Patient Modesty: Volume 50
This graphic modified by me from the graphic in an article in the July 30, 2010 New York Times sets an area of discussion on this Patient Modesty thread which we should settle by some consensus. Those with such intense physical modesty concerns that would interfere with an efficient medical workup and treatment have been, after reading the responses to this thread, in my mind statistical outliers since I never have experienced such patients in my years of medical practice. OK..that's one potential outlier. The other is the group of healthcare providers who have shown by their behavior and in many ways sexual and dominating actions creating emotional harm of their assigned patients. I suspect (and hope) this group of providers are also statistical outliers. I am not saying that such outliers whether patients or providers should be ignored but I think we must appreciate the majority of patients and providers who continue to attempt to improve health and service and not generalize the behaviors of the outliers to the entire population. This is the topic that I would like further discussion upon as characterized by this Volume's graphic. ..Maurice.
NOTE: FOR THOSE VISITORS WHO HAVE NOT AS YET READ VOLUME 49 AND WOULD LIKE TO DO SO FOR CONTINUITY (BUT NOT POST) MAY GO THERE WITH THIS LINK.
ADDENDUM; AS OF SEPTEMBER 10 2012, I HAVE STARTED A PETITION SIGNING DRIVE ON
ONE OF THE FREE PETITION WEBSITES TO ACCUMULATE SIGNATURES TO SEND TO THOSE OF RESPONSIBILITY IN THE MEDICAL SYSTEM REGARDING THE ISSUES AND CONCERNS AS PRESENTED IN THESE 50 VOLUMES OF PATIENT MODESTY. IF YOU WISH TO PARTICIPATE, GO TO THE FOLLOWING THEPETITIONSITE LINK.
http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/
Graphic: see above linked source.
NOTICE: AS OF TODAY OCTOBER 14, 2012
"PATIENT MODESTY: VOLUME 50" WILL BE CLOSED FOR FURTHER COMMENTS. YOU
CAN CONTINUE POSTING COMMENTS ON VOLUME 51
posted by Maurice Bernstein, M.D. @ 9:52:00 AM
142 comments
142 Comments:
Maurice
That looks to be a bell distribution curve,
correct? It has been found that if you add every
winning spread of lottery numbers the sum total
always falls within a narrow margin of a normal
distribution. It's a great little math gadget, that's
my point. Not so good for calculating behavior
patterns of people or predicting probability of
behavior.
PT
Maurice,
Thanks for answering my question.
You must understand that patients who become "outliers" are those who won't participate with the medical system at all. That's what extreme trauma does to individuals. It's only the healthy ones who can stand up and demand to be treated with dignity and respect. There are not too many of those.
There has never been research done to show what the statistics are but I am sure you would be amazed and it must also be noted that the more trauma caused, causes more outliers. There are far more than you can imagine on both sides of this equasion.
belinda
Belinda, is there something I could extrapolate from your comment that it is your view that it is really the behavior of the medical professional outlier which results producing emotional trauma on a patient which is the psychodynamic mechanism that will put that patient into the outlier category of those who seriously limit their medical care attributed to physical modesty?? If most of the physicians, nurses and aids treat the patient with care and courtesy that the patient would be comfortable exposing their bodies to the appropriate and needed medical attention and both groups would be represented within main distribution curve? So the main process to diminish the patient outliers would be to attend to uniform patient care and courtesy by the caregivers? ..Maurice.
Maurice
Here we are at the 50th modesty thread and we
have yet to define what constitutes a medical professional
outlier. You have mentioned that you have never observed
such behavior. Could it be that your definition differs
greatly from ours,please elaborate.
PT
PT, as I noted above it was my impression and interpretation that Belinda defined a "medical professional outlier" as one who does not present care and courtesy to a patient which then leads to emotional trauma to their patient. Certainly one who by the actions or words conveys sexual intent or disregard for a humanistic approach and unwillingness to try to understand the needs of the patient would be included in the "outlier" category. Outlier to me because I have never personally witnessed directly such behavior with a patient and I have never experienced that myself as a patient.
I would consider a patient as an outlier, as I have noted, if the patient sacrifices their diagnosis and treatment because of physical modesty either from some inherent modesty or as some reaction to psychologic trauma.
PT, does that answer your question?
As I noted in my introduction to Volume 50, I believe neither the outlier as a patient or the healthcare provider should be ignored and there should be some public and professional expression and action to remedy this entire problem. I hope in my own way with this blog thread I am doing that but as I have repeatedly stated it requires much more extensive public advocacy and attempts to remedy the situation.
Of course, the sexual perverts in the profession should be booted out! But to ensure full care and courtesy will require changes in the business and methods of providing care. There is not enough time and various pressures on physicians and other providers to assure the full acts of the care and courtesy to the patient regularly occur.
By the way, I do have a thread on "I Love My Doctor and Here is the Reason Why" with a number of visitor positive responses. Do you think these visitors are the outliers in this discussion? ..Maurice.
More: To read about why care and courtesy has the potential of being missing in the behavior of physicians in our current medical system, read the discussion on the thread "Cost and Degrading of Medical Practice: Overlooking, Underestimating Overhead" ..Maurice.
Maurice,
The answer to your question is yes.
It is important to note that once someone is mistreated, their tolerance for things that would be considered normal (if they had never been mistreated) in a healthcare setting are no longer tolerable.
This is because trauma changes the way people feel about their world around them.
Hospital settings do not afford previously traumatized patients the luxury of knowing and trusting individuals left to their care.
Humiliation studies confirm that people would rather die than suffer humiliation so I don't really understand what is so difficult to understand about the dynamic of the mindset of an outlier.
Using myself as my own guinea pig I have developed a set of dynamics for myself that are almost like a formula that does two things. One, gain support of healthcare providers and secondly, to provide an environment that works for me to ensure I get healthcare when I need it.
belinda
So, Belinda, if I understand what you write, if the patient can take the personal responsibility to anticipate and then communicate with the healthcare provider to gain support and to provide a more comfortable environment, some of those considered "negatives" on the part of provider can be prevented and perhaps move that provider out of the "outlier" part of the curve along with, at that point, also the patient.
I would heartily agree. Providers are no mind readers and unless the patient expresses fully what is on their own mind the usual routine will continue. If a doctor fails to allow a patient to "speak up", that is not a doctor with whom a patient should want to continue the relationship. ..Maurice.
Maurice,
I'm in the process of writing two books. One talks about my own personal story and how it affected me when it happened and how it effects me now. It also talks about the process I went through to end up where I am now with the healthcare industry.
The second book talks about the subject matter we are talking about now and what needs to happen within the medical industry and educating the patient so that they know enough to do the proper anticipatory screening prior to an experience.
The problem is even with these things that will help so much, there is no preparation for deviance other than knowing it exists and dealing with it as part of the general discussion of what you expect from your team and what is not acceptable. It can never be 100%.
However, that said, I want to add that your defining "one that does not provide care and courtesy" seems to whitewash cruel and degrading behaviors that I know are more common than the medical profession wants to admit and that has been covered up similarly to the abuses in other institutions.
belinda
Belinda, "as they say" I beg to disagree. I think that "care and courtesy" is not a "whitewash" and, indeed, covers the whole area of appropriate professional behavior towards patients from empathy to humanism to simply being thoughtful and polite. A physician cannot be thought of having care or courtesy who also is cruel and has "degrading behaviors". With regard to "cover up", I can't deny that has never occurred. Hopefully, "whistle blowers" like you will prevent "cover up" from happening. ..Maurice.
Maurice,
I don't think there's any disagreement here at all. I was lumping everyone together and you are talking about the norm for the healthy medical population.
It is interesting also, that there can be no ill intent at all but still leave the patient devastated as was the case that Art Stump illustrated in his book.
So...here's some "food for thought"...Some of the problem exists when the medical profession defends it's position to do things that humiliate people. Some of these "things" are unnecessary, some seem outrageous to the patient when the medical community didn't view this as a problem at all.
The problem is that patients can have have had great harm done to them when "standards of care" provide an environment that traumatizes people.
The mental health severity of this problem is one that the medical community should be looking to solve. Some are not, just taking those complaints to "risk management" and protocols are adjusted to limit liability instead of a real patient friendly atmosphere.
We are thankful for you, Dr. Sherman and others who really care about this issue.
Don't forget, it's not just the traumatized patient from a bad medical experience that avoids the healthcare system, but a whole element of previously sexually assaulted individuals who must enter the healthcare system.
belinda
Ah,Belinda, then would you conclude that the underlying psychologic basis (one might call it "etiology")for patients who express physical modesty to the extent to avoid diagnosis and treatment is that of prior experience with sexual assault some time in their life from a professional or from someone else? Hopefully, these events would be rare and thus the numbers of patients with such an experience and reaction would fall into the "outlier" category. ..Maurice.
"then would you conclude that the underlying psychologic basis (one might call it "etiology")for patients who express physical modesty to the extent to avoid diagnosis and treatment is that of prior experience with sexual assault some time in their life from a professional or from someone else?"
I really hope that this is not going to be the "take away' from all medical modesty issues. We have been stressing here for many volumes that there are many reasons why a person might have modesty/dignity/ gender requirements. Let's not set ourselves back a few years by allowing that type of blanket mentality.
The last thing we need ( no offense)is for the medical community to say "let's respect the needs of the abused, but the rest are just being petty."
Otherwise, our message is not getting through after/at all.
Suzy
Maurice
I think part of the "care and courtesy" definition difference may be this: Although you often use the term "medical profession" as a doctor you re often focused on physicians. We re talking about professionalism here, and the true professionals in medicine are doctors, nurses and some techs. Since WW2, esp. since the 1960s, a tremendous number of aides and "90-day wonders" have entered the medical "profession." Many of them do most of the intimate kinds of procedures we refer to, or are "assisting" doctors during such procedures. Many are wonderful caregivers and come into the field from life experiences that make them mature. A good number are very young and come right out of high school with little or no real life experiences.
Doctors in private practice hire and use these cna s or medical assistants and some doctors give them little or no supervision. Some of these caregivers learn the essential elements of their jobs from the hidden curriculum, and some of that comes from other caregivers who have learned from the same source.
I think these days we need to really separate doctors and nurses from all the other assistants, techs, cna s and aides wandering through hospital and clinic halls. These days many patients don t know who they re dealing with half the time while in the hospital. Someone who says they re with the nursing staff may not be a nurse but cna. Some cna s and med assts are actually called nurses by the receptionist and doctor. If doctors and nurses want to remain the professionals, they need to make sure they distinguish themselves clearly from those who, as far as I m concerned, are not "professionals" under that definition of the word, even though they may behave "professionally" and with care and courtesy.
Doug Capra
Dr. B,
"then would you conclude that the underlying psychologic basis (one might call it "etiology")for patients who express physical modesty to the extent to avoid diagnosis and treatment is that of prior experience with sexual assault some time in their life from a professional or from someone else?"
I don't think this is true at all. I would say that it far more likely that those who avoid care do so as a direct result of previous traumatic experience(s) of disrespectful care or treatment from the medical industry. This could include any number of things, such as violations of the patient's modesty or privacy, the condescending and abrasive attitudes of caregivers in response to a patient's question or objection, or more rarely even such things as physical or sexual abuse by caregivers.
It is my belief that where the sexual abuse victim issue comes into play in general is how the victims are treated when they first receive medical care for the abuse. If they are treated with compassion, sensitivity and respect, and allowed to control what is done for them and by who, then there is a good chance they can come through the exam and treatment experience without excessive additional mental trauma. Unfortunately, the overwhelming majority of emergency medical care and law enforcement community fail miserably in this respect. That is why the SANE and rape victim advocate programs came to be. In these situations the wants and needs of the victim must be the only priority, and everything else is secondary to that.
If you force or coerce the victim into things like photos or exams they are uncomfortable with, or accepting care from an examiner of the same gender as the perpetrator, you stand the very real chance of causing additional emotional trauma that can easily result in future care avoidance behavior. By being forceful or coercive, the caregivers get mentally lumped into the same category as the rapist.
I believe this is what Belinda was referring to......
Doug, I look at all involved in medical care as professionals since they all, all the way down to the nurses aides, in the United States are regulated by state law and they all must follow ethical guidelines by the medical and nursing profession. It is those requirements that set them apart as professionals.
Interestingly. clinical ethicists are as yet not really professionals since surprisingly they have no governmental or association guidance as to education, no code of ethics to follow and no governmental or association monitoring of their practices. Not everyone who works in medicine are professionals though even a nurses aide is a professional! She (most likely a "she" in the U.S.) better behave! ..Maurice.
Yeah to everybody! Suzy, exactly the opposite is true. If a study showed that certain behaviors cause psychological trauma, then one could conclude from that, that these behaviors need to be changed as "to do no harm" to someone else.
Every sexual assault victim, someone treated poorly with regard to their bodily privacy or disrespected in some other way will have issues. Some of them will reflect past medical experience, some won't. However, because there are certain behaviors laced with the underlying motif of loss of dignity and respect, then programs should be invented to support those who have trauma issues and secondly, make sure protocols reflect the elements that keep trauma from happening. Suzy, I hope this clarified some of my statements before.
Maurice, I know you think this is a minority issue and it might be to the extent that most unaffected patients will not really care about the gender of provider. They care about getting good competent medical care. Although, I would imagine that for some intimate issues that really have nothing to do with medical care like bathing and toileting, that most would probably prefer a member of their own gender.
belinda
Actually in California, where I reside, sexual battery which is sometimes referred to as sexual assault requires the following to prove a Penal Code 243.4 California Sexual Battery Charge: "The non-consensual touching of the intimate part of another for 1) sexual arousal,2. sexual gratification or 3.sexual abuse.
n order to obtain a conviction for a California sexual battery, the prosecution must prove each of the following three facts:
(1) That you touched the intimate part of another,
(2) That the touching was
(a) Against the will of the other person, or
(b) That consent was fraudulently obtained, and
(3) That you touched the other person to specifically cause sexual arousal, sexual gratification, or sexual abuse.
The above and more about the California difference between misdemeanor sexual battery and felony sexual battery can be found at the legal website of www.shouselaw.com
I thought it was important to document a resource for the legal definition of what we are discussing here. I assume California law is similar to many other states.
So.. are these legal criteria what is being discussed here as "sexual assault"? ..Maurice.
"Doug, I look at all involved in medical care as professionals since they all, all the way down to the nurses aides, in the United States are regulated by state law and they all must follow ethical guidelines by the medical and nursing profession. It is those requirements that set them apart as professionals."
I see where you're coming from, Maurice, and you do have a point. But you can only expand the definition of professional so far. Aides are not professional in the same way doctors are. You can't use the same word to describe the situation, not in my opinion. If everyone is a professional, no one is a professional. Continue to include everyone in the definition and you have no meaning at all. This is what I consider to be the deprofessionalization of American medicine. Doctors and nurses will continue to lose status as professionals if a young person just out of high school with a few months training is also considered a professional. My opinion.
While I have great respect for Dr. Bernstein, I could not disagree more with his definition of a "professional". Using the term that broadly in affect makes it meaningless and diminishes the effort and sacrifice true professionals put forth. We can essentially throw it on the scrap heap of useless words. Almost every job I can think of has some governmental regulation or oversight and accompanying ethical standards. Stretching the analogy, is every child who scribbles on paper an "artist"? Is every teen who flips burgers working under health department regulations a professional? A few hours at the local community college to become a CNA does not a professional make. LKT
There's an example I gave on Blog 49 of something that happened to me when having an ultrasound on a 10 week fetus.
The male tech required that I remove everything and wear a gown open in the front. This happened AFTER my horrific experience. I knew not to remove my clothing. Someone who had no idea of what to expect would have complied and only realized after or during the test that something wasn't right.
Maurice, while you would consider this behavior unprofessional, you seem to indicate that this is an oddity. This behavior isfar more common than an overt sexual assault in a medical setting.
Maurice, I know someone who is the Vice President of Risk Management in a major city hospital who told me in an interview that 40% of the complaints that come through the department are of this nature. How do you explain that if it is an oddity?
They call it sexual impropriety, however, depending on how degrading an experience becomes for the patient does not lessen the trauma and actually without the threat of physical assault causes more psychological damage because the mind is focused on the humiliation without a distracting "threat for life" factor.
belinda
Belinda:
I never said that there should not be protocols for everyone. I never said abuse victims should not have consideration. What I said was in response to this.....
"then would you conclude that the underlying psychologic basis (one might call it "etiology")for patients who express physical modesty to the extent to avoid diagnosis and treatment is that of prior experience with sexual assault some time in their life from a professional or from someone else?"
Please read my comment in context.
If you read some of the comments from past volumes you will see that many patients were told that they needed "professional help" because modesty issues must be related to abuse.This may be true for some, but not true for others. Since we want to advocate for everyone who has modesty and dignity needs, we can not pigeonhole people into assumed categories.
Is abuse serious? Of course! Does a huge amount of the population suffer from some type of abuse? Yes they do. I have contact everyday from people who feel that they were either abused by the medical arena in some fashion, or were not given consideration when other types of abuse occurred.
But that's NOT to say that everyone with modesty restrictions has had "prior experience with sexual assault some time in their life" and that was the question posed.
I am well aware of the trauma abuse causes, but the system has to be fixed for everyone. Otherwise...we have a double standard yet again: the point of my original post.
I assume the last posting was from Suzy. Correct? ..Maurice.
By the way, it could be that the term "abuse" really represents a disconnect in the communication between the patient and the people providing the examination, treatment or nursing care. The feeling of abuse may arise from the consequences of the patient being unaware of the established protocols, responsibilities and duties of those providing the service. Patients should, one way or another,mainly from the providers, be informed about the protocols and the duties before the actions. Patients should be given the opportunity to express their concerns, perhaps then leading to mitigation of those concern. Most importantly the patients should express their concerns, if they have them, and not remain quiet.
Abuse, as defined in the Free Medical Dictionary is "Abuse is defined as any action that intentionally harms or injures another person". I would agree with the word "intentionally" since otherwise the harm could have occurred from an unintentional occurance. ..Maurice.
Maurice, I agree with you completely.
While intent may be at the crux of the nature of abuse, the ramifications by inconsiderate behavior may be the same. If one is shot by friendly fire, do they not have a wound?
belinda
Dr B, I also disagree that all in medicine can be considered professionals. There are CNAs who usually have some highly variable state requirements to meet, but there are also assistants who have no certification and little if any training, especially in doctors' private offices. An assistant in a physician's office can be anyone. They frequently are completely untrained.
Joel, if an office employs such "assistants", it is their employer, the physician who is legally responsible for their training and performance and behavior. No, I would not call them professionals, though perhaps if one insists they are professionals since they work in a professional environment, maybe one could call them "medical professionals by proxy". ..Maurice.
Anonymous wrote the following post yesterday on the closed for posting Volume 12. ..Maurice.
At Saturday, August 18, 2012 11:35:00 PM, Anonymous said...
I understand what Suzy described. I had a traumatic miscarriage at 3 months in the Hospital. I went the obgyn for a explanation of why it happened (unusual case). I requested birth control to prevent getting pregnant and going through seeing my dead baby on a hospital table ever again ( mc happened an hour after arriving at the Hospital, well developed baby with fingers, toes, face and all). I was expected to have a pap because it had been 2 years and I agree that was important. I dressed in gown and waited for the exam. When the doctor arrived he checked my heart with a stethoscope, then complained that I was wearing a bra. I said yes I am. He said I needed to remove it for the breast exam. I said I did not want a breast exam and he told me in a baby voice "then no birth control". I said fine, he then prepared to do the pap smear and ran his hands from my thigh above the knee to right before my intimate area. It felt creepy! He did the pap smear, then did a disturbingly sexual feeling pelvic exam where I could feel him trying to stimulate areas inside my vagina he should not (the gspot and I'm not kidding, I'm very serious), I told him it hurt when he was reaching for my ovaries and he said "mmhm in a low voice). I was disgusted, he then asked one more time to examine my breasts and I said no still. He denied me the birth control. I am under 30, have children, and obviously know my breasts better than him, I can examine myself thank you. I complained to the practice, no one scolded him, he's allowed to bully mourning mothers all he wants. I asked to transfer to a female and the office claims none can see me for months there. They asked if I still want the male doc, I said no. The ACOG does not require boob fondling to get hormonal contraception, he's board certified, but he's still boldly attempting and probably succeeding in violating women. I still have to find a new doctor, still no pills, still fearful of miscarriage. Now more afraid of men. And angry! I'll be filing a complaint with the board that certifies him. These things do happen, It's real, and women really need your support and protection from this.
And just to be clear...this was a different Suzy from swf Suzy, which is me.
I have had numerous medical procedures over the last 5 or 6 years. Initially I simply accepted what was being done and the way it was being done. Then I started to stand up for myself. The immediate reaction from medical practitioners is that you are in some way "odd". When I required a colonoscopy, i insisted that I would not have the procedure unless it was an all male team of staff. The doctor dealing with me assumed (And told everyone else) that I wanted an all male team because i "was very embarrassed". The truth of the matter is that I simply did not want any women present for my procedure, my motive is my own business, it had NOTHING to do with embarrassment. The really annoying thing from a male perspective is to always be challenged as to "why" i want all male teams. Women rarely get challenged once they speak up. For men it is difficult to broach the issue in the first place, then to be almost ridiculed for asking, makes the whole process more unpleasant. I can't see the medical community offering gender choices in the near future, it is up to those of us who feel things must change, to be pro active and keep stating our wishes. Eventually, money will do the talking, once facilities see a financial advantage from marketing gender choice, it will become as natural as all other aspects of equality.
First off who is and isn't an outlier depends on a persons point of view. Dr. Bernstein, I believe you have commented that you do not believe locker rooms should be open to reporters, I agree, the majority of people polled agree, yet the atheletes who object are treated as outliers in the media because they control the message. A patient who believes strongly they have a right to same gender care will be treated like an outlier in the medical community because like sports reporters, the medical community controls the message.
Having regulations, expectations, and having them monitored and following them does not make one a professional. Go to allnurses, if they all follow the regulations and then go to a blog and discuss and make jokes about their patients, are they professionals? Conversely, I had a family member who took a few online courses and got her CNA, so now she is a professional and suddenly has the ability to seperate herself from "the regular person" and see patients not as naked men but patients and pretty much asexual. I respect and appreciate what you have done here, I have benefitted greatly from it, but you are defining professionalism from inside, much like reporters define themselves as professionals entitled to invade the privacy of atheletes in a locker room because they control the message. You don't have to have a college education or any practical experience to be a reporter and are allowed to view these atheletes in private moments, nor are these required in many medical settings, professionals may defined differently from the provider and the patients perspective,,which should carry the most wieght?. alan
Alan,..then disregard that those who deal with patients are "professionals" since some meet the criteria which I have outlined previously and some don't. Just consider all "workers in the healthcare provider field". Now you and the others writing to this thread set here the criteria regarding how they should behave with the subjects (patients) of their work: 1, 2, 3...and so forth.
Also, you should set the criteria of how the patient should behave when confronted with the presence of a healthcare provider. I agree the matters which are being discussed here have nothing to do with a titles such as "professional" or "MD" or "RN" but has simply to do with basic decent and thoughtful interaction between worker and patient. ..Maurice.
Maurice,
You have just said a mouthful. If medical workers (whether considered professional or not) had basic common sense and preservation of dignity, this thread probably wouldn't exist.
Medical workers should go through both training and mental health screening before they are licensed in whatever capacity. It would get rid of the deviants, expose anger issues against one gender or the other, or any sadistic behaviors. I'm sure some brilliant sychologist/psychiatrist could develop such a test.
Background checks should be included.
The cost of such protocols could be imbedded into the cost of any program chosen by the medical worker.
Humiliation, degradation and cruel and degrading treatment are not new in any institutional care. However, the medical community has a greater standard to adhere to because of the vulnerability of the patient.
Who's responsibility do you think it should be to protect patients who have previously suffered at the hands of unthinking, unfeeling, or deviant medical workers when the motive of the hospitals is to cover it up?
Who should advocate on behalf of the patient to dictate what they need. My opinion is the doctor in charge. The orders should not be made to make the patient seem defective, but rather to acknowledge that this patient had a bad time and that this is what they need.
Whose responsibility is it to discipline workers when they at best "make a mistake" or at worst, enjoy or punish those who are perceived to be uncooperative?
belinda
I think all aspects of society are in a constant state of change. Evolution of the medical industry is no exception. The whole patient, emotion and physical are becoming more center to the patient provider relationship where years ago it was more paternalsitic. As you state Dr. Bernstein it is up to the patient to recognize and take more of a role in that relationship, that will take time. but I do see the possibility, but, more people will have to step up, I think the medical community while somewhat resistant, will give patients what they want if they ask, we as patients have to have to develop the mentality to tell providers what we want...and that when coming from a submissive role, confronting what has been the dominant portion of the relationship is difficult. Time will tell whether that will be in mass enough to change the system...or as you say remain with the outliers....alan
You know, Alan, with regard to primary healthcare providers giving patients what the patients want requires time to listen to the patient's "speaking up". That time is almost unavailable now in most practices since the results of "speaking up" is the initiation of a discussion may end up time consuming. And there just isn't enough time. Soon, under the new healthcare program for Medicaid with the introduction of a host of new patients putting a greater burden on the current numbers of providers because of more patients to see. there will be even less time for these procedural issues raised by the patients. A necessary reaction to solve this issue would be to encourage more individuals to enter the profession of medicine, especially general medicine but also medicine/surgery in general.
Think about how much time for a visit with you is provided by your doctor currently; time to talk and time to discuss beyond taking a necessary history and performing the appropriate examination. Well, unless you and your doctor are in a "boutique" medicine relationship where you and the other patients private payments allows your doctor to attend to less patients and thus m more time available, otherwise as the Medicaid program enlarges, your doctor will have even less time.
I am all in favor of more time and time to seriously communicate with patients. ..Maurice.
You know Dr. Berstein, I was wondering about the same issue. If the ACA does indeed generate a greater amount of people seeking care and the number of providers stays the same, how are they going to then provide "patient centered care" which is currently so advocated (although not always practiced). I would also see a problem with doctors spending more time with patients if they are swamped, even more so than now. I also see this being a problem in the other aspects we have discussed here: getting care (and gender) that is respectful to the patient (patient centered). If the ACA does result in more crowded doctors offices, hospitals, etc. maybe patient centered care will suffer and we will all be given no choice but to accept "standard" procedures, care and personnel. Anyone else have thoughts on this? By the way, I am also in favor of doctors having more time to talk with patients. Jean
How sad that patients have such limited time with their provider. I am wondering if a good deal of this available appointment time is taken up by "well" visits, leaving very little time for patients who are acutely ill or have health concerns and symptoms they want to discuss? This has been my personal experience, as I usually end up having to go to Urgent Care whenever I am sick because my own doctor never has any appointments available. I was told that if I have my Annual Physical and establish myself as a patient, then when I am sick, I can get a timely appointment. However, when I call, I am told that the doc only does physicals these days, is out on these afternoons, etc. and cannot see me for 2-3 days. I also worked for a GP a couple of years ago and found that he also alotted most of his appointment slots for annual physicals. These "well" visits were allowed 30-40 minutes, while visits for patients who were ill or had symptoms got 10-15 minutes max. That certainly doesn't leave much time for "speaking up". I don't know how widespread this is. I also don't know if this type of scheduling is done for financial reasons. Just wondering if maybe the medical system is overloaded in part due to too much preventative care? LKT
And some may have already heard, there is controversy in the medical community whether annual physical examinations really is the best approach for "preventative care". ..Maurice.
LKT:
I agree with you completely! I also think doctors' offices are full of "patients" who are seeking preventive care only, i.e. annual physicals, excessive screening (over and above what the USPSTF recommends). I also personally think that is one of the reasons our health care costs are so high: too many people using the system who are not sick or symptomatic, just basically the "worried well". While a lot of people use the argument that preventive care saves money in the long run I just am not convinced. Dr. Bernstein is correct also in that these annual physicals are coming under scrunity; questionable as to even having any value. I also think that many people think they have to see a doctor for every little thing: a cold, rash, 24 hour bug, etc., things that would solve themselves with a little rest and OTC meds. But much of this is for a different discussion. Your point about patients who are actually sick not having as much time with a physician than those who are only in for preventive care is one well taken. Jean
While I agree that the "worried well" are wasting valuable resources with regards to doctor's offices and emergency rooms, I think we've gotten away from the original purpose of this blog which is patient modesty and how to change the mindset of the medical community that "this is your Dr. or nurse and you will accept whatever they propose to do to you because that's the way it's done" even if it goes against your morals or values with regards to modesty.
Chris
I think the "time drain" issue is related to the modesty issue in that if medical staff is stretched to the limit, patients are unlikely to have time to discuss modesty needs with their provider. Also, in response to Dr. Bernstein's comment about current rethinking of "well" care, I did a little research into an area that had been bothering me related to dermatology. There seems to be a huge emphasis on full body checks. One cannot go near a dermatology office without intense pressure to have every inch of skin examined no matter what issue they came in with. I find the idea of a stranger with their assistant looking at my intimate areas with a magnifying glass when my chance according to the American Cancer Society of a melanoma on the genitals is ONE in ONE Million (actual stat. 50% of whom are over 70 yrs.) is completely out of the question. What is going on here? Certainly if a person finds something unusual in this area they should have it checked but for the average person to be pressured into this extremely intimate exam yearly when the risk is negligible is beyond belief. Thanks to Dr. Bernstein and all the posters here for keeping me thinking about these issues. LKT
I'm waiting. I am waiting to see someone to describe here what is currently being initiated or already in progress to disseminate but also to strongly advocate to the public and the medical institutions the issues (lack of opportunity to communicate or lack of response to gender selection of the attendant by the patient, unwanted and unneeded and perhaps undisclosed visitors in an exam or procedure, unwanted and unnecessary bodily exposure and others) which have been discussed on this blog for 50 volumes all these past years.
As I have written previously, this is not the place to direct your complaints or directions to change the system. You should start with a petition website such as www.ipetitions.com
Has anyone at least started that way? Do it! Do something constructive rather than moaning and groaning on my blog.
OK, if I am missing something about this advocacy issue, please write here about my erroneous thinking.
I'm waiting. ..Maurice.
OK, OK... maybe I am being too "something or other" by repeatedly expressing "I'm waiting". Maybe I should take a more facilitative, a more helpful role. Maybe I should say "let's get started writing a petition here" where our visitors can formulate, discuss and revise for a final petition to put up on ipetitions.com
Why don't we all go to www.ipetitions.com or even www.change.org/petition (another petition website) and read about the procedures and then come back and somebody get started. Since we all can easily copy,edit and paste posting revisions should be easy.
What do you all think? This will be the first step in getting something going. Who starts? ..Maurice.
There are already laws protecting patient privacy. Dignity is mentioned in the patient bill of rights. There's even a privacy provision in Title 7.
With all said, please tell me how a petition would work? There's no sense in establishing new legislation when the old legislation is ignored.
Who in the medical community should be accountable for these practices that certainly breach privacy and dignity and are "standard of care".
The new way of doing business such as same day surgeries vs. an overnight stay, did not change the medical protocols. So, when someone went into the hospital overnight, a person was sent to the room to "prep" the patient in a private setting; usually a nurse for the women and an orderly for the men.
Now, the medical community thinks is just fine to strip someone of their clothing and dignity in front of a whole room of people while the patient is awake without any semblance of accountability to how someone would feel especially when they aren't warned. Compounding this issue is a total disregard from personhood where it's not uncommon to have janitors, sales people, or other unnecessary beings in the room while this is going on.
So tell me why it's a bona fide job qualification when someone applies for a job as a restroom attendant that the employee be the same gender, yet in the hospital, it's perfectly ok to have our privacy rights thrown out the window upsetting males and females alike and traumatizing some.
While I can respect some of the healthcare workers who earn it, my feelings about the profession as a whole are not too flattering. I've seen patients lied to about their treatment, left naked in their beds while the nurse runs out to do something else, patients being yelled at when they are frightened, patients being punished for being uncooperative.
Where are the ethics? Where is the trust? Wait until the medical profession realizes that the outliers are the majority. If it hasn't already happened, with this continued behavior, it will, sooner than you think coming to a hospital near you!
No petition will help; only reforms that come from the inside, starting in medical school with strong enough sanctions to strip the license of those repeat offenders.
belinda
That was a good post, well said Belinda.
PT
Belinda, if you have identified laws, if you have identified regulations then speak to them specifically as you write a petition to have those governmental or organizational bodies to acknowledge their laws, their regulations and to insist that they act on those professionals or other healthcare participants who fail to follow them. The goal would be to send the petitions, developed through the petition web-sites to each of these bodies. Can anyone provide a listing of the written laws or regulations and the governmental or organizational bodies so this method of advocacy can begin? ..Maurice.
It is my opinion that this approach will not work. The reason...you are fighting the medical lobby. The only way there can be impact is if it comes from the inside out.
Who should be accountable for the kind of changes that need to come about? The legal foundation has already been set.
How about the medical community acknowledging that patients are upset with the way they are being treated by digging out the assigned risk files of patient violations and lawsuits and developing procedures for patient care and sanctions for those who are inconsiderate in performing their duties due to the great harm that might ensue. That's all that needs to be done; and it's all they do to refuse.
It's time that the medical community recognizes that they are not treating patients with dignity, respectfully, or with informed consent (they are still hiding plenty).
What laws and regulations? First, let's start with the Patient Bill of Rights. It was written because they know patients have been damaged due to cruel and degrading treatment and VII where it is noted that hiring one gender over the other is okay if it's a bona fide job qualification.
No amount of petitions is going to get the medical community own up to what they try so hard to ignore.
It's up to us, the patients to say no all the time until the changes come from necessity. That's the only way it will happen. This is civil disobedience in it's finest hour.
Who can measure what a ruined life is or means? Why is someone's mental health less important an issue than physical health? Change will only happen when the system is so bogged down by non compliance that they have to change. No change to any form of institution has come about any other way. Shame on them.
belinda
Belinda, I am not trying to suppress your personal view of the behavior of healthcare providers as the mechanism or one of the mechanisms which lead to the modesty issues written about here..BUT.. I still don't think we all have yet enough data as to what proportion of the patient population is experiencing such healthcare provider behavior, who are dissatisfied, angry and so emotionally upset that they would potentially sacrifice their health because of that. I am not saying that the proportion is in the minority, though as I have written, I never have received such patient feedback.
I'm thinking..just writing to this blog that "patients to say no all the time until the changes come from necessity" is not enough. How many patients are experiencing behaviors to lead them to say "no"?
To make the medical system aware that the rules and laws are not being followed, if they are not, requires some statistical backup. One of the ways to survey this issue is to publicly, with the broad resource of ipetition or change.org present a petition and record what popular response and see how many people are interested.
Just writing to this blog for patients to "speak up", I think, is not the way to get this issue going and the way to make changes, as necessary, in the way the already established rules and laws are followed. What is the argument against my suggestion? ..Maurice.
Belinda
Absolutely the best commentary I have ever heard on this topic. I will refer back to your analysis often as I pursue work as a Patient Advocate. Informed patients refusing to "comply" does appear to be the answer in light of the current climate. If you have published any materials on this subject I would love to know about it. Lkt
Lkt Thank you. I'm a writer/researcher on the subject and the work is not yet complete. However, if you would like to contact me off line (with no monetary renumeration) I'd be happy to speak with you. Maurice has my contact information.
belinda
Maurice
One has to look no further than allnurses to
get statistical feedback. The subject matter of their
threads, their responses and how they choose to
shut down other threads gives a keen insight into
their culture.
PT
PT, I am not suggesting starting a petition to get some insight into the statistics regarding nursing behavior, I wanted us to begin to get an insight regarding the public's popularity with regard to supporting the views about the healthcare providers and changes in the medical system as proposed here. Make your petition and see if we get how many thousand responses from the public. This might show whether the concerns expressed here represent something to which there is significant popular consensus. ..Maurice.
What might be a better consensus is to research the assigned risk departments, find out the nature of the different kinds of modesty violations and what percentage of patients filed a complaint.
These complaints could be sorted into categories such as: standard of care (but patients felt violated), violations of privacy,
sexual misconduct, etc.
It might also be beneficial for the hospitals to contact recently admitted patients to find out about their psycho social experience and how it could be made better.
Putting a petition out there for the general population will not give you an accurate accounting of what's already happened and how people feel about their experience.
Some people may have feelings about this issue that have never actually been hospitalized.
This would not only prove what's been said but offer a framework for what needs to be done.
Opinions any one?
belinda
Belinda, a study of the number of patients who "file a complaint" and why only represent the number of the patients who "speak up" and not the number of people in society who hold the views of you and the others who are writing here. To show the medical system the popular interest in these views, you have to take a survey of the views and the need to have something done about them. You should use a popular petition website to attempt to carry out the survey I have suggested. If I understand you correctly, I am not sure how you would perform the survey you suggest and get a statistics from a statistically reasonable number of healthcare facilities. Also, I am not sure any facility would provide you with their numbers and causes. Sorry to be a "wet blanket" but I think you and the others should start a popular survey in a way that may be more productive and provide you with statistics that you could deliver to individual healthcare facilities in the form of a petition. ..Maurice.
I was about to put up the petition as worded below to the Care2 petition site on the internet but then I thought I should publish it here first and get your comments. I still think that such a petition would be of value in beginning an advocacy program. Let me know what you think or make changes in what I wrote. ..Maurice.
Care2 Petition Site
http://www.thepetitionsite.com/create.html
Title:Medical Care Providers Must Attend to Patient Modesty Issues and Provider Gender Requests
Target: The Medical System: government, medical associations, physicians, hospitals, clinics and employees
Issue: Human Rights
I speak for visitors, generally from the United States, writing to my "Patient Modesty" thread within the Bioethics Discussion Blog ( http://bioethicsdiscussion.blogspot.com ) over the past 6 years, thousands of comments about how badly they were treated by those in the medical system with regard to their physical modesty issues. They find lack of concern by healthcare providers and employees within the healthcare system and even governmental agencies with regard to patient requests to have those who examine, perform procedures, treat and perform nursing duties be of the patient-selected
gender, not to have visitors present during examination or procedures without the patient's consent, not to have to undress needlessly and if a body covering is necessary, that it be such that the patient feels comfortable about that covering. There is concern that some healthcare providers act unprofessionally when the patient's bodies are exposed and yet are unmonitored by their superiors. Some visitors express that they would forgo essential examination or procedures, even harming their health, because of the inability to get the healthcare provider of the gender they request or because of the behavior of the provider.
If you find that you agree that it is important that the medical community be made aware of these issues, please acknowledge this by signing this petition
First of all, I would like to thank you, Dr. Berstein, for actually writing and posting the petition draft. It speaks volumes to me that as a physician you were willing to do this when apparently none of the "patients" complaining here (including myself) attempted anything. I think the wording is good and I would be willing to sign such a petition. How it could be used to further the cause would obviously be another step to work out but at least it would be a beginning. It does not seem like any other steps have been taken to address the problem system-wide, although I do feel like many that have found this blog have become empowered to speak up and at least attempt to get the care that is respectful for them. That at least has helped some here, including myself. Thank you, Dr. Bernstein, for not only carrying on this blog for years and listening but for even taking these concernes seriously enough to get involved at this level (writing a petition). Jean
Jean, thank you for your kind words.
My interpretation and then concern about what is apparently not happening (to initiate an advocacy program) by those communicating together here on this patient modesty thread is that the individuals still feel ambiguous regarding the general validity or scope of their concerns or that they don't have the power to begin. I can't imagine they are simply "lazy".
With regard to validity and scope, I have virtually never seen any evidence against my blog visitors expressions except repeatedly coming from me, that in my experience as a physician including to date, I have never received communication from patients about their modesty concerns or requests---and that is the truth!
Why I am feeling involved in all this and want to start some advocacy program is because I am in favor of human ("patient") rights and when I read about even a few patients willing to delay or reject diagnosis or treatment because of their modesty issues, that to me is a warning sign that something in the medical system is wrong and should be corrected.
It is time now for all the visitors who come to this thread (and I know that the majority just read and don't write) and who agree with the concerns repeatedly commented here, make their opinions known and participate in the formation of an advocacy program. Again, in my opinion, a beginning method would be through the free web petition resource. What I was thinking at the time I aborted my writing to Care2 to first present my petition draft here, was that it shouldn't be just coming from me alone but from contributions by all you guys and gals. Go to these petition sites I have previously mentioned and read what has already occurred with many other topics. Starting the advocacy this way seems like a great first step. ..Maurice.
Dr B
Excellent! I might add a few suggestions to our
readers. From my experience there must be at least
three votes before the petition becomes mainstream.
We should start a petition at change.org as well
and use Dr Shermans site as a reference provided he
gives the O.K.
PT
PT, GO TO IT!
With regard to my written draft, if both you and Jean accept the wording, I will await one more visitor to this thread to agree with the wording (see my posting yesterday in italics and then I will put it up on thepetitionsite.
PT go ahead and start a petition on another petition site with referral to Dr. Sherman's blog and with your own wording..which, if you want, can be developed through postings here. You may want to make the expressions a bit more emotional than my more sedate wording. But, get to it!! ..Maurice.
p.s.- I await one more "go ahead" with my text.
Go for it.You have my support.I don't have a problem speaking my mind but it would be nice to not have to. AL
Dr. B.,
You have my vote. I appreciate all your good work.
BJTNT
It's up! To Get Started: Now go to the website and sign the petition.
http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/
..Maurice.
As of this moment, we have two signatures beyond my own on the petition! Let's see how long it will take to get to our first goal of 1000 signatures.
I will now place the url lnk to the petition on the introduction to this Volume. ..Maurice.
Thanks Maurice! What a great start!
belinda
WOW! 17 signatures on the petition at this moment and several excellent commentaries going along with the signature. I authorized this petition also to be noted on Facebook and Twitter. I am glad that folks outside of the USA are participating with the petition as I know they are also visiting this thread. I anticipate that we will hit 1000 signatures SOON! ..Maurice.
I think folks need to spread the word reference the petition. Thousands have commented on this and other blogs but its unlikely they are regular readers. Send the link to family and friends; participation should grow exponentially.
Ed
I hate to open this can of worms again, but some of you may want to go to the Kevin MD website and read "The ethics of performing a pelvic exam on an anesthetized woman". The most interesting part, to me, was that this doctor (a male) stated that at the beginning of his medical training, he and most other students thought it was unethical to do this exam on an anesthetized woman without her consent but by the end of their training most did not see it that way any longer. How does that speak to their medical training? It sort of tells me that they consider getting the proper experience much more important than properly informing patients to obtain consent. What does that say to patients? I personally find it quite disturbing. If they are not willing to obtain consent before doing an exam then they are probably suspicious that the patient would not consent (thus not giving them the learning experience) and those that would consent may be few and far between. Any comments on this?
I think its indicative of the holier than thou attitude many in medicine (not all) adopt when interacting with the mere mortal of the world. Absolutely sickening that anyone could rationalize this as acceptable behavior regardless of the motive.
Ed
It all has to do with "a need to know". From the medical student's point of view is the "need to know" how to perform a pelvic exam of value to the patient. From the patient's point of view is "need to know" who is entering my body when I am asleep.
My opinion sides with the patient's "need to know". I know there are teacher-surrogate patients available for medical students to learn the basics. There are many patients who, when informed, will allow students to examine them. Later, as a resident who is medically responsible for the patient with the help of attending physicians, the nuances of pelvic examination is developed.
Examinations without patient permission, in my opinion, is legal battery with potential consequences.
"Informed consent" by the way is more than expecting the patient or patient's legal surrogate to read the small print in a handed out long admission document and have that considered being "informed".
..Maurice.
Doug Capra wrote the following last evening but somehow was not published. ..Maurice.
I agree with your all your conclusions, Maurice. But I think it's more than just a "need to know." This issue is connected, I believe, to what I had to say in my article:
http://patientprivacyreview.blogspot.com/2011/08/its-no-trifle-to-be-medical-student-in_5433.html
The question is essentially an ontological one, i.e. what is the essence of the role "patient?" What is a patient? Once the "individual," the unique person enters the hospital and becomes the "patient," how is that role defined? Is the patient still an "individual" or is the patient now, in some sense, property? I believe that human beings are "seen" differently by some medical professionals once they become "patients."
Is it an unwritten rule that the patient is a tool once in the hospital, an object to be used as method for doctors to learn? Is that now the primary role of the patient, the patient's essence? Does the benefit of the many now trump the rights of the one? I realize that the academic curriculum today makes it clear that the patient should be asked permission to be used as a teaching tool and asked if observers or students can attend. But we all know there are ways to get around this, and these methods are not rare. Why would medical professionals want to "get around" this issue? It would depend upon how they "see" the patient.
These are the foundational questions, I believe. And how they're answered or taught affects how medical professionals view patients. As I point out in the article referenced above, American doctors studying in Paris, at least from about 1830 to 1900, experienced conditions where, once you entered a hospital, your body belonged to the state, and the state could do what ever it wanted to you. It made it quite convenient for training purposes -- one of the main reasons these American doctors went to Paris.
The question of "need to know" focuses on "need" and "knowledge." Whose "need" takes front seat? And does "knowledge" trump individual rights, and who gets the right to make that decision? For some, anyway, once someone enters the hospital, they cease to be a "person" and become a "patient," and that role is devoid of certain rights.
I may have written this previously, but if so, I will repeat it.
It is my view that beyond the economic or logistic aspects of the various healthcare facilities to follow requests of patients, there is another element which affects the behavior of the healthcare provider individuals themselves. And that element is the appearance and then treatment of the patient as an object rather than a subject. If the individual looks at the patient as an "object" which is delaying completion of work on other "objects" or delaying the provider from attaining some other activity of self-interest or that the "object" really only represents the challenge itself of coming to a diagnosis and appropriate treatment then the behavior of the provider will be ignoring the patient as a subject, the person of the illness and the provider's behavior will be as described in this thread.
Again and again, we teach the medical students that the patient is not some "object" to be discovered but a live human that needs to be understood and treated. But life and responsibilities as a medical student are different than later on in training and when they are in the final responsibilities of their careers.
Yes, the economic and logistic aspects of medical practice have to be changed for the needs of those writing here to be accomplished but also there is a need for all participant providers to be reminded and respond to the patient as the very subject of their work and not simply some object. ..Maurice.
There is no law that you must wear a hospital gown whilst a patient in the hospital.
Absence of a gown is a perfect way to maintain individuality and you will be looked at more as a person instead of a patient. This is just normal psychology.
If you must wear a gown, you can buy your own that look like "hospital issued" attire but still maintains an aspect of individuality.
I don't think medical professionals look to objectify their patients. However, they are only human too, and objectifying patients makes it easier to deal with the emotional work at hand dealing with serious diseases and death. It a more comfortable psychological place for them to live.
It's not until an individual patient does something to jolt the idea that this is a living individual with their own agenda that the medical professional sometimes stops to think about these issues.
Just a simple change in attitude of a patient can re-direct the way a doctor speaks to a patient. There are silent ways to let the medical professionals know what it is that you demand, mainly the respect of being an individual and recognition as such, that people have different needs.
belinda
Oh, Belinda, I think you noted an important element in the thinking of medical professionals leading to "objectifying" their patients and as you say it is related to the "emotional work" associated with the treating of a patient. It is also still part of the paternalistic views of the medical profession where the provider says to the patient "I know what to do or needs to be done and you don't.." and there is no further discussion. For the professional to listen further to the patient will only confuse an already difficult challenge. And yet, there is much more involved beyond "diagnose and treat" and that involves accepting the patient as a co-participant in the work to be done and listening to the patient's input and considering the patient's requests as part of the process of treatment. ..Maurice
Shucks.. as of now only 27 signatures on the petition I put on the Care2 the Petition site:
http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/
It could be that my presentation was a little too restrained. The site does recommend that some emotion be presented in the description of the issue. I suppose that some emotion is necessary to show others that the issue is important and that you truly have feelings to support and express it to the public.
PT, why not you and some of the other visitors begin, writing on this blog thread, a stronger worded (even emotional!) petition and then set it up on another petition site?
PT, you may get a more vigorous response. ..Maurice.
A petition is only as good as the vehicle that promotes the petition. If people don't know that it's there, you won't get a response as well.
Those writing here may be interested in a new thread I put up today "Doctors Maintaining 'Clinical Distance': A Patient Value or None"
http://bioethicsdiscussion.blogspot.com/2012/09/doctors-maintaining-clinical-distance.html#comments
The term "Clinical Distance" is used in the sense that physicians should not get emotionally involved with a patient's illness or other factors of the patient's life, should remain silent on all except diagnosis and therapy for the patient's illness.
I thought the topic might be pertinent to this Patient Modesty thread. If you have some comments on the issue of "clinical distance" go to the thread and write there.
..Maurice.
I am also a little disappointed at the small number of signatures on the petition. I do agree, however, that it may be due to the fact that many do not know it exists. So the challenge would be to spread the word, so to speak, to get more exposure and hopefully more signatures. I do not do Facebook but perhaps some who do can put the word out that way. Just an idea. Frankly, I think a stronger, more emotional petition may get an even lesser response. It may be too "out there" for some people. The way it is currently worded seems more slanted to the patient having access to respectful and sometimes gender requested care which may appeal to many people just based on the respectful, patient centered logic. Maybe not true but just my thoughts. Jean
I agree with Jean. Not a Facebook user either but social media is the vehicle to publicize this. A plug from Dr Sherman's blog and KevinMD would be helpful also.
Ed
Doug Capra wrote the following for commentary on this Patient Modesty thread but also to the new thread I have up regarding "Maintaining Clinical Distance: A Patient Value or None."
Maurice:
I'll post this also on your new thread, "Doctors Maintaining 'Clinical Distance': A Patient Value or None."
It's a review in the Sept. 27 New York Review of Books, by Jerome Groopman, of the book "God's Hotel: A Doctor,A Hospital, and a Pilgrimage to the Heart of Medicine" by Victoria Sweet. Groopman compares the book with The House of Shem by 1978), a roman a clef about a Boston teaching hospital.
Groopman writes: "Shem charted the trajectory of the many interns who arrived idealistic, with a humanistic vision of medicine, and end their first year of training bitter, cynical, depressed, and mercenary. The word used by Shem's young doctors for the elderly demented and debilitated patients is "GOOMERs" (Get Out of My Emergency Room). The doctor's feel that they can't do anything for the GOOMERs. (They should be "turfed," transferred out of y our charge as quickly as possible.)
(As a side note -- just last year an idealistic young medical student who had worked in the emergency room, hit me with another expression now used -- an arriving patient who has no chance of survival is referred to as CTD -- circling the drain.) An example of that dark, cynical humor perhaps needed for survival by human beings doing this kind of emotionally draining work.)
Shem's book advocates that clinical distance to the extreme.
Sweet's book is more balanced, about the human connection between doctor and patient. She writes:
"The essence of hospitality -- hospes -- is that guest and host are identical, if not in the moment, then at some moment. Whatever our current role, it was temporary. With time and the seasons, a host goes traveling and becomes a guest; a guest returns home and becomes a host. That is what the word "hospitality" encodes. And in a hospital, the meaning of that interchangeability is even more profound, because in a hospital, every host will for sure become a guest; every doctor, a patient."
But there is a often a huge difference between a guest and a patient, a difference involving pain and vulnerability and embarrassment and helplessness and yes, death. We know we'll all be guests and accept that. We know we'll all be patients, but we don't accept that as well. We don't want to accept that fact. We avoid it -- especially those who work daily around patients and see clearly what the "role" patient looks like.
Here's the article. I recommend it highly.
http://www.nybooks.com/articles/archives/2012/sep/27/medical-sanctuary/?pagination=false
I'm not a Facebook user but when I check online @ the Care2 petition website, "767,633 people like this" but only 28 signatures. Anyone care to comment on the meaning?
Ed
Ed.I have a Facebook account but I am not a Facebook scholar so I ask: how did you get to the website where you saw "767,633 people like this" and what does that number represent? As of this writing, there are 29 signatures. Can anyone who knows more about Facebook and Twitter help get our petition really going with signatures. Is there something we should be doing on Facebook or Twitter? Help. ..Maurice.
Dr Bernstein, each time I open the petition website (http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/), at the very bottom is a link that now says "767,761 people like this. Sign Up to see what your friends like." Its obviously a Facebook link but the numbers are up since I first noticed this afternoon. Not sure if its germane or not but I use Google Chrome as my browser.
On a side note, have you received any negative feedback from colleagues pertaining to your efforts on the issue of patient modesty? Specifically, any discussions with Urologists and their nearly universal all female staff?
Ed
I am no longer on facebook and never did understand completely how it works. However, 767,000 signatures are great but what we really want to know is out of a total sum of people who looked at the website, how many didn't like it. And...of those people how many worked in the medical profession.
This issue is one of the most important to paitents (as dignity is mentioned first after pain in the Patient Bill of Rights. Also, in the "real world" isn't dignity important to all of us?
People avoid medical procedures all the time and I'd bet the "ranch and the dog" that this gender issue is the main issue why.
belinda
As I recall, there were 28,000,000 complaints against
the airport TSA last year by airline travelers. I believe
there are an equivalent amount of complaints toward
health care facilities each year. A specific complaint
needs to be elevated to a level of awareness which
then leads to the question. What happens once we
reach 1000 signatures. Maurice, we all applaud your
efforts and I am going to brainstorm for a few days
on how we can increase the awareness of the petition.
PT
First, I want to reproduce the posting that Doug Capra attempted to post here today but for unknown reason was rejected. Secondly, I want to be sure that other visitors here who desired to post also were rejected by the system. If that has occurred to you, please, please write me: doktormo@aol.com about it so I can see if this is a general problem with this blogger mechanism. ..Maurice.
From Doug Capra:
I just sent a request to the site provided below, "Protecting Patient Rights," asking the owner to highlight our petition, and asking his readers to at least read the petition and the comments to see if they'd be interested in signing it. I would suggest others on this site do the same thing: Find medical credible medical blogs and ask the owner to at least ask their readers to consider signing the petition. Perhaps Dr. Bernstein or Dr. Sherman would write a short article for KevinMD about the petition.
Our problem is that the word isn't out. If it gets out I think we can get more signatures. How many more? I don't know. But let's find out. Here a link to the Protecting Patient Rights website.
Doug Capra
http://www.protectingpatientrights.com/blog/when-medical-staff-improperly-administering-or-injecting-drugs-kingston-new-york-medical-malpr.cfm
I think you'll find this article exactly what we are talking about.Goggle ( Dr. Evan Saunders sleazist gynecologist ever ).It fits right in with why i hate/don't trust doctors.I'm happy to say that he was found guilty by a jury.Would same gender health care solve alot of these like of things. AL
Al, the solution is more complicated because people have different needs.
What needs to be done is clean house and build a strong foundation to ensure the rights of patients while managing efficiency in the hospital environment. Impossible you say? I don't think it is and there is a way to do it.
We can all agree that "to do no harm" to the patient should be the primary concern of healthcare workers. At the current time, convenience and standards of practice that have morphed from quality dignified care to what we have now.
Part of this is because of same day surgical/procedures that gave prep time in the privacy in your room that now take place in the operating room while you are still awake.
Preparation is the key by both staff and patient. Patients need to be told what to expect (not the watered down version) and then if there are objections, they can be handled when the patient isn't in a compromising position.
Secondly, emergency situations need to be treated with more sensitivity to patient physical privacy. Every Tom, Dick, Harry, & Sheila don't have to be gawking at a conscience, restrained patient while their clothes are being cut off.
Lastly, responsibility to turn those "professionals" in when sexual impropriety (or worse) is discovered instead of covering it up as it is now.
The same gender care issue is separate and apart from that and until things change and because both genders have been guilty of offenses, it is the patient who must decide what they need and at what cost.
belinda
Again Doug is having trouble directly posting here so I am posting his great news regarding publicizing our petition. ..Maurice.
Attorney John Fisher, the blog owner of Protecting Patient Rights, wrote the following to me.
"Hi Doug--thank you for your comments and continued support of my website and blog. I will do better than repost it--I will make this tomorrow's blog post to get it out to as many readers as I can through my website, blog, Facebook, Twitter, and LinkedIn. Thank you again for bringing such an important issue to my attention!"
So, check out this website tomorrow to see what he has to say about our petition. Then, let's see if his articles gets us any more signatures. Here's the link to his blog: http://www.protectingpatientrights.com/
Dr Bernstein, I asked you a couple of straight forward questions 21 Sep; are you going to reply?
Ed
Ed, I see that same number of people who "like this" at the bottom of other petitions and I am sure it doesn't represent any petition but the "likes" for 2Care website.
To be honest, I really haven't discussed this matter with my colleagues generally including urologists but we did present the issue twice to the AMA News with ?? was it 200,000 doctor readers--a reasonable population for feedback--but with no responses..whatever that means. ..Maurice.
Dr Bernstein, thanks for the reply!
Ed
Sometimes what is written by a visitor to a thread is actually pertinent and worthy of publishing on a thread of another topic. The following is an example I received and published today on my "I Hate Doctors: Chapter 3" thread. This posting by a doctor shows that there are conscientious physicians who are trying to do their very best to help the patient with thoughtfulness and attention to care but may be frustrated by the way the public generally looks at physician behavior. For example, it is true that on this now 7 year thread on patient modesty there hasn't been a very happy outlook about the practices and behaviors of those in the healthcare provider profession. Right? ..Maurice.
From Anonymous:
It is very sad that all physicians are placed into one generalized group and hated as a whole. There is no question that there are absolutely insensitive pompous jerks in the field. I can think of a few right away and I would love to knock their block off. Not everyone is like that. And not everyone can afford the mansions and BMW's that some highly paid physicians can. I have practiced for 7 years full time as an ED physician (board certified) and worked in some of the poorest inner city hospitals. And I routinely work 20 to 30 hours of unpaid time a week staying at work extra and completing charts or even calling patient's at home to check on them because they don't have a primary care doctor (this is in addition to my fulltime work). When patients want a drink or a blanket, I get it for them myself, and I do not consider it beneath myself to change the soiled diapers of seniors, and place bedpans under them. I have always believed in God and my duty to people. I drive a second hand honda not a BMW and I rent (my kids don't have a lawn). But I thank God for this. My own family is not wealthy so I have felt it is my responsibility to help so I routinely give money to many of them on a monthly basis. But I am only human. With so much hate against my profession, I wonder if it is worth it. Even my family members who benefit from my income and prevent me from affording a better life for my family hint that I am a doctor and it is my duty to pay for their bills because I have a better income now. So how can I expect anything better from the public? My husband suggested earlier tonight that I quit. Perhaps seeing this blog was a sign from above. Perhaps it is getting time to leave the field. No amount of caring can counter the incredible hate that exists. Fortunately my husband has finished law school and only has to take the bar now. I always thought we had too many lawyers and not enough phsycicians. I was wrong. I will absolutely discourage my children from entering the medical profession. You do not have to be a physician to be able to help other people. Perhaps what we really do need is one less physician and one more lawyer.
Maurice, I wouldn't say that. Actually I've met many compassionate physicians during my journey.
Unfortunately, the subject matter of this blog is really outside the realm of their training and when they meet someone who has a special need not only don't they understand it, they don't know what to do about it. Sometimes they try and make things worse.
The important thing is is intent. It's very easy for a patient to get angry and "let them have it" and I admit I've done that. However, it's much more effective and respectful to explain where the breakdowns are. Otherwise, how can things change if there is no communication?
One more point, sometimes the disagreeable behavior isn't from a physician at all but by some other person.
I remember when my mother had a stroke on the opposite side of her already paralyzed body, I went to the hospital to see her. I was shocked to find out they took her to therapy and when I got there, she was sitting in a "Gerry chair" positioned in front of a full length mirror. I couldn't believe the insensitivity and stupidity of those hospital employees. The behavior was downright cruel. I was a raving maniac that they would take a women who couldn't speak or move any part of her body and treat her this way.
The same hold true for gross modesty violations that are cruel and degrading to the patiet, inexcusable.
The medical community has a problem when the mirror is held up.
It's humiliating to them that these things happen. This, I believe, is why you don't hear colleagues talking about this matter.
belinda
Here again is a comment received today from Doug Capra. ..Maurice.
Maurice:
I don't think that post on "I hate doctors" is about the general public hating doctors. I think it's more about one doctor reaching a tipping point and being all stressed out. It's an extreme emotional response to one thread on one blog. Does that thread represent all people? Certainly there are a few people who may hate doctors as a group, but that is not by any means how the general public thinks about the issue. The public is frustrated and stressed, too, about the current status of medicine in the U.S. That doesn't translate into all doctors being hated. In the past, when I read offensive postings on allnurses (I don't read that site anymore), I never thought that those postings represented all nurses. When I read extreme posts on your site, I don't think they represent all people.
I'm sorry that this particular doctor is stressed out. But to translate her personal situation into the fact that the general public hates doctors, is going to the extreme. Doug Capra
On the other hand, Doug..I posted that lady doctor's comments as an isolated example on this Patient Modesty tread that there are physicians who, in many ways, as she described, are caring about their patients. I know, one example, from an anonymous physician but I think the commentary is valid and shows that frustration with regard to the practice of medicine is present on both sides of the doctor-patient interactions. ..Maurice.
Please see my new article on adolescent male genital exams concerning reducing embarrassment. Feel free to post a comment.
Dr Sherman, great article and thanks for continuing to address unethical practices of many healthcare providers.
There is also a good article from MensHealth.com titled "Are Med Students Practicing On You?"
Ed
I failed to include the link.
http://www.menshealth.com/health/are-med-students-practicing-you
Ed
This article that Ed refers to is completely outrageous! Maurice, comments please. These practices are not only unethical and on top of it, they want torte reform. What a laugh!
This article is a few years old but also brings back the blog discussion about non-consensual pelvic exams given to women in the OR after they are out.
Both these practices happen every day throughout the world.
-amr
(Been awhile, but I'm still around and reading.)
Recommend reading this article (http://www.kevinmd.com/blog/2012/10/times-procedure-doc.html) and my comments. While strictly not a modesty issue, the patient concerns and issues are very similar.
Ed
It seems ludicrous to me that medical jobs/availability and comparisons to other types of work are even remotely comparable.
The medical culture has sold a bill of goods that is so mainstream that the one difference that is so fundamental to who we are as human beings and the kind of country that we profess living in, is simply removed.
It is our fundamental right to privay and that especially includes bodily privacy.
Worse yet, is the refusal of the medical establishment to acknowledge that people avoid certain tests, exams, and procedures in order to avoid humiliation. Instead of treating this as the real problem that it is, they pretend it isn't there ultimately disrespecting every patient's rights as they walk in the door, and feel justified in doing so to boot.
Instead of blaming their process for part of the problem, they squarely put the responsibility and blame to the patient.
belinda
Belinda, I agree 100%. Its misleading to compare airline pilot proficiency with that of a physician performing an unsupervised procedure on a patient for the first time. A passenger will never fly on a scheduled airline where one of the two pilots is not highly experienced. Unless a patient asks, this could be the first time a physician ever performs a particular procedure unsupervised.
Ed
Well said belinda.Patients do indeed have actual rights, not just the "moral compass" that certain entities have set forth.
http://leg.state.nv.us/NRS/NRS-449.html
This is the link to the Nevada Revised Statute that speaks to the Nevada law concerning "patient rights".
Would anyone care to send me the statutes from their state laws?
suzy
Maurice,
I have an emotional concern about which I'd value inputs.
My sig other has adv stage 3 CRC that is targeted for cure by his oncologist. He got a radiation burn on his penis, for which he was prescribed a salve medicine. He was later hospitalized for TPN, as he became unable to eat during treatment. Although physically able to apply the ointment himself, while in the hospital he had nurses doing this. I thought he was doing it himself, but when a nurse came to do this while I was present and their speaking tone changed to very soft while she applied ointment, I felt humiliated and left the room.
I wonder whether nurses should apply salves to penises of men who are fully capable to do so themselves? I figure if she has input on technique, she could provide that while he did the applying of cream. Or should they ask the patient his preference and apply it for him if he wants her to?
Thanks,
CSO
In Massachusetts, Section 70 E of the General Laws deals with patient rights.
http://www.malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section70e
Notice that the following sections, while allowing some wiggle room for hospitals (all of which must be licensed by the State), provide a strong basis for refusal of opposite gender intimate care by any mentally competent or conscious patient.
Also, it is useful to remember that at times hospital personnel need to be reminded that state law supersedes any rules or regulations published by the hospital itself, even if they tell you that “This is always the way we’ve done things!”
(h) to refuse to be examined, observed, or treated by students or any other facility staff without jeopardizing access to psychiatric, psychological, or other medical care and attention;
(i) to refuse to serve as a research subject and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic;
(j) to privacy during medical treatment or other rendering of care within the capacity of the facility;
MG
Doug Capra is still having problem posting. Here is what he sent me by e-mail this morning. ..Maurice.
From Doug Capra:
Those regs are all well and good, suzy, but at your URL link under NRS 449.720 you’ll find:
NRS 449.720 Specific rights: Care; refusal of treatment and experimentation; privacy; notice of appointments and need for care; confidentiality of information concerning patient. [Effective January 1, 2012.]
1. Every patient of a medical facility or facility for the dependent has the right to:
(a) Receive considerate and respectful care.
(Is that ever defined anywhere? Who gets to define what’s considerate and respectful based upon personal, spiritual, psychological, cultural contexts? Someone, find me any facility that has addressed what words like "respect" "dignity" and "considerate care" mean. It's naive to think that everyone just understands the meaning of those words in a medical context, and that everyone's meaning is the same.
(d) Retain his or her privacy concerning the patient’s program of medical care.
(What does this mean exactly? It seems to refer to the privacy of information, i.e. HIPAA regulations. Outside of medical information, what does the word "privacy" mean for a patient in a hospital setting?)
(e) Have any reasonable request for services reasonably satisfied by the facility considering its ability to do so.
(Who decides what’s reasonable and what criteria are used? And who decides the facility's "ability" to grant these "reasonable" requests. And notice that these requests won't be just "satisfied," they'll be "reasonably" satisfied. Who gets to decide what's reasonable and based upon what criteria?)
I contend you never find specific answers to these questions in writing because the default position is that the facility decides the answers to all these questions. If requests for specific gender care are made, and the facility hasn't hired and/or scheduled to make that possible -- then they can simply say they are not "able" to grant that request, that it isn't a "reasonable" request. Some of these regs are worded so vaguely that the patient is set up to lose any challenge or confrontation.
Now, let me be clear. Most of these regs are designed to protect the patient. But I'm focusing on the topic of this blog -- patient modesty and privacy and requests for same gender care.
Here's Pennsylvania:
http://www.pacode.com/secure/data/055/chapter5100/s5100.53.html
Yes Doug, some of the language is vague. But there are a few reasons why the (23 I believe) states that do have these laws would be the best places to start clarifing statutes.
Most people do not know that they have these legal rights (such as they are). Even the "Patient Bill Of Rights" is being softly re-written into a hospital handout that says we have rights, but the hospital will clarify those upon need. Well...that's often too late, as one is already caught in the system.
We need to know the rights that we do actually have, and work to make them stronger before they are all soft-peddled away.
suzy.
Thanx MG!
suzy
Maybe I'm the exception here but the vague language works to the patients' advantage. I define what "considerate and respectful care" is and if the physician or hospital cannot or will not comply with my request, I simply reply that I'm not refusing care; I'm refusing the manner or method they intend to provide it. If patients simply stood their ground, I'm relatively confident the facility will acquiesce. Ultimately, it's the patient that defines these statements by simply saying no. Unless a true emergency, we all have the ethical and legal right to decide who and to what degree someone participates in our healthcare; they cannot take that away from us.
Be careful what you ask for; the extremely well funded healthcare lobby will not roll over on these issues without a fight and despite the best efforts of many of us here (and other blogs), this issue is simply not on the public's radar.
On a side note, go to http://allnurses.com/general-nursing-discussion/adolescent-boys-genital-790827.html and comment. I'm disappointed in the tepid response so far.
Ed
Here is a new commercial from CBS cares regarding prostate exams.
It depicts a cartoonish German doctor, wearing a white glove, holding up his finger and speaking about how embarrassing it is for them to give these exams. Then he says, "if I can do it, you can do it". The end printed statement says, "Don't die from embarrassment".
What's wrong with this commercial?
First, it compares apples to oranges (giving vs. receiving the exam). Next, it puts the burden on the patient; not the system (read my previous blog). Lastly, it tries what they think is humor and again, not addressing why men feel embarrassed and what could diminish embarrassment and how they might help.
Frankly, I found the commercial condescending. Below is the website.
http://www.cbs.com/cbs_cares/topic/114435/32/1457581130/cbs-cares-prostate-cancer
belinda
I agree with Belinda! Go to http://www.cbs.com/info/user_services/fb_global_form.php and complain.
Ed
I posted the following:
My complaint is with CBS Cares Prostate Campaign. Considering the recent USPSTF recommendation on routine prostate cancer screening and the documented negative results many men have experienced, it's troubling that an acclaimed "objective" news organization continues to present a biased recommendation on this controversial issue to the public.
While I'm not surprised your "highly credible expert – Dr. Adam Feldman" strongly advocates for routine screening (as virtually all Urologists do), you conveniently fail to mention that they have a vested financial interest in screening men for prostate cancer.
Additionally, the continued use of humor or the portrayal of female physicians or nurses addressing male health issues is demeaning. Go to http://patientprivacyreview.blogspot.com/2012/05/mass-media-mens-health-by-joel-sherman.html for a detailed discussion on this issue. There is certainly nothing humorous about receiving a prostate exam or being diagnosed with prostate cancer, regardless of the providers' gender. Would it be acceptable in society today showing a young handsome male physician promoting pap smears; I think not.
I recognize not all feel the way I do but there are a number of studies that show a majority of guys are distinctly uncomfortable with opposite gender care of such an intimate nature; something women rarely have worry about any more.
In my case, I specifically selected a male Urologist. He stated a particular procedure was necessary, explained why and the associated risks; I consented. Instructed to strip from the waist down, he handed me a gown and stepped out of the exam room explaining he would be back in a few minutes. Sitting on the exam table having complied, imagine my surprise when he enters the room with a female assistant/nurse. I asked having specifically chosen a male Doctor, why do you assume it's okay for a female to be present without asking first? You would never expect a female patient to submit to an intimate examination or procedure with a male assistant without asking first, correct? He agreed. I expect the same consideration. You either perform the procedure without assistance or find a male assistant, otherwise I'm leaving.
Given the extremely personal nature of Urological care and the potential for embarrassment, why is privacy and dignity so callously disregarded on a routine basis for male patients? I understand the male/female ratio of nurses and assistants and the difficulties associated with same gender care. However, the failure to ask is presumptuous and unethical. Instead, providers in effect ambush patients into submissive compliance. Naked (gowned or not) in need of medical care is a difficult time to make a stand. Where is the informed consent? Frankly, the more troubling aspect is Urologists of either gender, are well aware of these issues, or should be, and apparently ignore them. This double standard needs to change for men to feel comfortable in seeking health-care! I'm convinced a number of us avoid needed medical care for this exact issue.
Ed
Ed, I will be sending a complaint to CBS. You may be giving them a little too much credit. The medical community doesn't have a clue.
It is also important that all the men must understand that in a surgical, procedural hospital environment, the medical staff is almost always mixed gender and women are faced with the same problems that men have.
Men, start asking for what you want. Remember every time you are not getting what you want, and you comply, you become part of the problem. Ask for same gender exam and if they can't do it when you get there, walk out. It's that simple and I've done it. Not only that, I wrote to the hospital and told them how much $$ they were losing because I was taking my business elsewhere~
belinda
Belinda, I personally have no problem with a mixed gender surgical team. Heavily sedated or knocked out, I could care less.
My particular complaint is primarily with outpatient care though still sensitive to the issue in a hospital setting (thankfully, my experience is limited).
Who do you perceive I'm giving a little to much credit to; elaborate please.
Ed
Ed, It's the medical community that generally doesn't have a clue. It's because of their training and the medical mindset, right of entitlement, and that "no one argues with the doctor" mindset.
You should know that in today's world, where pre-op admission is mostly a thing of the past, you might find yourself in the operating room, with lots of staff, naked and awake while being prepped. Discuss this issue with the staff to make sure you get what you need.
belinda
Ed and Belinda
Both of you made excellent points in your last posts. I
am asking the two of you for ideas, suggestions on how
to boost our petition. We really need to get this thing
going. I have been ill lately and just haven't had the
energy, but the two of you are making great comments.
Can you two help.
PT
Been there done that, complained about it. I recited my experience on this blog several volumes ago; actually quite liberating to discuss it with other like minded individuals. Once again, if I had been sedated or asleep like I was led to believe, I wouldn't have had a problem with it. It was that experience that led me to this blog and others. I think they do have a clue but choose to play dumb in hopes of making the issue go away; no longer in my case.
Ed
I must defend my profession. Doctors are not sexual perverts or "peeping Toms"! Those who are, are in the minority and should be thrown out of the profession, PERIOD. As I have written to this thread before, though I am not a surgeon, I have been in operating rooms may times as an observer for my own patients and also monitoring my medical students and I have never seen anything but actions by the OR staff to keep the patient warm and attend to modesty whether the patient is asleep or awake. And I mean NEVER. Yes, I have seen angry surgeons expressing their anger to the staff but none, including nursing staff encouraging or facilitating any prurient interests described here.
You could say that my observations from my experience in the OR makes be an outlier as a reporter of what is going on there. I, myself, can only report what I saw and didn't see. ..Maurice.
Dr Bernstein, I agree with you; in my case the two surgeons weren't in the OR when the incident I recited previously here occurred. My complaint has been with female nurses and one male all in an outpatient setting except for this one incident; the only time I've been hospitalized (one night) in my life. Although I will say, my limited experience with urologists as a outpatient, have not been positive. Not because of what they specifically did, but how they allowed their nurses to conduct themselves without my express consent.
Ed
Maurice, Did it ever occur to you that things did not happen because you were in the room?
I have had a several experiences that range from inappropriate to deviance. I'm nobody special, so until someone can prove to me that this is not a systemic problem, it is.
It's not just the doctors or just the nurses. It's the mindset. Salespeople in the OR? Women examined while asleep without explicit consent? Prepping patients while they are awake and in front of large staff by shaving them? What is all of that? This is standard of care stuff; not deviant behavior. I would categorize as "friendly fire". Does that mean that the patient doesn't get hurt?
We have found the profession silent about issues that matter, informed consent, disregard of dignity and privacy and you can defend all you want, but what you can't do is invalidate our experience because we had them, we live them. They changed how we feel about medical care.
Just saying anyone who is deviant should be thrown out is something we can all agree with. However, are reports against individuals made part of their personnel record so that a pattern can be formed? What are the consequences to these individuals? Have they apologized to anyone? Accountability an responsibility?
I can tell you if my situation had been handled differently instead of putting the blame on me when it was they who acted unprofessional and treated me in a cruel and degrading way without any recognition, apology or accountability, I wouldn't have the issues I have today.
And..to top it all off, the doctor in charge told me if I didn't like the way he ran his OR to go find another doctor! It's amazing that I didn't go beserk!
Deviant behavior is a small part. It's the major issues above that have traumatized some and deserve another look to see how privacy and dignity can preserved better.
belinda
Maurice
No one here is questioning your integrity as a
physician, your devotion to this blog and your work. We
are questioning the behaviors within the industry itself.
As you may know I have well over 30 years in
healthcare myself. I have seen more than my share of
disturbing behaviors. I would like to tell our readers that
before the advent of the internet the general public had
no way of knowing which physicians had been
disciplined. Even now, not all states are willing to share
that information. Consider that each state by state
nursing board is different on how they share disciplinary
records. Here in Arizona the state nursing board no
longer lists the reason the nurse appeared before the
board. Either they are on probation, revoked or
censored. I believe the public has a right to know.
One of the more interesting changes I have seen is
an attempt to make the secretive behaviors of hospitals
more transparent. The public is now able to view online
performance values of medical facilities. Another change I am beginning to see is that more and more
physicians are becoming hospital employees. Medical
groups are now being told to join or go elsewhere,yet
if you join you are subject to our rules, even pay cuts.
And finally, Belinda mentioned deviant behavior as
being a small part. This is where I disagree, deviant
behavior, sexual deviant behavior is a very large
problem in all medical institutions.
PT
And I agree with you Belinda wholeheartedly!
Ed
PT, I never wanted to believe that but would be very interested in learning more. My e mail is available and would like to have a dialogue with you off the blog if that's okay with you, contact Maurice and he will give you my contact information. Thanks.
belinda
PT, first I want to say that I appreciate your participation on this thread as one who has had a work relationship within the health industry. When you write "I have seen more than my share of disturbing behaviors", If you don't mind, I must ask you a personal question: What actions have you taken personally to attempt to prevent or mitigate these behaviors by those you observe? Have you, for example, spoken personally to the individuals, report their behavior to their work superiors or to appropriate govenmental agencies?
Shouldn't every patient or family "speak up" if "disturbing behaviors" are observed or are they intimidated not to do so by the attitude that there is an unequal power relationship between them and the doctors, nurses and institutions? What do you all think? ..Maurice.
Maurice,
I agree wholeheartedly. If you don't complain, then you are part of the problem. Sometimes, though, you have an experience and don't realize until some time afterward that you were upset by something. That's the essence of Post Traumatic Stress Disorder. The effects of the trauma occur after the incident.
belinda
Maurice
There exists within all medical institutions a
culture that promotes fear of reprisal. This culture
is ever so present in hospitals. Take for example a
well publicized case of the surgeon at mayo hospital
who with his cell phone took a picture of a patients
penis just before surgery. The patient had a tattoo
on his penis and the surgeon ( a fifth year resident),
wanted to show everyone the picture after surgery,
which he proceded to.
You can find this article on the web as it happened a few years ago. I did not work at that
facility, however, I know people who do and the case
unraveled when the anesthesiologist called the Arizona
republic ( the leading Phoenix newspaper) to report the
incident. Now, one must ask, why did the anesthesiologist not report it to administration, or to his
boss. Why did the anesthesiologist report it
anonymously to the newspaper? Fear of reprisal. If you
read the article, the surgeon was fired, reprimanded by
the medical board and the patient recieved a
250,000 dollar settlement.
Don't you think it's bad when even a physician has
fear of reprisal in attempting to be proactive and protect
the privacy of patients. That the physician could not go
to administration to report this for fear of reprisal. I too
learned a long time ago that if you see something, most
of the time the best way to bring something to light,
without identifying yourself is to report it anonymously,
sad isn't it.
PT
PT, Yes, it's terrible and it's probably because their job is on the line if they complain.
Patients on the other hand don't have that to worry about. I must say that I have no fear about any one at any time, voice my opinion all the time and don't care what they, or anyone thinks.
While elements of that mindset were there all those years ago, I would have pushed harder, yelled louder and gone to the press. While I can't go back in time, every time I'm faced with medical decisions, I feel as if I'm the boss, paying the check and if I don't like them, I let them have it and move on. They are a dime a dozen.
I do think my lack of fear is from the realization that there are things worse than death and once experienced that feeling, death doesn't scare me and I can afford to do things my way.
It is important to note that some of my doctors have been so for years and years and despite issues, I have navigated and treat all respectfully. They listen, advise and I cooperate when we have a plan for healthcare. It works both ways.
belinda
I just can't help but wonder why being sedated/unconscious is a free pass to ignore patient modesty. Just because you aren't aware of what is being done to you should not negate the fact that opposite sex workers are viewing and possibly commenting inappropriately on patient attributes (which as a nurse, I have seen too many times). Patients should be able to request same sex care in all aspects of their hospital stay if they so choose. Including surgery. It is possible to arrange, hospitals just don't want to do it because it means more work for them and possibly a little more expense.
If a patient claims they were sexually assaulted while in
the hospital, that facility is required to make a police
report within 24 hours. Seems ridiculous and these
laws were not mandated by hospitals, rather people
who were once patients that were assaulted while a
patient.
Hospitals don't really employ a police force. Their
security team are essentially door checkers with big
rings of keys. They are not trained to secure or
preserve evidence, interrogate or investigate. They
could have been car salesman yesterday. So why the
24 hour wait? Does this give the hospital an opportunity
to investigate on their own and for what? Who is doing
the investigating and how many of these sexual
assault cases actually reach the news media. Very
very few.
Patient sexual assault cases in nursing homes are
not rare. Given nationwide nursing homes represent
over 17 million beds. I personally know of individual
cases whereby patients reported they were sexually
assaulted but were told, " you imagined it all, it was
the medication".
PT
"I just can't help but wonder why being sedated/unconscious is a free pass to ignore patient modesty." I'm a realist and being male, I think its unreasonable to request same gender surgical teams because of modesty simply because of provider gender disparities. A female request is more likely to be honored for the same reason. If I don't know about it, I'm not embarrassed and therefore don't care. And at the end of the day, I still believe the vast majority are true professionals that really care. However, I'm sensitive to the issue because of how I was treated. I regret not climbing off the damn OR table with the sheet wrapped around me and walking out. If any thing remotely like that happens again, and they fail to respond to a polite but firm request to address the problem, I'm outta there. Like virtually everything in life, we all see this issue differently and that's ok.
Ed
PT, I appreciate your posts also! With respect to the petition, I haven't a clue. I'm disappointed in the response received and can only assume either the vast majority of folks don't care or its not being seen by the public; I'm hopeful its the former. I asked Dr Sherman @ patientprivacyreview.blogspot.com if he could help out & address the issue but no response. Their are also other sites that I haven't thought about until now; Trisha Torey @ patients.about.com, KevinMD, Suzy @ patientmodestysolutions.blogspot.com, www.protectyourmanhood.com, patientmodesty.org, blog.timesunion.com/mdtobe/protecting-patients-modesty/378, etc. If we're serious about change, we need to contact these sites individually and ask for a plug. I'm in, what about everyone else? Dr Bernstein started the ball rolling after repeatedly asking his readers to do the same; we failed so now its up to us to get the message out.
As a aside, I started the thread at allnurses.com by posting Dr Sherman's recent article about adolescent boys embarrassment during physical exams; nearly 50 responses and they killed the thread last night and I've been banned for "frequent spammer." Disappointed but not surprised; a patient that questions their unethical and unprofessional conduct is obviously a threat and they will suppress the issue to the max extent possible. I'm glad to share my posts if anyone is interested.
Ed
There is a physician at a major city hospital who wrote an article about patient's perceptions of being sexually abused in ICU. It was co-written by an attorney.
What I found interesting about the article was that patients in ICU are often too ill to give consent to care. So, if in the patient's mind, certain procedures or bathing may be against their will, however, they are in no condition to give nor deny consent.
It is an interesting scenario. Healthcare workers cannot ignore their duties to keep patients clean and free of bedsores.
The article clearly states that they feel the medications are making the patients believe they were sexually assaulted. Perhaps in some of the cases that's so and perhaps in some other cases they were and yet in some other cases, it was the patient perception.
belinda
It helps to proof prior to posting. I meant to say I'm disappointed in the response received and can only assume either the vast majority of folks don't care or its not being seen by the public; I'm hopeful its the Later.
Ed
Ed
Yes, the thread was removed on allnurses, I'm
never surprised by what they do anymore. I am just
getting over this illness and will brainstorm how we
can move our petition. We need to create links to
the petition as well as some ideas on changing
perceptions.
It's disturbing to note some of the comments on
the thread in regards to peoples thoughts and ideas
as to how healthcare should be delegated even to
other parents children.
PT
PT, I hope you get to feeling better! Yes, it is disturbing. Anyone can join but if you question the disparity in how males are generally treated with respect to modesty and dignity vice females your banned; not to say its a bed of roses for females either. They can post condescending and patronizing comments but the patient and paying customer cannot respond. I can only assume many (not all) enjoy the status quo and the corresponding embarrassment we suffer. Additionally, they perceive this issue as a threat to job security. I wish either Dr Sherman or Bernstein would question the site moderator on the rationale for deleting it. While I'm not confident such an inquiry would result in any real change, the mere fact that eminent physicians are questioning the issue might have a positive impact.
Ed
To Anon from Friday October12, 8:53 AM
Talking about it is one thing. Seeing it take place is quite another thing altogether. Here is a link to a youtube video. This was taped outside the USA. However, what is of note to me is the casual indifference regarding this patients exposure. Patient nudity is the norm in the OR. All in a day’s work I suppose? Obviously they took no pains to protect the patients modesty even though this was going to be published on the net.
http://www.youtube.com/watch?v=iUck30yPHvs&feature=g-user-f
-amr
I think we are allowing ourselves to be "disappointed" in the petition response a little too early.
A)How many of us even knew (or cared) that there was such a thing as a website petition until PT brought it to our attention?
B)How many of us struggled at first with the idea of gender, modesty, and how to mitigate what it was we actually wanted?
C) How many of us read all of these blogs for awhile before deciding to become a part of them?
D) How many people are prepared to go "public" and/or relive some of the most humiliating times of their lives?
We can't assume that there are people just waiting to hop the bandwagon and bring this discussion into their lifestyle so quickly. These decisions take time. And yes, the petition needs marketing "outside the family" to get attention, but let's not feel disappointed so soon, because this is why we often do not move forward!
suzy
Ed, with regard to your wish " I wish either Dr Sherman or Bernstein would question the site moderator on the rationale for deleting it." I have to say that as a moderator who is responsible for moderating his own blog, I really shouldn't raise concerns or be critical of how other moderators manage their own websites. I wouldn't expect to receive criticism from those moderators about my site.
The participating visitors have the responsibility for feedback but to be clear about it, I am not a visitor to allnurses. ..Maurice.
I understand perfectly; nothing to lose by asking and thanks for your continued support!
Ed
NOTICE: AS OF TODAY OCTOBER 14, 2012 "PATIENT MODESTY: VOLUME 50" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 51
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