REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD
Patient Modesty: Volume 52
And the discussion regarding the attention to patient physical modesty continues and seemingly still unresolved is the matter regarding the patient of which gender gets the best and wanted attention to their specific requests for their physical modesty... and which patient gender is usually ignored or unsatisfied in this matter. And what can be done about the suggested inequality? Continue onward.. ..Maurice.
Graphic: From Google Images and modified by me with Picasa3.
NOTICE: AS OF TODAY FEBRUARY 25 2013 "PATIENT MODESTY: VOLUME 52" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON
VOLUME 53
142 Comments:
Maurice, the topic of this blog is most disappointing. We all lose if we make this a gender entitlement problem instead of a problem for all.
When it comes down to it, you're the patient of whatever gender and the caregivers are such, whatever gender and when it's you on the line, who cares about a gender war.
I'm for fair, gender sensitive treatment for all. Anything less is a discredit to your blog and everything that it stands for.
Contributing to divisive positions doesn't solve the problem. Did you do that on purpose?
belinda
What I have seen with the comments on this Patient Modesty thread is a repeated return to patient gender inequality in both attention by providers and in resources available. The direction of those comments is more divisive than constructive. I would rather see comments directed to ways to improve the medical system for all patients regardless of gender. Yet.. despite my repeated suggestions for the development or practice of some advocacy action for patient physical modesty within the medical system, I see that advice forgotten. And I don't see even an attempt by my visitors to enlarge upon a program of more energetic petition development which I have, seemingly only myself, had started.
So no.. I am not encouraging division of genders on this issue for this Volume. What I did want is to start this Volume with something which, Belinda, you wrote, to re-orient the discussion to making a change for the good of all patients and what you stated "fair, sensitive treatment for all". If we all agree on this, then the next step is working out ways to make this a medical system reality. Advocacy..Spreading the Word! ..Maurice.
With regard to my petition on http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/ there has been only 42 signatures since September 10 2012 when I started the petition. Surely some visitors to my blog can do a better job of stimulating a petition drive! ..Maurice.
Belinda said. " We all lose if we make this a gender entitlement problem instead of a
problem for all."
Is this what you are really worried about Belinda, that we ALL lose. Men have
already lost and have so for a number of decades. When it comes to
discrimination, i'll always come out swinging. Discrimination is nothing new
in societies, the Irish, blacks, persecution of Jews, and for the last 40 years,
male patients in healthcare. Women in healthcare have engineered this structured
change whereby they are assured complete, absolute privacy in mammography
post-op gyn and L&D and many other areas of healthcare.All the while dictating
the care to male patients with the like it or leave it mentality. They attest to their
doctrine, women are professional to male patients, yet males can't be professional
to us when we are patients, quite the contrary and the web attests to this.
The fact is the female healthcare industry does not want to be in the same
shoes as their male patients. For that they fear they would be treated the same
manner they have treated their male patients! Is this what you are afraid of, Belinda.
I have heard it countless times,all men enjoy intimate care from female nurses
yet, we are criticized when we request same gender. This is a common tool used in
discrimination. It worked for years against minorities and other groups. Accept, or we
will make it hard on you!
PT
It is disappointing that PT had such a bad experience(s) with female healthcare workers. I, too, have had bad experiences with male and female healthcare workers.
Each of us has to determine what we will and will not tolerate. Men, stand up and refuse if you are not happy about your privacy needs in healthcare.
PT seems to think that in the medical arena all women are just having mammography and babies. First, if they find something and you need an ultrasound they do have male doctors in the room as well as male technologists. Male tech's are also in the room for echo cardiograms and other testing procedures like colonoscopy, Er, OR, surgeries and the like.
Privacy right and discrimination are not one and the same. It has even been set aside by Title VII as an issue because we all have a right to privacy. It is the law.
It is also proven that yelling, screaming, arguing and bullying do not do well when it comes to evoking change in a system.
We all have a right and responsibility to our healthcare needs.
Yes there is an imbalance in female nursing and until this same gender need is evoked by both genders nothing will be done.
It is my opinion that some people on this blog are clearly traumatized and becoming agitated by discussion.
I used to be one of those until I took the initiative to look past it, and move on to a healthy place for me. It's really important for those who are highly agitated to find that place in each of you. You will feel better and be effective in discussion and decisions that help everyone in healthcare.
The healthcare system is powerless to me because I've taken complete control of what I need or...not to partake in a system that degrades people, limits their value as intelligent and capable of making their own decisions. Do I pay a price for that? Perhaps...however I'm living my life my way, free of anxiety over a system that doesn't work for me.
Should you feel that I have some kind of delusion over this situation, think about the thousands who are avoiding healthcare because of this issue. It is real and the medical community chooses to think otherwise.
No institution can please everybody and the people who can be herded into compliance and held hostage to their health will partake and acquiesce to feeling degraded, humiliated, and patronized; a price I'm not willing to pay.
belinda
Belinda
Yes, women are having mammograms and delivering babies. They are also on post-op gyn floors for non-obstetric
reasons, ovarian cysts, hysterectomies, oopherectomies, etc. These types of services strictly do no employ male nurses
or techs. This essentially engulfs the broad spectrum of women's services. It's important to remember that the gender
structure of these services, facilities were orchestrated and set for decades by the female staff, not by female patients.
What have they done for male patients in any arena, regarding male issues or specifically, reproduction. I have heard
firsthand of male patients visiting a center for reproduction and asked to masturbate in a small room with playboy magazines
available, provided by the physicians office. Only to emerge from the room amongst female office staff giggling. If you need
a prostatectomy, seed implant for prostate cancer or male urological procedure, get ready to be treated like cattle through a
small army of careless, thoughtless female staff who couldn't care less about your privacy. There will be no center for mens
services, no advertisement for how well you will be treated and respected as they do with these Centers for womens services.
You will encounter( high probability) one of the 95 percent of female nursing staff who probably don't remember reading
their lippincott nursing manual on the page where it says," provide privacy for the patient,drape properly,etc. No, that page dosen't
matter to them. For once they entered the hugh complex called the feminine healthcare machine,they saw that womens privacy is
respected and paramount, while men dosen't count, irrevelent.
PT
One of the wisest comments made on this blog: belinda writes: "It is my opinion that some people on this blog are clearly traumatized and becoming agitated by discussion. I used to be one of those until I took the initiative to look past it, and move on to a healthy place for me. It's really important for those who are highly agitated to find that place in each of you. You will feel better and be effective in discussion and decisions that help everyone in healthcare."
This is one of the reasons you don't read much of my comments on this blog anymore. I'm tired of the ranting and complaining. It's not a question of "Getting over it." No -- it's more, as belinda says, moving beyond it to find a more healthy place for yourself. My belief is that once you stop feeling and believing yourself to be helpless, once you start becoming more proactive, making clear what you expect from health care professionals -- you'll begin to find that place. Anger, resentment and hate will eat you up from the inside. My experience has been that, in the field of communication, making your expectations and values clear is essential. To often people talk all around these issues rather than facing them up front. This is the old "elephant in the room" idea. Ironically, a good many health care professionals feel uncomfortable talking about this issue -- and they actually feel relieved when the patient brings it up and opens up the conversation. Yes, I know, I know. The professionals should bring up these issues with their patients. I don't disagree with that in an ideal world. But this isn't an ideal world. I'd rather face the world as it is and learn to negotiate my way through it. Ironically, that's one way to change that world -- but bringing into it along with yourself and openness about this topic. That begins to get it out in the open.
Anyway, thanks to belinda for presenting some wisdom on this blog.
Doug, you write:" The professionals should bring up these issues with their patients. I don't disagree with that in an ideal world. But this isn't an ideal world." Based on my own experience (prior to experiencing this thread), if that is representative, I doubt medical professionals themselves will bring up the modesty and gender topic conversation. Even now (and I am going to be teaching a workshop for 2nd year medical students about how to perform the male genital exam in a couple of weeks), while I will instruct the students how to respond if the patient develops a spontaneous penile erection, I am NOT going to have them introduce the subject as a rare possibility PRIOR to the examination. {Do you agree with that?) You all have to know that as physicians we come to the doctor-patient relationship with the orientation that the patient is there for the doctor to attend to making a diagnosis and providing appropriate treatment, relieving symptoms and hopefully producing a cure. A patient in distress has no other interests beyond the established interests set within standard informed consent. That is why, it is hopeless to wait for the doctor to start the modesty/gender discussion. It is wisest for the patient to bring up the subject and if the doctor has any courtesy and humanity in his or her head, that doctor will listen and try to inform and discuss the situation with the patient and hopefully accommodate. But, as I have already said, the patient should NOT wait but begin the conversation ahead of the exam or procedure. Otherwise, expect that you will become upset, angry and frustrated about the experience.. and will have trouble "getting over it". ..Maurice.
Maurice writes: "It is wisest for the patient to bring up the subject and if the doctor has any courtesy and humanity in his or her head, that doctor will listen and try to inform and discuss the situation with the patient and hopefully accommodate. But, as I have already said, the patient should NOT wait but begin the conversation ahead of the exam or procedure."
Within the current context of medical culture, i.e. the way things are in reality -- I agree with you. The patients must try to be proactive. I don't see that as an absolute, as you seem to. I don't see why providers cannot also share this responsibility.
When possible, the patient should bring this issue up before the exam or procedure. But in a significant number of instances, the patient doesn't see the doctor until the moment of the exam, esp. with specialists. EXAMPLE. You make an appointment with a doctor you've never seen before. You talk with a receptionist. You arrive at the office. You talk with a receptionist. You're taken to the exam room by a nurse or more likely a medical assistant. So far, you haven't met doctor. Next event -- When the doctor comes in you may already be gowned, prepped and on the table, and you haven't even met him/her. And who knows who will accompany the doctor?
You also write: "...while I will instruct the students how to respond if the patient develops a spontaneous penile erection, I am NOT going to have them introduce the subject as a rare possibility PRIOR to the examination. {Do you agree with that?)"
If I thought this was handled the way you describe it purely for the benefit of the patient, I would agree. But I think, more than will be admitted, a significant number of providers don't mention it because they are uncomfortable bring the subject up. Which brings up the question -- who's comfort should be most important -- the provider's or the patient's? Certainly both, but who should the provider be focused on? I do realize that there is a school a thought that suggests that bring up this subject might suggest a fear that is probably unlikely, or even cause the event. But I have yet to find any patient-centered studies, i.e. how do patients feel about this -- that back up that school of thought. I may be just one of those medical myths/cliches that's been passed down since Freud.
So, you ask do I agree? I don't know. I'm open based upon some solid evidence, which I don't really see anywhere.
Perhaps we should invite some blacks, Jews from the holocaust and Irish immigrants to this blog and
see how they got past the continual discrimination they faced in their everyday lives. I really doubt they
ever found that happy place. I know I don't, but then if you can't be direct in discussion forceful, critical
about a subject like this, stay out of the kitchen.
PT
Maurice, I agree with you one hundred per cent. Doug, thank you for your acknowledgment. I, too, am starting to share your feelings about posting and this one is the last of dealing with rantings from other bloggers. They shouldn't be chasing us away. We have something to say.
This issue is broad based and contextual as well. We cannot look at these modesty issues as a separate issue but part of the healthcare experience.
It is also out of my realm of understanding how anyone would attempt to invalidate the issues of half of the population. It is this mindset that is truly the foundation of intolerance, discrimination, and putting down in order to raise one or one's issues to the top at the detriment of everyone else.
belinda
Some have said they have found that "Happy place." No you haven't." if you did, you wouldn't be continually coming back to this
blog which only continually reinforces what you already know. It's like a junkie looking for a fix, you feel it pulsing through your veins
but instead, it takes you to a dark hateful place full of anger, resentment and guilt. It's called discrimination,courtesy of the feminine
nursing industry.
There are no answers and no solutions but I do believe and as I have mentioned this problem will remedy itself. Through economic
equilibrium as more and more males enter the nursing field. Noticed how many manufacturing jobs have disappeared and they won't
be returning any time soon. Males are graduating from nursing schools in record numbers, " dare to be a nurse" the ad reads.
Change is good! As these nurse ratchet crustaceans are forced out, die or fall by the wayside then perhaps the nursing industry
might be able to return to a viable respectable entity. Speaking of change,most hospitals have adopted a strict no smoking policy.Any
employee caught smoking on the hospital campus will be terminated. You are even starting to see medical facilities as a pre-requisite
to employment do nicotine testing. Positive for nicotine, we don't want you.
Nurses smoking all day long on the job is something I personally am glad to see eliminated. The number one topic once nurses begin
their smoke breaks, berating their male patients. Never mind the 550 lb female patient with bilateral ankle tattoos circumventing, begging
for another donut continuously on the call light.Topic gravitates to personal attacking comments about male patients, always ending the
comments about the males genitals. Yes change is good!
PT
PT, I agree about not using this thread only to "reinforce what you already know". That's why I keep waiting to see plans being developed here to make the wanted changes. And PT, I agree changes can be good including those for the medical system. So..now beyond cutting out smoking by medical staff, patients and visitors in a hospital, what other specific changes would my visitors suggest to compile as a list and to formally advocate? ..Maurice.
I agree with Belinda: I have found that "happy place", if that's what you want to call it, and I now know how I will address my concerns when I enter the medical arena to hopefully have a better experience. I do occasionally visit this blog just to see what has been posted and not for the reason PT stated. However, I too am tired of the "broken record" and hate directed at females in the health care field. I am sure there are both males and females out there that are guilty of disrespectful treatment of patients as I am quite convinced that there are health care providers of both sexes that are truly respectful and considerate. And I also agree with Belinda: all women's health does not have to do with mammograms and reproductive issues and when women go in for those other issues they are just as likely to get opposite gender care as males are. So even though men do have a harder time obtaining male nursing I think it should be accepted that modesty/same gender care is a concern for both sexes. Period. Jean
Jean said
" when women go in for those other issues they are just as likely to get opposite gender care as males. So even though men have a harder time obtaining
male nursing." Did you just contradict yourself, you do know that 95 percent of all nurses are female.
Maurice
I included smoking among nurses only to illustrate the disease by which most of them suffer from, diarrhea of the mouth. It is an
established fact that women carry more diseases on their hands than men do. One more reason to expidite more males into nursing,
as the number one cause of nocosomial infections among hospital patients is lack of hand washing. I am estatic though to see the
restriction of smoking in that it removes the opportunity for these people to gossip. Who is watching their patients when they are off
the hospital grounds smoking.
Each state BON list guidelines that nurses are bound by. Some are inappropriate draping, deliberately watching a patient change,
unnecessary exposure to list a few. If male patients ask for same gender provider, the request must not include verbal abuse, berating
a patients request as that constitutes unprofessional conduct.
Belinda
As more and more male nurses enter the nursing industry we expect the ratios to reach equilibrium. That would be fair for male
patients but I believe this old girl school mentality is on a tterminal time frame. Its been the " inside girl school mentality" that has tipped the
scales for them. You see, they were never looking out for you, a female outsider.non healthcare worker. In other words they were the original
architects of the system, designed and constructed exclusively for their privacy in mind, when they chose to seek the services.
You are just a number to build and continue the idea, the frame and continue the mindset, when they need it again. This would all
change with the advance of male nurses as the insiders will be long gone, ancient history. There will be no more catering to one specific group,
the discrimination that has plagued male patients will be long gone.
I have been seeing this change slowly,imperceptively. These scrubs that many female nurses have worn for years, sexually suggestive
patterns and symbols are now forbidden. Most hospitals have now instituted mandatory specific colors for each department. It is forbidden to work
at any hospital now wearing saturated doses of perfume. Something female nurses have done for years, the American lung as well as the asthma
association have denounced this practice as a lung irritant. Imagine being a patient with asthma and your nurse is standing next to you who just
took a bath in Calvin Klein. You can bet stocks took a dive at the local perfumery at Dillards.. Yes,change is Good!
PT
We understand and respect that each individual has his or her own comfort level with respect to privacy and modesty. Please answer the following questions to help us understand your preferences and help us make your visit with us as positive an experience as possible for everyone involved.
1. For non intimate exams or procedures, do you have a preference for the gender of your physician or other caregivers?
_____Male
_____Female
_____No Preference
2. For intimate exams or procedures, do you have a preference for the gender of your physician, nurses, assistants, or other caregivers?
_____Male
_____Female
_____No Preference
3. For your comfort, you may request a chaperon be present during any examination or procedure, especially intimate ones requiring any significant degree of exposure. Do you prefer to have a chaperon present during exams?
_____Yes
_____No
4. If yes, do you have a preference as to gender of the chaperon?
_____Male
_____Female
_____No Preference
If you have any other specific concerns regarding privacy or modesty, we encourage you to bring them up with your provider at the beginning of your visit, or write them down below.
----------------------------------
I would like to toss this up one more time for comments before putting it into the website. Anyone still see the value in it and /or see changes that should be made?
Thanx.....Suzy
Suzy
Those are all good questions but i doubt we'll ever see the health care profession ask them.They would rather pretend those issue's don't exist.It's just easier for them.They want you to just keep quiet and let us do our job.We don't really care what the patient wants.All it takes is a few strokes of a pencil to make it happen.Is that asking to much of them. AL
Suzy
I have here in my hand September's issue of the Arizona state board of nursing journal. For that month there were 78 cna's disciplined for
misconduct. There were166 rn's and lpn's disciplined for misconduct. As expected, over 95 percent of those disciplined were female, which correlates
with the high number of female healthcare workers. Until the workplace reaches equilibrium with equal genders how will this form go over with
management. I do think it is a very good idea and would support it being sent to every hospital and medical facility.
You see I don't see it being recieved with a warm welcome, particularly with the vast majority of female nursing staff. They already get their
needs met in mammography, L&D, post-op gyn, the emergency rooms and intensive care units. Those units are almost 100 percent female staff and
in many cases 100 percent.
PT
Suzy, I say SEND IT! It covers most of the concerns expressed on this thread over they years. I would also toss in as the unequivocal concluding preference:
"For all examinations and procedures, I specifically request those in attendance be first introduced and accepted by me.
_____Yes
_____No
On the other hand that might be a "killer" preference issue that would never be accepted by the hospital or clinic though I think that this is really a summation of what all the other 4 preferences is all about.
In any event,Suzy, now that you have something specific to offer, who will take the preference list to the public and to the hospitals, clinics and doctors' offices? Suzy it does no good simply sitting here on my blog or your website.
Any suggestions or actions by any of my visitors? ..Maurice.
AL:
I know this isn't going to be easy, or else it would have happened by now. But we can't really let that stop us... can we?
How about turning it around. What would you suggest that a patient say to bring this up at the visit? For our more timid clients....what would THAT paper say?
My thanks to Doug and Hexanchus who originally batted this around.
PT: Is there a link to that info?
Dr. Bernstein: Yes...this will take some action other than net exposure. I'll keep you posted!
Suzy
Suzy.
Several years ago i suggested that they put gender preference on your admission form.Dr. Bernstein said that would be inappropiate.He said to discuss your modesty concerns with the doctor.Ok.The nurse takes the male patient back to the room and tell him to take everything off and the doctor will see you shortly.A few minutes later a female doctor with 2 female staff walk into the room with the male sitting there naked.Thats the appropiate time?That's like leaving your ipad on the dash of your unlocked car and complaining about it getting stolen.What i have learned is to never leave it to them.Take their power away.When they give you the admission form make your changes.Write on there no male/female staff.It's not a contract until it's signed.Make sure you get a copy.Be nice but when they give you lip ask them if the suits and the state feel the same because we are going to find out.Don't be afraid to write letters of complaint.Your on your own.Look at the modesty blog.Only 45 people in the world are willing to standup and be heard.Shameful.Maybe when their pay is tied to patient complaints something might change.It's long over do.Thanks you all the help on moving this forward. AL
When I posted a version of what Suzy has here, my original thought was that hospitals and clinics should hand patients this form. But this is not going to happen, IMO. So what I now suggest is that patients turn this series of questions into a statement about what you desire and hand it in with all the paperwork required at a hospital or doctor's office. At the very least, it will be noticed and read by the receptionist and most likely open up the discussion with the provider who treats you. I can see some hospitals or clinics (not most) turning the patient down. But, once you've made the appointment and are there, it's difficult to send you away. I'm not saying to never bring this subject up beforehand, but IMO it does little good to try to discuss this with the receptionist making the appointment. They have zero control or power over this. It's unlikely you'll have a chance to speak to your specialist unless you have meet him/her before. That's why I suggest hand it in will all the other forms and make note to them that it's an extra form. See how they react. Perhaps this is a reverse of the "ambush" we've talked about before. But IMO these are the kinds of things patients can do to begin forcing change in this area.
My visitors here might be interested in a commentary written by a woman physician on KevinMD.com published yesterday which describes her view of gender inequality regarding how a woman physician behaves toward the patient as a person and not just a disease to diagnose. "They want us to hear their voices, their concerns, their fears and their pain. Things not easily quantified and objectified."
And the author says women physicians do a better job in that professional function.
Well, as you can imagine, there are a few responses, including men physicians and ...well, go to the link above and read and you can write there or come back and write here. ..Maurice.
Dr. Bernstein, although I and other visitors sometimes disagree with what you write in defense of other medical professionals (and non-professionals) I have a great deal of respect for you and what you have to say. I'm grateful for your dedication to this blog and this cause, even though it means that you sometimes have to stand up to your peers and read so many negative comments from your readers. You have a lot of guts and humility. Thanks for giving us so much of your time.
LG
PT, another problem I have with nurses (or any other healthcare worker) that smokes is their lack of intelligence or common sense. With all that we know today about the harm that smoking causes I wouldn't trust anyone in the healthcare field that is still stupid enough to smoke.
You also said "Most hospitals have now instituted mandatory specific colors for each department."
I like that idea because if each department has their own color maybe some day that will stop nurses or aides from just hanging out with a friend in another department while she is doing something like shaving a patient's groin. Maybe it will stop some cases of exposure to unnecessary gawkers. Those that think they have the right to be anywhere they want or see anything they want just because they are employed by the institution.
Thanks for your hard work suzy.
LG
LG
Thank you for your response. Personally, I don't smoke and I don't hold it against other people who
do. But those who smoke in healthcare from what I have seen over the years take many smoke breaks
every day,leaving their patients unattended. The most disturbing issue I have seen with those who smoke
in healthcare use it as a medium to talk about their patients. It's the gossiping about their patients and
personal tidbits in front of others that is disturbing. Now, for many of you wondering what smoking has
to do with this blog, a lot.
Smoke breaks are used as a vent session, those vent sessions invariably involve caregivers using
this opportunity to comment on personal issues about their patients to other caregivers who may not know
this patient, it's a hipaa violation. The comments are often ugly and misdirected. It is a testament and
demonstrates just how much gossip there really is and further illustrates how further your privacy declines.
PT
Suzy
In 2012, there were 16,342 nurses disciplined by the nursing boards. In the state of Texas alone,
2,715 for the year 2012, followed by Ohio with 1016 and Florida with 860. The national nursing database
gives the breakdown of how many nurses were disciplined in each state.
www.ncsbn.org/3873.htm#%20map
PT
Doug,
I agree. If left up to the providers, it will likely never happen. In forming such a written statement I would caution to keep it a simple and straightforward statement of preferences. Leave the "why" out of it - that can be dealt with later, if necessary.
While some may take offense, hopefully most will at lease be willing to open the conversation.
Happy New Year Everyone!
Hex
You have to analyze stats, Suzi and PT. So, 2715 nurses disciplined in Texas in 2012 -- out of a total of 347,150 (that stat from the same site). So what percentage are we talking about here?
Florida -- 860 nurses disciplined here in 2012, out of 326,250.
Ohio -- 1016 nurses disciplined here in 2012, out of 240,078.
An even more meaningful analysis would be to see precisely what kinds of infractions were committed. A good number may be minor. Now, I'm not condoning any nurse infractions, but you can use stats to tell almost any story you want to tell by just picking and choosing numbers and throwing them around.
To all my visitors to this thread from around the world, may I wish all a good, healthy and a comfortable New Year from sunny but currently relatively cold (58 deg F) Southern California, USA. ..Maurice.
Doug,
Well said! Simple numbers without context aren't worth much.
One of my favorite books on the subject is "How to use (and Misuse) Statistics" written by Gregory Kimble. It's a fairly easy read and I recommend it to anyone that wants a better understanding of how statistics are used.
Oddly enough, some of the worst abusers I have seen are the medical industry, especially when it comes to touting the efficacy and value of screening tests and exams.
As we have discussed here many times, context is everything.
For example, there is a chemical compound that is the cause of 4000 deaths and 6000 near deaths a year in the U.S. Further, it is the leading cause of accidental death in the US in children ages 1 to 4. When heated it can become extremely dangerous and can cause severe explosions when not properly handled. It is also one of the most aggressive chemical solvents known to man and is corrosive to many common structural materials and can cause severe damage. Given these well established facts, many would cry out for tight regulation or banning of this compound - until of course they find out that the extremely dangerous chemical I'm referring to is none other than the dastardly di-hydrogen oxide - or as we more commonly know it, H2O, or simply water.
It's all about spin......or in other words, the context in which information is presented.
Respectfully Suze, in number 2, there should be a third option, which is the possibility to decline all sorts of intimate care, regardless of your gender or that of the provider.
Otherwise, it's a moot point, you'll never own your own body if you cannot refuse some interventions.
Happy New Year people
Really Doug, you want me to go there, very well.
According to the FBI statistics there were just under 14,000 murders in the US in 2012.
That same year 16,342 nurses in the US were disciplined by state nursing boards.
Does this mean nurses are more ethical than murderers according to the recent poll.
Not at all,in fact nurses kill over 100,000 patients a year simply by not washing their hands.
It's called death by nocosomial infection, that's a hospital acquired infection.
With 2715 disciplined in Texas, 1016 in Ohio and Florida at 860 it would be a presidential sweep
if this were a race for electoral votes as if you take Texas, Ohio and Florida it's always a sure win.
Yet, this isn't about a race for the presidency, it's about bad thing that happen to good people when they
are ill. Speaking of Florida, that is where the female nurse that started the blog about her male patients
genitalia, Juicy Penis. She violated Hipaa. That is the blog you help championed against and got removed.
But still the nursing board did nothing. Nor did the Texas nursing board take action against Trauma Diva as well.
Both of these nurses and their actions are explained on Dr. Shermans site. Want to know how Florida fits into this
and the blog a female nurse started there.
I wonder what the poll would think about the nursing industry and their precious little darlings now.
PT
PT -- Let's just agree to disagree. When your thinking process takes you from nurse infractions to murderers to nurses as murderers -- then I'm at a loss to debate with you. I see no logical flow or analogy to it. You move from stats to illogical conclusions without going through a logical thinking process -- perhaps because your past experiences and hatred of nurses has blinded you. It's unfortunate, because you do make some important observations at times.
Doug
No one said you have to debate or challenge anyone here. I'm simply laying out some numbers and
a website. My goal was to illustrate how ineffective nursing boards really are through poor leadership, low
staffing or perhaps a lack of desire to discipline nurses. Several years ago the governor of California fired
nearly an entire nursing board for just cause.
I believe everyone should challenge the notion that nurses are the most ethical group and by doing so
bring attention to an industry that needs overhaul in many respects. By the way, one of the leading causes of
nurse license revocation is having a felony conviction. Remarkably, in the state of Indiana all new nurse
applications as of Oct 2011 require a felony background check and fingerprinting. A testament to how far behind
the times these boards really are. From a standpoint statistically does it really matter if someone dies from being
murdered versus someone who dies from a preventable infection.
I was simply making a point. That nurses kill patients about nine times more than the average national murder
rate. There are posters placed throughout hospitals these days, depicting a young boy lying in a hospital bed that says
" you could kill him with your bare hands, simply by not washing your hands."
The nursing industry and the selective service discriminate most against males in this country in that order
respectively than anyone other institution. This blog and it's subject matter tend to bring that point home for many
and you even brought up the notion that the nursing board did not bring action against the two nurses mentioned
on Dr Shermans site.
PT
Could we please stop all the bickering and get back to the real issue.Patient modesty.
There was a article in the local paper about "Guidelines for hospital doctor issues.Here are a few paragraphs.
1.Hospital employment agreements often include provisions that discourage doctors from sending patients to providers of services that are not affiliated with the hospital.
2.Hospitals have told doctors they must use their hospitals for laboratory work and certain imaging procedures,even if doctors found that they got better results or better service elsewhere.
3.In compensating doctors,hospitals often pay a salary with a bonus that depends on a doctors productivity.
So,ask the doctor if they will accommodate with a all male/female staff.If the answer is no,throw it back at them.Tell them you refuse to use their center if they won't accommodate.This way they will know why the patient didn't use their service.
If the doctors pay/bonus is connected with the patients using the hospitals centers, maybe someone will notice.These guidelines were issued to increase revenue.If they won't accommodate,take your health care dollars elsewhere. AL
AL
CMS already has rules in place to prevent physicians from profiting from diagnostic tests. It's called the anti-markup rule. Often times
the insurance decides where patients may go for tests. We are on the issue of patient modesty and an important issue of our right to privacy
is how effective a nursing board would be when that trust is broken. We have already seen how useless core values are and we will be I'm sure
further enlightened on how useless nursing boards are.
Physicians basically have no control on who delivers care to you when an order is written. They just order the tests and send you on your
way to the appropriate department. That responsibility falls on you, you are the first manager of your care.
PT
PT, That is correct except if you are hospitalized. My doctor ordered same gender care for me without telling me. She knew the issues, that abuse and impropriety and cruel and debgrading treatment was the backbone of why I wanted the same gender care.
While the hospital did accommodate, there was an issue I found very interesting.
They sent in a nurse to do a cardiogram. She didn't know what she was doing. I asked where the techs were and she told me that there were no female technicians on duty. My mistake was that I should have refused the test until there was because she messed it up and it gave readings that could have effected my diagnosis until I spoke up and asked them to repeat the test that ended up being normal.
So...the question is, wouldn't it speak better of the hospital to tell the patient what was ordered, give the patient a choice than to have shoddy unqualified people doing things just because of their gender? I would have refused the test unless the male techs used a technique that requires no exposure. They are doing this in several hospitals.
belinda
A short primer on state nursing boards(BON).
Who are nursing boards and what do they do? Supposedly, they protect the public
and regulate nursing license,discipline and offer suggestions on regulatory practices as well
as nursing education. What is relevant to this thread is how they would carry out an investigation
should one make a complaint to the board.
To begin, first it should be said that the heads of nursing boards are elected officials and
are given those positions by the governor of that state. Those elected officials are often composed
of 7 individuals of which 5 are nurses, an attorney who usually specializes in healthcare law, and
a public member. Furthermore, the 5 elected nurses are usually nurses who might be nursing
program directors at a college of nursing, directors of. A nursing home,etc. In other words, these
nurses are not your typical bedside nurse.
Now at any nursing board there may be as many as 50 to 70 staff. These staff are usually
distributed throughout the many departments of a nursing board such as Administration,monitoring,
receptionists,license,certification,information technology,legal secretary,investigations, hearings,
complaints and chemical dependence.
It is most important to remember that all nursing board staff are paid by tax payers monies,
yes paid for by you, not the hospitals or medical facilities. It is common for any state nursing board
to discipline thousands of nurses in one state in one year alone. In 2012, the Texas state nursing
board disciplined 2,715 for that year.
It is further interesting to note that any patient who has a legitimate complaint against a nurse
may file a complaint online. Once the process begins, the state nursing board will start the investigation
process, and the nurse you filed the complaint against will recieve a notice of an investigative process,
but won't be told of any further information until the nursing board completes their investigation. The
nursing board has the authority to revoke a nurses license on an emergency basis if it fears that nurse
presents an immediate danger to the public.
Another interesting statistic about nursing board complaints are that 95 percent of all complaints
submitted to state nursing boards are from hospitals and medical facilities. These are direct results from
drug diversion, impaired and/or gross patient safety issues and poor patient outcomes resulting from
nursing incompetence. Very very few patients ever submit complaints to the BON and those complaints
represent less than 3 percent of all complaints. The complaints that are reported are to the hospital
and those complaints usually do not go any further.
In my next primer i list some examples of patient complaints and how those complaints relate
to this blog.
PT
Now that was a useful and interesting post, PT. I look forward to the next one.
I am not sure that anything has changed in the medical system regarding physical modesty of patients (at least within the United States) since the 2005 Perspective article "Naked" written by Atul Gawande, young surgeon, in the New England Journal of Medicine
(N Engl J Med August 18 2005)and which was the basis for my first Volume on patient modesty titled "Naked" (Unfortunately, the link to the pdf file of the article is no longer valid and you will have to go to a library or find a friend with a subscription to NEJM to read the artilce.)
What the article is all about is that Atul is frustrated with the lack of professional standardization and unambiguous practices to carry out a medical evaluation but with attention to the modesty issues of most all patients.
And it seems from the stories written to this thread over the years: NOTHING HAS CHANGED! ..Maurice.
Maurice
I believe a lot has in fact changed in that people are being enlightened and often that forest
takes years to grow. No doubt you have planted the seeds, have you not?
PT
I completely agree with PT. I've learned to simply insist my personal dignity, privacy, and modesty standards will be met. If the facility in question fails to meet those standards, I simply go elsewhere.
Has anyone ever raised these issues with the ACLU?
Ed
I felt good and patted myself on my back as I came home from my workshop teaching for 2nd year medical students this afternoon. I saw over a 4hr period some 10 groups of 4-6 students each as they practiced male genital and rectal exams on plastic models. And with each group, I started out with the concerned mantra that I have witnessed all these years on this thread about modesty and the need for communication with the patient, hopefully initiated by the doctor before and during the examination. I also pointed out to them the added necessity and understanding for those patients who were new to the physician or those who had been "compelled" to have the examination such as for a sports physical or for employment. As they interacted with their plastic pelvic models speaking to them as they would to a real person, I encouraged them to continue explanation of what will happen next , what the person will feel and to inform as to how the person can actively help in the examination such as pulling back the foreskin or elevating the penis so that the student could inspect more fully. So these 50 or so 2nd year medical students have experienced a bit of our Patient Modesty thread philosophy. How they will behave later in their clinical experience both in school and beyond I can't be sure but at least I tried to give them the "message" today. ..Maurice.
Congragulations Maurice
You as always have our utmost respect.
PT
An e-mail to me today. Any comments? This is part 1. ..Maurice.
I am a 40 year old male with a female GP who I have been satisfied with during my annual visits over the past few years. I guess I am among the rare males who prefer female doctors and have seen several over the course of the last 10 years with excellent results. I am not shy about talking about my health, disrobing, or receiving any type of intimate exam from a woman doctor.
For me, and likely many of us, the physical exam process involves:
-Nurse takes vitals, leaves, tells me to undress and put on the gown
-The doctor enters and we discuss my health for a bit
-The physical exam, eyes, ears, throat, heartbeat, abdomen, etc
-The last two items are the genital exam and the DRE
-A few brief final words and it is over
I have not ever really felt entirely comfortably with end of the exam. I feel anxiety in the build up to it throughout the exam, and indeed for hours and even days beforehand. I am not sure why I am so anxious because I don’t mind having my genitals exposed and touched in this setting, nor does the DRE bother me. I am not modest with my body and I want to be examined thoroughly. I think it is the suddenness with which the exam ends, so abruptly right at that point that troubles me. I am left to dress and leave with little time adjust to the exposure that accompanies the GU and DRE. I feel that it is more the nature of the exam and the sequence that is the problem for me than the exposure. I feel some degree of shame after the doctor leaves and I am, just like that, getting dressed and out the door. It feels like the exam procedure is saving the “worst” part for last and then it seems like the doctor (any doc, not just my current GP) can’t get out the door fast enough and have done with the whole process, a feeling I do not enjoy in the least.
Here is an idea I have for my next exam:
1. In hopes of relieving some of my sense of post exam shame I plan to request that exam begin with the GU and DRE. I think this is a reasonable request.
2. My second request is a bit more unusual. I am going to ask that after the initial discussion is over I remove my gown, get the GU and DRE checks and stay uncovered for the rest of the exam. Essentially, have the entire physical examination portion in the nude, all parts of the exam including things like eye and throat, portions that require no state of undress at all. My hope is that by the end I will have relaxed and become comfortable with the entire process and the exposure anxiety I feel will be eliminated because I am exposed the whole time.
Part 2. ..Maurice.
I understand there is no clinical reason for me to be nude throughout, but there is some evidence that it may lead to a more satisfactory exam. This is a link I found to a study providing some evidence: http://www.michaelguth.com/?p=1227 In the study it seems that a certain number of men did remain nude throughout and were more comfortable as a result.
I am not sure how I would feel if the exam was performed while I was nude. I am not modest at all so I don’t think I would feel uncomfortable, but I am concerned that my doctor will think I am a little crazy or an exhibitionist and be suspicious of me. I do not know if the clinic would even allow such an exam, maybe they some guidelines against it. If she does grant my request I wonder if it would be on the condition of the presence of a chaperone. Part of me feels like this is such an unusual request that will result in an exam unlike any she ever performs that there is only a small chance it will be honored.
To conclude, I want to be examined in a way that makes me most comfortable before, during, and after the exam. I am interested in trying this new method though I am unsure of how it will make me feel in the end. I do not want to make my doctor suspicious of me, I value that level of trust I feel while in her care. If I send this message ahead of my exam and she is reluctant I will be somewhat concerned. Unless she replies, “no problem, we can do exam that way,” I don’t know how the situation will play out. Seems like there is only one way to find out and going to another doctor is always an option though I would rather not.
I would appreciate any thoughts you have on this issue. Thank you.
Go, but you are changing the dynamic. Even if “no problem, we can do exam that way,” be prepared for a chaperone or a MA entering the room during the exam for [insert any excuse here]. Since you are not modest, I see no problem with your request.
BJTNT
After reading the last few posts, I am once again brought back to the question: What is with the seeming obsession with genital exams? Why are symptomless people putting themselves through such psychological distress as in the previous post? Why does a forty year old man need a genital exam and DRE every year? I just wish doctors would be more up front with patients about what is really necessary and free them from the misery of these unnecessary checks. LKT
The porn industry has larger revenues than Microsoft,Google,Amazon,EBay,Yahoo,
Apple and Netflicks combined. There are 4.2 million porn sites on the Internet equalling
420 million pages. There are 68 million daily searches for Internet porn and the largest
age group searching for porn is the 35-49 group. There were 957 million adult video rentals
in 2006. Women accessing adult websites each month average about 9.4 million.
Medical fetish porn accounts for about 16 percent of all porn and those revenues alone
could purchase almost every medical school in this country lock,stock and barrel! It is truly
pathetic that some have to pollute this blog with their demented fantasies while some of us
want a little respectful care and privacy. It's enough to make you sick.
PT
PT, you have to explain yourself concerning your last comment tonight.
Was it in reference to the my received e-mail which I posted today? And, if so, where is the pornography?
So far, as far as I have noted, there hasn't been any pornographic writings here. In fact, actually as I had attempted a few years ago on this thread to get the view of a porn actress or actor with regard to their own patient modesty, if any. As you may recall, I did get a naturist or two write here but no porn stars.
PT, one other request. Please supply us with the links for your statistics. It isn't that I think you are making up the numbers but I feel it would be worth while for those of us with interest to have access to the sources of those statistics to get the details of how they were obtained.
PT, keep writing, your views are appreciated but may be occasionally challenged. ..Maurice.
I agree with LKT: why is it necessary to have exams of the genitals on a yearly basis??? Especially for men since they can obviously see/feel if something is not normal and address it as such. I really don't understand why women either, for that matter, need to have visual inspections of their genitals on a yearly basis. In my opinion when there is a problem with one's genitals that person will most likely know and can consult a doctor at that point. It may only make sense for someone (especially a woman) to have these exams if they are being exposed to multiple sexual partners on a regualr basis so at risk for STDs. Otherwise it makes no sense to me. And also the DRE in men: I wouldn't think doctors would do that until the man reaches his 50s to check the prostate. Just don't understand why healthy people are going to the doctor every year for an exam this thorough when current studies all point to the lack of evidence for their usefullness. Jean
PT, don't forget to add those numbers for the amount of men who access porn each month as you have with the women. Also, the source of your information.
Here is the e-mail response from the man whose initial e-mail I posted yesterday. I suggested in my reply that full nudity for the full exam may not be acceptable by a doctor because of the shivering effect of chilling which interferes with auscultation and palpation. Also full nudity can be distracting to the doctor who is trained to examine in a segmentally uncovered fashion. I think this individual has an entirely different concern than what is usually written here. It appears to be the lack of a conclusion to a "climax" of a genital and rectal exam. I hope, beyond today's e-mail, he will write directly here so we can get a better picture of his concern. ..Maurice.
I have been examined in just my undershorts in the past and have not got the shivers. I generally run "hot" and don't like the heat to be too high at home or work so the shivers seem unlikely.
The study in the link that I sent prompted my interest in having the exam while nude, it seemed like some men had done this and had a better experience as a result. I did contact Dr. Guth who performed the survey and he encouraged me to make the request and cite the article in doing so.
I don't want to create an overly awkward situation but I feel that exam is already quite awkward. I would like to feel like the nudity and the exposure is not a big deal and is natural. I am at the office to have my body examined, here is my body, examine me. Some might say she is a doctor she has seen it all and won't care, others that this will surely make her uncomfortable and me as well.
I cannot find much more evidence of this beyond that one source. My idea is to try it and see. I think it is likely that the request, if I do make it, will be turned down for whatever reason. I doubt I would leave my doctor just so I could get examined in this way if that was the case because there is no guarantee that another doctor would grant it. Given this likelihood I may not even say anything and just have the exam as usual. If I knew that my doctor would not mind then I would do it for sure. I do respect her though, and would not want her to feel uncomfortable or suspicious.
By all means, post the situation to the blog anonymously. I would be interested to see what the response is from the community.
If I've learned anything from following the patient modesty issue is no one sees this issue exactly the same. What's OK for some is a major violation to others. My gut feeling is a physician receiving this request would view the patient as an exhibitionist. There is a time and place for everything but the exam room is not appropriate. He needs to consider what's comfortable for the physician as well and I'm relatively confident there are few male and far fewer female physicians that are. Regardless of whether the physician agrees, I personally consider myself a professional equal with my physicians and would never do anything that might change that perception.
That said, I do agree that conducting the genital/DRE at the end is less than optimum. I dread these exams and the anxiety I feel detracts from open and frank communication. Get it over with up front.
Ed
The best thing that could happen would be for this guy to be told to keep his nude self at home until he actually needs a doctor for something! Call the doctor in about ten years when a DRE might be warranted. Our medical system is jammed with the "worried well" while truly ill people can't get a GP appointment. Overworked doctors need to find ways to keep healthy young people out of their offices. In my own case I was led to believe that I needed a full body skin check every year. I went for several years until the derm stated that I really did not need to return unless something changed. I thanked her for her candor. That is how it should work. If a patient does not realize something is unnecessary, the doctor should let them know. LKT
Did it occur to anyone that this person is "putting us on".
Our society has certain norms. If this person isn't a nudist (or even if he were) who would be comfortable being examined in the nude when everyone else is dressed? It doesn't make sense.
My opinion is that this person is into salacious medical stories and this is their way of presenting such on this blog...a waste of time and beneath the dignity of a response.
belinda
Belinda, your first sentence does make a reasonable point and I wonder why being naked would benefit his primary concern about the conclusion of the genital/rectal procedure itself.
However, beyond that, I am not sure about disseminating a "salacious story" , since this individual only wrote his concerns to me in an e-mail for my opinion and it was my suggestion that I put it up on the blog thread, about which he subsequently agreed. So I don't think his view was directed initially to be publicized on our blog. Anyway, I hope he comes here and directly clarifies his concerns. ..Maurice.
I do not think he is "putting us on."
He told us at the beginning that he prefers female doctors, and I can't help but wonder if he would want to sit there naked the whole time if it were a male doctor ? Maybe he just likes to expose himself to females...but maybe not.
I am a female who prefers male doctors for intimate exams, and I get NO THRILLS from it, I just feel more comfortable. (I had a female doctor make an unnecessary offensive comment about my body once.)
LJ
Here is another female physician writing another patronizing article on why men need babysitting with respect to their healthcare.
http://www.today.com/id/43429948/ns/health/#.UPc-rCez6Sp
Ed
Yes Ed,
Loved the comment about the men taking someone with them. (No doubt the female partner). As if mere men can't take it in. Perhaps men should go with women so they can get the message correct also?
We are after all talking about a health check I assume, not a severe illness when taking someone with you makes sense.
Chris
I find it interesting that the "war of the sexes" is still being debated. I personally feel while it is not THE issue, it is A issue that must be acknowledge, we have seen numerous examples (Dr, Orange, Urologist Keigel, and the latest example on Dr. Kevin's blog) that sexism against male patients is accepted in the medical community. While respect for all would solve everything, that will be difficult to achieve without acknowledging and dealing with the double standard. Females have faced this on many fronts and the first step of resolving it was getting the larger community to acknowledge it rather then deny it exists.
On another front, while we have not achieved a large scale revolution, we have made some strides individually. one thing I have had a high degree of success with it using facilities websites and email. the last time I had a proceedure I simpley used the contact us on the website and emailed my concerns, I got an email response acknowledging, instructing, and they forwarded the request to the appropriate people in the departments. it is so much easier doing it with email to put your concerns out there and you have a written record of responses...works well for me because of this thread, give it a try....alan
Chris, she was addressing routine health screening for guys. I thought the following was the worst:
"Men are usually good at taking directions when the directives are spelled out clearly."
While that may be true for some, it's certainly also true for some women.
And since when are routine health screenings considered "directive" in nature? Last time I checked, informed consent was a prerequisite.
Ed
In President Obama's 2nd Inauguration Speech today, he stresses, I think the need for gender equality when he emphasized "It is now our generation's task to carry on what those pioneers began, for our journey is not complete until our wives, our mothers and daughters can earn a living equal to their efforts." Should he have also stressed the importance of equality of treatment of the genders in other respects? I am sure those writing to this thread would say "yes". I am sure you think that there are aspects of gender inequalities that are not recognized by the public and should also be included in a consideration of tasks for "completion". ..Maurice.
If you haven't heard, the X ray machines at the airports that are very graphic are being removed by June 2013. What a victory for us all.
They don't want to say but I'm sure this is about $$. Passengers who saw this as an issue stopped flying. I am one of those and wrote dozens of letters to everyone about this issue.
Privacy rights should be equal and until the patient population insists on same gender care when needed nothing will change....until their pocketbooks show a loss or problem.
It's time to treat the medical profession as the business it is. Schedule your tests, tell them what you need and then when you don't get it, walk out. Then...write a letter to the head of the department telling them why you walked out, what they promised and what other testing they will miss because you took your business elsewhere.
This may be difficult in some cases where capitation is an issue, but if it is not, you might want to schedule the same test at two different places so that you have a back up.
Until it is felt in the pocket book nothing will happen.
belinda
There are a number of posters on this blog that make valuable points, but belinda is the best.
Thanks to all - keep up the good work.
BJTNT
Maurice
Several posts back you asked me " And if so, where is the pornography."
Look up the definition of pornography, what do you see? All the ingredients
are there. Exhibition, voyuerism and yet it dosen't just involve adults, it includes
children. This is why there seemed to be large group exams for young men where
women would make themselves present, ie military induction exams and sports, hernia
exams for boys at schools.
Describe one nude group exam for the elderly for me, can you Maurice. There are non
and it's odd isn't it in that all the more so for medical exams since the elderly are more
at risk for a disease process than the young. Why were just the young targeted for these
group exams, no offense but who wants to look at elderly nude people?
Would Linda Lovelace be making porn videos in her 80's and would there be a market, I
don't think so. Do people who become patients have the expectation that they may become
the object of pornography for others in the medical industry? Are the residents of a nursing
home required to line up nude for group medical exams, well for some they would have to
be nude in their wheelchairs cause they can't stand. Are you seeing the contrast here and if
so who would be the observers, non I'm sure as who would be aroused in this situation.
There really is not much difference between porn and erotica and I'm suggesting that patients
are used as media for the gratification of others in the healthcare setting. Last year alone over
a hundred million viewers sought porn on the internet. Are we to assume that not one of these
viewers are healthcare workers.
PT
PT I always appreciate your posts. I regularly volunteer to take elderly folks to medical appointments. Most request that I come in with them when they see the doctor. I have yet to see one of them be asked to disrobe in any way or put on a gown no matter what they came in for. A friend of mine's mom complained of severe back pain for ten days. She was given pain meds but nothing helped. It was not until she was admitted to the hospital that her daughter looked at her back and saw that she had Shingles. During multiple doctor visits no one had ever actually looked at her back. I imagine if she had been twenty-five instead of seventy-five her back would have examined much more thoroughly. LKT
I have never in my career seen either an elderly patient nor one of much lesser years of age examined in the nude. We don't teach our medical students to do so and, in fact, as I have noted here previously, do advise segmental uncovering with attention to patient physical comfort and modesty. I have only heard about dermatologists performing such nude full skin exams by our medical school derm professor who, as I have mentioned here previously, supported segmental uncovering as the most accurate way to detect small significant lesions.
Yes, we all know of cases of missed diagnoses if patients are not uncovered adequately but nudity is totally unnecessary. Unnecessary, except for the work of those physicians performing their duties of examining bodies thoroughly (as I witnessed today), for example, in the Coroner's Office, where the deceased's clothing is neither necessary for patient modesty or the thorough autopsy process. ..Maurice.
Dr Bernstein, yes there are certainly gender inequalities not recognized by the public but the president has enough to worry about. I was certainly unaware until I needed medical care. Laws currently written apply to both gender's but it's the application that many of us take issue with. That's your profession's problem as well as mine and others.
Ed
A cousin of mine who was in her 80's at the time and a hospitalized patient was asked by a male doctor to remove her gown for an examination. Her reply was, "Why would you want to embarrass an old lady?" She refused.
Many requests are made of patients to do things that do nothing to enhance their examination experience either due to "procedure" or due to something else. I have told stories of inappropriate demands to undress that have happened to me. There is also the women in a NY hospital after having a mastectomy who was approached by a male doctor, stripped of her sheets and gown in front of a room full of students. This incident was written up in the NY newspapers. What would be the purpose of this?
This time, I'm with PT. Absolutely, sexual abuse, violations and inappropriate everything happen in all hospitals and the reason?...because they can.
belinda
Well Maurice
Interesting that you mention the autospy process and wether they were nude or not. I have in
the past been required to visit the morgue on a few occasions. The deceased were fully clothed
as they were murder cases and their clothing was part of the crime scene as well which I will add
were left on them. It is worth mentioning that the morgue is one place where you don't get observers
from what I've seen. Now, what happens when deceased are transported to a funeral home is another
story. I have read quite a few disturbing stories,newspaper accounts of unprofessional behavior at
funeral homes. In many states licensing of morticians and funeral homes have come under considerable
scrutiny.
If you don't mind Maurice I would like to share a true story with our readers. About 20 years ago
an older gentleman had passed away at a local hospital in a well to do part of town. His body was retrieved
by the funeral home. Later that day the funeral home called the hospital and said " we did not get paperwork
for his organ donation." The hospital's reply was " he was not an organ donor." The funeral home replied " he
must have been. His penis was cut off, he was lying in a pool of blood." The reply from the hospital was, " you
don't donate your penis, what do you mean he was lying in a pool of blood." At that point the deceased became a
murder investigation. This happened on Halloween night, sadly the case has not been solved. It has yet to be determined
if this was his cause of death or a sadistic cult act that occurred while this patient was in the hospital or at the funeral
home. The family publicly asked for help and posted a $10,000 reward.
PT
LKT
Exactly, you have provided an example of what I have observed. Are the elderly considered
unworthy of a thorough workup compared to the young. Why the emphasis on group exams for
younger people and what was the driving force?Does the importance of preservation for the
young and healthy supersede the elderly? Which group is more at risk for disease processes?
Odd isn't it that we never hear of group medical exams for the elderly where there is partial or full
nudity. I can just hear some of the comments from some elderly if asked " you want to do what" Suppose
they are not so easily ambushed or is it just that no one takes an interest on that one. But then,if that ever
happened they would have to open a whole new segment on the mister polls. The provider that wants to do
that better not have another pressing appointment as it might take an hour for some of these elderly just to
remove half of their clothing. Better pack a lunch on that one. It might just take the entire nursing staff half
the day just to round these residents up. Be interesting to see what the AMA( American medical association)
stance on this one if that ever happened.
PT
PT, based on my experience of with years of taking my 2nd year medical students to the Coroner's Office to observe the autopsies, when we arrive to watch the beginning of an autopsy, ALL the bodies are without clothing. However, in suspected criminal cases, we see the police detectives watching at the autopsy tables and I am sure that after the deceased is first brought in they are clothed and then appropriately undressed under police supervision if that is necessary. In addition, I have been with the students within the cold storage area where hundreds of bodies are kept and they are all without clothing.
Pertinent to the discussions on this thread, here is a new thought: I would like to read opinions regarding setting the limits of physical modesty only to those who are alive and will never apply to those who are deceased. Obviously, based on what has been previously written here, there is different opinions expressed regarding physical modesty concerns, when awake, of those patients who are unconscious but alive at the time they are viewed by others. But does physical modesty apply to those who are dead? And, if so, who should bear the modesty and why? Virtually philosophical questions, I think, but it should be interesting to read your answers. ..Maurice.
Dr. B,
Interesting re notion of dead bodies and modesty. Don’t have time to write a lot about this, but here are a few examples where the dead body is treated with modesty, all pertaining to viewing of the body by the public versus non-public or medical “professionals”.
1. When a body is presented for identification to a family member, it is draped.
2. On the widely popular tv show ncis, for awhile the naked body at autopsy had a bright light obscuring the genitals but it was clear that the body was undraped.
3. In later seasons of ncis, they started actually draping the genitals with a towel. It would be interesting to ask the producers why they changed this.
4. Saw a video on youtube with the German guy that does the shows regarding the human anatomy. He was dissecting a female and made a point that her face was draped to protect her “privacy”. Interestingly, on the set he had live nude models (male/female) he was using as props. Their faces were not draped.
5. Again on youtube, there is a corner doing an autopsy on a young woman who overdosed. They had her genitals covered with a towel. When the towel moved, someone off camera reached in and adjusted it.
6. Why do we bury our dead clothed if dead bodies should no longer be treated with modesty?
I think this points to what are the societal norms vs what is the acculturated norms of the medical community and how each view the human body in death and in life.
-amr
amr, thanks for a very informative commentary especially ending with a thoughtful question: "what are the societal norms vs what is the acculturated norms of the medical community and how each view the human body in death and in life." And that leads to the question: who is being protected by any physical modesty which is being expressed by those still living and may be simply observing the body? Is it assumed that it should be the observers who need to constrained in their observations by the need to maintain, even in death, patient modesty? If so, that would put patient physical modesty as a very high concept. On the other hand, as I understand the U.S. Federal HIPAA law regarding patient medical privacy, the requirements continue beyond the death of the patient. Should physical privacy be similarly considered? ..Maurice.
Some religions dictate that a body of the opposite sex may not be viewed after death. Special provisions are made at the funeral parlor for that special treatment for an all male or all female staff depending on the gender of the deceased.
It is however, in some religions forbidden to be cremated so if you want the modesty regulations, you have to be buried.
I'm sure that if this is important to someone, their family would want to honor the dignity of that person. You would need to find a funeral parlor that could comply.
belinda
"I have never in my career seen either an elderly patient nor one of much lesser years of age examined in the nude."
Dr Bernstein I have all the respect in the world for you, but in that statement you sound like a typical uncaring healthcare worker. Naked is naked, whether it's all at once or in segments. That might be acceptable if the patient's problem or suspected problem is on their groin area, butt or female breasts. Then the examiners should always be the same gender. But for any other reason those areas should always be covered, and no unnecessary person should be viewing it.
I couldn't care less who sees my chest, back or legs so I don't see any reason why they would need to keep them covered while staring at my privates. What's the point?
amr,
I noticed the NCIS thing too. I also noticed how many unnecessary people are in and out of the area during the autopsy or while the body is just lying there. I imagine it's no different in real life. I think a dead body deserves all the respect a living body gets (or should get). My greatest fear in death is having my body mutilated by an autopsy but after that is knowing how much my body will be disrespected by probably dozens of people, including women. It often makes me think about taking a boat out into the ocean when the time is right and tying an anchor to my leg. I would rather have my body eaten by sea creatures than put up for display in a hospital, morgue or funeral home.
GR
My mother is 85 years old and has been in a nursing home for almost 5 years now. I said
mom,when was the last time you had a physical. She laughed at me and said, son I can't
even remember, maybe 50 years ago. I'm certain it was when she had her hysterectomy.
There are women in her nursing home who are about her age and some older who still
have their uterus. Why are the young so heavily screened, with group physicals and why
specifically men targeted for these group exams with females present.
If you think this practice has ended you are wrong and on my next post I will tell you the
new wave with computer ordering with a scrib present. Nevertheless, I out of curiosity called
17 nursing homes in my city and interestingly not one had a medical exam room nor a gyn
table to do pelvic exams. I spoke with a nurse at one facility and when I asked her if their
facility had a gyn table her response was "why would we have one of those."
My point it seems that no one is interested in doing pelvic exams on senior citizens. Nor
is anyone interested in doing group physical exams on the elderly. If they did would there
be observers for either gender. Would anyone show up if it were publicly announced. They
were certainly present it seems during induction physicals for men so much so that the military
banned opposite gender observers in 2000 per US army guidelines. Pathetic that a non-medical
military commander had to tell physicians how to conduct a group medical exam. One of the oaths
of Hippocrates, I will respect the privacy of my patients. Maybe these would be physicians were
sick that day.
What if at the conclusion of medical school all the soon to be physicians had to be examined
nude in a group medical exam. This exam could be held say in the library or in any public room
in the building and all the applicants had to walk nude in a large group from one station to the
next. Would any of the applicants object to this despite being told it's mandatory to graduate.
Would this drive the point home to people how redundant and disturbing this would appear and
what would you think about the observers who went out of their way just to be there that day to
see this. I really can't see any logical basis, that well meaning people actually sat down at a table
and worked this out logistically. That any kind of group exam has to be the result of a sick deviant
mind with sexual undertones. That any group exam to me is a hipaa violation in that the person next
to you would most certainly know your name and might have knowledge of your medical status during
such exam. I'm curious as to what if any the AMA's thoughts are on group exams.
PT
PT, a group medical exam with nude medical students as a teaching tool is a ridiculous imaginative hallucination on your part. However, and I may have previously mentioned this on my blog, in the past (don't know if still ongoing) medical residents training in a local hospital here in Southern California were assigned as part of their training to be full time patients, remaining in a hospital bed and subjected to all the dignities and indignities which appear to go along being a hospital patient. If that experience didn't teach them a thing or two, I don't know why not. My residency training at Los Angeles County Hospital did not include this special experience though with my own medical problems, twice hospitalized, I am fully aware of what goes on within the hospital bed railings. And NO, I did not ask for and rejected any VIP treatment.
GR, I can assure you, in our medical school "Introduction to Clinical Medicine" course where the faculty including me teach first and second year medical students how to perform a physical exam, NEVER, NEVER do we advise patient nudity but stress selective uncovering to preserve modesty and prevent chilling. ..Maurice.
Maurice
Yes, I am aware of the residents in southern California who as part of their training to be full time patients and
no I do not believe it is the same experience as an actual patient. No, I'm not hallucinating with a ridiculous imagination
for group medical exams as a teaching tool. I am simply reiterating what you apparently find repulsive for a group medical
exam and to be truthful, it's no more suggestive of an actual experience of a patient. Then why not let the experience entail
how the medical community has regards for patient privacy over the last 50 years, that would be a true learning experience.
PT
Maurice said
" And no, I did not ask for and rejected any VIP treatment.".....Are you suggesting
there exists a class hierarchy among patients. Were you offered VIP treatment, apparently so
and I suppose people have forgotten the golden rule.
PT
PT, pertinent to the discussion on this thread, here is what I wrote about VIP treatment of physicians in October 2004 thread "Physician as Patient (2). ..Maurice.
What is the VIP syndrome? The Very Important Person (VIP) syndrome is a pattern of behavior by both the ill physician and his/her healthcare providers that may be deleterious to the established standards of medical care. From the ill physician’s point of view, his or her illness as a physician requires special attention by the caregivers not given to the other patients. The physician is to be treated as a professional and is to be kept fully informed about all the clinical details and is to be consulted as a colleague by the treating physician. The ill physician may request that appointments or lab tests take priority over others for personal convenience. When hospitalized, the physician may be demanding about which nurses are assigned and how they respond to requests. Also, the family of the sick doctor may be similarly demanding.
I suspect that the VIP behavior by the ill physician is not as common as the potential for altered behavior by the treating physician. Unless the treating physician has had lengthy experience caring for medical colleagues, the experience of being a doctor’s doctor can be emotionally traumatic with anxiety, uncertainty, anger and guilt. From the outset, history taking of the doctor may be more incomplete than the average patient since there may be a tendency to avoid asking important but personally embarrassing questions such as involving mental illness, family problems, sex or drug and alcohol use. Physical exams of the ill physician may be more casual and pelvic, breast or rectal exams may be omitted. Testing may be inadequate especially if the appropriate test is uncomfortable. Telling the ill physician the diagnosis and treatment options may be difficult if the treating physician is personally uncomfortable with the conclusion and identifies with a patient with whom he or she has professionally interacted. All of these VIP elements do nothing but worsen or delay proper diagnosis and treatment
Proper communication with the ill physician is essential and probably the most important thing that a treating physician can do is at the outset to make it clear that the sick doctor is going to be treated as a patient and not as a doctor.
For more reading on this topic: "’Doctoring’ Doctors and Their Families” by Stuart A. Schneck, MD
JAMA. 1998; vol.280, pages 2039-2042.
"PT, a group medical exam with nude medical students as a teaching tool is a ridiculous imaginative hallucination on your part."
Yet that's exactly what your profession stipulated for millions of young Americans serving their country in harm's way. A ridiculous and imaginative reality for those young men that's still practiced to a degree today unfortunately!
Frankly, I'm disappointed in the patronizing tone!
Ed
Ed, but let's not take out these modesty concerns and military screening behavior on our innocent medical students who have had nothing to do with whatever is the enlistment screening protocol. The students know and by their behaviors express much more about patient modesty than those who are not familiar with medical school education are aware. The example, I have frequently seen and I believe I have noted it here on this thread is the non-action of removing or having the patient remove the stockings so that the skin of the feet can be inspected, so the temperature of the skin can be palpated, so the sensation of the toes can be accurately tested and to more thoroughly examine the pulse strength of the dorsalis pedis and posterior tibial arteries in the feet. With regard to other body areas, there is cautious resistance to adequate uncovering of the areas. And they always ask permission to uncover.
Rather than attack the medical student with nude examinations, why don't we advise such an exercise on the government officials who create the military induction physicals. And I am sure they are not medical students but governmental bureaucrats who disregard modesty for efficiency. ..Maurice.
p.s.- Medical students endure plenty of emotional trauma in their learning experience during their 4 years and don't need any more.
First, I disagree with the anonymous post that naked is naked and it doesn't matter if it's at once or in pieces.
Yes, it does matter. For starters, stripped of one's clothing all at once is neither expected by the patient. Exposing only what's needed gives a clinical meaning to the exam, preserves the dignity of the patient to some extent. I'm sure anonymous has not experienced one vs. the other.
Maurice, in reference to your comments regarding mental trauma of the medical student...I throw it back to you. Why add more sense of trauma to the medical patient when such simple things could be done without (and to use your word) punishing them any more.
belinda
Belinda, what "simple things" are you suggesting beyond what we already teach them about sequential uncovering, a general attention to patient modesty and a need to communicate with the patient who is being examined about what is to be done and to look for their permissions as the physical exam continues? ..Maurice.
It's interesting what students are taught in med school and what they do in real life.
But that's besides the point. My complaint is not with MDs re: patient modesty, but the violations by the support staff which is wide-spread from my experience and the problem.
BJTNT
Maurice
Remember that I was one of those recruits who during the Vietnam war had a group medical exam
with non-medical female observers. I do not know what the experience of others were and I'm sure there
were many,however, I placed full blame on the physician for the observers at my exam as it was completely
avoidable. In my opinion, any group exam is a violation of ones civil rights. It's a recipe for a gay circus parade
complete with every fetish imaginable.
Furthermore, ground rounds is the opposite of a group medical exam. That is where each inpatient is visited
(ambushed) with the attending and 15 residents in tow. A patient is in there room and in walks the attending and a
large group of residents. To the uninitiated 20 year old, their first though is, you could not figure out what's wrong
with me so you rounded up another 15 other physicians to help. Yet, in reality it is obtrusive don't you think. To most
patients this is intimidating, which is why I always request non-teach. There is a better way to perform grand rounds.
PT
Maurice
With all due respect and I say this sincerely, but you will never find me sympathetic to your
precious little medical students. Are you suggesting that there is even a class hierarchy among students,
particularly among those who are stressed the most. I once knew a medical resident who in her first year
of residency killed 4 patients. Likewise, I knew of a soldier in Vietnam who killed 265 enemy soldiers in
his first tour. Who do you think was stressed the most? Does this man deserve anymore emotional trauma
than your medical student. It's easy to point a finger at the government bureaucrats, but the buck stopped
with the physician and it was they who took an oath, I will respect the privacy of my patients. The soldier
took an oath as well,I will defend the constitution of the united states.
PT
PT was asking a rhetorical question. His point, which I agree with, is the medical profession is perfectly comfortable with the status quo; as long as they're clothed, they could care less about the patient's perspective. Reverse the roles and most would show more empathy. For a myriad of reasons, providers will not raise the issue. Moreover, those reasons have absolutely nothing to do with patient autonomy, rights, or the medical ethics taught to your students. Additionally, while I believe you're sincere in addressing these issues, few of your peers apparently agree with you.
Recently, a fourth year medical student posted on her blog (M.D. to be) an article about the practice of medical students performing pelvic and prostate exams on anesthetized patients in the absence of informed consent (http://blog.timesunion.com/mdtobe/should-med-students-obtain-consent-before-genital-exams/2868/). The AMA in 2003 condemned the practice and the ACOG in 2007, while more nuanced, essentially said the same thing. This practice and others continue because no one in your profession subscribes to a common standard of ethics or even standard care practices. The reality is patients are on their own with respect to basic human modesty, dignity, and privacy.
Your point that we should blame government bureaucrats is disingenuous. The people running these induction centers went to the same medical schools and universities providers in the civilian world attended. Additionally, while I agree expediency during war was the overriding consideration (correctly IMO), there is no excuse for the disparity in the way these exams were conducted for male and female enlistees during peacetime, and especially since the all-volunteer force was instituted. In my limited experience since retiring, medical care I've received has been distinctly lacking with respect to modesty, dignity, and privacy in comparison to that received in the USAF.
Finally, you speak as if all medical students receive training related to these issues as your students do. Surely, you recognize that's not correct. Emotional trauma? Has it occurred to you that the training is the underlying basis for the medical professions sense of entitlement to our bodies?
Ed
Ed, I, as a physician and an active participant (including on a hospital ethics committee) in clinical ethics will never say anything against the concept of informed consent in all medical situations. To me, examining a patient who could give consent and refuses represents legal battery.
With regard to "entitlement", I would say that is the wrong word to use regarding the relationship of the medical professions to the patient. The body and mind of the patient belongs only to the patient and nobody else is entitled to them. The body and mind of the patient is, however, the main professional subject of the practicing physician as permitted by the patient. ..Maurice.
Maurice...What simple things?
Ok, here goes:
First, accountability, responsibility for violations, reporting of same, consequences on an even basis. Background checks on all employees (including janitors) who work in a hospital, the stoppage of coverups for sexual impropriety, a change in the culture with regard to fear of losing one's job if they speak, an explanation of behaviors that are standard of care but clearly not looking at the feelings of the patient, immediate dismissal after a certain number of determined violations, stop taking informed consent from the patient because you are omitting information that is important to them (including what to expect with bodily exposure, limiting psychological trauma that has already been determined to exist. These are just a few, literally off the top of my head.
It is interesting that you would ask that question in light of the stories, feelings, and experiences of the bloggers. There is some kind of disconnect and I do mean that respectfully.
There is so much that the medical community could be doing that they simply are not. Nobody who works in it wants to step up to the plate to protect patients.
belinda
Belinda, I agree.
But many of these are not "simple" to resolve throughout this nation and this world because many you described are medical system administrative issues and like politics there is often inertia or disagreement by those who are directly responsible for changing medical system practices. Please don't blame the individual physicians for deficiencies in the whole system with regard to the issues you note.
If you want doctors to have an opportunity to make changes in how they themselves behave in doctor patient interaction, start, as a first step, by getting the HMOs and others in the industry to make sure that doctors have the time available with each patient to communicate including listening to the patient and not having to rush through history,examinations and procedures because of a schedule demanded by others in order to meet their administrative requirements.
Think of society behaviors that are illegal, immoral and/or a danger to oneself and others and yet are practiced by large numbers of the population. Changing cultural "norms" regardless how unethical and unwanted they are by the public are not "simple". ..Maurice.
Maurice
I still maintain that at the end of graduation all medical students in this country
should all walk to the first floor of their school, remove all their clothing and walk in a
single file throughout the morning while carrying a banner that says, I will respect the
privacy of of my patients. I will let them wear their shoes only, I was not given that
privilege.
This should be announced to get the maximum number of observers, non-
medical observers at that. Wait a minute, wait a minute. I just had another thought,
all nursing programs must do the same and their banner should read, I will honor
and respect my patients privacy and yes they can wear their shoes only.
As a result of this there will be some backlash as expected. An enormous
increase in the number of posts on your blog Maurice. This will no doubt create a few
unexpected fetish desires, ie voy forum posts, some medical students being arrested
for flashing students at the local H.S. A large number of these students might actually
drop out for a new found lack of trust for the medical industry.
I really don't see a problem with medical students being required to be nude for
a group exam, after all you said it's just modesty and that you care more about the technical
skills and ability of the provider so what is the problem. Maybe we should all write the dean
of medical schools and say look, millions of our military had to do this all thanks to physicians
who operated 65 mep centers in the US. Let's make this a learning tool, complete with non-
medical observers, cause a real group exam has to include non-medical female observers and
to make it fair to your female medical students, we will bring in some young male jocks from
the local colleges to improve the " group exam effect". What ever the heck that is,courtesy of
again, our past illustrious medical school graduates!
PT
Maurice, It is the doctors who allow me to navigate through the system. I don't blame them. Out of everyone, they are our best advocates "to do no harm". It is the lower level employees where the system runs itself based on rules and regulations.
It is interesting that medicine has made so many strides yet when it comes to personal dignity, autonomy and mental health we might as well be living in the dark ages because there has been no progression; in fact there has been a regression since the Civil Rights Act was passed.
The saddest thing in all of this is if employees would treat their patients the way they would want to be treated, none of this nonsense would be going on.
belinda
I agree with BJTNT's statement that " My complaint is not with MD's re: patient modesty, but the violations by the support staff which is wide-spread from my experience and the problem."
At least for most modest men, there is little difficulty in locating a male physician; but problems often arise because in his office the PA, the nurses, the CNAS, etc are almost always female and for the most part they act as if you have forfeited any right to modesty by scheduling an appointment with the physician who employs them.
I have had the same wonderful physician for a number of years. The problem is that he is in his early 70's and I realize it won't be long before he retires and I'll need to find a replacement.
I have considered the possibility that when scheduling an appointment with a prospective primary care physician I should attach the following Patient Privacy Statement to the office paperwork I will be required to complete. (The statement is largely taken directly from posts on this site)
Patient Privacy Statement
• For all intimate exams or procedures, I will accept only the presence of male physicians, nurses, assistants, or other caregivers.
• For all examinations and procedures, I specifically request that those in attendance be first introduced and accepted by me.
Signature _________________________________________________ Date _____________
I would appreciate feedback from site contributors as to the wisdom of this idea. Should I use this statement or will it immediately brand me as a "difficult" patient whom the physician would rather not deal with? Would it be preferable to wait until I meet the physician and discuss my modesty concerns with him at that time? Any comments or opinions are welcome.
MG
MG, your idea has merit but what you are intimating is that unless you have a written contract you will not trust your provider. While that may not be your intent, that is what your saying.
What I have done and works for me all of the time is have that talk with my doctor simply explaining what I need and if my needs cannot be met, time will be wasted because I will withdraw my consent.
You could send the doctor of copy for your file and while you are not asking them to sign on the dotted line, you have made your intentions clear and if there is a problem, they will have a hard time trying to charge you for a visit that you walk out on when you have made your needs clear.
This works well for procedures at the hospital too because if you give them your letter, if they violate your wishes, you have a case. Hope this helps.
belinda
Belinda's recommendation is fine. Personally, the next time I have a gender specific healthcare appointment and the physician arrives or invites into the exam room a third party (regardless of gender), here is how I plan to deal with it:
To the nurse/assistant/tech/chaperon:
"Would you please excuse us, Dr. XXXXXX and I need to have a private conversation, thank you."
Once alone with the Doctor, I'll ask the following:
"I made an appointment specifically with you, not your staff. Why is his/her presence required?"
"What specifically are his/her professional qualifications?"
If the third party were female, I'd ask the following question:
"You wouldn't expect a female patient to consent to this exam or procedure with a male nurse/assistant/tech/chaperon attending without prior informed consent would you? I'm entitled to the same consideration."
Obviously, if my questions are not answered satisfactorily, I'm leaving.
Additionally, this works regardless of the physicians' gender. Moreover, I'll never consent to the presence of a medical assistant/tech/chaperon for any gender specific healthcare needs. Personally, a high school graduate with limited vocational training has not earned the "professional" distinction to participate in gender specific healthcare, including answering healthcare history questions.
Ed
I just put up a new thread "Following Orders:Obedience to Authority Figures in Medicine" where I pose a bunch of questions to my visitors. I thought visitors on this thread would find something to say on the new thread. Please click the above link and contribute your views there. ..Maurice.
First off belinda, your "anonymous" poster clearly goes by GR. Secondly, you wrote "I'm sure anonymous has not experienced one vs. the other."
How could you possibly know what hospital experiences I've been through? Do you think you're the only person here that's been victimized? Have you been left completely uncovered on a table after a heart attack and been helpless to do anything while doctors, nurses and God knows who else walks around the area with no regards whatsoever to the hunk of naked flesh lying there? The only person who seemed to give a crap about my modesty was the receptionist, and I don't understand what the heck she was doing back there in the first place. She and my wife kept closing the curtain to my cubicle and immediately after someone else would open it again.
But later when they had me covered but pulled the sheet up to check my catheter and other things I felt just as embarrassed as I did when my upper chest wasn't covered. There's no difference.
Open your eyes belinda, your experiences, whatever they were, weren't unique and isolated incidents. Other people besides you have been through that crap. Get off your high horse.
GR
GR, You are absolutely right and I should have reserved my comments in a general format. If you were offended I apologize.
So, that said, I should point out that I am a writer/researcher in the area of the psycho social aspects of medical care that are detrimental to mental health. Additionally, my work also has to do with patient ramifications of such experience.
Humiliation (and particularly extreme humiliation) is a wound to the psyche. Some people develop post traumatic stress disorder; some don't. Everyone who feels humiliated is traumatized and several things happen after a trauma that wounds the very essence of who we are as human beings. First, it changes who we are in that we are all products of our experiences so we may feel differently about the medical community when something happens in a hospital or other medical environment. Secondly, when someone has an event that equates to a public stripping, subsequent experiences even though they may be less severe, still feels traumatic and humiliating.
If someone is repeatedly subjected to different stressful events in the same genre, in time, it takes less and less to traumatize.
To answer your question, my experience was extremely difficult as it involved the public, sexual abuse, and other aspects that are the subject of one of two books that will eventually be published. I have used myself as my own guinea pig to push and probe the boundaries that will be included in my work.
Should anyone want a list of reading on the subject of humiliation studies, ptsd, or any other relevant information, please tell Dr. Bernstein and he will give you my e mail address. Please put the blog in the caption.
Maurice, as a matter of record, if the medical community knows the damage they do, (and they do via assigned risk reports), why don't they take more of an initiative to police this area of medical care. There was just an article written that people are absolutely avoiding medical care due to modesty issues.
belinda
Belinda, I am not sure the "medical community" really knows about "damage they do". If you are writing about physicians, as I have written many, many times on this thread I never was aware of "damage" as described here because there was never any comments by the patients to me about physical modesty issues or events they had experienced either in my office or in other offices. So, I might conclude that other doctors likewise are also ignorant about the concerns and consequences of whatis being discussed on our thread. ..Maurice.
p.s.- Belinda, if you have a reference to that article about "avoiding medical care", please post it here. Thanks.
Several years ago I interviewed a Director of Risk Management at a major city hospital. This person is now the VP of Risk management at that same hospital.
She told me some startling information with the agreement that I would keep anonymity. It was noted as part of that conversation that 40% of the lawsuits to the hospital had to do with sexual impropriety and modesty violations. You might want to take a walk down to your hospital's risk management to see what's happening.
After hearing our voices all these years, is there any doubt that damage has been done?
I commented previously on the commercial that was a network public service announcement about a cartoon like doctor with a foreign accent, mocking patients for avoiding colonoscopy. This alone, is proof that people are not getting their screenings because of modesty issues and the issue of being silly about avoiding medical care. Never once, did they try to figure out what would make this easier for patients.
I will do some research to find that article and others that are pertinent to our discussions and post in the next few days.
belinda
This is an excellent article on the humiliation dynamic. While it isn't specific to the medical industry, it does feed into what we are all feeling when our modesty needs are not met and worse yet, ignored. We are devalued, degraded, humiliated, helpless, and vulnerable. It talks about doing "anything to avoid" being put into a repetitive situation and anything includes suicide.
http://questgarden.com/00/42/5/050821222545/files/KleinHumiliationDynamic.pdf
What right does the medical community have to continue practices that degrade us, humiliate us all under the guise of "lifesaving" when 99% of these things happen when there is no endangerment? Must we agree to be humiliated to get the medical care that we're paying for?
It's time that the mental health community dictate practices to the medical industry to improve their "standard of care" and some not so "standard of care" cruel and degrading treatment and most of all "to do no harm".
People...wake up and say No. Once you do it a few times, it rolls off your tongue and leaves most in the medical community dumbfounded.
Only we can change the culture; one patient at a time. And...don't forget to ask your loved ones to support your initiatives with their own medical treatment by asking questions that let the medical community know that the status quo isn't acceptable.
More to come...
belinda
Sorry Maurice, how can you say that you and other doctors are unaware of the damage they do when violating patients' modesty/privacy? When doctors' family members go into hospital, every member of staff knows not to treat the family member in the shabby way they treat everyone else. Who are you trying to kid? your attempt at naivete is unconvincing.doctors like to think of themselves as a cut above the rest of us because we don't have medical degrees (a sign of idiocy)but when it is convenient you have no knowledge of the effects you have on others.
Lewis, doctors have their own physical modesty issues in various degrees like we assume most patients bear. It is not that the medical profession is ignorant that the same issues can be present in their patients and that is why they are taught to consider customary patient physical modesty behavior beginning in their early days in medical school. As far as "damage" is concerned unless the patient speaks up and communicates with the medical provider before or at the time or after an examination about specific modesty concerns how can you expect the provider to be aware of the modesty standards set by the patient and whether "damage" had occurred. Patients just don't speak up but hopefully with words and actions developed by those writing to this blog and other similar sites, this will change.
I would say that doctors, despite their own modesty would not sacrifice health for modesty. I know that I wouldn't. And I am sure that physicians would speak up if they or their family members were treated with gross inattention to customary issues of patient modesty.
As I had written previously, VIP (very important person)treatment of physician or physician families as patients by physicians or nursing staff where medical procedures or nursing standards are altered out of irrational concern about upsetting the patient but which potentially lead to errors or hazards should always be discouraged. And I have personally rejected VIP treatment. ..Maurice.
Maurice, you are forgetting something very important. Most patients don't know ahead of time what to expect so raising modesty concerns about being exposed in front of a whole room of people is out of the radar unless the patient has had previous experiences.
The responsibility to do the homework on the ramifications of traumatic reactions with regard to personal autonomy, modesty and degrading treatment is up to the medical community. It is well known in the literature that public stripping is one of the worst experiences one can endure. Just like friendly fire, are we not harmed just the same when it happens unexpectedly, sexual impropriety, or other unprofessional behavior or an audience exists in the medical arena?
Walking away from this responsibility is not only a "cop out", it's almost unethical. What do you think?
belinda
I received this e-mail yesterday and I certainly think it fits with Belinda's last posting. It's in 2 parts since it is over the character limit to blogger.com ..Maurice.
Hello Dr. Bernstein,
For reasons, that will become obvious, I would like to remain anonymous. I am a male in his 30s residing in Tennessee. I recently came across your blog entitled "Naked". Today, February 8, 2013, I had an appointment scheduled with my female dermatologist. I have been a patient of this practice for a couple of years, but it was the second time I had been seen by this doctor that I saw today. The reason I had to pick a new doctor is that the previous doctor, I had been seeing, moved away.
My first experience with this new doctor was a professional one. I had come to her as a normal dermatology checkup with concerns of itching in my groin and peritoneum area, a bump at the base of my penis, and some skin tags on the back side of my left arm pit. During that visit, I remember the nurse (or member of office staff in scrubs) handing me a gown and telling me to strip all the way down, right before she opened the door and left the room. I proceeded to do as the nurse asked me as soon as the door was shut, and just as I was finishing putting on the gown on, I heard a knock at the door. I replied "come in". The doctor and nurse entered the room, the doctor introduced herself and I shook her hand. She asked me why I was there that day. I replied that it was a checkup from the previous time that I was there. She asked me about any concerns or problem spots I had. I explained that I had been experiencing a great amount of itching in my genital and peritoneum area, a mole at the base of my penis shaft, and the skin tags on the backside of my left arm pit. She began her examination with the 3 points of concern, then checking the rest of my body for any thing else to be concerned about. I do not recall if she left the room in between the exam and the procedure to remove the bump and skin tags. But I remember the experience being what I would classify as very professional.
Every appointment, with a doctor in this practice, in the past, I have been taken to the examination room where the nurse (?) takes a history, and asks about new concerns. Usually on their way out, The nurse(?) will hand me a gown and tell me strip down to my underwear or to strip completely ( based on ailments and concerns that I had).
Today was different.
The e-mail continued. ..Maurice.
The nurse, who was new to me, did not hand me a gown, or tell me how far I should strip down. While waiting for the doctor to arrive, I took off my boots and emptied my jean pockets into them. I was also looking around the room, and noticed a poster with illustrations of different types of skin cancer. The one marked melanoma sparked an interest with me as I had a dark spot in my underwear region that resembled it. The doctor, who used to teach at a local prestigious university, arrived to the examination room, and began asking me about my acne. I told her the places where I had seen acne (mostly on my shoulders, but a couple of other areas as well). With her and the nurse in the room, she asks me to remove my shirts so she could examine my shoulders and other places on my upper body. I have a bump on my lower back, so I loosened my pants and pulled them down slightly, so she could examine. She seemed to be wrapping up the examination, when she asked me if I had any other concerns. I mentioned a spot on my upper inner thigh that looked similar to a picture on the poster. With out hesitation, and with me still bare chested and without a gown, She asks me to remove my clothing so she could get a closer look at it. The spot is in the area where my left thigh meets the peritoneum. A place that could not be examined without removing both my pants and underwear. Using both hands, I pulled down both my pants and underwear to where she could examine. This left my penis exposed for a couple of moments to where the doctor and nurse (or at least I hope she was a nurse) would be able to see. As I sat down, I placed my right hand over my penis to keep what dignity and modesty remained in tact ( at this time, I am completely naked with the exception of my socks and my pants and underwear which are around my ankles). She briefly looked at it, told me that she would have it removed, then finally started looking for a gown for me to cover up with. As she was examining the spot I kept my penis covered with my hand, to keep her from possibly being distracted by having a penis just inches from her face. I expected that she would be professional, but kept it covered just in case she was distracted. After I put the gown on, and finished removing my pants and underwear from around my ankles, she explained that there would be a shot given to numb the pain, and she left the room. This left just the nurse and myself in the room. I suspect the nurse had not noticed very much as she was typing notes throughout the examination. She said that she would need to take a picture of the area. I raised up that side of the gown to where that part was exposed, but my penis was covered by the gown. She placed a label with a 5 digit number ( I believe the number was 26651) on the examination paper, to where it was visible in the picture. She took the picture with the Ipad she was taking notes on. She then gave me a shot in that area to numb the pain of removing the spot. Shortly there after, she left the room explaining that they would be back soon. About 5-10 minutes later, they returned, removed the spot and explained that they would send off the spot to be tested, and would call with the results once they had received them. The Doctor also gave me instructions on how to care for the wound area until it heals. Both she and the nurse left. Once the door shut, I began getting dressed as the exam and procedure was over.
My concerns about this situation is why would a doctor of the opposite gender find it appropriate to be in the room as I completely disrobed. As soon as she walked in, and saw me fully clothed, should she not have given me a gown, and asked me to disrobe while they waited in the hallway? I am comfortable being examined by a female doctor, even when It involves my genital region, but I do not understand the appropriateness of this situation.
Sincerely,
Confused in TN
How common is it to send a teenage boy in to strip and fondle a female patient? I know, I know, the medical world doesn't like the word "fondle" but I can't imagine a better example of fondling than inserting a foley into a male patient. It seems to be almost a certainty that a male patient in need of a foley will be "handled" by a female, often a teenager and with an audience, but I've personally never heard of a young male doing it to a female. In the rare occasion that it might happen I can't imagine the teenage boy was allowed to be in the room alone with her.
I've never seen a prostitute but from what I hear $20 will get you pretty much the same experience that a man gets from nurses and CNAs in a hospital. But instead of being considered dirty hookers they call themselves "heroes" or "angels". I don't see much difference. L
Confused in TN should have known how unprofessional his dermatologist was the first time she allowed her "assistant" to be present and participate in unethical activities as if she was a professional. If he was such a wussy that he would allow her to take such liberties on him without even knowing what job description the assistant had maybe he deserved to be treated unprofessionally. Stand up for yourself you pansy. If you believed you weren't being treated professionally don't do what she says just because she's wearing scrubs.
Since the person who posted the comment at 4:55 AM on February 10th is fond of giving advice, I do hope you are equally as receptive to receiving it. Might I suggest that you avoid leaving comments when you have been out drinking, or had trouble sleeping, or whatever your problem was? Clearly, such issues give you diarrhea of the mouth. It would be best to keep it shut until the spasm passes.
Concerning your response to “Confused in TN”, I am no fan of chaperones, and I will not permit their use during one of my appointments. However, I am much better prepared for such an occurrence now than I would have been before discovering Dr. Bernstein's and Dr. Sherman's blogs.
Prior to that time, I was like most men. That is, I had never heard of a “chaperone”, and I tended to believe that anyone in scrubs was either a doctor or a nurse. Had a doctor brought in a “nurse” during my examination, I would have been caught totally unprepared, and I would have assumed that the assistant's presence was necessary.
I doubt very much that I would have questioned this, until after the appointment. And, of course, by then it's too late. Besides, having taken time off from work, spent a long while in the waiting room, and desiring a diagnosis and a treatment for whatever issue brought me to the doctor's office, would I do anything to disrupt my examination?
Now? Yes, I would. Not so long ago, I would not. That does not make me a “wussy”, just as “Confused in TN” was not one, either. I won't speak for him, but I think he behaved like most men would, especially since he was concerned for his health, and may not have realized that the “nurse” was probably not needed for his examination.
Name calling and blaming the victim are hardly constructive feedback to what was an honest question by someone who appears to be new to these issues.
Here's a great tip that works very well. Before you leave for the exam, think about where your boundaries are, what you will and will not accept.
This way, you know where your limits are. Should anyone feel uncomfortable about your state of undress or who is in the room, stop the exam and say, "I'm not comfortable with this. I need some privacy to prepare for the exam and would appreciate only me and the doctor". Then if they balk, leave. Nothing is going to happen to you if you stop an examination.
Secondly, and this, I think is probably the most important thing I could say on this blog.
Every time you do something that makes you uncomfortable, you are sabotaging yourself. When one patient complains about a protocol nothing happens. Every time you advocate for yourself, you are advocating for all of us. The benefit...you will feel better about yourself, exerting your rights as a human being with regard to privacy and are keeping yourself from feeling humiliating.
Anyone who would feel afraid to do the above needs to start thinking about why.
belinda
Hello Dr. B.
I've been following your blog over the last few weeks leading up to, and following, treatment for kidney stones. I am a white male, 47, living in the southeast US. I have always been concerned about my modesty - particularly in medical settings. I can attest first hand to the inequalities between the way males and females are treated when it comes to institutionalized nudity.
In middles school, we boys were required to undress and take group showers during PE class - regardless of whether or not we'd actually broken a sweat. I could not understand why we had to go through the humiliation of being paraded nude in front of peers and teachers. I still don't understand. But boys aren't supposed to be shy about that kind of stuff, right? Girls in my school were not required to take such showers.
Boys participating in sports in my school were required to submit to group physicals conducted by female practitioners in our gymnasium with very little privacy screening. These examinations were conducted while female students were nearby. But boys aren't supposed to be shy about that kind of stuff, right? Girls in my school were not required to submit to group examinations before playing sports.
As an adult, I've twice had my modesty violated in non life threatening medical settings that still affect me. I now know that it's up to me to speak up, stand my ground and be prepared to walk out if my needs are not addressed. I realize that obtaining intimate care from only male practitioners requires extra research and diligence, but it can be done. Women typically don't have to take such measures to secure same gender care for breast and pelvic issues.
Jon
Those visiting this thread may be interested in a new thread which also deals with a physician communication issue with the patient. It is about the questions related to "curbside consultations", informal consultations to educate a doctor on how to proceed in the care of a patient but without notifying the patient about the consultation. I thought you all might be interested to read and write there. ..Maurice.
Definition of a group: two or more persons. Physicians took an oath, I will respect the privacy of my patients, I suppose they lied. Physicians who disregard the oath they took are called liars. Would you trust a physician who lies to you, who disregards your privacy. One who would ambush you in a group exam, that is to have other people in the exam room who have no business being there.
One would think that with both personel and financial constraints placed on the healthcare industry that people have other work to do rather than stand and observe,gawk,leer at others during a medical exam. Do
you assume the physician to honor the oaths he/she
took or should you have to remind them beforehand.
You never should have to remind them! That is their
job,their responsibility and that is the job they signed up
for. That is why people invented the concept of oaths.
It's not a job for liars!
PT
See the cultural values and patient empowerment in this article that articulates why patients don't comply. More to come...
http://www.patientcompliancemedia.com/Improving_Patient_Compliance_article.pdf
belinda
Belinda, thanks for the URL to a very important article. The text of your URL might not be fully readable..it wasn't readable on my computer.. so here is as a clickable link:
Improving Patient Compliance".
I am also going to put it up on my recent thread concerning orders vs compliance. ..Maurice.
To the person that asked if a young male would be allowed to insert a catheter on a female the answer is yes. And they can also do other things as bed baths, change sanitary towels, etc.
that said, they're not teenagers although they might be in their early twenties. And the women they care for are usually at least a decade older, parents wouldn't trust them with their teenage daughters.
When hospitalized I had an horrifying experience, I watched a very young male nurse prep a woman that was to undergo a scheduled Caesarean. As I was on the bed next to her in the gyn wing, I couldn't help but watch the whole thing in glaring detail. She didn't give a damn but maybe I should have called both of them on it. I didn't want to see that, and if I cared so much to watch other women's genitalia I'd turn to porn.
I wonder if any posters have been forced to watch humiliating procedures on other patients, and if such events have affected their healthcare decisions.
There are things I have seen, however, it is after I had my own horrific experience.
PTSD can happen if you are a spectator to something traumatic, so it doesn't have to happen to you in order to be traumatized. I hope this helps.
belinda
I had a teenager prep my leg for knee surgery. She didn't see anything (unless she looked up my shorts while she was prepping me) but I imagine if I was having a hernia surgery she would have done that as well. At least she would have tried, but I would have put an end to that immediately.
LG
On the advice of my primary care physician, I am meeting with a doctor next week to make arrangements for an upper endoscopy. I've checked out the procedure on line and a number of sites imply that I will be asked to wear only a hospital gown. I fail to understand why I should be nearly nude from the waist down in order for a physician to insert a scope into my mouth. Does anyone know of any legitimate medical reason why I shouldn't be a allowed to wear sweat pants or scrubs, or at least a pair of shorts during this procedure. When I see the physician who will perform the test, I want to well informed so that I can be firm in my desire to protect my dignity and modesty as much as possible.
As many of you may already know a black female
nurse recently in Flint Michigan sued the hospital
where she worked. The basis of her suit being the
hospital removed her from caring for a white baby
at the request of the father. The baby's father
is supposedly a neo-nazi and requested no blacks
care for his child. His request was granted.
The court found in favor of the black nurse mostly
I believe was due to a note in the patients chart that
no black nurses. Women frequently make decisions
regarding race and gender on services provided to
them. This even extends to healthcare and no one
even takes a second notice.
We see this in mammography, L&D as well as post-
op gyn. It will be interesting to see how this ruling if
any impacts the attitudes in healthcare.
PT
To Anonymous from today: I am not a gastro-enterologist but in answer to your question I would suspect that, if there was a reason beyond maintaining a clean environment for the procedure, as part of safety precautions for upper gastro-intestinal endoscopy emergent access to the femoral vein located in the groin region is readily available. Otherwise, if no colonoscopy or radiologic procedure is considered, I don't know. ..Maurice.
Maurice
An upper endoscopy is properly referred to as
an EGD. Often,an iv is started in the ac vein of the
forearm for a mild sedative. I have never seen a
femoral line started for this procedure unless of course
the patient is currently hospitalized and just so happens
to have a central venous catheter placed in the groin,
but on an outpatient basis, never. There is no need what so ever to have your pants removed for an EGD, nor even an ERCP and for that matter even a peg tube
insertion via endoscopy. Period!
PT
I had a upper GI and had the same experience, with a little extra. I was in the waiting area with a mixed gender group of about 5-6 patients. The "nurse" in scrubs come in calls our names and says follow me, as we walk down the hall she announces everything off and I mean everything, gowns on and assigns curtained rooms...I really wasn't happy but followed instructions. A woman in my office had the same procedure, different facility, she was allowed to keep everything except her shirt on. This was before I discovered this thread. It won't ha[[en again to me, contact them either call and email them in advance and express your desire to remain clothed from the waist down, you will be surprised what simply asking accomplishes. The follow outdated procedures that serve no purpose because we don't even ask. Please for your own peace of mind and for those who follow, tell them what YOU want. Your writing the check.
I would agree. If a patient finds that some order by the clinical staff has not been previously explained and is disturbing to the patient, it is all part of informed consent that the staff must explain the rationale for the order. Then, the patient can autonomously decide whether the explanation is reasonable to continue or, if personally unreasonable and no other satisfactory option is available, to reject and move on. As a patient I would do the same. However, I would not ignore the need for the procedure if I agreed with the doctor that it was essential for my health. ..Maurice.
I have had several endoscopy procedures and never undress at all.
Your mindset must not be "what they allow" but what will I allow. When you tell them that you won't comply, they will fold (especially if you're scheduled.
PT, courts have ruled that there is a profound difference between race and gender regarding privacy. While age, religion, ethnicity are not considered lawful, privacy is considered a right to every individual and that being the case, is why, when it is requested for same gender care that your request is considered and most times met if possible. This privacy right is noted in Title VII of the Civil Rights Act and I have posted this issue. several times.
belinda
PT, I know that you will enjoy this article as we all should. It protects everyone's right to privacy and doesn't discriminate. The rest of this issue rests solely on men to step up and speak out--Congratulations!!
http://www.nursinglaw.com/malefemale2.htm
belinda
Belinda
I have no intentions of looking up that site. I
do not look up articles that nurses write. Why would
I care about what the Fem-Nazi health care machine
writes. There is no such thing as nursing law, nurses
don't make laws and they don't tell PT what or what
not to do. When I am the patient I am the boss and
my decisions are final, that goes for the physicians
as well. Everyone it seems is so afraid of death once
they enter these facilities they do what everyone tells
them. It's inevitable, we are all going to die someday
and when that someday comes for me it will be on
my terms. Nothing worse than dying at the hands
of some idiot and even worse is being helpless at
the hands of some stupid Fem-Nazi female nurse
who eats more bon-bon's, watches more tv and
thinks she knows more than any other hominid on
this planet.
PT
PT, I think you are going a bit, if not more than a bit, over the top, so to speak, in placing all presumably female nurses into the category you describe. The nurses are not the ones responsible for laws that can affect the practice of nursing. And what do you mean by "Fem-Nazi" female nurse? I am not sure that based on my experience in medical care that female nurses have degraded their profession to that of Nazi philosophy or actions.
Can you provide specific investigative documentation of their philosophy or actions which supports your conclusions and generalization? Has there been investigations by legal or political bodies in this regard? Just wondering... ..Maurice.
PT, this article is about nursing law in New Jersey. You, above all would be pleased. However, if you are too narrow minded to read the article; your loss; it's everything you've been asking for.
belinda
As I've indicated, I have no desire to read the article
and for that matter any article that those wretched
nurses write. It's rhetorical propaganda that is designed
to further propagate their ideals and their feministic
goals. I equate the healthcare industry as analgous
to the Nazi movement against Jews, only men have
been the target from the beginning. That goal has been
to keep males out of nursing and keep male patients
repressed.
PT
I've been following the recent discussion. What everyone needs to understand is that requests for same gender care are part of dignity and respect. And this is embedded in literally all medical ethics, core value statements and policies and patient rights documents. I do realize that in too many cases it's not followed. But it's not followed because patients don't speak up and insist. I agree with belinda. The laws and policies support both men and women. Hiring policies don't support his necessarily. Neither do staffing policies. But then, the hiring and staffing policies go against the mission and core value statements. In most cases, patients who speak up will get what they need, esp. if they threaten cancel the appointment or procedure and/or go somewhere else. And esp. if they refuse to back down. But, from my experience, most providers are sensitive to this issue and will try to grant the request. Sometimes they can't. It's not their fault. They may want to. That's when a polite refusal and letters pointing out how the hiring and staffing doesn't support the mission and core values will help. But patients need to advocate for the care they want. That's the way it is.
Doug
If you review the core value statements of
every hospital in this country, you will find that most
do not include dignity and respect. You will be hard
pressed to find those two words in their mission and
core values. Often, many believe those values come
from the patient bill of rights, they do not. The patient
bill of rights essentially involve the affordable care act.
If you review this blogspot at least a year
ago, I brought up the mission and core values if you
recall and in doing so suggested that virtually every
employee, including physicians could not recite one
phrase of the core values, let alone the mission
statement. Therefore it is meaningless. How meaningless is it? About about as meaningless as the
oath a physician takes.
Who are the caretakers of the core values
within hospitals, the nursing directors. Whose job is
It to insure that as an institution, those core values
are carried out. ( Now remember,the core values are
those which form the foundation from which they perform and conduct themselves.)
Thus, the nursing directors have the responsibility to insure the values become a model
from which all employees adhere, conform and
practice. Yet, this never happens.
PT
PT
Most hospitals either state the words dignity and respect in their core values and mission -- or, it's clearly implied. If not, patients need to consider this and, if possible, use the hospitals that do include this. Same goes for patient rights documents. Most state or clearly imply these concepts and talk about cultural values.
I do agree that what's called mission integration is difficult. How do you embed these values into the whole system? I do agree that many if not most hospital employees may not be able to recite the core values and mission. But that doesn't mean that patients can't recite those concepts to the employees. When they hear them from the patient, they'll recognize them. Employees know they exist.
You give nursing directors too much blame for this not happening. They do play an important role, but they are not the sole determination of a hospital's culture. It's much more complicated. In fact, I would say the opposite -- I'd say that most nursing directors are very much in touch with this issue and try to accomplish a positive, dignified, respectful, and safe culture for patients. The problems they run into are from other elements of the hospital culture -- which could include the necessary time and resources to accomplish the mission. These days, quality issues and medical error issues and big in the system -- and hospitals are really trying to eliminate them. Of course, it's because they're not being paid by the Feds if these errors happen. But it is a positive move forward. And with patient satisfaction surveys being tied to payments as well, hospitals are much more in touch of respect and dignity issues.
I don't know where you work or have worked, PT. But all hospitals are not like the ones you describe. I don't deny they exist. But I do say that patients need to be even more savvy today in asserting the kind of care they expect.
The underlying theme on this "Patient Modesty" seems to drive me to open it up on other threads. Well, I just put up a new thread "Challenging Your Autonomy: Others Telling You What Not to Eat".
Yes, the theme here and on the new thread is,I think you will agree, personal autonomy.
Go there and review the links and then write there your comments. Also you may enjoy the GIF graphic I found. ..Maurice.
Doug
If you ever review the questionnaire patients
recieve from Press Ganey, nowhere in that survey
does it say anything about privacy, respectful care,
etc. The questions more pertain to, did the food
taste good, did your physician spend enough time
with you. The results from these questions ultimately
along with other data comprise the H-caps scores.
Human resources do not hire new staff, the
hospital directors do this exclusively. Remember, that
the hospital directors closely resemble gender ratios
of the nursing industry, 95% female. They are of the
old school mentality and really couldn't care less
what the requests of male patients are on those units.
When 100% of nursing staff are female on a
post-op surgical floor or a step down medical floor
what does it matter what the core vales say. Since
when does a patient who can recite the companies
mission statement or core values make this known
to an employee. Seems redundant dosen't it.
In response to the hospitals I have worked
would include over 10 major medical centers,
numerous facilities and just about every hospital
between Chicago and California. They are all the
same.
PT
Doug
I might add that the CEO of press ganey
is a nurse, no surprise there. I have invited them here
to this blogspot in hopes of giving us some insight as
to why their questionnaires don't include questions
such as " were you provided with respectful care,
did you choose same gender care for intimate procedures and/or were you given the option.
Of course not, do you really think they want to
open up a big can of worms. The hospitals "pay"
these people for these stupid surveys. How did you
enjoy the taste of the food? Anything that tastes
good is usually not good for you!
Doug, you always seem overly optimistic about
progress in medical facilities. What facilities have you
worked at? Are you familiar with scribes,ever hear of
them. Computerized charting has come to most
emergency rooms, that means no more paper charts.
Now laziness knows no bounds, it doesn't
discriminate against people or occupations and as
such physicians can be lazy too. So lazy in fact that
they hire fresh out of high school kids who push a
computer on wheels right into your exam room in the
emergency room. This "kid" essentially types what
the physician states during the exam process.
The "kid", scribe cannot enter orders, ie blood
tests, diagnostic test and so forth, they just type the
history. Now you are probably thinking that according
to the AMA this violates suggestions put forth on
chaperones in that this scribe not only takes the
history, but is there during the entire exam process.
My question to you Doug is this, are we making
progress or going backwards.
PT
PT
I know from experience and from interviews and case studies that -- if patients assertively challenge these privacy issues (scribes, chaperones, etc.), they won't happen. Occasionally, patients may run in to institutional resistance. That's the moment when the rubber meets the road. At that point, if the patient refuses the exam, treatment or procedure and/or if the patient starts to walk out -- amazing things happen. Especially if the patient uses the words dignity, respect, double-standard, privacy/modesty violation, my value system, I'll file a complaint, Joint Commission, etc. Providers are in tune with those terms and this issue. They don't want more paperwork or an investigation. I'm not suggesting patients get angry or abusive. They should be polite, civil but assertive.
Yes -- I think cultural mores are changing and things are getting better in the area we're discussing -- except, of course, the cost of medical care. That's another issue, but costs are insane and way out of control. I do acknowledge the difficult in any system of assuring that the mission and/or core values work their way down the hierarchy to the lowest level worker. But it can be done. We see it with some of the more successful businesses and corporations. It's not impossible. In this regard, the medical culture has a long way to go.
NOTICE: AS OF TODAY FEBRUARY 25 2013 "PATIENT MODESTY: VOLUME 52" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 53.
Post a Comment
<< Home