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 54
It seems that back and forth comments on this thread continues the disagreement regarding which gender is subjected to or is suffering more from acts within the medical community which intrudes upon the patient's physical modesty, perhaps even causing psychological harm. My view is this discussion shouldn't be relegated to a gender issue but directed to establishing changes in medical practice to be followed by all of its caregivers for patients of
all genders.
For those who are first time visitors to this thread may benefit to follow the discussion by reading the previous Volume
"Patient Modesty: Volume 53". ..Maurice.
Graphic: A repeat of the graphic I set for "Patient Modesty: Volume 4" June 26, 2008.
NOTICE: AS OF TODAY MAY 26,2013 "PATIENT MODESTY: VOLUME 54" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON
VOLUME 55.
153 Comments:
Al,
In response to your comments below:
Hi Misty. The site I referred to is " Lebanon couple sue over physical exam of 9-year-old son at school ". But there in another site that will really raise your blood pressure. It's " Federal government headstart program violates - The Cutting Edge ". They are doing genital exams on 3-5 year old preschool kids. One father was threatened with jail time for spanking, forcing his kids to go to church, saying prays before mealtime and bedtime, and forcing them to read the bible. If this isn't big brother what is. I hope this helps. Good luck. AL
I found the case you are talking about at http://www.pennlive.com/midstate/index.ssf/2011/12/federal_judge_refuses_to_dismi.html. The case happened at a different school in Pennsylvania. It is so sad about how many unnecessary genital exams are done on kids.
Misty
In reply to Maurice Bernstein, M.D.:
You have stated
"Though you might disagree, I just can't see that PT's description of the nurse's sexual preference, particularly in these days of changing and accepting views of homosexuality as slander."
I want to clarify that it was not PT's reference to the nurse's sexual orientation that was the issue. It was the way his comment insinuated that the nurse's actions were coming from a place of pettiness and mean spirited intentions. I am sad you did not understand that.
You are free to do what you like on this, your own forum. But so am I, and mainly due to PT's presence here, and the way in which he is defended/supported by some, I won't be entering into the discussion again. That nurse deserved to have her reputation defended against PT's defecating and unsubstantiated claims, especially given the topic here and her admirable efforts to protect patients from harm. I appreciate your own efforts but I get a bad vibe from this forum.
Anon1
StayingFit,
Not sure why you included Misty in your attack on me? I don't think Misty made the comments that you were referring to. I really like her site and see lots of good and balanced information on it, but don't want her mistakenly sideswiped for comments that I made.
And in relation to that, I will relieve you all by announcing this will be my last comment. I will leave you to return to your cozy little club from now on.
It's time to stop as I notice that there hasn't been a single convincing rebuttal (i.e., anyone with actual evidence) to counter the main points that I've posted, and I'm sure that some of you have been Googling your selves into a frenzy trying to find anything you could to smack me down. That you couldn't has been a great comfort and the ways that you've responded have been as amusing as they've been revealing.
Interesting that Dr. B. has now posted his concern that this "discussion shouldn't be relegated to a gender issue" only after a few voices start to be raised against some of the anti-female ranting that seemed to pass as ethics discussion. Gender comments seemed to be fair comment as long as they went in one direction I suppose? I couldn't help but notice a trend towards male physicians siding with one another or remaining silent on the sidelines when anti-female material was posted. This includes that lack of holding someone to account for posting potentially slanderous comments. I know of a lawsuit currently under way where someone is seeking court orders to have internet providers forced to reveal the names of anonymous posters who spread vicious rumors over the internet.
I will leave you alone from now on - but will check to see if there is a double standard that results in my comment not being posted :)
It has certainly been an eye opener!
SD
I tend to agree a bit with Anon1's comment about getting a bad vibe from this forum. I was more interested in reading it when it initially started but lately I feel it has gotten to be more of a platform for arguing about how much worse men have it in both regards to getting their needs met in medical situations and in their underreported incidences of sexual assault. While I am not saying that these facts may indeed be true I do feel, as Maurice said in his intro to this thread, that the posters here should be more interested in ways we can get the system to change to respect ALL patients' medical modesty needs. I feel like the original point or goal of this forum has been lost. Until everyone admits that we all have viable issues and concerns, regardless of sex, and some compassion starts showing, we just will not get anywhere. In addition, some of the more reasonable, sane voices from past threads have all but disappeared and I can't help but think it may be because of the current direction of this blog. When it all comes down to it, I don't see why it matters whether men or women have it worse, but just that it gets better for EVERYONE! Jean
SD
"It is easy to find crime statistics or carefully done research that supports the conclusion that women are far more likely to be the victims of sexual offenses, and that men are far more likely to be the perpetrators."
Are you talking about medical situations or just sexual assault in general? In most aspects of human life men are much less likely to be taken advantage of by women, for obvious physical reasons. But during aspects such as medical and penal situations men's physical advantages are taken away. That's the area I'm talking about.
As this is a medical ethics blog, do you have any documented specifics or studies that are pertinent to this blog? I don't think most contributors to this blog care much about spending the time to refute or substantiate your statistics since it is mostly unrelated to the subject here.
Dr Bernstein, I think you have been equally fair to both genders and I appreciate what you do. There are also plenty of women defending men and men defending women. I know you're not refusing to post certain comments.
Thanks for all the great input Misty, Suzy, StayingFit and others. -
While I never maintained that I "advocate denial of the reality that such imbalance exists in the first place. ", I would simply say that statistics are gathered by the concerned segments of society that choose relevance in that social, domestic, or foreign subject. That being said, if we look at ALL information we may find that we as either gender have many more issues in common than we admit. That should really be the lesson learned in the battle of the genders.
Many of us through the years of "Bernstein-Blogging" believe that this subject is a human one, rather than a male or female one. The fact that some here have put humility and embarrassment aside to share their very personal stories should touch and concern all human hearts.
Why would we want to let indignities and humiliations be swept under carpets just because it did not happen to us and/or our gender?
Everyone has statistics. What everyone really needs is concern for each other.
I for one would like to go back to that.
Suzy
Currently
There is a thread on allnurses titled, Rn as
patient in own hospital, under hipaa and nursing
challenges. Apparently, she went to the emergency
room where she works, to be seen as a patient.
Subsequently, she learned that her private
patient information had been discussed among
staff. Many nurses simply refuse to be a patient
at the hospital where they work for these vary
reasons. They don't trust the nursing staff they
work with, their ethics and their credibility.
Personally, I have seen that myself and yes
I have heard them say this. I have heard them
say, if I am ever brought here by ambulance, make
sure I am covered up. What does this say to patients
who want to have their privacy respected? How far
should hipaa go to protect a patients privacy.
It's always interesting to read the comments by
other nursing staff. Interesting, they say it's wrong,
yet, where are the nurses who commit hipaa violations
and perhaps they too should post and tell their side
as to why they violate hipaa..
If nursing cannot respect another nurse, their
privacy and hipaa information,what makes you the
patient believe that your privacy rights and hipaa
information will be respected.
PT
A few words from me for those who are relatively new to this blog tread of "Patient Modesty":
First, the commentaries describing conflicts between genders in medical practice and care, with regard to behavior or consequences is not some unique, novel topic here but has been going on for years. Take time to go back to my first volumes of the series, back virtually 7 years and read what my visitors wrote then and in the subsequent thousands of comments. I have read it all!
I don't delete these postings since it is the spontaneous part of the discussion of patient modesty issues and as moderator I don't want to take a view in the back and forth discussions. Yes, I have repeatedly expressed a couple views throughout the years on this thread. Based on my many, many, many years of internal medicine practice, I have never encountered an issue regarding my patient's physical modesty (no patient has ever spoken up about it) and so this has led to my supposition that those patients with modesty issues which would lead to significant emotional upset represent a statistical outlier minority. And this I have repeatedly stated here. I don't know if there are actual valid statistics otherwise but as moderator I will leave it to the debaters writing here to document.
Again, as moderator, the only other personal view I have presented about the general tone of commentaries here is that it would be more productive if instead of simply expressing moans and groans on this blog thread, I strongly suggested that folks get together an form advocacy groups to spread the word and try to get changes in the way the medical system handles patient modesty issues. I suggested my visitors starting a petition drive for the changes desired and which I started since none of the others here expressed interested in starting however my attempt turned out to have an anemic petition site response and was terminated.
In conclusion, as moderator, I allow virtually all requests to post to be posted unless frankly and unproductively ad hominem or the response is not pertinent to the general topic of modesty or is only spam.
Those commentators who are upset by the responses others give in reaction to a view, remember that many more visitors are viewing this patient modesty blog and who are only reading and not writing and many might agree with your comment. If you are upset with the response, a discussion technique would be to come back with another approach to explaining your view and not just walk away in disgust.
I guess, I wrote a bit more than a few words, but I thought it was necessary. ..Maurice.
WHEN MANY VECTORS COLLIDE.
Hi all my bit might be kinda long so I appologise in advance.
I've had a lifelong aversion/fear to nudity. And I have also been medicaly boarded for the last 15 years due to what they thought was ankelyting spondelosis or S.I.
Anyway I last week went to see a surgeon who requested a new MRI and found L5 disk ruptured and emptied itself out and there is a protrusion in the disk above.
So I have to option to possibly be repaired after 15 years worth of sometimes indescribable suffering.
The surgeon wants to inject stuff into the disks and also talked about some rubber plug (not sure if planned for same day) under xray and under aneasthetic. Not exacly sure how that part works as I had a heart stent implanted about 15 months back. And no the procedure did not include any nudity. The OR nurses simply cut the side of the paper underwear I was given to wear under the gown, pulled it tight to keep my wedding jewels covered and taped it to my body so I was never exposed.
My problem with my fear of nudity (infront of basicaly any gender) I have traced back to my first traumatic memory, which happened in a hospital. I was about 3 years old when I was dropped off at the day hospital where I was put in a cot in a room with all the other kids. I have never been in a cot before and it was like a cage. Anyhow later in the day I woke up naked and my penis was all messed up and I was naked and in the cage and other women and mommies kept comming into the room. When my mom arrived the afternoon to take me home, my first words to her was "Doctor Devil cut off my pee pee". It was just a normal circumsicion back in the 70's neccessitated by medical need due to infection. And probably looks like any circumsised gentleman's sausage today.
In one foul moment so much was taked from me without my understanding or consent.
I was instantly left with a total fear of annesthesia, a fear of loss of control, I was left naked and my stuff handled and cut and left in a bloody mess. As old as I am I still see the movie of the day play down in my head. So my gymnophobia does not stem from a sexual experience. It stems from the worst case OR scenario any man could ever dream of being actualy expeienced. I am such a dignified man I can not handle the thought of being being exposed and have my arse and penis seen by women in the OR not even to mention to maybe need a catheter. Both of these would be dealbrakers for me.
SO here I am between the devil and the deep blue sea. Possibly get healed but be traumatised by being exposed to women (actualy the men too, but I could get over that). I honestly don;t believe I'd be able to get through the humiliation and loss of dignity, alive.
Sad thing is I now have a 10 month old daughter (also the last time I had sex after the trauma caused by exposure of my wife during the birth despite makeing all kinds of arrangements with her female gynaecologist, I learned that day never to trust a doctor again as they will say anything to get you into the OR).
I feal so helpless and torn and for the first time understand the dilema of someone who might consider ending it all (prefferably in a huge all consuming fire so it exludes exposure in the morgue).
I don't think that any counceling could help, at best it would try to coerce me into accepting that which I find unacceptable with every cell in my body.
I just needed to verbalise this I have not been able to sleep or eat for the last 3 days or so since I found out about the surgery plans... they actualy wanted me in surgery tommorrow, but luckily there is some kind of delay with my medical aid.
NAD
To all: I want to explain why I continue to publish visitor commentaries written to this blog which represent a kind of "moaning and groaning" (such as that by NAD above) and which I have previously and repeatedly written are not of value in achieving the goal of changing the medical system behavior with regard to patient modesty.
As a physician, I have seen the benefit of ventilation in easing emotional distress. And if this blog can provide a resource for such ventilation, particularly if the writer realizes that he or she is ventilating to a world-wide audience who might provide further insight or support for the problem, well then I see that there is that therapeutic basis for continuing that publishing. Anyway, that is my explanation. ..Maurice.
Sorry, Maurice, but I don't see NAD's post as "moaning and groaning." Neither do I see it as "not of value in achieving the goal of changing the medical system behavior with regard to patient modesty."
It's value is in what's known today as Narrative Medicine. See http://www.narrativemedicine.org/
NAD is telling a story that the medical community needs to needs to address. It has the system-changing value, of course, only if the medical community pays attention to it and takes it seriously. If NAD's is regarded merely as a "freak," an extreme case that is not worthy of consideration, then shame on the system.
Today, Narrative Medicine seems to focus mostly on cancer stories and other chronic diseases. They get the attention, as they should. The only time modesty issues seem to be taken seriously is if they are blended in with these cancer and chronic disease narratives. Even then, modesty stories are often just placed in the background rather than included as an essential part of a patient's emotion and/or spiritual health. NAD's story of a 3-year-old child's medical trauma and how that has affect his life should be just as important. But apparently it isn't. It isn't considered life-threatening, like cancer. But it is if people like NAD don't seek treatment because of their phobia.
NAD deserves praise for his willingness to tell his story on your blog, even though it will probably be disregarded as insignificant by most in the medical community.
We have posted Misty's latest article on informed consent is missing from urinary catheterization.
Go have a look.
Doug, I didn't belittle NAD's disclosure of his history and emotional experience by characterizing it as "moaning and groaning" since I think this is an important personal emotional issue for him which needs to be effectively resolved as well as his debate about his needed operation. What I did imply is that we have had sad stories like this throughout all the 54 Volumes in the past 8 years. Maybe, as part of a formal advocacy program visitors here should collect all these emotional stories on my blog and present them to Narrative Medicine for wider distribution.
Any visitor response to NAD's immediate concern about surgery? ..Maurice.
That's a good idea, Maurice. Some of these stories are excellent examples, and since this thread has been running as long as it has, we have many good stories. You're correct in that these stories randomly placed throughout this thread don't have the value they would have were they collected, sorted and placed perhaps in categories. If we combined some of the stories on your blog with those on Dr. Sherman's and my blog, we would be able to get enough good samples. Then, perhaps some day, a graduate student might go through them and determine the themes and motifs and come to some conclusions. We have enough anecdotal data here to do a worthwhile study. The study would be even more valuable if some of these blogs would be willing to identify themselves and/or be interviewed to give more detail and clarify some of the narratives.
But my point still is that modesty narratives don't hold much weight within the medical profession unless they're carefully embedded within chronic disease and cancer (and other serious medical) stories. Unless it's a live and death situation, the modesty issue seems to claim less value within the profession. A good example would be Art Stumps book "My Angels are Come." The serious modesty violation is embedded within a cancer story. Using the cancer story as a frame, Stump is able to highlight the emotional impact of what happened to him.
Welcome NAD. I've had similar problems and have heard of many others as well. This blog is a great place to read that other people have suffered the same indignities as you. I've read many great suggestions on how to cope with it and possible ways to bring positive changes.
Sometimes you have to be patient cause some commenters have their own agendas, but overall I think this blog is great.
GR
Dr. Bernstien while I don't doubt you havent heard a lot of protests from paitents, one might ask, have you asked them? Does the medical community ask? I know i have never been asked. I have heard a ton of comments from friends that indicate it makes a lot of people uncomforatble or embarassed to one degree or another. One should not have to be traumatized to a large degree for this to matter to providers. Our comfort should be important, not whether we are avoiding care or traumatized. It is not unlike female reporters in the locker room. The message is controlled by the "offenders" so would one really expect them to shine a light on the issue. the only time you hear a problem with female reporters in the locker room it is the atheletes who are portrayed as offenders, how many times have you seen reporters ask atheletes if they care? how many times have you asked providers ask if patients care?..Don
There is a thread on allnurses about funny reactions of patients, It starts with a cartoon of two female nurses standing beside the bed of a male patient whom is screaming and the caption, just for the record this is a common reaction for men when you mention catheter. SD can say what she wants, and I understand that it is wasted energy to argue who has it worse, the fact is males do face issues when it comes to respect of modesty in the medical community that are different than females face. There are many many places where the opposite is true, recognizing this does not diminish what females face, denying it exists however does diminish the issues males face...Don
Don, let me tell you and the others my experience and actions in the practice of internal medicine. The patients have never asked and I have never asked about modesty issues. What I have always done and what I have instructed my medical students I teach is to inform the patient what I plan to do next in examination or procedure and how it will be carried out including exposing or "manipulating" (hands on) any part of the body including in the case of the usually modesty sensitive parts of the body and then await some form of informed consent. The consent usually is wordless without the patient expressing a "no" and with no resistance as I start the exam or procedure. The other responses would be a simple "OK" or "I understand". I tell the patient what I intend to do next even "look in your ears, nose and mouth" or to the woman "I am going to examine your lungs and heart in front, help me by lifting your gown" Thus the patient is informed and it is the patient's responsibility to say "no" if that is their decision. The next step for me with a "no" response is, I would stop the exam and then to ask "why" and I would wait for a explanation. My practice was that of general physical exam including as necessary breast (both male and female), genitalia (male and female) including hernia and rectal and penile urethral swabs for STDs.
Really, I haven't had any rejection attributed to a modesty issue and that is why I have the view that physical modesty affecting an exam or procedure as not something greater than an statistical outlier issue.
I hope this detailing in this post clarifies on this thread my experience. Now I cannot extend this discussion to remark about any other internist or other specialist and their own experiences. Dr. Sherman is a cardiologist and may not have had the usual experience as myself in general internal medicine but I still would like to hear from him here about his experience. (Excuse me, Joel if you have already has described this on your own blogs.)
..Maurice.
Maurice,
With due respect, you are one person, yet you seem to base all your feelings that this is an "outlier" issue on your experience alone.
Why not start asking every patient you see how they feel about opposite gender care for intimate exams and see what you get.
Also, I don't know what kind of examinations you do in your practice, but, if they don't include intimate examinations with clothes off, this might never be an issue that you've had experience.
So..while we are all a product of our experience, based on hundreds of conversations with both men and women, it would seem that it is you that might be the outlier.
belinda
Dr Bernstein: My feelings about the fact that you have never had a patient express modesty concerns are as follows:
1. Many patients feel like exposure is part of the exam and, even if they are embarrassed, humiliated, etc., they will endure it for the sake of their health and never express a concern.
2. The female patients that go to you are aware that you are a male and have made their choice, so it can be asssumed that those women do not have a problem with modesty when it comes to being examined by a male physician. You are most likely not seeing any women who have a problem with this issue, which could be a significant number.
3. Many patients do not feel like they can voice or express a concern like modesty because they fear they will be ridiculed and thought to be a nut case. (Related to #1)
I know that in the past, the few times I have seen a doctor I never felt like I could bring up the subject of how uncomfortable and difficult it is for me to be exposed, even for a medical exam. I honestly feel like this is the case for a lot of people: they just do not know how to approach the subject and so leave it unsaid and just suffer through it. Maybe we modest people are in the minority but I do feel like there are a large number of individuals out there who would welcome the conversation and the effort of medical staff to address the problem. They just do not know how to start that conversation. This blog has empowered me to do exactly that if the need arises in the future, for which I am grateful.
Also, Don I understand completely your point and I do think men are ridiculed much more than women if they express modesty concerns. I don't think it is appropriate for jokes to be made about men't discomfort, etc. It is a lot about a double standard which I am totally against. I think we should all be treated equally with respect and compassion. Yes, men do have it worse when it comes to this. I suppose that's just ingrained attitudes that men are somehow thicker skinned and shouldn't show any weakness, vulnerability, etc. They are supposed to just "tough it out". I do wish more men would step up to the plate and demand their modesty needs be met in the medical arena because, frankly, I think it would help all of us. Jean
Maurice, either I didn't see your complete post, or I posted and then your comment was on there.
I would imagine, that most people including me (before my experience) would not object to a necessary exam especially if told ahead of time what to expect.
What I'm trying to say is that your experience is comparing apples to oranges especially in a hospital setting when often patients are not told what to expect and then find great difficulty not only with unexpected bodily exposure but loss of control issues, etc.
Someone who had these issues and knew they were going to the doctor would not have made the appointment with an opposite gender physician so, it would make sense that in your perception, this would be an "outlier" position.
It's not a fair comparison and wouldn't be the venue to ask patients already in your care how they feel about an issue when there couldn't be one to begin with or you wouldn't be the doctor involved.
belinda
I fully agree that my experience with patients may represent that my practice was itself a statistical outlier in terms of the issue of patient modesty. I am not aware of the details of communication or responses others practicing medicine except as rather thoroughly described by visitors to my blog thread.
I think that it is a bad decision for the doctor (and not the patient) to first bring up a question of the patient's physical modesty issues when the patient has been given information about what is going to happen next in the examination or procedure. After all, the focus of the visit is diagnosis and treatment and not primarily one of a discussion about modesty. Sure, if the patient brings up the issue, it would be wrong for the doctor to ignore responding but I would not agree for the doctor to say to the patient something like "You haven't talked with me before on the topic of your modesty issues and though I explained what I was planning to do regarding the examination, I understand that there are a number of patients who would feel very embarrassed by undergoing this exam and I wondered if you would be one of them." I think such a question would be similar to telling the patient "I am going to examine your breast for masses, tell me how would you feel if I found a cancer there?" Is such frank routine handling of modesty or cancerphobia questions posed to patients prior to the examination necessary or even proper? ..Maurice.
I think what we're talking about here might be considered a good example of how the health care system sometimes makes unfounded assumptions. The system sometimes assumes, as Maurice says that "the patient has been given information about what is going to happen next in the examination or procedure.." In my experience, rarely is the patient given enough information about draping, caregiver gender, exposure involved, and who will be observing or assisting during an exam or procedure. So, Maurice is correct from where he's coming from, i.e. assuming that if this information is fully given and the patient says nothing then all is fine. But what we often hear from patients is that they're caught by surprise or, as some say, "ambushed." That's my first point.
Secondly, most medical professionals are not unaware of patient embarrassment due to exposure. Some of them feel just as embarrassed as the patient. They way they may cover their embarrassment is not to talk about it, and move quickly and deliberately, sometimes without letting the patient know what will come next. Be quick. Or, knock the patient out and expose the patient and do the prep without evening letting the patient know that will happen.
In fairness, some medical professionals think that if they bring up topics like modesty they may be influencing behavior by the power of suggestion. There is some truth to this. But this is an individual reaction, and this is another example of assuming that this applies to all patients. It doesn't.
But as I've said for many years on this and other blogs -- the key is communication. The system seems to assume that once taught the importance of communication and informed consent, it just happens and if the patient doesn't object, they feel okay about it. IMO, that's very far from the truth. Even medical professionals who communicate well, only communicate what they think important -- and rarely is any issue involving exposure, caregiver gender, draping, nudity, observers considered important enough to communicate. It's assumed that by showing up and signing vague permission to treat documents, the patient has agreed to whatever will happen.
Maurice, I agree with you regarding telling the patient what to expect and the rest is up to the patient EXCEPT...when this is done on the spot and the patient doesn't either have time to digest all the information or is too overwhelmed by the idea that they will be exposed and "X" amount of people will be in the room.
A friend who knew I was researching the topic explained to me that she was to see the doctor for a dermatology appointment due to a rash on her legs. Sitting in her underwear, a number of medical students entered her exam room without her informed consent.
The door still open, the physician asked her to remove her bra. (She had no rash on her breasts). She was so stunned, she just sat there like a deer in headlights. Then the physician asked one of the female students to help her unhook her bra. She was very big breasted and she spilled out of it leaving her topless in front of a bunch of students and an open door.
She was completely traumatized due to no medical necessity for her to remove her bra and for the complete insensitivity of everyone involved.
This is what traumatizes patients. These stories are not outlier stories, they are what happens every day in medical care somewhere.
This is the kind of behavior that needs to be recognized, addressed, and consequences implemented.
Why in the world would this doctor want to humiliate the patient? What could his purpose be when there was no rash on her upper body?
Nobody can answer that, but it reminds me of the story in the NY Times when a doctor on rounds visiting a mastectomy patient removed her blankets and her gown in front of a group of medical students. Can someone please respond to the purpose of such treatment. It's humiliating, degrading, traumatizing and without medical necessity or purpose and yet...nothing happens to the professionals involved.
belinda
Dr. Maurice,
How often do you do pap smears and breast examinations on women? Many women actually go to the gynecologist for those exams instead of an Internal Medicine doctor.
Do you have many female patients that you’ve never done any breast and pelvic exams? If so, that is probably why you have not heard female patients expressing concerns about modesty. As a woman, I’ve gone to many male doctors over the years, but I have never had any pap smears and breast or pelvic exams by them so the issue of patient modesty did not come up. I went to them mostly for ear and throat issues. I personally would never go to a male doctor for intimate female health issues.
When you do prostate and genital exams on male patients, do ever have female nurses present? If not, that is probably why your male patients have not expressed concerns about modesty.
I am very curious. What led you to start this blog about patient modesty concerns? When was the first time you started thinking about patient modesty?
Mdr
Dr. Bernstein, I do not intend to say medical providers and reporters are the same, because they are not. We visit providers for our beneifit, reporters are their for their own. But if we applied the same litmus test to both cases "silence or lack of resistance is consent". One would then say any athelete that is uncomfortable or embarressed by opposite gender reporters present while they shower and change are outliers? I truely respect you for what you are doing, which makes this even more telling to me. Athletes who complain are labeled sexist and attacked by the media so most just endure it. Just because people endure these intrusions does not mean they are OK with them, they may simply think they have no choice or are to intimidated to speak up on their own. I know that was me and even after these years of "enlightenment" from this blog and others I still struggle with making it known, but I am better at it because of this & Dr Sherman's blog. I would bet a lot more of your patients were very uncomfortable but just didn't say anything, just like me. I would like to know if this was the case of others who post here. Let me give ask you a question. If 100 women came to a clinic for a mamogram. They were lead back to the room and gowned by a female nurse, then a male mammographer came and announced he was doing the proceedure. Another clinic, 100 women, they are asked at intake We have two mammographers, one male one female do you have a preference. Do you think the number that declined to have the male would be the same? I think what everyone here is saying is while we believe you when you say you have never had a patient bring it up, it doesn't mean none of them had issues with modesty or that the number whom did would have spoke up, all it says is that they didn't say anything. A large number might have concerns, the degree might have been different, but it doesn't make us outliers. I know there were procedures that caused me a great deal of anxiety that I said nothing about, and possibly the provider could not tell how humiliated I felt. I completley believe your comments, I just don't agree with what you think they say. I have been there and done that. Don
Dr B, as you suggest as a cardiologist I don't do genital or breast exams routinely. Nonetheless most women's breasts are briefly exposed at some point. A few women would clearly rather not be exposed and I don't insist except on new patients where it is important that I be able to fully auscultate the heart. Sometimes the reluctance is do to older women having trouble getting in and out of their bras. The infrequent adolescent I see are usually discomfited; their mothers are with them for the physical.
I have never had a patient bring up modesty concerns, but it is usually fairly obvious if they have them. There are no female cardiologists in my locale.
I think Dr. Sherman's comment is something most people posting here suspect. I would admit a lot of us do everything we can to hide out discomfort, but I honestly question how someone could not see if not sense the discomfort. When a person is exposed infront of opposite gender, when we are having something inserted, probed, or manilulated, how can common sense not dictate that the person is embarassed. Whether they say so or not, how could someone not understand the natural instict is to be embarassment and discomfort. While to some degree it cannot be avoided, to deny it exists is an interesting question. Is it possible admitting it creates an unpleasant situation for providers. They have no desire to cause harm to patients, if they admit it causes emotional harm, they admit they are part of that so it is easier to live in a state of denial. It is also just as likely providers ae so focused on the physical the emotional is lost on them. We do not always know ourselves as well as we wish we did. providers are no different, they just have a different profession...don
I still say "speak out your discomfort" directly to your doctor, to the hospital administration and to the medical system. They will stop and listen if you speak up. I know I would in the past and as I continue working with patients..I will. ..Maurice.
I'm going to say something that may come as a surprise to some of you.
I can remember many a doctor visit when my doctors were male, had intimate exams and never felt embarrassed at all.
I chose the specific doctor, trusted that person and his expertise so when it came time for the exam, it was just part of the visit.
I will say, in those days, you met with the doctor in his office before the exam, fully dressed, discussed problems or concerns and then given time in the exam room to change into a gown.
Maybe it's this acknowledgement of a person as whole, maybe it was the idea that the physician could meet you in your entirety, as your dress is an expression of who you are.
They always say and there is a power differential between doctor and patient. The above scenario, doctor selection, greeting you as a whole person lessens that power differential. After all, it was the patient who started that ball rolling.
This, is much different than going to a hospital to have a baby and being forced with opposite gender care you don't know for the most intimate internal examinations intimate exams in an environment that seemed to me like "Grand Central Station". I don't even remember being bothered so much with that; not until I lost every vestige of trust and respect for the medical community based on ridiculous behavior and worse yet, lack of accountability and acknowledgment that there is a problem.
belinda
That you belinda. The modesty issue has much more to do with establishing trust and good communication. The system has changed. Time takes over. I'm not saying that many doctors don't try to take the time and establish that trust. Many do. But these days one loses contact with one's personal physical very early on in the process when one goes to a hospital. The patient is immediately confronted with strangers, who are most of the time rushed on time with too much of a patient load, especially the nurses and cna's. Not only is there little time to establish any trust, but a significant number of caregivers today don't want to make meaningful personal contact. They just get the job done and move on to the next job. That's the basic system today, with some exceptions. As I've said before, most people will go either way with gender care if they feel safe and respected. That means trust and that takes time. Many doctors today have lost the autonomy they had years ago. They're working for or embedded within systems that control much of what they do. And values have changed in culture.
Doug, I would agree with what you wrote. Physicians are now subjected to the requirements set by their employers or HMOs including limitation of time in order to attend to more patients. Also physicians do not have the opportunity now unlike in the past to set their own goals of patient management and other elements of professional autonomy. It is into this changed environment that the patient enters with the unchanged need for attention, diagnosis and treatment. Added to this, they now appear with the degree of autonomy they never had in the past and many are aware of the new power. They may appear in the doctor's office already "educated" about their symptoms and what to expect by the media and internet. What is necessary is that there should be time and opportunity for patients to have time to exchange their education and all their expectations with the doctor. And by the way, this exchange of expectations shouldn't be going just one way since the doctor should have the time and opportunity to do likewise. This communication between doctor and patient, if permitted by the system, should level the playing field and provide more understanding service on the part of the physician and more acceptance of that service by the patient. ..Maurice.
Dr. Bernstein,
Don made excellent points. Many patients indeed care about their modesty, but many of them feel powerless and intimidated to speak up.
Medical Patient Modesty recently had an exhibit table at a conference in Florida. We passed out educational brochures about MPM. We also had a display board explaining why Medical Patient Modesty was needed and patient modesty concerns such as urinary catheterizations without consent, patients being stripped unnecessarily for surgeries that do not require it, patients’ wishes being disregarded once under anesthesia, etc. Many people shared that they had never heard of MPM before.
The truth is many people are bothered by how they have to give up their modesty, but at the same time many of them have been taught that they must let medical professionals do pretty much anything without questioning. As you know, some doctors and nurses tell some patients to get over their patient modesty concerns and try to tell them that they have seen everything.
Medical Patient Modesty has gotten so many emails from people who were upset about how their modesty was violated in medical settings over the past few years. Most of those patients actually did not speak up because they felt powerless.
We had comments from people who were upset about some things that happened to them in medical settings. I’ll share some comments we got from people who came by our table.
1.) One woman who had just had a colonoscopy two days earlier said she had a female doctor, but that she was upset that they demanded that she be fully nude for colonoscopy. I shared with her that they should have offered her “moon” shorts. I believe that all medical facilities should have those colonoscopy shorts. This lady also wondered if they really honored her wishes about a female doctor.
2.) Several people expressed how they were upset that they were stripped naked unnecessarily for surgeries.
Misty
For those interested in a topic which describes a disturbing medical professional behavior, you might be interested to go to a new thread titled "Medical Slang Leading to Logical Fallacy: A Practice to be Avoided" which is a copy of an original article I wrote and was published by bioethics.net. Derogatory slang referring to the patient as a person, probably most common in emergency rooms, I feel leads not only as a insult to the patient but promotes erroneous evaluation of the medical situation by the professionals making and accepting that slang. ..Maurice.
Misty
You had a table set up at a conference for medical
patient modesty? My hats off to you.
PT
I wanted to share a personal story because I know some of you have been in a similar position. I was really upset to hear a male nurse talking about how he was going to give my grandmother a bath 3 years ago when she was in ICU after heart bypass surgery. The surgery went well and she is doing good today. My grandma probably doesn’t know that this happened because she was still out from the surgery and that breaks my heart that her wishes were not honored when she was still out from anesthesia. It’s a hard subject for me to discuss this personal story because I feel guilty that I didn’t speak up. I could see that it bothered my mom and aunt by their expressions, but I think they felt powerless like I did. If I could go back, I would have spoken up and said that he could not give her a bath and talked to the nursing supervisor. It really bothered me that there were so many female nurses on that floor that could have given her a bath. I was upset the next day when the same nurse made comments about how my grandma should not hide her abdomen from him and that he had seen everything. Based on my conversation with a doctor, I learned that nurses are often give gender neutral assignments and it was very common for male nurses to give women bath today. He said that we must speak up. I don’t feel this is fair because so many family members are taken off guard and they are in difficult situations especially when their family members have had major surgery. One of the things I’d like to do is to encourage nursing departments to make it a requirement for all nurses to ask patients and their family for preferences about gender of nurses for certain procedures. I’m very glad that we have more male nurses today because many male patients and their wives desire male nurses. But it bothers me that hospitals tend to be gender neutral. One of the things I really want to educate people about is that they need to be aware that they could have a nurse of opposite sex bathe them or do intimate procedures on them. Many people don’t think about this issue until the last minute. Our family was in a such vulnerable position because we were concerned about how my grandma was recovering because she had a major surgery. I have heard of other cases where family members of female patients or female patients were upset that a male nurse gave them a bath. Many of those family members were in a vulnerable position too.
I am sure that there were many male patients in the hospital that day who desired to have a male nurse. The nursing department should have assigned that male nurse to male patients.
I feel that nurses should always be compassionate and sensitive to patients’ wishes about modesty. I know that there are some nurses who are sensitive to patients’ wishes for modesty. I heard that many nursing schools don’t even really address patient modesty. It is so sad about how many nurses are insensitive when patients express their wishes or concerns about modesty.
Misty
Dr. Bernstein, I would like to disect this discussion a little more. I agree with you 100% patients need to speak up more. While there are a ton of issues with that aspect of this, I would like to look at the original issue, are patients with modesty issues outliers. My contention is they are not outliers, patients with modesty concerns who speak up are. While the degree may vary from uncomfortable to traumatized, from my conversations with people whom have been patients many if not most are embarassed and have concerns. You are more involved in this issue than any other provider other than Dr. Sherman I know of, and yet you assume since people are silent they have no concerns. Dr. Sherman made the statement, while women whom were exposed said nothing, he could tell some were embarassed. I would suspect if providers were looking they would see the same, or perhaps if some were honest they would admit the same. So while I respect you a great deal for taking this on, and I agree with you 100%, I think your contention that patients with modesty concerns are outliers, is not on inaccurate, insteadI think it shines a light on the mindset of providers that is an intregal part of this issue....don
don, my argument is not that I think patients who have physical modesty concerns are statistical outliers. What my view is that patients who have physical modesty concerns and express them to their caregivers or those who avoid examination or procedures because of their modesty concerns are the outliers. If those of us in medical school education didn't suspect that most all patients have some degree of modesty (??excluding naturists) whether expressed or not we wouldn't be talking about modesty issues with our students and how to go about examinations with attention and care to modesty.. for example, telling patients about what is going to happen next and to perform sequential undraping rather than unnecessary exposing of the patient's body both for modesty comfort and to prevent chilling and shivering. I hope I have explained my views and definitions. ..Maurice.
Dr. Bernstein, I have only posted once before. My issue is not with physicians. I am a male who has a female GP and a female dermatologist. I chose them. They both examine all of me. I could not care less about being partially draped and sequentially un-draped. After all, what is the difference between 10 seconds or 10 minutes? I would also never expect one of them to explain step by step what they will do.
My concern is with office staff which is 100% female. Last year, I had full-anesthesia outpatient surgery. I was awakened by two young females (probably not even LVNs) who said they were there to dress me. The surgeon never advised me of this. This was an ambush! Why should I have to ask questions of which I would never think? Again, I am okay with female physicians. I might even choose a female urologist if she had male staff. Everyone has different degrees of modesty.
Your blog has taught me to ask more questions and be more assertive. However, I also believe that physicians should explain, without being asked, who will be helping with any procedures and in what capacity.
Please continue this blog. It is helpful. -- Gerald
Maurice, so what you're saying is that if you express concerns or avoid procedures you are an outlier.
My question is....if you reason to be an "outlier" is it really fair to label people as all they are doing is protecting themselves from a system that as you can see is far from perfect, or the cause of different patient behavior based on their experience?
belinda
Belinda, what I wrote was "patients who have physical modesty concerns and express them to their caregivers or those who avoid examination or procedures because of their modesty concerns are the outliers." And as I have written, this is a statistical fact, based on my own years of internal medicine practice. Maybe I should have better written "In my experience such patients do not even exist"! But, as I have said that maybe my practice itself was a statistical outlier if surveys were taken with other practices finding that most patients actually do express their modesty concerns to doctors and most patients would avoid exams and procedures due to their modesty if their modesty requests are rejected. Of course, my reading these years of this Patient Modesty thread it would be obvious that such patients at least do exist.
I did not intend that my description represent a derogatory labeling of patients but only an expression of a statistical conclusion based on my own experience. ..Maurice.
I understand why you haven't had problems yourself Dr. Bernstein. As other people have noted, if I made an appointment with you for an examination I would already be well aware that I will be undressed in front of a male doctor. And I believe that you would explain to me what you will do to me before you do it.
What I'd like to know is, for example, would you then tell me beforehand (if it is the case) that after I am given general anesthesia three women, an older woman and two teenagers will strip me naked, wrestle a urinary catheter through my penis and shave off all my body hair while two other teenage nursing students watch? Then every half hour a different CNA will go in and check the catheter, and so on.
I understand why you personally wouldn't have problems with your patients. You do exactly what's expected. But I think it would be very different if you were, for example, a substitute gynecologist. If a woman was lying there in stirrups and you walked in and said "surprise, I'm substituting for Dr. Mary today and Andrew the 19 year old CNA will be assisting me", you would probably get some different responses.
For me, doctors themselves aren't the problem. It's the support staff that are very often the unethical ones. But since the doctors are well aware of what will happen, and in many cases hire and send the women in himself, he still deserves the blame. -
I think one of the big myths about support staff working with doctors is that doctors are in control. This may be the case in private practice, clinics owned by a doctor or a group of doctors. But when you go to the hospital, your doctor may not work at the hospital, but has privileges there. That doctor doesn't control who does what to you after he completes surgery. Those decisions are made by department heads or head nurses. I think it's important to tell your doctor your needs regarding modesty. The doctor may agree to your needs but find that he's ignored at the ICU or floor level. Some doctors who may have seniority or clout at the hospital may be able to get you what you need. Others may not. My point is that patients need to discuss their needs not just with their doctors but also with the hospital, and I don't mean with the receptionist. How things are done can be very specific to individual head nurses on individual floors. Don't necessarily expect to have things done your way if you talk with your doctor about it. Be prepared to be proactive once you're in the hospital. And you need to make sure you talk to the right people, the ones who make scheduling decisions.
One of Medical Patient Modesty’s goals is to educate patients about how to have as much modesty as possible for surgeries. There is no reason for underwear to be removed for many surgeries that do not involve the genitals. It is important for patients to know what body parts will be exposed for each surgery so they can make a request for all same gender team if necessary.
Please take a look at an article I just put up about modesty concerns during gallbladder removal surgery. It is possible to wear underwear and shorts (as long as there is no metal) for this type of surgery. There is no need to have an urinary catheter inserted for this surgery since it only takes about an hour. I also included a link about gallbladder surgery alternatives that people can check out before they consent to surgery.
If a male patient is allowed to keep his shorts and/ or underwear on for this type of surgery, there would be no modesty concerns since only his chest and belly would have to be exposed. Male patients still need to take precautions to make sure that their underwear and shorts are not removed and that urinary catheter is not inserted.
Unfortunately, it is impossible for a female patient to wear a bra to cover her breasts for the surgery since gallbladder is located so close to the breasts. A female patient who does not want any men to see her breasts will need to select a female general surgeon, a female anesthesiologist or nurse anesthetist, female scrub technicians, and female nurses.
As many of you may know, female surgeons are much harder to find than female gynecologists. You usually can find several female general surgeons in big cities. This is a big challenge for women who may live 200 miles or more away from a big city. A lady may have to drive a long distance, but it is worth it.
Misty
SD,
Concerning your comment of April 29, I think your characterization of my previous post as "an attack on you" is unfair. I do, indeed, take issue with the statistics that you gave, for the reasons that I stated. However, this should not be regarded as any sort of personal attack. It is simply a disagreement, and one about which I feel very strongly.
As to your statement that you will be leaving this blog, I hope that isn't true. While we may disagree on some particulars, these are much less important than our advocacy for a patient's right to respectful treatment. I believe that staying connected to others who believe as you do would be best for all.
I should mention that I addressed my comment to both you and Misty, because her initial post after yours seemed to agree with your statistics. Since my points to both of you would be the same, I saved on time and redundancy by making a single reply.
Also, I see that a LOT of comments have been made since I last visited, and I have some serious catching up to do. My apologies to those of you who have been replying to more recent comments, but I just saw this one from SD, and felt the need to respond.
One aspect of privacy and modesty violations in health care that isn't discussed too often concerns patient interactions with pharmacists. Here we have an example of Pfizer deciding to sell Viagara over the internet, directly to patients:
http://www.cnbc.com/id/100710599
The company has several reasons for this, including a loss of business to online pharmacies, many of which sell counterfeit pills at an extreme discount. Well, at $25 a pill, can anyone really blame men for taking their chances with alternative suppliers?
However, one major reason for this change in business model is, what the article calls, “the embarrassment factor”. Many men have trouble enough in discussing their ED with their doctors (and their doctors' staff). But, they then have to face the pharmacist, or, more likely, the assistant who records the transaction on the pharmacist's behalf, in order to fill their prescription. Men have turned to online pharmacies, in order to avoid this.
I view this as a positive change, much as I suffer no illusions that Pfizer is doing this from some sense of altruism. It is evidence of what many have said on this blog: when we, the customers, impact their bottom line, they, the health care providers, will make changes.
Doug,
I appreciate the excellent points you made. I agree with you that too many people falsely assume that their doctors are in control of who will be present for surgeries. In many cases, doctors have agreed to patients’ requests. But their requests could be disregarded by an anesthesiologist or a nurse. For example, a patient might tell her/his doctor that he/she does not consent to Versed, but her/his wishes could be disregarded by an anesthesiologist. The hospital or an anesthesiology practice often assigns an anesthesiologist to a surgery patient. I have observed that some doctors say that it is okay for the patient to keep his/her underwear on for surgery, but then nurses in OR say no. Also, many doctors are often busy getting ready for surgeries that they do not really have time to talk to the anesthesiologist and nurses about the patients’ wishes.
Doctors do have some control especially if their patients have surgical procedures inside their offices. As you know, many urologists do vasectomies in their offices. All urologists should have plenty of male nurses available in their offices.
You will notice in my articles about gallbladder removal surgery and modesty during childbirth that I mention that patient should talk to nursing supervisor and hospital. I have asked several all female OB/GYN practices if they can work to guarantee that a woman would have an all female team at the hospital and they told me to contact the hospital to discuss the need for female anesthesiologist and nurses. It also would be prudent for the patient to meet with the anesthesia practice if possible.
Misty
Staying Fit, thanks for introducing the new topic of "historical sexual modesty" in the medical environment. Although my long running thread on "Patient Modesty" was originally started as "Naked" based on the article of the same name in the New England Journal of Medicine and was oriented to physical modesty in medicine, historical modesty of sexual significance is certainly pertinent to the overall discussion here.
One question to those who have written here or to those who haven't would be: if you find that physical modesty can be an important issue in your medical care, do you likewise feel uncomfortable for healthcare providers, in general, be made aware of your sexual private concerns but from a historical point of view. The concerns could vary from homosexuality to specific sexual practices to sexual inadequacies, the latter as suggested by Staying Fit.
By the way, we do teach our first year medical students to take a sexual history on all patients as part of taking the complete history of a new patient. Questions should include the lifetime number of sexual partners, male or female or both, oral, anal or vaginal sex, and, of course, sexually transmitted diseases. It is worth noting here how rarely the student has failed to get informative responses from the patients. ..Maurice.
While I can't speak for others, I'm amazed patients routinely offer such sexual history details. Additionally, how is that history even relevant to a patient receiving healthcare. Frankly, the number of partners, their gender, the type of sex, and STD history is none of their business! In what manner does this information enable better healthcare for the patient?
Ed
Ed, think of sexually transmitted diseases, most are significantly treatable if diagnosed and the subtlety of many of their symptoms. This area of medical questioning is just as important as asking about alcohol use or the symptoms: chest pain or shortness of breath. ..Maurice.
We're talking history here and not a patient needing STD treatment. Again, how is the history relevant? And the alcohol I consume is none of your business either!
Ed
Ed, as an example, a patient enters the hospital ill with a cluster of symptoms which were not diagnosed in the outpatient setting. A complete history is the standard of practice for the hospital admission and the alcohol/drug and sexual history is part of the admission history. Actually, a complete history should be taken when a patient starts to be followed by a general physician as an outpatient both for possible relevance to any symptoms at the time but also for the physician to discuss general health issues which could be of benefit for the patient's future health. Unfortunately, time limitations precludes such important initial comprehensive histories for many patients. ..Maurice.
I would not be comfortable sharing a sexual history with anyone; nobody's business, not in a risk group. It's a matter of privacy.
What possible knowledge other than statistics would that information be if there is no sexually transmitted disease involved?
This will sometimes come up when visiting a new doctor regardless of the discipline, but it's rare. I would just say no thanks.
belinda
I'm not being disrespectful and truly appreciate your sponsorship of this blog but you live in a perfect world called academia. Unfortunately, patients do not. I'm expected to share my most intimate symptoms with the receptionist just to schedule the appointment, then a high school graduate (I think) who escorts me to the exam room where I'm expected to repeat my symptoms so she can record it in my EHR. I'm lucky if I actually get to spend 10 minutes with the physician! I could really care less what the standard of practice is in the hospital; my personal life is well personal. Patients are not idiots and are well aware of the risks of alcohol, smoking, and STDs. I wouldn't hesitate to share those personal details with a trusted physician if I thought my health was at risk. However, I will not answer personal questions posed by those who haven't earned my trust nor the professional distinction to be privy to them.
Ed
Think of a first visit to a doctor and the patient says "Doc, I'm here because I am tired all the time and I don't know why." So the next step is for the doctor to take a history. Oh, the doctor discovers that the patient has started a new job..but the symptom started some weeks before that. The doctor already knows that the patient is 34 and unmarried. The doctor will not be of diagnostic benefit to the patient by failing to ask the sexual history. With regard to the symptoms which might initially be presented in a patient who has HIV/AIDS, read the following from MayoClinic.com:
HIV symptoms
HIV is an infection with the human immunodeficiency virus. HIV interferes with your body's ability to effectively fight off viruses, bacteria and fungi that cause disease, and it can lead to AIDS, a chronic, life-threatening disease.
When first infected with HIV, you may have no symptoms at all. Some people develop a flu-like illness, usually two to six weeks after being infected.
Early signs and symptoms
Early HIV signs and symptoms may include:
Fever
Headache
Sore throat
Swollen lymph glands
Rash
Fatigue
These early signs and symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, you are very infectious. More-persistent or -severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.
As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic signs and symptoms such as:
Swollen lymph nodes — often one of the first signs of HIV infection
Diarrhea
Weight loss
Fever
Cough and shortness of breath
Later stage HIV infection
Signs and symptoms of later stage HIV infection include:
Persistent, unexplained fatigue
Soaking night sweats
Shaking chills or fever higher than 100.4 F (38 C) for several weeks
Swelling of lymph nodes for more than three months
Chronic diarrhea
Persistent headaches
Unusual, opportunistic infections
..Maurice.
Once again, you're missing the point. I've never had a physician ask face to face a health history. In my experience, those questions are addressed by forms and I simply annotate N/A or not applicable. I think its telling that no one has ever followed with further inquiries if the sexual history was that critical to my healthcare.
Ed
Dr. Bernstein I appreicate the explaination, I agree with you on both issues to a large degree. The number who avoid healthcare and express their concerns are probably a minority. The numbers who delay, hesitate, or dread care is probably a majority as is the number of people who have concerns about modesty. I agree with your comments now that I more fully understand, especially clarification that it was not intended to have negative connotations. Where I think the majority of the people posting here differ is the steps taken to address it. Where the medical community choses low cost options, comunicating, professionalism, assuring, I think the majority would prefer other options such as being able to leave various articles on when possible, choice of gender, etc. I think there is a resistance on the part of providers to make those accomodation or even acknowledge them, I think it starts with economics and become entitlement on the part of providers. I had a surgery once and emailed the hospital requesting a idea of what i could expect to transpire and got a very generic email back, something I would have gotten in health class 35 years ago. I tried several times and got what I felt was dancing around the issue. It doesn't change the answer to this, Patients have to speak up, whether you want your providers or the institution to change how they deal with this, they are not going to do so unless you speak up and only numbers will change the situation as a whole. We can argue all day whether they should or should not, the fact is they won't unless challenged. Should providers know, I think they should and do, but there is an "inner circle" approach to dealing with it. So, if you want something different to happen, you have do do something different, like demand it...thanks Dr. Bernstein, and Misty, my compliments for the tabling idea...that is changing not complaining....don
It's too bad that you never had a doctor ask "face to face" a health history. Unless the issue was something like an acute dislocation of a shoulder, some common vague symptom such as "fatigue" which I noted above or a host of other symptoms with multiple possible causes requires something more than a "not applicable" designation by the patient on an entry form. The question is how would the patient know that the common symptom is "not applicable" to a sexual history when even the physician at this point may not be able to give that conclusion.
Let the physician ask the patient directly about the sexual history. And then if the patient states "non applicable", the doctor can look the patient in the eye and say "I wonder why you say that? Do you know something about the cause of your symptom that I am yet unaware?" Hopefully, with that direct statement, the doctor will learn something further.
I hope most patients don't think that a physician attempting to make a diagnosis is some kind of a "game". It really isn't. The physician knows the consequences that may occur with a missed diagnosis. A physician who is "slipshod" in taking a history or a patient who is unwilling to provide assistance by relating the history may suffer the consequences.
Sexual transmitted diseases and their associated symptoms are not gone yet and we (both doctors and patients) should do everything we can to establish a STD diagnosis, if present. I can tell you, Ed and the other visitors here. that I see no chance that teaching students about taking a complete sexual history is going to be disappearing from the medical school curricula. ..Maurice.
To reiterate, "I wouldn't hesitate to share those personal details with a trusted physician if I thought my health was at risk. However, I will not answer personal questions posed by those who haven't earned my trust nor the professional distinction to be privy to them." Once again, its all about who asks, why, and how.
Ed
Maurice, I think the medical community would gain more compliance from patients if they asked whether they exhibited the symptoms of sexually transmitted diseases instead of asking those questions that are private to almost everyone.
That way, the doctor could make conclusions and recommend tests based on symptoms, rather than gathering information that is probably irrelevant to those who are at low risk.
Most savvy adults know symptoms of std's with the exception of HIV (thanks for those) and anyone having a problem would probably seek medical care because they are either physically uncomfortable or feeling ill.
It's my opinion that it's probably a mistake to ask the questions without basis because you won't get an honest answer from the patients who are uncomfortable. Not too many would just tell you that they refuse to answer.
All the symptoms could be listed on a questionnaire, then reviewed by the doctor during the visit to save time and gather what's needed for the patient's health and an accurate exam.
belinda
Re taking a medical history: I have had the same experience as Ed. I have never had a doctor take a medical history from me. The rare occasions that I have seen a doctor I have just filled out the history on a form prior to seeing the doctor and those have never included information on sexual history (but have included alcohol consumption and smoking history). I highly doubt that the doctor even looks at these forms. The doctor generally just askes questions related to the problem I am there for. Maybe the reason this has happened is that I do not see a primary care physician on a regular basis but only seek care when symptomatic. And I do also agree that patients are not stupid and if they suspect that they may have an STD they will then share their sexual history with the doctor. And, actually, when I was younger and had to see a GYN for birth control (with the mandatory PAP test) I was not even asked about sexual history, which is really baffling since cervical cancer is caused by the HPV virus, which is sexually transmitted (multiple partners would increase the risk). There was a real disconnect there since if I would have been asked the doctor would have found out that I was at an extremely low risk and the screening was probably of little to no benefit for me. A little unethical in my opinion but I was young and naive and just believed that it was something I had to do to get birth control. A whole other story.
And I have to add that Don's comments are right on: we seem to see eye to eye on this issue. I also want to commend Misty for taking this one step further and actually having the guts to go directly to the medical community. Jean
I completely agree with Ed regarding the issue of providing a sexual history that is often requested by a physician's office. Several years ago I was asked to fill out a new patient form that included a section that contained intimate questions about my sexual history. I left that section blank and returned the form to the receptionist. A few minutes later, she asked to speak to me and told me that I had "forgotten" to fill out that section of the patient history form. I explained to her that if I had any concerns or problems in that area I would definitely discuss them verbally and privately with the physician; but I was not about to put such private information in writing where anyone in the office could read it. The receptionist replied that no one in the office would do so but of course this was not true because she could not have known that section of the history was blank if she had not looked at it.
MG
MG, I can see your point. The document should have been looked at only by the doctor who would pick up the missing response. Personally I disagree with the idea of having the patient fill out any medical history list in the waiting area prior to speaking with the doctor. There is no privacy available for any part of the history. Obviously, it is done to save time for the doctor and the visit.
With regard to the taking of a sexual history by the students, the practice in my medical school is for the students to begin that part of the history with a specific preface to the effect: "I am about to ask you personal sexual questions. I want you to know that I understand this information is sensitive to you and what you tell me will be kept private and only between you and me." And, indeed, when the students write up the interview for the instructor's review, the patient's name is never written on the paper. Also, I have rarely heard of a patient rejecting the student's request. Whether this is related to the patient demographics because the my groups have gone to Los Angeles County Hospital for patient workup. On the other hand, as I recall, some years ago when we had the students participating in workups at a private hospital, also rejections were rare.
I wonder if those patients who reject responding to a sexual history taken as a routine in a general medical history would also be the ones with the highest degree of physical modesty concerns. ..Maurice.
You may be interested in this article on KevinMD from a woman physician who accuses a man of sexism for initially refusing an intimate exam from her.
Joel, I just put up my 2 cents on that article on KevinMD and it was as follows:
"Can't we all get along?" If there are suspicions on either side of the bed rail regarding sexism, this will never be productive or of value for the individuals involved nor the medical system in general. Right now, we have to live with the medical care realities until it is changed and those accusations of sexism has to be set aside and whatever are the genders involved the goal is to accomplish the best for the patient along with, unless otherwise proven, respect for the physician. "Getting along" should be looked upon as therapeutic activity.
Hopefully, we are not dealing with the issue of sexism as we are discussing patient modesty on this blog thread. It's all about ignorance, misunderstandings,poor judgment and sensitivities but not really about prejudice, stereotyping or discrimination of one gender over another.. is it? ..Maurice.
I again refer to the same article above by a woman physician accusing a man of sexism for refusing an intimate exam from her.
All the negative comments made a difference. The physician has now apologized and stated she was wrong.
Civil communication does make a difference.
Dr. Sherman,
Thank you so much for bringing the article by Dr. Koven to our attention! I was very pleased by her response too. I think it is always important to educate doctors and nurses about the importance of being sensitive to patient modesty. You also will notice that I made additional comments about how grateful I was that there are more female doctors today. We definitely need plenty of doctors and nurses of both genders to accommodate patients' preferences.
Misty
So here is an interesting event I was involved in today. As indicated earlier I have started efforts to recruit men into nursing which included a medical scholarship. This connected me with a group called AHEC which is a federally funded program to bring young people into health care, There was a group of professionals from education and local hospitals. The discussion of the programs some of the schools were involved in including interning at local hospitals. There was discussion as to the min. age which eventually ended at 16. They talked about the rotation and included a young woman witnessed a birth, imaging, surgery, etc. So, here is the question where is the balance between the need to groom providers and patient rights. I had an employee whom told me he had been asked if a local HS girl could be present during his colonoscopy, he indicated he consented, and she watched the procedure. Today I would have asked, when did they ask you. I was recently asked if a student studying to be a NP could shadow my MD during my physical, I agreed with the stipulation that when it came time for the prostate and hernia exam she would have to leave, The nurse said I don't blame you they made me ask. Another time my dermologist whom I really like asked if a "female medical student" could observe my exam and qaulified that it would be above above the waist. So even people like I will accomodate when it is handled properly. I think this goes beyond students, if providers made more of an attempt to properly involve patients instead of hiding or dictating...how much would this issue be reduced. My concern for surgery would be greatly diminished if i were allowed to wear shorts when possible, yet as simple and obvious as this is...doesn't happen.....don
Interesting story, Don. But I would question both the ethics and legality of allowing any minor (under 18) to participate in any procedure or exam of a patient. They are not legally bound by any HIPAA requirements. They are not ethically bound by any professional guidelines. They can be required to sign any document saying anything -- and that would be worthless because they are minors. If the violate any HIPAA requirements or ethical requirements, they cannot be held liable.
As long as the patient is told what I've written above, and still agrees to the minor's observing -- then what can be done. But they're not told. In my opinion, the consent given by the patient then is not true "informed" consent.
Sorry, I just don't like the idea of a high school student observing any medical exam or consultation I have. I wouldn't allow it. If these students need exposure to the medical field to see if they are interested maybe they can go with family members/friends and observe at those times. I don't think one needs to sit in on surgeries, exams, procedures, etc. to realize that medicine may be a field they are interested in. Just seems like there should be other ways to introduce them to that career field besides having them observe actual patient exams or procedures. It's not like they are medical students: they are minors in high school! Especially weird was the high school student who observed a man's colonoscopy. Funny thing about that is my experience is a lot of doctors won't even let you have your husband/wife or other family member present during a procedure like that. But it's ok if a minor high school student observes? Just a little strange but I guess if the patient didn't have a problem with it then a-ok. But in my opinion if that begins to be accepted then others may feel pressured into accepting the same. I personally think any "shadowing" or observing should be limited to actual medical students and then only with informed consent. Jean
"But it's ok if a minor high school student observes? Just a little strange but I guess if the patient didn't have a problem with it then a-ok."
Jean, I agree with what you say but I would take it even further and never give an institution that would even suggest something so ridiculous my business.
Here is the thing, while I have been as adament as anyone about the issue, I do not say this is wrong period. the guy I knew did not have a problem with it. There are people who do not share the feelings of this group. It is perfectly fine for them to consent and it serves a great benefit to everyone including those of us who would not feel comfortable doing so. The problem I see is to often there is either no consent for some of these things, maniputlated consent (ie asking at the last minute), or coercion (you don't mind, or so and so will be assisting me. The medical community does things a certain way to achieve a desired outcome. If they truely wanted informed consent it would be done on an intake form where the patient would feel the least pressure to agree when they really didn't feel comfortable. Not asking if a patient would prefer to leave underwear on means the liklihood that they would have to agree to do so would increase vs just not asking. the students get have to complete a term of class room, then 4-8 hours of instruction from the hospital before they are allowed to partcipate. The NP that supervises this said she puts the fear of God in them about HIPPA. As this unfolds I will investigate but I got the feeling they were open with patients but I will find out how open and report back.
I am going back to KevinMD's blog and ask the Dr. to elaborate a little on her apology. Did she recognize the issue of gender preference in this setting and sexism are two different things? Or did she just feel choice by gender in that setting is sexist period. don
I for one do not believe Dr. Koven's admission to
being wrong is sincere,her comments reflect a state
of mind in that regards.
PT
I wanted to let everyone know that one of Medical Patient Modesty’s goals is to develop an online database of medical procedures, listing their implications on modesty. This will include information about what body parts must be exposed and the different options for these procedures that can be done to maintain modesty. This is valuable because many people are unaware that they can ask for other procedures that could protect their modesty better. For example, we would list in our database that women can search on procedures for detecting ovarian cysts. This will be very helpful because many women are unaware that they can ask for an abdominal ultrasound instead of a transvaginal ultrasound if they are suspected to have ovarian cysts. Abdominal ultrasounds are usually just as good in detecting ovarian cysts if a lady does not mind having a full bladder for the ultrasound.
This database will help to prepare patients to speak up about their wishes if they prefer that a same gender provider do the procedure or to have an alternative procedure that protects their modesty better. We know that there are many procedures that you do not have to give up your modesty. For example, there is no need to take any of your clothes off for a strep throat test.
We will need to hire a nurse consultant to help us with this project. We have not secure the funding yet for this project.
Please look at http://patientmodesty.org/Online%20Database%20of%20Medical%20Procedures.doc for more details. If you do not have Office Word on your computer, you will not be able to view this document.
What do you all think? Do you have some suggestions about what you would like to see in this online database of medical procedures?
Misty
Misty
I believe you would be treading into some dangerous unchartered territory with this database. No, an abdominal ultrasound is not and does not provide the same data anatomically as does a transvaginal (endovaginal) ultrasound. An abdominal ultrasound is primarily designed for the gallbladder, liver and other upper abdominal digestive organs.
A pelvic ultrasound is utilized for the reproductive
organs but can never achieve the view needed for
a precise interpretation, the axial view. This is why
a transvaginal pelvic ultrasound is performed. The
patient inserts the transducer and is covered the
entire time.
From my perspective,unless you are a board
certified radiologist,you would be giving out medical
advice regarding substitutable exams which is not
good medical practice. A clinician would most likely
never and I mean never substitute a procedure just
for the benefit of a patients modesty.
Truth of the matter is most exams cannot be
substituted from a radiological perspective. There
is something called the standard of care which designates the type of procedure that a diagnosis
must follow. In conclusion, you could be charged for
practicing medicine without a license,not to mention
giving misguided information to patients who may
have a serious medical problem.
I am as much an advocate for patient privacy and
modesty as you are,yet we need to approach this issue
from a standpoint that assures good medical care and
safety for the patient. Yes, there are good alternatives,
but let the clinician decide the course of care, our job
then is to dictate our concerns to those who deliver
that care.
PT
Here's one Misty. When receiving a cardiogram, lift your gown to just under your breasts to have the leads placed and then lower the upper part of the gown as you would wearing a strapless for the upper leads. There is no exposure at all and they are now doing this procedure in several hospitals instead of completely exposing the patient.
belinda
Belinda. In the early stages of my wife's treatment for cancer, they wanted a cardiogram. There were several people in the room already when a male tech entered and said he needed to do a cardiogram. She was already wearing a gown and the tech put the leads on her back, shoulder, side, and under her breast. The leads were already stuck on his fingers and all he did was touch them in place. When he was done, he grabbed the leads, gave them a tug, off they came and off he went. He left the sticky part in place for you to remove. There was no exposure what so ever. I was standing 2 feet away and watched the entire thing. If he could do it why can't the others. Why would a female be required to be topless to have this test? AL
Al, To answer your question, "I don't know".
My aunt was hospitalized last week and in the emergency room, they, too, wanted a cardiogram. The technician was male.
It was interesting to note, that the only side they fitted with leads was her left. The bottom line is that this male tech left her left breast completely exposed during the entire procedure.
My aunt knows how strongly I feel about this issue, yet I said nothing because this issue isn't important to her and she would have been very upset if I had started. So, I didn't. I did wonder though, why he left her exposed when it would have been so easy to cover her.
belinda
PT,
Some women’s ovarian cysts have been successfully found on pelvic ultrasounds. It really varies.
We will not be giving medical advice. The online database of medical procedures will be a very important tool for patients to use to research the maximum amount of modesty they can have. You can certainly have more modesty with colonoscopy if they will let you wear “moon” shorts that only expose the buttocks. Look at Belinda’s comments about cardiogram. Some technicians might demand that a woman be topless for this procedure.
Unfortunately, many doctors and nurses do not attempt to protect your modesty so it is important for patients to be empowered. Also, many medical professionals rarely provide you with information about what must be exposed and how much modesty you could have.. There are so many surgeries that do not really require patients to take their underwear off. For example, there is no reason for underwear to be off for surgeries that involve the foot, hand, nose, knee, etc. As you may have noticed, I recently wrote an article about modesty concerns during gallbladder surgery. Every patient should be able to wear underwear for this type of surgery. However, a woman’s breasts would be exposed some for this surgery because one of the incisions is done right below the breasts. If a woman does not want her breasts to be exposed to any men, she must choose an all female team.
Patients will be empowered to stand up for their rights by this database. Then they can go to their doctors to discuss procedures that they might be having.
Look at a question that a man emailed Medical Patient Modesty:
Can you send me a list or link that tells all the medical procedures that involve bodily exposures for everyone?
This is exactly why there is a need for the online database of medical procedures. The database would be helpful to patients with modesty concerns to make a decision about whether they should have an all same gender team.
Misty
This cardiogram thing got me to thinking. You keep hearing that they don't employ male techs in the imaging department. If a male told them about his modesty concerns , couldn't they offer the option of him holding the transducer on his testicles under a sheet with no exposure ? I would think the tech would know if the images are clear. Since I never had one done I was wondering if it was possible. Also, how many other procedures could be done this way ? AL
Misty,
I've got one for you.
Cardiac cath - The typical approach is through the femoral artery in the groin, which requires some exposure for both the prep and the procedure.
Alternatively, most of the time this procedure can be successfully accomplished via either the brachial artery (upper arm) or radial artery (wrist) without the need for any intimate exposure whatever.
Recovery and care for the cath site are also easier (arm/wrist are easily elevated and compression of the site is much easier to accomplish).
Misty
The highest resolution transducer has a penetrating depth of only about 7.8 inches. What
would your website suggest to a morbidly obese
female facing the possibility of endometrial cancer.
PT
PT,
Misty already told you. The patient could request females only! What Misty is saying is that patients have choices and should be made aware of them in order to be their own best advocate with regard to their own bodies. She is not recommending any particular procedure or test over another. She is just trying to make patients aware that they don't need to be led like sheep to accept something that may not ultimately be necessary and that often, things can be arranged to address both the patient's physcial and mental well being at the same time.
Chris
It would also be up to the doctor to advise a patient if one procedure would be better than another for a variety of reasons and depending on what's more important to the patient would be the way to go.
So many times patient are offered an open MRI machine and they are never told that the pictures are not of the quality or clarity of an enclosed machine. Sometimes patients just don't care...as in anything else.
belinda
PT,
Chris made excellent points. An obese woman will need to talk to her doctor about which type of ultrasound would work best for her. It is simply important for all patients to know about how much bodily exposure is required for each procedure and the maximum amount of modesty they can have. One lady came to the exhibit table for Medical Patient Modesty at a conference in Florida last month upset because she had colonoscopy two days earlier. She said that they demanded that she be nude for the colonoscopy which was unnecessary. All medical facilities should offer colonoscopy shorts similar to http://www.monmouthsurgical.com/colonoscopy-shorts so a patient’s buttocks would only be exposed. I am sure that many patients would be more willing to pay a little extra for a colonoscopy short.
We will not give people medical advice. They will need to take information from the database and discuss with their doctors. For example, a doctor might tell a patient that he/she must be completely nude for a colonoscopy and patient can stand up and say no that a colonoscopy short must be provided or he/she will not have the colonoscopy. Some medical facilities indeed provide those colonoscopy shorts.
Misty
PT,
Chris made excellent points. An obese woman will need to talk to her doctor about which type of ultrasound would work best for her. It is simply important for all patients to know about how much bodily exposure is required for each procedure and the maximum amount of modesty they can have. One lady came to the exhibit table for Medical Patient Modesty at a conference in Florida last month upset because she had colonoscopy two days earlier. She said that they demanded that she be nude for the colonoscopy which was unnecessary. All medical facilities should offer colonoscopy shorts similar to http://www.monmouthsurgical.com/colonoscopy-shorts so a patient’s buttocks would only be exposed. I am sure that many patients would be more willing to pay a little extra for a colonoscopy short.
We will not give people medical advice. They will need to take information from the database and discuss with their doctors. For example, a doctor might tell a patient that he/she must be completely nude for a colonoscopy and patient can stand up and say no that a colonoscopy short must be provided or he/she will not have the colonoscopy. Some medical facilities indeed provide those colonoscopy shorts.
Misty
Recently Dr. Sherman pointed out an article on KevinMD that touched upon the modesty issue. Many from this and our blog responded and we made a difference.
Here's another article that discusses the need for true patient-centered care that realistically considers the individual needs of the patient. Of course, many in the medical field will considered this "customer service" nonsense. I wrote a reply. Here's a quote from the article that can tie right into our topic here:
"Current approaches to patient-centered care are based on aggregated preferences rather than individualized needs. Researchers and health systems deploy focus groups and surveys to assess general patient preferences in an effort to determine “what patients want.” But patients are a diverse group with diverse needs. Characterizing general beliefs and preferences alienates those whose needs and preferences do not align with the majority. The result has been a monolithic view of patients and their needs — a framework that prevents the delivery of truly patient-centered care.
All service industries share the challenge of providing tailored, individualized service. In response, leaders in customer service have developed tools and infrastructure to understand and respond to individual needs and preferences. Health care providers should leverage these approaches."
This is yet another opportunity to get our word out. I encourage all those on this blog to respond to this article showing how the modesty and gender choice issue fits right into this model. And give the author credit for bring this up.
Here's the website:
http://www.kevinmd.com/blog/2013/05/patientcentered-care-requires-learning-service-industries.html
Chris
Gee golly! Tell misty that for a transvaginal
ultrasound all patients are covered with a sheet, even
if the ultrasound tech is a female! Why dosen't that
ever happen for male patients who require a testicular
ultrasound?
Colonoscopy has considerable risks,perforation
and death. I seriously doubt anyone has ever been
asked to be completely nude for a colonoscopy,but then
with 99.8% of all endoscopy nurses being female you
never know.
Colonoscopy pants, really. Are you kidding
me? There are tests that are much safer and just as
effective as a colonoscopy and requires no premedication.
PT
There are no standard procedures for draping so they differ from one hospital to another.
A relative of mine had a testicular ultra sound and was completely covered.
belinda
belinda
Once again you offer false and misleading
facts when readers to this blog are entitled to the
truth. It's always your friend or a relative that had this
done or that done this or that way and only when it
conforms to your argument. I look down on people
like you who contort the facts and add to the false
hood of the great double standard only to propagate
the female agenda.
sonoguide.com/smparts_testicular.HTML
Male patients are never completely covered
for these exams although they could be. The majority
of ultrasound techs are female, the techniques and
the mentality were taught to them by a standard
curriculum from female ultrasonographer instructors.
Hospitals do not set protocols on draping
techniques,the state nursing boards do. They do NOT
differ from hospitals as you imply. The ARRT does
not set standards for ultrasound techs on how they
drape.It is a gender driven standard or should I say
a gender driven double standard! No one sets
standards on how sonographers drape. Am I making
myself clear.
PT
PT,
The link that you gave: sonoguide.com/smparts_testicular.HTML did not work. Can you please double check? I am very interested in seeing that web site.
Misty
It never seems to amaze me how obtuse providers are with respect to mens' healthcare. They can't figure out why men under-utilize ED treatment. Follow the link:
http://stlouis.cbslocal.com/2013/05/14/study-majority-of-men-with-erectile-dysfunction-do-not-seek-treatment/
No, PT, you are not. Read the article "Naked". You, are no authority, sorry. And...in the future all negative comments will not be addressed. You are a non entity to me full of rage and anger. Get some help!
belinda
OK OK! "Can't we all get along??" One can be critical of another's conclusions and provide alternates (that's called discussion) which can still be free of personality descriptions on either side of the issue.
Actually PT's URL works with html used in lower case. It appears to be a rather valuable link regarding standards for sonography. Here is the link:
http://sonoguide.com/smparts_testicular.html
Again, "Can't we all get along?" ..Maurice.
Dr. Bernstein,
Thank you for figuring out the URL! I thought it was a very informative article. Every medical facility should always have at least one male ultrasound technician on call at all times for male patients who are uncomfortable with female technicians. Many men are embarrassed to talk to female medical personnel about male health issues.
Misty
I've heard from many rape victims that the worst part of their tragic experience was their feeling of a total loss of control. A stranger was making the decision about what happened to their body and they couldn't do anything to stop it. Is that really any different than what happens in many medical situations? I see it that way, so whenever I go into a hospital or clinic I feel like I'm in a building full of serial rapists.
"There are tests that are much safer and just as
effective as a colonoscopy and requires no premedication."
Out of curiosity what types of exams are they? What options do we have?
"A relative of mine had a testicular ultra sound and was completely covered."
Covered some of the time maybe but I'll bet they get several peeks during the process, so what's the point of being covered some of the time? I guess it's possible that being partially covered could be used to block the view of a chaperone, assistant or any other useless person that might walk into the room, but I doubt they would ever demonstrate that type of courtesy since they all claim to be "professionals" and therefore have the right to see or do anything they want.
It just astounds me how barbaric many procedures still are in the 21st century. With modern technology, human rights and American political correctness you would think that we could be making some advancement in medical ethics, but when it comes to that I think we're still in the dark ages.
GR
Quoting from the study-majority-of-men-with-erectile-dysfunction-do-not-seek-treatment article,
"...Dr. Ajay Nangia, an associate professor of Urology at the University of Kansas Medical Center in Kansas City, was quoted as saying in a press release “We need to have a better understanding of where the disconnect between diagnosis and treatment occurs.”
Is she really that clueless? The key word being "she". It's difficult enough for men to humiliate themselves by going in and admitting they have a problem like that, then being sent from one woman to the next to the next. Do they really think gender plays no part in why men avoid the situation altogether? When will we see male clinics like women have or at least show enough respect to have men on staff to allow male patients to maintain a little bit of dignity?
People like Dr. Ajay Nangia ARE the problem. RS
GR, Patients are draped to make them more comfortable even is whoever is doing the test may have more visual access.
I suppose it could be compared to a woman having an ob/gyn check without a drape placed over her legs.
I have seen hospital deliveries on
television programs where a tent is provided and the only person who has visual access to the patient is the doctor and nobody else.
It also could be compared to a full body exam for skin cancer who is examined part by part and completely covered except for the part being examined versus being nude for the exam. Most people would tolerate option one better.
belinda
Belinda,
It is true that many people want as much modesty as possible. I think it’s always useful to drape as much as possible. But that does not make many people any more comfortable with opposite sex intimate care. Many women do not want a male OB/GYN to deliver their baby at all. I am sure you probably saw the article about same gender maternity care that I wrote that was published on Dr. Sherman’s blog. Sometimes, a male anesthesiologist has to help to administer epidural to a woman in labor. It is possible to keep her private parts covered so the male anesthesiologist would never see any of her private parts.
Misty
I wanted to let you all know that one lady who had acid reflux avoided an unnecessary colonoscopy because she changed her diet at the encouragement of a friend at http://patientmodesty.org/acidreflux.aspx.
It is important that patients research procedures and health issues before they consent to a procedure. Doctors often do not inform patients that some health issues such as gallstones and acid reflux could be resolved by a change in diet.
Misty
Misty, I agree with you 100% and my post was not reflective of gender.
Same gender care should be a mandate, not a request for anyone who needs it regardless of the gender of the patient.
Additionally, standard of care practices should be evaluated with a focus on limiting the amount of vulnerability and exposure; everything to keep the patient most comfortable.
belinda
Bellinda said "It also could be compared to a full body exam for skin cancer who is examined part by part and completely covered except for the part being examined versus being nude for the exam. Most people would tolerate option one better."
I have not seen any scientific study on this anecdotal statement. It would be difficult to perform a scientific study to evaluate your statement that you posit as fact.
I have full skin checks by a female dermatologist. I personally argue it makes no difference to be exposed for one minute or one hour. In fact, I would hypothesize that after a few minutes of exposure, one begins to feel much more comfortable.
Anonymous stated at 4:28am "...whenever I go into a hospital or clinic I feel like I'm in a building full of serial rapists." Perhaps one who feels this way should visit with a therapist. The two situations are so extremely far apart.
Gerald
Common sense...We have perceptions based on our natural tendency to cover ourselves, our cultural norms, etc. Women sometimes feel differently about these things than men but not always.
While some might be comfortable with a nude exam, our natural and cultural tendencies state something quite different for the majority of us. Additionally, a nude exam exaggerates the power differential between medical personnel and the patient.
Some would have no problem with a nude exam, most would, and some, would consider it cruel and degrading treatment because full exposure at the same time is not required. Add a few people in the room who weren't expectd, an insensitive comment about the patient's body and you have a recipe for humiliation.
It's all about vulnerability. One of the first tactics in torture is to strip the individual. They do it to take away their personhood and identity and treat them a non person.
Just because the environment is different, doesn't mean that with the wrong people, a nude exam would be more traumatic for most, then to be covered except for the part being examined.
What the covering does has little to do with covering and more to do with showing the patient that you respect them as an individual and you care enough to attempt to make them as comfortable as possible.
I don't think we need a scientific experiment to validate feelings of being cared for and respected.
belinda
"I have full skin checks by a female dermatologist. I personally argue it makes no difference to be exposed for one minute or one hour."
By choosing a female dermatologist for a full skin check Gerald either doesn't care at all about being naked in front of women for an hour at a time, which makes me wonder what brought him to this blog, or he's an exhibitionist who came here to brag.
I do agree with him on one point though. Whether it's for a minute, an hour or a one second glance it's still the same sight. Draping is pointless if you don't feel right about who's seeing you exposed. If it's just a slightly embarrassing inconvenience, like being exposed to someone of the same gender, draping can be an advantage. But if it's someone you believe shouldn't be seeing you for even a second, draping doesn't improve the situation much.
For example, being a modest guy, if I was changing in a men's locker room and a man walked in I would cover up quickly. I would be embarrassed if he saw me for a second but not nearly as much as if I had to walk all the way across the locker room in front of him. Either way I would be embarrassed but it wouldn't ruin my week. But if a woman intentionally walked into the men's locker room, even a very quick glance would infuriate me because I believe she should never be allowed to walk in there, especially if she worked there and felt entitled to go in whenever she wanted (because she's a "professional" and works there).
Experience helps us over time, as does talking to people that are experienced and familiar with the situation. Much like learning through experience which gyms to avoid because women feel entitled to enter men's locker rooms, we need to pay attention to which doctors use opposite-gender support staff for intimate exams and procedures and avoid those places.
Unfortunately while gaining that experience we're often forced to suffer through bad situations. And at times we're stuck at one place and can't get out of it, such as being required to visit certain doctors only, for insurance reasons. Or in the case of a gym, already paying for a year's membership we can't get out of before we learn that female employees are allowed to enter both locker rooms.
Some people don't care much about either scenario, but many of us feel outraged about the lack of respect, morality and dignity. We should always be informed about what's going on beforehand and be given a choice. -
Actually, the title of this thread "Patient Modesty" is the general topic for discussion and I am open to various views to be written here since this is a discussion site. For example, in the earlier volumes of this thread I have encouraged and had the views, as patients, of a couple of male naturists and one male artist model (would they be also called "exhibitionists"??). I wish we had more to explain their views regarding "patient modesty". I was even looking for a pornography star or starlet (shucks!,never got one). I think it is important to understand the decision of these particular humans with regard to being exposed in a medical situation in order to more fully understand patient modesty in general. ..Maurice.
I wanted to let you all know that Medical Patient Modesty has a new article about Versed and Sedation. Versed is a very powerful amnesiac drug that medical professionals have used on patients who have expressed concerns about modesty. Once you are under the influence of Versed, you usually cannot speak up about modesty or pain. One hysterectomy patient was given this sedative drug because she expressed that she did not want any males involved in her surgery. Please spread awareness about this article.
Misty
"It's all about vulnerability"
I think that's about the best description I've heard Belinda. There are other reasons as well but you nailed it with that word. Stripping patients, very often unnecessarily is a tactic to keep that person under control and make them afraid to speak up for themselves. It also keeps the patient production line going faster because I imagine most people just want to get the appointment over with as fast as they can in order to get their clothes back on, therefore limiting wasting the doctor's time with a lot of questions. Time that costs the doctor or hospital money.
I believe it also boosts the doctor's or nurse's ego to have that much power and control over other human beings. (especially nurses because it makes them feel like they're actually professionals)
I was very pleased to see this suggestion on http://stopcoloncancernow.com/media-center/releases/women-colonoscopies-5-ways-to-make-it-easier:
•Wear Your Boxers Backwards
If modesty during the procedure is a concern, then wear a pair of boxers backwards. Some gastroenterologists, like Dr. Pichney, offer "moon pants", which are paper shorts worn from the waist down during the procedure. Women should ask their GI if that option is available.
This is a great idea about how you can protect your modesty when you have a colonoscopy.
Misty
Here's an eye opener! "The American Congress of Obstetricians and Gynecologists recommends the first visit should be between the ages of 13 to 15. The exam should be an opportunity to educate teens about their bodies and help them establish a relationship with a gynecologist at an early age."
Really? Are they serious? Can't imagine why any teen needs to see a OB/GYN at that age. What if they're not sexually active? This ranks right up there with all men should receive annual PSA testing. Its not about our health, dignity, modesty, or privacy; its all about money.
Follow the link: http://gma.yahoo.com/blogs/abc-blogs/teens-expect-first-gynecologist-visit-162720722.html
Ed
That ABC News article is not really consistent with the American College of Obstetrics and Gynecology actually concluded in their Committee Opinion August 2012 with regard to the initial age for pelvic or breast examinations. Here is the excerpt:
Patients Younger Than 21 Years
Currently, the College recommends that the first visit to the obstetrician–gynecologist for screening and the provision of preventive services and guidance take place between the ages of 13 years and 15 years. This visit generally does not include pelvic examination. The focus of this visit should be on patient education. During this visit, the obstetrician–gynecologist can establish the clinician–patient relationship and engage in age-appropriate discussion of anatomical development, body image, self-confidence, weight management, immunizations (including the human papillomavirus vaccine), contraception, and prevention of STIs (5).
The College recommends that pelvic examinations be performed only when indicated by the medical history for patients younger than 21 years (6). An “external-only” genital examination can provide the health care provider with the opportunity to evaluate the patient for normal external genital anatomy, issues of personal hygiene, and abnormalities of the vulva, introitus, and perineum that might require further investigation. The external-only examination also provides the clinician with the opportunity to educate the patient on the range of normal female anatomy.
No evidence supports the routine internal examination of the healthy, asymptomatic patient before age 21 years, although it is recognized that pelvic pathology sometimes is identified by a pelvic examination on an asymptomatic patient. A pelvic examination always is an appropriate component of a comprehensive evaluation of any patient who reports or exhibits symptoms suggestive of female genital tract, pelvic, urologic, or rectal problems. For patients younger than 21 years with problems, such as menstrual disorders, vaginal discharge, or pelvic pain, an internal examination may be necessary.
The College guidelines for cervical cytology screening published in May 2009 now recommend beginning cervical cancer screening at age 21 years, irrespective of sexual activity of the patient (6). This is based on the current understanding of human papillomavirus infection in the adolescent patient and the pathophysiology of invasive cervical cancer.
Testing for STIs is recommended for sexually active adolescents. Nucleic acid amplification testing on urine samples or vaginal swab specimens is now an acceptable form of screening for gonorrhea and chlamydial infections (7, 8) obviating the need for cervical sampling. Other options that do not require an internal examination include self-collected vaginal swabs for diagnosing yeast infections, trichomoniasis, and bacterial vaginosis.
..Maurice.
From the same ACOG Opinion as documented in my last posting, here is the pertinent extract about Breast Examinations:
No data exist regarding the ideal age at which to begin clinical breast examinations in the asymptomatic, low-risk patient. Expert opinion suggests that the value of clinical breast examination and the ideal time to start such examinations is influenced by the patient’s age and known risk factors for breast cancer. The occurrence of breast cancer is rare before age 20 years and uncommon before age 30 years (10). Based on available evidence, the College, the American Cancer Society (ACS), and the National Comprehensive Cancer Network recommend that clinical breast examination be performed annually in women aged 40 years and older. Although the value of a screening clinical breast examination for women with a low prevalence of breast cancer (eg, women aged 20–39 years) is not clear, the College, ACS, and the National Comprehensive Cancer Network continue to recommend clinical breast examination for these women every 1–3 years ..Maurice.
During the Vietnam conflict as well as the 1st and 2nd
gulf wars there were soldiers receiving combat pay or
otherwise known as imminent danger pay. The current
administration believes that you should only get this
pay if someone was shooting at you. Why should army
nurses get combat pay when they are no where near
enemy lines. Myself and many others wrote to members
of President Obama's administration over the course of
several years.
It finally happened. If you are a soldier and you are in
a position where you regularly get shot at great, you
deserve that $225.00 a month, or $7.50 a day. If you
are some army nurse at some hospital several hundred
miles from a combat zone,too bad. You lose that pay.
You never earned it in the first place. Nurses at an
inner city hospital see patients with gsw's all day long,
you are not special and never were, get over yourself!
Why should you recieve combat pay when you are
cozy in some field hospital, watched too many episodes
of mash living up your dream and getting paid for it,not
any more. When a marine or army patrol takes
direct fire, improvised explosives and land mines, that
is combat pay.
Thank you president Obama for making this change
and I will keep up the letter writing to see that women
are drafted just like everybody else.
Oh and btw, it was some female army nurse who
started this practice.
tiger hawk.blogspot.com/2005/05/nurses-secret-weapon.htm
PT
PT, Bravo, I agree regarding the combat pay too.
I also agree with drafting women except for one thing....Right now there is a terrible problem with women who are sexually assaulted by their fellow soldiers in the field.
Until the military can provide a safe environment for women to serve, I do not support draft.
I do support a mandatory stint working for the military in administrative stateside positions until this terrible problem is dealt with. The statistics on this are astounding and much worse than previously thought.
Here is the link for the Huffington Post article.
http://www.huffingtonpost.com/2012/10/06/military-sexual-assault-defense-department_n_1834196.html
belinda
PT the only reason I allowed your last commentary to be posted is that I wanted to follow it with my question to you: how is what you wrote related to the issue of how patient modesty is expressed and the issue of why patient modesty is expressed in whatever venue it is needed to expressed?
What you wrote is a good argument to be debated but in a thread of another topic (such as "the ethics of paying for risk" or "comparing different occupations for value, is it fair? Is it possible?")
We should try to keep the theme of discussion on this very long running thread consistent with the basic topic within its title. ..Maurice.
Well Maurice
Since we are closing in on Memorial day, I thought
it would be fitting to enlighten our readers that it's not
just at civilian hospitals where patients recieve bad care, it's everywhere. Why reward bad behavior, Medicare,Medicaid, pay for performance as you may know.
Just one of the reasons Walter Reed VA medical
center was closed. Would you mind creating a link to
the site I left on my last post. It was a female army nurse who started this practice and took her bad
behaviors to the civilian world. A postcard on eBay
depicting a female army nurse during the 70's peeping
through a window to a medical induction exam.
The point of my post, bad behaviors should not
be rewarded and why does not Press Ganey ask
post hospitalized or outpatients the very question. Was
your privacy respected? Who cares if the hospital food
didn't taste good, it's not supposed to!
I'm suggesting military nurses have taken bad
behaviors to the civilian sectors. There are many accounts of unprofessional behavior in the military
nursing sector. They should never recieve anything more regarding pay or rewards than their civilian
counterparts.
PT
As a urologist in private practice I was interested in reading the many threads here. It was obvious that many patients have issues with modesty especially as regards the assistant to the physician as well as issues with the lack of control. First though it it not possible in the private offices to have assistants of each gender to assist in procedures every effort should be made to make sure the first introduction to the patient should not be (in the case of a female) when the patient is in stirrups. Certainly a face to face conversation with the physician to discuss a procedure and to assure the patient that his or her modesty will be considered. This can be done by having the female assistant enter the room first and talk to the patient if female. The exam table should never face the hall but rather a blank wall. As for the concern of loss of control this can only be alleviated by concern, understanding and proper preparation as the patient cannot be in control of any test or procedure and can only gain some comfort by choosing his or her physician with whom they are comfortable with.
"First though it it not possible in the private offices to have assistants of each gender to assist in procedures every effort should be made to make sure the first introduction to the patient should not be (in the case of a female) when the patient is in stirrups."
Not possible for a private urology practice to have a single male nurse or assistant! Why not since you do the hiring and firing?
I fired my urologist over this issue when I asked him that question. Of the three urologists at that practice, the two male urologists saw 80% of the practices male patients. Patient preferences are clear. His response was he can't afford to hire all male staff and I replied why not one. His paternalistic response was "we're all professionals here."
Its not about professional status, what they've seen, or the procedures performed. I am the patient and paying customer and my personal comfort level is the only thing that matters.
I now see a urologist (practice has five urologists) with two male nurses. So yes it is possible if you truly cared for your patients!
Ed
I find it interesting that a urologist's post would be mainly focused on female patients discomfort when the vast majority of these encounters would include male patients and female assistants. I have never seen a male nurse/assistant in my urologist office and would bet most men would report similar experiences, I would really like to hear how many readers, male or female have male assistants at a urology visit. You can pick your urologist, they pick the assistants....don
To Urologist on May 19th,
Many patients do not want opposite sex intimate care under any circumstances. A female patient can easily go to a female urogynecologist for urological issues. Every male urologist should work to hire male nurses and medical assistants to be available for male patients. I encourage you to take time to read why patient modesty is important and Why Patient Modesty is a Serious Issue?. Think about how many men may have avoided the urologist for serious problems such as cancer because they were uncomfortable with female nurses.
Misty
Don,
You made very interesting points. It’s very disappointing that your urologist’s office does not have male nurses or assistants. I encourage you to consider talking to the urologist and practice administrator about how important it is for them to hire male nurses or assistants to be present for procedures that require assistance of a nurse or assistant. I heard of a case where a male patient talked to his urologist about how he did not want any female nurses to assist in his vasectomy. The urologist agreed and he did the vasectomy and prepping all by himself.
Women have the option of going to a female urogynecologist for urological issues so they can definitely avoid male urologists.
I think we need to educate nursing schools about the importance of encouraging males to become nurses and to apply for nursing jobs in urological practices.
Misty
"First though it it not possible in the private offices to have assistants of each gender to assist in procedures "
Impossible? Not true. When approximately seventy-five percent of Urology patients are male and you provide no male assistants it means you care little about the modesty concerns of patients. All the talking and introducing in the world does not change the fact that the assistant is female. Can you imagine a Gynecologist with all male assistants? It takes more effort to hire male nurses/assistants and probably higher salaries to attract them. Why bother, just continue hiring the young female $10 per hour assistants right out of high school. I would love to see more Urology practices who employ male assistants open up and put the others out of business. I am simply fed up with the the Urology fields' "take it or leave it" attitude. LKT
I find the urologists comments interesting in two regards:
1. He states that it is not possible to have assistants of both genders in offices like his. "Not possible?" That's an incredible statement. The subtext of that statements is that he and and some other urologists are going to make absolutely no effort to try to get both genders in their offices. Can anyone on this blog imagine anyone in almost any profession making the same statement if it involved getting a women into a male dominated profession? Try to imangine that. I would suggest that to say that it's "impossible" to find a male as an assistant in a urolgist office, is at best stereotyping males and at worst a sexist statement. I personally know of urologists offices that do have male assistants.
2. His post is directly about the gender of assistants in a urolgoist office. Thus, notice when he talks about patient modesty, he uses "his or her." Although it may be difficult for a female patient to find a female urologist in some areas -- if she did, it would never be impossible for her to have a female assistant with that female urologist.
As I read his post, he seems to be saying that this is the way it is and will be. It's an attitude directed mostly toward men. It's an attitude that most medical professionals would be fearful of directing toward women with regards to their modety. It's a clear reflection of the double standard.
I would ask this urologist to respond ot my comments, but I won't hold my breath. It's not uncommon for medical professionals to come on this blog, make a counter statement or two regarding opinions expressed here, then disappear. They don't seem to want to engage. They seem to just want to state the status quo and imply that the status quo will never change, at least at their offices.
I see a urologist annually. I once asked why there were no male assistants there. He said they have trouble keeping them. But the next year there were two that I saw. On this years visit the assistant who brought me in was a man who turned out to be a male nursing student who said he had worked there for several years. We talked for awhile. He was very much aware of modesty issues that many men have.
It is very possible to get male assistants.
Each urologist openly posts which medical
insurance plans they accept. The corporate offices
of these medical insurance companies are easily
found on the web. In addition, every medical
insurance company has a complaint department.
It is not uncommon for a medical insurance
company to drop a provider. Furthermore, a business
has an ethical obligation that upon providing a Health
insurance plan for it's employees,selected physicians
on those plans should be respectful of the patients
needs.
PT
"On this years visit the assistant who brought me in was a man who turned out to be a male nursing student who said he had worked there for several years."
I would take a male student over a female with 30 years experience any day. To me that's just 30 years of gawking at and fondling unsuspecting mens' privates. They're not much different than experienced prostitutes.
From this urologists post it sounds as though he is
the same urologist who left a comment on KevinMD a
number of months ago. When questioned about his
female only staffing he would not elaborate. It would
be interesting to see his reaction if his wife or daughter
complained about male only mammographers at the
clinic and they left refusing their exam. ( Not that there
are any male mammographers).
I have read some accounts of female urology staff
at these urology clinics performing intimate procedures
on male patients. We all know that urologists hire
female staff almost exclusively for a) to protect them
from accusations of sexual assault be it true or false
from female patients. b) To surround themselves
with females, tends to be the norm at all these clinics
if you have ever noticed.
Truth is there is an abundance of male medical
assistants available, they just don't get hired. I know,
I have spoke with a few of them. Another interesting
comment I once heard was from a younger male in
his early 20's who mentioned that he was referred to
a urologist for recurring epididymitis. He felt that from
the moment he walked in the clinic every female
employee there stared at him the entire time.
What if you as a male patient complained to the
urologist that a female staff inappropriately touched
you during an intimate procedure while there at the
urology clinic. Would they notify the police as required
by state law within 24 hours or risk 6 months in jail
and a $2500.00 fine. That is the penalty for not
reporting sexual assault at any medical facility.
If you became ill at any medical facility and required
hospitalization, would the rules of EMTALA be followed
and if so although do not quote me on this one, but
I believe the clinic would be responsible for the cost
of the ambulance. Regarding hospitals, there is a 250
foot rule that applies to all emergency rooms as well.
I would ask our readers if any one knows of an
attorney that is well versed in the subject of BFOQ
that could give legal advice on this blog regarding
this matter. It would seem to me that if a urologist
hires females exclusively for his female patients
yet it can be shown that a considerable number of
his patients are male it certainly is discrimination.
PT
We really need an online directory of all-male urological practices and urological practices that have male nurses and assistants available for male patients in the United States. There are certain exams and procedures that a male urologist could do by himself.
As many of you may know, Medical Patient Modesty has an all female ob/gyn directory. It has not been updated in a while.
Medical Patient Modesty is still in beginning stages at this time so we are limited in what we can do at this time. I am the president of MPM, but I do not get paid at this time. But it is my hope to hire an executive assistant someday to assist with contacting medical practices all across the US to see which ones will accommodate patients’ preferences for same sex doctors and nurses after we secure the necessary funding. It is a big concern to us that many urologists do not hire male nurses and assistants. This must change. We have received some emails from men who were treated terribly in medical settings when they expressed their wishes about modesty and male nurses.
I also hope that someday we can hire a nurse consultant who will speak at nursing schools about the importance of honoring patients’ wishes for modesty. Nursing schools should put a big emphasis on the importance of increasing male nurses to work with male patients. Urologists also should actively recruit male nurses and assistants.
I am very pleased to hear that Dr. Sherman’s urologist has two male assistants. Many male patients would be happy with male nurses or assistants with just a little experience over a female one with 30 years of experience.
For anyone who is interested in supporting Medical Patient Modesty, you can check our GoFundMe page (http://www.gofundme.com/patientmodesty).
Misty
I have just put up on this blog a series of threads titled "Medical Student and YOU". They reference links to the Jefferson College of Medicine website which presents the visitor a vignette, a brief video drama and then the perspective of a medical student and a faculty member. I bring these new threads up here because issues which have been discussed on this Patient Modesty thread are presented there.
Look at my new threads and go to the links, experience the issue and the return to those threads and write about your impressions. I think you will find the medical school website presentation and the drama videos quite interesting and pertinent.
Here are the urls for the 3 new threads:
http://bioethicsdiscussion.blogspot.com/2013/05/a-medical-student-and-you-like-to-know.html#comments
http://bioethicsdiscussion.blogspot.com/2013/05/a-medical-student-and-youpatient.html#comments
http://bioethicsdiscussion.blogspot.com/2013/05/a-medical-student-and-you-matter-of.html#comments
..Maurice.
Doug, great post, great idea on the med students and suggesting they hire from that pool. And I noticed the same here, Kevin MD, allnurses, when confronted they avoid or disappear.
Dr. Sherman thanks for the ideas.
Misty, i had the same thought about the directory and will be in touch, and i was one whom requested no nurse for my vasectomy and my provider complied, great conversation all.
Here is an e-mail I received today and obtained permission to post it here anonymously. A hospital name is deleted. ..Maurice.
I am a white male in my 50's that had never considered the subject of patient privacy until I had a terrible experience at [a local hospital] I was admitted by my physician for correction of what was termed an anal fissure.
On the day of the surgery I went to admissions and, like most patients, I suspect, signed the admission papers without reading them too carefully and took a seat. I was eventually admitted and prepared for surgery and at the appointed time was wheeled into the operating room. To my surprise, besides my doctor, the anesthesiologist and a few nurses, there were a number of other people in the operating arena. In all, I counted 17 people. I was trying to register all of this at about the same time that I was given a needle in my lower spine.
The next thing I know, I am waking up in recovery, and the surgery is over. Two things happened next.
First, the nurse seemed to want me out of there and woke me up a number of times to get up and go to the bathroom. I got up but literally couldn't support myself because my legs were still numb. She helped me to the bathroom and told me that I needed to go to the bathroom before I could leave. After trying for several minutes she threatened to come in there and help me. At that point I lied to her and told her I had gone. She told me to get dressed and then proceeded to explain to me my post-operative routine, shoving the instructions into my jacket pocket.
Well, NONE of this registered and three days later, trying to defecate, I broke all of the stitches and bled - a lot! I called the doctor who asked if I had followed the protocol he had given me. I advised him that I had not received any instructions. The next day my wife is taking that jacket to the cleaners and finds all of the instructions. There were instructions to bath in warm water, to use a particular type of cream, etc. None of this had been followed, with the result that the operation failed. I continued to see him and used nitroglycerin cream to increase blood supply and eventually it healed. As a result of my experience, the doctor changed his pre-op procedures to make sure all of his patients received instructions BEFORE surgery. CONTINUED NEXT COMMENT
CONTINUED FROM ABOVE
The second thing that happened is that I was later told that my operation had been observed by a number of medical students. When I wrote the hospital to protest this gross invasion of my modesty, dignity and privacy, I was informed that [the hospital] is a teaching hospital and that I had signed the admission forms allowing this to occur. Never in my wildest dreams would I have envisioned that a number of people would be allowed to observe my body in this most vulnerable state with my genitalia in full view, without them even mentioning that this might, let alone would, happen! In further investigation, I found that [the hospital] to this day, doesn't post their admission forms online. If they did, you would know to come prepared with a written objection to these kinds of practices. I now have a written notice prepared in the unlikely event I would ever need to go to any teaching hospital in the future.
The net result is that now I am a distrustful patient who is hyper cognizant of my medical information and would never, under any circumstances, allow medical students or others not directly involved in my care access to me.
Now, with all of this in mind, what are a patient's rights in regards to patient photography? If I want to have a cosmetic surgery performed, can I refuse to be photographed? This all comes down to who is able to view these photos after the fact. My view is that patient privacy is talked about, but the reality is that any fresh faced 20-something can access my medical records at the doctor's office and I don't want this to ever be allowed to happen. Also, do these photographs become available to my general practitioner? My position is that before and after pictures are nobody's business but mine. If I want them, which I don't, I could take my own.
Sorry for the length of this e-mail, but I wanted to provide perspective for why I feel the way I do before I asked about patient photography. I'm sure, to most people, this isn't any big deal. It never was to me, either, until I got caught up in the issue of privacy in a most unpleasant way.
To the Anonymous of 8:03pm today, if you have previously used a pseudonym, you forgot to include it in your comment. We all would be interested in who makes very complimentary comments! ..Maurice.
sorry, I forgot the 8:03 post was mine. So today i go in for my DOT physical and could not help but think of this thread throught the process. My long time MD did the following, did not ask me to drop my shorts for hernia exam, just pulled them out a little and conducted the exam (much less uncomfortable than standing there with them around your ankles), completed the hernia & prostate exam and said i have a few more tests but i will let you get dressed before i do them, waited till i stepped behind the door to open and exit so as not to be viewed from the hall. This stuff can be done, this is a whole lot different than annom. post though I fear his is pretty common which causes much of the problem we have trusting. We are suppose to trust and yet feel ambushed. So I guess the bottom line is seek those whom understand and educate those that don't. I don't know that I feel there is a huge movement on the horizon that will change this, but I do think we can start the evolution one person at a time and in the process, help ourselves. The big thig is be proactive before, assertive during, and vocal after, positive and negatively. i am sending my PCP a thank you tomorrow and acknowledging the consideration. don
I would urge everyone to got to the allnurses site and read the thread on the customer service model. While it is not about modesty perse, it does give an interesting glimpse in the mindset of the provider, in this case nurses. The mentality that they are there for the physical and customer comfort & satisfaction are an annoyance gives insight into what we are facing here. I realize you have doubts as to the value of that site Dr. Bernstein but I would be interested in your and Dr. Sherman's thoughts on the comments. If patient satisfaction is viewed with such a low priority, what does modesty mean. That is our challenge to re-educate.....don
Sorry the title of the thread is Please let me vent
OK been a long day, the thread is Customer Service Model, Oh Please just let me vent is an intersting read on nurses complaining on just about everything to do with patients, related but not as on target....don
Don, I presume the title "Customer Service Model" at allnurse.com is the following url:
http://allnurses.com/general-articles-about/customer-service-model-834324.html
If so, it is about management scripting nurses communication with patients. The argument against the practice has to do with degrading humanistic nursing verbal intercourse with their patients. I would agree with the argument against scripting. ..Maurice.
the concept of scripting to me was probably a reaction to the sentiment expressed by the nurses to the concept of "customer service". Perhaps the statement summed up much of the sentiment was I follow the "I am here to save your butt not kiss it" or "this is a hospital not a hotel". When there is this mentality it shows to the patient and affects how nurses view and interact with patient. The days of providers as diety like or on a pedastal are changing. The competition for patients money has gone more commercial and competitive. The script is there to cover the mentality of save not kiss and to change the mentality toward the patient focus vs the provider being the focus. Where this ties into our conversation can be seen in the infamous " I have seen it before" and "I am a professional" which makes the provider not the patient the focus of the interaction. If one reads the allnurse thread often it is easy to see how some of the nurses have the old model of how dare you question, I will determine what is right for you. Go back and read the responses and forget the script and concentrate on how they view the whole concept of customer service which is just another way of saying "patient first" or patient focus. Then see if scripting may be a reaction to the mentality expressed by the nurses....don
I agree with Maurice, but Don has a good point. Why would scripting be so popular these days as a mandate coming down from management? A few reasons:
1. It's used all over in other service businesses. Does it work? Some research say it does, but I question that. Customers can tell when scripting is not sincere but just words forced upon employees. It annoys some people.
2. Complaints are coming in to managers. Sometimes they themselves hear what's being said to patients and how it's being said. Let's face it -- the medical culture isn't famous for it's great communication skills. It's a big problem in many organizational cultures, especially medicine.
3. And yes, some nurses react extremely negatively to any mention of customer service. It's the old, once you enter our domain you belong to us, essentially. We set the rules. In fairness to nurses, the relationship between patients and nurses isn't only a provider/customer one. It's much more complicated. A employee at McDonalds isn't required to remind customers that what they eat there might not be in the best interest of their health. Nurses do have a patient education mission, and sometimes they need to do things or tell things to patients that the patient may not want done or head, but is in the patient's best interest. Still -- the patient can always say no, and that can annoy nurses. It annoys anyone if you're trying to help someone and they won't cooperate. But, bottom line, they have a right not to cooperate. It's their life.
Bottom line on scripting for me -- In most cases it doesn't work. A nurse or any other scripting employee either better have internalized the value of the script so it comes out real OR they had better go to to New York or Hollywood and take acting lessons. Most scripts turn into thoughtless words just spewed out because the boss says it needs to be said.
I agree with nurses who fight against scripting -- but the idea behind it may be valid. What providers say to patients, especially how they say it, and the attitude behind it is critical to the whole relationship.
Don,
The below statement:
" I have seen it before" and "I am a professional" which makes the provider not the patient the focus of the interaction” is pretty common. I am so tired of hearing medical professionals making those statements. They should respect patients’ preferences. I was very unhappy with how a male nurse looked at my grandma funny when she expressed she did not want him to see her private parts. He replied by saying “Don’t hide it from me. I have seen everything.” That male nurse focused on himself rather than my grandma. It was really frustrating that a male nurse gave my grandma a bath without her consent and her family’s consent while she was still recovering from heart bypass surgery. There were plenty of female nurses around who could have bathed her. I thought it was strange that they seemed to assign female nurses to male patients on that floor. I am sure that many of those male patients felt humiliated by the female nurses. Too many hospitals give gender neutral assignments to nurses. The male nurse that they assigned to my grandma could have been assigned to work with male patients instead.
I am glad you had a good experience with the doctor the other day. I think it’s an excellent idea to write thank you letters to doctors when they honor your wishes for modesty. I’m so glad that you stood up for your wishes that you did not want any female nurses to be a part of your vasectomy.
Misty
Here is an interesting discussion titled "How do men feel about seeing a urologist who is female?" at
http://www.urologymatch.com/node/2775#comment-15026.
It takes days and sometimes weeks for comments to be posted so patience is key.
Ed
Dr Bernstein & Doug at the risk of being repetitive I know when I have scripted in my business, that is when the staff does not engage the customer properly on their own. We try give them the freedom to do this on their own, when they do not we put in measures to at least get superficial greetings. The purpose is as much to create a mind set as to put a canned message out there. Get them in the habit of greeting and thanking. Now we have to resort to this in a service industry that drums it constantly. Now try to change the mindset in a profession where historically providers have felt the physical is the ends and the means are justified be it compromising modesty or assuming an attitude don't question we know best....try to turn that ship. I heard a advertisement for Rush in Chicago about the technology and private rooms all focused on a more comfortable customer experience...healthcare is more and more competitive, those who figure out the patient experience quickest will win....don
For those interested, I just put up a new thread on whether a physician should maintain confidentiality of what the patient tells the doctor but under all circumstances. Go to the link and comment there, if interested. ..Maurice.
"when they do not we put in measures to at least get superficial greetings. The purpose is as much to create a mind set as to put a canned message out there. Get them in the habit of greeting and thanking."
Don -- I see where you're coming from and you make a good point. But here's my point. The "at least a superficial greetings" is okay as far as it goes. Creating a mindset is also good as far as it goes. Getting them in the habit is again good as far as it goes. So what's missing? Coaching. Too often with scripting (as with other customer service training), the employees are given the script and then pretty much left alone to develop the mindset and habit on their own. Some can do that. Most can't. They need supervision, coaching, encouragement, evaluation -- and finally, retraining and/or dismissal if they just don't get it. That's what's too often missing in the formula.
Here is a wonderful example of "scripting" for the employees if this wasn't (as I suspect)only a public advertisement for the Cleveland Clinic. Maybe more videos of this kind (demonstrating to the staff what is going through the minds of patients) would help toward diminishing the conflicts and emotional trauma as described on our blog thread. ..Maurice.
As most of you know, Dr. Sherman did a wonderful article about how informed consent is missing from pap smears more than 3 years ago. I have been doing some research for an article I’m planning on writing about pap smears. My goal is to address risk factors and risk level groups. Not all women are at risk for cervical cancer. Some women will actually never be exposed to HPV. I agree with Dr. Sherman that a woman can determine her risk level pretty much based on her sexual history.
I felt the section about birth control pills on What are the risk factors for cervical cancer on American Cancer Society’s web site was misguided. The section included this information:
Oral contraceptives (birth control pills)
There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped. In one study, the risk of cervical cancer was doubled in women who took birth control pills longer than 5 years, but the risk returned to normal 10 years after they were stopped.
I feel this is flawed. Look at an article by a doctor about how birth control pills do not really cause cervical cancer I think he provided a well-balanced perspective.
While it is true that it’s very common for women to have multiple sexual partners that raise their chances of getting HPV infections, there are also many married and virgin women who have never been exposed to HPV. I do not think that this study is fair to women who never have been exposed to HPV. Many virgin women before they get married start on birth control pills a few months before their wedding.
I think American Cancer Society should do research on the following two groups of women:
1.) A true virgin woman who has never engaged in any kind of sexual activity including heavy petting, oral sex, anal sex, and skin to genital contact.
2.) A married woman who has never engaged in any type of sexual activity with anyone except for her husband who also never engaged in any type of sexual activity with anyone else.
I believe that this research would show no cervical cancer cases unless the woman’s mother took DES or HPV infection during pregnancy.
I am so fed up with the guidelines that do not take into consideration that not every woman is at risk for cervical cancer and that some women have a much higher risk of cervical cancer than other women. I went to an amazing wedding where the pastor announced that both the groom and the bride were virgins almost 6 years ago. The groom was 30 years old and the bride was 26. More people are virgins on their wedding nights than you can imagine. I do not feel this particular woman is at risk for cervical cancer.
I would be interested in hearing people's thoughts about the misconception that birth control pills increase cervical cancer. 99% of cervical cancer cases are caused by HPV, a Sexually Transmitted Disease.
Misty
Misty, I presume all your concern about etiology of cervical cancer as due to oral contraceptives is related specifically to the issue of unnecessary, unneeded pelvic examinations. I just wanted to clarify how this concern was related to the subject of this blog thread. ..Maurice.
Dr. Bernstein,
Yes, this is related to unnecessary pap smears and pelvic exams. As you can see in Dr. Sherman's article, he never indicated that pap smears and pelvic exams are never necessary. The point is every woman should be informed of the risks of cervical cancer and then decide if she wants a pap smear.
I was disappointed by the flawed research about birth control pills on American Cancer Society's web site. A woman should not be pressured into having a pap smear just because she takes birth control pills.
Misty
Maurice, here's a medical question for you.
While there is an absolute basis for what Misty says regarding HPV, I ask this opinion.
Would a pelvic examination help to determine if a woman has ovarian cancer or an irregularity that deserves more investigation by the combination of vaginal examination and pressing on a woman's abdomen during the exam as is routinely done?
If the answer is yes, would it make sense for women who are in the "safe category" to have an annual pelvic exam, just as we do mammography?
belinda
Dr. Bernstein,
I just realized I made a typo in one of my sentences:
As you can see in Dr. Sherman's article, he never indicated that pap smears and pelvic exams are never necessary.
It should have said: never unnecessary. It is true that pap smears are necessary for women with certain risk factors.
Belinda, go back to my May 18 posting for both a link to the American College of Obstetrics and Gynecology opinion on this topic as well as the except which I put up.
It is true that, by pelvic exam, the examination of the uterus for the detection of gross abnormalities is far more valuable than pelvic examination of the ovaries and Fallopian tubes.
..Maurice.
NOTICE: AS OF TODAY MAY 26,2013 "PATIENT MODESTY: VOLUME 54" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 55.
Post a Comment
<< Home