Bioethics Discussion Blog: Patient Modesty: Volume 51

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Sunday, October 14, 2012

Patient Modesty: Volume 51




It is all about "spreading the word".  In all of these  previous 50 Volumes and literally thousands of postings on this blog, the observations of visitors regarding the inadequate state of preserving patient modesty by the medical caregivers  have been amply described and rarely, if at all, argued against.  It is my opinion that it is well past the time to proceed and, if the "word" is important and vital, to begin to  spread the word to the general public and, of  course, to the medical system itself. 

Not seeing any significant public activism about this issue by my visitors,  I have put up on one internet petition site http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/ a statement expressing my summary of all that has been written on this Patient Modesty thread.   Currently, the petition is not drawing much response of support by the public in terms of signing the petition.  Obviously, this petition requires more publicity.  In fact, the writing of perhaps even more  descriptive and emotional petitions on other sites or publicizing the current site would be more effective to gain signatures than my simple summary .

I hope this Volume 51 of Patient Modesty be used as a communication site for the visitors to focus on their own "spreading the word" both through petitions and other means.  If you want change, start it now!  ..Maurice.


NOTICE: AS OF TODAY DECEMBER 21 2012 "PATIENT MODESTY: VOLUME 51" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 52 




145 Comments:

At Monday, October 15, 2012 9:31:00 PM, Blogger Maurice Bernstein, M.D. said...

I was wondering what my visitors to this thread might think that some if not all of the experiences they document here is part of a mechanism within the medical system of "interpersonal manipulation". The behavior of the service provider to actually attempt to have the patient conform to the self-serving desires of the provider by what the provider says or actually does. Thus rather than allowing the patient to consider him/herself as the "boss" who is paying the bill to have the provider carry out their professional duties, the provider takes command through various actions and excuses. Or is this hypothesis regarding the basis for my visitors' concerns unlikely and an unfair conclusion regarding the medical provider's behavior. In other words, psychologic manipulation for personal benefit is not what is really going on in the practice of medicine. What do you think? ..Maurice.

 
At Tuesday, October 16, 2012 5:03:00 AM, Anonymous Anonymous said...

Maurice, you pose an interesting premise. I think that the conformity issue is a by-product of the systems; not that the systems were designed to produce the end product. However, it is there.

Patients do not always have the foresight to understand the dynamic and it is shocking to me when I speak with friends and family and realize they are like herded sheep when it comes to their relationships with the healthcare profession.

A couple of examples. Some labs now are asking for credit card information in order to have their blood work performed. I watched an office full of people walk up to the counter and conform with their information. I walked up and said no and they didn't blink; didn't give me an argument; said nothing I was prepared to go elsewhere. As it turned out they billed me an extra $75.00 and it would have been an argument and bother to get the money off my credit card...and told them so next visit.

These medical professionals (aside from doctors), the front office people, the nurses and techs are given procedures that they are supposed to follow. I believe they are put into place to streamline the process. They are not bucked by patients.

However, in my experience, you can refuse, and by doing so you are elevating yourself from patient to person. You are respected and your requests are usually met, if done in a polite way.

Another example. Most labs won't give you your test results and tell you to wait until your doctor calls. Patients wait with anxiety and worry when something is wrong. I always request my results, pick them up if I have to. Waiting for results is more stressful for me, then finding out bad news. So why should I, if that's what's best for me, have to wait to get results for a test that I paid for? Again, taking charge, carving your relationships really helps but kind of "goes out the window" when faced with medical crises and hospitalization.
belinda

 
At Tuesday, October 16, 2012 8:46:00 AM, Blogger Maurice Bernstein, M.D. said...

Doug Capra is still having trouble posting. The following is what he wrote me this morning and permitted me to post. I think it is in keeping with what Belinda just wrote. ..Maurice.


I think the system, or perhaps the better word is the culture of medicine, can have more influence sometimes than the individual provider -- or, the culture can influence the individual provider to side with it. I think we sometimes underestimate the power of culture. We think we can easily transcend cultural forces all around us. Medical culture has its good and bad aspects, like all cultures. But like all cultures, it looks out for itself, and uses those within it to survive. So, individual providers must see the power of the culture, recognize it, accept its influence, and then they can work against it when its not in the best interest of the patient. But even then it's difficult to fight against something as powerful as culture because it can destroy you. We underestimate group-think. We underestimate the power of authority over how far we're willing to go against our personal belief systems. Yes, the system, the culture will manipulate both providers and patients to do what's in the best interest of the system. Some providers know this and perhaps help it along. Others know this and just accept it. Others may try to fight it subtly. Some may be oblivious to it. But it's there.
Doug

 
At Tuesday, October 16, 2012 9:08:00 AM, Blogger Maurice Bernstein, M.D. said...

So, Doug, do you think that the medical culture is actually "Machiavellian" in that it is attempting to twist, manipulate the patients' responses to fit the culture's own needs. This negative behavior pattern, of course, assumes that patients themselves are not part of the medical culture itself and are just some objects to be manipulated by the culture. But is that really the case? Doug, don't you think that one cannot divorce patients from being active participants in that very medical culture you are describing? What I mean is: what patients do and what patients not do will effect the behavior of the culture? Should we look to patients as also responsible for the medical culture behavior? Just something to think about. ..Maurice.

 
At Tuesday, October 16, 2012 10:54:00 AM, Blogger amr said...

Dr. Bernstein,

Machiavellian? No. Acting in self interest? Yes. I've spoken before here in the blog where head of obgyn at major teaching schools in LA have stated that it is the responsibility of the patient to accept pelvic exams in the OR after they are put to sleep. There has been many articles about how students are pressured to do the exams even when they know it is wrong. But after going through the program, there ideas about it being wrong "change". This is the perpetuation of "culture."

-amr

 
At Tuesday, October 16, 2012 12:44:00 PM, Anonymous Anonymous said...

So, why is it okay for the medical culture to be what it is and that our social cultures and norms when it comes to nudity in mixed company is ignored? It just further denegrates the personhood of patients and makes this conflict much worse than we already thought that it was.
Belinda

 
At Wednesday, October 17, 2012 3:12:00 PM, Blogger Maurice Bernstein, M.D. said...

From Doug Capra written today. ..Maurice.

Maurice writes: "So, Doug, do you think that the medical culture is actually "Machiavellian" in that it is attempting to twist, manipulate the patients' responses to fit the culture's own needs."

As amr said, I wouldn't use the word "Machiavellian." Medical culture, esp. in institutions, does what all cultures do. Cultures are powerful forces. Their influence is all around us to such an extent that we often don't even realize why we're doing what we're doing -- or, we think that we're acting completely on our free will.


Perhaps one of the best examples of what I’m talking about can be found by reading (or seeing) the drama “Wit” by Margaret Edson. It can be read in less than half an hour. It won the 1999 Pulitzer Prize for Drama. It follows the last hours of university professor Dr. Vivian Bearing as she goes through experimental chemotherapeutic treatment for her metastatic ovarian cancer. Her expertise is poet John Donne and his Holy Sonnets, esp. “Death Be Not Proud,” and we see her come face to face with the topics she has been teaching theoretically for many years -- as she also faces the humiliation and impersonal treatment that can result in cases like hers.

The play shows the powerful force of medical culture and how most patients, esp. in life-death situations like this, quickly play the role of “patient” and give in to the power dynamic.



Maurice – you should consider having your students read this play. If you read it, I'd like to hear your response.


Now, I will admit that dramas like this often focus plot and subject matter in order to get their point across. All doctors and nurses don’t behave like those shown in this play. Many hospices and hospitals are much more empathetic and caring than is shown here. But what we do see in this play is where institutional and medical professional culture can end up if those wielding the power are not careful. This is what happens when you don't actually "think" about what you're doing and why you're doing it.

 
At Wednesday, October 17, 2012 3:42:00 PM, Blogger Maurice Bernstein, M.D. said...

At my medical school, students have been given the opportunity to see the motion picture "The Doctor" as well as seeing a presentation of "Wit" as part of the humanities/ethics program for them.

While it may occur at any time that
a physician or a nurse may experience the "life of a patient" within the medical system, it is very important I think for medical school or residency programs schedule some time where these physicians to be or new physicians experience what it is like to be on the other side of the bed railing as a hospital patient. This is a sure way to implant the seed of attention to the trials and tribulations of being a patient, strapped to a hospital bed with IV tubing and having their privacy invaded by doctors and nurses. With this experience, that seed will grow into a more understanding and humanistic doctor.

For an excellent presentation of the topic of doctor as a patient can including the experiences of Anton Checkhov, Keats and others be found at Epistemologica multiply.com with the title "Physician Heal Thyself".
..Maurice.

 
At Thursday, October 18, 2012 5:06:00 PM, Anonymous Anonymous said...

Well this came to my attention the other day. It is from the Spanish Society of Gynecologists and Obstetricians online newsletter. There are a series of cartoons draw by a male gynecologist depicting the most offensive and degrading drawings and jokes of women during childbirth and of women's aliments imaginable. Apperently it caused an uproar in Spain but the society refused to aplogise. They cannot see what is wrong with the cartoons.
Everything that women suspected that male doctors thought about us behind our backs is confirmed here.
See the link.It takes a while to load.
http://www.keepandshare.com/doc/3152620/spanish-comic-strip-from-sego-pdf-september-21-2011-1-13-am-3-9-meg?dn=y
MP

 
At Wednesday, October 24, 2012 3:16:00 PM, Anonymous Anonymous said...

I completely agree with everyone on this site that much needs to improve in the medical arena regarding patient care, gender preferences, and modesty. I do not necessarily agree that nothing is being done about it. I have listened to the many accounts, and have experienced my own violations at the hands of medical professionals in my lifetime. Recently I needed a number of urology tests and procedures to be done by my urologist at a North Texas municipal hospital. I feared the worst, but was shockingly surprised. I feel like everyone I dealt with that day took every measure above and beyond to respect my privacy, modesty and dignity throughout the process. It was really more than I expected, I voiced no concerns about these issues before hand, but was treated like I had (in a positive way). I absolutely could not have asked to be treated any more respectfully. No, all male care was not freely offered, but I did not ask for it so I dont know what the response would have been. Afterward I was contacted by a Med/Surg rep, a patient care rep, and a customer sat. rep. All 3 asked detailed questions about the quality of my care, and all 3 specifically asked questions about whether or not my modesty and privacy were respected. Its not a perfect world, but I am not a pessimist and I call this progress.
MikeB

 
At Thursday, October 25, 2012 4:15:00 AM, Anonymous Anonymous said...

Hello.My comment is to Mike.I wouldn't call that progress,i'd call that missed opportunity.I believe that they don't see any reason to change.They didn't ask and you didn't tell.Later,they gave you 3 opportunities to voice your concerns.Why would they stir the pot and bring up the gender issue.If there is going to be any progress we all have to stand up every chance we get and make the issue known.If we accept what they want to provide , nothing will change.Only if you stand up and dig in your heels , will we see any real change.That's just my opinion.Thanks. AL

 
At Thursday, October 25, 2012 9:02:00 AM, Anonymous Anonymous said...

It can be obvious how architecture dictates privacy
among genders. Consider Labor and Delivery suites
in general, private rooms. They don't even share the
same pacu( post-operative recovery unit). They have
their own. Recently, I was eating at a restaurant and
after visiting the mens room noticed that the urinals
were placed as such that anyone walking by would
have full visibility of the urinals, provided someone
was walking in or out of that mens room. Was that
architecture accidental or deliberate. I have seen this
the case with many mens rooms in general.
Interestingly, this restaurant probably caters more
to women than men, considering the theme of that
establishment.

MikeB

The customer service reps are reading
from a script and they all say that and in no way
is that an absolute goal of those who initially provide
your care. It is just a psychological ploy with words.

PT

 
At Thursday, October 25, 2012 3:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is the comment Doug Capra wrote today. ..Maurice.

To MikeB:
Thanks for your report. What I would like to hear from you are the details of your visit. Now, I'm not saying you need to reveal information that you consider to be private -- but so often patients don't feel comfortable reporting the details of visits like yours. Thus, we get generalizations and vague images of what's really happening. We end up talking about the issue in a factual vacum. It would help, if you feel comfortable describing your visit, precisely what happened and, thus, perhaps people might understand why you feel the way you do about how you were treated.
I do agree with you that dignified treatment is out there and that many caregivers are aware of modesty issues and try to mitigate as much as possible. I also agree with those who responded that, by not asking gender choices, caregivers are still assuming too much and and thus asking how you feel about your treatment after the fact can be useless.

 
At Friday, October 26, 2012 12:27:00 PM, Anonymous Anonymous said...

Doug
My experience consisted of a number of exploratory/test procedures followed by a surgical procedure taking the better part of a whole day. To even partly describe them would require far more pages than the forum could support. It would be easier to describe my experience in the system which I use to base my judgement. I have experienced my share of shoddy care and have followed this forum for years, so I went in ready to fight back and stand up for myself. I never needed to. The best I can do is say everyone went out of their way to ensure my bodily exposure was at absolute minimum, only when required and with the professionalism and respect. One cannot realistically go in for a urological procedure/surgery and expect not to be exposed. I expected that, but also expected the exposure to be only when required, discreet and respectfully done. I personally have no gender preferences, but do demand to be treated with respect. This experience was exceptional in every way, and a vast improvement over what I have experienced in the past. Due to injuries sustained from martial arts and motocross, I would need 4 hands to count my hospital visits and surgeries on. Add on another 10 years of competitive athlete experience and all the medical exposure for physicals and such that goes along with it. I've had plenty of contact with medical personnel, at times it was unprofessional at best and abusive at worst. My last was the best one ever. The day before surgery I met with the nurse for labs. We discussed history and any/all of my concerns. I took the opportunity to explain a comfort issue regarding a unique neurological response I have to the IV and for once it was addressed. In the past I got the "suck it up" blowoff. I cannot say what the response would have been if I asked for male care, but we cannot simply assume they would be discounted. We then are guilty of the same baseless assumptions we accuse the providers of. I was given every opportunity to voice any special concerns, nobody ever asked me in the past. Like I said, I have never experienced such patient comfort centered care. No, they did not expressly ask "Would you prefer a male nurse?" I dont think that is their responsibility to play 100 questions to inquire about every personal niche. You have to speak up for yourself. They did not assume anything, gave me the opportunity to voice any concerns, and I was happy with that. I don't think asking after the fact is useless. The answers they get is an indicator of whether or not modesty is honored in practice. But I can hear it already, they dont truly care what the answer is either way, rifght?

I am not trying to change anybody's mind, I am simply relating a positive experience that suggests ours is not a hopeless cause. I also discussed the same matters we discuss on this forum with some family members of mine. There are 4 of them in the medical profession with a combined 75 years of experience. I attempted to relate some of the positive feedback I got from them on this forum and got nothing but people discounting the validity of the responses I related. I am not trying to change any minds, just trying to add a glimmer of positive to a landslide of negativity. I keep my mind and eyes open and am encouraged by positive changes I see. This is based on real life experience, not just from what I read in the internet. If some want to reinforce each other with negativity that is their right too.
MikeB

 
At Friday, October 26, 2012 3:49:00 PM, Anonymous Anonymous said...

Mike B., I agree with you. When one is treated respectfully the modesty issue goes into the background and becomes almost a non issue.

That's not so for me and many others who were abused by the healthcare system. I refuse to feel degraded and a mixed gender team would do just that for me. So, under normal circumstances, I see where you're coming from.

Those with a history of sexual abuse/assault and especially those of us subjected to cruel and degrading treatment in a sexually charged medical environment need more. It's great that you had a great experience but I'm appalled at the status quo of your family who work in the medical environment.

Please tell them for me that their job is "to do no harm", treat the whole patient and that everyone in the USA has a right to their bodily privacy.
belinda

 
At Sunday, October 28, 2012 8:52:00 AM, Anonymous Anonymous said...

MikeB

Not to be disrespectful to your opinions, nor
to your comments but, I think you are in denial. You
say that you have no gender preferences, yet you
have described your experience with medical
personnel as "unprofessional at best and abusive
at worst ". My experience has lead me to believe
that men tend to be displayed as freaks in a side
show within the medical community.
The female dominated healthcare industry
will insure that this syndrome you suffer from " I
must deserve this" continue unless you decide
that you will no longer be a sideshow freak. By
the way the government has given us tools to
punish hospitals and medical facilities who continue
down this path of discrimination, it's called Hcap
scores.


PT

 
At Sunday, October 28, 2012 8:55:00 PM, Anonymous Anonymous said...

I think what's important here is to understand that everyone's needs are different based on their specific set of circumstances. What works for some, may not for another.

PT, I wonder, how easy is it to work in the medical environment when this issue is important to someone.

I'm not trying to single you out personally, but rather understand how stressful it might be to have to put on the "armor" every day. How does that make you and others who see this issue as it is? I'm wondering if it's a feeling of helplessness

It would seem to be that it might be traumatic seeing all the things that shouldn't be and do people of like minds who work in healthcare ever discuss the issue in groups?

Perhaps that might be a great way to get advocacy going from the inside.
belinda

 
At Sunday, October 28, 2012 9:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, do you mean an "employee whistle blower"? Doesn't that take courage on the employee's part? Would "from the inside" provide more pressure for correction and change than pressure through advocacy from the outside? Speaking of "outside" is anybody considering to set up another petition on the internet with a bit more oomph than what I created? ..Maurice.

 
At Monday, October 29, 2012 5:21:00 AM, Anonymous Anonymous said...

Maurice, I actually was thinking more of a support group of not disgruntled, but disappointed workers regarding the medical ethics in their workplace concerning cruel and degrading treatment toward patients. Workers like PT who understand what's going on and want to see that it's corrected.

I would then publish a survey, send it to everyone who works in the hospital for an anonymous critque of their observations and then have them sent that to the assigned risk department.

It might create some kind of firestorm when the assigned risk department realizes the depth and breath of the observations.

I don't think any petition will work because of the diversity of the problem, the inability of people who have not had these experiences to understand and finally, the stonewalled attitudes of medical personnel who don't care, don't want to be inconvenienced.

It's interesting that the TSA has started to remove the X ray machines from the larger airports replacing them with a machine that produces "gumby" type bodies. They are refusing to say that the modesty issue has anything to do with it, however, what they don't want you to know is that the airline industry has been greatly impacted with people refusing to fly. While it attempts to fix the problem (and really doesn't), the bottom line, just like in medicine, they don't want to address the human rights issue that is underneath respect, dignity and privacy.
belinda

 
At Monday, October 29, 2012 1:27:00 PM, Blogger Maurice Bernstein, M.D. said...

Despite all of the privacy and modesty concerns which have been described here both in the clinic setting but also as a hospitalized patient, there are still a group of patients providing a problem for the hospital staff: those patients who find hospital life so pleasant and comforting or so protective from outside personal problems that they, presumably without those privacy and modesty concerns, refuse to leave, refused to be discharged despite told by their doctors that they no longer need hospital treatment and may leave. This patient behavior poses a problem to the hospital staff regarding how to resolve the conflict.

I set this issue up as a new thread on my blog hoping for visitor feedback regarding this. If you can contribute to that discussion, go to that thread "Patiemt Refusal to Leave the Hospital: And Now What?" and write there. ..Maurice.

 
At Thursday, November 01, 2012 5:44:00 PM, Anonymous Anonymous said...

Dr Bernstein, I've watched with interest the lack of response you've received reference a second petition with oomph; disappointed but not surprised. I've previously made suggestions on getting the word out that resulted in essentially the same response. Once again, I'll help in any way I can. That said, I remain convinced the majority of folks who've had these experiences are embarrassed to discuss them even anonymously.

Ed

 
At Thursday, November 01, 2012 5:59:00 PM, Blogger Maurice Bernstein, M.D. said...

But Ed, if you go through all the Patient Modesty volumes comments including the first one "Naked", you will be impressed as I was impressed how many visitors (many, many), writing anonymously, detailed their personal modesty experiences. I don't think that anonymous depiction of what happened to them is affected by embarrassment and is the cause of advocacy inertia. ..Maurice.

 
At Thursday, November 01, 2012 6:44:00 PM, Anonymous Anonymous said...

Dr. Bernstein.I think most people want someone else to do the work.They don't want to be bothered with the issue.Alot of people will complain , but when it comes to putting their name on the line they back away.Let someone else stick their neck out.As long as it's not you they come for your ok but pretty soon it's your turn and there is no one left but you.I personally will never understand why the medical field doesn't respect a patients request.They are there to serve the patient, the patient isn't there to serve them.If you have no patients you have no job.Take care of your customer or someone else will.
AL

 
At Thursday, November 01, 2012 7:49:00 PM, Blogger Maurice Bernstein, M.D. said...

AL, but where are the requests? As I have written here dozens of times, in my 50 plus years in internal medicine practice and still participating, I can't recall any modesty requests by my patients. I simply followed what I understood were the standard professional rules for attention to patient modesty and need for chaperons for female pelvic exams. I have a feeling, and I have said this before, that the vast majority of physicians of all specialties may have had the same experience as myself: patients either satisfied or if not, not speaking up.

I can say that I am doing my part, though tiny in the overall med student population, in emphasizing the modesty issue to the medical students I teach since starting this thread by telling them my experience with this blog thread and stressing the issues brought out by my visitors here and which might well apply to some patient the student will, in their career, be examining. And as I written before, I was associated with two articles in the AMA News and recently the petition. It just has to be up to the "victims" (and "victims" may be a valid description) themselves to speak up and themselves spread the word. ..Maurice.

 
At Thursday, November 01, 2012 8:51:00 PM, Anonymous Anonymous said...

Dr Bernstein.I hear and understand what your saying.I'm talking about the attitude you get when you ask nicely.I've heard most of the excuses as to why they don't want to accommodate.Don't have any,what's the difference,etc.If we didn't care we wouldn't have brought it up.It's when they treat you like your stupid or there is something wrong with you , that gets me.The blogs are full of people's experiences with modesty violations.You should be able to voice your concerns and have the medical field honor them.I personally have spoken up many times and the only time you get what you ask for is when your willing to fight for it.It shouldn't have to be that way.Treat me with respect and i'll give you respect in return. AL

 
At Friday, November 02, 2012 5:03:00 PM, Anonymous Anonymous said...

Dr Bernstein, I suffered through embarrassed silence until I discovered your blog. With respect to your 50 years of experience as a internal medicine specialist, did you routinely require the assistance of a female nurse/assistant for outpatient exams/procedures of male patients of an intimate nature or below the waist nudity? I think your experience in that regard is probably limited correct? With respect to female patients, did you ask them their preference with respect to chaperons and if not, I'm betting the chaperons you used were female, correct?

Here are two relatively recent studies on chaperons from the UK and Australia. I think the results, especially of female patients, surprising!

http://journals.lww.com/stdjournal/Fulltext/2007/12000/The_Differing_Views_of_Male_and_Female_Patients.13.aspx

http://pmj.bmj.com/content/83/975/64.abstract

Ed

 
At Friday, November 02, 2012 6:14:00 PM, Anonymous Anonymous said...

Google opposite gender medical care, California Statevuniversity of long beach and read the policy, it states any male dr conducting intimate exams on a female will have a female chaparone. It further states female Dr's conducting intimate exams while not required may have a chaparone. Important difference male Dr's will have a FEMALE chap, female Dr's if they have one it does not specify gender. While I am glad you had a positive experience, if you did have a gender preference, my guess is your experience might have been totally different. This is a college, supposedly more advanced, and yet the blatant double standard is so accepted they put it in print without fear. Respect, and respect for gender preferences are two different things....alan

 
At Saturday, November 03, 2012 10:25:00 AM, Anonymous Anonymous said...

"As I have written here dozens of times, in my 50 plus years in internal medicine practice and still participating, I can't recall any modesty requests by my patients."

Respectfully Dr. Bernstein....I do not doubt what you say, but you also say your expectation has always been that the need for care should "trump" modesty. No doubt most in the medical arena have voiced that expectation, and the public is well aware of that.
"Good" and "Compliant" patients will not speak up when they have a problem with modesty when they are told that they should not have a problem with modesty! Just because people have been conditioned to not speak up does not mean that that is a 'good' sign that they do not have an issue. It just means that they are told not to have that issue.
It really is an incredible cycle, and you never really know if you have "good" humiliated patients who do what they are told, or if you have patients who have no modesty issues.
To date all we really know is that they are silent about it. Most people are silent about embarassment and humiliation, but how is that a good thing..........?

suzy

 
At Monday, November 05, 2012 8:50:00 AM, Anonymous Anonymous said...

Alan


You will find these policies consistent with every
college and University. Furthermore, the providers
are often medical residents or worse physician
assistants. It's a freakshow mentality. Male patients
are treated as freaks in this sideshow if you consider
it begins with pe and hernia exams, all the boys are
nude with the female teachers and nurses observing.
It continues in military induction exams, again with
every female clerk in the building being there at that
precise moment. If you really want to see a grand
freakshow visit a level one trauma. I have seen 40-50
people in these rooms. Totally unnecessary to have
that volume of people there, considering 5 of them
are with registration. It takes one person to register
one patient. Take your daughter to work day. Female
nurses all brought their daughters to work with them,
" watch mom place a foley cath. In this male patient."
If the nurses daughter was not there,no problem,
ask those three candy strippers if they want to watch
a medical procedure. It takes on a freak show
mentality when you bring crowds of people in when
most have absolutely no business being there.
These freak shows always encompass male
patients and the other ingredient in any freak show
are the gawkers, the more the better for them.


PT

 
At Friday, November 09, 2012 11:21:00 AM, Anonymous Anonymous said...

Not long ago I was in the hospital for a day surgery procedure. After recovery they wheeled me back to my day surgery staging room (curtained off area) where my wife was waiting. They told my wife the anesthesia would make me forgetful and not remember much for the rest of the day. The nurse told me that they wanted me to try to go to the bathroom to urinate, then left the room to return a bit later. I tried to get up but couldn’t. The gown they used for my surgery was a heavy paper backed with plastic. During my procedure it got moved many times and now was tangled up in my legs. It was also wet with some blood, so I tore it off, and had my wife help me get my boxers on. I was still sitting on the bed with nothing but my boxers on when the nurse returned. She had another nurse in tow along with her as they were stopping by my room on the way to check on another patient. They asked if I was ready to try to get down to the restroom, which was about fifty feet down the hall of the day surgery unit. I said yes, but would need some help getting dressed for the walk down. One nurse said it would be perfectly fine to just walk down in my underwear. I was still quite groggy but was aware enough to know the hallway was quite busy, and said repeated that I needed to put something on. Again, nurse #1 reiterated it was not necessary to get dressed, proceeded to remove my IV bag from the tower and handed it to me. She said “Just go ahead and walk down there like that.” I was still sedated and had to go quite badly so at the time I was not all that concerned. If not for the medication I no doubt would have been, but lacked the capacity to argue. I said fine, and started to get up. As I did nurse #2 quipped in “Besides, it will give you a chance to show off your chest.” Even when heavily drugged, that did not seem right. I turned around to see if I heard what I thought I did. None of them, not even my wife reacted in any way, so I assumed I heard it wrong. I wandered down to the john and back, and eventually went home. The next day after all the anesthesia wore off more details of the day before came back to me. I asked my wife if I really did go all the way down to the restroom in my underwear like I thought. Indeed I did. I asked also if a showing off my chest comment happened. It did just as I recalled. I asked my wife “Didn’t you think that was inappropriate?” She said no, the nurse was just joking and the ones who joked around were better than the ones that didn’t. It was no big deal. I didn’t feel the same way, I think it was BS. How long would a male nurse been employed if he sent a female patient down the hall in her underwear and assured her it was OK because she could show off her legs?
Scott

 
At Saturday, November 10, 2012 8:21:00 AM, Anonymous Anonymous said...

Scott, I totally agree. You were treated unethically and unprofessionally while you were vulnerable and should formally complain to your physician, the hospital, and your state nursing board. Its not how they view or see the issue; how the patient feels is the only thing that matters. Frankly, your wife should have advocated for you; I know mine will!

Ed

 
At Saturday, November 10, 2012 6:20:00 PM, Anonymous Anonymous said...

Exactly Ed, I would have expected my wife to have stood up for me as well. Her response may still be telling though. My wife completely blew off the situation just like the nurses and she has never worked in health care a day in her life. Perhaps it is women in general who have no conception of modesty and respect for mens privacy, and not necessarily a concept confined to female nurses.
Scott

 
At Saturday, November 10, 2012 7:03:00 PM, Anonymous Anonymous said...

Scott there are several aspects to your post that have come up before. The fact that men's modesty is often just not recognized. Consider all three people in your room were female. I don't think it is malicious as often as it is just a lack of concern or recognition. Do yourself and other men a favor, file a complaint which comes to Dr Bernstein's comment and my question to Dr. Bernstein, you have said several times no one has ever brought up the issue of modesty, I believe you. What i would ask, have you been aware of a patient being embaressed, uncomfortable, or to the more extreme feeling humiliated by the process. Have you ever had the feeling or that opposite gender exposure was responsible. I believe you when say no one said anything, but were you ever aware or had the feeling expressed or not.....alan

 
At Saturday, November 10, 2012 10:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Alan, in my entire career and as we teach the medical students about general issues of professional behavior and patient modesty, I have always been aware to acknowledge the concept of physical modesty in all patients and to be aware or attentive for patients' concerns in this regard. In other words, I was careful not to ignore modesty or it's expression by the patient. With the cautions on my part to avoid unnecessary exposure and follow guidelines for chaperons, I felt comfortable in this regard, particularly since I never got any action or words by any patient to the contrary.

I must tell you, however, that my and perhaps all physicians' primary attention to the whole patient has not been that of patient modesty but instead the need to understand the patient's symptoms and possible diagnoses along with treatment. Patients don't go to the doctor for the treatment of modesty so modesty is not the primary goal of the doctor (nor really the patient).

Nevertheless, I would not be carrying on this patient modesty thread on my blog all these years if I felt the expression of patient modesty here was something trivial and of no importance. ..Maurice.

 
At Sunday, November 11, 2012 4:30:00 PM, Anonymous Anonymous said...

Scott

I strongly encourage you to visit your state nursing board via the website. Look up the guidelines on sexual impropriety, those guidelines will exactly mimic the unprofessional behavior you experienced. Anyone can file a complaint to the nursing board online and as always I suggest you submit an additional complaint to the facility administrators, being the CEO and CNO.
Completely bypass the patient advocacy
department,their attempt will be to sweep your complaint under the rug.

PT

 
At Monday, November 12, 2012 7:29:00 AM, Blogger amr said...

Scott,

I would disagree with PT. Also include the patient advocacy department. If they do blow you off, you can use that fact in communication with others in the organisation as an exemplar of the problem they have.

--amr

 
At Monday, November 12, 2012 11:25:00 AM, Anonymous Anonymous said...

A YouTube video on male patient modesty: http://www.youtube.com/watch?v=zHzkaFdK64Y

Ed

 
At Tuesday, November 13, 2012 4:54:00 AM, Anonymous Anonymous said...

I never doubted your concern for patients Dr. Berstein. I was trying to get a little more understanding of the fact that no one had ever expressed concern for their modesty. I think part of the chasim between the posters here and providers, even concerned providers is you were aware of the embarrassment but felt what you were doing addressed it and was sufficent on your part. Patients fell you have to know they are embarassed and or humiliated and aren't asking or doing anything/enough. To a degree we have had the teacher/student or perhaps even principle/student relationship. In my years you just did not question, you complied. things are changing with second opinions and questioning. I was just confirming what I was thinking, providers know, some think it isn't an big issue for the patient, some know and don't think it is a big enough issue to inconvenience themselves. Sort of a don't ask don't tell approach to patient care.....alan

 
At Tuesday, November 13, 2012 5:39:00 AM, Anonymous Anonymous said...

Ed, an excellent video; probably one of the best with one exception.

This is not a male or female issue; it's a human issue and it seems imperative that improving this issue should be for both genders where there is common ground; then branching off into specific needs of each gender.

It is interesting, but the subject of others involved in examinations with regard to gender is not mentioned.
belinda

 
At Tuesday, November 13, 2012 5:48:00 AM, Blogger the singleton said...

Great topic!

1. Wouldn't an easy and non-stressful option (for at least the gender issue) be to mandate that during intake all medical facilities must ask for patients' preference for male-only, female-only care for religious and/or personal reasons? OR that they are open to any sex for non-intimate procedures, but prefer same-sex for any intimate procedures? (OR that they require permission to be asked before each procedure?) Then in all but absolute emergencies (for which the patient signs agreement or a waiver), the patients' preference is documented and they don't have to face possible shaming or on-the-spot pressure to acquiesce.

The patient's choice could be color-coded on paperwork, the patient's door and/or wristbands so everyone knows at a glance what to do.
Asking for preference is the standard for massage therapists, which coincidentally is a profession that are masters at making people feel protected even while they may be completely nude under draping. If massage therapists can be taught protocols like "When working on left leg, cover right leg", why can't medical professionals? WHY isn't this subject built into the instruction of every procedure medical professionals will have to perform?! At the very least shouldn't medical actors be fluent in patient advocacy and modesty concerns and be a part of the evaluation process for doctors/nurses, etc?

2. While I personally understand the connotations of the phrase "patient modesty", the word modesty is quaint, almost to the point of being archaic. It is not used by most in the general public (outside of conservative religious circles). I fear you may have to overcome the images it brings up of swooning Victorian ladies in high-collared, low hem-lined dresses... of prudes.

Prudes are always ridiculed and are told to "get over and just get used to" girls in bikinis, sex on TV, breastfeeding in public. Wouldn't a better term be "courtesy" (on the part of the medical professional)? I think that would re-frame the discussion in a more palatable way.

3. I'm a woman, and I could easily see the matter of gender preference devolving into a feminism minefield. It could be misinterpreted that men only want male medical professionals because they don't believe women aren't good enough, smart enough, professional enough to take care of their male patients. I think this may account for at least a part of the resistance on the part of female nurses in particular. Women have had to fight in so many other professional fields and this is one of the few areas where they are top dog.

I can imagine that they perceive their role as being one of the few places in the world where men should be forced to accept their authority like they have to do everywhere else. I don't mean to say that they do this to be deliberately malicious to the male patent, but that their frame of mind is momentarily on their professional authority and credibility rather than the male patient's modesty requirements.

 
At Tuesday, November 13, 2012 5:53:00 AM, Blogger the singleton said...

4. I'm an internet addict and have never heard of the Care2 site. You will get much more attention for the petition at the well-known site Change.org. This link gives you instruction on how to get attention for your petitions http://www.change.org/guides

5. Also, if you want to get more attention for the petition and the cause, you must, must, must get a Facebook page and use it! You can post links to articles that you find or anything that you write and people will share them to all their friends and family. If you introduce yourself to facebook groups devoted to chronic medical conditions and you will probably get attention even faster since they are in and out of hospitals and doctor's offices more frequently than the rest of the population. Mary Shomon's Thyroid page is a good example both as a specialty site that you should tap into and as an example of the kind of interaction you can expect from the public. https://www.facebook.com/thyroidsupport?fref=ts


6. Petition wording... People have SHORT attention spans. We actually have a fairly new acronym -- TL;DR -- which means "Too long, Didn't read". Although the content of the petition is accurate and appropriate, you should consider have 5-10 short bullet-pointed statements(not paragraphs) in plain English, followed by either a link or expanded explanations of what each of the statements mean if people want to read further. (basically do the opposite of what I've done in this 2-part comment!)

6.1 -- I would even consider creating and linking to an additional petition with language specifically geared toward male patients. Target all age groups, but I think you may have a great deal of luck with teen-early twenties, gay men and the elderly. Who knows, perhaps it will also spark support for more men in the nursing field!

7. I'm not sure if you do this already, but you should also comment as much as you can on other blogs (that are meant for the general public), sites and Youtube videos -- even if it's not related to modesty -- and have a standard signature line at the end of every comment that gives your credentials and links to your blog, your Facebook page and the petition. This will make your information pop up more in search results and most people can't resist the urge to click if they like what you've said. About.com has a patient advocacy site that you might want to contribute to. http://patients.about.com/od/caringforotherpatients/ss/becomeadvocate.htm

 
At Tuesday, November 13, 2012 9:28:00 AM, Anonymous Anonymous said...

Belinda I agree with you and while I'm not defending the author his survey did address male patients exclusively. I sent him an email asking why comments on the youtube site are not permitted and why wasn't opposite gender care addressed.

Ed

 
At Tuesday, November 13, 2012 2:11:00 PM, Anonymous Anonymous said...

Scott,
I'm so sorry for your experience. As a nurse and a wife, I am appalled on two levels. On a professional level, you should never have been subjected to that kind of treatment from any of your health care providers. That was completely inappropriate; and as a wife, I can't believe the flippant way your wife reacted to your obvious discomfort. But, in her defense, maybe she wanted to look like the good,compliant family member who didn't want to make waves and be branded as "the troublemaker in room ..." I've been in that position with my own family members and have had other health care providers look askance when I've advocated for their wishes (modesty and otherwise). It used to bother me that I was considered "that troublemaker who's a nurse", but it doesn't anymore because, while I can sympathize with the nursing staff, the wishes of my loved ones trump whatever convenience or expediency the hospital/medical staff want to try to force on us. And there are options available to comply with most requests. It just isn't necessarily expedient or cost effective to the institution.
I would discuss this situation honestly with your wife and don't be afraid to hold your ground and complain long and loud to all the powers that be.

 
At Wednesday, November 14, 2012 7:54:00 AM, Anonymous Anonymous said...

"A few hours at the local community college to become a CNA does not a professional make."

Good description. I have a 17 year old niece in the 11th grade who got her CNA certification at a JC down the road from her high school during school hours and received high school credits.

The other day she described to the family (very graphically) the way to change an old man's diaper, how to hose him down and other similar things, giggling the entire time. This is the same girl that was recently caught peeking under the door with a mirror while her brother and his friends were getting changed for the pool.

Should she be considered a professional? Is she the type that should be trusted to observe a man being given a foley, or prepped for surgery, or giving a boy her own age a bedbath?

I suppose now that she got her certificate the official term changed from "voyeurism" to "medical research". It blows my mind what they can get away with just because they're wearing scrubs and have a certificate on their bookshelf. (and don't have a penis)


"(3) That you touched the other person to specifically cause sexual arousal, sexual gratification, or sexual abuse."

How can we prove in court what this person was thinking about when he/she was poking and prodding and squeezing and fondling while in the "act" of "doing their job"? Who has the power to decide that?
GR

 
At Wednesday, November 14, 2012 4:20:00 PM, Anonymous Anonymous said...

GR,
You are so right; and it isn't necessarily limited to those very young CNAs. Because, with all due respect to Maurice, I've seen the same behavior exhibited by all suppposed "medical professionals" from aides to MDs and from the operating room to the ER to the floors.
When is medicine going to wake up and realize that the "neutral gender" either doesn't exist or is, at the very least, extremely rare and that patients should have the right to choose who provides for their medical needs.
Saving your life should not mean losing your dignity!
CS

 
At Wednesday, November 14, 2012 4:51:00 PM, Blogger Maurice Bernstein, M.D. said...

I totally reject behaviors of those working in medical care to making some sort of personal sexual interest out of the work, regardless of status. I think that CNAs, RNs or MDs who demonstrate this thinking or behavior in any way should be scrutinized for removal from this work. Care of patients is not a route to providing sexual excitement to the day's events. Their job requirements are not to be "peeping Toms". This also applies to medical or nursing students and I also refuse to accept the behavior of students to examine patients, for whatever reason, either awake or under anesthesia without expressed permission of that patient. Period. ..Maurice.

 
At Thursday, November 15, 2012 4:22:00 AM, Anonymous Anonymous said...

I think when a nurse decides to apply ointment to a man's penis who is perfectly capable of doing it himself (as described by his wife on an earlier comment)it is a good example of the great possibility that the nurse gets pleasure out of doing it, ie sexual assault. She should at the very least let his wife do it. That type of situation makes the nurses seem more like prostitutes than medical providers.

 
At Thursday, November 15, 2012 4:42:00 AM, Anonymous Anonymous said...

I don't understand how some of you don't have a problem being seen or fondled by the opposite gender if you're unconscious, but let it bother you when you're awake. The complete loss of control is what I fear the most. When I'm awake I'm able to defend myself and my morals but while asleep they can do whatever they want to me and I can't stop them or control the situation. If I'm being abused I want to know about it.


 
At Thursday, November 15, 2012 5:01:00 AM, Anonymous Anonymous said...

The moderaters of allnurses.com are used to having complete control, as proven by all their bragging about their medical exploits. They're bullies on that website the same way they're bullies in their hospitals and offices. Just like the blog, if they hear anything against them or something they don't agree with at work they'll shut you up. Many are pervs and don't like to be called on it so they get rid of you.

 
At Thursday, November 15, 2012 4:33:00 PM, Anonymous Anonymous said...

Re: Allnurses

Absolutely, it resembles a police state mentality that
imposes martial law regarding their moderation. Removing
threads that threaten the feminine healthcare machine.
The good news is their days are numbered and a
little birdie told me so.

PT

 
At Friday, November 16, 2012 8:51:00 AM, Blogger Maurice Bernstein, M.D. said...

Since patients' consent and dissent to decisions and actions of those in the medical profession is an underlying theme in this "Patient Modesty" thread, my visitors here might be interested in a new thread I put up titled "Slow and Show CPR: Patient's Best Interest?" and can be accessed with this link. All hospital patients currently will have cardio-pulmonary resuscitation (CPR) as a unconsented order on admission if the patient should suffer a cardiac and/or pulmonary arrest. How the resuscitation is carried out is at the discretion of the hospital staff and may lead to behaviors known as "slow" or "show" codes where the staff may decide that an energetic response is clinically unnecessary. My question to my visitors is whether instead of patients having to have a "do not resuscitate" order written by the doctor as a specific dissent to a universal order, the CPR itself should be a procedure that is requested through informed consent by the patient on admission. If you have any opinion regarding consent and dissent with regard to CPR in a hospital environment, don't write anything on this thread but go to the above linked thread and write your opinions there. ..Maurice.

 
At Thursday, November 22, 2012 2:53:00 PM, Blogger Maurice Bernstein, M.D. said...

Today, L Olson wrote a comment to this thread but I would like the visitor to submit it again but without the naming the "friend" and without the naming of the university but to describe what practices by the university the friend is concerned about and which is pertinent to the issues discussed here on this thread.
Thanks. ..Maurice.

 
At Thursday, November 22, 2012 3:58:00 PM, Anonymous Anonymous said...

To Belinda,

If you did not find my youtube video to be useful, then perhaps it is because you have a ridiculously narrow view of modesty issues. In your mind, as long as there as same-gender health care providers, then all is fine. The point of my video, which obviously escaped you, was that for some men, modesty implies no invasions of privacy, period.

One of the reasons I posted my video http://www.youtube.com/watch?v=zHzkaFdK64Y was specifically to refute people like you who contend it is all just a question of different-gender providers.

Michael

 
At Friday, November 23, 2012 5:34:00 AM, Anonymous Anonymous said...

Michael,

Privacy issues are different for each and every individual and...if you've read this blog over the years I talk about how this issue is not gender specific; that it's about dignity and respect for everyone.

It's not that I found your video to be erroneous, it was just lopsided and forgetting that there is another gender who have these issues.

Surveys and research have been done and most people do prefer same gender care to limit embarrassment and that includes men.

For some, same gender care means the difference between obtaining care and avoiding care.

While we differ on aspects of the problem, I do commend the effort made to address that there is one; however, it involves everyone; not just men.

Why are you so angry?...And, who are "people like me"? I'm just like everyone else. Did you ever ask yourself what happened to this person that would impact gender issues in healthcare?

If you are physician, might I add that you are not respecting someone else's right to have a different opinion than you on part of the problem and that is...exactly the problem.
belinda

 
At Friday, November 23, 2012 12:49:00 PM, Blogger Doug Capra said...

Michael:
I was also surprise by the anger expressed in your post. I, along with belinda, agree that you've produced an excellent video and I commend you. The only criticism I have is that it tended to ignore the gender issue completely, i.e. how some men (and women) feel about opposite gender care, mostly for intimate exams and procedures. As I've written often on this blog and others, the issue is mostly about communication, especially how the patient is approached. It's about being treated with dignity and respect, and I believe that most patients won't focus on the gender of the caregiver if they feel safe and respected.

 
At Friday, November 23, 2012 2:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Welcome back Doug.

I do want to express, perhaps again, my belief that most physicians cannot conceive that an ill patient and one who is concerned about their health and even life would have modesty trump a physical exam or procedure. I must add that it is a belief, perhaps only developed from my own view of the issue since I can't give any statistics. I do agree that when the patient is not ill at the time and only some sort of screening or "routine" exam is being carried out that patient modesty can be a valid major concern both by the patient and the physician that all physicians should consider. I am not saying that doctors should ignore the possibility of patient modesty issues when the patient is ill but I think the major direction of thought by the doctor should be to do what is needed to make a diagnosis and begin treatment.

There has to be priorities in life especially in critical situations and I think diagnosis and treatment of a sick patient may be a priority over modesty if the modesty requests of the patient will hinder a necessary medical workup.

Noted on this thread have been experiences of absolutely unnecessary modesty intrusions of people in the patient's environment that have nothing to do with proper diagnosis and treatment. These intrusions whether in the presence of either a sick or healthy patient should not be tolerated.

..Maurice.

 
At Friday, November 23, 2012 3:24:00 PM, Anonymous Anonymous said...

Maurice, I couldn't agree with you more except...what if a patient's mental health is more important than their physical health and that person has a history of cruel, degrading treatment or torture.

Would you say that the person should submit to save their life to the detriment of their mental health?

Humiliation studies focus on the psychological damage of such treatment and the avoidance of treatment. Sexual assault and abuse victims are not a small number in our society.

Wouldn't it seem that an approach in treating the entire patient makes more sense than creating a situation that treats only the physical? That's the way that the system is made up today. Gender is a non issue.

Patients with a history of psychological trauma may have a trigger of an opposite gender caregiver. Those patients, especially those with PTSD have a disability and as such, have rights. I don't think it's out of line for a previous victim of rape (regardless of the gender of the patient) who needs same gender care shouldn't receive that care.

Additionally, the standard of care in most hospitals, prepping patients in the OR, etc is not mentally healthy as a rule at the current time. As seen on this blog, unnecessary gawkers and an audience can only make a patient (even one without a previous history) feel vulnerable and humiliated when a slight change in procedure could alleviate that kind of stress. Additionally, patients are not informed of what is about to happen to them when they are feeling so vulnerable that adds to a cause of trauma (the unexpected).
belinda

 
At Friday, November 23, 2012 4:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda you wrote "Would you say that the person should submit to save their life to the detriment of their mental health?" That certainly is up to the decision of the patient and not that of the healthcare provider.
But the patient should consider that if they died as a result of their decision, their mental health concern would be moot. If they didn't die but remained physically sick because of their decision they would still have their mental illness along with the physical illness continuing. No illness would then be resolved. ..Maurice.

 
At Friday, November 23, 2012 5:02:00 PM, Anonymous Anonymous said...

People are products of their experience. It's very difficult for someone, for example, to imagine the mental anguish of someone who had been tortured and then be placed in an environment that seems threatening to them.

Healthcare because of the unexpected nature of illness, insensitivity of some employees, and abusive situations that often happen in that environment (based on our blog and assigned risk management interviews), it would be common sense for someone in that mindset would be extremely cautious and avoid certain practices.

Below is a website of an organization whose focus is to end humiliating practices.

http://www.humiliationstudies.org/

This said, without having had a certain type of experience, it's very difficult for someone to understand the mindset of someone who has. That also doesn't mean that someone who has had such an experience is mentally ill.

Studies have shown that people will do anything including to avoid medical care when they feel humiliated. It's a fact supported by research. This would include medical care and was the subject matter of a recent TV commercial citing avoidance of prostate exams.
belinda

 
At Friday, November 23, 2012 6:56:00 PM, Anonymous Anonymous said...

Dr. Paul Whang, a staff Anesthetist at a busy urban hospital in Toronto, wrote a book in 2010 titled “Operating Room Confidential: What Really Goes On When You Go Under." So using Google books I decided to take a free peak at it. In it he writes:

Even under general anesthetic, the introduction of scopes through the penises of young men can be very stimulating. Their bodies are full of raging hormones, and the nerves around the penises are at their most sensitive. Though the patient is asleep, Mr. Penis is awake and ready for action. Even the introduction of numbing gel or the application of sterilizing solution on or near the penis can produce a very full erection during, for example, hernia surgeries and appendectomies. In the O.R. we confess to a cruel rite of indoctrination, inflicted upon the innocent rookie nurses, making use of this well-known physiologic reaction. During their first days in the operating room, we ask them to sterilize these surgical areas. “Oh, by the way, Anna, why don't you apply some iodine to the surgical area? We want to assess your sterilization techniques.” We stand back and mischievously observe their stunned reaction when the penis comes alive — throbbing, rising and pointing.

So Dr Bernstein. here is a fellow MD admitting that the OR staff will "play games" with the bodies of vulnerable patients for their amusement and entertainment.

http://books.google.com/books?id=wpmyuyQQTBkC&site

 
At Friday, November 23, 2012 9:35:00 PM, Blogger Maurice Bernstein, M.D. said...

I know about "music in the OR during surgery" and about surgeons throwing scalpels (I have witnessed both) but I have never seen gross sexual "game playing" by anyone in the operating room. (I must note that I could not find the specific extract in the Google book sample link which Anonymous presented in the commentary.)

Introducing and demonstrating a normal physiologic reaction to a "rookie" nurse which might be experienced in the future is professionally acceptable. To make or describe this experience more than nursing education is wrong. ..Maurice.

 
At Saturday, November 24, 2012 6:30:00 AM, Anonymous Anonymous said...

"Professionally acceptable" in the absence of informed consent, while the patient is unconscious; acceptable to whom? Providers apparently find the practice of pelvic exams for training without consent acceptable but patients do not. The intentional inducement of an erection, for whatever reason, isn't acceptable either. While medical providers consider this acceptable, its certainly not professional. Its actually presumptuous, unethical, unprofessional, and reprehensible!

Ed

 
At Saturday, November 24, 2012 7:42:00 AM, Anonymous Anonymous said...

Perhaps "game playing" isn't the correct term, how about "prank" since Whang say "we confess to a cruel rite of indoctrination" that targets nurses (predominantly female) involving a certain physiologic reaction unique to males.

In the link provided there is a search field. Type the word scope, click Search Inside" and Google will find all of the places in the book where that word occurs and show a limited section of text where the word is found. Now type sensitive and repeat the process each time using a key word to reveal more. You can reconstruct entire paragraphs that way.

For most of my life I thought doctors and nurses were 100% professional 100% of the time when in a clinical setting. What Dr Whang describes is not professional. Yet is seems to be acceptable in that hospital's culture.

 
At Saturday, November 24, 2012 8:29:00 AM, Blogger Maurice Bernstein, M.D. said...

A visitor who names herself "Traumatized Patient" has given me permission to post her e-mails to me on this thread. ..Maurice.
_________________

I read some of the blogs by staff at a Physicians office on the female staff being told to enjoy themselves while a male patient comes in for an exam. That was horrible and I'm a female. I feel legal action should be taken again a Doctor that invites non-clinical staff in during a medical exam and the patient was humiliated. It makes me sick and to think that, that type of behavior goes on in hospitals when women are having procedures done. I am a patient who for years thought of suicide because I could handle the horrible attitudes and behaviors of medical staff. I would rather die than go to a medical facility to have anything done due to the monsters that are so cold hearted towards other human beings. I have been in therapy for years over the stupidity of educationed idiots. I would not treat animals as poorly as medical staff treat patients as far as leaving people with no dignity and humiliated and this is what people are having to pay for in this society. So much for saving lives. When people leave medical facilities and feel they wish they were dead and need therapy for years so they do not commit suicide what kind of monsters are being created in the medical community? I wonder about the medical training who trains people to be cold hearted killers emotional and mentally. Yes you can hurt people that badly. I praise the wife who spoke up for her husband. I pray that women gets justice and serious changes are made in the medical community in regards to patient modesty.
___________________________

In my opinion since there is really no help out there for patients who suffer with severe modesty issues and if they feel their rights have been violated? There is really no where they can go to get help. I searched for that very thing and suffered almost to my end. The one good thing is I work out and stay as healthy as possible and have never had a broken bone and have never had to be hospitalized except for childbirth twice and both times had a women doctor deliver and almost jumped off the table to personally kick students from entering my room! I feel people who suffer from gymnophobia to be more specific suffer til they are put on heavy meds or commit suicide. I answer phones and talk to patients and have talked with a patient who came in unconscience to then later find he had his clothes removed and he was suffering mentally and emotionally. My heart went out to this young man. Knowing first hand this is not a light issue for some it is life and death! People commit suicide everyday and some never get the chance to talk about why-they feel no one will understand and no one will listen. I am speaking first hand and I still suffer from the calus cold hearted medical staff and others who have been forced to shut up and comply. I felt many times as others I have read just let us die rather than be put the thru embarrassment and humiliation of going thru a medical facility that does not care or even an gyno office who treats people like lab rats. If I was having another child I would rather have it at home-heck with the hospitals. They only care about the physical being but stupidity about mental and emotional health has suicide so high! Wake up people, I hear everyday from people who say they would never step foot in another hosptial-I can only simpithize. Hello-I work in a hospital and take calls everyday from patients. But because of my own pain and suffering I can be of more support to those hurting and have gone on to hopefully get my degree in counseling!


 
At Saturday, November 24, 2012 8:54:00 AM, Anonymous Anonymous said...

Is there no protection at all for anesthetized patients? It seems that anything and everything these medical "professionals" do to the patient is somehow construed to be for medical "training" or "medically necessary". Are we at the point where patients and their families need to hire medical chaparones to accompany them into surgeries for their protection? Imagine how a family would feel to know that as they anxiously wait during their son's surgery, the medical staff is having fun and games with their son's genitals. What if this was a young female patient being handled by a male nurse, while others stood by and watched for signs of arousal? I believe patients must have the option of being prepped for surgery privately, prior to anesthesia, and be accompanied by a chaparone of their own choosing. I also think more surgeries and procedures done without GA, using nerve blocks, etc. might be helpful as the patient would be alert and thus possibly treated more respectfully. There are problems with all of these options, but something has to change. Lkt

 
At Saturday, November 24, 2012 11:26:00 AM, Blogger Maurice Bernstein, M.D. said...

In the midst of the current discussion, I would like to bring up a question I posed back in Volume 8 in January 2009 and see what our current group of visitors think about it. ..Maurice.


I am interested in learning about the specificity of the privacy/physical modesty concerns related to the healthcare provider's gender. What I want to ask those who have concerns about their physical modesty and/or privacy, how do they feel with regard to sensitive historical privacy with regard to the provider's gender. Would it make any difference in the gender selection of a provider if intimate questions are being asked or may be asked of the patient. For example, regarding sexuality or sexual practices or other aspects of the sexual history, if these questions were asked in a professional manner and were a necessary component of the patient's medical history? (I don't mean in an office visit for a simple "cold", the provider asks whether the patient masturbates regularly!) Or, in terms of general privacy, would responding to questions about financial worries in a depressed patient or marital discord issues require gender selection? … So.. is there also gender selection concern in history taking?

 
At Saturday, November 24, 2012 2:51:00 PM, Blogger Patrick Fitzgerald said...

Recently a female nurse in a ICU gave me pain medication against my wishes and then rubbed my genitals until I ejaculated. I am currently still trying to get justice but things are not looking good as it is impossible for me to have any evidence. I would have needed to video the incident, which I obviously did not. The next time I go into a ICU I will need to hire a security guard. The Police are not interested, the Hospital has been very unhelpful and I am still waiting for a reply to my complaint from a Heath Practitioner organisation and the Human Rights Commission. If no action is taken I will eventually be putting my story on a blog. Currently I have listed things to watch out for on a blog as a warning to others.

SEXUALASSAULTintheICU.blogspot.com

Patrick

 
At Saturday, November 24, 2012 9:23:00 PM, Anonymous Anonymous said...

Effective tomorrow, what tiny minuscule respectful care
that exists for men will cease. I make this declaration
without fear of reprisal, nor impunity . For all intents
and purposes we wouldn't notice it anyway. You don't
know what you are missing if you never had it in the
first place.

PT

 
At Saturday, November 24, 2012 11:07:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, with respect and without reprisal, I must tell you I disagree with your "You don't
know what you are missing if you never had it in the
first place." If you were informed that others had experienced "respectful care" and many actually do experience that care, then surely, even those who never "had it in the first place" would now know what they are missing!

No disrespect from me and.. a good try! ..Maurice.

 
At Sunday, November 25, 2012 1:19:00 AM, Anonymous Anonymous said...

I've liked some of the last few comments. Concerning "Traumatized Patient", it's nice to read that someone in that position actually cares. I agree with her and Lkt. Keep fighting Patrick.

I don't see why my modesty, dignity and morals should be any different when I'm sick than when I'm not. It's still the same sexual abuse whether or not I'm in pain. The only difference is when I'm drugged up or unconscious I can't defend myself.

I'm one of those people that "Traumatized Patient" is writing about. I decided years ago that death, even suicide is better than being sexually abused by medical "professionals". From what I've seen and heard there isn't anybody in the medical profession that I can trust to keep me out of unethical situations, so I plan on dying young.
LG

 
At Sunday, November 25, 2012 4:01:00 AM, Anonymous Anonymous said...

"Would it make any difference in the gender selection of a provider if intimate questions are being asked or may be asked of the patient."

Absolutely. I (a man) won't answer intimate questions about sexual history, private parts or even bowel movements if asked by a woman or with a woman present. That goes for women doctors and especially support staff or receptionists. If my reason for being there concerns my privates or embarrassing health problems I would make up another reason for being there to any woman and then spring it on my male doctor or nurse once he got in there. If I believe a question isn't pertinent to my situation I wouldn't answer it. If it is pertinent I would request (insist on) waiting for the doctor. Receptionists don't need to know anything about me. MAs don't need to know how much I weigh, if I'm sexually active or if I've ever had hemorrhoids.

I also don't see the point of allowing other unnecessary practices such as being weighed when I'm there to renew an Ambien prescription (without a history of problems) or the use of an unnecessary assistant or chaperone. Medical issues should be one on one with a doctor, not an entire office.

 
At Sunday, November 25, 2012 4:30:00 AM, Anonymous Anonymous said...

"Recently a female nurse in a ICU gave me pain medication against my wishes and then rubbed my genitals until I ejaculated."

What was her excuse for doing that? What was her method of administering the pain medication? Did she trick you, lie to you or force you to comply? Were you conscious when she gave you the meds or the hand job?

My personal experience was to be lied to by the nurse, convinced I wouldn't be stripped naked (it was an adenoid extraction) and then doing it to me once I was unconscious. As far as I know she didn't milk me. I consider her a sexual abuser but yours sounds like a straight-up prostitute.

Kudos on having the courage to talk to so many people about such a humiliating experience. Too bad they all allow such a cover-up. I wonder if the cops would have shown any interest if the genders were reversed.

 
At Sunday, November 25, 2012 3:24:00 PM, Anonymous Anonymous said...

"In the O.R. we confess to a cruel rite of indoctrination, inflicted upon the innocent rookie nurses, making use of this well-known physiologic reaction. During their first days in the operating room, we ask them to sterilize these surgical areas. “Oh, by the way, Anna, why don't you apply some iodine to the surgical area? We want to assess your sterilization techniques.” We stand back and mischievously observe their stunned reaction when the penis comes alive — throbbing, rising and pointing."

I'm sorry Dr. Bernstein, but after reading and re-reading this several times (if indeed this is a legitimate quote) there really is no way to interpret this as an educational experience. And if stimulating a patient to erection IS actually a learning experience, then I have to wonder what caliber of education they are receiving/what sort of life experiences they are so naive and ignorant about/and how they missed sex-ed and biology classes to such a gross extent.

And how about informed consent?
"Mr. Jones....while you are under we will be demonstrating to rookie nurses that males get erections. You on board with that?" I doubt it, so in that case it is a cruel "prank" on the poor patient and not the nurse.

Seriously. What kind of educational purpose does humiliating a patient serve? And if it does, what kind of uneducated buffoons are we letting into the OR with vulnerable patients.

Not buying this one: especially since it was an admission of "guilt". Condoning this behavior is just wrong.

 
At Sunday, November 25, 2012 4:14:00 PM, Blogger Maurice Bernstein, M.D. said...

When I wrote: Introducing and demonstrating a normal physiologic reaction to a "rookie" nurse which might be experienced in the future is professionally acceptable. To make or describe this experience more than nursing education is wrong. I didn't intend to mean that a procedure would be carried out on the patient that was not for the primary purpose to follow surgical protocol for benefiting this patient's surgery. Secondary, would be the education of the "rookie" nurse to a physiological response which might occur during the procedure. The way the episode was described in the book appeared to imply the action was for the amusement of the observers, an action which is professionally inappropriate. ..Maurice.

 
At Sunday, November 25, 2012 4:23:00 PM, Blogger Maurice Bernstein, M.D. said...

Please, please.. all those who are signing on as Anonymous, please end your comment with a consistent pseudonym so myself and the other visitors can have attain some continuity in the reading of a writer's views. The Anonymous writers should update us by indicating the date and time as recorded of their previous postings. Thanks. ..Maurice.

 
At Sunday, November 25, 2012 5:37:00 PM, Anonymous Anonymous said...

Regarding Dr Whang’s book, I used the search inside feature anonymous mentioned to. search for the word "modesty" and found only one instance. Dr Whang states "But as they say, once you come into hospital, male or female, you've got to leave all modesty at the door."

Really now, who decided that? If that means I will only be exposed as is absolutely necessary for a procedure to be performed I might accept that. If it means the medical staff can do anything they want to me in any way they want then there is no way I would accept that.

To gain more insight into what Dr Whang meant by that I expanded the search and found the context of his statement. He writes:

During cystoscopic surgery, the legs are placed in stirrups. Most women have
had their legs in stirrups before. For most men, it's a new experience. Men are also a little more squeamish about cystoscopic procedures than women, since it involves introducing a scope into their penis. During the procedure, they'll probably be surrounded by at least two to three lovely urological nurses, who assist during the procedure.
Exposing themselves to these lovely women, with feet up in stirrups, waiting to
have an object pushed into the penis, has been described by some men as a “psychologically challenging” experience. But as they say, once you come into hospital, male or female, you've got to leave all modesty at the door. The urologist can use two different types of scopes. Both types are inserted into the penis or urethra to look into the urinary system. The first is a flexible scope about the thickness of a pencil with a fiber-optic scope and light. Usually, no general anesthetic is required, because freezing gel, squeezed into the penis or urethra, is adequate. However, after the procedure, there can be an uncomfortable burning sensation upon urination that can last for a few days. The second type of scope, the rigidscope, is a different beast. Having a diameter ranging from a quarter-of-an-inch to almost half- an-inch (.56 cm to .9 cm), inserted through the penis or urethra, can be very uncomfortable for many patients.

~Elliot

 
At Sunday, November 25, 2012 7:15:00 PM, Anonymous Anonymous said...

As I'm relatively confident many females would be uncomfortable discussing their gynecological symptoms with a male receptionist, assistant, nurse, or physician, I absolutely will not discuss my urological symptoms with a female provider. I've had one receptionist rudely insist I provide those details and that physician (male) is no longer my doctor!

Ed

 
At Sunday, November 25, 2012 8:32:00 PM, Blogger Doug Capra said...

What surprises me most about what Dr. Whang has published is not his attitude. I expect there to be a certain number of narcissists in his profession who publish books that focus on themselves -- his feelings, his experience, his everything. It's all about him. The patient is merely an object he works on, an inert thing on the operating table. It's like the attitude expressed in the article I wrote about medical training in Paris in the early 1800's. It was an unspoken rule -- once you entered the hospital you essentially belonged to the state. Your body was theirs.
What does surprise me is that a book like this is published by a medical professional with statements like the ones reprinted here -- and it's just considered okay by the profession. No reprimand. No chastisement, no pubic concern about his comments. It's not difficult to assume that many if not most OR people read these things and thing, oh, well, that's just the way it is. On the other hand, if many or most medical professionals are upset with this doctor's unprofessional comments, why don't they say or do something about it? Again, we see the reluctance on the part of other medical professionals to go after fellow professionals when they trespass beyond ethical boundaries.
The following comment by the doctor: "But as they say, once you come into hospital, male or female, you've got to leave all modesty at the door."
That comment is obtuse. "Who" says that? His answer is "They" say it. Wow. Who is "They?" He would probably say, "Well, everyone." Who's everyone? I'll bet the core values of his hospital don't say things like that. I'll be the hospital's patient right's document doesn't say that.
What it comes down to is that some unempathetic, insensitive, narcissistic caregivers make bold, general statements like that and believe they represent the entire profession and the entire society.
I can't help but wonder what the good doctor thinks patient reaction to statements like we read here will be? Does he think most patients will feel better about going under the knife after reading his book? What would be his purpose in relating stories like the one's he does tell?
His is a disturbing book.

 
At Sunday, November 25, 2012 8:35:00 PM, Blogger Maurice Bernstein, M.D. said...

Ed and others: Is your resistance to talk (give a history) to healthcare providers of the opposite gender apply only to symptoms or issues related to the genitals or sexuality? Or will your resistance also apply to other personal historical information including social (such as work and inter-personal relations), economic, psychologic and symptoms not directly related to the genital area? If so, how can you explain this resistance? Can the resistance of healthcare provider exploring your mind be as provider gender specific as exploring your genitals?

I know I am becoming redundant describing my own professional experiences but I must say I never, never experienced from any of my female patients a refusal to answer my history question. It just has never happened! I never heard "I won't answer that!"

Hopefully, no patient will "die young" because of refusal of diagnosis and treatment because of fear of gender during history taking, examination, procedures and treatment. ..Maurice.

 
At Sunday, November 25, 2012 8:48:00 PM, Blogger Doug Capra said...

Maurice writes: How do patients "feel with regard to sensitive historical privacy with regard to the provider's gender. Would it make any difference in the gender selection of a provider if intimate questions are being asked or may be asked of the patient. For example, regarding sexuality or sexual practices or other aspects of the sexual history..."

So much depends upon context, Maurice, and not merely the gender of the provider, but the "professional" or "nonprofessional" status of the questioner -- and the relevance of the question.

For example, I agree with those who say that cna's and medical assistants have no business doing such a history. Some patients may even object to a PA or a nurse asking such questions. Who's the patient's relationship with? The doctor and/or his entire staff? These days some doctors see little need to build trust. They just assume that if if the patient walks into the office, or "presents" the patient automatically trusts everyone on staff or should. What an assumption! Trust has to be built, but, as we all know, that takes time -- and that's a problem. We need to just get on with it and move to the next patient.
If the history taker knows he/she's heading toward these kinds of questions, that needs to be honestly addressed -- "Now, I'm going to ask you some very personal questions. They may be uncomfortable for you, but the are necessary -- see the next paragraph.
Also, whoever is doing the questioning needs to show how these personal, intimate questions are specifically relevant to the treatment. The patient has every right to ask "Why are you asking me such personal question?" And the history taker needs to be able to justify how that question is directly related to treatment. The answer can't be: "I'm asking you this question because it's on the form." "Or because I need to."
I think patients are more willing to speak up when asked these kinds of questions if they seem unrelated to their reason for seeing the doctor. Might the gender of the questioner matter? Certainly, esp. if the questioner is a cna or a medical assistant -- assuming the patient even knows the difference.

 
At Monday, November 26, 2012 4:00:00 AM, Anonymous Anonymous said...

"cruel rite of indoctrination, inflicted upon the innocent rookie nurses"

It's "cruel" to do that to "innocent" nurses? Do people like that really consider the NURSES the victims? I wish I could get my hands on him and his perverted nurses. I wonder how many of his former patients (victims) read his book and realized that it might have been his penis that was the butt of those cruel and inhumane pranks.


"they'll probably be surrounded by at least two to three lovely urological nurses, who assist during the procedure."

First off, what possible reason could there be to have more than one assistant? Secondly can you imagine a scenario where three "lovely" male "assistants" (nonprofessionals in my opinion)were invited in to stare at a woman in stirrups? Especially when 1 or 2 of them is completely unnecessary?

I may be a little naive when it comes to medical procedures but I can't figure out one single reason for a nurse to masterbate a patient to completion. That woman should be in prison. Can anyone give me an excuse to why they would do something like that?

GR

 
At Monday, November 26, 2012 4:06:00 AM, Anonymous Anonymous said...

Does anyone know what type of surgeon/specialist that Dr Whang is? Could you imagine a Urologist named Whang? He probably has a terrible case of little man syndrome from years of being teased. His cruelty is probably his way of getting revenge.

 
At Monday, November 26, 2012 7:02:00 AM, Anonymous Anonymous said...

What if things are a bit more complicated? What if the age of the questioner and perhaps not gender, nor level of expertise.

Example...a male provider who is the same age as the female patient may ave a better result for intimate questions than a thirty year old male asking questions of a 70 year old female.

Levels of comfort have so many aspects based on life experience that it might be impossible to gage.

However, just as physical modesty presents it's own set of circumstances, the same might be said for questioning, it's relevancy to a particular illness and the difference between asking questions because you can and their purpose.

Example...a female patient is greeted by a male medical student when she goes to the pullmonologist. She is happy to accommodate the student, has discussions. Then...she feels and then proves that he has crossed the line by asking her about the frequently and the condition of her bowels. She asks why this is relevant and he replies, "I was just curious". This is a question that any patient would answer if it were relevant to the care.

Sometimes questions are asked when they really don't need to be so personal, ex. how many sexual partners have you had in your life?
What is the purpose of the question when the patient is 85? An explanation why the question is being asked is paramount to the comfort of that patient, and providing a positive environment for that patient to answer.

People who have issues are not so different from people who don't except that their life experience is different.

Respect, accountability of the medical professionals asking the questions, telling patient what happens with their answers means the difference between getting accurate answers or lies from patients that serves no purpose to anyone. Nobody wants to feel violated whether it's physical or mental.
belinda

 
At Monday, November 26, 2012 7:44:00 AM, Blogger Maurice Bernstein, M.D. said...

Oops! I accidentally deleted a posting by PT at 9:47 PM yesterday.
Here is what he wrote. ..Maurice.




Maurice


You have mentioned that you have never seen
unprofessional misconduct and I assume never
experienced it as well. I on the other hand have and
that brings us to a crossroad. At what point does
skepticism dilute the value of of your positives versus
my negatives.


PT

 
At Monday, November 26, 2012 9:13:00 AM, Blogger Maurice Bernstein, M.D. said...

To Belinda: "I was just curious" would be an inappropriate answer for a medical student would say and I wouldn't expect the student to say that. They are spending their time with the patient not for simple "curiosity" but to achieve a profession goal for themselves and to be of value to the patient. Often students pick up historical information or physical exam findings which are overlooked or as not recorded by the professional medical staff. We teach our first and second year medical students to explain why they are asking questions involving a sexual history and also to preface the question with a statement to the patient that the information provided will be kept confidential.

..Maurice.

 
At Monday, November 26, 2012 12:40:00 PM, Anonymous Anonymous said...

I would like to ask a question to the readers of this blog.How many of you would be willing to travel to a different city or state and possibly pay alittle more , if you were guaranteed to receive the gender of your choice for all intimate care.The OR would offers all male tuesdays and all female thursdays where the complete staff is one gender.Where their moto is to treat the whole patient.Where they want to make your stay as comfortable and as stress free as possible.If providing same gender intimate care is what it takes to get you there,that is what they will do.Back to my question.How many of you would go? AL

 
At Monday, November 26, 2012 2:30:00 PM, Anonymous Anonymous said...

Al,
Yes, but I live in a metropolitan area where it would be easy to travel within the area. The problem is that there's so little integrity in medical operations that if it involved being unconscious I wouldn't believe their promise.
BJTNT

 
At Monday, November 26, 2012 2:52:00 PM, Anonymous Anonymous said...

BJTNT.What if they would allow a patient advocate of your choice to follow you thru your stay ? AL

 
At Monday, November 26, 2012 3:18:00 PM, Anonymous Anonymous said...

Maurice, that is what he said. I, in turn, did not answer the question other an a cursory, "I'm fine".

I will tell you that I will think twice about letting someone in again. It really doesn't benefit me at all. I think it's important to share that the physician's in a teaching hospital spend about 20 minutes prepping the students to meet you so if you do refuse, they've wasted their time. Wouldn't it be nice if they asked you first and then when you refuse they are not "put out"? So, I will instruct my physician when I make my next appointment that I no longer want to participate in their teaching program.

Al, I'd go anywhere to get what I need. However, I find that if you treat the staff respectfully and don't give them "wiggle room" by telling them if you don't get what you need, then it's NO, that they will try their very best to accommodate. You can always refuse treatment provided you are competent.
belinda

 
At Monday, November 26, 2012 3:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, as I have previously noted on this thread, the medical students where I teach and hopefully in other medical schools require that the students first ask the patient permission to perform a history and a physical examination. If the patient refuses, the student will go on to another patient. Also, you have to be observing them as I do and you will see that the students often, perhaps actually too often in my opinion, preface their question with an explanation of why it is appropriate to ask. For the physical exam, we want them to explain what the student is going to do next as they proceed during the exam. We stress that it is very important that the patient recognize that they, as a patient, should be an active participant in the history taking and physical examination and not some passive object for the student. ..Maurice.

 
At Monday, November 26, 2012 7:08:00 PM, Anonymous Anonymous said...

Al,
No on an advocate. I think that the medical operations staff would resent my lack of trust in them and would respond with minimum care. Their rationalization would be that the less they do,the smaller the chance that the advocate would object.
A patient advocate is addressing the symptom and not the cause of the problem in medical operations -a sea change is necessary.
BJTNT

 
At Monday, November 26, 2012 7:34:00 PM, Anonymous Anonymous said...

"I do want to express, perhaps again, my belief that most physicians cannot conceive that an ill patient and one who is concerned about their health and even life would have modesty trump a physical exam or procedure."

Dr. Bernstein: After all of these years I still have a problem reconciling that statement. Basically you are saying that most doctors can not understand why someone would not concede an entire belief system of morals and humanity based on the fact that they do not agree with it.
They may say that if it is a small concern then take all the time you need to find a system that works for your moral standards...but if it is a large concern then change your entire way of thinking to what the medical community has said all along. And that is "Your system of beliefs in life mean very little to us." That is demeaning to those who believe that conceding for someone else's beliefs is hypocritical to your own.
It just makes me feel as if most in the medical sorority think that we can have our own little tiny moral lives, but can move our entire moral compass when it conflicts with that of the learned community. I'm sorry, but I have a guttural opposition to someone saying what they believe is right and what I believe is wrong....

At the heart of the matter I am guessing that that is not how you personally feel.

Suzy

 
At Monday, November 26, 2012 7:47:00 PM, Anonymous Anonymous said...

Regarding Dr. Whank:

Here is a classic example of the fight we are mounting. A Dr. who is well aware that he is purposfully humiliating his male patients, and his solution is to rub it in and write about his disregard. It makes me truely sick with anger inside.....so much so that often I want to walk away from this subject in disgust.
But then I would be no better than the doctor with the beautiful urological nurse fetish that he inflicts on innocent male patients.

Disturbing.

Suzy

 
At Monday, November 26, 2012 8:11:00 PM, Anonymous Anonymous said...

Al


Why in the world should I pay a little more? Isn't
that double the discrimination towards male patients. The notion that I should have to pay more for what would constitute respectful care. The thought of driving to another city or town, really! Do women pay more for
having a 100 percent female mammography team. Is
there or has there always been a surcharge on a
mammogram, perhaps L&D too. Perhaps we should place a tax on Viagra to pay for all these special programs that men never recieved.

Those taxes most certainly would be conceived by
a female congresswomen.How about this idea. To go
to the closest hospital and then refusing opposite gender care. Is that really that hard to say?


PT

 
At Monday, November 26, 2012 8:28:00 PM, Anonymous Elizabeth (Aust) said...

I wonder then how things get so out of hand after some of these people graduate...I've been chatting to a woman online who created a forum to inform and warn women about doctors and screening. This experience was no doubt, a large part of the motivation to create the site...her story made me VERY uncomfortable.

I've never agreed with opportunistic screening, it can be abused in the wrong hands, it's unfair and IMO, unethical.

There is also research which suggests there can be lasting psychological damage when someone feels forced into an invasive exam, some people may even develop PTSD.

So..A 22 year old Canadian woman sees a doctor with a twisted ankle.
The doctor immediately asked when she had her last pap test and then aggressively stated she'd have to have that done before he could help with her ankle. The woman was asked to strip off and was examined completely naked with no chaperone present. (no gown or sheet)

We might not think twice about seeing just any doctor with a sprained ankle, but may consider carefully our choice of doctor for something like a DRE or pap test.

I wonder how many other women were treated in this way. A woman should be able to see a doctor and receive treatment for a sprained ankle without this sort of threat.

Her words:
"Yes, it was very concerning regarding the examination in the buff. I never knew any better as it was my first pap and pelvic. He was VERY thorough, started between my legs, checked both orifices, then moved his way slowly up my body, palpating all parts extremely carefully.

I had not gone for the purpose of a pelvic/pap. I was there for a twisted ankle and was aggressively pressured into it. I had no family dr as there was no need for one, so it happened at a walk in clinic affiliated with the university I attended. He was shocked I wasn't on the pill and I made it very clear I had no intention of going on it. Not only did he pressure me into the exam, he wrote a prescription for the pill and forced that on me as well. On my way out I left the prescription with the ladies at the front desk"

It seems these doctors are rarely reported...some women are left confused and some are simply too embarrassed or traumatized to mention the doctor's conduct to anyone. This incident happened in the mid 90s...it would be interesting to know whether other women have complained about his conduct.

If it happened here and the woman went that next step and complained...the doctor would be in trouble. Routine breast and pelvic exams are not recommended at any age in symptom-free women and are not required for the Pill. (or for a sprained ankle!) Women may be pressured opportunistically to have a pap test, but I think the doctor's behaviour as a whole would be viewed as a major concern...aggression, her age, no chaperone, leaving the young woman completely naked, demanding unrelated and unnecessary exams "before" he'd look at her ankle.

I also wonder if the script for the Pill was to cover him in case she complained, I know these exams are "required" by many doctors in the States and Canada for the Pill...then it would be her word against his.

I'd still be inclined to lodge a complaint...even if the passage of time means nothing is done. It may make these doctors uncomfortable if they keep hearing from the Medical Board, even if it's just passing on a complaint that can easily be fobbed off or explained away...

I think the consult room can be an intimidating place, and the power dynamic can be difficult and overwhelming. I think it's best to only see doctors you know or come recommended or be prepared to get up and walk out.
These experiences stay with us.
How do others view this sort of conduct? Is it too late to make a complaint?

 
At Monday, November 26, 2012 9:50:00 PM, Blogger Maurice Bernstein, M.D. said...

Suzy, with regard to the statement: "I do want to express, perhaps again, my belief that most physicians cannot conceive that an ill patient and one who is concerned about their health and even life would have modesty trump a physical exam or procedure" here is my argument. Except in a life-threatening emergency situation or if in a desolated part of the world with no readily available choice of doctors, most patients bearing their modesty issues and who are sick and require diagnosis and treatment would seek out the physicians and gender most comfortable with them and not sacrifice health and life to their modesty.

To accomplish this, the patient should begin the initial conversation with the doctor with "I have some concerns about this visit that I would like first to talk to you about." I am sure that any doctor worth his or her professional responsibility would respond with "talk to me, I want to hear". I know I would.

Screen the doctor before entering into a doctor-patient relationship. If you are uncomfortable don't enter that relationship and except in a life-threatening emergency situation, get up and leave. Even an office-visit charge if actually required would be worth the benefit of identifying an unwanted relationship.

Whereas I agree with the quoted statement, I also think the patient should take responsibility for the selection of the physician they allow to take a history and perform a physical or perform procedures by communicating their concerns at the outset and not allow their health and life to be sacrificed because of their modesty. ..Maurice.

 
At Tuesday, November 27, 2012 2:59:00 AM, Anonymous Anonymous said...

"What if the age of the questioner and perhaps not gender, nor level of expertise."

Good point belinda. I feel much more comfortable talking to an old woman about my health than a 19 year old girl, especially if her professional history is well known. That also goes for procedures.

I once needed a gama gobulin shot before doing missionary work overseas. When I found out that it had to be administered in the hip and the only nurse was a woman I actually considered canceling my plans. But I started asking the other young men that had already had their shots in the previous weeks and they all told me that she was an older, experienced woman (with a beehive) and all they had to do was loosen their belt in a private room. Luckily they were right. She treated us with respect and let us keep our dignity. A male nurse would have made more sense since most of us were male, but she was acceptable under the circumstances. Unfortunately several of the younger guys that were about a year behind me told me that they didn't have the same experience. At that time they began to use nursing students from the nearby university. A couple of guys told me that they unexpectedly had their pants and undies yanked down to their knees by a teenage girl. So much for progress. If that's how it was when I was there I most likely would have dropped out first, or been kicked out because my instinctive reflex would have been to swing my arm around and smack her in the face.

So yes, age, experience and reputation mean a lot.
LG

 
At Tuesday, November 27, 2012 3:35:00 AM, Anonymous Anonymous said...

Right on suzy.

Dr Bernstein, I have no doubt that you run a tidy ship with your students in class and during clinical work, but there are the Dr Whangs of the world that don't. Where I live there often isn't much of a choice when it comes to specialists. Choice of gender may be possible but same gender support staff isn't. The support staff are what worry me the most anyway. Also, it's difficult to seek out physicians that would comply with my moral beliefs. Do I ask the receptionist if the doctor allows a female assistant to stand there and gawk at my genitals? If I ask a friend about their experience they'll probably just tell me to grow up and be a man.
LG

 
At Wednesday, November 28, 2012 10:25:00 AM, Anonymous Anonymous said...

A young female nurse is assigned to care for a young
comatose male patient in an intensive care unit. This
female nurse notices the patient has a jewelry piercing
on his penis. The nurse invites another female nurse
who is not assigned to his care to view his penis
piercing. This is a factual event that occurred.

Would you view the nurses behavior as

a) unprofessional
b) professional
c) business as usual
d) irrelevant cause if the patient knew it's only a modesty problem on the male patients part.
e) write your own comment.

PT

 
At Wednesday, November 28, 2012 4:58:00 PM, Anonymous Anonymous said...

PT
It's just business as usual. In your job, if you see something interesting you might well call that to the attention of your co-worker.
We patients are the problem because we think that our humanity should be respected, but it's just a job to medical operations [MO] staff - yes a job with power and control over persons that most employees don't have in their jobs.
Compare medical operations to a factory assembly line. The foreman and bosses don't care what happens to the material, but only that the process produces a good looking product that can be sold. MO administrators don't care about the process as long as the patient still looks OK so that a box can be checked and payment made.
MO staff gives us the same respect that material receives going down the assembly line. It's we, the patients, that's are the problem.
BJTNT











 
At Thursday, November 29, 2012 12:13:00 AM, Anonymous Anonymous said...

BJTNT wrote "It's just business as usual." Is that your opinion or do you just accept it as reality? I would guess the latter since you don't seem to like it that way. What you say makes sense, unfortunately.

PT, I'd say (a) and (c) along with unethical, immoral and insulting. Although with that particular case, maybe 1 case out of 100, the patient may be trying to attract attention to it, in his case by getting it pierced.

I know someone who's baby son is very well endowed. After birth and a few other visits his endowment was the topic of the day for the nurses. It seems every nurse in the hospital had to check it out. I don't imagine he cared much at the time but I don't think it would have mattered to the nurses how old he was. His mother was very disgusted by it though. She didn't like a lot of the comments (and compliments). I really feal sorry for him and his future medical experiences.

GR

 
At Friday, November 30, 2012 12:41:00 PM, Blogger Maurice Bernstein, M.D. said...

PRIVACY, MODESTY, SEXUAL ABUSE? Virtually all who are commenting on this thread are bringing up experiences and issues of privacy, modesty and sexual abuse in what we all hoped was a humanistic and ethical medical system. The comments sound terrible particularly to those of us who are, in fact, providers within the system.

Are we intentionally disregarding privacy? Are there limits to the patient desires for historical and physical privacy when the patient, usually voluntarily, comes into the system for help? The system has thought about privacy as detailed in the HIPAA federal regulations regarding communication of hospital records. But privacy at the bedside level with always only one patient per room has yet to be attained. And if patients require gender selection of caregivers as criteria for privacy, that has not been regularly available.

Modesty, what does modesty really imply? It is defined in Webster's Dictionary,applicable to what is being discussed here, as propriety in dress and talk. Modesty can be attainable in usual civic and personal situations but one could argue that particularly when entering a medical situation, the usually modest person may need to undress themselves in talk and dress to achieve a beneficent goal.

There is no excuse for sexual abuse within the medical system but even what will be stated as sexual abuse could be explained as that of the uninformed eye of the beholder and that what is said to be abuse is really not. I am not defending sexual abuse only suggesting that all the facts in context be known first.

Yes, there has been ignorance previously on my part and in the past and presently on the part of the medical system about the experiences written to this thread.
But we all, including some patients, have to learn more about how privacy, modesty and sexual abuse issues can be used to apply to the creation of the most beneficial, altruistic and humanistic approaches for a better medial care system. ..Maurice.






 
At Friday, November 30, 2012 3:30:00 PM, Anonymous Anonymous said...

This blog has so much traction because all the comments, points, and criticisms that we make regarding patient modesty also applies to the broad culture of medical operations{MO}. "It's all about them."
When a male violates female modesty we tend to call him a pervert. When a female violates male modesty, it's probably more about power and control than perversion.
Therefore, we need to broaden our reforms so that patients are addressed with humanity. If the current MO culture continues, we patients have no chance of being treated with respect.
BJTNT

 
At Saturday, December 01, 2012 4:31:00 AM, Anonymous Anonymous said...

"Ed and others: Is your resistance to talk (give a history) to healthcare providers of the opposite gender apply only to symptoms or issues related to the genitals or sexuality? Or will your resistance also apply to other personal historical information including social (such as work and inter-personal relations), economic, psychologic and symptoms not directly related to the genital area? If so, how can you explain this resistance? Can the resistance of healthcare provider exploring your mind be as provider gender specific as exploring your genitals?"

Dr Bernstein, I apologize for my late reply. I won't discuss or answer any question posed by either gender that I feel is not directly related to my medical symptoms, especially those of a social, economic, or "psychologic" nature. The provider must convince me why their inquiry is pertinent to my symptoms and how that information will aid in treatment. Why do I need to explain "this resistance"?

What's interesting about this discussion is the presumed manner history is solicited. I've never been asked to provide a medical history via interview with a provider. It's always been asked IAW the requisite paperwork. Those questions I consider irrelevant I leave blank or annotate as N/A.

With respect to "exploring your genitals", I've previously cited here my recent experience with a female receptionist mandating my detailed urological symptoms before she would schedule a 15 minute appointment.

Physicians (and ancillary staff) expect patients to bare their body and soul simply because of the MD at the end of their name! That's not good enough for me.

Ed

 
At Saturday, December 01, 2012 7:49:00 AM, Anonymous Anonymous said...

Maurice, this is a complicated issue.
Let me start by saying that norms have changed in healthcare (with regard to the provider; not the patient).

Years ago when a man entered the hospital, an orderly would take care of intimate details of care and a female nurse would take care of the women. There was some expectation of privacy. The operating room was just that and by the time patients entered, they were prepped the night before,and when they came into the OR were knocked out and surgery ensued.

Then....things stated to change. No more going into the hospital the night before where prepping took place in the privacy of your room.

The Civil Rights Act was passed and the medical community ignored the privacy provisions for patients.

So...at the very least, now we have patients awake, being prepped in a very public area without any regard to their privacy or sense of modesty. Couple that with the idea that in a doctor's office, one is draped from head to toe, where a feeling of privacy was expected.

Now, that same patient is thrusted into the hospital setting, with the same expectations of respect and privacy and the next thing you know they are laying on an operating room table being stripped, prepped in front of everyone. Medically, I think no thought of the patient was considered. However, from a psycho social viewpoint, horrendous outcomes could happen including ptsd with what could be considered "friendly fire'. Now, patients are complaining and the assigned risk departments are being contacted by irate, traumatized patients.

Add any sexual impropriety including gaukers, extra's who don't belong in the room or someone who is deviant and you have a prescription for abuse, though still under "standard of care".

What needs to happen is for an independent study into what procedures will instill feelings of humiliation, degradation and disrespect from the patient perspective.

Most of us can agree that being striped publicly would be humiliating or traumatizing to anyone. Why, then, is it okay and acceptable in a medical setting? Let's face it 99% of the time these situations are not life and death.

Procedures need to be put into place to protect that patient and keeping them feeling safe; not violated. That means, privacy screens in the OR around the table.
Prepping should additionally be done without extra people in the room. Most of all, the patients need to feel respected; not like a piece of meat that has no feelings.

Those of us who were subjected to poor treatment have valid reasons for not participating in the future. You can't understand that.

PTSD is a normal reaction to extraordinary circumstances. They say if ten people experienced the same thing, some would be traumzatized; some not. I say, given the proper triggers for each person, then they all would be traumatized. Evidence shows that PTSD happens to a higher percentage of sexual assault victims than to any other trauma source; including war. Humiliation is at the core. Until the medical community recognizes the whole person, punishes those who violate human decency standards and that this problem is looked at with the same veracity as cancer, it won't be solved.

When you look at the harm caused, the lack of medical attention that is a by-product and the mortality of those individuals, it is an epidemic.

The first step is for the medical profession to acknowledge that they have a problem. The rest will follow.
belinda

 
At Saturday, December 01, 2012 8:08:00 AM, Blogger Maurice Bernstein, M.D. said...

Ed, we don't teach the first and second year medical students to get the patient's history by scanning the patient's checklist. Doctors who are satisfied with taking a history only that way should go back to medical school. The purpose of taking a history is to develop a differential diagnosis of the patient's illness so as to lead as promptly as possible to a final diagnosis and treatment. A checklist without thoughtful communication between doctor and patient is worthless and I mean worthless and in fact can lead, without communication, to erroneous jumping to conclusions. (Ed, are you sure that your physicians never took your history by directly talking with you?)

Ed, you wrote "Physicians (and ancillary staff) expect patients to bare their body and soul simply because of the MD at the end of their name!" My question to patients such as you "Do patients expect doctors to make the best attempt to diagnose and treat without some appropriate baring of the patient's body and soul?" If you don't already enter the office with that expectation, you will be disillusioned and angry. ..Maurice.

 
At Saturday, December 01, 2012 8:32:00 AM, Blogger Doug Capra said...

As Ed says, Maurice, and as I've said over the years on this blob, most patients expect to be treated with dignity and respect and to feel safe. Some, who have had bad experiences in the past, expect the worst and that affects their attitude toward the system and providers. One problem is, I think, that most patients, esp. unexperienced ones, have high expectations in this regard -- and whenever anyone goes into a situation with high expectations and those expectations are disregarded or ignored -- the result is a loss of trust that is difficult to regain.
Personally, I've never had to give a history to anyone but my personal physician who I trust so I will hold nothing back. But in the system today, too often providers expect "trust" to enter the clinic or hospital with the patient. Some don't regard "trust" as something that has to be earned. In the health care system, that trust is earned or lost from the moment the patient makes contact with the system, from the first phone call, to contact with the receptionist, then to the nurse who leads the patient into the exam room. When viewing a new doctor or new specialist, rarely does the patient have an opportunity to speak to that actual doctor before the exam. The first meeting is usually in the exam room, often times with a surprise chaperone.
It's about respect, dignity, trust, and treating people as individuals.

 
At Saturday, December 01, 2012 10:28:00 AM, Anonymous Anonymous said...

Dr Bernstein, I've never been interviewed by a provider seeking a comprehensive medical history. My experience with medicine is primarily through annual flight physicals in the USAF and now semi annually as mandated by the FAA. Otherwise I've seen only a Cardiologist and Urologist and their questions were symptom specific; yes I'm sure!

I truly appreciate what you do both as a teacher and your role in supporting this blog. However, you teach the ideal academic standard whereas my view is what I've actually experienced and that's not been entirely positive.

I previously stated here that the concept of informed consent is an academic one not practiced in the real world due to expediency and profit. Apparently, history taking is another such concept.

I absolutely expect to bare my body and soul to a physician but that specifically does not include anyone on his support staff without my express consent. I fired my first Urologist for this exact reason. He was actually a great guy but his all female support staff needs remedial training on treating people with respect and dignity!

Ed

 
At Saturday, December 01, 2012 1:27:00 PM, Blogger Maurice Bernstein, M.D. said...

Ed and Doug, I don't think that any patient coming into a doctor's office for the first time should expect to have their own expectations of trust and ideals of office management fully met. This is particularly so, if the patient is already in distress from concern or symptoms of the underlying illness. It is because of this realistic conclusion I have written that I want to state again what I have written here in the past and that is the suggestion of ethicist Robert Veatch: to communicate with the doctor before you become his or her patient.

Make an appointment with the doctor in his/her office for the primary purpose of understanding the office procedure and learning something about the doctor and his/her views and behavior. Yes, this can be done in a 15 minutes office visit where YOU, as a potential patient-to-be, will be asking the questions ("taking the history") and performing the inspection of the office and doctor ("performing the physical"). What you will want to know and what you want to speak about is precisely the issues that have been described on this thread.
And I will tell you this: if the doctor or doctor's office won't allow such a 15 minute visit by the patient-to-be, that doctor is definitely NOT FOR YOU!

Maybe you won't learn everything you need to know about the doctor and the office but that doctor will certainly know something about your own independent personal interests and that is a whole lot more than all doctors know about a patient on their first meeting in that relationship. Yes, patient should be encouraged to "speak up" after the relationship has been developed but to have an initial meeting when you are not yet the doctor's patient will be the most effective in the development of the best doctor-patient relationship. If you have any questions about this suggestion on my part, please post it here since it is very pertinent to this thread's topic. ..Maurice.

 
At Sunday, December 02, 2012 8:22:00 AM, Anonymous Anonymous said...

"I don't think that any patient coming into a doctor's office for the first time should expect to have their own expectations of trust and ideals of office management fully met."

That attitude is the fundamental problem. Short of the ER, as the paying customer and patient, I will insist my expectations of trust and ideals will be fully met. The sooner patients adopt the same attitude, the sooner the medical profession will change.

Ed

 
At Sunday, December 02, 2012 10:06:00 AM, Blogger Maurice Bernstein, M.D. said...

Ed, I stick by my statement "I don't think that any patient coming into a doctor's office for the first time should expect to have their own expectations of trust and ideals of office management fully met." What I mean is that every patient can differ from any other patient in their own individual expectations and allowances within that experience. Doctors can only know these differences and expectations when told by the patient just what is personally expected in terms of "trust" and in terms of the office management. And that is why I would strongly recommend an initial visit to the doctor and the office only to determine whether the doctor appears to meet the patient's requirements so that a comfortable and trusting doctor-patient relationship can be started. As I already wrote, any doctor who refuses this preliminary screening by the patient-to-be should be considered unacceptable for most patients. ..Maurice.

 
At Sunday, December 02, 2012 1:07:00 PM, Blogger Joel Sherman MD said...

We have posted a new article by Misty Roberts, founder of medical patient modesty organization. The article is about elderly patients and modesty. Take a look.

 
At Sunday, December 02, 2012 2:22:00 PM, Blogger Doug Capra said...

"I stick by my statement "I don't think that any patient coming into a doctor's office for the first time should expect to have their own expectations of trust and ideals of office management fully met."

I see where you're coming from Maurice, and I don't disagree entirely. But consider this. All hospitals and most clinics have mission statements and/or core values. Some have patient rights and responsibilities posted. Are not these expectations? If a core value is "compassion" shouldn't that be expected? If a mission statement talks about respecting patient dignity, should that be expected?
The problem is that those terms are not defined, and it may be assumed that everyone just knows what they mean. Certainly everyone knows what "compassion" means, right? And "dignity?" I would say, no, not everyone agrees. If a doctor or clinic does use those terms, it certainly is assumed that they know what they mean for their clinic and will go by their definitions.
You also write: "And that is why I would strongly recommend an initial visit to the doctor and the office only to determine whether the doctor appears to meet the patient's requirements so that a comfortable and trusting doctor-patient relationship can be started."
Although I agree that this is the ideal, I would also suggest that the medical profession is not used to being "interviewed" by patients for services rendered. That's not how medicine works today, unless you're dealing with "a second opinion," which you have to pay for. I've actually had experiences with this. While calling for an appointment with a specialist, I asked the receptionist if I could talk with the doctor about something -- not a modesty issue. Could he call me sometime at his convenience? She asked and the doctor said "no." I made the appointment anyway, and when I asked the doctor why he wouldn't talk with me or call me back, he said that, since I wasn't his patient, he had no obligation to talk with me. I supposed I could have made an appointment, paid $250 for a 15 minute consult, and asked my questions. This particular doctor didn't really need any patients. He was already making enough money in his practice. He could pretty much do what he wanted.
I'd suggest to you that a significant number of doctors, perhaps not most, may take this point of view. I really don't know how prevalent that attitude is.

 
At Sunday, December 02, 2012 3:38:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree that what is "trust", what is "compassion" and how "dignity" is defined and what is expected will be different with each individual and therefore each individual must express their own definition and expectations to others as it becomes necessary. By the way, since we are considering how terms are defined, when the words "sexual abuse" is used in these postings, how is that act defined? For example, in a nursing home, would male or female nurse giving a male or female elderly patient a bed bath against the patient's wishes be considered "sexual abuse" or simply "abuse" if that at all. Is the sexuality related to the fact that the patient's body is exposed and washed but without sexual intent by the nurse. "Trust, compassion,dignity and sexual abuse have meanings but are they all defined and expressed simply in through the eyes and mind of the beholder? ..Maurice.




 
At Sunday, December 02, 2012 4:05:00 PM, Anonymous Anonymous said...

Actually, any touching of a patient without consent is considered battery which includes a bed bath. From biotech.law.lsu.edu/map/BatteryNoConsent.html

"As a pure legal issue, forcing treatment on an unwilling person is no different from attacking that person with a knife. The legal term for a harmful or offensive touching without permission is battery. Battery is a criminal offense, and it can also be the basis of a civil lawsuit. The key element of battery is that the touching be unauthorized, not that it be intended to harm the person. Thus forcing beneficial care on an unwilling patient would be battery.

Ed

 
At Sunday, December 02, 2012 4:09:00 PM, Anonymous StayingFit said...

"that is why I would strongly recommend an initial visit to the doctor and the office only to determine whether the doctor appears to meet the patient's requirements so that a comfortable and trusting doctor-patient relationship can be started. As I already wrote, any doctor who refuses this preliminary screening by the patient-to-be should be considered unacceptable for most patients. ..Maurice."

Well Maurice, I changed doctors 2 years ago. I contacted 5 general practitioner's offices. And everyone, yes EVERYONE, steadfastly refused to book a "get to know you" appointment. They insisted that I list that practitioner as my primary care physician, and that I book a "new patient" physical as my first appointment with that office. Since I am allowed, under my insurance, precisely ONE physical examination per calendar year, this means that I would have to choose that doctor, and, if dissatisified, wait ANOTHER year before I could try a different office. I would also have to try my luck with that office, and hope that they examination was done in a respectful manner. I would have no opportunity to evaluate this prior to my first visit.

This is a fact that these doctors know very well. Under the rules that most of us must abide, we CANNOT shop for a doctor who meets our needs. Apparently, this suits them just fine. Otherwise, they would instruct their office personnel to allow us to meet with them, prior to selecting them as our PCP.

 
At Sunday, December 02, 2012 4:33:00 PM, Blogger Maurice Bernstein, M.D. said...

And yet, Ed, from your same internet source "Yet even when a patient has refused care, the physician is unlikely to be charged with the crime of battery if the treatment was meant to be beneficial. This is not an endorsement for acting against a patient’s will. It is a recognition that the criminal law is reticent to punish physicians unless it is clear that they intended to cause harm." I presume this would also apply to a nurse bathing a patient which is only intended to be beneficial and of no harm.
So how is sexual abuse defined in terms of a physical exam or medical procedure or nursing care? ..Maurice.

 
At Sunday, December 02, 2012 4:49:00 PM, Blogger Maurice Bernstein, M.D. said...

StayingFit, I am surprised and saddened that you had such an experience. To me, these doctors are not interested in you as a person but only as a patient with insurance and if that is the case, they, to me, would be unacceptable. I still stick to the advice that Dr. Veatch has long proposed for an introductory meeting between doctor and possible patient-to-be to better achieve an understanding between both parties regarding the nature of the anticipated relationship but before it begins. ..Maurice.

 
At Monday, December 03, 2012 5:16:00 AM, Anonymous Anonymous said...

Everything involving nudity that is done against a patient's wishes should be a sexual assault. Doing it without a patient's informed consent in a non-emergency situation should also be considered sexual abuse. Emergency situations should be considered case by case.

 
At Monday, December 03, 2012 6:08:00 AM, Anonymous Anonymous said...

I agree with Ed about history taking. The few times I have been to a doctor they have never taken a history from me: they have only asked questions pertinent to the symptoms I am seeing them for. I have only ever had to fill out the paper questionnaire prior to the visit and have no idea whether or not the doctor ever even looks at it (Personally, I highly doubt that they do.) And as far as booking a get-to-know the doctor visit, I have never requested that but it is a good idea. I do find it hard to believe that most doctors, however, would do it but either way you would have to pay and most probably out of pocket since I wouldn't imagine insurance companies would reimburse for something that is probably not "codable". So people in most cases do not have the luxury of screening for doctors who fit their criteria for respectful treatment. Of course they can always change after an initial visit but that gets all very frustrating and makes it hard to establish a "relationship" with any one doctor. For those of us who do not have a PCP that they regularly see and only seek out a doctor's help when symptomatic, finding one who fits our needs is even harder. And even if a person has a primary care physician they feel comfortable with they always face the same problems when having to seek out help from a specialist. It would be a hard task to take the time and money to interview every specialist to find one who also fits the bill. So, all in all, the idea of having a get-to-know you appointment with a doctor may be idealistic but most probably unrealistic. Jean

 
At Monday, December 03, 2012 6:48:00 PM, Anonymous Anonymous said...

Jean, it's easier here in
Australia. I went doctor shopping
until I found my current GP. It
cost me about $100 for 3 visits,
gap payments, but was money very
well spent. I didn't want to debate
the merits of screening exams and
tests at every consult, things I'd
decided to decline. (a common
problem for women) A simple note
appears on the inside cover of my
file and valuable consult time is
focused on the reason for my visit.
It has definitely helped to foster a respectful
two-way relationship.
Elizabeth

 
At Monday, December 03, 2012 6:55:00 PM, Blogger Doug Capra said...

"I agree that what is "trust", what is "compassion" and how "dignity" is defined and what is expected will be different with each individual and therefore each individual must express their own definition and expectations to others as it becomes necessary."

I wasn't clear in my post. What I meant is that there are some universals in this world that may transcend culture. "Compassion" is probably one of those universals. It may be more difficult with the world "dignity." But I do think there are generally accepted mores within our mainstream culture that to some extent define bodily privacy. This is not to say that we don't have a diverse population that represents other cultures.

 
At Tuesday, December 04, 2012 11:29:00 AM, Anonymous Anonymous said...

"Doctors can only know these differences and expectations when told by the patient just what is personally expected in terms of "trust" and in terms of the office management."

Once again, this statement highlights the vast disparity between how a patient expects to be treated vice what doctors are prepared to offer; a fundamental problem that doctors (& ancillary staff) should address. Why is the responsibility solely that of the patient? We patients read all these wonderful words addressing privacy and dignity in patient rights documents and then experience embarrassment and humiliation inflicted by "professionals." That is your professional problem, not the patients, and yet you argue we need to address it individually. While there are certainly exceptions, I think most would agree visiting a physician is something the vast majority doesn't enjoy regardless of the ailment. Add the inexperienced patient and an embarrassing or intimate problem to your professions attitude regarding modesty, dignity, and privacy and it's a recipe for disaster.

Addressed to nurses from a male patient perspective, the following comment from DonMD (http://allnurses.com/operating-room-nursing/modesty-issues-130341-page7.html) is an attitude if practiced by all medical "professionals", would largely address many patient complaints.

The bottom line is that a man without pants is as exposed, in any position, as a woman in stirrups for a pelvic exam, and should be given as much privacy as we accord a woman in that situation. All patients need to be treated as if they are the most modest person on the planet. You won't cause emotional harm if you treat the less modest person with the utmost regard for privacy.

"Yet even when a patient has refused care, the physician is unlikely to be charged with the crime of battery if the treatment was meant to be beneficial. This is not an endorsement for acting against a patient’s will. It is a recognition that the criminal law is reticent to punish physicians unless it is clear that they intended to cause harm."

The attitude of your professional colleagues on modesty, dignity, and privacy clearly causes emotional harm and patients have no recourse because in the physicians' professional opinion, the treatment administered is "meant to be beneficial."

We can't win for losing!

Ed

 
At Wednesday, December 05, 2012 7:00:00 PM, Blogger Maurice Bernstein, M.D. said...

PLEASE NOTE: If you are posting to this thread and your comments are not appearing, please write me e-mail about it: doktormo@aol.com

Thanks. ..Maurice.

 
At Saturday, December 08, 2012 3:14:00 PM, Blogger Maurice Bernstein, M.D. said...

I want to inform the visitors to this thread that I put up a new thread titled "Growing a Doctor: The Seed" in which I challenge my visitors there to pretend that they are a faculty member of a medical school admission's team and they are sitting across a desk with a student who wants to become a doctor and to be admitted to the school. What questions would you ask the student and what answers would you be expecting to try to select the student that you hope will become the "good" doctor that you and society would want. If you are interested to do so, go to the thread and write there. ..Maurice.

 
At Saturday, December 08, 2012 7:26:00 PM, Blogger Maurice Bernstein, M.D. said...

I thought visitors to this thread would be interested in a current Gallup survey comparing highest and lowest regarding honesty and ethical standards in a host of occupations.

In the category of very high/high
1. nurses
2. pharmacists
3. medical doctors
11. bankers
12. journalists
21. members of Congress
22. car salespeople

Click on the above link to read the entire list and statistics. Then come back and tell us what this survey means to you in terms of what has been discussed on this thread all these years. ..Maurice.


 
At Sunday, December 09, 2012 8:38:00 AM, Anonymous Anonymous said...

What a racket that survey continues to be each
year. Who do you think is paying these companies for
such twisted data. Follow the money trail. Have any of
you ever seen or taken such a survey.

PT

 
At Sunday, December 09, 2012 9:26:00 AM, Anonymous Anonymous said...

Maurice,
The results of the Gallup survey you cited that ranks nurses at the top regarding honesty and ethical standards comes as something of a surprise and what it means to me is that a great portion of those responding to the survey are quite naïve about many of those in the nursing profession.
I have several reasons for believing this but for now let me cite just one. A number of years ago I dated a nurse and know that she acted quite professionally when dealing with patients. If a male patient expressed resistance to intimate care she would calmly reassure him of her professionalism and the fact that to trained nurses a hand, a foot, a knee, or a penis, were all basically the same; simply body parts that needed care so there was no reason for patient embarrassment.
However, during the time I dated this nurse, I had the occasion to be in social situations with a number of nurses and after a few drinks when the “shop talk” began I never recall hearing a single story about a hand, foot, or knee but I did hear a great many “interesting” and “hilarious” stories about penis size, erections, male embarrassment, etc.. I even heard one woman describe in detail the private anatomy of a man she and another nurse had gone to school with.
Were these women acting with honesty and high ethical standards when dealing with their patients? Of course not! But they were able to convince most of these patients that they were.
In short, because opposite gender intimate care is convenient and cost saving the medical profession has managed to convince a great many male patients that female providers become genderless angles of mercy when performing their jobs. For a great many nurses nothing could be further from the truth and I believe that at least the majority of those contributing to this thread are aware of this fact.
MG

 
At Sunday, December 09, 2012 2:06:00 PM, Anonymous Anonymous said...

A survey is only as good as the quality of the data used. So, I ask the following:

age and gender of those surveyed, what experience have they had with the medical industry (hospitalizations, procedures etc), how many family members have they cared for...just a few variables.

We are all producta of our experience. Having cared for parents, husband's parents, step parent, aunt and uncle, senior cousin with poa and my own medical issues, I wish that survey had some validity; it doesn't.
belinda

 
At Sunday, December 09, 2012 4:48:00 PM, Blogger Maurice Bernstein, M.D. said...

For details of how this Gallup survey was performed click on this link. ..Maurice.

 
At Sunday, December 09, 2012 7:43:00 PM, Anonymous Anonymous said...

Medical students are still performing genital exams (pelvic and prostate) without informed consent in the OR. See the following links:

http://blog.timesunion.com/mdtobe/should-med-students-obtain-consent-before-genital-exams/2868/

http://www.capitol.hawaii.gov/session2012/Testimony/HB2232_TESTIMONY_JDL_03-27-12.pdf

Follow this link if you want to read the condescending and paternalistic comments of current medical students towards patients' right to decline student participation in their healthcare.

http://www.kevinmd.com/blog/2012/11/medical-student-sees-lucky-day.html

While I can't speak for others, I'm amazed nurses and physicians are rated so highly.

Ed

 
At Sunday, December 09, 2012 8:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Just in case the url for the pdf file from Hawaii is not readable on Ed's posting (wasn't on my computer) here is the clickable link to the file.

By the way Ed, if that Ed on KevinMD website thread was you, you did appear rather "hot under the collar" which I can understand. And Doug Capra's postings were cool as usual. ..Maurice.

 
At Sunday, December 09, 2012 9:06:00 PM, Anonymous Anonymous said...

Guilty!

Ed

 
At Sunday, December 09, 2012 10:43:00 PM, Anonymous Anonymous said...

My first observation I noticed with the Gallup poll was
the small sampling number, just over 1000. Among the
sampling number how many have interacted with a business executive, HMO manager or attorney. Some
are Spanish speaking only, suggesting that perhaps
their interaction with the group is limited, certainly that
might be the case with a college teacher in this country
if you are Spanish speaking only.
The real problem I have with this poll is the missing data for the military. Despite the thousands of deaths and injuries our brave troops have endured,the sacrifices made apparently were not good enough for
the list. Pathetic!

PT

 
At Monday, December 10, 2012 1:18:00 AM, Anonymous Anonymous said...

I agree with the others about the Gallup poll. I think so many people are just blind. We're taught at school that nurses are good but then personal experiences throw that out the window.

GR

 
At Monday, December 10, 2012 8:36:00 AM, Anonymous Anonymous said...

Polls and surveys are a soft discipline. Enjoy them, but don't base decisions on their results.
BJTNT












 
At Monday, December 10, 2012 9:00:00 AM, Anonymous Anonymous said...

PT, I couldn't agree with you more. The following link shows that Gallup included military officers for the following years: 2002, 2004, 2007, and 2010.

http://www.gallup.com/poll/File/145031/Honesty_Ethics_Dec_3_2010.pdf

Can't explain their rationale.

Ed

 
At Wednesday, December 12, 2012 8:18:00 PM, Anonymous Anonymous said...

Nurses should never have been included in the gallup
pole. They are not considered professionals, they wear
uniforms and use time clocks.

The definition of a hypocrite: A person who pretends
to have virtues, moral or religious belief, principal,etc
that he or she does not actually possess, especially
a person whose actions belie stated beliefs.

In this country mammography is performed exclusively
by women and any nurse who recieves a mammogram
is a hypocrite. They did after all institute this system
that benefits only them.

PT

 
At Thursday, December 13, 2012 9:04:00 AM, Anonymous Anonymous said...

PT, most would agree that one would consider a professional one whom spent years in school, got a degree and then went to practice their profession.

Are male nurses professional?

While there are professionals in all walks of life whose credibility and integrity is questioned, your continued singling out women who
are unprofessional is offensive.

You don't want to have that war on this blog making this a gender issue. The continued rant that makes women in medicine sexual abusers and the men fine is ridiculous. It doesn't matter what the gender of the offenders.

Both genders own the problem. Both genders are at fault. It is the problem that needs to be recognized.

The medical community should be tracking the offenders, disciplining them and have consequences for workers who don't turn over offenders. This is the only way that the problem can be addressed in an effective manner.

Until the medical community does this, we will all have problems.
belinda

 
At Thursday, December 13, 2012 9:48:00 PM, Anonymous Anonymous said...

Belinda, this one's for you:

http://www.cbc.ca/news/health/story/2012/12/09/toronto-ontario-doctors-sexual-abuse-discipline.html

Anon1

 
At Friday, December 14, 2012 3:57:00 AM, Anonymous Anonymous said...

Male nurses are just as unprofessional as female nurses, and it's just as wrong for them to treat female patients in the wrong manner that we discuss on this blog. My only argument is that male nurses often have written or implied rules about dealing with female patients that female nurses don't seem to have with men. Examples such as men not being allowed to be alone in the room with female patients and male nurses being banned from many L & Ds. I've never heard a case of female nurses or "assistants" being banned from Urology clinics or other naked male situations.
I don't want to start a debate about men vs. women because I truly believe that everybody is equal, but it seems that men have lost more than their share of rights in the last few decades. Whatever advantage men used to have has been taken away and then some.

Someone mentioned orderlies earlier on this page. Many years ago my father was an orderly in a hospital, including the emergency room and surgeries. At that time and place all male patients got orderlies and all women got female CNAs. In all the time he worked there he never saw a single undressed female patient. I mean, duh! What has happened to the medical profession? Has it completely lost it's ethical values or is money the only thing that matters now? Certainly other hospitals throughout human history have had the same insulting lack of ethics that we have today. I doubt that hospital was the only one in history that used such common sense, but I wonder why they seemed to get it when others don't. I don't know if they still practice that kind of human decency today but I'd like to hope they do.
e

 
At Saturday, December 15, 2012 7:15:00 AM, Anonymous Anonymous said...

Anon 1, Thanks for the article. Maurice, this question is for you.

The Canadians are recognizing that there is a problem, that something needs to be done about this problem.

We, on this blog, recognize there is a problem and that something needs to be done about it.

The question,,, Maurice, do you think that a property line between our two countries clearly defines with clear barriers as to behaviors, or...do you feel that this problem is largely ignored due to the lack of coverage in it's full scope and the medical lobby in this country?

Secondly, how can it be in your experience, that these issues do not exist? I think that they do, but that in your capacity, you, personally haven't been exposed to these areas.
belinda

 
At Saturday, December 15, 2012 8:33:00 AM, Anonymous Anonymous said...

I believe I made myself clear regarding the gallup
pole when I said nursing does not fall into the category
of professional status. When I say nursing I mean all
that do nursing, men, women, rn's, lpn's, ma's and cna's.
They wear uniforms and use a time clock. There are
well over 4 million people in this country that do nursing
services and over a 100 million interactions each year
and I assure you that a sampling of 1000 with some of
those as non english speaking is hardly scientific.
Btw, I don't consider members of the press as professional either. The second point I made and concerns the mentioned issue of trust and ethics, how
can any group who makes concessions for only one
gender be considered ethical. Are you professional if
you are a hypocrite and that you discriminate? Is that
ethical. This already is a gender issue and it's about
one industry, nursing whereby the feminine dominated
aspect, 95 percent plus have, for the last 40 years
deliberately and systematically discriminated against
the male population and potential male employees from
the nursing industry.

PT

 
At Friday, December 21, 2012 3:02:00 AM, Anonymous Anonymous said...

I consider myself far from a misogynist but it's hard to argue against some of the points that PT makes.

I also think gender segregation concerning medical nudity is a great idea. The only victims with that would be the pervs that enjoy getting naked for opposite gender medical staff.

L

 
At Friday, December 21, 2012 4:06:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY DECEMBER 21 2012 "PATIENT MODESTY: VOLUME 51" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 52 ..Maurice.



 

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