impressed upon them that what they are asking patients to do is as bad or worse as them being asked to partcipate it helps. My point was I do feel providers have an us and them policy, not intentionally, perhaps not even conciously. By rationalizing asking students to partcipate is different and its OK to not partcipate becasue they are collueges, to make accomodations for providers when they are patients becasue they are co-workers and its different they rationalize and justify why they will not do the very things they ask patients to do. I think this is contributory to the issue. It might be self preservation, if they enter everyday feeling they are causing emotional trauma to patients, I think it would conflict with what they want to do, help the patient. My point was not that I expected Dr. Bernstein to inflict this on them just to teach them, it was that I would like to see them abandon the justification that them not wanting to be subject to this is different...worse, than what we are dealing with...I think the better approach is to tell them, the feelings of anxiety you are feeling at thinking about having to do this are the same emotions your patients may be dealing with so keep that in mind and try to minimize or accomodate it. That, would also help these 8 students who will touch 1,000's. I don't believe inflicting emotional truama on students just so they can see how we feel makes sense if they can learn it other wise. I have never been shot, but I understand being shot has to be very painful becasue no one says otherwise. Providers are telling eachother that us "patients getting shot" doesn't hurt as bad as them getting shot because.... What are they to think?.....alan
alan:
I agree with your above post. If anyone here had the impression that I meant Dr. Bernstein should force anything unwelcome upon his students then that was certainly the wrong impression. I simply meant that their aversion is of equal ethical value as a patients, and there could be a huge lesson learned by the statistics of that.
In learning situation, if students experience excessive stress, they won't learn. If the focus is on the stress, the focus won't be on what needs to be learned. Basic Maslow.
Having said that -- there are also what we call "teachable" moments -- times when, if certain points are made, they may be absorbed, integrated more readily into a value person's value system. These moments of student discomfort with their own modesty seem to be perfect teachable moments for medical students. The intent isn't to cause excessive stress. But here there is an opportunity to move students gently out of their comfort zones and into the reality of how a significant number of their patients feel about modesty. These specific teachable moments could create an emotional connection, not just an intellectual connection, with what it means to be embarrassed and humiliated.
Doug, there is nothing further to teach the first and second year medical student regarding patient modesty beyond the basic information they are all taught already. The students demonstrate their own modesty in the situations they are presented and they, on my observation, clearly demonstrate they anticipate and understand modesty concerns of the patients they are examining. There is nothing further to teach except to tell them "there is some population of patients who are very concerned regarding the gender of the healthcare person attending to them and some population of patients who are so concerned about the gender issue and their own modesty reactions that they might even avoid an essential examination or procedure if their concerns are not attended to." I am beginning to introduce this concept, derived from my experience on this thread, to the students I teach. ..Maurice.
Maurice -- I'm not questioning what you do or how you do it. Your the expert. I do assume from what you say that these students are making that emotional connection to some extent. I'm just pointing out the difference between an intellectual connection and an emotional one. Learning something intellectually is one thing. Telling students about modesty is one thing. Feeling that learning experience is much more significant. This goes for all kinds of learning.
I have to agree with Doug here a little Dr, Bernstein. I don't have any basis to question your teaching or how you interact with your students. I have no qualifications at all to even wiegh in. However, I would suggest that your comments seem to fall in line with what other providers have posted, that asking themselves or students to partcipate in intimate exams or providing special accomodations for providers is not the same as what we as patients experience is myoptic. I understand you are in the best position to know what your students need or feel, however, it still seems you hold the view that the mere fact that providers work together makes the issue of exposure and modesty so completely different that it deserves special consideration, consideration that providers do not offer or consider for patients. I feel this is completly driven by a self serving perspective. Not intentionaly, not conciously, certainly not malicously, but I think most of us, including most patients would agree. I would think it would be reasonable to point this out to students and would not include a lot of time or effort...alan
OK, sorry to be a frequent poster or to beat this one to death but...I was thinking about the last time I was in for my annual check-up and my PCP mentioned next year would be 10 years since my last colonoscopy and we would need to think about scheduling it prior to next years check up. I made the comment how much I hated the thought and was thinking about going to a imaging center in another town my brother had used rather than our local hospital. (I should say I live in a town of about 2,500 people.) He said why would you do that, when I told him I was uncomfortable with the fact that I knew almost everyone at the hospital, go to church with some of the nurses, are int he same clubs, social circles etc.. He looked at me like I just grew a 3rd eye, and then made THE COMMENT "these people do this all the time, they are very professional and won't think a thing of it". What about ME? He then proceeded to tell me how important it was for the community to support the hospital if we wanted to keep it. I never really thought about it in this context until I was reading this blog. There are small town hospitals all over this country, there are Dr's offices in nearly every small-medium town in this country, we know the people in those facilities personally, we know and interact with them and their families, and yet we are expected to drop our modesty just because. This applies not only to the unavoidable, but the avoidable. I have related how a friend of mine had a woman we know "assist" in his vasectomy and how embarrassed he was. The Dr. knew he was family friends as the 3 of us had kids in the same class. My MD did mine without an "assistant". Happens all the time. I appreciate the honest dialouge here, I appreciate it when someone calls BS on patients with unrealistic demands and criticism. So, I have to call BS on giving providers a pass just because they know each other. Call it what it is, professional curtosey, and use it for a learning experience. OK I will try to move on....alan
alan -- Here's your chance to get some quid pro quo, that is, something for something. You could say to the doctor -- You have certain needs. What are they. They seem to be that he wants you to use the local hospital. Okay, now you have your needs. What are they? If it's the fact that you know everyone, there may be nothing they can do about that. If it's that you'd prefer an all male team, maybe the can do that. They don't want you to use another hospital. Perfect opportunity to negotiate.
Is it legal in the U.S. for nurses to lie to patients about what will happen after they are given general anesthesia? I was promised before an adenoid extraction that the shorts I was wearing wouldn't be touched, but after the surgery I found out that I was stripped naked once I lost consciousness after being given the anesthesia. There was no emergency and I was very clear about not being undressed. Before agreeing to the surgery they gave their word I wouldn't be. Is there anything I can legally do about it?
SL
SL,
You could start by making a formal complaint to your surgeon and to hospital. You could refuse to pay and suggest a negotiation for being lied to. If you did not put your requirement in writing, you might not have too much of a leg to stand on, but suggesting that they pay for their “mistake” will get their attention. You could write to you local paper, you could put a bad review for the hospital on the net. You could put a bad review on the net for your doctor.
You also need to decide what it is that you want. If it only an apology, they will be quick to give you that. Do you want to change the system?
Did your doctor know of your requirement? If not, then this becomes an uphill road.
I have seen OR photos where for neck surgery, a women was stripped naked and was being prepped all the way down to her stomach.
Bottom line, there is no real law broken per se except for assault and that would be hard to prove if you did not have a paper trail.
My wife had surgery where she said – no salespeople and the her med-legal record showed that they let a sales person into the OR. This is at a very large hospital in LA.
I hope Dr. B agrees that these behaviors generally lead to the demise of respect for the medical profession. It only has to happen once.
amr
@amr
Why was there sales people in the OR? I've never heard of this.
Actually, anyone could walk into an OR. It's not like there's a locked door and no one really questions you if just walk in, at least in my experience. Even if you don't walk in, you can look into the OR from the door. There's not much privacy in the hospital or OR. If you're at a large teaching hospital, you can forget about privacy. The focus is not just on patient care, but also on education and research.
SN
Let me be clearer. She checked off on the surgery consent form "no medical reps". So she did it in writing, and it still happened. Most surgery suites today have cameras running from many angles, and there is a telepresence in the OR. All for the good of humanity as a whole and the efficiency of the hospital in specific.
amr
Though I am not a surgeon, is my understanding, and though I haven't been a witness, that there are on occasions representatives of surgical device companies within the operating room instructing the surgeons regarding the techniques of using newly acquired surgical devices. The goal is surgeon education and safety for the patient. I don't believe that patients are informed of their presence since they are considered part of the surgical team for the operation. Whether each and every member of the team be first acknowledged and approved by the patient is another matter.
There is merit to having such surgical device representative present for the initial uses of devices on a live human being rather than relying on prior surgeon training on animals or simulated patients.
I can't say whether these representatives ever are in the operating room with the intent to sell the device to the hospital. If so, that, to me, is an entirely different matter and I would think that, in that case, the patient should be aware that their body is being used for basically a sales rather than an educational reason and should be an active participant in the approval of the presence of the rep for this commercial reason.
If there are any surgeons reading this thread, I hope they jump in and correct any misunderstandings I have about this issue. ..Maurice.
SL what ever you do don't just let it slide. Definately start with the facility, write a letter/email and send it to multiple people in the hospital. include the patient advocate, hospital administrator, and your surgeon. Let them know you want to discuss it with them before you decide to file a complaint with JACHO and posibly consider contacting an attorney to pursue civil or crimminal charges. It will get their attention if they know you may take this to the next level. If you get a response and meeting ask for specfic actions they will take to address this. Please let us know how this goes, again please do not let this slide....alan
Dr. B,
The "rep" in my wife's OR was a suture rep. Hardly a "new" device in the OR. Why don't you take a walk out of your class room and go visit some of your surgeon faculty friends and ask them for yourself. I took just a few minutes and found several discussions about "reps" in the OR.
Sales Rep in the Operating Room
VacTruth
I appreciate that you agree that these practices are wrong. But they exist, and they are VERY common. If it happens at the "other" large teaching hospital across town from USC, I would be shocked to find that it isn't practiced at USC as well. It isn't enough to simply provide "lip service" to inappropriate behavior of your fellow professionals. You are a teacher for god sake of the next generation of doctors. You are in a unique position to effect change. You seem to not want to exercise your influence.
My wife read your entry and lol'ed saying: Oh pleszzze. Remember she comes from a medical family, her father a ortho surgeon. As I see it: "not a surgeon" is code for burying your head in the sand.
When the web offers immediate refutation for your position, asking surgeons to weigh in is ludicrous. Medicine is a business, the patient serves as money and research. Modesty is simply not considered.
-amr
amr, as I said, the selling of devices by a rep in the OR is another matter and should meet standards of professional surgical procedures in the OR and should first be accepted by the patient. With regard to the standards of professional surgical procedures, I am unaware of the details since I do not work in the operating room. Let us have a surgeon provide us with those details and then our visitors can argue with a surgeon.
By the way, I teach medical students how to take a medical history and perform a physical examination. The students are later taught in their 3rd and 4th years about principles and standards of behavior and practice in the operating room when they are in their surgical clerkships.
..Maurice.
These two quotes from the two articles amr provided:
1. "And, at the foot of the operating table, there’s Chuck Bates, a guy who studied biology in college and always wanted to go to medical school but never did.
Instead, he began his career selling hot dogs to grocery stores. As the surgeon prepares to make an incision, Bates stares at the X-ray monitor. Come up one centimeter and make your incision there, Bates tells the surgeon. A little later, when it appears that the doctor is going to use his hand to push a needle into the patient’s spine, Bates suggests that he try a mallet instead. Just tap-tap-tap, Bates advises."
2. "The day prior to the woman's surgery, the Johnson & Johnson salesman met with the woman's surgeon and his partner, claiming that he had obtained permission for using the new device from the Chairman of the Department of Ob/Gyn and the Administrative Director of Surgical Services at Beth Israel. The next day the salesman appeared in hospital scrubs with the device in the operating room where the woman was scheduled for surgery. When the operating room nurses pointed out that they had no training in use of the machine, they were told that the salesman would operate the controls."
Are these for real, or are they skits from Saturday Night Live? These salesmen are actively participating in the actual operation. In the first case, the surgeon is taking orders from the salesman who is actually directing the surgeon's movements. The patient has a right to know and approve this. How can anyone question the patient's right to know what's happening in these situations? Has everybody forgotten what informed consent means?
Doug,
These were two website almost at random. Google: Sales Reps in the Operating Room. There you will find also official protocols for sales people to be in the OR. However, what I learned is that these "protocol" are often ignored by hospital personnel.
When my mom was having knee replacement surgery at a large catholic affiliated hospital on the west side of LA, I witnessed a conversation between a senior salesman and junior salesman in the parking lot. The "new guy" was being told how to behave in the OR when they go in. They were in scrubs. (Have no idea if they changed them b4 going into the OR.) They had a sample case they were going to take in with them. I lingered by my car to observe their setup. It was all normal consumables - nothing "fancy".
Dr. B, by saying that as an ethicist and a teacher of 1 & 2 year med student your job and knowledge is limited is like what a young deer does. To hide the baby deer buries its head underneath itself. Since they can't see you, you can't see them. Your lack of curiosity makes you a very integral part of what is wrong with medicine. (Sorry to be so harsh.) I also understand that you are aware of the politics involved with asking too many questions and rocking the boat.
A long time ago on this blog you mentioned that you take your students to observe operations. Since you have been a doc and teacher for years, you clearly have had the opportunity to interface with hospital personnel. You don't need to have the mountain come to you…..
Here is a list of items to observe.
1. How many video feeds are there in the OR. Where do they go and who has access.
2. Are the feeds on at the start of prepping and at the end of the operation (when the patient is normally fully exposed)
3. What is the policy at USC regarding sales reps. Find out how carefully these policies are practiced.
4. Are reps allowed to practice medicine at USC?
5. Find out if anyone looks at the opt out on the consent form for reps as a matter of course.
6. Talk to 3 and 4th year students and residents and ask them about the ob/gyn rotation and if they have done or have witnessed non-consensual pelvic / rectal exams
7. Do maintenance people (phone, lights etc) do their work in the OR with patients
8. Does USC allow swap-outs - meaning that the surgeon of record doesn't perform the surgery but a resident does.
9. What are the classification of observers and their age. (A 16 year old boy because he is interested in surgery was allowed to observe surgeries for an entire day at a hospital here in Los Angeles. He is a member of my extended family. My brother was allowed to wander the OR suite one day as the guest of a doctor friend of his in Los Angeles. He recounted several instances of modesty violations. One he remembered vividly was an OR suite with a large glass panel window along the main corridor of the suite. The entire OR was visible. The gown was quickly removed from the female patient by a male tech. The tech's body language, leering smile and hand gestures told of his "appreciation" for her naked form.)
These are all off the top of my head. I could come up with a similar list for the ER.
Frankly these are rhetorical and for the blog to consider. I see no indication from your responses over the last 6 years that doing your own research would be of any interest to you. Again, sorry to be harsh, but it is clearly why change respecting the patient will be slow in coming, if it ever does. It must be a patient revolt and federal laws with penalties that will be required to change behaviors. But that will be problematic. The virtual strip searches at the airports have not been revolted against.
It is not enough to voice your agreement these practices are wrong. And to marginalize these as "outliers" is hiding your head like the young deer. Anyone can go on discovery heath and look at the shows regarding life in the ER and see openly the culture of our hospital system.
-amr
Epiphan is just one company that offers integrated Streaming and Recording Video Feeds from the OR. Please note at the bottom of this web site a graphic that indicated that the feed can and is fed into the internet. There is no effort that I know of that is discussing the ethics from the patients perspective regarding these technologies in the OR.
Again it took me longer to create this blog entry than to find this link above.
-amr
Often you see these reps in ortho cases, directing the
surgeon with new equipment. The equipment could
range from total knee implants, hip and other hardware.
Many facilities now require that the rep not know
the identity of the patient, but I know for a fact that is
never,ever the case. I have seen the reps many times
in surgery cases. Personally, I believe their presence
is unnecessary if the surgeon would simply take the
time to read the instructions on the new hardware,
before the surgery.
PT
amr, your list of questions are certainly appropriate to ask but I am not the one to do the answering nor the one to do the questioning. I have enough to do on my plate these days with my responsibilities than research the answers to these questions. Yet, in order to determine unethical or illegal behavior in the operating rooms, they should be researched and they should be answered. Amr, it is up to you and the other advocates who strongly suspect wrong to either directly get the answers or to motivate appropriate resources to discover the answers for you and even for me. Why not speak up what you know and what you suspect and what others know and what they suspect to the Los Angeles Times and their reporters to take over the project of finding out and then publishing in a major newspaper the results? The Times is a great resource and have published prize winning investigations in the past. That is the way to get to the bottom of all of your concerns and to hopefully initiate some changes in misbehavior within the operating rooms if present.
In my own way and perhaps more than most other physicians (Dr. Sherman, excluded), I feel that continuing this blog thread with a potential nation-wide and world-wide distribution, I have contributed steadily to the dissemination of patient concerns which I believe do need to be disseminated. This is what I have done and currently have the capacity to do and the rest is up to you guys and gals. Get the answers to your questions and then advocate the needed changes based on the facts.
I hope I have made my position clear. You are all on the right track to want the facts. Now, do something yourselves to get them and then act. ..Maurice.
Within the last few posts, many topics have intersected regarding patient modesty and informed consent. I want to make my position clear on one of those, i.e. corporate technicians and/or salesmen in the OR working with the doctor. As medical procedures become even more technical today, using all kinds of robotics and machines, these relationships between surgeons and salesmen will become even more common, even embedded in the culture of the OR (if it isn't already). My position isn't necessarily that they don't belong there or, or that they have necessarily have no role in the procedure. My postion is, regardless, the patient has a right to know and approve -- and I don't mean by signing a general, legalese document with permission granted in fine print somewhere at the bottom.
We have talked about the site allnurses before. There is a thread running on the side called topic of the day and the issue is "Etiquate in the OR" and it deals with providers making inappropriate comments about an unconcious paitent. It is pretty disturbing the number of people who justify it. It is a well they can't hear and well they are just venting justification. Once again an us and them mentality shows through....alan
re: "Etiquate in the OR" on allnurses. Please Dr Bernstein, tell us all how in all the times you've been in an OR, you've never seen something like this happen, surgery is all business, nothing is exposed that doesn't need to be exposed, etc, etc. I need a good laugh. Margo
Two observations on that thread and the issue, alan.
1. Most responded that the find the practice terrible. Some admitted that it happens not infrequently. One said, as the circulating nurse, that she isn't hesitant to admonish those who behave that way. Unfortunately, in unhealthy hospital cultures, those overhearing such comments believe their jobs may be at stake if they complain or file a report.
2. That kind of behavior diminishes those involved and diminishes trust in the system. In no way does it diminish the patient. It's adolescent behavior which shouldn't be tolerated.
Doug I agree with your observations 100%. This or similar issues have come up before on allnurses. The common thread with them is while many say it is wrong, many also justify it under the we are just human. My big problem with that is the medical community they hold themselves out as being above this to get patients to comply and then justify as being just human when they fail. This scenerio plays out in different degrees, a woman in our office was relating how her 18 year old son just had surgery and the nurses (whom she knows) said they always argue who has to shave the hairy guys, especially the old fat guys as its just gross...so what ever happened to a body part is just a part? The other thing you see is the failure to hold eachother accountable. I understand the dynamics that allow this to happen, fear of termination, fear of being alienated from your co-workers, the "mob" mentality. I think this once again does come back to the us and them mentality, us providers stick together. I think that is natural, what I think disturbs me the most is that providers will not recognize that it exists and what impact it has on how they approach and practice. The first step to solving alcoholism is to recognize the problem. Providers have yet to recognize or admit tot he problem. Honesty with themselves and patients seems a relative term...alan
I read the OR Etiquette piece at allnurses and I must say that I found most respondents to be disapproving of the inappropriate comments made about the large patient in the OR. I was actually quite impressed with several of the nurses comments: they seemed quite respectful and committed to their patients' dignity. Of course there were a few who made attempts to justify the practice of "gossip". But let's face it; you are going to have members of any profession who are going to be more committed to doing the right thing, etc. and you are going to have those bad apples who just do their job and complain, gossip and act otherwise unprofessionally. It happens everywhere. The frightening part about it happening in the medical world is that the behavior affects patients in profound ways. And there is no way for patients to know when they go into that world if they are getting compassionate individuals on their team. They just sometimes find out the hard way.
Anyone who has done any research into medical practices knows that reps are in the OR often.
My cousin works in the field and tells me stories all the time.
Secondly, a major city hospital was cited for permitting intimate exams on females without their explicit consent. This hospital now uses "paid patients" to be examined and to educate the staff.
It would be most appreciated if Dr. Bernstein would acknowledge that these common practices do exist.
belinda
alan:
Over the years I've had my issues with allnurses, and I still have problems with some threads. But this thread is a good example of the positive aspects of the site. A nurse brings up this OR issue because it upsets her. Most respond with disgust at the practice. You write: "The common thread with them is while many say it is wrong, many also justify it under the we are just human." I don't think they're justifying the practice, but just saying that it's human. I agree with you that, what's most upsetting, is that too many hear that kind of talk and say nothing, make no attempt ot correct it. You write: "providers will not recognize that it exists and what impact it has on how they approach and practice." This thread shows that providers do recognize that this behavior exists, it's potential affect on the patient, and do not agree with it and want to stop it. I give allnurses credit for bring this kind of issue out in the open and showing that most nurses regard it as truly unprofessional.
However Doug, how many suggest doing something about it. Saying they are just human provides the excuse. Saying, we have held ourselves out to patients as being above this, you need to report it holds them accountable. When I read do something about it, it must stop, then I will agree. At one time people may have been disquested by racism, but failing to do anything about it allowed the offensive behavior to continue, silence was complicent in the offense....alan
There never has and never will be a thread on allnurses
that will ever convince me that those evil little trolls
are the little angels they make themselves out to be.
PT
PT, I doubt anyone who describes themselves as whatever on a blog but signs in anonymously or with a pseudonym and without presenting any evidence to prove that they are within the medical profession should be classified either as trolls or angels within the medical profession. They are nothing but commentators and should be taken as such and nothing more. And.. unfortunately even on my blog I have to respect each visitor who writes anonymously as simply a commentator and nothing more. How can anyone make more of these writers without documented facts about them as persons. That doesn't mean that anonymous visitors to blogs should be ignored but certainly ad hominem descriptions about any one of them are not only poor taste but in addition are factually meaningless. ..Maurice.
p.s.- By the way at 147 comments on this Volume..we are about ready for moving on to Volume 48 shortly. You all do want to continue here on this topic, don't you?
yes
BJTNT
are we actualy supposed to vote?
No votes. My interest was only for any comments about further value of this thread. I think that such a question is pertinent in view of the fact that this thread is reaching 7 years in age and it seems like most every combination and permutation regarding patient modesty has been discussed here.
Well... maybe not. I wonder if you all know what is happening in the state of Virginia. Here is an excerpt from today's Chicago Tribune but also present in a number of other news sources:
This month Republican majorities in both chambers in Virginia's Legislature passed one of the strictest mandatory pre-abortion ultrasound bills in the nation — a measure that's certain to require women seeking early-stage abortions to submit to being vaginally penetrated by a condom-covered electronic probe before the abortion is allowed to proceed.
The procedure is called a "transvaginal ultrasound," and it's the best and sometimes only way in the first stages of pregnancy for physicians to obtain images that "contain the dimensions of the fetus, and accurately portray the presence of external members and internal organs of the fetus," as the bill requires.
Such ultrasounds are common medical procedures. But make no mistake. The proposed regulation, which Republican Virginia Gov. Bob McDonnell previously indicated he will sign if, as expected, legislators send a final version to his desk next week, has nothing to do with the practice of medicine.
My opinion is that this law is a disgusting way to try to get around the Roe vs Wade abortion decision of the Supreme Court. ..Maurice.
Thank you Maurice, I agree. Furthermore, the purpose of it will only traumatize women making one of the most difficult decisions in their lives.
Forcing anyone to go through a procedure at the hands of medical personnel (who are also forced by the law) will be forcing the medical community to contribute to the detriment of mental health for women who are already vulnerable.
This is truly obscene.
belinda
NOTICE: AS OF TODAY FEBRUARY 20, 2012 "PATIENT MODESTY: VOLUME 47" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 48
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